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Hurst EA, Mellanby RJ, Handel I, Griffith DM, Rossi AG, Walsh TS, Shankar-Hari M, Dunning J, Homer NZ, Denham SG, Devine K, Holloway PA, Moore SC, Thwaites RS, Samanta RJ, Summers C, Hardwick HE, Oosthuyzen W, Turtle L, Semple MG, Openshaw PJM, Baillie JK, Russell CD. Vitamin D insufficiency in COVID-19 and influenza A, and critical illness survivors: a cross-sectional study. BMJ Open 2021; 11:e055435. [PMID: 34686560 PMCID: PMC8728359 DOI: 10.1136/bmjopen-2021-055435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The steroid hormone vitamin D has roles in immunomodulation and bone health. Insufficiency is associated with susceptibility to respiratory infections. We report 25-hydroxy vitamin D (25(OH)D) measurements in hospitalised people with COVID-19 and influenza A and in survivors of critical illness to test the hypotheses that vitamin D insufficiency scales with illness severity and persists in survivors. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Plasma was obtained from 295 hospitalised people with COVID-19 (International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)/WHO Clinical Characterization Protocol for Severe Emerging Infections UK study), 93 with influenza A (Mechanisms of Severe Acute Influenza Consortium (MOSAIC) study, during the 2009-2010 H1N1 pandemic) and 139 survivors of non-selected critical illness (prior to the COVID-19 pandemic). Total 25(OH)D was measured by liquid chromatography-tandem mass spectrometry. Free 25(OH)D was measured by ELISA in COVID-19 samples. OUTCOME MEASURES Receipt of invasive mechanical ventilation (IMV) and in-hospital mortality. RESULTS Vitamin D insufficiency (total 25(OH)D 25-50 nmol/L) and deficiency (<25 nmol/L) were prevalent in COVID-19 (29.3% and 44.4%, respectively), influenza A (47.3% and 37.6%) and critical illness survivors (30.2% and 56.8%). In COVID-19 and influenza A, total 25(OH)D measured early in illness was lower in patients who received IMV (19.6 vs 31.9 nmol/L (p<0.0001) and 22.9 vs 31.1 nmol/L (p=0.0009), respectively). In COVID-19, biologically active free 25(OH)D correlated with total 25(OH)D and was lower in patients who received IMV, but was not associated with selected circulating inflammatory mediators. CONCLUSIONS Vitamin D deficiency/insufficiency was present in majority of hospitalised patients with COVID-19 or influenza A and correlated with severity and persisted in critical illness survivors at concentrations expected to disrupt bone metabolism. These findings support early supplementation trials to determine if insufficiency is causal in progression to severe disease, and investigation of longer-term bone health outcomes.
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Affiliation(s)
- Emma A Hurst
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Richard J Mellanby
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Ian Handel
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - David M Griffith
- Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Adriano G Rossi
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
| | - Timothy S Walsh
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Manu Shankar-Hari
- Intensive Care Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, Kings College London, London, UK
| | - Jake Dunning
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Natalie Z Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Scott G Denham
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Kerri Devine
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Paul A Holloway
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Shona C Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Romit J Samanta
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Hayley E Hardwick
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Wilna Oosthuyzen
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | | | - J Kenneth Baillie
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Clark D Russell
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
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Nakano T, Chiang KC, Chen CC, Chen PJ, Lai CY, Hsu LW, Ohmori N, Goto T, Chen CL, Goto S. Sunlight Exposure and Phototherapy: Perspectives for Healthy Aging in an Era of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010950. [PMID: 34682694 PMCID: PMC8535353 DOI: 10.3390/ijerph182010950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/10/2023]
Abstract
Most humans depend on sunlight exposure to satisfy their requirements for vitamin D3. However, the destruction of the ozone layer in the past few decades has increased the risk of skin aging and wrinkling caused by excessive exposure to ultraviolet (UV) radiation, which may also promote the risk of skin cancer development. The promotion of public health recommendations to avoid sunlight exposure would reduce the risk of skin cancer, but it would also enhance the risk of vitamin D3 insufficiency/deficiency, which may cause disease development and progression. In addition, the ongoing global COVID-19 pandemic may further reduce sunlight exposure due to stay-at-home policies, resulting in difficulty in active and healthy aging. In this review article, we performed a literature search in PubMed and provided an overview of basic and clinical data regarding the impact of sunlight exposure and vitamin D3 on public health. We also discuss the potential mechanisms and clinical value of phototherapy with a full-spectrum light (notably blue, red, and near-infrared light) as an alternative to sunlight exposure, which may contribute to combating COVID-19 and promoting active and healthy aging in current aged/superaged societies.
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Affiliation(s)
- Toshiaki Nakano
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (K.-C.C.); (P.-J.C.); (L.-W.H.)
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
- Correspondence: (T.N.); (S.G.); Tel.: +886-7-731-7123 (T.N.); +81-975-53-2165 (S.G.)
| | - Kuei-Chen Chiang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (K.-C.C.); (P.-J.C.); (L.-W.H.)
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
| | - Chien-Chih Chen
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Po-Jung Chen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (K.-C.C.); (P.-J.C.); (L.-W.H.)
| | - Chia-Yun Lai
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
| | - Li-Wen Hsu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (K.-C.C.); (P.-J.C.); (L.-W.H.)
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
| | - Naoya Ohmori
- Faculty of Nursing, Josai International University, Togane 283-8555, Japan; (N.O.); (T.G.)
- Kazusa Institute for Drug Discovery, Josai International University, Togane 283-8555, Japan
| | - Takeshi Goto
- Faculty of Nursing, Josai International University, Togane 283-8555, Japan; (N.O.); (T.G.)
- Kazusa Institute for Drug Discovery, Josai International University, Togane 283-8555, Japan
| | - Chao-Long Chen
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
| | - Shigeru Goto
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (C.-C.C.); (C.-Y.L.); (C.-L.C.)
- Faculty of Nursing, Josai International University, Togane 283-8555, Japan; (N.O.); (T.G.)
- Nobeoka Medical Check Center, Fukuoka Institution of Occupational Health, Nobeoka 882-0872, Japan
- Correspondence: (T.N.); (S.G.); Tel.: +886-7-731-7123 (T.N.); +81-975-53-2165 (S.G.)
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253
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Zhang C, Jin H, Wen YF, Yin G. Efficacy of COVID-19 Treatments: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Front Public Health 2021; 9:729559. [PMID: 34650951 PMCID: PMC8506153 DOI: 10.3389/fpubh.2021.729559] [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] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/01/2021] [Indexed: 01/09/2023] Open
Abstract
Background: We provided a comprehensive evaluation of efficacy of available treatments for coronavirus disease 2019 (COVID-19). Methods: We searched for candidate COVID-19 studies in WHO COVID-19 Global Research Database up to August 19, 2021. Randomized controlled trials for suspected or confirmed COVID-19 patients published on peer-reviewed journals were included, regardless of demographic characteristics. Outcome measures included mortality, mechanical ventilation, hospital discharge and viral clearance. Bayesian network meta-analysis with fixed effects was conducted to estimate the effect sizes using posterior means and 95% equal-tailed credible intervals (CrIs). Odds ratio (OR) was used as the summary measure for treatment effect. Bayesian hierarchical models were used to estimate effect sizes of treatments grouped by the treatment classifications. Results: We identified 222 eligible studies with a total of 102,950 patients. Compared with the standard of care, imatinib, intravenous immunoglobulin and tocilizumab led to lower risk of death; baricitinib plus remdesivir, colchicine, dexamethasone, recombinant human granulocyte colony stimulating factor and tocilizumab indicated lower occurrence of mechanical ventilation; tofacitinib, sarilumab, remdesivir, tocilizumab and baricitinib plus remdesivir increased the hospital discharge rate; convalescent plasma, ivermectin, ivermectin plus doxycycline, hydroxychloroquine, nitazoxanide and proxalutamide resulted in better viral clearance. From the treatment class level, we found that the use of antineoplastic agents was associated with fewer mortality cases, immunostimulants could reduce the risk of mechanical ventilation and immunosuppressants led to higher discharge rates. Conclusions: This network meta-analysis identified superiority of several COVID-19 treatments over the standard of care in terms of mortality, mechanical ventilation, hospital discharge and viral clearance. Tocilizumab showed its superiority compared with SOC on preventing severe outcomes such as death and mechanical ventilation as well as increasing the discharge rate, which might be an appropriate treatment for patients with severe or mild/moderate illness. We also found the clinical efficacy of antineoplastic agents, immunostimulants and immunosuppressants with respect to the endpoints of mortality, mechanical ventilation and discharge, which provides valuable information for the discovery of potential COVID-19 treatments.
