201
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Guha R, Mathioudaki A, Doumbo S, Doumtabe D, Skinner J, Arora G, Siddiqui S, Li S, Kayentao K, Ongoiba A, Zaugg J, Traore B, Crompton PD. Plasmodium falciparum malaria drives epigenetic reprogramming of human monocytes toward a regulatory phenotype. PLoS Pathog 2021; 17:e1009430. [PMID: 33822828 PMCID: PMC8023468 DOI: 10.1371/journal.ppat.1009430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/27/2021] [Indexed: 12/24/2022] Open
Abstract
In malaria-naïve children and adults, Plasmodium falciparum-infected red blood cells (Pf-iRBCs) trigger fever and other symptoms of systemic inflammation. However, in endemic areas where individuals experience repeated Pf infections over many years, the risk of Pf-iRBC-triggered inflammatory symptoms decreases with cumulative Pf exposure. The molecular mechanisms underlying these clinical observations remain unclear. Age-stratified analyses of uninfected, asymptomatic Malian individuals before the malaria season revealed that monocytes of adults produced lower levels of inflammatory cytokines (IL-1β, IL-6 and TNF) in response to Pf-iRBC stimulation compared to monocytes of Malian children and malaria-naïve U.S. adults. Moreover, monocytes of Malian children produced lower levels of IL-1β and IL-6 following Pf-iRBC stimulation compared to 4-6-month-old infants. Accordingly, monocytes of Malian adults produced more IL-10 and expressed higher levels of the regulatory molecules CD163, CD206, Arginase-1 and TGM2. These observations were recapitulated in an in vitro system of monocyte to macrophage differentiation wherein macrophages re-exposed to Pf-iRBCs exhibited attenuated inflammatory cytokine responses and a corresponding decrease in the epigenetic marker of active gene transcription, H3K4me3, at inflammatory cytokine gene loci. Together these data indicate that Pf induces epigenetic reprogramming of monocytes/macrophages toward a regulatory phenotype that attenuates inflammatory responses during subsequent Pf exposure. Trial Registration: ClinicalTrials.gov NCT01322581.
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Affiliation(s)
- Rajan Guha
- Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
- * E-mail: (RG); (PDC)
| | - Anna Mathioudaki
- Structural and Computational Biology Unit, The European Molecular Biology Laboratory, Heidelberg, Germany
| | - Safiatou Doumbo
- Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Didier Doumtabe
- Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Jeff Skinner
- Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Gunjan Arora
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Shafiuddin Siddiqui
- Laboratory of Genome Integrity, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Shanping Li
- Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Kassoum Kayentao
- Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Aissata Ongoiba
- Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Judith Zaugg
- Structural and Computational Biology Unit, The European Molecular Biology Laboratory, Heidelberg, Germany
| | - Boubacar Traore
- Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Peter D. Crompton
- Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
- * E-mail: (RG); (PDC)
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202
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Jiang N, Liu YN, Bao J, Li R, Ni WT, Tan XY, Xu Y, Peng LP, Wang XR, Zeng YM, Liu DS, Xue Q, Li JS, Hu K, Zheng YL, Gao ZC. Clinical features and risk factors associated with severe COVID-19 patients in China. Chin Med J (Engl) 2021; 134:944-953. [PMID: 33813510 PMCID: PMC8078348 DOI: 10.1097/cm9.0000000000001466] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines. METHODS A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19. RESULTS A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ2 = 8.183, P = 0.004). CONCLUSIONS The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.
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Affiliation(s)
- Ning Jiang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Yan-Nan Liu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Jing Bao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Ran Li
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Wen-Tao Ni
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Xing-Yu Tan
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Yu Xu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Li-Ping Peng
- Department of Respiratory and Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xiao-Rong Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yi-Ming Zeng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Dai-Shun Liu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Zunyi, Zunyi, Guizhou 563000, China
| | - Qing Xue
- Department of Respiratory and Critical Care Medicine, Ningde People's Hospital, Ningde, Fujian 352000, China
| | - Jia-Shu Li
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222061, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Ya-Li Zheng
- Department of Respiratory, Critical Care, and Sleep Medicine, Xiang’an Hospital of Xiamen University, Xiamen, Fujian 361111, China
| | - Zhan-Cheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
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203
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Lamadrid P, Alonso-Peña M, San Segundo D, Arias-Loste M, Crespo J, Lopez-Hoyos M. Innate and Adaptive Immunity Alterations in Metabolic Associated Fatty Liver Disease and Its Implication in COVID-19 Severity. Front Immunol 2021; 12:651728. [PMID: 33859644 PMCID: PMC8042647 DOI: 10.3389/fimmu.2021.651728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
The coronavirus infectious disease 2019 (COVID-19) pandemic has hit the world, affecting health, medical care, economies and our society as a whole. Furthermore, COVID-19 pandemic joins the increasing prevalence of metabolic syndrome in western countries. Patients suffering from obesity, type II diabetes mellitus, cardiac involvement and metabolic associated fatty liver disease (MAFLD) have enhanced risk of suffering severe COVID-19 and mortality. Importantly, up to 25% of the population in western countries is susceptible of suffering from both MAFLD and COVID-19, while none approved treatment is currently available for any of them. Moreover, it is well known that exacerbated innate immune responses are key in the development of the most severe stages of MAFLD and COVID-19. In this review, we focus on the role of the immune system in the establishment and progression of MAFLD and discuss its potential implication in the development of severe COVID-19 in MAFLD patients. As a result, we hope to clarify their common pathology, but also uncover new potential therapeutic targets and prognostic biomarkers for further research.
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Affiliation(s)
- Patricia Lamadrid
- Transplant and Autoimmunity Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Alonso-Peña
- Clinical and Translational Research in Digestive Pathology Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain
| | - David San Segundo
- Transplant and Autoimmunity Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Immunology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Mayte Arias-Loste
- Clinical and Translational Research in Digestive Pathology Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Gastroenterology and Hepatology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Javier Crespo
- Clinical and Translational Research in Digestive Pathology Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Gastroenterology and Hepatology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Marcos Lopez-Hoyos
- Transplant and Autoimmunity Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Immunology Department, Marques de Valdecilla University Hospital, Santander, Spain
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204
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Sebastião CS, Neto Z, Martinez P, Jandondo D, Antonio J, Galangue M, de Carvalho M, David K, Miranda J, Afonso P, Inglês L, Carrelero RR, de Vasconcelos JN, Morais J. Sociodemographic characteristics and risk factors related to SARS-CoV-2 infection in Luanda, Angola. PLoS One 2021; 16:e0249249. [PMID: 33765102 PMCID: PMC7993870 DOI: 10.1371/journal.pone.0249249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/10/2021] [Indexed: 01/07/2023] Open
Abstract
This study aimed to investigate the characteristics related to SARS-CoV-2 in Luanda, Angola. A total of 622 individuals were screened for SARS-CoV-2 from January to September 2020. Chi-square and logistic regression were used to identify the relationship between sociodemographic characteristics and SARS-CoV-2. Of the 622 tested, 14.3% tested positive. The infection rate was the same for both genders (14.3%). Individuals ≥40 years old, from non-urbanized areas, and healthcare professionals had a higher frequency of infection. The risk of infection was very high in individuals ≥60 years old (AOR: 23.3, 95% CI: 4.83-112), in women (AOR: 1.24, 95% CI: 0.76-2.04), in Luanda (AOR: 7.40, 95% CI: 1.64-33.4), and healthcare professionals (AOR: 1.27, 95% CI: 0.60-2.71), whereas a low risk was observed in individuals from urbanized areas (AOR: 0.44, 95% CI: 0.26-0.75). Our results suggest that Angolan authorities should implement a greater effort in non-urbanized areas and among healthcare professionals since when these individuals presented any indication for a COVID-19 test, such as fever/cough/myalgia, they were more likely to test positive for SARS-CoV-2 than having some other cause for symptoms.
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Affiliation(s)
- Cruz S. Sebastião
- Centro de Investigação em Saúde de Angola, Caxito, Angola
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
- Instituto Superior de Ciências da Saúde, Universidade Agostinho Neto, Luanda, Angola
| | - Zoraima Neto
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Pedro Martinez
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | - Janete Antonio
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | | | | | - Julio Miranda
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Pedro Afonso
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Luzia Inglês
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | - Jocelyne Neto de Vasconcelos
- Centro de Investigação em Saúde de Angola, Caxito, Angola
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Joana Morais
- Instituto Nacional de Investigação em Saúde, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
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205
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Li X, Yu Q, Qin F, Zhang B, Lu Y. Serum Vitamin D Level and the Risk of Urinary Tract Infection in Children: A Systematic Review and Meta-Analysis. Front Public Health 2021; 9:637529. [PMID: 33816422 PMCID: PMC8017300 DOI: 10.3389/fpubh.2021.637529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the association between serum vitamin D concentration and the risk of urinary tract infection (UTI) in children. Human studies reported the serum vitamin D level in children with UTI and healthy controls were collected from PubMed, Scopus, Embase, and Cochrane databases. The strictly standardized mean difference (SSMD) and 95% confidence interval (CI) were calculated to evaluate the relationship between serum vitamin D levels and risk of UTI. The results of analysis showed that serum vitamin D levels in children with UTI were significantly lower than healthy control children (SSMD: 0.891, 95% CI: 0.707–1.075, p < 0.000; SSMD: 0.797, 95% CI: 0.500–1.094, p < 0.000, respectively). It can be concluded that there is a significant negative relationship between serum vitamin D level and risk of UTI in children.
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Affiliation(s)
- Xiaoyan Li
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing Yu
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Feng Qin
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Biyu Zhang
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanming Lu
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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206
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Guilger-Casagrande M, de Barros CT, Antunes VAN, de Araujo DR, Lima R. Perspectives and Challenges in the Fight Against COVID-19: The Role of Genetic Variability. Front Cell Infect Microbiol 2021; 11:598875. [PMID: 33791232 PMCID: PMC8005637 DOI: 10.3389/fcimb.2021.598875] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
In the last year, the advent of the COVID-19 pandemic brought a new consideration for the multidisciplinary sciences. The unknown mechanisms of infection used by SARS-CoV-2 and the absence of effective antiviral pharmacological therapy, diagnosis methods, and vaccines evoked scientific efforts on the COVID-19 outcome. In general, COVID-19 clinical features are a result of local and systemic inflammatory processes that are enhanced by some preexistent comorbidities, such as diabetes, obesity, cardiovascular, and pulmonary diseases, and biological factors, like gender and age. However, the discrepancies in COVID-19 clinical signs observed among those patients lead to investigations about the critical factors that deeply influence disease severity and death. Herein, we present the viral infection mechanisms and its consequences after blocking the angiotensin-converting enzyme 2 (ACE2) axis in different tissues and the progression of inflammatory and immunological reactions, especially the influence of genetic features on those differential clinical responses. Furthermore, we discuss the role of genotype as an essential indicator of COVID-19 susceptibility, considering the expression profiles, polymorphisms, gene identification, and epigenetic modifications of viral entry factors and their recognition, as well as the infection effects on cell signaling molecule expression, which amplifies disease severity.
