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Waris A, Din M, Iqbal N, Yar L, Khalid A, Nawaz M, Baset A, Ali M. Evaluation of serum procalcitonin level as a biomarker for disease severity in COVID-19 patients. New Microbes New Infect 2021; 43:100922. [PMID: 34336223 PMCID: PMC8302477 DOI: 10.1016/j.nmni.2021.100922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) has infected millions of individuals around the globe. Forecasting the COVID-19 severity is essential, and various biomarkers could be used to evaluate it. The current study was therefore aimed to evaluate the serum pro-calcitonin (PCT) level as a biomarker for bacterial co-infection and disease severity in COVID-19 patients. A total of 430 COVID-19 positive individuals were examined, in which 332 (77.2%) were male individuals while 98 (22.8%) were female individuals. Among the examined samples, 281 were classified as moderate (PCT value 0.07 ± 0.06 ng/mL), 95 were severe (PCT value 0.5 ± 0.4 ng/mL), and 54 were classified as critical (PCT value > 1 ng/mL) individuals. The increase in the total serum level of PCT was observed with the severity of the disease (p < 0.05). The statistical analysis represented no association of PCT value with gender (p 0.9650) while revealed a significant association (p < 0.001) with the age and PCT value in COVID-19 patients. It can be concluded that the serial PCT measurement could determine the prognosis of the disease and the presence of bacterial co-infection in COVID-19 patients. Further exploration of the topic is needed to evaluate the effect of different therapies on the PCT level and to prescribe specific treatment options for coinfection.
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Affiliation(s)
- A. Waris
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - M. Din
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - N. Iqbal
- Department of Statistics, Quaid-i-Azam University, Islamabad, Pakistan
| | - L. Yar
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - A. Khalid
- Sahiwal Medical College, University of Health Sciences, Lahore, Pakistan
| | - M. Nawaz
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - A. Baset
- Department of Zoology, Bacha Khan University, Charsadda, Pakistan
| | - M. Ali
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
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202
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Hossein Kazemi M, Kuhestani Dehaghi B, Roshandel E, Bonakchi H, Parkhideh S, Mehdizadeh M, Hajifathali A. Association of HScore Parameters with Severe COVID-19: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:322-338. [PMID: 34539007 PMCID: PMC8438337 DOI: 10.30476/ijms.2021.88404.1910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/20/2020] [Accepted: 01/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several reports have associated the severe Coronavirus disease-2019 (sCOVID-19) with secondary-hemophagocytic lymphohistiocytosis (sHLH) and proposed utilizing the hemophagocytic syndrome diagnostic score (HScore) for sCOVID-19 patients. We conducted a systematic review and meta-analysis to find the possible association of HScore parameters with severity in COVID-19 patients. METHODS A systematic search was performed in Medline via PubMed, EMBASE, and Cochrane databases using all HScore and COVID-19 keywords. The studies were all from 2020, and the study language was limited to English. The records were screened based on inclusion/exclusion criteria. Random/fixed-effect models were employed for meta-analysis, based on the I2 index of parameters. The pooled mean differences were estimated for continuous parameters. The pooled odds-ratio was estimated for fever. The level of significance was set at 0.05. RESULTS Eighteen studies (comprising 2459 patients) out of 26151 screened studies were included in this meta-analysis. The results showed that the level of leukocyte, neutrophil, aspartate transaminase (AST), ferritin, and fibrinogen were significantly higher in sCOVID-19 patients than in non-severe ones. Significant lower levels of lymphocyte, platelet, and hemoglobin were also found in sCOVID-19 patients than non-severe patients. Fever was nearly associated with two times increased odds of sCOVID-19 (P=0.051). CONCLUSION Lymphopenia, thrombocytopenia, hypohemoglobinemia, hyperferritinemia, high levels of AST, and fever are common features of both sCOVID-19 and HLH. However, the leukocytosis, neutrophilia, and hyperfibrinogenemia found in sCOVID-19 are in contrast with HScore. Conclusively, HScore parameters could be risk factors for sCOVID-19. However, some parameters' roles are contradictory, suggesting the need for further investigation and a new way of HScore interpretation in sCOVID-19 patients.A preprint of this study was published at https://www.researchsquare.com/article/rs-54490/v2.
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Affiliation(s)
- Mohammad Hossein Kazemi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Kuhestani Dehaghi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Roshandel
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Bonakchi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayeh Parkhideh
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Mehdizadeh
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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203
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The effect of COVID-19 positivity on inflammatory parameters and thirty day mortality rates in patients over sixty five years of age with surgically treated intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2021; 45:3025-3031. [PMID: 34471936 PMCID: PMC8409697 DOI: 10.1007/s00264-021-05201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/22/2021] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the effect of COVID-19 positivity on inflammatory parameters and 30-day mortality rates in patients over 65 years of age who were operated on for intertrochanteric femur fractures (IFF). Methods Eighty-seven patients (31 males, 56 females) who had a dynamic hip screw (DHS) or proximal femur nail (PFN) for the IFF between March 2020 and November 2020 were included in the study. The patients were divided into two groups as COVID-19 confirmed and probable positive (Group 1) and COVID-19 negative (Group 2). Time to surgery, operation duration, length of hospital stay, 30-day mortality, rates of the intensive care unit (ICU) referral, and inflammatory parameters such as haemoglobin, CRP, sedimentation, PCT, D-Dimer, and ferritin were evaluated. Results No significant difference was observed in terms of demographic data such as age, gender, comorbidity, and fracture type between the groups. Thirty-day mortality, ICU referral rate, blood transfusion rate, and hospitalization period were higher in Group 1 (p = 0.016, p = 0.012, p = 0.031, and p = 0.011, respectively). The inflammatory parameters were higher in Group 1 compared to Group 2 in the preoperative and postoperative periods (p < 0.05). Conclusion COVID-19 positivity increases inflammatory parameters (as expected) and increases the 30-day mortality and ICU requirement in patients with surgically treated IFF.
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204
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Ehlting C, Wolf SD, Bode JG. Acute-phase protein synthesis: a key feature of innate immune functions of the liver. Biol Chem 2021; 402:1129-1145. [PMID: 34323429 DOI: 10.1515/hsz-2021-0209] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023]
Abstract
The expression of acute-phase proteins (APP's) maintains homeostasis and tissue repair, but also represents a central component of the organism's defense strategy, especially in the context of innate immunity. Accordingly, an inflammatory response is accompanied by significant changes in the serum protein composition, an aspect that is also used diagnostically. As the main site of APP synthesis the liver is constantly exposed to antigens or pathogens via blood flow, but also to systemic inflammatory signals originating either from the splanchnic area or from the circulation. Under both homeostatic and acute-phase response (APR) conditions the composition of APP's is determined by the pattern of regulatory mediators derived from the systemic circulation or from local cell populations, especially liver macrophages. The key regulators mentioned here most frequently are IL-1β, IL-6 and TNF-α. In addition to a variety of molecular mediators described mainly on the basis of in vitro studies, recent data emphasize the in vivo relevance of cellular key effectors as well as molecular key mediators and protein modifications for the regulation and function of APP's. These are aspects, on which the present review is primarily focused.
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Affiliation(s)
- Christian Ehlting
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Hospital of the Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf, Germany
| | - Stephanie D Wolf
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Hospital of the Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf, Germany
| | - Johannes G Bode
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Hospital of the Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf, Germany
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205
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Dejani NN, Elshabrawy HA, Bezerra Filho CDSM, de Sousa DP. Anticoronavirus and Immunomodulatory Phenolic Compounds: Opportunities and Pharmacotherapeutic Perspectives. Biomolecules 2021; 11:biom11081254. [PMID: 34439920 PMCID: PMC8394099 DOI: 10.3390/biom11081254] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023] Open
Abstract
In 2019, COVID-19 emerged as a severe respiratory disease that is caused by the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The disease has been associated with high mortality rate, especially in patients with comorbidities such as diabetes, cardiovascular and kidney diseases. This could be attributed to dysregulated immune responses and severe systemic inflammation in COVID-19 patients. The use of effective antiviral drugs against SARS-CoV-2 and modulation of the immune responses could be a potential therapeutic strategy for COVID-19. Studies have shown that natural phenolic compounds have several pharmacological properties, including anticoronavirus and immunomodulatory activities. Therefore, this review discusses the dual action of these natural products from the perspective of applicability at COVID-19.
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Affiliation(s)
- Naiara Naiana Dejani
- Department of Physiology and Pathology, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
| | - Hatem A. Elshabrawy
- Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA;
| | - Carlos da Silva Maia Bezerra Filho
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-900, Brazil
| | - Damião Pergentino de Sousa
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-900, Brazil
- Correspondence: ; Tel.: +55-83-3216-7347
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206
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Bintoro SUY, Dwijayanti NMI, Pramudya D, Amrita PN, Romadhon PZ, Asmarawati TP, Bachtiar A, Hadi U. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res 2021; 10:791. [PMID: 34904053 PMCID: PMC8596187 DOI: 10.12688/f1000research.53803.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 04/05/2024] Open
Abstract
Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java. Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020. Result : Of 538 probable COVID-19 patients, 217 tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, were significantly different in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univatiate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality. Conclusion : This research shows that hematologic and coagulation parameters were increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly with increasing disease severity. Coronary heart disease is an independent predictor of mortality.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ni Made Intan Dwijayanti
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Dana Pramudya
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Putu Niken Amrita
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Tri Pudy Asmarawati
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Arief Bachtiar
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Department of Pulmonology and Respiratory Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Usman Hadi
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
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Bintoro SUY, Dwijayanti NMI, Pramudya D, Amrita PN, Romadhon PZ, Asmarawati TP, Bachtiar A, Hadi U. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res 2021; 10:791. [PMID: 34904053 PMCID: PMC8596187 DOI: 10.12688/f1000research.53803.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 04/05/2024] Open
Abstract
Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java. Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020. Result : Of 538 probable COVID-19 patients, 217 tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, were significantly different in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univatiate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality. Conclusion : This research shows that hematologic and coagulation parameters were increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly with increasing disease severity. Coronary heart disease is an independent predictor of mortality.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ni Made Intan Dwijayanti
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Dana Pramudya
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Putu Niken Amrita
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Tri Pudy Asmarawati
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Arief Bachtiar
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Department of Pulmonology and Respiratory Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Usman Hadi
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
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Bintoro SUY, Dwijayanti NMI, Pramudya D, Amrita PN, Romadhon PZ, Asmarawati TP, Bachtiar A, Hadi U. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res 2021; 10:791. [PMID: 34904053 PMCID: PMC8596187 DOI: 10.12688/f1000research.53803.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java. Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020. Result : Of 538 probable COVID-19 patients, 217 were tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, showed significantly different result in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univariate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality. Conclusion : This research shows that hematologic and coagulation parameters increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly as the disease gets more severe.. Coronary heart disease is an independent predictor of mortality.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ni Made Intan Dwijayanti
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Dana Pramudya
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Putu Niken Amrita
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Tri Pudy Asmarawati
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Arief Bachtiar
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Department of Pulmonology and Respiratory Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Usman Hadi
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
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209
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Khalid A, Ali Jaffar M, Khan T, Abbas Lail R, Ali S, Aktas G, Waris A, Javaid A, Ijaz N, Muhammad N. Hematological and biochemical parameters as diagnostic and prognostic markers in SARS-COV-2 infected patients of Pakistan: a retrospective comparative analysis. ACTA ACUST UNITED AC 2021; 26:529-542. [PMID: 34334100 DOI: 10.1080/16078454.2021.1950898] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: This study was conducted to investigate alteration in blood parameters and their association with the presence, severity, and mortality of COVID-19 patients as the data on hematological abnormalities associated with the Pakistani COVID-19 patients is limited.Methodology: A double-centered, hospital-based comparative retrospective case study was conducted, to include all the admitted patients (n = 317) having COVID-19 Polymerase chain reaction (PCR) positive. The control group (n = 157) tested negative for COVID-19.Results: Of 317 admitted cases, the majority were males n = 198 (62.5%). Associated comorbidities, lower lymphocytes, platelets, and higher White blood cells, neutrophil, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were found in COVID-19 cases as compared to healthy controls (p < 0.001 for all). The biochemical parameters of cases including Ferritin, D-Dimer, CRP, IL-6, LDH, ALT, AST, and APTT also showed a statistically significant difference compared with standard values (p < 0.001 for all). However, their comparison with a severity level of the severe and non-severe groups showed significance for WBCs, neutrophils, NLR (p < 0.001 for all), and PLR (p = 0.06) only. Receiver operating characteristic curve analysis showed that NLR had the highest area under curve (0.84) followed by 1/lymphocyte (0.82), neutrophils (0.74), PLR (0.67),1/platelets (0.68) and WBC's (0.65). Comparison of cases and controls with recommended cut-off values derived from sensitivity and 1-specificity was also done (p < 0.001).Conclusion: Monitoring all the hematological and biochemical parameters including novel hemograms NLR, PLR can aid clinicians to identify potentially severe cases at early stages and initiate effective management in time which may reduce the overall mortality of COVID-19 patients.