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Affiliation(s)
- Chenyang Zhang
- Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong SAR, China
| | - Huaqing Jin
- Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong SAR, China
| | - Yi Feng Wen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Guosheng Yin
- Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong SAR, China.,Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, United States
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254
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Tejada Cifuentes F, Lloret Callejo Á, Tirado Pérez MJ, Romero Candel G. Perfil de efectividad y seguridad de la colchicina en pacientes con diagnóstico de COVID-19 en un área sanitaria. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2021. [DOI: 10.55783/rcmf.140304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objetivo: describir la evolución y la seguridad de la utilización de colchicina en pacientes no ingresados con diagnóstico de COVID-19 leve-moderado en la Gerencia de Atención Integrada (GAI) de Albacete.
Métodos: estudio observacional retrospectivo. De los 389 participantes incluidos en el primer reclutamiento, se seleccionaron 315 con datos válidos. La variable principal del estudio ha sido el fallecimiento o ingreso hospitalario en pacientes con diagnóstico de COVID-19 y tratamiento con colchicina. Se registraron variables sociodemográficas, clínicas y tratamientos y comorbilidades concomitantes.
Resultados: fallecieron 6 (1,90%) pacientes y 49 (15,5%) requirieron ingreso hospitalario. A un 58,4% se les prescribió un antibiótico, siendo la azitromicina el más utilizado y el responsable en un 32,7% de las posibles interacciones. Un 34,5% y un 43% de pacientes recibieron heparinas de bajo peso molecular (HBPM) y corticosteroides respectivamente. En el 42,3% de pacientes no se tuvo en cuenta el valor del aclaramiento de creatinina al dosificar la colchicina. La edad elevada muestra una relación estadísticamente significativa con la gravedad de la clínica (68,5 versus 58,9) y con la variable recaída (ingreso + urgencias) (63,25 versus 58,54).
Conclusiones: en nuestra muestra, la utilización de colchicina en pacientes ambulatorios no ha modificado el curso de la enfermedad en pacientes diagnosticados de COVID-19.
Palabras clave: colchicina, COVID-19, coronavirus, tratamiento.
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Affiliation(s)
- Francisco Tejada Cifuentes
- Servicio de Farmacia de Atención Primaria. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ángeles Lloret Callejo
- Servicio de Farmacia de Atención Primaria. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - María José Tirado Pérez
- Servicio de Farmacia de Atención Primaria. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Gregorio Romero Candel
- Servicio de Farmacia. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
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255
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Szarpak L, Filipiak KJ, Gasecka A, Gawel W, Koziel D, Jaguszewski MJ, Chmielewski J, Gozhenko A, Bielski K, Wroblewski P, Savytskyi I, Szarpak L, Rafique Z. Vitamin D supplementation to treat SARS-CoV-2 positive patients. Evidence from meta-analysis. Cardiol J 2021; 29:188-196. [PMID: 34642923 PMCID: PMC9007480 DOI: 10.5603/cj.a2021.0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Vitamin D is a likely candidate for treatment as its immune modulating characteristics have effects on coronavirus disease 2019 (COVID-19) patients. It was sought herein, to summarize the studies published to date regarding the vitamin D supplementation to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients. METHODS A systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome were 14-day and in-hospital mortality reported as an odds ratio (OR) with the associated 95% confidence interval (CI). RESULTS Eight articles were included in the review with a combined total of 2,322 individual patients, 786 in the vitamin D supplementation group and 1,536 in the control group. The use of vitamin D compared to the group without vitamin D supplementation was associated with a lower 14-day mortality (18.8% vs. 31.3%, respectively; OR = 0.51; 95% CI: 0.12-2.19; p = 0.36), a lower in-hospital mortality (5.6% vs. 16.1%; OR = 0.56; 95% CI: 0.23-1.37; I2 = 74%; p = 0.20), the rarer intensive care unit admission (6.4% vs. 23.4%; OR = 0.19; 95% CI: 0.06-0.54; I2 = 77%; p = 0.002) as well as rarer mechanical ventilation (6.5% vs. 18.9%; OR = 0.36; 95% CI: 0.16-0.80; I2 = 0.48; p = 0.01). CONCLUSIONS Vitamin D supplementation in SARS-CoV-2 positive patients has the potential to positively impact patients with both mild and severe symptoms. As several high-quality randomized control studies have demonstrated a benefit in hospital mortality, vitamin D should be considered a supplemental therapy of strong interest. Should vitamin D prove to reduce hospitalization rates and symptoms outside of the hospital setting, the cost and benefit to global pandemic mitigation efforts would be substantial.
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Affiliation(s)
- Luiza Szarpak
- Institute of Outcomes Research, Polonia University, Czestochowa, Poland
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Krzysztof J Filipiak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Aleksandra Gasecka
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Wladyslaw Gawel
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
- Department of Surgery, The Silesian Hospital in Opava, Czech Republic
| | | | | | | | | | - Karol Bielski
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
- Emergency Medical Service and Medical Transport Dispatcher, Warsaw, Poland
| | - Pawel Wroblewski
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | | | - Lukasz Szarpak
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, TX, United States
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Goyal M, Goyal N. ROLE OF VITAMIN D SUPPLEMENTATION IN THE PREVENTION OF INFECTION AND SEVERE COURSE IN COVID-19: TESTING THE HYPOTHESIS. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.3.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disrupted the normal activities of various settings, including clinics, laboratories, and libraries. As the world deals with the fast-mutating causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), apart from the search for the best vaccine candidate, efforts towards repurposing existing molecules to save lives must continue. Considerable interest has centered around the implications of vitamin D deficiency and its supplementation on the outcomes in patients with COVID-19. We hypothesize that vitamin D supplementation has the potential to confer protection against SARS-CoV-2 infection and a severe COVID-19 course. Various animal, human observational as well as interventional studies have shown a protective role of vitamin D in COVID-19. More robustly designed studies where vitamin D is supplemented prophylactically and administered to those already infected are needed to determine the precise contribution of this supplementation in preventing SARS-CoV-2 infection and modifying the course of COVID-19.
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257
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Zolezzi M, Paravattil B, El-Gaili T. Using motivational interviewing techniques to inform decision-making for COVID-19 vaccination. Int J Clin Pharm 2021; 43:1728-1734. [PMID: 34599721 PMCID: PMC8486954 DOI: 10.1007/s11096-021-01334-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
Motivational interviewing is a patient-centered communication style used to enhance a person’s internal motivation for attitudinal change by exploring and solving inherent ambivalences. In the face of rising COVID-19 vaccine hesitancy, pharmacists and other health care professionals may use motivational interviewing to enable individuals making informed decisions with regards to the COVID-19 vaccines. The purpose of this article is to integrate theory with practice by describing a scenario that illustrates how motivational interviewing skills and strategies can be used to reduce COVID-19 vaccine hesitancy.
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Affiliation(s)
- Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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Annweiler C, Beaudenon M, Simon R, Guenet M, Otekpo M, Célarier T, Gautier J. Vitamin D supplementation prior to or during COVID-19 associated with better 3-month survival in geriatric patients: Extension phase of the GERIA-COVID study. J Steroid Biochem Mol Biol 2021; 213:105958. [PMID: 34332023 PMCID: PMC8319044 DOI: 10.1016/j.jsbmb.2021.105958] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The objective of this extension phase of the quasi-experimental GERIA-COVID study was to determine whether vitamin D3 supplementation taken prior to or during COVID-19 was associated with better 3-month survival in geriatric patients hospitalized for COVID-19. METHODS Intervention group was defined as all participants supplemented with vitamin D3 prior to or during COVID-19 (n = 67). Supplements were either bolus vitamin D3 (ie, 50,000 IU per month, or 80,000 IU or 100,000 IU or 200,000 IU every 2-3 months), or daily supplementation with 800 IU. Comparator group involved those without vitamin D supplements (n = 28). Outcome was 3-month mortality. Covariables were age, sex, functional abilities, history of malignancies, cardiomyopathy, undernutrition, number of acute health issues, antibiotics use, systemic corticosteroids use, and 25(OH)D concentration. RESULTS 76.1 % (n = 51) of participants survived at 3 months in Intervention group, compared to only 53.6 % (n = 15) in Comparator group (P = 0.03). The fully-adjusted hazard ratio for 3-month mortality was HR = 0.23 [95 %CI: 0.09;0.58](P = 0.002) in Intervention group compared to Comparator group. Intervention group had also longer survival time (log-rank P = 0.008). CONCLUSIONS Vitamin D3 supplementation was associated with better 3-month survival in older COVID-19 patients.