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Affiliation(s)
- Mariana Guilger-Casagrande
- Institute of Science and Technology, São Paulo State University–UNESP, Sorocaba, Brazil
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
| | - Cecilia T. de Barros
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
| | - Vitória A. N. Antunes
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
| | - Daniele R. de Araujo
- Human and Natural Sciences Center, Federal University of ABC, Santo André, Brazil
| | - Renata Lima
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
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207
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Shi X, Aronson SJ, Ten Bloemendaal L, Duijst S, Bakker RS, de Waart DR, Bortolussi G, Collaud F, Oude Elferink RP, Muro AF, Mingozzi F, Ronzitti G, Bosma PJ. Efficacy of AAV8-h UGT1A1 with Rapamycin in neonatal, suckling, and juvenile rats to model treatment in pediatric CNs patients. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2021; 20:287-297. [PMID: 33511243 PMCID: PMC7809245 DOI: 10.1016/j.omtm.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/28/2020] [Indexed: 12/18/2022]
Abstract
A clinical trial using adeno-associated virus serotype 8 (AAV8)-human uridine diphosphate glucuronosyltransferase 1A1 (hUGT1A1) to treat inherited severe unconjugated hyperbilirubinemia (Crigler-Najjar syndrome) is ongoing, but preclinical data suggest that long-term efficacy in children is impaired due to loss of transgene expression upon hepatocyte proliferation in a growing liver. This study aims to determine at what age long-term efficacy can be obtained in the relevant animal model and whether immune modulation allows re-treatment using the same AAV vector. Neonatal, suckling, and juvenile Ugt1a1-deficient rats received a clinically relevant dose of AAV8-hUGT1A1, and serum bilirubin levels and anti-AAV8 neutralizing antibodies (NAbs) in serum were monitored. The possibility of preventing the immune response toward the vector was investigated using a rapamycin-based regimen with daily intraperitoneal (i.p.) injections starting 2 days before and ending 21 days after vector administration. In rats treated at postnatal day 1 (P1) or P14, the correction was (partially) lost after 12 weeks, whereas the correction was stable in rats injected at P28. Combining initial vector administration with the immune-suppressive regimen prevented induction of NAbs in female rats, allowing at least partially effective re-administration. Induction of NAbs upon re-injection could not be prevented, suggesting that this strategy will be ineffective in patients with low levels of preexisting anti-AAV NAbs.
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Affiliation(s)
- Xiaoxia Shi
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Sem J Aronson
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Lysbeth Ten Bloemendaal
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Suzanne Duijst
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Robert S Bakker
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Dirk R de Waart
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Giulia Bortolussi
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Fanny Collaud
- Genethon, 91000 Evry, France.,Université Paris-Saclay, Université d'Evry, INSERM, Genethon, Integrare Research Unit UMR S951, 91000 Evry, France
| | - Ronald P Oude Elferink
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
| | - Andrés F Muro
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | | | - Giuseppe Ronzitti
- Genethon, 91000 Evry, France.,Université Paris-Saclay, Université d'Evry, INSERM, Genethon, Integrare Research Unit UMR S951, 91000 Evry, France
| | - Piter J Bosma
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AGEM, Meibergdreef 69-71, 1105 BK Amsterdam, the Netherlands
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208
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Pathangey G, Fadadu PP, Hospodar AR, Abbas AE. Angiotensin-converting enzyme 2 and COVID-19: patients, comorbidities, and therapies. Am J Physiol Lung Cell Mol Physiol 2021; 320:L301-L330. [PMID: 33237815 PMCID: PMC7938645 DOI: 10.1152/ajplung.00259.2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic, and the reality of the situation has finally caught up to the widespread reach of the disease. The presentation of the disease is highly variable, ranging from asymptomatic carriers to critical COVID-19. The availability of angiotensin-converting enzyme 2 (ACE2) receptors may reportedly increase the susceptibility and/or disease progression of COVID-19. Comorbidities and risk factors have also been noted to increase COVID-19 susceptibility. In this paper, we hereby review the evidence pertaining to ACE2's relationship to common comorbidities, risk factors, and therapies associated with the susceptibility and severity of COVID-19. We also highlight gaps of knowledge that require further investigation. The primary comorbidities of respiratory disease, cardiovascular disease, renal disease, diabetes, obesity, and hypertension had strong evidence. The secondary risk factors of age, sex, and race/genetics had limited-to-moderate evidence. The tertiary factors of ACE inhibitors and angiotensin II receptor blockers had limited-to-moderate evidence. Ibuprofen and thiazolidinediones had limited evidence.
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Affiliation(s)
- Girish Pathangey
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
| | | | | | - Amr E Abbas
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan
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209
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Chen W, Lin Y, Huang H, Cai M, Lin D, Su M, Su Z, Zhuang X, Yu X. A Retrospective Study of the Epidemiologic and Clinical Characteristics of COVID-19 Among Hospitalized Patients in Quanzhou, China. INFECTIOUS MICROBES & DISEASES 2021; 3:32-40. [PMID: 38630071 PMCID: PMC8011347 DOI: 10.1097/im9.0000000000000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has spread throughout China. However, information about COVID-19 in cities and regions outside Wuhan is limited and the indicators that predict the length of hospital stay for patients with COVID-19 are unclear. Therefore, we collected clinical data from 47 patients with COVID-19 in Quanzhou City. The median age was 38 years [interquartile range (IQR): 31-50 years], and 24 (51%) were male. There were 8 mild, 36 moderate, and 3 severe/critical cases. The median interval from exposure to disease onset was 13 days (IQR: 8-18 days). The incidence of severe/critical cases was 33% (3/10) in patients with hypertension. Common symptoms included fever (83%), cough (77%), fatigue (40%), a sore, dry throat (28%), and diarrhea (21%). One patient (2%) developed respiratory distress syndrome on day 13 of inpatient treatment. Six patients had leukopenia, 17 had elevated C-reactive protein (CRP), and 8 had lymphocytopenia and elevated lactate dehydrogenase (LDH). The median length of hospitalization was 22 days (IQR: 16-30 days). Dynamic monitoring of LDH, CRP, and neutrophil-lymphocyte ratio predicted whether length of hospitalization would exceed 21 days. Most patients presented with mild and moderate disease. Patients with hypertension were more likely to become severe or critical. Dynamic monitoring of LDH, CRP, and neutrophil-lymphocyte ratio levels can help predict delayed discharge from the hospital.
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Affiliation(s)
- Wenhuang Chen
- Department of Infectious Disease, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
- These authors contributed equally to this work
| | - Yijian Lin
- Department of Respiratory Disease, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
- These authors contributed equally to this work
| | - Hongbo Huang
- Department of Respiratory Disease, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Maosheng Cai
- Department of Respiratory Disease, Shishi City General Hospital, Quanzhou, Fujian, China
| | - Dongheng Lin
- Department of Respiratory Disease, Anxi County Hospital, Quanzhou, Fujian, China
| | - Milong Su
- Department of Clinical Laboratory, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Zhijun Su
- Department of Infectious Disease, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Xibin Zhuang
- Department of Respiratory Disease, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Xueping Yu
- Department of Infectious Disease, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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210
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Sexual dimorphism in immunometabolism and autoimmunity: Impact on personalized medicine. Autoimmun Rev 2021; 20:102775. [PMID: 33609790 DOI: 10.1016/j.autrev.2021.102775] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
Immune cells play essential roles in metabolic homeostasis and thus, undergo analogous changes in normal physiology (e.g., puberty and pregnancy) and in various metabolic and immune diseases. An essential component of this close relationship between the two is sex differences. Many autoimmune diseases, such as systemic lupus erythematous and multiple sclerosis, feature strikingly increased prevalence in females, whereas in contrast, infectious diseases, such as Ebola and Middle East Respiratory Syndrome, affect more men than women. Therefore, there are fundamental aspects of metabolic homeostasis and immune functions that are regulated differently in males and females. This can be observed in sex hormone-immune interaction where androgens, such as testosterone, have shown immunosuppressive effects whilst estrogen is on the opposite side of the spectrum with immunoenhancing facilitation of mechanisms. In addition, the two sexes exhibit significant differences in metabolic regulation, with estrous cycles in females known to induce variability in traits and more pronounced metabolic disease phenotype exhibited by males. It is likely that these differences underlie both the development of metabolic and autoimmune diseases and the response to current treatment options. Sexual dimorphism in immunometabolism has emerged to become an area of intense research, aiming to uncover sex-biased effector molecules in the various metabolic tissues and immune cell types, identify sex-biased cell-type-specific functions of common effector molecules, and understand whether the sex differences in metabolic and immune functions influence each other during autoimmune pathogenesis. In this review, we will summarize recent findings that address these critical questions of sexual dimorphism in immunometabolism as well as their translational implications for the clinical management of autoimmune diseases.
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211
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Bai Y, Tao X. Comparison of COVID-19 and influenza characteristics. J Zhejiang Univ Sci B 2021; 22:87-98. [PMID: 33615750 PMCID: PMC7885750 DOI: 10.1631/jzus.b2000479] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
The emergence of coronavirus disease 2019 (COVID-19) not only poses a serious threat to the health of people worldwide but also affects the global economy. The outbreak of COVID-19 began in December 2019, at the same time as the influenza season. However, as the treatments and prognoses of COVID-19 and influenza are different, it is important to accurately differentiate these two different respiratory tract infections on the basis of their respective early-stage characteristics. We reviewed official documents and news released by the National Health Commission of the People's Republic of China, the Chinese Center for Disease Control and Prevention (China CDC), the United States CDC, and the World Health Organization (WHO), and we also searched the PubMed, Web of Science, Excerpta Medica database (Embase), China National Knowledge Infrastructure (CNKI), Wanfang, preprinted bioRxiv and medRxiv databases for documents and guidelines from earliest available date up until October 3rd, 2020. We obtained the latest information about COVID-19 and influenza and summarized and compared their biological characteristics, epidemiology, clinical manifestations, pathological mechanisms, treatments, and prognostic factors. We show that although COVID-19 and influenza are different in many ways, there are numerous similarities; thus, in addition to using nucleic acid-based polymerase chain reaction (PCR) and antibody-based approaches, clinicians and epidemiologists should distinguish between the two using their respective characteristics in early stages. We should utilize experiences from other epidemics to provide additional guidance for the treatment and prevention of COVID-19.
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Affiliation(s)
- Yu Bai
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaonan Tao
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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212
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Sha J, Qie G, Yao Q, Sun W, Wang C, Zhang Z, Wang X, Wang P, Jiang J, Bai X, Chu Y, Meng M. Sex Differences on Clinical Characteristics, Severity, and Mortality in Adult Patients With COVID-19: A Multicentre Retrospective Study. Front Med (Lausanne) 2021; 8:607059. [PMID: 33644092 PMCID: PMC7906985 DOI: 10.3389/fmed.2021.607059] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Coronavirus disease-2019 (COVID-19) epidemic is spreading globally. Sex differences in the severity and mortality of COVID-19 emerged. This study aims to describe the impact of sex on outcomes in COVOD-19 with a special focus on the effect of estrogen. Methods: We performed a retrospective cohort study which included 413 patients (230 males and 183 females) with COVID-19 from three designated hospitals in China with a follow up time from January 31, 2020, to April 17, 2020. Women over 55 were considered as postmenopausal patients according to the previous epidemiological data from China. The interaction between age and sex on in-hospital mortality was determined through Cox regression analysis. In addition, multivariate Cox regression models were performed to explore risk factors associated with in-hospital mortality of COVID-19. Results: Age and sex had significant interaction for the in-hospital mortality (P < 0.001). Multivariate Cox regression showed that age (HR 1.041, 95% CI 1.009–1.073, P = 0.012), male sex (HR 2.033, 95% CI 1.007–2.098, P = 0.010), the interaction between age and sex (HR 1.118, 95% CI 1.003–1.232, P = 0.018), and comorbidities (HR 9.845, 95% CI 2.280–42.520, P = 0.002) were independently associated with in-hospital mortality of COVID-19 patients. In this multicentre study, female experienced a lower fatality for COVID-19 than male (4.4 vs. 10.0%, P = 0.031). Interestingly, stratification by age group revealed no difference in-hospital mortality was noted in women under 55 compared with women over 55 (3.8 vs. 5.2%, P = 0.144), as well as in women under 55 compared with the same age men (3.8 vs. 4.0%, P = 0.918). However, there was significantly difference in women over 55 with men of the same age group (5.2 vs. 21.0%, P = 0.007). Compared with male patients, female patients had higher lymphocyte (P < 0.001) and high-density lipoprotein (P < 0.001), lower high sensitive c reaction protein level (P < 0.001), and lower incidence rate of acute cardiac injury (6.6 vs. 13.5%, P = 0.022). Conclusion: Male sex is an independent risk factor for COVID-19 in-hospital mortality. Although female mortality in COVID-19 is lower than male, it might not be directly related to the effect of estrogen. Further study is warranted to identify the sex difference in COVID-19 and mechanisms involved.