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Affiliation(s)
- Atiqa Khalid
- Department of Pathology, Sahiwal Medical College Sahiwal, affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Muhammad Ali Jaffar
- Department of Pathology, Sahiwal Medical College Sahiwal, affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Tabinda Khan
- Department of Pathology, Sahiwal Medical College Sahiwal, affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Raees Abbas Lail
- Department of Pathology, Sahiwal Medical College Sahiwal, affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Sana Ali
- Allama Iqbal Open University Islamabad, Islamabad, Pakistan
| | | | - Abdul Waris
- Quaid-e-Azam University Islamabad, Islamabad, Pakistan
| | - Amnah Javaid
- Department of Pathology, Sahiwal Medical College Sahiwal, affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Nouman Ijaz
- Department of Pathology, Sahiwal Medical College Sahiwal, affiliated with University of Health Sciences Lahore, Lahore, Pakistan
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Yonas E, Alwi I, Pranata R, Huang I, Lim MA, Gutierrez EJ, Yamin M, Siswanto BB, Virani SS. Effect of heart failure on the outcome of COVID-19 — A meta analysis and systematic review. Am J Emerg Med 2021; 46:204-211. [PMID: 33071085 PMCID: PMC7347316 DOI: 10.1016/j.ajem.2020.07.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background Several comorbidities have been associated with an increased risk of severity and mortality in coronavirus disease 2019 (COVID-19), including hypertension, diabetes, cerebrovascular disease, chronic kidney disease, and chronic obstructive pulmonary disease. Purpose In this systematic review and meta-analysis, we attempted to investigate the association between heart failure (HF) and poor outcome in patients with COVID-19. Methods We performed a systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and medRxiv with the search terms, “Heart failure” and “COVID-19”. The outcome of interest was mortality and poor prognosis (defined by incidence of severe COVID-19 infection, admission to ICU, and use of ventilator) in patients with preexisting heart failure with coronavirus disease. Results We identified 204 potential articles from our search, and 22 duplicates were removed. After screening of the titles and abstracts of the remaining 182 articles we identified 92 potentially relevant articles. We excluded 74 studies due to the following reasons: four studies were systematic reviews, two studies were meta-analyses, three articles were literature reviews, and 65 articles did not report on the outcome of interest. Finally, we included the remaining 18 studies in our qualitative synthesis and meta-analysis. There were 21,640 patients from 18 studies. HF was associated with hospitalization in COVID19 HR was 2.37 [1.48, 3.79; p < 0.001], high heterogeneity [I2, 82%; p < 0.001]. HF was associated with a poor outcome demonstrated by an OR of 2.86 [2.07; 3.95; p < 0.001] high heterogeneity [I2, 80%; p < 0.001]. Patient with preexisting HF was associated with higher mortality OR of 3.46 [2.52, 4.75; p < 0.001] moderately high heterogeneity [I2, 77%; p < 0.001]. Conclusion Patients with heart failure are at increased risk for hospitalization, poor outcome, and death from COVID-19. A significant difference in mortality between patients with and without heart failure was observed, patients with heart failure having a higher mortality.
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211
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Çolak Ş, Genç Yavuz B, Yavuz M, Özçelik B, Öner M, Özgültekin A, Şenbayrak S. Effectiveness of ozone therapy in addition to conventional treatment on mortality in patients with COVID-19. Int J Clin Pract 2021; 75:e14321. [PMID: 33971067 PMCID: PMC8236993 DOI: 10.1111/ijcp.14321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
AIM In this study, we aimed to investigate the effectiveness of ozone therapy, which is one of the integrative medicine applications that has been used safely for many years, on the prevalence of mortality in patients receiving COVID-19 treatment. METHODS This was a prospective, controlled study conducted on patients with COVID-19 who were hospitalised. In this study, 55 patients were included. The patients were divided into two groups as the ozone and control group. Ozone therapy (major autohemotherapy) was applied to 37 patients who were being treated with the appropriate COVID-19 treatment protocol determined by the infectious diseases committee of our hospital. The ozone treatment protocol consisted of seven sessions (one session per day) of intravenous ozone administration, applied in a volume of 100 mL and a concentration of 30 μg/mL. Only the conventional COVID-19 treatment protocol was applied to 18 patients in the control group. Clinical follow-up was performed until the discharge of the patients from the hospital with successful treatment or until the mortality occurred. Factors affecting mortality were analysed using univariate regression analysis. RESULTS Intensive care unit (ICU) hospitalisation was required in 6 of the 37 patients who were treated with ozone (16.2%), while 4 of 18 patients in the control group required ICU treatment (22.2%) (P = .713). When the mortality rates between the two groups were compared, mortality was lower in the ozone group (P = .032). As a result of univariate logistic regression analysis performed to investigate the factors affecting mortality, treatment with ozone therapy was determined as a risk factor for mortality. Patients receiving ozone therapy appear to have a lower mortality risk (odds ratio [OR]: 0.149, 95% confidence interval [CI] 0.026-0.863, P = .034). CONCLUSION In this study, the findings suggested that the administration of ozone therapy along with the conventional medical treatment in patients hospitalised for COVID-19 could reduce mortality.
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Affiliation(s)
- Şahin Çolak
- Haydarpaşa Numune Training and Research HospitalDepartment of Emergency MedicineUniversity of Health SciencesIstanbulTurkey
| | - Burcu Genç Yavuz
- Haydarpaşa Numune Training and Research HospitalDepartment of Emergency MedicineUniversity of Health SciencesIstanbulTurkey
| | - Mürsel Yavuz
- Kosuyolu Rezonans ClinicIntegrative MedicineIstanbulTurkey
| | - Burak Özçelik
- Haydarpaşa Numune Training and Research HospitalDepartment of Emergency MedicineUniversity of Health SciencesIstanbulTurkey
| | - Metin Öner
- Haydarpaşa Numune Training and Research HospitalDepartment of Emergency MedicineUniversity of Health SciencesIstanbulTurkey
| | - Asu Özgültekin
- Haydarpasa Numune Training and Research HospitalDepartment of Anesthesiology and Intensive CareUniversity of Health SciencesIstanbulTurkey
| | - Seniha Şenbayrak
- Haydarpasa Numune Training and Research HospitalDepartment of Infectious Disease and Clinical MicrobiologyUniversity of Health SciencesIstanbulTurkey
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Schouten J, De Waele J, Lanckohr C, Koulenti D, Haddad N, Rizk N, Sjövall F, Kanj SS. Antimicrobial stewardship in the ICU in COVID times: the known unknowns. Int J Antimicrob Agents 2021; 58:106409. [PMID: 34339777 PMCID: PMC8323503 DOI: 10.1016/j.ijantimicag.2021.106409] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
Since the start of the COVID-19 pandemic, there has been concern about the concomitant rise of antimicrobial resistance. While bacterial co-infections seem rare in COVID-19 patients admitted to hospital wards and intensive care units (ICUs), an increase in empirical antibiotic use has been described. In the ICU setting, where antibiotics are already abundantly—and often inappropriately—prescribed, the need for an ICU-specific antimicrobial stewardship programme is widely advocated. Apart from essentially warning against the use of antibacterial drugs for the treatment of a viral infection, other aspects of ICU antimicrobial stewardship need to be considered in view of the clinical course and characteristics of COVID-19. First, the distinction between infectious and non-infectious (inflammatory) causes of respiratory deterioration during an ICU stay is difficult, and the much-debated relevance of fungal and viral co-infections adds to the complexity of empirical antimicrobial prescribing. Biomarkers such as procalcitonin for the decision to start antibacterial therapy for ICU nosocomial infections seem to be more promising in COVID-19 than non-COVID-19 patients. In COVID-19 patients, cytomegalovirus reactivation is an important factor to consider when assessing patients infected with SARS-CoV-2 as it may have a role in modulating the patient immune response. The diagnosis of COVID-19-associated invasive aspergillosis is challenging because of the lack of sensitivity and specificity of the available tests. Furthermore, altered pharmacokinetic/pharmacodynamic properties need to be taken into account when prescribing antimicrobial therapy. Future research should now further explore the ‘known unknowns’, ideally with robust prospective study designs.
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Affiliation(s)
- Jeroen Schouten
- Department of Intensive care, Radboudumc, Nijmegen, The Netherlands.
| | - Jan De Waele
- Department of Intensive Care, UZ Gent, Gent, Belgium
| | - Christian Lanckohr
- Antibiotic Stewardship Team, Institut für Hygiene, Universitätsklinikum Münster, Germany
| | - Despoina Koulenti
- Critical Care Department, 'Attiko' University Hospital, Athens, Greece; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nisrine Haddad
- Division of Infectious Diseases, American University of Beirut Medical Center, Lebanon
| | - Nesrine Rizk
- Division of Infectious Diseases, American University of Beirut Medical Center, Lebanon
| | - Fredrik Sjövall
- Department of Intensive care, Skane University Hospital, Malmö, Sweden
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Lebanon
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213
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Clinical Mortality Review of COVID-19 Patients at Sukraraj Tropical and Infectious Disease Hospital, Nepal; A Retrospective Study. Trop Med Infect Dis 2021; 6:tropicalmed6030137. [PMID: 34287389 PMCID: PMC8293465 DOI: 10.3390/tropicalmed6030137] [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: 06/18/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17:1. Most were above 65 years of age (72%) and had two or more comorbidities (64%). The most common comorbidities among the patients who had died during hospital stay were hypertension (58%) followed by diabetes mellitus (50%) and chronic obstructive airway disease (24%). The median duration from the symptom onset to death was 18 days, ranged from the minimum of 2 days till maximum of 39 days. D-dimer was found to be >1 mg/L in 58% cases and ferritin was >500 ng/ml in 42% patients at presentation. A total of 42% patients had thrombocytopenia, 80% patients had lymphocytopenia and 60% had Neutrophil to Lymphocyte ratio >11.75 with the mean NLR of 18.38. Of total mortalities, 16% patients also showed microbiological evidence of secondary infection; Male gender, age more than 65 years, multiple comorbidities with lymphocytopenia, elevated Neutrophil lymphocyte ratio and elevated inflammatory markers were risk factors found in majority of mortalities in our study. These findings could be utilized for early triage and risk assessment in COVID-19 patients so that aggressive treatment strategies could be employed at the earliest to reduce mortalities due to COVID-19 in future.