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Affiliation(s)
- Cédric Annweiler
- School of Medicine, Health Faculty, University of Angers, Angers, France; Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France; UPRES EA 4638, University of Angers, Angers, France; Gérontopôle Autonomie Longévité des Pays de la Loire, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON, Canada.
| | - Mélinda Beaudenon
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Romain Simon
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Mialy Guenet
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Marie Otekpo
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Thomas Célarier
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint-Etienne, France; Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France; Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Jennifer Gautier
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
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Ramirez-Sandoval JC, Castillos-Ávalos VJ, Paz-Cortés A, Santillan-Ceron A, Hernandez-Jimenez S, Mehta R, Correa-Rotter R. Very Low Vitamin D Levels are a Strong Independent Predictor of Mortality in Hospitalized Patients with Severe COVID-19. Arch Med Res 2021; 53:215-222. [PMID: 34711432 PMCID: PMC8516726 DOI: 10.1016/j.arcmed.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
Abstract
Background There is controversy regarding the association between hypovitaminosis D and COVID-19 outcomes. Aim of the study We assessed the association between 25-hydroxyvitamin D levels and COVID-19 outcomes in hospitalized subjects with severe SARS-CoV-2 infection. Methods Retrospective cohort study. Serum 25-hydroxyvitamin D levels of subjects with severe COVID-19 pneumonia were measured at hospital admission, between March 17th, 2020, and March 1st, 2021. Results Out of 2,908 patients, 571 (19.6%) had vitamin D deficiency (defined as a serum 25-hydroxyvitamin D level <12.5 ng/mL [<31.25 nmol/L]), and 1069 (36.7%) had levels between 12.5 ng/mL (31.25 nmol/L) and 20 ng/mL 850 nmol/L). Compared to subjects without vitamin D deficiency, those with 25-hydroxyvitamin D level <12.5 ng/mL had higher rates of in-hospital mortality at 30 d (28.0 vs. 17.3%; p <0.001), global mortality (31.9 vs. 20.8%; p <0.001), mechanical ventilation requirement (23.8 vs. 17.2%; p <0.001), and significantly longer hospital stay (median [interquartile range] of 9 [6–17 d] vs. 7 [5–12 d], p <0.001). In the unadjusted analysis, the risk of in-hospital death was greater for patients with vitamin D deficiency (HR 1.43; 95% CI, 1.20–1.70; p <0.001). After adjusting for confounders, the risk of in-hospital death within 30 d remained significantly greater in patients with vitamin D deficiency (HR 1.46; 95% CI, 1.21–1.76; p <0.001). The risk was reduced but remained significant with 25-hydroxyvitamin D levels between 12.5 ng/mL and 20 ng/mL (HR 1.31; 95% CI 1.10–1.55, p = 0.02). In comparison with other clinical biomarkers, vitamin D deficiency was an independent predictive marker of in-hospital mortality after adjusting for confounders. Conclusion Very low 25-hydroxyvitamin D levels measured at hospital admission were significantly associated with in-hospital mortality and are a useful prognostic biomarker in severe COVID-19 patients.
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Affiliation(s)
- Juan C Ramirez-Sandoval
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - Valeria Jocelyne Castillos-Ávalos
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Armando Paz-Cortés
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Airy Santillan-Ceron
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Sergio Hernandez-Jimenez
- Centro de Atención Integral al Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Roopa Mehta
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Ricardo Correa-Rotter
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Kakavas S, Karayiannis D, Mastora Z. The Complex Interplay between Immunonutrition, Mast Cells, and Histamine Signaling in COVID-19. Nutrients 2021; 13:nu13103458. [PMID: 34684460 PMCID: PMC8537261 DOI: 10.3390/nu13103458] [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: 09/03/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Abstract
There is an ongoing need for new therapeutic modalities against SARS-CoV-2 infection. Mast cell histamine has been implicated in the pathophysiology of COVID-19 as a regulator of proinflammatory, fibrotic, and thrombogenic processes. Consequently, mast cell histamine and its receptors represent promising pharmacological targets. At the same time, nutritional modulation of immune system function has been proposed and is being investigated for the prevention of COVID-19 or as an adjunctive strategy combined with conventional therapy. Several studies indicate that several immunonutrients can regulate mast cell activity to reduce the de novo synthesis and/or release of histamine and other mediators that are considered to mediate, at least in part, the complex pathophysiology present in COVID-19. This review summarizes the effects on mast cell histamine of common immunonutrients that have been investigated for use in COVID-19.
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Affiliation(s)
- Sotirios Kakavas
- Critical Care Department, “Sotiria” General Hospital of Chest Diseases, 152 Mesogeion Avenue, 11527 Athens, Greece;
| | - Dimitrios Karayiannis
- Department of Clinical Nutrition, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece
- Correspondence: ; Tel.: +30-213-2045035; Fax: +30-213-2041385
| | - Zafeiria Mastora
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Ghelani D, Alesi S, Mousa A. Vitamin D and COVID-19: An Overview of Recent Evidence. Int J Mol Sci 2021; 22:10559. [PMID: 34638897 PMCID: PMC8509048 DOI: 10.3390/ijms221910559] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/14/2022] Open
Abstract
The novel coronavirus severe acute respiratory syndrome (SARS-CoV-2) has progressed rapidly from an outbreak to a global pandemic, with new variants rapidly emerging. Coronavirus disease 2019 (COVID-19), the disease resulting from SARS-CoV-2 infection, can lead to multiorgan damage. Due to the extremely contagious and fatal nature of the virus, it has been a priority of medical research to find effective means of treatment. Amid this search, the role of vitamin D in modulating various aspects of the innate and adaptive immune system has been discussed. This review aims to consolidate the research surrounding the role of vitamin D in the treatment and prevention of COVID-19. While there are some conflicting results reported, the consensus is that vitamin D has a host of immunomodulatory effects which may be beneficial in the context of COVID-19 and that low levels of vitamin D can result in dysfunction of crucial antimicrobial effects, potentially contributing to poor prognosis. Studies also show that the effects of low vitamin D can be mitigated via supplementation, although the benefits of vitamin D supplementation in the treatment of COVID-19 remain controversial.
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Affiliation(s)
| | | | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3168, Australia; (D.G.); (S.A.)
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Nogues X, Ovejero D, Pineda-Moncusí M, Bouillon R, Arenas D, Pascual J, Ribes A, Guerri-Fernandez R, Villar-Garcia J, Rial A, Gimenez-Argente C, Cos ML, Rodriguez-Morera J, Campodarve I, Quesada-Gomez JM, Garcia-Giralt N. Calcifediol Treatment and COVID-19-Related Outcomes. J Clin Endocrinol Metab 2021; 106:e4017-e4027. [PMID: 34097036 PMCID: PMC8344647 DOI: 10.1210/clinem/dgab405] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 01/08/2023]
Abstract
CONTEXT COVID-19 is a major health problem because of saturation of intensive care units (ICU) and mortality. Vitamin D has emerged as a potential treatment able to reduce the disease severity. OBJECTIVE This work aims to elucidate the effect of 25(OH)D3 (calcifediol) treatment on COVID-19-related outcomes. METHODS This observational cohort study was conducted from March to May 2020, among patients admitted to COVID-19 wards of Hospital del Mar, Barcelona, Spain. A total of 930 patients with COVID-19 were included; 92 were excluded because of previous calcifediol intake. Of the remaining 838, a total of 447 received calcifediol (532 μg on day 1 plus 266 μg on days 3, 7, 15, and 30), whereas 391 were not treated at the time of hospital admission (intention-to-treat). Of the latter, 53 patients were treated later during ICU admission and were allocated in the treated group in a second analysis. In healthy individuals, calcifediol is about 3.2-fold more potent on a weight basis than cholecalciferol. Main outcome measures were ICU admission and mortality. RESULTS ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required the ICU, compared to 82 (21%) out of 391 nontreated (P < .001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, sex, linearized 25-hydroxyvitamin D levels at baseline, and comorbidities showed that treated patients had a reduced risk of requiring the ICU (odds ratio [OR] 0.13; 95% CI 0.07-0.23). Overall mortality was 10%. In the intention-to-treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 nontreated (P = .001). Adjusted results showed a reduced mortality risk with an OR of 0.21 (95% CI, 0.10-0.43). In the second analysis, the obtained OR was 0.52 (95% CI, 0.27-0.99). CONCLUSION In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality.
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Affiliation(s)
- Xavier Nogues
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Diana Ovejero
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Marta Pineda-Moncusí
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
| | - Roger Bouillon
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat, 3000 Leuven, Belgium
| | - Dolors Arenas
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona 08003, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona 08003, Spain
| | - Anna Ribes
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
| | - Robert Guerri-Fernandez
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
- Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona 08003,Spain
| | - Judit Villar-Garcia
- Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona 08003,Spain
| | - Abora Rial
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Carme Gimenez-Argente
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Maria Lourdes Cos
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Jaime Rodriguez-Morera
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Isabel Campodarve
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - José Manuel Quesada-Gomez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Fundación Progreso y Salud, CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Hospital Universitario Reina Sofía, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Natalia Garcia-Giralt
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
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Abdrabbo M, Birch CM, Brandt M, Cicigoi KA, Coffey SJ, Dolan CC, Dvorak H, Gehrke AC, Gerzema AEL, Hansen A, Henseler EJ, Huelsbeck AC, LaBerge B, Leavens CM, Le CN, Lindquist AC, Ludwig RK, Reynolds JH, Severson NJ, Sherman BA, Sillman HW, Smith MA, Smith MA, Snortheim MJ, Svaren LM, Vanderpas EC, Wackett MJ, Wozney AJ, Bhattacharyya S, Hati S. Vitamin D and COVID-19: A review on the role of vitamin D in preventing and reducing the severity of COVID-19 infection. Protein Sci 2021; 30:2206-2220. [PMID: 34558135 PMCID: PMC8521296 DOI: 10.1002/pro.4190] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) is a pathogenic coronavirus causing COVID‐19 infection. The interaction between the SARS‐CoV‐2 spike protein and the human receptor angiotensin‐converting enzyme 2, both of which contain several cysteine residues, is impacted by the disulfide‐thiol balance in the host cell. The host cell redox status is affected by oxidative stress due to the imbalance between the reactive oxygen/nitrogen species and antioxidants. Recent studies have shown that Vitamin D supplementation could reduce oxidative stress. It has also been proposed that vitamin D at physiological concentration has preventive effects on many viral infections, including COVID‐19. However, the molecular‐level picture of the interplay of vitamin D deficiency, oxidative stress, and the severity of COVID‐19 has remained unclear. Herein, we present a thorough review focusing on the possible molecular mechanism by which vitamin D could alter host cell redox status and block viral entry, thereby preventing COVID‐19 infection or reducing the severity of the disease.