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Affiliation(s)
- Jing Sha
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Guoqiang Qie
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Qingchun Yao
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Wenqing Sun
- Department of Intensive Care Unit, Shandong Provincial Chest Hospital, Jinan, China
| | - Cuiyan Wang
- Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, China
| | - Zhongfa Zhang
- Jinan Infectious Diseases Hospital, Shandong University, Jinan, China
| | - Xingguang Wang
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Peng Wang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Jinjiao Jiang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Xue Bai
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Yufeng Chu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Mei Meng
- Department of Critical Care Medicine, Ruijin Hospital, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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213
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Chu M, Bian L, Huang J, Chen Y, Wu D, Wang H. Clinical characteristics and outcomes of 48 patients hospitalized for COVID-19 infection in Wuxi: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e23991. [PMID: 33592854 PMCID: PMC7870199 DOI: 10.1097/md.0000000000023991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023] Open
Abstract
Since the first infected case of Coronavirus Disease 2019 (COVID-19) was reported in Wuhan, China in December 2019, the virus has spread swiftly, inflicting upon millions of people around the globe. The objective of the study is to investigate and analyze the clinical characteristics and outcomes of patients infected with COVID-19 in Wuxi, China.Cross-sectional study.The Fifth People's Hospital of Wuxi, China.A total of 48 COVID-19 patients were enrolled in the study from 23 January 2020 to 8 March 2020, and the clinical data of these subjects were collected.Epidemiological, clinical, laboratory, and radiologic characteristics, as well as treatment and outcome data, were collected and analyzed.Of these 48 patients with confirmed COVID-19, 3 were mild cases (6.3%), 44 were moderate cases (91.7%), 1 was severe case (2.1%). The median age of the subjects was 45 years (interquartile range [IQR], 24-59; range, 5-75 years). Twenty-five of the patients (52.1%) were male and 23 (47.9%) were female. Twenty-eight cases (58.3%) returned to Wuxi, Jiangsu Province. Thirty-four (70.8%) cases were infected due to clustering epidemic and 29 cases (85.3%) were attributable to family-clustering epidemic. No obvious clinical symptoms were observed in the cohort of patients, except for 3 mild cases. The most common symptoms include fever (41 [85.4%]), cough (28 [58.3%]), asthenia (13 [27.1%]), expectoration (11 [22.9%]), diarrhea (10 [20.8%]), and dyspnea (5 [10.4%]). Seventeen (35.4%) patients had lower lymphocyte values than baseline, 31 patients (64.6%) had higher d-dimers to exceed the normal range. The distribution of high-resolution computed tomography (HRCT)-positive lesions were as follows: left lung in 5 cases (10.4%), right lung in 9 cases (18.8%), and bilateral lungs in 31 cases (64.6%). In terms of density of lesions: 28 cases (58.3%) showed ground glass shadows in the lung, 7 cases (14.6%) showed solid density shadows, and 10 cases (20.8%) showed mixed density shadows. Extrapulmonary manifestations found that mediastinal lymph nodes were enlarged in 2 cases (4.2%) and that pleural effusion was present in 1 case (2.1%). All patients underwent treatment in quarantine. Forty-five (93.8%) patients received antiviral treatments, 22 (45.8%) patients received antibacterial treatments, 6 (12.5%) patients received glucocorticoid treatments, 2 (4.2%) patients received high flow oxygen inhalation treatments, and 6 (12.5%) patients received noninvasive ventilation treatments. As of 8 March 2020, all 48 patients included in this study were cured. The average time of hospitalization of the 48 patients was 18 ± 6 (mean ± SD) days, the average time of the lesion resorption was 11 ± 4 days, and the average time taken to achieve negativity in the result of nucleic acid examination was (10 ± 4) days.The epidemiological characteristics of 48 COVID-19 patients in Wuxi were mainly imported cases and clustered cases. The clinical manifestations of these patients were mainly fever and cough. Laboratory results showed that the lymphocytopenia and increased d-dimer are positively correlated with disease severity. Pulmonary imaging showed unilateral or bilateral ground glass infiltration. Most of the patients entered clinical recovery stage within 15 days after hospitalization.
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Affiliation(s)
- Meiping Chu
- Department of Respiratory and Critical Care Medicine, Wuxi Fifth People's Hospital
| | | | - Jiehui Huang
- Department of Respiratory and Critical Care Medicine, Wuxi Fifth People's Hospital
| | - Yigang Chen
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University
| | | | - Hao Wang
- Xirui Stem Cell Technology Co., Ltd, Jiangsu 214002, PR China
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214
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Yan X, Wang J, Yao J, Estill J, Wu S, Lu J, Liang B, Li H, Tao S, Bai H, Liu H, Chen Y. A cross-sectional study of the epidemic situation on COVID-19 in Gansu Province, China - a big data analysis of the national health information platform. BMC Infect Dis 2021; 21:146. [PMID: 33546618 PMCID: PMC7863032 DOI: 10.1186/s12879-020-05743-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background In December 2019, a pneumonia caused by SARS-CoV-2 emerged in Wuhan, China and has rapidly spread around the world since then. This study is to explore the patient characteristics and transmission chains of COVID-19 in the population of Gansu province, and support decision-making. Methods We collected data from Gansu Province National Health Information Platform. A cross-sectional study was conducted, including patients with COVID-19 confirmed between January 23 and February 6, 2020, and analyzed the gender and age of the patients. We also described the incubation period, consultation time and sources of infection in the cases, and calculated the secondary cases that occurred within Gansu for each imported case. Results We found thirty-six (53.7%) of the patients were women and thirty-one (46.3%) men, and the median ages were 40 (IQR 31–53) years. Twenty-eight (41.8%) of the 67 cases had a history of direct exposure in Wuhan. Twenty-five (52.2%) cases came from ten families, and we found no clear reports of modes of transmission other than family clusters. The largest number of secondary cases linked to a single source was nine. Conclusion More women than men were diagnosed with COVID-19 in Gansu Province. Although the age range of confirmed cases of COVID-19 in Gansu Province covered almost all age groups, most patients with confirmed COVID-19 tend to be middle aged persons. The most common suspected mode of transmission was through family cluster. Gansu and other settings worldwide should continue to strengthen the utilization of big data in epidemic control.
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Affiliation(s)
- Xuanchen Yan
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Jianjian Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Jingwen Yao
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China.
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Shouyuan Wu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jie Lu
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Baoping Liang
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Hongmin Li
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Shengxin Tao
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Huanli Bai
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Hongliang Liu
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, China. .,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China. .,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China.
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215
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Medrado B, Lyra J, Nascimento M, Beiras A, Corrêa ÁCDP, Alvarenga EC, Lima MLC. Men, masculinity and the new coronavirus: sharing gender issues in the first phase of the pandemic. CIENCIA & SAUDE COLETIVA 2021; 26:179-183. [PMID: 33533839 DOI: 10.1590/1413-81232020261.35122020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022] Open
Abstract
This article presents reflections on masculinity and the social construction of gender - based on the global phenomenon of the new coronavirus pandemic - produced by researchers who are part of the national research team on comprehensive health care policy for men in Brazil. From a gender-based standpoint, the article contends that it is necessary to note that cis heteronormative male socialization is guided by three core issues: 1) the submission to practices of care of self and others; 2) the rejection of preventive health practices, due to a distorted matrix of risk perception (and a certain sense of "invulnerability"); 3) the domestic dynamics marked by postures of command, order, and honor. These dimensions of everyday life were profoundly upset in this first phase of the epidemic, in which confinement became the most recommended alternative. These issues are configured as recurring (though not recent) repertoires that glorify the central model of a male order that needs to become an object of reflection, insofar as they endanger the health of men and women and, more broadly, of the status quo of the accepted tenets of domestic and social order.
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Affiliation(s)
- Benedito Medrado
- Departamento de Psicologia, Centro de Filosofia e Ciências Humanas, Universidade Federal de Pernambuco. R. Academico Hélio Ramos s/n, Cidade Universitária. 50740-530 Recife PE Brasil.
| | - Jorge Lyra
- Departamento de Psicologia, Centro de Filosofia e Ciências Humanas, Universidade Federal de Pernambuco. R. Academico Hélio Ramos s/n, Cidade Universitária. 50740-530 Recife PE Brasil.
| | - Marcos Nascimento
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fiocruz. Rio de Janeiro RJ Brasil
| | - Adriano Beiras
- Departamento de Psicologia, Centro de Filosofia e Ciências Humanas, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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216
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Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford) 2021; 59:iv38-iv46. [PMID: 33053194 PMCID: PMC7566372 DOI: 10.1093/rheumatology/keaa543] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
Mounting evidence reveals evident sex differences in physiology, disease presentation and response to medication in axial SpA (axSpA). Unfortunately these data are often neglected in clinical practice and research. In this review, myths that still exist on diagnosis, disease manifestation and drug effectiveness were argued against data of the most recent literature. The aim is to increase awareness of sex differences in the clinical aspects of axSpA.
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Affiliation(s)
- Tamara Rusman
- Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Rianne E van Bentum
- Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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217
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Shepherd R, Cheung AS, Pang K, Saffery R, Novakovic B. Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics. Front Immunol 2021; 11:604000. [PMID: 33584674 PMCID: PMC7873844 DOI: 10.3389/fimmu.2020.604000] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Sexual dimorphism refers to differences between biological sexes that extend beyond sexual characteristics. In humans, sexual dimorphism in the immune response has been well demonstrated, with females exhibiting lower infection rates than males for a variety of bacterial, viral, and parasitic pathogens. There is also a substantially increased incidence of autoimmune disease in females compared to males. Together, these trends indicate that females have a heightened immune reactogenicity to both self and non-self-molecular patterns. However, the molecular mechanisms driving the sexually dimorphic immune response are not fully understood. The female sex hormones estrogen and progesterone, as well as the male androgens, such as testosterone, elicit direct effects on the function and inflammatory capacity of immune cells. Several studies have identified a sex-specific transcriptome and methylome, independent of the well-described phenomenon of X-chromosome inactivation, suggesting that sexual dimorphism also occurs at the epigenetic level. Moreover, distinct alterations to the transcriptome and epigenetic landscape occur in synchrony with periods of hormonal change, such as puberty, pregnancy, menopause, and exogenous hormone therapy. These changes are also mirrored by changes in immune cell function. This review will outline the evidence for sex hormones and pregnancy-associated hormones as drivers of epigenetic change, and how this may contribute to the sexual dimorphism. Determining the effects of sex hormones on innate immune function is important for understanding sexually dimorphic autoimmune diseases, sex-specific responses to pathogens and vaccines, and how innate immunity is altered during periods of hormonal change (endogenous or exogenous).
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Affiliation(s)
- Rebecca Shepherd
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Ken Pang
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Brain and Mitochondrial Research, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Richard Saffery
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Boris Novakovic
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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218
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Zuccaro V, Celsa C, Sambo M, Battaglia S, Sacchi P, Biscarini S, Valsecchi P, Pieri TC, Gallazzi I, Colaneri M, Sachs M, Roda S, Asperges E, Lupi M, Di Filippo A, Seminari E, Di Matteo A, Novati S, Maiocchi L, Enea M, Attanasio M, Cammà C, Bruno R. Competing-risk analysis of coronavirus disease 2019 in-hospital mortality in a Northern Italian centre from SMAtteo COvid19 REgistry (SMACORE). Sci Rep 2021; 11:1137. [PMID: 33441892 PMCID: PMC7806993 DOI: 10.1038/s41598-020-80679-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.