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214
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Michailides C, Velissaris D. Common anti-oxidant vitamin C as an anti-infective agent with remedial role on SARS-CoV-2 infection. An update. Monaldi Arch Chest Dis 2021; 91. [PMID: 34284566 DOI: 10.4081/monaldi.2021.1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/26/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease -2019 (COVID-19) has led to a worldwide multifaceted crisis. The medical world agonizes to contend with the problem, but a string of tested medications has been proven unavailing. Vitamin C is well described as a salutary antioxidant and some trials conclude that it may be a potential antiviral drug. In high doses, Vitamin C can alternate crucial steps in the pathogenesis of sepsis and acute respiratory distress syndrome. This dynamic was the driving force behind trials around the world that tried immunonutrition as a weapon against clinical entities. We summarize the mechanisms of action of Vitamin C and its role against infections and the current literature referring to the potential role of Vitamin C in SARS-CoV-2 infection, also as a contingent treatment agent.
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215
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Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, Dileep P, Patel S, Shah M, Parikh T, Darji P, Patel A, Goswami G, Shah A, Shah S, Lathiya H, Shah M, Sharma P, Chopra S, Gupta A, Jain N, Khan E, Sharma VK, Sharma AK, Chan ACY, Ong JJY. Mucormycosis and COVID-19: An epidemic within a pandemic in India. Mycoses 2021; 64:1253-1260. [PMID: 34255907 PMCID: PMC8446956 DOI: 10.1111/myc.13353] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
Importance Coronavirus disease (COVID‐19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID‐19 infection. Methods This prospective, observational, multi‐centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID‐19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID‐19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded. Results Of the 2567 COVID‐19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID‐19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate‐to‐severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad‐spectrum antibiotics while most (n = 37, 78.7%) received at least one anti‐viral medication. Mean time elapsed from COVID‐19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre‐existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate‐to‐severe pneumonia, requiring oxygen supplementation and mechanical ventilation. Conclusions Mucormycosis can occur among COVID‐19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad‐spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high‐risk populations.
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Affiliation(s)
| | - Suktara Sharma
- Department of ENT, GCS Medical College, Ahmedabad, India
| | | | - Sanjay Sharma
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, India
| | - Amit Batra
- Department of Neurology, Max Hospital, New Delhi, India
| | | | | | | | | | | | | | - Amit Patel
- Zydus Hospital, Ahmedabad, Gujarat, India
| | | | - Anand Shah
- Zydus Hospital, Ahmedabad, Gujarat, India
| | | | - Harsh Lathiya
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, India
| | | | - Pranita Sharma
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, India
| | - Surabhi Chopra
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, India
| | - Ankur Gupta
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, India
| | - Neha Jain
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, India
| | - Erum Khan
- BJ Medical College and Civil Hospital, Ahmedabad, India
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Amanda C Y Chan
- Division of Neurology, Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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216
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Assimakopoulos SF, Markantes GK, Papageorgiou D, Mamali I, Markou KB, Marangos M, Michalaki MA. Low serum TSH in the acute phase of COVID-19 pneumonia: thyrotoxicosis or a face of "non-thyroidal illness syndrome"? Clin Chem Lab Med 2021; 59:e420-e423. [PMID: 34246200 DOI: 10.1515/cclm-2021-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Stelios F Assimakopoulos
- Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece.,Division of Infectious Diseases, University of Patras School of Health Sciences, Patras, Greece
| | - Georgios K Markantes
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Dimitris Papageorgiou
- Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Irene Mamali
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Kostas B Markou
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Markos Marangos
- Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece.,Division of Infectious Diseases, University of Patras School of Health Sciences, Patras, Greece
| | - Marina A Michalaki
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
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217
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Sarabia De Ardanaz L, Andreu-Ubero JM, Navidad-Fuentes M, Ferrer-González MÁ, Ruíz Del Valle V, Salcedo-Bellido I, Barrios-Rodríguez R, Cáliz-Cáliz R, Requena P. Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment. Front Pharmacol 2021; 12:620187. [PMID: 34276355 PMCID: PMC8281134 DOI: 10.3389/fphar.2021.620187] [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: 10/22/2020] [Accepted: 06/14/2021] [Indexed: 01/08/2023] Open
Abstract
Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23-5.64), age (HR 1.05; 95% CI 1.02-1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00-1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p = 0.013), troponin I (p = 0.013), C-reactive protein (p = 0.013), neutrophils (p = 0.024), and fewer platelets (p = 0.013) and lymphocytes (p = 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters.
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Affiliation(s)
| | - Jose M Andreu-Ubero
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Miriam Navidad-Fuentes
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Victor Ruíz Del Valle
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Inmaculada Salcedo-Bellido
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España.,Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España.,Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rafael Cáliz-Cáliz
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pilar Requena
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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218
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Zein AFMZ, Sulistiyana CS, Raffaelo WM, Pranata R. Ivermectin and mortality in patients with COVID-19: A systematic review, meta-analysis, and meta-regression of randomized controlled trials. Diabetes Metab Syndr 2021; 15:102186. [PMID: 34237554 PMCID: PMC8236126 DOI: 10.1016/j.dsx.2021.102186] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/08/2023]
Abstract
AIMS This systematic review and meta-analysis aims to investigate the effect of ivermectin on mortality in patients with COVID-19. METHODS A comprehensive systematic literature search was performed using PubMed, Scopus, Embase, and Clinicaltrials.gov from the inception of databases up until April 9, 2021. The intervention group was ivermectin and the control group was standard of care or placebo. The primary outcome was mortality reported as risk ratio (RR). RESULTS There were 9 RCTs comprising of 1788 patients included in this meta-analysis. Ivermectin was associated with decreased mortality (RR 0.39 [95% 0.20-0.74], p = 0.004; I2: 58.2%, p = 0.051). Subgroup analysis in patients with severe COVID-19 showed borderline statistical significance towards mortality reduction (RR 0.42 [95% 0.18-1.00], p = 0.052; I2: 68.3, p = 0.013). The benefit of ivermectin and mortality was reduced by hypertension (RR 1.08 [95% CI 1.03-1.13], p = 0.001); but was not influenced by age (p = 0.657), sex (p = 0.466), diabetes (p = 0.429). Sensitivity analysis using fixed-effect model showed that ivermectin decreased mortality in general (RR 0.43 [95% CI 0.29-0.62], p < 0.001) and severe COVID-19 subgroup (RR 0.48 [95% CI 0.32-0.72], p < 0.001). CONCLUSIONS Ivermectin was associated with decreased mortality in COVID-19 with a low certainty of evidence. Further adequately powered double-blinded placebo-controlled RCTs are required for definite conclusion.
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Affiliation(s)
- Ahmad Fariz Malvi Zamzam Zein
- Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati, Department of Internal Medicine, Waled General Hospital, Cirebon, Indonesia.
| | - Catur Setiya Sulistiyana
- Department of Medical Education, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia.
| | | | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
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Cobre ADF, Stremel DP, Noleto GR, Fachi MM, Surek M, Wiens A, Tonin FS, Pontarolo R. Diagnosis and prediction of COVID-19 severity: can biochemical tests and machine learning be used as prognostic indicators? Comput Biol Med 2021; 134:104531. [PMID: 34091385 PMCID: PMC8164361 DOI: 10.1016/j.compbiomed.2021.104531] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to implement and evaluate machine learning based-models to predict COVID-19' diagnosis and disease severity. METHODS COVID-19 test samples (positive or negative results) from patients who attended a single hospital were evaluated. Patients diagnosed with COVID-19 were categorised according to the severity of the disease. Data were submitted to exploratory analysis (principal component analysis, PCA) to detect outlier samples, recognise patterns, and identify important variables. Based on patients' laboratory tests results, machine learning models were implemented to predict disease positivity and severity. Artificial neural networks (ANN), decision trees (DT), partial least squares discriminant analysis (PLS-DA), and K nearest neighbour algorithm (KNN) models were used. The four models were validated based on the accuracy (area under the ROC curve). RESULTS The first subset of data had 5,643 patient samples (5,086 negatives and 557 positives for COVID-19). The second subset included 557 COVID-19 positive patients. The ANN, DT, PLS-DA, and KNN models allowed the classification of negative and positive samples with >84% accuracy. It was also possible to classify patients with severe and non-severe disease with an accuracy >86%. The following were associated with the prediction of COVID-19 diagnosis and severity: hyperferritinaemia, hypocalcaemia, pulmonary hypoxia, hypoxemia, metabolic and respiratory acidosis, low urinary pH, and high levels of lactate dehydrogenase. CONCLUSION Our analysis shows that all the models could assist in the diagnosis and prediction of COVID-19 severity.
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Affiliation(s)
| | - Dile Pontarolo Stremel
- Department of Forest Engineering and Technology, Universidade Federal Do Paraná, Curitiba, Brazil
| | | | - Mariana Millan Fachi
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Monica Surek
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Astrid Wiens
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil,Corresponding author
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220
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Primorac D, Stojanović Stipić S, Strbad M, Girandon L, Barlič A, Frankić M, Ivić I, Marasović Krstulović D, Jukić I, Halassy B, Hećimović A, Matišić V, Molnar V. Compassionate mesenchymal stem cell treatment in a severe COVID-19 patient: a case report. Croat Med J 2021; 62:288-296. [PMID: 34212566 PMCID: PMC8275939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/05/2021] [Indexed: 04/03/2024] Open
Abstract
COVID-19 presentations range from cold-like symptoms to severe symptoms with the development of acute respiratory distress syndrome (ARDS). We report on a severe COVID-19 patient who was mechanically ventilated and who developed ARDS and bacterial infection. Because of rapid clinical deterioration and the exhaustion of other treatment options, the family and attending physicians requested a compassionate use of adult allogeneic bone marrow-derived mesenchymal stem cells (MSC) in addition to commonly used immunosuppressive, antiviral, and supportive therapy. The clinical course is discussed thoroughly, with a special emphasis on the safety and effect of MSC therapy. Compassionate MSC treatment, given in three rounds, affected ARDS regression. The patient was discharged from the intensive care unit after 31 days and from hospital after 49 days in a good general condition. MSC treatment was not associated with any side effects and was well tolerated in a three-week period; therefore, it should be studied in larger trials and considered for compassionate use.