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Affiliation(s)
- Mobeen Abdrabbo
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Cole M Birch
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Michael Brandt
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Kelsey A Cicigoi
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Stephen J Coffey
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Connor C Dolan
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Hannah Dvorak
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Ava C Gehrke
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Audrey E L Gerzema
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Abby Hansen
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Ethan J Henseler
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Alyssa C Huelsbeck
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Ben LaBerge
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Caterra M Leavens
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Christine N Le
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Allison C Lindquist
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Rickaela K Ludwig
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Jacob H Reynolds
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Nathaniel J Severson
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Brandon A Sherman
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Hunter W Sillman
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Michael A Smith
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Macey A Smith
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Marissa J Snortheim
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Levi M Svaren
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Emily C Vanderpas
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Miles J Wackett
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Alec J Wozney
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Sudeep Bhattacharyya
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Sanchita Hati
- Department of Chemistry and Biochemistry, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
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Association of Low Molecular Weight Plasma Aminothiols with the Severity of Coronavirus Disease 2019. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9221693. [PMID: 34557267 PMCID: PMC8455204 DOI: 10.1155/2021/9221693] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/01/2021] [Indexed: 01/16/2023]
Abstract
Objective Aminothiols (glutathione (GSH), cysteinylglycine (CG)) may play an important role in the pathogenesis of coronavirus disease 2019 (COVID-19), but the possible association of these indicators with the severity of COVID-19 has not yet been investigated. Methods The total content (t) and reduced forms (r) of aminothiols were determined in patients with COVID-19 (n = 59) on admission. Lung injury was characterized by computed tomography (CT) findings in accordance with the CT0-4 classification. Results Low tGSH level was associated with the risk of severe COVID-19 (tGSH ≤ 1.5 μM, mild vs. moderate/severe: risk ratio (RR) = 3.09, p = 0.007) and degree of lung damage (tGSH ≤ 1.8 μM, CT < 2 vs. CT ≥ 2: RR = 2.14, p = 0.0094). The rGSH level showed a negative association with D-dimer levels (ρ = -0.599, p = 0.014). Low rCG level was also associated with the risk of lung damage (rCG ≤ 1.3 μM, CT < 2 vs. CT ≥ 2: RR = 2.28, p = 0.001). Levels of rCG (ρ = -0.339, p = 0.012) and especially tCG (ρ = -0.551, p = 0.004) were negatively associated with platelet count. In addition, a significant relationship was found between the advanced oxidation protein product level and tGSH in patients with moderate or severe but not in patients with mild COVID-19. Conclusion Thus, tGSH and rCG can be seen as potential markers for the risk of severe COVID-19. GSH appears to be an important factor to oxidative damage prevention as infection progresses. This suggests the potential clinical efficacy of correcting glutathione metabolism as an adjunct therapy for COVID-19.
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Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19. Nutrients 2021; 13:nu13093293. [PMID: 34579171 PMCID: PMC8472175 DOI: 10.3390/nu13093293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The literature on nutrition and COVID-19 mainly focuses on the importance of nutrition to preserve life and prevent clinical deterioration during the acute phase of illness. However, there is a lack of information guiding practice across the whole patient journey (e.g., hospital to home) with a focus on targeting recovery (e.g., long COVID). This review paper is of relevance to doctors and other healthcare professionals in acute care and primary care worldwide, since it addresses early, multi-modal individualised nutrition interventions across the continuum of care to improve COVID-19 patient outcomes. It is of relevance to nutrition experts and non-nutrition experts and can be used to promote inter-professional and inter-organisational knowledge transfer on the topic. The primary goal is to prevent complications and support recovery to enable COVID-19 patients to achieve the best possible nutritional, physical, functional and mental health status and to apply the learning to date from the COVID-19 pandemic to other patient groups experiencing acute severe illness.
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Li X, van Geffen J, van Weele M, Zhang X, He Y, Meng X, Timofeeva M, Campbell H, Dunlop M, Zgaga L, Theodoratou E. An observational and Mendelian randomisation study on vitamin D and COVID-19 risk in UK Biobank. Sci Rep 2021; 11:18262. [PMID: 34521884 PMCID: PMC8440633 DOI: 10.1038/s41598-021-97679-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
A growing body of evidence suggests that vitamin D deficiency has been associated with an increased susceptibility to viral and bacterial respiratory infections. In this study, we aimed to examine the association between vitamin D and COVID-19 risk and outcomes. We used logistic regression to identify associations between vitamin D variables and COVID-19 (risk of infection, hospitalisation and death) in 417,342 participants from UK Biobank. We subsequently performed a Mendelian Randomisation (MR) study to look for evidence of a causal effect. In total, 1746 COVID-19 cases (399 deaths) were registered between March and June 2020. We found no significant associations between COVID-19 infection risk and measured 25-OHD levels after adjusted for covariates, but this finding is limited by the fact that the vitamin D levels were measured on average 11 years before the pandemic. Ambient UVB was strongly and inversely associated with COVID-19 hospitalization and death overall and consistently after stratification by BMI and ethnicity. We also observed an interaction that suggested greater protective effect of genetically-predicted vitamin D levels when ambient UVB radiation is stronger. The main MR analysis did not show that genetically-predicted vitamin D levels are causally associated with COVID-19 risk (OR = 0.77, 95% CI 0.55-1.11, P = 0.160), but MR sensitivity analyses indicated a potential causal effect (weighted mode MR: OR = 0.72, 95% CI 0.55-0.95, P = 0.021; weighted median MR: OR = 0.61, 95% CI 0.42-0.92, P = 0.016). Analysis of MR-PRESSO did not find outliers for any instrumental variables and suggested a potential causal effect (OR = 0.80, 95% CI 0.66-0.98, p-val = 0.030). In conclusion, the effect of vitamin D levels on the risk or severity of COVID-19 remains controversial, further studies are needed to validate vitamin D supplementation as a means of protecting against worsened COVID-19.
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Affiliation(s)
- Xue Li
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jos van Geffen
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Michiel van Weele
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Xiaomeng Zhang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Yazhou He
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Xiangrui Meng
- Vanke School of Public Health, Tsinghua University, Beijing, 10084, China
| | - Maria Timofeeva
- Colon Cancer Genetics Group, Cancer Research UK Edinburgh Centre and Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- DIAS, Danish Institute for Advanced Study, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Malcolm Dunlop
- Colon Cancer Genetics Group, Cancer Research UK Edinburgh Centre and Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Lina Zgaga
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Republic of Ireland.
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland.
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Fan L, Zhu X, Zheng Y, Zhang W, Seidner DL, Ness R, Murff HJ, Yu C, Huang X, Shrubsole MJ, Hou L, Dai Q. Magnesium treatment on methylation changes of transmembrane serine protease 2 (TMPRSS2). Nutrition 2021; 89:111340. [PMID: 34116393 PMCID: PMC8102075 DOI: 10.1016/j.nut.2021.111340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The viral entry of SARS-CoV-2 requires host-expressed TMPRSS2 to facilitate the viral spike protein priming. This study aims to test the hypothesis that magnesium (Mg) treatment leads to DNA methylation changes in TMPRSS2. METHODS This study is nested within the Personalized Prevention of Colorectal Cancer Trial, a double-blind 2 × 2 factorial randomized controlled trial, which enrolled 250 participants from Vanderbilt University Medical Center. RESULTS We found that 12 wk of personalized Mg treatment significantly increased 5-methylcytosine methylation at cg16371860 (TSS1500, promoter) by 7.2% compared to the placebo arm (decreased by 0.1%) in those ages < 65 y. The difference remained statistically significant after adjusting for age, sex, and baseline methylation as well as correction for false discovery rate (adjusted P = 0.014). Additionally, Mg treatment significantly reduced 5-hydroxymethylcytosine levels at cg26337277 (close proximity to TSS200 and the 5' untranslated region, promoter) by 2.3% compared to an increase of 7.1% in the placebo arm after adjusting for covariates in those ages < 65 y (P = 0.003). The effect remained significant at a false discovery rate of 0.10 (adjusted P = 0.088). CONCLUSIONS Among individuals ages < 65 y with calcium-to-magnesium intake ratios equal to or over 2.6, reducing the ratio to around 2.3 increased 5-methylcytosine modifications (i.e., cg16371860) and reduced 5-hydroxymethylcytosine modifications (i.e., cg26337277) in the TMPRSS2 gene. These findings, if confirmed, provide another mechanism for the role of Mg intervention in the prevention of COVID-19 and treatment of early and mild disease by modifying the phenotype of the TMPRSS2 genotype.