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Affiliation(s)
- Valentina Zuccaro
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Ciro Celsa
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
- Doctoral Programme in Oncology and Experimental Surgery, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Margherita Sambo
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Salvatore Battaglia
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | - Paolo Sacchi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Simona Biscarini
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Pietro Valsecchi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Teresa Chiara Pieri
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Ilaria Gallazzi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Marta Colaneri
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Michele Sachs
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Silvia Roda
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Erika Asperges
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Matteo Lupi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Alessandro Di Filippo
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Elena Seminari
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Angela Di Matteo
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Stefano Novati
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Laura Maiocchi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - Marco Enea
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | - Massimo Attanasio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Calogero Cammà
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Raffaele Bruno
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy.
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.
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Azab SM, Zytoon AA, Kasemy ZAA, Omar SF, Ewida SF, Sakr KA, Ella TFA. Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity. Emerg Radiol 2021; 28:453-467. [PMID: 33417113 PMCID: PMC7791339 DOI: 10.1007/s10140-020-01875-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment. METHODS This was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease. RESULTS Patient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = - 0.245, P = 0.005), lymphocytes% (r = - 0.586, P < 0.001), RBCs (r = - 0.2488, P = 0.005), Hb (gm/dl) (r = - 0.342, P < 0.001), and HCT (r = - 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation. CONCLUSION Clinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.
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Affiliation(s)
- Sameh Mostafa Azab
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ashraf Anas Zytoon
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Zeinab Abdel Aziz Kasemy
- Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Suzan Fouad Omar
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Suzy Fayez Ewida
- Clinical Physiology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Karim Ayman Sakr
- School of Health Sciences, Western University, London, Ontario, Canada
| | - Tarek Fawzy Abd Ella
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Rabbani G, Shariful Islam SM, Rahman MA, Amin N, Marzan B, Robin RC, Alif SM. Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis. Expert Rev Respir Med 2021; 15:705-716. [DOI: 10.1080/17476348.2021.1866547] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Golam Rabbani
- Bangladesh Betar (Radio), Ministry of Information, Dhaka, Bangladesh
| | | | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Australia
- Australian Institute of Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Nuhu Amin
- Infectious Diseases Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Bushra Marzan
- School of Public Health, Guangxi Medical University, Nanning, China
| | | | - Sheikh M. Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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221
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Hu J, Wang Y. The Clinical Characteristics and Risk Factors of Severe COVID-19. Gerontology 2021; 67:255-266. [PMID: 33406518 PMCID: PMC7900480 DOI: 10.1159/000513400] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/21/2020] [Indexed: 01/08/2023] Open
Abstract
Objective We aim to investigate the clinical characteristics and risk factors for the severe cases of coronavirus disease 2019 (COVID-19) in comparison with the non-severe patients. Methods We searched PubMed, EMBASE, Web of Science, and CNKI to collect all relevant studies published before July 26, 2020, and a total of 30 papers were included in this meta-analysis. Results In the severe COVID-19 patients, 60% (95% CI = 56–64%) were male, 25% (95% CI = 21–29%) were over 65 years old, 34% (95% CI = 24–44%) were obese, and 55% (95% CI = 41–70%) had comorbidities. The most prevalent comorbidities were hypertension (34%, 95% CI = 25–44%), diabetes (20%, 95% CI = 15–25%), and cardiovascular disease (CVD; 12%, 95% CI = 9–16%). The most common blood test abnormalities were elevated C-reactive protein (CRP; 87%, 82–92%), decreased lymphocyte count (68%, 58–77%), and increased lactate dehydrogenase (69%, 95% CI = 57–81%). In addition, abnormal laboratory findings revealing organ dysfunctions were frequently observed in the severe cases, including decrease in albumin (43%, 95% CI = 24–63%) and increase in aspartate aminotransferase (47%, 95% CI = 38–56%), alanine aminotransferase (28%, 95% CI = 16–39%), troponin I/troponin T (TnI/TnT; 29%, 95% CI = 13–45%), and serum Cr (SCr; 10%, 95% CI = 5–15%). Conclusion The male, elderly and obese patients and those with any comorbidities, especially with hypertension, diabetes, and CVD, were more likely to develop into severe cases. But the association between hypertension, diabetes, CVD, and severity of COVID-19 was declined by the increase of age. A significant elevation in cardiac TnI/TnT, the hepatic enzymes, and SCr and the reduction in lymphocytes with elevated CRPs are important markers for the severity. Specific attention should be given to the elderly male and obese patients and those with indications of severe immune injury in combination with bacterial infection and indication of multi-organ dysfunction or damages.
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Affiliation(s)
- Jianhua Hu
- Department of Internal Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yanggan Wang
- Department of Internal Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China, .,Medical Research Institute of Wuhan University, Wuhan, China,
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Risk Factors and Patient Profile of Infective Endocarditis due to Gemella spp.. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2021; 9:103-115. [PMID: 33585676 PMCID: PMC7877815 DOI: 10.12691/ajmcr-9-2-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The diagnosis of infective endocarditis is difficult, especially when it involves atypical organisms. Therefore, our study identified risk factors of infective endocarditis caused by rare pathogen, Gemella spp. METHODS A systematic review was conducted to investigate characteristics of endocarditis patients infected with Gemella spp. using the search term "Gemella" and "endocarditis." Case reports were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 83 articles were selected for review. RESULTS Five species of Gemella were identified. Typical patients were males between 31 and 45 years of age. On admission, patients had fever, tachycardia, and normal blood pressure. Common clinical manifestation other than fever included fatigue and weakness, chills and sweating, and nausea, vomiting, diarrhea, and weight changes. One in four reported a history of congenital heart disease, and a recent oral cavity infection. Laboratory tests reveal anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, elevated C-reactive protein is observed among adult and geriatric populations only. Mitral and aortic valves were most commonly infected by Gemella spp.. The most common Gemella spp.-susceptible antibiotics were penicillin, vancomycin, cephalosporin, macrolide, and aminoglycosides. However, antibiotic resistance was observed against penicillin, aminoglycoside, and fluoroquinolone. Antibiotic course of at least six weeks resulted in superior clinical improvements than durations under six weeks. Finally, one in two patients underwent valve replacement or repair, with common complications affecting the cardiovascular, neurological, and renal systems. Finally, death occurred in 1 in 8 patients, half of which occurred post-surgical procedure, and the majority occurring equal to or greater than 1 week from admission. CONCLUSION Our systematic review highlights the importance of considering rare pathogens, particularly in the presence of predisposing risk factors.
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Fedeli P, Cannovo N, Scendoni R, Cingolani M. Legal and Ethical Issues Regarding Minors in the Italian Coronavirus Flu Emergency. Front Pediatr 2021; 9:544461. [PMID: 33575234 PMCID: PMC7870794 DOI: 10.3389/fped.2021.544461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022] Open
Abstract
On February 21, 2020, Italy became one of the countries hit by an epidemic of the new coronavirus that causes "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). Even a month before that, however, the Italian government began issuing a series of decrees and ordinances aimed at the containment of the virus in Italy, the first of them on January 25, 2020. The COVID 19 infection has been faced as an epidemic through measures to enforce a high degree of isolation. These regulations hold for minors, as well, with consequent difficulties for this age group. While at the moment young people appear to be the least vulnerable to the severe complications of COVID 19, the psychological problems that may be brought on by pandemic-related restrictions should be taken into serious consideration.
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Affiliation(s)
| | | | - Roberto Scendoni
- Law Department, Legal Medicine Section, Macerata University, Macerata, Italy
| | - Mariano Cingolani
- Law Department, Legal Medicine Section, Macerata University, Macerata, Italy
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Mukherjee S, Saha K. COVID-19, hypertension, and diabetes – Hunt for the link! JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_40_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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225
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Huang D, Miao H, Zhang Z, Yang Y, Zhang L, Lure FYM, Wang Z, Jaeger S, Guo L, Xu T, Liu J. Longitudinal changes of laboratory measurements after discharged from hospital in 268 COVID-19 pneumonia patients. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:741-762. [PMID: 34397444 DOI: 10.3233/xst-210920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Monitoring recovery process of coronavirus disease 2019 (COVID-19) patients released from hospital is crucial for exploring residual effects of COVID-19 and beneficial for clinical care. In this study, a comprehensive analysis was carried out to clarify residual effects of COVID-19 on hospital discharged patients. METHODS Two hundred sixty-eight cases with laboratory measured data at hospital discharge record and five follow-up visits were retrospectively collected to carry out statistical data analysis comprehensively, which includes multiple statistical methods (e.g., chi-square, T-test and regression) used in this study. RESULTS Study found that 13 of 21 hematologic parameters in laboratory measured dataset and volume ratio of right lung lesions on CT images highly associated with COVID-19. Moderate patients had statistically significant lower neutrophils than mild and severe patients after hospital discharge, which is probably caused by more efforts on severe patients and slightly neglection of moderate patients. COVID-19 has residual effects on neutrophil-to-lymphocyte ratio (NLR) of patients who have hypertension or chronic obstructive pulmonary disease (COPD). After released from hospital, female showed better performance in T lymphocytes subset cells, especially T helper lymphocyte% (16% higher than male). According to this sex-based differentiation of COVID-19, male should be recommended to take clinical test more frequently to monitor recovery of immune system. Patients over 60 years old showed unstable recovery process of immune cells (e.g., CD45 + lymphocyte) within 75 days after discharge requiring longer clinical care. Additionally, right lung was vulnerable to COVID-19 and required more time to recover than left lung. CONCLUSIONS Criterion of hospital discharge and strategy of clinical care should be flexible in different cases due to residual effects of COVID-19, which depend on several impact factors. Revealing remaining effects of COVID-19 is an effective way to eliminate disorder of mental health caused by COVID-19 infection.
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Affiliation(s)
- Deyang Huang
- Guangzhou Eighth People's Hospital, Guangdong, China
| | - Hengyuan Miao
- Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China
| | - Ziqi Zhang
- Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China
| | - Yanhong Yang
- Guangzhou Eighth People's Hospital, Guangdong, China
| | | | | | - Zixian Wang
- Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China
| | - Stefan Jaeger
- National Library of Medicine, National Institutes of Health, Rockville Pike, Bethesda, MD, USA
| | - Lin Guo
- Shenzhen Zhiying Medical Co., Ltd, Shenzhen, China
| | - Tao Xu
- Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China
- Biomanufacturing and Rapid Forming Technology Key Laboratory of Beijings, Department of Mechanical Engineering, Tsinghua University, Beijing, China
- Key Laboratory for Advanced Materials Processing Technology, Ministry of Education, Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Jinxin Liu
- Guangzhou Eighth People's Hospital, Guangdong, China
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226
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Li X, Xu Z, Wang T, Xu X, Li H, Sun Q, Zhou X, Chen G. Clinical laboratory characteristics of severe patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 9:184-190. [PMID: 32954048 PMCID: PMC7491425 DOI: 10.1016/j.cegh.2020.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To identify clinical characteristics of severe patients with COVID-19. METHODS The WHO database of publications on COVID-19 and PubMed were searched from inception to March 20, 2020 and all valuable studies were analyzed using Stata 15.0. RESULTS We selected forty-four studies with 13,497 patients. In the comparison of severe and non-severe groups, age over 50 (OR = 4.090; 95% CI = 2.422-6.907, P = 0.000) and underlying disease (OR = 3.992; 95% CI = 2.631-6.507, P = 0.000) are risk factors. Female gender (OR = 0.740; 95% CI = 0.622-0.881, P = 0.001) is a protective factor. Characteristics like dyspnea (OR = 4.914; 95% CI = 3.069-7.867, P = 0.000), lymphopenia (OR = 5.528; 95% CI = 3.484-8.772, P = 0.000), thrombocytopenia (OR = 3.623; 95% CI = 1.034-12.691, P = 0.044), elevated C-reactive protein (OR = 5.217; 95% CI = 2.459-11.070, P = 0.000) and D-dimer (OR = 3.780; 95% CI = 1.481-9.648, P = 0.005) were more frequently in severe cases. Diffuse lesions and consolidation (OR = 4.680; 95% CI = 3.183-6.881, P = 0.000) in imaging was considered reliable. CONCLUSIONS Men older than 50 with underlying disease are susceptible to develop severe pneumonia while female gender is protective. The typical symptom of severe pneumonia was dyspnea, but high fever, headache and diarrhea were not significantly different among patients with varying degrees of severity. Lymphopenia, thrombocytopenia, elevated C-reactive protein and D-dimer occurred more frequently in severe patients and yet leukopenia is not a characteristic laboratory indicator. Diffuse lesions and consolidation are important imaging features to distinguish severe pneumonia.