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Affiliation(s)
- Dragan Primorac
- Dragan Primorac, St. Catherine Specialty Hospital, Trpinjska 7, 10000 Zagreb, Croatia,
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The Clinical Significance of Procalcitonin Elevation in Patients over 75 Years Old Admitted for COVID-19 Pneumonia. Mediators Inflamm 2021; 2021:5593806. [PMID: 34326704 PMCID: PMC8245241 DOI: 10.1155/2021/5593806] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
Aim To investigate the clinical significance of procalcitonin (PCT) elevation on hospital admission for coronavirus disease-19 (COVID-19) and its association with mortality in oldest old patients (age > 75 years). Methods The clinical records of 1074 patients with chest high-resolution computed-tomography (HRCT) positive for interstitial pneumonia and symptoms compatible for COVID-19, hospitalized in medical wards during the first pandemic wave in a single academic center in Northern Italy, were retrospectively analyzed. All patients had serum PCT testing performed within six hours from admission. Information on COVID-19-related symptoms, comorbidities, drugs, autonomy in daily activities, respiratory exchanges, other routine lab tests, and outcomes were collected. Clinical characteristics were compared across different admission PCT levels and ages. The association of admission PCT with mortality was tested separately in participants aged > 75 and ≤75 years old by stepwise multivariate Cox regression model with forward selection. Results With increasing classes of PCT levels (<0.05, 0.05-0.49, 0.5-1.99, and ≥2 ng/ml), there was a significant trend (P < 0.0001) towards older age, male gender, wider extension of lung involvement on HRCT, worse respiratory exchanges, and several other laboratory abnormalities. Each incremental PCT class was associated with increased risk of hospital death at multivariate models in subjects older than 75 (hazard ratio for PCT ≥ 2 vs. <0.05 ng/ml: 30.629, 95% confidence interval 4.176-224.645, P = 0.001), but not in subjects aged 75 or younger. Conclusions In patients admitted for COVID-19, PCT elevation was associated with several clinical, radiological, and laboratory characteristics of disease severity. However, PCT elevation was strongly associated with hospital mortality only in oldest old subjects (age > 75).
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Wibowo A, Pranata R, Lim MA, Akbar MR, Martha JW. Endotheliopathy Marked by High von Willebrand Factor (vWF) Antigen in COVID-19 is Associated with Poor Outcome: A Systematic Review and Meta-analysis. Int J Infect Dis 2021; 117:267-273. [PMID: 34192577 PMCID: PMC8236128 DOI: 10.1016/j.ijid.2021.06.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background This systematic review and meta-analysis aimed to compare the levels of von Willebrand Factor (vWF) antigen in patients with coronavirus disease 2019 (COVID-19) with a poor outcome compared with those with a good outcome, and explored factors that may affect the difference in terms of vWF antigen between the two groups. Methods A comprehensive literature search of PubMed, Embase and Scopus databases was undertaken from inception until 7 April 2021. The primary outcome was poor outcome, which is a composite of mortality and severity of COVID-19. Results Ten studies including a total of 996 patients were included in this systematic review and meta-analysis. vWF antigen was higher in patients with poor outcomes [standardized mean difference (SMD) 0.84 [0.45–1.23], P<0.001; I2=87.3, P<0.001). For subgroup analysis on studies that reported the vWF antigen level as a percentage, the mean difference was 121.6 [(53.7–189.4), P<0.001; I2=92.0, P<0.001]. Meta-regression showed that the SMD between poor outcome and good outcome was affected by the platelet count (coefficient 0.0061, P=0.001), d-dimer level (coefficient 0.0007, P=0.026) and factor VIII level (coefficient 0.0057, P=0.031), but not by age (coefficient -0.0610, P=0.440), gender (coefficient 0.0135, P=0.698), obesity (coefficient 0.0282, P=0.666), hypertension (coefficient 0.0273, P=0.423), diabetes (coefficient 0.0317, P=0.398) or malignancy (coefficient 0.0487, P=0.608). Conclusion This meta-analysis showed that the level of vWF antigen was significantly higher in patients with COVID-19 with a poor outcome, signalling marked endotheliopathy. Meta-regression showed that the differences became larger as the platelet count, d-dimer level and factor VIII level increased.
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Affiliation(s)
- Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | | | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
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Rosati F, Muneretto C, Baudo M, D'Ancona G, Bichi S, Merlo M, Cuko B, Gerometta P, Grazioli V, Giroletti L, Di Bacco L, Repossini A, Benussi S. A multicentre roadmap to restart elective cardiac surgery after COVID-19 peak in an Italian epicenter. J Card Surg 2021; 36:3308-3316. [PMID: 34173273 PMCID: PMC9292840 DOI: 10.1111/jocs.15776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND During the Italian Phase-2 of the coronavirus pandemic, it was possible to restart elective surgeries. Because hospitals were still burdened with coronavirus disease 2019 (COVID-19) patients, it was focal to design a separate "clean path" for the surgical candidates and determine the possible effects of major surgery on previously infected patients. METHODS From May to July 2020 (postpandemic peak), 259 consecutive patients were scheduled for elective cardiac surgery in three different centers. Our original roadmap with four screening steps included: a short item questionnaire (STEP-1), nasopharyngeal swab (NP) (STEP-2), computed tomography (CT)-scan using COVID-19 reporting and data system (CO-RADS) scoring (STEP-3), and final NP swab before discharge (STEP-4). RESULTS Two patients (0.8%) resulted positive at STEP-2: one patient was discharged home for quarantine, the other performed a CT-scan (CO-RADS: <2), and underwent surgery for unstable angina. Chest-CT was positive in 6.3% (15/237) with mean CO-RADS of 2.93 ± 0.8. Mild-moderate lung inflammation (CO-RADS: 2-4) did not delay surgery. Perioperative mortality was 1.15% (3/259), and cumulative incidence of pulmonary complications was 14.6%. At multivariable analysis, only age and cardiopulmonary bypass (CPB) time were independently related to pulmonary complications composite outcome (age >75 years: odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.25-5.57; p = 0.011; CPB >90 min. OR: 4.3; 95% CI: 1.84-10.16; p = 0.001). At 30 days, no periprocedural contagion and rehospitalization for COVID-19 infections were reported. CONCLUSIONS Our structured roadmap supports the safe restarting of an elective cardiac surgery list after a peak of a still ongoing COVID-19 pandemic in an epicenter area. Mild to moderate CT residuals of coronavirus pneumonia do not justify elective cardiac surgery procrastination.
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Affiliation(s)
- Fabrizio Rosati
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Massimo Baudo
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe D'Ancona
- Department of Cardiovascular Research, Vivantes Klinikum Urban, Berlin, Germany
| | - Samuele Bichi
- Division of Cardiac Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Merlo
- Division of Cardiac Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Besart Cuko
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | - Laura Giroletti
- Division of Cardiac Surgery, Humanitas Gavazzeni, Bergamo, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Repossini
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Sun AM, Hoffman T, Luu BQ, Ashammakhi N, Li S. Application of lung microphysiological systems to COVID-19 modeling and drug discovery: a review. Biodes Manuf 2021; 4:757-775. [PMID: 34178414 PMCID: PMC8213042 DOI: 10.1007/s42242-021-00136-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
There is a pressing need for effective therapeutics for coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The process of drug development is a costly and meticulously paced process, where progress is often hindered by the failure of initially promising leads. To aid this challenge, in vitro human microphysiological systems need to be refined and adapted for mechanistic studies and drug screening, thereby saving valuable time and resources during a pandemic crisis. The SARS-CoV-2 virus attacks the lung, an organ where the unique three-dimensional (3D) structure of its functional units is critical for proper respiratory function. The in vitro lung models essentially recapitulate the distinct tissue structure and the dynamic mechanical and biological interactions between different cell types. Current model systems include Transwell, organoid and organ-on-a-chip or microphysiological systems (MPSs). We review models that have direct relevance toward modeling the pathology of COVID-19, including the processes of inflammation, edema, coagulation, as well as lung immune function. We also consider the practical issues that may influence the design and fabrication of MPS. The role of lung MPS is addressed in the context of multi-organ models, and it is discussed how high-throughput screening and artificial intelligence can be integrated with lung MPS to accelerate drug development for COVID-19 and other infectious diseases.
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Affiliation(s)
- Argus M. Sun
- Department of Bioengineering, Samueli School of Engineering, University of California - Los Angeles, 420 Westwood Plaza 5121 Engineering V University of California, Los Angeles, CA 90095-1600 USA
- UC San Diego Healthcare, UCSD, La Jolla, CA 92037 USA
| | - Tyler Hoffman
- Department of Bioengineering, Samueli School of Engineering, University of California - Los Angeles, 420 Westwood Plaza 5121 Engineering V University of California, Los Angeles, CA 90095-1600 USA
| | - Bao Q. Luu
- Pulmonary Diseases and Critical Care, Scripps Green Hospital, Scripps Health, La Jolla, CA 92037 USA
| | - Nureddin Ashammakhi
- Department of Bioengineering, Samueli School of Engineering, University of California - Los Angeles, 420 Westwood Plaza 5121 Engineering V University of California, Los Angeles, CA 90095-1600 USA
- Department of Biomedical Engineering, College of Engineering, Michigan State University, East Lansing, MI 48824 USA
| | - Song Li
- Department of Bioengineering, Samueli School of Engineering, University of California - Los Angeles, 420 Westwood Plaza 5121 Engineering V University of California, Los Angeles, CA 90095-1600 USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095 USA
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Saeed GA, Helali AAA, Shah A, Almazrouei S, Ahmed LA. Chest CT performance and features of COVID-19 in the region of Abu Dhabi, UAE: a single institute study. ACTA ACUST UNITED AC 2021; 4:248-256. [PMID: 34179688 PMCID: PMC8211305 DOI: 10.1007/s42058-021-00075-1] [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: 09/23/2020] [Revised: 04/14/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Abstract
Objective We aim to investigate high-resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test. Methods Data of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specificity of the CT scan were calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results. Results The typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans. The ground glass opacities were seen in 50/74 (89.3%) of the positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%. Using RT-PCR as a standard of reference, chest HRCT scan revealed a sensitivity of 68.8% and specificity of 70%. Conclusion The commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground-glass opacities. The performance of HRCT scan can vary depending on multiple factors.
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Affiliation(s)
| | | | - Asad Shah
- General Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | | | - Luai A Ahmed
- Institute of Public Health, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
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Nizami DJ, Raman V, Paulose L, Hazari KS, Mallick AK. Role of laboratory biomarkers in assessing the severity of COVID-19 disease. A cross-sectional study. J Family Med Prim Care 2021; 10:2209-2215. [PMID: 34322414 PMCID: PMC8284239 DOI: 10.4103/jfmpc.jfmpc_145_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/17/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Corona virus disease 2019 (Covid-19) has high infectivity and mortality rate. Covid-19 patients can suddenly deteriorate and develop life threatening complications. Hence, there is a need to identify laboratory biomarkers in order to categorize high risk patients. The main purpose of the study is to investigate the role and correlation of laboratory parameters such as total leucocyte count (TLC), absolute lymphocyte count, platelet count, C-Reactive Proteins (CRP), serum ferritin, serum lactate dehydrogenase (LDH), serum procalcitonin and D-dimer in severe and non-severe Covid-19 patients. METHODOLOGY This retrospective cross-sectional study was conducted at Latifa Women and Child Hospital in the UAE after obtaining ethical committee clearance. Based on the symptoms and the criteria by National Institute of Health, USA, 109 patients were divided into three groups: Non-severe with 75, severe with 18 and critical with 16 patients. Laboratory data of these patients were assessed through the electronic medical records (SALAMA). Statistical analysis was done using Statistical Packages for Social Sciences (SPSS) version 25.0 (SPSS/PC; SPSS-25.0, Chicago, USA). Laboratory test profiles were expressed as mean (SD). Independent 't' test and ANOVA were used to study the significance of means. P value less than 0.05 was considered significant. RESULT Males were more severely affected than females. Severe and critically ill Covid-19 patients had a significantly higher TLC, serum LDH, ferritin and CRP and lower absolute lymphocyte count. PCT and D-dimer were significantly elevated in critical group. CONCLUSION Along with clinical presentation and radiological findings, biochemical parameter may also be considered as important predictors for assessing severity in covid-19 patients.