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Affiliation(s)
- Lei Fan
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Xiangzhu Zhu
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Wei Zhang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Douglas L Seidner
- Center for Human Nutrition, Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Reid Ness
- Department of Medicine, Division of Gastroenterology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Harvey J Murff
- Division of Geriatric Medicine, General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chang Yu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Xiang Huang
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martha J Shrubsole
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Qi Dai
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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268
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Harvey NC, Cooper C, Raisi-Estabragh Z. Vitamin D and COVID-19 disease: don't believe everything you read in the papers! Reply to Dr William B. Grant. Aging Clin Exp Res 2021; 33:2639-2641. [PMID: 34387839 PMCID: PMC8363087 DOI: 10.1007/s40520-021-01957-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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269
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Harvey NC, Cooper C, Raisi-Estabragh Z. Vitamin D supplementation and COVID-19 disease: safety but unproven efficacy-reply to Dr Helga Rhein. Aging Clin Exp Res 2021; 33:2635-2636. [PMID: 34406642 PMCID: PMC8371426 DOI: 10.1007/s40520-021-01947-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Zahra Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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270
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Mainak Banerjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, 700020, India
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271
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Soliman AR, Abdelaziz TS, Fathy A. Impact of Vitamin D Therapy on the Progress COVID-19: Six Weeks Follow-Up Study of Vitamin D Deficient Elderly Diabetes Patients. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [PMCID: PMC9198671 DOI: 10.1177/20101058211041405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) is an ongoing pandemic causing considerable fatalities worldwide. Vitamin D modulates the immune response through effects on various cells, such as: macrophages, B and T lymphocytes, neutrophils, and dendritic cells. Aim To explore whether supplementation of vitamin D, in the form of a single intramuscular cholecalciferol injection, to patients with diabetes, COVID-19, and low vitamin D levels could improve the prognosis of those patients. Methods This was a placebo-controlled randomized prospective study. The study has two arms as follows: the intervention arm (40 vitamin D deficient diabetes elderly patients that acquired SARS-CoV-2), compared to the control arm (16 elderly diabetes patients, with deficient vitamin D with SARS-CoV-2). Patients in the intervention arm were given vitamin D as a single intramuscular injection (200,000 IU); patients in the control arm were given placebo. The primary outcome was mortality within 6 weeks of the diagnosis of COVID-19. Clinical, laboratory, treatment, and outcome data were recorded after 6 weeks of follow-up. Results No significant difference in 6 weeks mortality was observed between patients who received vitamin D and patients who received placebo (17.5% vs 18.8%, p = 0.838). Age, presence of hypertension, and chronic obstructive pulmonary disease were independent predictors of mortality at 6 weeks. Conclusion Vitamin D supplementation did not reduce the severity or mortality of COVID-19 at 6 weeks. Further large scale studies are required to explore the effect of vitamin D therapy on survival in patients with diabetes mellitus who acquire COVID-19.
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Affiliation(s)
- Amin R. Soliman
- Internal Medicine Department, Kasr al Ainy School of Medicine Cairo University, Egypt
| | - Tarek Samy Abdelaziz
- Internal Medicine Department, Kasr al Ainy School of Medicine Cairo University, Egypt
| | - Ahmed Fathy
- Internal Medicine Department, Kasr al Ainy School of Medicine Cairo University, Egypt
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272
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Lira ACD, Silva APD, Diniz MV, Nascimento AVD, Silva WRCD, Pereira CLD, Rodrigues ML, Campelo Júnior EDB, Lima K. Vitamin D levels and SARS-CoV-2 assay results in health care workers in Brazil. Rev Assoc Med Bras (1992) 2021; 67:1226-1228. [DOI: 10.1590/1806-9282.20210726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Kledoaldo Lima
- Universidade Federal de Pernambuco, Brazil; Instituto de Medicina Integral Professor Fernando Figueira, Brazil
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273
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Leech C, Hartley E, Pillai P, Holmes M, Jones K, Darbyshire D. Emergency Medicine Journal COVID-19 monthly top five. Emerg Med J 2021; 38:398-400. [PMID: 34449414 DOI: 10.1136/emermed-2021-211498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Caroline Leech
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Edward Hartley
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Priyanka Pillai
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marius Holmes
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Karen Jones
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Daniel Darbyshire
- Health Innovation One, Lancaster University Lancaster Medical School, Lancaster, UK.,Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK
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274
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Tomasa-Irriguible TM, Bielsa-Berrocal L, Bordejé-Laguna L, Tural-Llàcher C, Barallat J, Manresa-Domínguez JM, Torán-Monserrat P. Low Levels of Few Micronutrients May Impact COVID-19 Disease Progression: An Observational Study on the First Wave. Metabolites 2021; 11:metabo11090565. [PMID: 34564381 PMCID: PMC8467487 DOI: 10.3390/metabo11090565] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
We report an observational study performed between March and May 2020 in a Spanish university hospital during the SARS-CoV-2 pandemic. The main objective was to analyse the association between the levels of micronutrients in severe COVID-19 patients and their outcome. Adult patients with a positive polymerase-chain-reaction (PCR) for SARS-CoV-2 in the nasopharyngeal swab or in tracheal aspirate culture in the case of intubation were included. Micronutrient data were obtained from plasma analysis of a standard nutritional assessment performed within the first 24 h of hospital admission. Vitamins A, B6, C and E were analysed with HPLC methods; 25-OH-vitamin D by immunoassay and zinc by colorimetric measurements. One hundred and twenty patients were included. We found that 74.2% patients had low levels of zinc (normal levels >84 µg/dL) with a mean value of 63.5 (SD 13.5); 71.7% patients had low levels of vitamin A (normal levels >0.3 mg/L) with a mean value of 0.17 (SD 0.06); 42.5% patients had low levels of vitamin B6 (normal levels >3.6 ng/mL) with a mean value of 2.2 (SD 0.9); 100% patients had low levels of vitamin C (normal levels >0.4 mg/dL) with a mean value of 0.14 (SD 0.05); 74.3% patients had low values of vitamin D (normal levels >20 ng/mL) with mean value of 11.4 (SD 4.3); but only 5.8% of patients had low levels of vitamin E (normal levels >5 mg/L) with a mean value of 3.95 (SD 0.87). The variables associated with the need for ICU admission were low levels of zinc (standard error 0.566, 95% CI 0.086 to 0.790, p = 0.017), low levels of vitamin A (standard error 0.582, 95% CI 0.061 to 0.594, p = 0.004), age over 65 (standard error 0.018, 95% CI 0.917 to 0.985, p = 0.005) and male gender (standard error 0.458, 95% CI 1.004 to 6.040, p = 0.049). The only variable that was independently associated with the need for orotracheal intubation was low levels of vitamin A (standard error 0.58, 95% CI 0.042 to 0.405, p = 0.000). Conclusions: Low levels of vitamin A and zinc are associated with a greater need for admission to the ICU and orotracheal intubation. Patients older than 65 years had higher mortality. Randomized clinical trials are needed to examine whether micronutrient supplementation could be beneficial as an adjunctive treatment in COVID-19.
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Affiliation(s)
- Teresa-Maria Tomasa-Irriguible
- Intensive Care Unit, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (L.B.-B.); (L.B.-L.)
- Correspondence:
| | - Lara Bielsa-Berrocal
- Intensive Care Unit, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (L.B.-B.); (L.B.-L.)
| | - Luisa Bordejé-Laguna
- Intensive Care Unit, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (L.B.-B.); (L.B.-L.)
| | - Cristina Tural-Llàcher
- Internal Medicine Department, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Jaume Barallat
- Biochemical Department, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Josep-Maria Manresa-Domínguez
- North Metropolitan Research Support Unit, Jordi Gol i Gurina Foundation Institute for Research in Primary Health Care (IDIAPJGol), 08303 Mataró, Spain; (J.-M.M.-D.); (P.T.-M.)
| | - Pere Torán-Monserrat
- North Metropolitan Research Support Unit, Jordi Gol i Gurina Foundation Institute for Research in Primary Health Care (IDIAPJGol), 08303 Mataró, Spain; (J.-M.M.-D.); (P.T.-M.)