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Affiliation(s)
- Xiang Li
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhongmou Xu
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Tianyi Wang
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiang Xu
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Haiying Li
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qin Sun
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xinmin Zhou
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, Jiangsu Province, China
| | - Gang Chen
- Department of Clinical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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227
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Rondón-Quintana HA, Zafra-Mejía CA. Covid 19 death analysis in Colombia. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: This article shows an analysis of the evolution up until date (May 4-2021), of official coronavirus cases statistics (CC) and the total number of deaths (TND) due to SARS-CoV-2 in Colombia. Additionally, said information is shown in correlation to other variables such as Case Fatality Rate (CFR), age range of persons, their typical reported co-morbidities and the cities where there has been highest concentration of cases. Materials and Methods: From March 16 2020 until today, information regarding the daily number of new confirmed cases (DNC) and daily confirmed deaths (DD) was registered in a database with the purpose of estimating the evolution of CC, TND and CFR. The age of deceased was also registered, as well as their gender, prior co-morbidities and city of death. The evolution of TND with the time of other countries were compared to that of Colombia. A mathematical equation that represents the epidemiological curve of TND evolution of different countries across time was defined. Results: In Colombia, the average age of people who die due to COVID-19 is of 69.5±14.7 years (median and mode of 71 and 80 years, respectively), and the virus is less lethal amongst a population under the age of 40. The greater part of deaths have taken place in people with prior co-morbidities and of the male gender. Conclusion: Most of the persons that have deceased are those of senior age, mainly with prior co-morbidities, and predominantly of male gender. Epidemiological peaks of COVID-19 are consistent with the rainy and winter seasons, and with the traditional epidemiological peaks of flu or influenza.
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228
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Li G, Liu Y, Jing X, Wang Y, Miao M, Tao L, Zhou Z, Xie Y, Huang Y, Lei J, Gong G, Jin P, Hao Y, Faria NR, Clercq ED, Zhang M. Mortality risk of COVID-19 in elderly males with comorbidities: a multi-country study. Aging (Albany NY) 2020; 13:27-60. [PMID: 33472167 PMCID: PMC7835001 DOI: 10.18632/aging.202456] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic causes severe morbidity and mortality. This multi-country study aimed to explore risk factors that drive mortality in COVID-19 patients who received neither dexamethasone nor remdesivir. We analyzed a cohort of 568 survivors and 507 non-survivors from China, European regions, and North America. Elderly males ≥70 years accounted for only 25% of survivors, but this rate was significantly higher in non-survivors from China (55%), European regions (63%), and North America (47%). Compared with survivors, non-survivors had more incidences of comorbidities such as cerebrovascular disease and chronic obstructive pulmonary disease (COPD, p-values<0.05). Survival analyses revealed age, male gender, shortness of breath, cerebrovascular disease, and COPD as mortality-associated factors. Survival time from symptom onset was significantly shorter in elderly versus young patients (median: 29 versus 62 days), males versus females (median: 46 versus 59 days), and patients with versus without comorbidities (mean: 41 versus 61 days). Mortality risk was higher in elderly males with comorbidities than in young females without comorbidities (p-value<0.01). Elderly male survivors with comorbidities also had longer hospital stays than other survivors (25 versus 18.5 days, p-value<0.01). Overall, the high mortality risk in elderly males with COVID-19-associated comorbidities supports early prevention and critical care for elderly populations.
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Affiliation(s)
- Guangdi Li
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yacong Liu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xixi Jing
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yali Wang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Miao Miao
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Li Tao
- School of Mathematics and Statistics, Central South University, Changsha, China
| | - Zhiguo Zhou
- The First Hospital of Changsha, Changsha, China
| | - Yuanlin Xie
- The Fourth Hospital of Changsha, Changsha, China
| | | | - Jianhua Lei
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guozhong Gong
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Jin
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nuno Rodrigues Faria
- Department of Zoology, University of Oxford, Oxford, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Min Zhang
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
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Mathew RP, Jose M, Jayaram V, Joy P, George D, Joseph M, Sleeba T, Toms A. Current status quo on COVID-19 including chest imaging. World J Radiol 2020; 12:272-288. [PMID: 33510852 PMCID: PMC7802080 DOI: 10.4329/wjr.v12.i12.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
With each day the number coronavirus disease 2019 (COVID-19) cases continue to rise rapidly and our imaging knowledge of this disease is expeditiously evolving. The role of chest computed tomography (CT) in the screening or diagnosis of COVID-19 remains the subject of much debate. Despite several months having passed since identifying the disease, and numerous studies related to it, controversy and concern still exists regarding the widespread use of chest CT in the evaluation and management of COVID-19 suspect patients. Several institutes and organizations around the world have released guidelines, recommendations and statements against the use of CT for diagnosing or screening COVID-19 infection and advocating its use only for those cases with a strong clinical suspicion of complication or an alternate diagnosis. However, these guidelines and recommendations are in disagreement with majority of the widely available literature, which strongly favour CT as a pivotal tool in the early diagnosis, management and even follow-up of COVID-19 infection. This article besides comprehensively reviewing the current status quo on COVID-19 disease in general, also writes upon the current consensus statements/recommendations on the use of diagnostic imaging in COVID-19 as well as highlighting the precautions and various disinfection procedures being employed world-wide at the workplace to prevent the spread of infection.
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Affiliation(s)
| | - Merin Jose
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
| | - Vinayak Jayaram
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
| | - Paul Joy
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
| | - Danny George
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
| | - Maria Joseph
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
| | - Teena Sleeba
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
| | - Ajith Toms
- Department of Radiology, Rajagiri Hospital, Kochi 683112, Kerala, India
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Otuonye NM, Olumade TJ, Ojetunde MM, Holdbrooke SA, Ayoola JB, Nyam IY, Iwalokun B, Onwuamah C, Uwandu M, Abayomi A, Osibogun A, Bowale A, Osikomaiya B, Thomas B, Mutiu B, Odunukwe NN. Clinical and Demographic Characteristics of COVID-19 patients in Lagos, Nigeria: A Descriptive Study. J Natl Med Assoc 2020; 113:301-306. [PMID: 33358220 PMCID: PMC7759120 DOI: 10.1016/j.jnma.2020.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022]
Abstract
Introduction COVID-19 is an emerging, rapidly evolving global situation, infecting over 25 million people and causing more than 850,000 deaths. Several signs and symptoms have been described to be characteristic of the disease. However, there is a dearth of report on the description of the clinical characteristics of the disease in patients from Nigeria. This study was designed to provide a description of the clinical and demographic characteristics of COVID-19 patients in Nigeria. Methods This study is a case series that includes patients that are evaluated between May and August 2020, and diagnosed with COVID-19. Patient health records were reviewed and evaluated to describe the clinical characteristics on presentation. Results A total of 154 COVID-19 patients were included in this study, with a mean age (S.D.) of 46.16 (13.701). Most of the patients survived (mortality rate of 2.6%), and were symptomatic (89.6%). There were more males (74.7%) than females, and the most common symptoms were fever, breathing difficulty, dry cough and malaise. Co-morbidities were also present in almost half of the study participants (49.4%). Conclusion This study presents the most extensive description, to date, on the clinical and demographic characteristics of COVID-19 patients in Nigeria. Males are more likely than females to be infected with COVID-19 and the most occurring symptoms are fever, breathing difficulty, malaise, dry cough and chest pain. Old age and the presence of co-morbidities may also be associated with developing the severe disease.
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Affiliation(s)
| | - Testimony Jesupamilerin Olumade
- Department of Biological Sciences, Redeemer's University, Ede, Osun state; African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun state
| | | | | | | | - Itse Yusuf Nyam
- Central Research Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Bamidele Iwalokun
- Molecular Biological and Biotechnology Department, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Chika Onwuamah
- Centre for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Mabel Uwandu
- Centre for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Akinola Abayomi
- Lagos State Ministry of Health, Alausa, Ikeja, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine University of Lagos, Nigeria; Lagos State Primary Health Care Board, Lagos, Nigeria
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Li Z, Feng L, Cui W, Zhang J, Huang Y, Zhao Y, Teng F, Wu D, Wang H, Deng L, Yu Q. Sex differences in patients with COVID-19: a retrospective cohort study and meta-analysis. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND: Accumulated evidence revealed that male was much more likely to higher severity and fatality by SARS-CoV-2 infection than female patients, but few studies and meta-analyses have evaluated the sex differences of the infection and progression of COVID-19 patients.
AIM: We aimed to compare the sex differences of the epidemiological and clinical characteristics in COVID-19 patients; and to perform a meta-analysis evaluating the severe rate, fatality rate, and the sex differences of the infection and disease progression in COVID-19 patients.
METHODS: We analyzed clinical data of patients in Changchun Infectious Hospital and Center, Changchun, Northeast China; and searched PubMed, Embase, Web of Science, and Cochrane Library without any language restrictions for published articles that reported the data of sex-disaggregated, number of severe, and death patients on the confirmed diagnosis of adult COVID-19 patients.
RESULTS: The pooled severe rate and fatality rate of COVID-19 were 22.7% and 10.7%. Male incidence in the retrospective study was 58.1%, and the pooled incidence in male was 54.7%.
CONCLUSION: The pooled severe rate in male and female of COVID-19 was 28.2% and 18.8%, the risky of severe and death was about 1.6folds higher in male compared with female, especially for older patients (> 50 y).
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232
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Cattelan AM, Di Meco E, Trevenzoli M, Frater A, Ferrari A, Villano M, Gomiero F, Carretta G, Sasset L. Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study. BMC Infect Dis 2020; 20:934. [PMID: 33297986 PMCID: PMC7724444 DOI: 10.1186/s12879-020-05647-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not. METHODS This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups. RESULTS 303 were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p < 0.01), had a higher fatality rate (14.5% vs. 3.8%, p < 0,01), had more hypertension (72.4% vs. 44%, p < 0,01) and diabetes (31.9% vs. 21%, p = 0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p < 0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p = 0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-Reactive-Protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-Reactive-Protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p < 0.01). CONCLUSIONS The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.