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Affiliation(s)
- Deba J. Nizami
- Department of Obstetrics and Gynecology, Latifa Hospital, Dubai Health Authority, Dubai, UAE
| | - Vidya Raman
- Department of Obstetrics and Gynecology, Latifa Hospital, Dubai Health Authority, Dubai, UAE
| | - L. Paulose
- Department of Obstetrics and Gynecology, Latifa Hospital, Dubai Health Authority, Dubai, UAE
| | - Komal S. Hazari
- Department of Obstetrics and Gynecology, Latifa Hospital, Dubai Health Authority, Dubai, UAE
| | - Ayaz K. Mallick
- Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
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Lukito AA, Widysanto A, Lemuel TAY, Prasetya IB, Massie B, Yuniarti M, Lumbuun N, Pranata R, Meidy C, Wahjoepramono EJ, Yusuf I. Candesartan as a tentative treatment for COVID-19: A prospective non-randomized open-label study. Int J Infect Dis 2021; 108:159-166. [PMID: 34038766 PMCID: PMC8142270 DOI: 10.1016/j.ijid.2021.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aimed to investigate whether the addition of candesartan to the standard care regimen improved the outcome in patients with coronavirus 2019 (COVID-19). METHODS A prospective non-randomized open-label study was undertaken from May to August 2020 on 75 subjects (aged 18-70 years) hospitalized in Siloam Kelapa Dua Hospital. Uni- and multi-variable Cox regression analyses were performed to obtain hazard ratios (HRs). The primary outcomes were: (1) length of hospital stay; (2) time to negative swab; and (3) radiological outcome (time to improvement on chest X ray). RESULTS None of the 75 patients with COVID-19 required intensive care. All patients were angiotensin-receptor-blocker naïve. In comparison with the control group, the candesartan group had a significantly shorter hospital stay [adjusted HR 2.47, 95% confidence interval (CI) 1.16-5.29] after adjusting for a wide range of confounders, and no increased risk of intensive care. In the non-obese subgroup, the candesartan group had a shorter time to negative swab (unadjusted HR 2.11, 95% CI 1.02-4.36; adjusted HR 2.40, 95% CI 1.08-5.09) and shorter time to improvement in chest x ray (adjusted HR 2.82, 95% CI 1.13-7.03) compared with the control group. CONCLUSION Candesartan significantly reduces the length of hospital stay after adjustment for covariates. All primary outcomes improved significantly in the non-obese subgroup receiving candesartan.
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Affiliation(s)
- Antonia Anna Lukito
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia; Mochtar Riady Institute of Nanotechnology, Tangerang, Indonesia.
| | - Allen Widysanto
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | - Theo Audi Yanto Lemuel
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | - Ignatius Bima Prasetya
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | - Billy Massie
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | - Mira Yuniarti
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | | | - Raymond Pranata
- Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | - Cindy Meidy
- Pelita Harapan University, Tangerang, Indonesia
| | - Eka Julianta Wahjoepramono
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Siloam Hospitals, Tangerang, Indonesia
| | - Irawan Yusuf
- Medical Science Group Team, Tangerang, Indonesia; Pelita Harapan University, Tangerang, Indonesia; Mochtar Riady Institute of Nanotechnology, Tangerang, Indonesia
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Impact of tocilizumab on clinical outcomes in severe covid-19 patients and risk of secondary infection: A case-control study. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.942700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Martha JW, Pranata R, Lim MA, Wibowo A, Akbar MR. Active prescription of low-dose aspirin during or prior to hospitalization and mortality in COVID-19: A systematic review and meta-analysis of adjusted effect estimates. Int J Infect Dis 2021; 108:6-12. [PMID: 34000418 PMCID: PMC8123385 DOI: 10.1016/j.ijid.2021.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Background This study aimed to investigate whether the active prescription of low-dose aspirin during or prior to hospitalization affects mortality in patients with coronavirus disease 2019 (COVID-19). Aspirin is often prescribed for secondary prevention in patients with cardiovascular disease and other comorbidities that might increase mortality, and may therefore falsely demonstrate increased mortality. To reduce bias, only studies that performed an adjusted analysis were included in this review. Methods A systematic literature search of PubMed, Scopus, Embase and Clinicaltrials.gov was performed, from inception until 16 April 2021. The exposure was active prescription of low-dose aspirin during or prior to hospitalization. The primary outcome was mortality. The pooled adjusted effect estimate was reported as relative risk (RR). Results Six eligible studies were included in this meta-analysis, comprising 13,993 patients. The studies had low-to-moderate risk of bias based on the Newcastle–Ottawa Scale. The meta-analysis indicated that the use of low-dose aspirin was independently associated with reduced mortality {RR 0.46 [95% confidence interval (CI) 0.35–0.61], P < 0.001; I2 = 36.2%}. Subgroup analysis on in-hospital low-dose aspirin administration also showed a significant reduction in mortality [RR 0.39 (95% CI 0.16–0.96), P < 0.001; I2 = 47.0%]. Conclusion Use of low-dose aspirin is independently associated with reduced mortality in patients with COVID-19, with low certainty of evidence.
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Affiliation(s)
- Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | | | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
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Petrillo M, Brogna C, Cristoni S, Querci M, Piazza O, Van den Eede G. Increase of SARS-CoV-2 RNA load in faecal samples prompts for rethinking of SARS-CoV-2 biology and COVID-19 epidemiology. F1000Res 2021; 10:370. [PMID: 34336189 PMCID: PMC8283343 DOI: 10.12688/f1000research.52540.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 08/11/2023] Open
Abstract
Background Scientific evidence for the involvement of human microbiota in the development of COVID-19 disease has been reported recently. SARS-CoV-2 RNA presence in human faecal samples and SARS-CoV-2 activity in faeces from COVID-19 patients have been observed. Methods Starting from these observations, an experimental design was developed to cultivate in vitro faecal microbiota from infected individuals, to monitor the presence of SARS-CoV-2, and to collect data on the relationship between faecal bacteria and the virus. Results Our results indicate that SARS-CoV-2 replicates in vitro in bacterial growth medium, that the viral replication follows bacterial growth and it is influenced by the administration of specific antibiotics. SARS-CoV-2-related peptides have been detected in 30-day bacterial cultures and characterised. Discussion Our observations are compatible with a 'bacteriophage-like' behaviour of SARS-CoV-2, which, to our knowledge has not been observed or described before. These results are unexpected and hint towards a novel hypothesis on the biology of SARS-CoV-2 and on the COVID-19 epidemiology. The discovery of possible new modes of action of SARS-CoV-2 has far-reaching implications for the prevention and the treatment of the disease.
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Affiliation(s)
- Mauro Petrillo
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | | | | | - Ornella Piazza
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Guy Van den Eede
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- European Commission, Joint Research Centre (JRC), Geel, Belgium
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Petrillo M, Brogna C, Cristoni S, Querci M, Piazza O, Van den Eede G. Increase of SARS-CoV-2 RNA load in faecal samples prompts for rethinking of SARS-CoV-2 biology and COVID-19 epidemiology. F1000Res 2021; 10:370. [PMID: 34336189 PMCID: PMC8283343 DOI: 10.12688/f1000research.52540.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/08/2023] Open
Abstract
Background Scientific evidence for the involvement of human microbiota in the development of COVID-19 disease has been reported recently. SARS-CoV-2 RNA presence in human faecal samples and SARS-CoV-2 activity in faeces from COVID-19 patients have been observed. Methods Starting from these observations, an experimental design was developed to cultivate in vitro faecal microbiota from infected individuals, to monitor the presence of SARS-CoV-2, and to collect data on the relationship between faecal bacteria and the virus. Results Our results indicate that SARS-CoV-2 replicates in vitro in bacterial growth medium, that the viral replication follows bacterial growth and it is influenced by the administration of specific antibiotics. SARS-CoV-2-related peptides have been detected in 30-day bacterial cultures and characterised. Discussion Our observations are compatible with a 'bacteriophage-like' behaviour of SARS-CoV-2, which, to our knowledge has not been observed or described before. These results are unexpected and hint towards a novel hypothesis on the biology of SARS-CoV-2 and on the COVID-19 epidemiology. The discovery of possible new modes of action of SARS-CoV-2 has far-reaching implications for the prevention and the treatment of the disease.
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Affiliation(s)
- Mauro Petrillo
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | | | | | - Ornella Piazza
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Guy Van den Eede
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- European Commission, Joint Research Centre (JRC), Geel, Belgium
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Petrillo M, Brogna C, Cristoni S, Querci M, Piazza O, Van den Eede G. Increase of SARS-CoV-2 RNA load in faecal samples prompts for rethinking of SARS-CoV-2 biology and COVID-19 epidemiology. F1000Res 2021; 10:370. [PMID: 34336189 PMCID: PMC8283343 DOI: 10.12688/f1000research.52540.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 04/04/2024] Open
Abstract
Background Scientific evidence for the involvement of human microbiota in the development of COVID-19 disease has been reported recently. SARS-CoV-2 RNA presence in human faecal samples and SARS-CoV-2 activity in faeces from COVID-19 patients have been observed. Methods Starting from these observations, an experimental design was developed to cultivate in vitro faecal microbiota from infected individuals, to monitor the presence of SARS-CoV-2, and to collect data on the relationship between faecal bacteria and the virus. Results Our results indicate that SARS-CoV-2 replicates in vitro in bacterial growth medium, that the viral replication follows bacterial growth and it is influenced by the administration of specific antibiotics. SARS-CoV-2-related peptides have been detected in 30-day bacterial cultures and characterised. Discussion Our observations are compatible with a 'bacteriophage-like' behaviour of SARS-CoV-2, which, to our knowledge has not been observed or described before. These results are unexpected and hint towards a novel hypothesis on the biology of SARS-CoV-2 and on the COVID-19 epidemiology. The discovery of possible new modes of action of SARS-CoV-2 has far-reaching implications for the prevention and the treatment of the disease.
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Affiliation(s)
- Mauro Petrillo
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | | | | | - Ornella Piazza
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Guy Van den Eede
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- European Commission, Joint Research Centre (JRC), Geel, Belgium
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Napodano C, Callà C, Fiorita A, Marino M, Taddei E, Di Cesare T, Passali GC, Di Santo R, Stefanile A, Fantoni M, Urbani A, Paludetti G, Rapaccini GL, Ciasca G, Basile U. Salivary Biomarkers in COVID-19 Patients: Towards a Wide-Scale Test for Monitoring Disease Activity. J Pers Med 2021; 11:jpm11050385. [PMID: 34066701 PMCID: PMC8151878 DOI: 10.3390/jpm11050385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 01/08/2023] Open
Abstract
The ongoing outbreak of coronavirus disease 2019 (COVID-19), which impairs the functionality of several organs, represents a major threat to human health. One of the hardest challenges in the fight against COVID-19 is the development of wide-scale, effective, and rapid laboratory tests to control disease severity, progression, and possible sudden worsening. Monitoring patients in real-time is highly demanded in this pandemic era when physicians need reliable and quantitative tools to prioritize patients’ access to intensive care departments. In this regard, salivary biomarkers are extremely promising, as they allow for the fast and non-invasive collection of specimens and can be repeated multiple times. Methods: We compare salivary levels of immunoglobulin A subclasses (IgA1 and IgA2) and free light chains (kFLC and λFLC) in a cohort of 29 SARS-CoV-2 patients and 21 healthy subjects. Results: We found that each biomarker differs significantly between the two groups, with p-values ranging from 10−8 to 10−4. A Receiving Operator Curve analysis shows that λFLC level is the best-suited candidate to discriminate the two groups (AUC = 0.96), with an accuracy of 0.94 (0.87–1.00 95% CI), a precision of 0.91 (0.81–1.00 95% CI), a sensitivity of 1.00 (0.96–1.00 95% CI), and a specificity of 0.86 (0.70–1.00 95% CI). Conclusion: These results suggest λFLC as an ideal indicator of patient conditions. This hypothesis is strengthened by the consideration that the λFLC half-life (approximately 6 h) is significantly shorter than the IgA one (21 days), thus confirming the potential of λFLC for effectively monitoring patients’ fluctuation in real-time.