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275
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Which ones, when and why should renin-angiotensin system inhibitors work against COVID-19? Adv Biol Regul 2021; 81:100820. [PMID: 34419773 PMCID: PMC8359569 DOI: 10.1016/j.jbior.2021.100820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022]
Abstract
The article describes the possible pathophysiological origin of COVID-19 and the crucial role of renin-angiotensin system (RAS), providing several “converging” evidence in support of this hypothesis. SARS-CoV-2 has been shown to initially upregulate ACE2 systemic activity (early phase), which can subsequently induce compensatory responses leading to upregulation of both arms of the RAS (late phase) and consequently to critical, advanced and untreatable stages of COVID-19 disease. The main and initial actors of the process are ACE2 and ADAM17 zinc-metalloproteases, which, initially triggered by SARS-CoV-2 spike proteins, work together in increasing circulating Ang 1–7 and Ang 1–9 peptides and downstream (Mas and Angiotensin type 2 receptors) pathways with anti-inflammatory, hypotensive and antithrombotic activities. During the late phase of severe COVID-19, compensatory secretion of renin and ACE enzymes are subsequently upregulated, leading to inflammation, hypertension and thrombosis, which further sustain ACE2 and ADAM17 upregulation. Based on this hypothesis, COVID-19-phase-specific inhibition of different RAS enzymes is proposed as a pharmacological strategy against COVID-19 and vaccine-induced adverse effects. The aim is to prevent the establishment of positive feedback-loops, which can sustain hyperactivity of both arms of the RAS independently of viral trigger and, in some cases, may lead to Long-COVID syndrome.
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276
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Hill A, Elke G, Weimann A. Nutrition in the Intensive Care Unit-A Narrative Review. Nutrients 2021; 13:nu13082851. [PMID: 34445010 PMCID: PMC8400249 DOI: 10.3390/nu13082851] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care and Anesthesiology, University Hospital RWTH Aachen University, D-52074 Aachen, Germany
- Correspondence: (A.H.); (A.W.); Tel.: +49-(0)241-80-38166 (A.H.); +49-(0)341-909-2200 (A.W.)
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany;
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Surgical Intensive Care Unit, Klinikum St. Georg, D-04129 Leipzig, Germany
- Correspondence: (A.H.); (A.W.); Tel.: +49-(0)241-80-38166 (A.H.); +49-(0)341-909-2200 (A.W.)
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277
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Filippatos F, Tatsi EB, Michos A. Immune response to SARS-CoV-2 in children: A review of the current knowledge. Pediatr Investig 2021; 5:217-228. [PMID: 34540321 PMCID: PMC8441939 DOI: 10.1002/ped4.12283] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
Host immune responses to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), especially in children, are still under investigation. Children with coronavirus disease 2019 (COVID‐19) constitute a significant study group of immune responses as they rarely present with severe clinical manifestations, require hospitalization, or develop complications such as multisystem inflammatory syndrome in children (MIS‐C) associated with SARS‐CoV‐2 infection. The deciphering of children’s immune responses during COVID‐19 infection will provide information about the protective mechanisms, while new potential targets for future therapies are likely to be revealed. Despite the limited immunological studies in children with COVID‐19, this review compares data between adults and children in terms of innate and adaptive immunity to SARS‐CoV‐2, discusses the possible reasons why children are mostly asymptomatic, and highlights unanswered or unclear immunological issues. Current evidence suggests that the activity of innate immunity seems to be crucial to the early phases of SARS‐CoV‐2 infection and adaptive memory immunity is vital to prevent reinfection. Despite the limited immunological studies from children with COVID‐19, this review compares data between adults and children in terms of innate and adaptive immunity to SARS‐CoV‐2, discusses the possible reasons why children are mostly asymptomatic, and highlights unanswered or unclear immunological issues.
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Affiliation(s)
- Filippos Filippatos
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School National and Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Elizabeth-Barbara Tatsi
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School National and Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Athanasios Michos
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School National and Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
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278
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Güven M, Gültekin H. Association of 25-Hydroxyvitamin D Level with COVID-19-Related in-Hospital Mortality: A Retrospective Cohort Study. J Am Coll Nutr 2021; 41:577-586. [PMID: 34370620 DOI: 10.1080/07315724.2021.1935361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The primary aim of this study was to compare the 25(OH)D level between patients with COVID-19 and the reference population. The secondary aim was to determine the association of 25(OH)D level with COVID-19-related in-hospital mortality. METHODS The COVID-19-positive group comprised 520 hospitalized patients and the reference population comprised 15,789 COVID-19-negative patients. The 25(OH)D level was categorized as vitamin D deficiency (25[OH]D < 20 ng/mL) and severe vitamin D deficiency (25[OH]D < 12 ng/mL). RESULTS While the incidence of vitamin D deficiency was similar in both groups, the incidence of severe vitamin D deficiency was higher in patients with COVID-19 than in the reference population (68.3% [n = 355] vs. 55.1% [n = 8,692], p < 0.001). Severe vitamin D deficiency in patients with COVID-19 was higher in the intensive care unit (ICU) group than in the non-ICU group (75.3% [n = 183] vs. 62% [n = 172], p = 0.001). The incidence of severe vitamin D deficiency was 65.4% (n = 280) in survivors and 81.5% (n = 75) in nonsurvivors (p = 0.003). However, multivariable Cox proportional hazard regression analysis showed no relationship between 25(OH)D level and in-hospital mortality. The median survival times of patients with and without severe vitamin D deficiency were not different, as shown by Kaplan-Meier survival analysis. CONCLUSION Severe vitamin D deficiency is more common in patients with COVID-19 and may play a significant role in worsening the prognosis of these patients. However, the 25(OH)D level was not observed to effect COVID-19-related in-hospital mortality.
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Affiliation(s)
- Mehmet Güven
- Department of Endocrinology and Metabolism, Şırnak State Hospital, Şırnak, Turkey
| | - Hamza Gültekin
- Department of Intensive Care Unit, Şırnak State Hospital, Şırnak, Turkey
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279
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Daei Sorkhabi A, Sarkesh A, Daei Sorkhabi A, Entezari-Maleki T, Rashedi J, Bannazadeh Baghi H. Vitamin supplementation as a potential adjunctive therapeutic approach for COVID-19: biological and clinical plausibility. J Basic Clin Physiol Pharmacol 2021; 33:55-77. [PMID: 34380185 DOI: 10.1515/jbcpp-2021-0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/17/2021] [Indexed: 12/11/2022]
Abstract
The recent pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Disease 2019 (COVID-19) has introduced itself into the human population in the 21st century after the coronavirus diseases SARS-CoV and Middle East respiratory syndrome (MERS-CoV). Major investigations are underway worldwide in the search for pharmaceutical interventions for COVID-19 and many agents are administered in off-label routes. Several cases are under study to check or restrict clinical manifestations of COVID-19. According to the fact that the efficacy of some micro-nutrients like vitamins is proven to treat or prevent infectious diseases because of their antimicrobial and immunomodulatory activity, the potential role of vitamins in the COVID-19 treatment or prevention must be considered.
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Affiliation(s)
- Amin Daei Sorkhabi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aila Sarkesh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Daei Sorkhabi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalil Rashedi
- Department of Laboratory Sciences, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
The COVID-19 pandemic has generated high interest in factors modulating risk of infection, disease severity and recovery. Vitamin D has received interest since it is known to modulate immune function and vitamin D deficiency is associated with increased risk of respiratory infections and adverse health outcomes in severely ill patients. There are no population representative data on the direct relationship between vitamin D status and SARS-CoV-2 infection risk and severity of COVID-19. Data from intervention studies are limited to 4 studies. Here we summarise findings regarding vitamin D status and metabolism and their alterations during severe illness, relevant to COVID-19 patients. Further, we summarise vitamin D intervention studies with respiratory disease outcomes and in critically ill patients and provide an overview of relevant patient and population guidelines. Vitamin D deficiency is highly prevalent in hospitalised patients, particularly when critically ill including those with COVID-19. Acute and critical illness leads to pronounced changes in vitamin D metabolism and status, suggestive of increased requirements. This needs to be considered in the interpretation of potential links between vitamin D status and disease risk and severity and for patient management. There is some evidence that vitamin D supplementation decreases the risk of respiratory tract infections, while supplementation of ICU patients has shown little effect on disease severity or length of treatment. Considering the high prevalence of deficiency and low risks associated with supplementation, pro-actively applying current population and patient management guidelines to prevent, monitor and correct vitamin D deficiency is appropriate.