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Affiliation(s)
- Anna Maria Cattelan
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy.
| | - Eugenia Di Meco
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Marco Trevenzoli
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Alessia Frater
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Anna Ferrari
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Marco Villano
- Information Technology System Unit, Azienda Ospedale Università di Padova, Padova, Italy
| | - Federica Gomiero
- Information Technology System Unit, Azienda Ospedale Università di Padova, Padova, Italy
| | - Giovanni Carretta
- Department of Directional Hospital Management, Azienda Ospedale Università di Padova, Padova, Italy
| | - Lolita Sasset
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
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233
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Galbadage T, Peterson BM, Wang JS, Jayasekara A, Ramirez DA, Awada J, Walsh JP, Gunasekera RS. Molecular Mechanisms Lead to Sex-Specific COVID-19 Prognosis and Targeted Therapies. Front Med (Lausanne) 2020; 7:589060. [PMID: 33364247 PMCID: PMC7753152 DOI: 10.3389/fmed.2020.589060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Clinical and epidemiological studies have identified male sex as an important risk factor for COVID-19 clinical outcomes and mortality. This raises the question as to how this risk factor can be addressed in the prognosis, clinical management, and the treatment of patients with Coronavirus disease 2019 (COVID-19). Currently, there are no guidelines or protocols to help alter the course of sex-specific COVID-19 prognosis, especially in severe disease presentations. This is partly due to the lack of research studies characterizing the differences in male vs. female host response to the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection and a lack of a well-rounded understanding of the molecular mechanisms involved. Here, we discuss three distinct but interconnected molecular-level differences in males and females that likely play an essential role in the COVID-19 prognosis. We review interactions of SARS-CoV-2 with host cell angiotensin-converting enzyme 2 (ACE2) in the viral entry between males vs. females and discuss the differential regulation of the renin-angiotensin system (RAS) between the two sexes. Next, we present immune response disparities and how immune function and endocrine regulation may render males increasingly vulnerable to severe COVID-19. We describe the interconnected roles of these three regulatory systems in males and females in response to SARS-CoV-2 infection. Finally, we highlight the clinical implications of these mechanisms to patients with COVID-19 and propose putative targeted therapies that can help reduce COVID-19 severity in those critically ill.
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Affiliation(s)
- Thushara Galbadage
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Brent M Peterson
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Jeffrey S Wang
- Department of Infectious Diseases, Southern California Permanente Medical Group, Pasadena, CA, United States
| | - Avishka Jayasekara
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Danny A Ramirez
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - Joseph Awada
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - John P Walsh
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Richard S Gunasekera
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
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Alkhowailed MS, Alqossayir F, Rasheed Z, Alkhamiss A, Alsalloom AA, Ali A, Shariq A, Alamer A, Almohaileb FI, Alharb MH, Alhomaidan HT, Alsulmi HA, Al Abdulmonem W. Comprehensive review on novel COVID-19: a Saudi perspective. ARAB JOURNAL OF BASIC AND APPLIED SCIENCES 2020. [DOI: 10.1080/25765299.2020.1852731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Fuhaid Alqossayir
- Family and Community Medicine Department, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Abdullah Alkhamiss
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | | | - Ahmed Ali
- Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Department of Microbiology, Qassim University, Buraidah, Saudi Arabia
| | - Ali Alamer
- Radiology and Medical Imaging Department, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Faisal I. Almohaileb
- Family and Community Medicine Department, Qassim University, Buraidah, Saudi Arabia
| | - Muslet H. Alharb
- Family and Community Medicine Department, Qassim University, Buraidah, Saudi Arabia
| | | | - Hussam A. Alsulmi
- Department of Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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235
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Nebreda-Mayoral T, Miguel-Gómez MA, March-Rosselló GA, Puente-Fuertes L, Cantón-Benito E, Martínez-García AM, Muñoz-Martín AB, Orduña-Domingo A. Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30404-3. [PMID: 33413990 PMCID: PMC7713607 DOI: 10.1016/j.eimc.2020.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Bacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19. METHOD Retrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses. RESULTS Of the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon β-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RIs (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50 vs. 29%; p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii. CONCLUSION The outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients.
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Affiliation(s)
- Teresa Nebreda-Mayoral
- Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - María Antonia Miguel-Gómez
- Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - Lucía Puente-Fuertes
- Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Elena Cantón-Benito
- Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Ana María Martínez-García
- Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - Antonio Orduña-Domingo
- Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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236
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Chen Y, Li T, Ye Y, Chen Y, Pan J. Impact of Fundamental Diseases on Patients With COVID-19. Disaster Med Public Health Prep 2020; 14:776-781. [PMID: 32375909 PMCID: PMC7240136 DOI: 10.1017/dmp.2020.139] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In December 2019, a new type of coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appeared in Wuhan, China. Serious outbreaks of coronavirus disease 2019 (COVID-19), related to the SARS-CoV-2 virus, have occurred throughout China and the world. Therefore, we intend to shed light on its potential clinical and epidemiological characteristics. METHODS In this retrospective study, we included 50 confirmed fatal cases of SARS-CoV-2 reported on Chinese official media networks from January 16, 2020, to February 5, 2020. All the cases were confirmed by local qualified medical and health institutions. Specific information has been released through official channels. According to the contents of the reports, we recorded in detail the gender, age, first symptom date, death date, primary symptoms, chronic fundamental diseases, and other data of the patients, and carried out analyses and discussion. RESULTS In total, 50 fatal cases were reported: median age was 70 y old, and males were 2.33 times more likely to die than females. The median number of days from the first symptom to death was 13, and that length of time tended to be shorter among people aged 65 and older compared with those younger than 65 (12 days vs 17 days; P = 0.046). Therefore, the older patients had fewer number of days from the first symptom to death (r = -0.40; P = 0.012). CONCLUSIONS In our study, we found that most of the deaths were elderly men with chronic fundamental diseases, and their COVID-19 progression to death time was shorter. At the same time, we demonstrated that older men are more likely to become infected with COVID-19, and the risk of death is positively correlated with age.
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Affiliation(s)
- Yiguang Chen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tianhua Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yongyi Ye
- Guangdong Medical University, ZhanJiang, Guangdong, China
| | - Yongjian Chen
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jun Pan
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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237
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Chedraui P, Pérez-López FR. The severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection and the climacteric woman. Climacteric 2020; 23:525-527. [PMID: 33252294 DOI: 10.1080/13697137.2020.1837547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection has affected millions of individuals worldwide, causing high mortality rates and severe physical sequelae, with a negative impact on society, economy, health care, lifestyle and personal relationships. Studies have confirmed this infection has sex and age differences in terms of disease severity and immune response, with a particular relationship with the anti-Müllerian hormone, a marker of aging, and estradiol, a marker of ovarian function. Postmenopausal women seem to present a more severe infection as compared to premenopausal ones. Estradiol protects the vascular system, mediating with the renin-angiotensin-aldosterone system, whereas testosterone enhances the levels of angiotensin-converting enzyme and the transmembrane protease serine-type 2, thus delaying viral clearance in men as compared to women. This new infection will stay among us, transforming our social, economic and daily lifestyle, and hence medical and health care as well as the use of menopause hormone therapy will need redefining, considering both preventive and curative perspectives.
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Affiliation(s)
- Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine, and Aragón Health Research Institute, Zaragoza, Spain
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238
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Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male 2020; 23:1416-1424. [PMID: 32508193 DOI: 10.1080/13685538.2020.1774748] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) is an emerging disease that was first reported in Wuhan city, the capital of Hubei province in China, and has subsequently spread worldwide. Risk factors for mortality have not been well summarized. Current meta-analysis of retrospective cohort studies was done to summarize available findings on the association between age, gender, comorbidities and risk of death from COVID-19 infection. METHODS Online databases including Web of Science, PubMed, Scopus, Cochrane Library and Google scholar were searched to detect relevant publications up to 1 May 2020, using relevant keywords. To pool data, random-effects model was used. Furthermore, sensitivity analysis and publication bias test were also done. RESULTS In total, 14 studies with 29,909 COVID-19 infected patients and 1445 cases of death were included in the current meta-analysis. Significant associations were found between older age (≥65 vs <65 years old) (pooled ORs = 4.59, 95%CIs = 2.61-8.04, p < .001), gender (male vs female) (pooled ORs = 1.50, 95%CIs = 1.06-2.12, p = .021) and risk of death from COVID-19 infection. In addition, hypertension (pooled ORs = 2.70, 95%CIs = 1.40-5.24, p = .003), cardiovascular diseases (CVDs) (pooled ORs = 3.72, 95%CIs = 1.77-7.83, p = .001), diabetes (pooled ORs = 2.41, 95%CIs = 1.05-5.51, p = .037), chronic obstructive pulmonary disease (COPD) (pooled ORs = 3.53, 95%CIs = 1.79-6.96, p < .001) and cancer (pooled ORs = 3.04, 95%CIs = 1.80-5.14, p < .001), were associated with higher risk of mortality. CONCLUSIONS Older age (≥65 years old), male gender, hypertension, CVDs, diabetes, COPD and malignancies were associated with greater risk of death from COVID-19 infection. These findings could help clinicians to identify patients with poor prognosis at an early stage.
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Affiliation(s)
- Mohammad Parohan
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Asal Seraji
- Department of Nursing, Damavand Branch, Islamic Azad University, Damavand, Iran
| | - Mohammad Hassan Javanbakht
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Sarraf
- Iranian center of Neurological research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Djalali
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Rokni M, Ahmadikia K, Asghari S, Mashaei S, Hassanali F. Comparison of clinical, para-clinical and laboratory findings in survived and deceased patients with COVID-19: diagnostic role of inflammatory indications in determining the severity of illness. BMC Infect Dis 2020; 20:869. [PMID: 33225909 PMCID: PMC7680983 DOI: 10.1186/s12879-020-05540-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/23/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Since December 2019, when a cluster of pneumonia cases due to SARS-CoV-2 initially emerged in Wuhan city and then rapidly spread throughout the world, the necessity for data concerning the clinical and para-clinical features of Iranian patients with COVID-19 was highlighted. Therefore, we aimed to compare the clinical, para-clinical and laboratory evidences of deceased patients with survival group. METHODS We extracted data regarding 233 patients with laboratory-confirmed COVID-19 from Buali Hospital in Iran; clinical/para-clinical and inflammatory indexes data were collected and analyzed. The data of laboratory examinations and chest CT findings were compared between deceased and survived patients. RESULTS The mean age of the patients was 49.8 years and 64% of our patients were male. The acute respiratory distress syndrome occurred in 64 patients, 52 who were admitted to the ICU, which all of them underwent invasive mechanical ventilation, and 28 who died. Lymphopenia (79%), neutrophilia (79%), and thrombocytopenia (21%) were the most frequently observed laboratory findings of the deceased group on admission. Most patients (68%) had a high systematic immune-inflammation (SII) index of > 500 and increased C-reactive protein level (88%). Levels of inflammatory indexes such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and SII were documented to be significantly elevated in the deceased group when compared with the patients who survived (P < 0.0001, P < 0.001, P < 0.0001, respectively). The most commonly presented symptoms were fever (70%) and cough (63%) on admission. Headache was uncommon (11%). Ground-glass opacity with consolidation (mixed) was the most common radiologic finding on chest CT (51%). No radiographic or CT abnormality was found in 15 of 204 patients (7%). CONCLUSION Small fraction of patients with COVID-19 may present without fever and abnormal radiologic findings. Elevated NLR, PLR and SII can be considered as prognostic and risk stratifying factor of severe form of disease.
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Affiliation(s)
- Mohsen Rokni
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Somaye Asghari
- Department of Immunology, Buali Hospital of Laboratory, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shahabodin Mashaei
- Infectious Diseases and Tropical Medicine Research Center, Buali Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fahimeh Hassanali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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240
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Xu H, Wang Z, Feng C, Yu W, Chen Y, Zeng X, Liu C. Effects of SARS-CoV-2 infection on male sex-related hormones in recovering patients. Andrology 2020; 9:107-114. [PMID: 33152165 DOI: 10.1111/andr.12942] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causing the pandemic of coronavirus disease 2019 (COVID-19), may attack testes by angiotensin-converting enzyme 2. OBJECTIVE To assess whether SARS-CoV-2 infection can affect sex-related hormones and testicular function in recovering patients. MATERIALS AND METHODS The patients were separately classified according to the duration of viral shedding (long-term positive vs normal-term group, with the former cases having a duration > 50 days) and disease severity (moderate vs severe group). Differences in sex-related hormone levels were compared between groups and linear regression analysis was used to compare the associations of testosterone (T) and estradiol with various clinical and laboratory factors. RESULTS A total of 39 COVID-19-infected patients were included in this study. The mean T level was in the normal reference range while the mean estradiol level was above the normal limit. There were no significant differences between the long-term positive and normal-term groups in T (P = .964), follicle-stimulating hormone (FSH; P = .694), luteinizing hormone (LH; P = .171), prolactin (PRL; P = .836), or T/LH (P = .512). However, estradiol was higher in the normal-term group than the long-term positive group (P < .001). Moreover, there were also no significant differences between the moderate and severe groups in sex-related hormones, duration of viral shedding, or serum biochemical or inflammation indicators. Additionally, regression analyses showed that there were no associations between the T level and the clinical and laboratory factors, while estradiol was negatively associated with the duration of viral shedding. CONCLUSION In males infected with SARS-CoV-2, most sex-related hormones (T, FSH and LH levels) remain within the normal reference ranges after recovery from COVID-19, and no significant associations were observed between T level and disease duration or severity. At present, there is insufficient evidence to show that SARS-CoV-2 causes hypogonadism and sterility, but the potential risk should not be ignored.