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Affiliation(s)
- Cecilia Napodano
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.N.); (G.L.R.)
| | - Cinzia Callà
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
| | - Antonella Fiorita
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Eleonora Taddei
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.T.); (M.F.)
| | - Tiziana Di Cesare
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Giulio Cesare Passali
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Riccardo Di Santo
- Dipartimento di Neuroscienze, Sezione di Fisica, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.D.S.); (G.C.)
| | - Annunziata Stefanile
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.T.); (M.F.)
| | - Andrea Urbani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
| | - Gaetano Paludetti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Gian Ludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.N.); (G.L.R.)
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.D.S.); (G.C.)
| | - Umberto Basile
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
- Correspondence:
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Bai G, Furushima D, Niki T, Matsuba T, Maeda Y, Takahashi A, Hattori T, Ashino Y. High Levels of the Cleaved Form of Galectin-9 and Osteopontin in the Plasma Are Associated with Inflammatory Markers That Reflect the Severity of COVID-19 Pneumonia. Int J Mol Sci 2021; 22:ijms22094978. [PMID: 34067072 PMCID: PMC8125627 DOI: 10.3390/ijms22094978] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
Numbers of patients with coronavirus disease 2019 (COVID-19) have increased rapidly worldwide. Plasma levels of full-length galectin-9 (FL-Gal9) and osteopontin (FL-OPN) as well as their truncated forms (Tr-Gal9, Ud-OPN, respectively), are representative inflammatory biomarkers. Here, we measured FL-Gal9, FL-OPN, Tr-Gal9, and Ud-OPN in 94 plasma samples obtained from 23 COVID-19-infected patients with mild clinical symptoms (CV), 25 COVID-19 patients associated with pneumonia (CP), and 14 patients with bacterial infection (ID). The four proteins were significantly elevated in the CP group when compared with healthy individuals. ROC analysis between the CV and CP groups showed that C-reactive protein had the highest ability to differentiate, followed by Tr-Gal9 and ferritin. Spearman's correlation analysis showed that Tr-Gal9 and Ud-OPN but not FL-Gal9 and FL-OPN, had a significant association with laboratory markers for lung function, inflammation, coagulopathy, and kidney function in CP patients. CP patients treated with tocilizumab had reduced levels of FL-Gal9, Tr-Gal9, and Ud-OPN. It was suggested that OPN is cleaved by interleukin-6-dependent proteases. These findings suggest that the cleaved forms of OPN and galectin-9 can be used to monitor the severity of pathological inflammation and the therapeutic effects of tocilizumab in CP patients.
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Affiliation(s)
- Gaowa Bai
- Research Institute of Health and Welfare, Kibi International University, Takahashi 716-8508, Japan; (G.B.); (A.T.)
| | - Daisuke Furushima
- Department of Drug Evaluation and Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka 422-8526, Japan;
| | - Toshiro Niki
- Department of Immunology, Kagawa University, Kagawa 761-0793, Japan;
| | - Takashi Matsuba
- Department of Microbiology and Immunology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan;
- Department of Animal Pharmaceutical Science, School of Pharmaceutical Science, Kyusyu University of Health and Welfare, Nobeoka, Miyazaki 882-8508, Japan
| | - Yosuke Maeda
- Viral Section, Department of Microbiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan;
| | - Atsushi Takahashi
- Research Institute of Health and Welfare, Kibi International University, Takahashi 716-8508, Japan; (G.B.); (A.T.)
| | - Toshio Hattori
- Research Institute of Health and Welfare, Kibi International University, Takahashi 716-8508, Japan; (G.B.); (A.T.)
- Correspondence: (T.H.); (Y.A.); Tel.: +81-866-22-9469 (T.H.); +81-22-308-7111 (Y.A.); Fax: +81-866-22-9469 (T.H.); +81-22-308-9921 (Y.A.)
| | - Yugo Ashino
- Department of Respiratory Medicine, Sendai City Hospital, Miyagi 982-8502, Japan
- Correspondence: (T.H.); (Y.A.); Tel.: +81-866-22-9469 (T.H.); +81-22-308-7111 (Y.A.); Fax: +81-866-22-9469 (T.H.); +81-22-308-9921 (Y.A.)
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Wijaya I, Andhika R, Huang I, Purwiga A, Budiman KY, Bashari MH, Reniarti L, Roesli RMA. The use of Janus Kinase inhibitors in hospitalized patients with COVID-19: Systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100755. [PMID: 33969237 PMCID: PMC8088409 DOI: 10.1016/j.cegh.2021.100755] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background The evidence of using JAK inhibitors among hospitalized patients with COVID-19 is conflicting. The systematic review and meta-analysis aimed to address the efficacy of Janus Kinase (JAK) Inhibitors in reducing risk of mortality among hospitalized patients with COVID-19. Methods Several electronic databases, including PubMed, EuropePMC, and the Cochrane Central Register of Controlled Trials, with relevant keywords "COVID-19″ AND ("JAK inhibitor" OR "Ruxolitinib" OR "Tofacitinib" OR "Fedratinib" OR "Baricitinib") AND ("Severe" OR "Mortality"), were used to perform a systematic literature search up to December 11, 2020. All studies pertinent to the predetermined eligibility criteria were included in the analysis. Our outcome of interest was all types of mortality, clinical improvement, and clinical deterioration. Dichotomous variables of our outcomes of interest were analyzed using Maentel-Haenszel formula to obtain odds ratios (ORs) and 95% confidence intervals (CI) with random-effects modeling regardless of heterogeneity. Results Five studies with a total of 1190 patients and were included in this systematic review and meta-analysis. The use of JAK inhibitors was associated with a reduced risk of mortality (OR 0.51, 95% CI 0.28-0.93, P = 0.02; I2: 7.8%, P = 0.354) and clinical improvement (OR 1.76, 95% CI 1.05-2.95, P = 0.032; I2: 26.4%, P = 0.253). The use of JAK inhibitors was not associated with a reduced risk of clinical deterioration (OR 0.58, 95% CI 0.28-1.19, P = 0.136; I2: 24.1%, P = 0.267). Conclusion The use of JAK inhibitors was significantly associated with a reduced risk of mortality, and clinical improvement in hospitalized patients with COVID-19.
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Affiliation(s)
- Indra Wijaya
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Rizky Andhika
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ian Huang
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Aga Purwiga
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Kevin Yonatan Budiman
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Muhammad Hasan Bashari
- Department Biomedical Sciences, Division of Pharmacology and Therapy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Lelani Reniarti
- Department of Pediatrics, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rully Marsis Amirullah Roesli
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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Rakhmat II, Kusmala YY, Handayani DR, Juliastuti H, Nawangsih EN, Wibowo A, Lim MA, Pranata R. Dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in coronavirus disease 2019 (COVID-19) - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr 2021; 15:777-782. [PMID: 33838614 PMCID: PMC8012165 DOI: 10.1016/j.dsx.2021.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS This study aims to synthesize evidence on dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in COVID-19 patients and factors affecting it. METHODS We performed a systematic literature search from PubMed, Scopus, and Embase databases from inception of databases up until 7 March 2021. Studies that met all of the following criteria were included: 1) observational studies or randomized controlled trials that report COVID-19 patients, 2) reporting DPP-4 inhibitor use, 3) mortality, and 4) mortality based on DPP-4 inhibitor use. The exposure was DPP-4 inhibitor, defined as DPP-4 inhibitor use that started prior to COVID-19 hospitalization. The control group was patients with no exposure to DPP-4 inhibitor. The outcome was mortality. The pooled effect estimate was reported as risk ratio (RR). RESULTS There were 4,477 patients from 9 studies in this systematic review and meta-analysis. 31% of (15%, 46%) the patients use DPP-4 inhibitor. Mortality occurs in 23% (15%, 31%) of the patients. DPP-4 inhibitor was associated with lower mortality in patients with COVID-19 (RR 0.76 [0.60, 0.97], p = 0.030, I2: 44.5%, p = 0.072). Meta-regression analysis showed that the association between DPP-4 inhibitor and mortality was significantly affected by metformin (RR 1.02 [1.00, 1.04], p = 0.048) and angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) use (RR 1.04 [1.01, 1.07], p = 0.006), but not age (p = 0.759), sex (reference: male, p = 0.148), and hypertension (p = 0.218). CONCLUSION DPP-4 inhibitor use was associated with lower mortality in COVID-19 patients, and the association was weaker in patients who were also taking metformin and/or ACE inhibitors.
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Affiliation(s)
- Iis Inayati Rakhmat
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Yudith Yunia Kusmala
- Department of Internal Medicine, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Dewi Ratih Handayani
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Henny Juliastuti
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Eka Noneng Nawangsih
- Department of Microbiology, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | | | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
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GENÇ AB, YAYLACI S, DHEİR H, GENÇ AC, İŞSEVER1 K, ÇEKİÇ1 D, KOCAYİĞİT H, ÇOKLUK E, KARACAN A, ŞEKEROĞLU MR, TOPTAN ÇAKAR H, GÜÇLÜ5 E. The predictive and diagnostic accuracy of long pentraxin-3 in COVID-19 pneumonia. Turk J Med Sci 2021; 51:448-453. [PMID: 33315349 PMCID: PMC8219078 DOI: 10.3906/sag-2011-32] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background/aim The purpose of this study is to evaluate serum pentraxin-3 (PTX-3) levels in Sars-CoV-2 virus infection (COVID-19) patients and to investigate whether PTX-3 predicts the disease prognosis. Materials and methods This study was conducted on 88 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia between April 15 and August 15, 2020. The patients were divided into two groups as survived patients and non-survived patients. Both groups were compared according to demographic features, comorbid conditions and measurement of the PTX-3 and other laboratory parameters of the patients. Results Of 88 patients with COVID-19, 59 (67%) were discharged with complete cure and 29 (33%) resulted in death. 46 (52.3%) of the patients were men. PTX-3 median value (IQR) was 3.66 ng/mL (0.9–27.9) in all patients, 3.3 ng/mL (0.9–27.9) in survivors and 3.91 ng/mL (1.9–23.2) in nonsurvivors which was significantly higher (P = 0.045). As a receiver operating characteristic curve analysis the cut-off value of PTX-3 for predicting mortality in patients was 3.73 with 65% sensitivity and 65% specificity (AUC: 0.646, 95% CI: 0.525– 0.767, P = 0.045). Also, we found significant cut-off values with respect to D-dimer, D-dimer/PTX-3, high-sensitivity troponin, high- sensitivity troponin/PTX-3, lymphocyte, PTX-3/lymphocyte, procalcitonin, procalcitonin/PTX-3, CRP, and CRP/PTX-3 (P < 0.05). Conclusion In this study, as far as we know, for the first time, we have shown PTX-3 as the new mortality biomarker for COVID-19 disease.