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Reis BZ, Fernandes AL, Sales LP, Santos MD, dos Santos CC, Pinto AJ, Goessler KF, Franco AS, Duran CSC, Silva CBR, Macêdo MB, Dalmolin HHH, Baggio J, Balbi GGM, Antonangelo L, Caparbo VF, Gualano B, Murai IH, Pereira RMR. Influence of vitamin D status on hospital length of stay and prognosis in hospitalized patients with moderate to severe COVID-19: a multicenter prospective cohort study. Am J Clin Nutr 2021; 114:598-604. [PMID: 34020451 PMCID: PMC8194634 DOI: 10.1093/ajcn/nqab151] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/09/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vitamin D acts as a mediator in the immune system regulating antiviral mechanisms and inflammatory processes. Vitamin D insufficiency has been suggested as a potential risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, although its impact on the prognosis of hospitalized patients with coronavirus disease 2019 (COVID-19) remains unclear. OBJECTIVE This multicenter prospective cohort study was designed to investigate whether serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with hospital length of stay and prognosis in hospitalized patients with COVID-19. METHODS Patients with moderate to severe COVID-19 (n = 220) were recruited from 2 hospitals in Sao Paulo, Brazil. Serum 25(OH)D concentrations were categorized as follows: <10 ng/mL, 10 to <20 ng/mL, 20 to <30 ng/mL, and ≥30 ng/mL, and <10 ng/mL and ≥10 ng/mL. The primary outcome was hospital length of stay and the secondary outcomes were the rate of patients who required invasive mechanical ventilation and mortality. RESULTS There were no significant differences in hospital length of stay when the 4 25(OH)D categories were compared (P = 0.120). Patients exhibiting 25(OH)D <10 ng/mL showed a trend (P = 0.057) for longer hospital length of stay compared with those with 25(OH)D ≥10 ng/mL [9.0 d (95% CI: 6.4, 11.6 d) vs. 7.0 d (95% CI: 6.6, 7.4 d)]. The multivariable Cox proportional hazard models showed no significant associations between 25(OH)D and primary or secondary outcomes. CONCLUSIONS Among hospitalized patients with moderate to severe COVID-19, those with severe 25(OH)D deficiency (<10 ng/mL) exhibited a trend for longer hospital length of stay compared with patients with higher 25(OH)D concentrations. This association was not significant in the multivariable Cox regression model. Prospective studies should test whether correcting severe 25(OH)D deficiency could improve the prognosis of patients with COVID-19.
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Affiliation(s)
- Bruna Z Reis
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alan L Fernandes
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas P Sales
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mayara D Santos
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Caroline C dos Santos
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana J Pinto
- Applied Physiology and Nutrition Research Group, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Karla F Goessler
- Applied Physiology and Nutrition Research Group, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andre S Franco
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camila SC Duran
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla BR Silva
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina B Macêdo
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Henrique HH Dalmolin
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Janaína Baggio
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guilherme GM Balbi
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leila Antonangelo
- Clinical Pathology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria F Caparbo
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Food Research Center, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Igor H Murai
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa MR Pereira
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Address correspondence to RMRP (e-mail: )
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282
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Menshawey E, Menshawey R, Nabeh OA. Shedding light on vitamin D: the shared mechanistic and pathophysiological role between hypovitaminosis D and COVID-19 risk factors and complications. Inflammopharmacology 2021; 29:1017-1031. [PMID: 34185200 PMCID: PMC8239482 DOI: 10.1007/s10787-021-00835-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus (SARS-COV-2) is the culprit of the Coronavirus Disease (COVID-19), which has infected approximately 173 million people and killed more than 3.73 million. At risk groups including diabetic and obese patients are more vulnerable to COVID-19-related complications and poor outcomes. Substantial evidence points to hypovitaminosis D as a risk factor for severe disease, the need for ICU, and mortality. 1,25(OH)D, a key regulator of calcium homeostasis, is believed to have various immune-regulatory roles including; promoting anti-inflammatory cytokines, down regulating pro-inflammatory cytokines, dampening entry and replication of SARS-COV-2, and the production of antimicrobial peptides. In addition, there are strong connections which suggest that dysregulated 1,25(OH)D levels play a mechanistic and pathophysiologic role in several disease processes that are shared with COVID-19 including: diabetes, obesity, acute respiratory distress syndrome (ARDS), cytokine storm, and even hypercoagulable states. With evidence continuing to grow for the case that low vitamin D status is a risk factor for COVID-19 disease and poor outcomes, there is a need now to address the public health efforts set in place to minimize infection, such as lock down orders, which may have inadvertently increased hypovitaminosis D in the general population and those already at risk (elderly, obese, and disabled). Moreover, there is a need to address the implications of this evidence and how we may apply the use of cheaply available supplementation, which has yet to overcome the near global concern of hypovitaminosis D. In our review, we exhaustively scope these shared pathophysiologic connections between COVID-19 and hypovitaminosis D.
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Affiliation(s)
- Esraa Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Rahma Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Omnia Azmy Nabeh
- Faculty of Medicine, Department of Medical Pharmacology, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
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283
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Alves M, Fernandes MA, Bahat G, Benetos A, Clemente H, Grodzicki T, Martínez-Sellés M, Mattace-Raso F, Rajkumar C, Ungar A, Werner N, Strandberg TE. Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications. Eur Geriatr Med 2021; 12:725-739. [PMID: 34031865 PMCID: PMC8143992 DOI: 10.1007/s41999-021-00504-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/15/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. METHODS We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. RESULTS Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. CONCLUSIONS Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.
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Affiliation(s)
- Mariana Alves
- Faculty of Medicine, Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Serviço de Medicina III, Hospital Pulido Valente, CHULNUniversity of LisbonUniversidade de Lisboa, Lisbon, Portugal
| | - Marília Andreia Fernandes
- Department of Internal Medicine, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gülistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Athanase Benetos
- Department of Geriatrics and FHU CARTAGE-PROFILES, CHRU de Nancy and INSERM 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Hugo Clemente
- Department of Geriatrics, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBER-CV. Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Andrea Ungar
- Department of Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Nikos Werner
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Timo E Strandberg
- Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, N00029, Helsinki, Finland.
- University of Oulu, Center for Life Course Health Research, Oulu, Finland.
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284
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George CH, Alexander SPH, Cirino G, Insel PA, Izzo AA, Ji Y, Kendall DA, Panettieri RA, Patel HH, Sobey CG, Stanford SC, Stefanska B, Stephens G, Teixeira M, Ahluwalia A. Editorial policy regarding the citation of preprints in the British Journal of Pharmacology (BJP). Br J Pharmacol 2021; 178:3605-3610. [PMID: 34328225 DOI: 10.1111/bph.15589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | | | - Paul A Insel
- University of California, San Diego, California, USA
| | | | - Yong Ji
- Nanjing Medical University, Nanjing, China
| | | | | | - Hemal H Patel
- University of California, San Diego, California, USA
| | | | | | | | | | - Mauro Teixeira
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amrita Ahluwalia
- William Harvey Research Institute, Queen Mary University of London, London, UK
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285
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Vitamin D supplementation for the treatment of COVID-19: Summary of a living Cochrane review. Explore (NY) 2021; 17:481-482. [PMID: 34294560 PMCID: PMC8236124 DOI: 10.1016/j.explore.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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286
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Taha R, Abureesh S, Alghamdi S, Hassan RY, Cheikh MM, Bagabir RA, Almoallim H, Abdulkhaliq A. The Relationship Between Vitamin D and Infections Including COVID-19: Any Hopes? Int J Gen Med 2021; 14:3849-3870. [PMID: 34335050 PMCID: PMC8318784 DOI: 10.2147/ijgm.s317421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
Abstract
Vitamin D is proposed to have a potential role in the pathogenicity, clinical presentation, prognosis, complications, and treatment of several diseases. In addition to its well-known role in calcium metabolism, vitamin D regulates both innate and adaptive immunity, and subsequently modulates the antiviral and antibacterial inflammatory immune responses. In view of the emerging coronavirus disease 2019 (COVID-19) pandemic, searching for potential therapeutic and protective strategies is of urgent interest, and vitamin D is one of the promising agents in this field. In this review, we present data from literature that supports the promising role of vitamin D in treatment and/or prevention of several infections including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes vitamin D metabolism and its role in inflammation, thrombosis and immune regulation. It also reviews, in short, the role of vitamin D and the impact of its deficiency in several infections namely tuberculosis, influenza, human immunodeficiency virus (HIV), and SARS-CoV-2. Considering the roles of vitamin D on immune modulation, controlling of thrombosis, and attacking several microorganisms, the current review will elaborate on the association between these salient roles of vitamin D and the pathogenicity of various infectious agents including COVID-19. Consequently, the comprehensive finding of the current review shows a possible significant impact of vitamin D supplement as a hope in preventing, treating, and/or improving the progression of certain infections, specifically during the worldwide attempts to fight against the COVID-19 pandemic and minimize the severity of health complications encountered accordingly. In addition, avoiding a status of vitamin D deficiency to obtain its positive effects on the immune system and its protective mechanism during infections will be a general benefit overall.