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Affiliation(s)
- Hui Xu
- Health Management Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhixian Wang
- Department of Urology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chunxiang Feng
- Department of Pathogenic Biology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Yu
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Chen
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyong Zeng
- Department of Urology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chang Liu
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Jung SY, Choi JC, You SH, Kim WY. Association of Renin-angiotensin-aldosterone System Inhibitors With Coronavirus Disease 2019 (COVID-19)- Related Outcomes in Korea: A Nationwide Population-based Cohort Study. Clin Infect Dis 2020; 71:2121-2128. [PMID: 32442285 PMCID: PMC7314113 DOI: 10.1093/cid/ciaa624] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Renin-angiotensin-aldosterone system (RAAS) inhibitors may facilitate host cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or attenuate organ injury via RAAS blockade. We aimed to assess the associations between prior use of RAAS inhibitors and clinical outcomes among Korean patients with coronavirus disease 2019 (COVID-19). METHODS We performed a nationwide population-based cohort study using the Korean Health Insurance Review and Assessment database. Claim records were screened for 69 793 individuals who were tested for COVID-19 until 8 April 2020. Adjusted odds ratios (ORs) were used to compare the clinical outcomes between RAAS inhibitor users and nonusers. RESULTS Among 5179 confirmed COVID-19 cases, 762 patients were RAAS inhibitor users and 4417 patients were nonusers. Relative to nonusers, RAAS inhibitor users were more likely to be older, male, and have comorbidities. Among 1954 hospitalized patients with COVID-19, 377 patients were RAAS inhibitor users, and 1577 patients were nonusers. In-hospital mortality was observed for 33 RAAS inhibitor users (9%) and 51 nonusers (3%) (P < .001). However, after adjustment for age, sex, Charlson comorbidity index, immunosuppression, and hospital type, the use of RAAS inhibitors was not associated with a higher risk of mortality (adjusted OR, 0.88; 95% confidence interval, 0.53-1.44; P = .60). No significant differences were observed between RAAS inhibitor users and nonusers in terms of vasopressor use, modes of ventilation, extracorporeal membrane oxygenation, renal replacement therapy, and acute cardiac events. CONCLUSIONS Our findings suggest that prior use of RAAS inhibitors was not independently associated with mortality among COVID-19 patients in Korea.
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Affiliation(s)
- Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jae Chol Choi
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hun You
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Wang JB, Wang HT, Wang LS, Li LP, Xv J, Xv C, Li XH, Wu YH, Liu HY, Li BJ, Yu H, Tian X, Zhang ZY, Wang Y, Zhao R, Liu JY, Wang W, Gu Y. Epidemiological and clinical characteristics of fifty-six cases of COVID-19 in Liaoning Province, China. World J Clin Cases 2020; 8:5188-5202. [PMID: 33269255 PMCID: PMC7674744 DOI: 10.12998/wjcc.v8.i21.5188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pneumonia of uncertain cause has been reported in Wuhan, China since the beginning of early December 2019. In early January 2020, a novel strain of β-coronavirus was identified by the Chinese Center for Disease Control and Prevention from the pharyngeal swab specimens of patients, which was recently named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is evidence of human-to-human transmission and familial cluster outbreak of SARS-CoV-2 infection. The World Health Organization(WHO) recently declared the SARS-CoV-2 epidemic a global health emergency. As of February 17, 2020, 71329 laboratory-confirmed cases (in 25 countries, including the United States and Germany) have been reported globally. Other than its rapid transmission, the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) remain unclear. In December 2019, coronavirus disease (named COVID-19 by the WHO) associated with the SARS-CoV-2 emerged in Wuhan, China and spread quickly across the country. AIM To analyze the epidemiological and clinical characteristics of confirmed cases of this disease in Liaoning province, a Chinese region about 1800 km north of Wuhan. METHODS The clinical data of 56 laboratory-confirmed COVID-19 cases due to 2019-nCoV infection were analyzed. The cases originated from eight cities in Liaoning province. RESULTS The median age of the patients was 45 years, and 57.1% of them were male. No patient had been in direct contact with wild animals. Among them, 23 patients (41.1%) had resided in or traveled to Wuhan, 27 cases (48.2%) had been in contact with confirmed COVID-19 patients, 5 cases (8.9%) had been in contact with confirmed patients with a contact history to COVID-19 patients, and 1 case (1.8%) had no apparent history of exposure. Fever (75.0%) and cough (60.7%) were the most common symptoms. The typical manifestations in lung computed tomography (CT) included ground-glass opacity and patchy shadows, with 67.8% of them being bilateral. Among the patients in the cohort, 78.6% showed reduction in their lymphocyte counts, 57.1% showed increases in their C-reactive protein levels, and 50.0% showed decreases in their blood albumin levels. Eleven patients (19.6%) were admitted to intensive care unit, 2 patients (3.5%) progressed to acute respiratory distress syndrome, 4 patients (7.1%) were equipped with non-invasive mechanical ventilation, and 1 patient (1.8) received extracorporeal membrane oxygenation support. There were 5 mild cases (5/56, 8.9%), 40 moderate cases (40/56, 71.4%), 10 severe cases (10/56, 17.9%), and 1 critical case (1/56, 1.8%). No deaths were reported. CONCLUSION SARS-CoV-2 can be transmitted among humans. Most COVID-19 patients show symptoms of fever, cough, lymphocyte reduction, and typical lung CT manifestations. Most are moderate cases. The seriousness of the disease (as indicated by blood oxygen saturation, respiratory rate, oxygenation index, blood lymphocyte count, and lesions shown in lung CT) is related to history of living in or traveling to Wuhan, underlying diseases, admittance to intensive care unit, and mechanical ventilation.
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Affiliation(s)
- Jing-Bo Wang
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Hai-Tao Wang
- Department of General Surgery, The Second Affiliated Hospital of Shenyang Medical College, Shenyang 110002, Liaoning Province, China
| | - Lei-Shi Wang
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Lu-Ping Li
- Department of Clinical Laboratory, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Jiao Xv
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Chun Xv
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Xing-Hai Li
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Yun-Hai Wu
- Department of Intensive Critical Medicine, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Hong-Yan Liu
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Bai-Jun Li
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Hong Yu
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Xia Tian
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Zhi-Yu Zhang
- Department of Infectious Diseases Clinic, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Yan Wang
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Rui Zhao
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Jin-Yang Liu
- Department of Infectious Diseases Clinic, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Wei Wang
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
| | - Ye Gu
- Department of Infectious Disease, The Sixth People’s Hospital of Shenyang, Shenyang 110006, Liaoning Province, China
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Olvany JM, Sausville LN, White MJ, Tacconelli A, Tavera G, Sobota RS, Ciccacci C, Bohlbro AS, Wejse C, Williams SM, Sirugo G. CLEC4E (Mincle) genetic variation associates with pulmonary tuberculosis in Guinea-Bissau (West Africa). INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2020; 85:104560. [PMID: 32971250 PMCID: PMC7962542 DOI: 10.1016/j.meegid.2020.104560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022]
Abstract
Tuberculosis (TB) is the leading cause of death from a single infectious agent. According to the WHO, 85% of cases in 2018 were pulmonary tuberculosis (PTB), making it the most prevalent form of the disease. Although the bacillus responsible for disease, Mycobacterium tuberculosis (MTB), is estimated to infect 1.7 billion people worldwide, only a small portion of those infected (5-10%) will transition into active TB. Because such a small fraction of infected people develop active disease, we hypothesized that underlying host genetic variation associates with developing active pulmonary disease. Variation in CLEC4E has been of interest in previous association studies showing either no effect or protection from PTB. For our study we assessed 60 SNPs in 11 immune genes, including CLEC4E, using a case-control study from Guinea-Bissau. The 289 cases and 322 controls differed in age, sex, and ethnicity all of which were included in adjusted models. Initial association analysis with unadjusted logistic regression revealed putative association with seven SNPs (p < 0.05). All SNPs were then assessed in an adjusted model. Of the six SNPs that remained significant, three of them were assigned to the CLEC4E gene (rs12302046, rs10841847, and rs11046143). Of these, only rs10841847 passed FDR adjustment for multiple testing. Adjusted regression analyses showed that the minor allele at rs10841847 associated with higher risk of developing PTB (OR = 1.55, CI = 1.22-1.96, p-value = 0.00036). Based on these initial association tests, CLEC4E seemed to be the predictor of interest for PTB risk in this population. Haplotype analysis (2-SNP and 3-SNP windows) showed that minor alleles in segments including rs10841847 were the only ones to pass the threshold of global significance, compared to other haplotypes (p-value < 0.05). Linkage disequilibrium patterns showed that rs12302046 is in high LD with rs10841847 (r2 = 0.67), and all other SNPs lost significance when adjusted for rs10841847 effects. These findings indicate that rs10841847 in CLEC4E is the single best predictor of pulmonary tuberculosis risk in our study population. These results provide evidence for the hypothesis that genetic variation of CLEC4E influences risk to TB in Guinea-Bissau.
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Affiliation(s)
- Jasmine M Olvany
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Lindsay N Sausville
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Marquitta J White
- Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA
| | | | - Gloria Tavera
- Department of Clinical Translational Science Collaborative, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Rafal S Sobota
- Northwestern Memorial Hospital, Northwestern University, Chicago, IL 60611, USA
| | - Cinzia Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, 00131, Rome, Italy; Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Anders S Bohlbro
- Department of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Christian Wejse
- Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark; Center for Global Health, School of Public Health, Aarhus University, Skejby, Denmark
| | - Scott M Williams
- Departments of Population and Quantitative Health Sciences, and Genetics and Genome Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Giorgio Sirugo
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Mendes A, Serratrice C, Herrmann FR, Genton L, Périvier S, Scheffler M, Fassier T, Huber P, Jacques MC, Prendki V, Roux X, Di Silvestro K, Trombert V, Harbarth S, Gold G, Graf CE, Zekry D. Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study. J Am Med Dir Assoc 2020; 21:1546-1554.e3. [PMID: 33138936 PMCID: PMC7491997 DOI: 10.1016/j.jamda.2020.09.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine predictors of in-hospital mortality related to COVID-19 in older patients. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients aged 65 years and older hospitalized for a diagnosis of COVID-19. METHODS Data from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results. RESULTS Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001). CONCLUSIONS AND IMPLICATIONS In older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
| | - Christine Serratrice
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Laurence Genton
- Clinical Nutrition, University Hospitals of Geneva, Geneva, Switzerland
| | - Samuel Périvier
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Max Scheffler
- Division of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Fassier
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Huber
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Virginie Prendki
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Xavier Roux
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Katharine Di Silvestro
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Véronique Trombert
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Stephan Harbarth
- Division of Infectious Diseases and Infection Control Program, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Gabriel Gold
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe E Graf
- Division of Internal Medicine and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Dina Zekry
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
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245
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Anastassopoulou C, Gkizarioti Z, Patrinos GP, Tsakris A. Human genetic factors associated with susceptibility to SARS-CoV-2 infection and COVID-19 disease severity. Hum Genomics 2020; 14:40. [PMID: 33092637 PMCID: PMC7578581 DOI: 10.1186/s40246-020-00290-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The emergence of the novel coronavirus in Wuhan, Hubei Province, China, in December 2019 marked the synchronization of the world to a peculiar clock that is counting infected cases and deaths instead of hours and minutes. The pandemic, highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has indeed caused considerable morbidity and mortality and drastically changed our everyday lives. As we continue to become acquainted with the seventh coronavirus known to infect our species, a number of its characteristics keep surprising us. Among those is the wide spectrum of clinical manifestations of the resulting coronavirus disease 2019 (COVID-19), which ranges from asymptomatic or mildly symptomatic infections to severe pneumonia, respiratory failure, and death. MAIN BODY Data, now from patient populations, are beginning to accumulate on human genetic factors that may contribute to the observed diversified disease severity. Therefore, we deemed it prudent to review the associations between specific human genetic variants and clinical disease severity or susceptibility to infection that have been reported in the literature to date (at the time of writing this article in early August 2020 with updates in mid-September). With this work, we hope (i) to assist the fast-paced biomedical research efforts to combat the virus by critically summarizing current knowledge on the potential role of host genetics, and (ii) to help guide current genetics and genomics research towards candidate gene variants that warrant further investigation in larger studies. We found that determinants of differing severity of COVID-19 predominantly include components of the immune response to the virus, while determinants of differing susceptibility to SARS-CoV-2 mostly entail genes related to the initial stages of infection (i.e., binding of the cell surface receptor and entry). CONCLUSION Elucidating the genetic determinants of COVID-19 severity and susceptibility to SARS-CoV-2 infection would allow for the stratification of individuals according to risk so that those at high risk would be prioritized for immunization, for example, if or when safe and effective vaccines are developed. Our enhanced understanding of the underlying biological mechanisms could also guide personalized therapeutics. Such knowledge is already beginning to provide clues that help explain, at least in part, current epidemiologic observations regarding the typically more severe or benign disease course in older males and children, respectively.