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Affiliation(s)
- Ahmed Bilal GENÇ
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Selçuk YAYLACI
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Hamad DHEİR
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Ahmed Cihad GENÇ
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Kubilay İŞSEVER1
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Deniz ÇEKİÇ1
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Havva KOCAYİĞİT
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Erdem ÇOKLUK
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Alper KARACAN
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | | | - Hande TOPTAN ÇAKAR
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Ertuğrul GÜÇLÜ5
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
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Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y. Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications. World J Gastroenterol 2021; 27:1716-1727. [PMID: 33967552 PMCID: PMC8072196 DOI: 10.3748/wjg.v27.i16.1716] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
- Department of Microbiology, Royal College of Surgeons in Ireland - Bahrain, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Yasser El-Sawaf
- Department of Tropical Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Gastroenterology, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
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Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y. Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications. World J Gastroenterol 2021. [PMID: 33967552 DOI: 10.3748/wjg.v27.i16.1716.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
| | - Nermin Kamal Saeed
- Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Tanta University, Tanta 31527, Algharbia, Egypt
| | - Yasser El-Sawaf
- Department of Tropical Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
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Kokturk N, Babayigit C, Kul S, Duru Cetinkaya P, Atis Nayci S, Argun Baris S, Karcioglu O, Aysert P, Irmak I, Akbas Yuksel A, Sekibag Y, Baydar Toprak O, Azak E, Mulamahmutoglu S, Cuhadaroglu C, Demirel A, Kerget B, Baran Ketencioglu B, Ozger HS, Ozkan G, Ture Z, Ergan B, Avkan Oguz V, Kilinc O, Ercelik M, Ulukavak Ciftci T, Alici O, Nurlu Temel E, Ataoglu O, Aydin A, Cetiner Bahcetepe D, Gullu YT, Fakili F, Deveci F, Kose N, Tor MM, Gunluoglu G, Altin S, Turgut T, Tuna T, Ozturk O, Dikensoy O, Yildiz Gulhan P, Basyigit I, Boyaci H, Oguzulgen IK, Borekci S, Gemicioglu B, Bayraktar F, Elbek O, Hanta I, Kuzu Okur H, Sagcan G, Uzun O, Akgun M, Altinisik G, Dursun B, Cakir Edis E, Gulhan E, Oner Eyuboglu F, Gultekin O, Havlucu Y, Ozkan M, Sakar Coskun A, Sayiner A, Kalyoncu AF, Itil O, Bayram H. The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients. Respir Med 2021; 183:106433. [PMID: 33957434 PMCID: PMC8079263 DOI: 10.1016/j.rmed.2021.106433] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023]
Abstract
The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.
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Affiliation(s)
- Nurdan Kokturk
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Cenk Babayigit
- Department of Pulmonary Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
| | - Seval Kul
- Department of Biostatistics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Pelin Duru Cetinkaya
- Department of Pulmonary Medicine, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey.
| | - Sibel Atis Nayci
- Department of Pulmonary Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey.
| | - Serap Argun Baris
- Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Oguz Karcioglu
- Department of Pulmonary Medicine, Halil Sıvgın Cubuk State Hospital, Ankara, Turkey.
| | - Pinar Aysert
- Department of Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ilim Irmak
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Aycan Akbas Yuksel
- Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara, Turkey.
| | - Yonca Sekibag
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Oya Baydar Toprak
- Department of Pulmonary Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Emel Azak
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli Turkey.
| | - Sait Mulamahmutoglu
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Caglar Cuhadaroglu
- Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
| | - Aslihan Demirel
- Department of Infectious Disease, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey.
| | - Bugra Kerget
- Department of Pulmonary Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | | | - Hasan Selcuk Ozger
- Department of Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Gulcihan Ozkan
- Department of Pulmonary Medicine, Maslak Acibadem Hospital, Istanbul, Turkey; Operating Room Services Department, Nisantasi University, Vocational School, Istanbul, Turkey.
| | - Zeynep Ture
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Begum Ergan
- Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Vildan Avkan Oguz
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Oguz Kilinc
- Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Merve Ercelik
- Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey.
| | - Tansu Ulukavak Ciftci
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ozlem Alici
- Department of Infectious Disease, Faculty of Medicine, Turkiye Gazetesi Private Hospital, Istanbul, Turkey.
| | - Esra Nurlu Temel
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Ozlem Ataoglu
- Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey.
| | - Asena Aydin
- Department of Pulmonary Medicine, Kestel State Hospital, Bursa, Turkey.
| | | | - Yusuf Taha Gullu
- Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey.
| | - Fusun Fakili
- Department of Pulmonary Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Figen Deveci
- Department of Pulmonary Medicine, Faculty of Medicine, Firat University, Elazig, Turkey.
| | - Neslihan Kose
- Department of Pulmonary Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey.
| | - Muge Meltem Tor
- Department of Pulmonary Medicine, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
| | - Gulsah Gunluoglu
- Department of Pulmonary Medicine, University of Health Science, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Sedat Altin
- Department of Pulmonary Medicine, University of Health Science, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Teyfik Turgut
- Department of Pulmonary Medicine, Faculty of Medicine, Firat University, Elazig, Turkey.
| | - Tibel Tuna
- Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey.
| | - Onder Ozturk
- Department of Pulmonary Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Oner Dikensoy
- Department of Pulmonary Medicine, Faculty of Medicine, Taksim, Acibadem University, Istanbul, Turkey.
| | - Pinar Yildiz Gulhan
- Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey.
| | - Ilknur Basyigit
- Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Hasim Boyaci
- Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - I Kivilcim Oguzulgen
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Sermin Borekci
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Bilun Gemicioglu
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Firat Bayraktar
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Osman Elbek
- Department of Pulmonary Medicine, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey.
| | - Ismail Hanta
- Department of Pulmonary Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Hacer Kuzu Okur
- Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
| | - Gulseren Sagcan
- Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
| | - Oguz Uzun
- Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey.
| | - Metin Akgun
- Department of Pulmonary Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Goksel Altinisik
- Department of Pulmonary Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Berna Dursun
- Department of Pulmonary Medicine, Ankara Memorial Hospital, Ankara, Turkey.
| | - Ebru Cakir Edis
- Department of Pulmonary Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey.
| | - Erkmen Gulhan
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
| | - Fusun Oner Eyuboglu
- Department of Pulmonary Medicine, Baskent University, School of Medicine, Ankara, Turkey.
| | - Okkes Gultekin
- Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Yavuz Havlucu
- Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Metin Ozkan
- Department of Pulmonary Medicine, Ankara Memorial Hospital, Ankara, Turkey.
| | - Aysin Sakar Coskun
- Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Abdullah Sayiner
- Department of Pulmonary Medicine, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Ali Fuat Kalyoncu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oya Itil
- Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Hasan Bayram
- Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Istanbul, Turkey.
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Nawangsih EN, Kusmala YY, Rakhmat II, Handayani DR, Juliastuti H, Wibowo A, Lim MA, Pranata R. Colchicine and mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia: A systematic review, meta-analysis, and meta-regression. Int Immunopharmacol 2021; 96:107723. [PMID: 34162130 PMCID: PMC8075849 DOI: 10.1016/j.intimp.2021.107723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Objective This systematic review, with meta-analysis and meta-regression aims to evaluate the effect of colchicine administration on mortality in patients with coronavirus disease 2019 (COVID-19) and factors affecting the association. Methods A systematic literature search using the PubMed, Scopus, and Embase databases were performed from inception of databases up until 3 March 2021. We included studies that fulfill all of the following criteria: 1) observational studies or randomized controlled trials (RCTs) that report COVID-19 patients, 2) reporting colchicine use, and 3) mortality within 30 days. There was no restriction on the age, inpatients or outpatients setting, and severity of diseases. The intervention was colchicine administration during treatment for COVID-19. The control was receiving placebo or standard of care. The outcome was mortality and the pooled effect estimate was reported as odds ratio (OR). Random-effects restricted maximum likelihood meta-regression was performed to evaluate factors affecting the pooled effect estimate. Results Eight studies comprising of 5530 patients were included in this systematic review and meta-analysis. There were three RCTs and five observational studies. Pooled analysis showed that colchicine was associated with lower mortality in patients with COVID-19 (OR 0.47 [0.31, 0.72], p = 0.001; I2: 30.9, p = 0.181). Meta-regression analysis showed that the association between colchicine and mortality was reduced by increasing age (OR 0.92 [0.85, 1.00], p = 0.05), but not gender (reference: male, p = 0.999), diabetes (p = 0.376), hypertension (p = 0.133), and CAD (p = 0.354). Conclusion This meta-analysis indicates that colchicine may reduce mortality in patients with COVID-19. Meta-regression analysis showed that the benefit was reduced as age increases. PROSPERO: CRD42021240609.
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Affiliation(s)
- Eka Noneng Nawangsih
- Department of Microbiology, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Yudith Yunia Kusmala
- Department of Internal Medicine, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Iis Inayati Rakhmat
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Dewi Ratih Handayani
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.
| | - Henny Juliastuti
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | | | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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Savla SR, Prabhavalkar KS, Bhatt LK. Cytokine storm associated coagulation complications in COVID-19 patients: Pathogenesis and Management. Expert Rev Anti Infect Ther 2021; 19:1397-1413. [PMID: 33832398 PMCID: PMC8074652 DOI: 10.1080/14787210.2021.1915129] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction SARS-CoV-2, the causative agent of COVID-19, attacks the immune system causing an exaggerated and uncontrolled release of pro-inflammatory mediators (cytokine storm). Recent studies propose an active role of coagulation disorders in disease progression. This hypercoagulability has been displayed by marked increase in D-dimer in hospitalized patients. Areas Covered This review summarizes the pathogenesis of SARS-CoV-2 infection, generation of cytokine storm, the interdependence between inflammation and coagulation, its consequences and the possible management options for coagulation complications like venous thromboembolism (VTE), microthrombosis, disseminated intravascular coagulation (DIC), and systemic and local coagulopathy. We searched PubMed, Scopus, and Google Scholar for relevant reports using COVID-19, cytokine storm, and coagulation as keywords. Expert Opinion A prophylactic dose of 5000–7500 units of low molecular weight heparin (LMWH) has been recommended for hospitalized COVID-19 patients in order to prevent VTE. Treatment dose of LMWH, based on disease severity, is being contemplated for patients showing a marked rise in levels of D-dimer due to possible pulmonary thrombi. Additionally, targeting PAR-1, thrombin, coagulation factor Xa and the complement system may be potentially useful in reducing SARS-CoV-2 infection induced lung injury, microvascular thrombosis, VTE and related outcomes like DIC and multi-organ failure.
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Affiliation(s)
- Shreya R Savla
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India
| | - Kedar S Prabhavalkar
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India
| | - Lokesh K Bhatt
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India
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Shah Alam M, Czajkowsky DM, Aminul Islam M, Ataur Rahman M. The role of vitamin D in reducing SARS-CoV-2 infection: An update. Int Immunopharmacol 2021; 97:107686. [PMID: 33930705 PMCID: PMC8052476 DOI: 10.1016/j.intimp.2021.107686] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is having a disastrous impact on global health. Recently, several studies examined the potential of vitamin D to reduce the effects of SARS-CoV-2 infection by modulating the immune system. Indeed, vitamin D has been found to boost the innate immune system and stimulate the adaptive immune response against SARS-CoV-2 infection. In this review, we provide a comprehensive update of the immunological mechanisms underlying the positive effects of vitamin D in reducing SARS-CoV-2 infection as well as a thorough survey of the recent epidemiological studies and clinical trials that tested vitamin D as a potential therapeutic agent against COVID-19 infection. We believe that a better understanding of the histopathology and immunopathology of the disease as well as the mechanism of vitamin D effects on COVID-19 severity will ultimately pave the way for a more effective prevention and control of this global pandemic.