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Affiliation(s)
- Cleo Anastassopoulou
- Laboratory of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
| | - Zoi Gkizarioti
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - George P Patrinos
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
- Zayed Center of Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- College of Medicine and Health Sciences, Department of Pathology, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Athanasios Tsakris
- Laboratory of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
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246
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Who Is Afraid of CRP? Elevated Preoperative CRP Levels Might Attenuate the Increase in Inflammatory Parameters in Response to Lung Cancer Surgery. J Clin Med 2020; 9:jcm9103340. [PMID: 33080990 PMCID: PMC7603240 DOI: 10.3390/jcm9103340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
During surgery, ATP from damaged cells induces the release of interleukin-1β, a potent pro-inflammatory cytokine that contributes to the development of postoperative systemic inflammation, sepsis and multi-organ damage. We recently demonstrated that C-reactive protein (CRP) inhibits the ATP-induced release of monocytic interleukin-1β, although high CRP levels are deemed to be a poor prognostic marker. Here, we retrospectively investigated if preoperative CRP levels correlate with postoperative CRP, leukocyte counts and fever in the context of anatomical lung resection and systematic lymph node dissection as first line lung cancer therapy. No correlation was found in the overall results. In men, however, preoperative CRP and leukocyte counts positively correlated on postoperative days one to two, and a negative correlation of CRP and fever was seen in women. These correlations were more pronounced in men taking statins and in statin-naïve women. Accordingly, the inhibitory effect of CRP on the ATP-induced interleukin-1β release was blunted in monocytes from coronary heart disease patients treated with atorvastatin compared to monocytes obtained before medication. Hence, the common notion that elevated CRP levels predict more severe postoperative inflammation should be questioned. We rather hypothesize that in women and statin-naïve patients, high CRP levels attenuate trauma-induced increases in inflammatory markers.
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247
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Bachmann MC, Bellalta S, Basoalto R, Gómez-Valenzuela F, Jalil Y, Lépez M, Matamoros A, von Bernhardi R. The Challenge by Multiple Environmental and Biological Factors Induce Inflammation in Aging: Their Role in the Promotion of Chronic Disease. Front Immunol 2020; 11:570083. [PMID: 33162985 PMCID: PMC7591463 DOI: 10.3389/fimmu.2020.570083] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022] Open
Abstract
The aging process is driven by multiple mechanisms that lead to changes in energy production, oxidative stress, homeostatic dysregulation and eventually to loss of functionality and increased disease susceptibility. Most aged individuals develop chronic low-grade inflammation, which is an important risk factor for morbidity, physical and cognitive impairment, frailty, and death. At any age, chronic inflammatory diseases are major causes of morbimortality, affecting up to 5-8% of the population of industrialized countries. Several environmental factors can play an important role for modifying the inflammatory state. Genetics accounts for only a small fraction of chronic-inflammatory diseases, whereas environmental factors appear to participate, either with a causative or a promotional role in 50% to 75% of patients. Several of those changes depend on epigenetic changes that will further modify the individual response to additional stimuli. The interaction between inflammation and the environment offers important insights on aging and health. These conditions, often depending on the individual's sex, appear to lead to decreased longevity and physical and cognitive decline. In addition to biological factors, the environment is also involved in the generation of psychological and social context leading to stress. Poor psychological environments and other sources of stress also result in increased inflammation. However, the mechanisms underlying the role of environmental and psychosocial factors and nutrition on the regulation of inflammation, and how the response elicited for those factors interact among them, are poorly understood. Whereas certain deleterious environmental factors result in the generation of oxidative stress driven by an increased production of reactive oxygen and nitrogen species, endoplasmic reticulum stress, and inflammation, other factors, including nutrition (polyunsaturated fatty acids) and behavioral factors (exercise) confer protection against inflammation, oxidative and endoplasmic reticulum stress, and thus ameliorate their deleterious effect. Here, we discuss processes and mechanisms of inflammation associated with environmental factors and behavior, their links to sex and gender, and their overall impact on aging.
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Affiliation(s)
| | - Sofía Bellalta
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roque Basoalto
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Yorschua Jalil
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Macarena Lépez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anibal Matamoros
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Institute of Biological Sciences (ICB), Federal University of Pará, Belem, Brazil
| | - Rommy von Bernhardi
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Wigén J, Löfdahl A, Bjermer L, Elowsson-Rendin L, Westergren-Thorsson G. Converging pathways in pulmonary fibrosis and Covid-19 - The fibrotic link to disease severity. RESPIRATORY MEDICINE: X 2020; 2:100023. [PMID: 33083782 PMCID: PMC7546672 DOI: 10.1016/j.yrmex.2020.100023] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/08/2023] Open
Abstract
As Covid-19 affects millions of people worldwide, the global health care will encounter an increasing burden of the aftermaths of the disease. Evidence shows that up to a fifth of the patients develop fibrotic tissue in the lung. The SARS outbreak in the early 2000 resulted in chronic pulmonary fibrosis in a subset (around 4%) of the patients, and correlated to reduced lung function and forced expiratory volume (FEV). The similarities between corona virus infections causing SARS and Covid-19 are striking, except that the novel coronavirus, SARS-CoV-2, has proven to have an even higher communicability. This would translate into a large number of patients seeking care for clinical signs of pulmonary fibrosis, given that the Covid-19 pandemic has up till now (Sept 2020) affected around 30 million people. The SARS-CoV-2 is dependent on binding to the angiotensin converting enzyme 2 (ACE2), which is part of the renin-angiotensin system (RAS). Downregulation of ACE2 upon virus binding disturbs downstream activities of RAS resulting in increased inflammation and development of fibrosis. The poor prognosis and risk of developing pulmonary fibrosis are therefore associated with the increased expression of ACE2 in risk groups, such as obesity, heart disorders and aging, conferring plenty of binding opportunity for the virus and subsequently the internalization of ACE2, thus devoiding the enzyme from acting counter-inflammatory and antifibrotic. Identifying pathways that are associated with Covid-19 severity that result in pulmonary fibrosis may enable early diagnosis and individualized treatment for these patients to prevent or reduce irreversible fibrotic damage to the lung. Covid-19 may lead to pulmonary fibrosis. Urgency to monitor severe cases of Covid-19 longitudinally post-infection. Convergent pathways in idiopathic pulmonary fibrosis and Covid-19. Antifibrotic treatment in Covid-19.
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Affiliation(s)
- Jenny Wigén
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Anna Löfdahl
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Leif Bjermer
- Department of Clinical Sciences, Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Linda Elowsson-Rendin
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
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Gabriele L, Fragale A, Romagnoli G, Parlato S, Lapenta C, Santini SM, Ozato K, Capone I. Type I IFN-dependent antibody response at the basis of sex dimorphism in the outcome of COVID-19. Cytokine Growth Factor Rev 2020; 58:66-74. [PMID: 33071044 PMCID: PMC7543933 DOI: 10.1016/j.cytogfr.2020.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, induces severe pneumonia mainly in elderly males. Epidemiological data clearly indicate sex-based differences in disease outcomes, with men accounting for about 70 % of deaths, despite similar susceptibility to infection. It is well known that females are endowed with higher capacity to produce antibodies, which correlates with viral clearance and disease resolution in the context of SARS-Cov-2 infection. Many X-linked immune genes escape X inactivation showing biallelic expression in female immune cells, particularly in plasmacytoid dendritic cells (pDCs). PDCs are more active in females and endowed with high capability to induce IFN-α-mediated B cell activation and differentiation into antibody-producing plasma cells throughout epigenetic mechanisms linked to trained immunity. Thus, we hypothesize that following SARS-CoV-2 infection, epigenetic modifications of X-linked genes involved in pDC-mediated type I IFN (IFN-I) signaling occurs more effectively in females, for inducing neutralizing antibody response as an immune correlate driving sex-biased disease outcome.
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Affiliation(s)
- Lucia Gabriele
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.
| | - Alessandra Fragale
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Giulia Romagnoli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Parlato
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Lapenta
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Maria Santini
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Keiko Ozato
- Division of Developmental Biology, National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Imerio Capone
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.
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Comparative Analysis of 95 Patients with Different Severity in the Early Outbreak of COVID-19 in Wuhan, China. ACTA ACUST UNITED AC 2020; 2020:4783062. [PMID: 33062082 PMCID: PMC7537711 DOI: 10.1155/2020/4783062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/13/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
Objective To explore the clinical characteristics of patients with different severity in the early outbreak of COVID-19, hoping to provide reference for clinical diagnosis and treatment. Methods We retrospectively analyzed the clinical data of 95 COVID-19 patients in Wuhan Red Cross Hospital of China from January 17 to February 13, 2020. All patients were investigated with epidemiological questionnaires. Outcomes were followed up until April 1, 2020. Results There were 53 males and 42 females, aged 22-84 years (mean 57.3 years). Clinical classification included 54 cases of common type, 27 cases of severe type, and 14 cases of critical type. Six patients had been exposed to the local Huanan seafood market. There were 38 clusters of COVID-19, including 27 family clusters and 11 work unit clusters. Common symptoms included fever (86 (90.5%) of 95), cough (73 (76.8%)), and fatigue (50 (52.6%)). Laboratory findings showed that the most common abnormalities were lymphopenia (75 (78.9%)), elevated D-dimer (60 (63.2%)), and elevated C-reactive protein (56 (58.9%)) on admission. All patients had abnormal chest computed tomography, showing patchy shadows or ground-glass opacities. Severe and critical cases were older, more likely to have shortness of breath, more likely to have underlying comorbidities, and more likely to have abnormal laboratory findings than common cases. The prognosis of patients with different degrees of severity was significantly different. All common and severe patients (100%) were cured and discharged from the hospital, while 10 (71.4%) of 14 critical patients died. Conclusions COVID-19 has fast transmission speed and high pathogenicity. We must assess the severity of the disease and take corresponding treatment measures as early as possible.
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