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Affiliation(s)
- Mohammad Shah Alam
- Department of Anatomy and Histology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh.
| | - Daniel M Czajkowsky
- Bio-ID Centre, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Md Aminul Islam
- Department of Medicine, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Md Ataur Rahman
- Department of Surgery and Radiology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
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Pranata R, Lim MA, Huang I, Yonas E, Henrina J, Vania R, Lukito AA, Nasution SA, Alwi I, Siswanto BB. Visceral adiposity, subcutaneous adiposity, and severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis. Clin Nutr ESPEN 2021; 43:163-168. [PMID: 34024509 PMCID: PMC8032475 DOI: 10.1016/j.clnesp.2021.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19. METHODS We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR). RESULTS There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm2 [27.0, 56.4], p < 0.001; I2: 0%) and TFA (mean difference 64.6 cm2 [26.2, 103.1], p = 0.001; I2: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm2 [-4.9, 23.4], p = 0.199; I2: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p = 0.002; I2: 49.3%). CONCLUSION Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not. PROSPERO ID CRD42020215876.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | | | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia.
| | | | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia.
| | - Antonia Anna Lukito
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia.
| | - Sally Aman Nasution
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Idrus Alwi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
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Andargie TE, Tsuji N, Seifuddin F, Jang MK, Yuen PS, Kong H, Tunc I, Singh K, Charya A, Wilkins K, Nathan S, Cox A, Pirooznia M, Star RA, Agbor-Enoh S. Cell-free DNA maps COVID-19 tissue injury and risk of death and can cause tissue injury. JCI Insight 2021; 6:147610. [PMID: 33651717 PMCID: PMC8119224 DOI: 10.1172/jci.insight.147610] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The clinical course of coronavirus 2019 (COVID-19) is heterogeneous, ranging from mild to severe multiorgan failure and death. In this study, we analyzed cell-free DNA (cfDNA) as a biomarker of injury to define the sources of tissue injury that contribute to such different trajectories. METHODS We conducted a multicenter prospective cohort study to enroll patients with COVID-19 and collect plasma samples. Plasma cfDNA was subject to bisulfite sequencing. A library of tissue-specific DNA methylation signatures was used to analyze sequence reads to quantitate cfDNA from different tissue types. We then determined the correlation of tissue-specific cfDNA measures to COVID-19 outcomes. Similar analyses were performed for healthy controls and a comparator group of patients with respiratory syncytial virus and influenza. RESULTS We found markedly elevated levels and divergent tissue sources of cfDNA in COVID-19 patients compared with patients who had influenza and/or respiratory syncytial virus and with healthy controls. The major sources of cfDNA in COVID-19 were hematopoietic cells, vascular endothelium, hepatocytes, adipocytes, kidney, heart, and lung. cfDNA levels positively correlated with COVID-19 disease severity, C-reactive protein, and D-dimer. cfDNA profile at admission identified patients who subsequently required intensive care or died during hospitalization. Furthermore, the increased cfDNA in COVID-19 patients generated excessive mitochondrial ROS (mtROS) in renal tubular cells in a concentration-dependent manner. This mtROS production was inhibited by a TLR9-specific antagonist. CONCLUSION cfDNA maps tissue injury that predicts COVID-19 outcomes and may mechanistically propagate COVID-19–induced tissue injury. FUNDING Intramural Targeted Anti–COVID-19 grant, NIH.
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Affiliation(s)
- Temesgen E Andargie
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA.,Department of Biology, Howard University, Washington DC, USA
| | - Naoko Tsuji
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, Maryland, USA
| | | | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA
| | - Peter St Yuen
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, Maryland, USA
| | - Hyesik Kong
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA
| | - Ilker Tunc
- Bioinformatics and Computation Core, NHLBI, Maryland, USA
| | - Komudi Singh
- Bioinformatics and Computation Core, NHLBI, Maryland, USA
| | - Ananth Charya
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA
| | | | - Steven Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Fairfax, Virginia, USA
| | - Andrea Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Robert A Star
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, Maryland, USA
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Handayani DR, Juliastuti H, Nawangsih EN, Kusmala YY, Rakhmat II, Wibowo A, Pranata R. Prognostic value of fasting hyperglycemia in patients with COVID-19 - Diagnostic test accuracy meta-analysis. ACTA ACUST UNITED AC 2021; 23:100333. [PMID: 33842733 PMCID: PMC8019489 DOI: 10.1016/j.obmed.2021.100333] [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: 03/10/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
Aims This meta-analysis aimed to assess the prognostic value of fasting hyperglycemia in patients with COVID-19. Methods A systematic literature search on PubMed, Embase, and Scopus were performed up until February 18, 2021. Fasting hyperglycemia was defined as fasting plasma glucose level above the reference value. The outcome of interest was poor outcome, which was a composite of mortality and severe COVID-19. The effect estimate was in odds ratio (OR). Results There were 9045 patients from 12 studies included in this systematic review and meta-analysis. The prevalence of fasting hyperglycemia was 29%. The incidence of poor outcome was 15%. Fasting hyperglycemia was associated with poor outcome in COVID-19 (OR 4.72 [3.32, 6.72], p < 0.001; I2: 69.8%, p < 0.001). Subgroup analysis in patients without prior history of diabetes showed that fasting hyperglycemia was associated with poor outcome in COVID-19 (OR 3.387 [2.433, 4.714], p < 0.001; I2: 0, p = 0.90). Fasting hyperglycemia has a sensitivity of 0.57 [0.45, 0.68], specificity of 0.78 [0.70, 0.84], PLR of 2.6 [2.0, 3.3], NLR of 0.55 [0.44, 0.69], DOR of 5 [3, 7], and AUC of 0.74 [0.70, 0.78] for predicting poor outcome. In this pooled analysis, fasting hyperglycemia has a 32% post-test probability for poor outcome, and absence of fasting hyperglycemia confers to a 9% post-test probability. Meta-regression and subgroup analysis showed that the sensitivity and specificity varies by chronic kidney disease but not by age, male (gender), hypertension, and chronic kidney disease. Conclusion Fasting hyperglycemia was associated with mortality in COVID-19 patients, with or without diabetes. Prospero CRD42021237997.
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Affiliation(s)
- Dewi Ratih Handayani
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Henny Juliastuti
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Eka Noneng Nawangsih
- Department of Microbiology, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Yudith Yunia Kusmala
- Department of Internal Medicine, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Iis Inayati Rakhmat
- Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.,Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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Unal Y, Demirkilic U, Balik I, Aydin K, Zor MH, Bozkurt AK. Pilot Study of Application of Combined Transbronchial and Intravenous Ultraviolet C (UVC) and Laser Beam Application for the Treatment of Critical COVID-19 Infection. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2021. [DOI: 10.29333/jcei/10811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Samprathi M, Jayashree M. Biomarkers in COVID-19: An Up-To-Date Review. Front Pediatr 2021; 8:607647. [PMID: 33859967 PMCID: PMC8042162 DOI: 10.3389/fped.2020.607647] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023] Open
Abstract
The ongoing pandemic of coronavirus disease 2019 (COVID-19) poses several challenges to clinicians. Timely diagnosis and hospitalization, risk stratification, effective utilization of intensive care services, selection of appropriate therapies, monitoring and timely discharge are essential to save the maximum number of lives. Clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact these components of patient care. COVID-19 is not a localized respiratory infection but a multisystem disease caused by a diffuse systemic process involving a complex interplay of the immunological, inflammatory and coagulative cascades. The understanding of what the virus does to the body and how the body reacts to it has uncovered a gamut of potential biomarkers. This review discusses the different classes of biomarkers - immunological, inflammatory, coagulation, hematological, cardiac, biochemical and miscellaneous - in terms of their pathophysiological basis followed by the current evidence. Differences between children and adults are highlighted. The role of biomarkers in the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C) is reviewed. The correlation of biomarkers with clinical and radiological features and the viral load, temporal evolution and the effect of treatment remain to be studied in detail. Which biomarker needs to be evaluated when and in whom, and how best this information can contribute to patient care are questions which currently lack convincing answers. With the evidence currently available broad guidelines on the rational use of available biomarkers are presented. Integrating clinical and laboratory data, monitoring trends rather than a single value, correlating with the natural course of the disease and tailoring guidelines to the individual patient and healthcare setting are essential.
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Betti M, Bertolotti M, Ferrante D, Roveta A, Pelazza C, Giacchero F, Penpa S, Massarino C, Bolgeo T, Cassinari A, Mussa M, Chichino G, Maconi A. Baseline clinical characteristics and prognostic factors in hospitalized COVID-19 patients aged ≤ 65 years: A retrospective observational study. PLoS One 2021; 16:e0248829. [PMID: 33760885 PMCID: PMC7990225 DOI: 10.1371/journal.pone.0248829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individual differences in susceptibility to SARS-CoV-2 infection, symptomatology and clinical manifestation of COVID-19 have thus far been observed but little is known about the prognostic factors of young patients. METHODS A retrospective observational study was conducted on 171 patients aged ≤ 65 years hospitalized in Alessandria's Hospital from 1st March to 30th April 2020 with laboratory confirmed COVID-19. Epidemiological data, symptoms at onset, clinical manifestations, Charlson Comorbidity Index, laboratory parameters, radiological findings and complications were considered. Patients were divided into two groups on the basis of COVID-19 severity. Multivariable logistic regression analysis was used to establish factors associated with the development of a moderate or severe disease. FINDINGS A total of 171 patients (89 with mild/moderate disease, 82 with severe/critical disease), of which 61% males and a mean age (± SD) of 53.6 (± 9.7) were included. The multivariable logistic model identified age (50-65 vs 18-49; OR = 3.23 CI95% 1.42-7.37), platelet count (per 100 units of increase OR = 0.61 CI95% 0.42-0.89), c-reactive protein (CPR) (per unit of increase OR = 1.12 CI95% 1.06-1.20) as risk factors for severe or critical disease. The multivariable logistic model showed a good discriminating capacity with a C-index value of 0.76. INTERPRETATION Patients aged ≥ 50 years with low platelet count and high CRP are more likely to develop severe or critical illness. These findings might contribute to improved clinical management.
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Affiliation(s)
- Marta Betti
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
- * E-mail:
| | - Marinella Bertolotti
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of “Piemonte Orientale” and Cancer Epidemiology, CPO Piemonte, Novara, Italy
| | - Annalisa Roveta
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Carolina Pelazza
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Fabio Giacchero
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Serena Penpa
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Costanza Massarino
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Tatiana Bolgeo
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Antonella Cassinari
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Marco Mussa
- Infectious Diseases Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Guido Chichino
- Infectious Diseases Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
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Evaluation and Transplantation of a SARS-CoV-2 Seropositive Kidney Candidate. Case Rep Nephrol 2021; 2021:6613023. [PMID: 33747584 PMCID: PMC7945674 DOI: 10.1155/2021/6613023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic affected transplant center activity in areas with high number of cases such as New York City and prompted reevaluation of patients awaiting organ transplant diagnosed with SARS-CoV-2 infection. To resume safe transplantation at our center, we found it necessary to (1) identify transplant candidates with possible exposure to or history of COVID-19 infection, (2) outline a clinical and laboratory assessment to determine adequate clinical recovery from COVID-19 for transplantation, and (3) determine whether the possibility of perioperative COVID-19 transmission from the patient to staff would pose unacceptable risk. Here, we describe our center's approach to proceeding with transplantation in a SARS-CoV-2 seropositive living donor kidney transplant recipient and describe early posttransplant outcomes.
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