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Affiliation(s)
- Rbab Taha
- Department of Transplant Infectious Disease, University Health Network, Toronto, Ontario, Canada
| | - Shahd Abureesh
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Shuruq Alghamdi
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rola Y Hassan
- Department of Internal Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohamed M Cheikh
- Department of Internal Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
- Department of Medicine, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Rania A Bagabir
- Department of Immunology and Hematology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Alzaidi Chair of Research in Rheumatic Diseases, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Altaf Abdulkhaliq
- Department of Clinical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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287
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Güven M, Gültekin H. The effect of high-dose parenteral vitamin D 3 on COVID-19-related inhospital mortality in critical COVID-19 patients during intensive care unit admission: an observational cohort study. Eur J Clin Nutr 2021; 75:1383-1388. [PMID: 34302132 PMCID: PMC8299443 DOI: 10.1038/s41430-021-00984-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/24/2023]
Abstract
Background In many studies, vitamin D has been found to be low in COVID-19 patients. In this study, we aimed to investigate the relationship between clinical course and inhospital mortality with parenteral administration of high-dose vitamin D3 within the first 24 h of admission to patients who were hospitalized in the intensive care unit (ICU) because of COVID-19 with vitamin D deficiency. Methods This study included 175 COVID-19 patients with vitamin D deficiency [25(OH) D <12 ng/mL] who were hospitalized in the ICU. Vitamin D3 group (n = 113) included patients who received a single dose of 300,000 IU vitamin D3 intramuscularly. Vitamin D3 was not administered to the control group (n = 62). Results Median C-reactive protein level was 10.8 mg/dL in the vitamin D3 group and 10.6 mg/dL in the control group (p = 0.465). Thirty-nine percent (n = 44) of the patients in the vitamin D3 group were intubated endotracheally, and 50% (n = 31) of the patients in the control group were intubated endotracheally (p = 0.157). Parenteral vitamin D3 administration was not associated with inhospital mortality by multivariate logistic regression analysis. According to Kaplan–Meier survival analysis, the median survival time was 16 d in the vitamin D3 group and 17 d in the control group (log-rank test, p = 0.459). Conclusion In this study, which was performed for the first time in the literature, it was observed that high-dose parenteral vitamin D3 administration in critical COVID-19 patients with vitamin D deficiency during admission to the ICU did not reduce the need for intubation, length of hospital stay, and inhospital mortality.
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Affiliation(s)
- Mehmet Güven
- Department of Endocrinology and Metabolism, Şırnak State Hospital, Şırnak, Turkey.
| | - Hamza Gültekin
- Department of İntensive Care Unit, Şırnak State Hospital, Şırnak, Turkey
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288
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Giacalone A, Tovani-Palone MR, Marin L, Febbi M. Current Evidence on Vitamin C, D, and Zinc Supplementation for COVID-19 Prevention and/or Treatment. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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289
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Zgliczyński WS, Rostkowska OM, Sarecka-Hujar B. Vitamin D Knowledge, Attitudes and Practices of Polish Medical Doctors. Nutrients 2021; 13:2443. [PMID: 34371953 PMCID: PMC8308710 DOI: 10.3390/nu13072443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Vitamin D deficiency occurs in as much as 90-95% of the Polish population, although this condition is known to cause negative long-term health implications. The role of medical doctors in advising proper supplementation, monitoring and correcting the levels of 25-hydroxyvitamin D in individuals is of great importance and should be used to help mitigate its common deficits. The aim of this study was to evaluate knowledge, attitudes and practices of Polish physicians regarding vitamin D supplementation in order to identify areas for improvement and determinants for the knowledge gaps. Methods The study group comprised 701 medical doctors aged 32.1 ± 5.3 years on average, mostly women (71.61%). An original survey questionnaire was developed for the purpose of the study. Results The mean vitamin D knowledge score was 6.8 ± 2.3 (in a scale 0-13) and was related to gender (p < 0.001), type of specialization (p = 0.032), D3 supplements use (p < 0.001), recommending supplementation to patients (p = 0.005), to relatives and friends (p < 0.001) and to healthy adults (p < 0.001). In terms of self-administration, 14% of respondents take vitamin D all-year-round while 24% only in autumn and winter. 25% of respondents monitor their vitamin D (25-hydroxyvitamin D) serum concentration. Most participants (61%) did not recommend supplementing vitamin D to their patients on a regular basis. Conclusions The study indicates that medical doctors in Poland need to have more training and education on vitamin D supplementation in order to better address the problem of its deficits in the population.
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Affiliation(s)
- Wojciech Stefan Zgliczyński
- Center of Postgraduate Medical Education, Department of Lifestyle Medicine, School of Public Health, 01-826 Warsaw, Poland
| | - Olga Maria Rostkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland;
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland;
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290
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Werneke U, Gaughran F, Taylor DM. Vitamin D in the time of the coronavirus (COVID-19) pandemic - a clinical review from a public health and public mental health perspective. Ther Adv Psychopharmacol 2021; 11:20451253211027699. [PMID: 34290856 PMCID: PMC8274110 DOI: 10.1177/20451253211027699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Individuals with serious mental disorders (SMD) may have a higher risk of vitamin D (VIT-D) deficiency. They also experience higher mortality because of coronavirus disease 2019 (COVID-19) infection. Therefore, we have conducted a comprehensive review to examine the significance of VIT-D for public health and public mental health during the ongoing COVID-19 pandemic. This review had three specific aims, from a global perspective to (a) create a profile of VIT-D and review the epidemiology of VIT-D deficiency, (b) explore VIT-D deficiency as risk factor for SMD and COVID-19 infections and (c) examine the effectiveness of VIT-D supplementation for both conditions. We found that, in terms of SMD, the evidence from laboratory and observational studies points towards some association between VIT-D deficiency and depression or schizophrenia. Mendelian randomisation studies, however, suggest no, or reverse, causality. The evidence from intervention studies is conflicting. Concerning COVID-19 infection, on proof of principle, VIT-D could provide a plausible defence against the infection itself and against an adverse clinical course. But data from observational studies and the first preliminary intervention studies remain conflicting, with stronger evidence that VIT-D may mitigate the clinical course of COVID-19 infection rather than the risk of infection in the first place. From a public health and public mental health point of view, based on the currently limited knowledge, for individuals with SMD, the benefits of VIT-D optimisation through supplementation seem to outweigh the risks. VIT-D supplementation, however, should not substitute for vaccination or medical care for COVID-19 infection.
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Affiliation(s)
- Ursula Werneke
- Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College and National Psychosis Service, South London & the Maudsley NHS Foundation Trust, London, UK
| | - David M. Taylor
- Maudsley Hospital, Pharmacy Department Denmark Hill, King’s College London and Institute of Pharmaceutical Science, London, UK
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291
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Annweiler C, Mercat A, Souberbielle JC. Learning from previous methodological pitfalls to propose well-designed trials on vitamin D in COVID-19. J Steroid Biochem Mol Biol 2021; 211:105901. [PMID: 33864925 PMCID: PMC8045428 DOI: 10.1016/j.jsbmb.2021.105901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Cédric Annweiler
- University of Angers, UPRES EA 4638, France; Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France.
| | - Alain Mercat
- Department of Medical Intensive Care, University Hospital, Angers, France
| | - Jean-Claude Souberbielle
- Service des explorations fonctionnelles, hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
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292
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Rawat D, Roy A, Maitra S, Shankar V, Khanna P, Baidya DK. "Vitamin D supplementation and COVID-19 treatment: A systematic review and meta-analysis". Diabetes Metab Syndr 2021; 15:102189. [PMID: 34217144 PMCID: PMC8236412 DOI: 10.1016/j.dsx.2021.102189] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vitamin-D is an immune-modulator which might be linked to disease severity by SARS-CoV-2. METHODS Meta-analysis of RCTs and quasi-experimental studies, evaluating the role of vitamin-D supplementation in COVID patients was done. RESULTS Total 5 studies (3 RCTs and 2 Quasi-experimental) including n = 467 patients were included. Vitamin D didn't reduce mortality (RR 0.55, 95%CI 0.22 to 1.39, p = 0.21), ICU admission rates (RR 0.20, 95% CI 0.01-4.26, p = 0.3) and need for invasive ventilation (RR 0.24, 95% CI 0.01-7.89, p = 0.42). CONCLUSION No significant difference with vitamin-D supplementation on major health related outcomes in COVID-19. Well-designed RCTs are required addressing this topic.
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Affiliation(s)
- Dimple Rawat
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.
| | - Avishek Roy
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Vivek Shankar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - Puneet Khanna
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
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293
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Vitamin D and coronavirus disease 2019 (COVID-19): rapid evidence review. Aging Clin Exp Res 2021; 33:2031-2041. [PMID: 34118024 PMCID: PMC8195723 DOI: 10.1007/s40520-021-01894-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has re-ignited interest in the possible role of vitamin D in modulation of host responses to respiratory pathogens. Indeed, vitamin D supplementation has been proposed as a potential preventative or therapeutic strategy. Recommendations for any intervention, particularly in the context of a potentially fatal pandemic infection, should be strictly based on clinically informed appraisal of the evidence base. In this narrative review, we examine current evidence relating to vitamin D and COVID-19 and consider the most appropriate practical recommendations. OBSERVATIONS Although there are a growing number of studies investigating the links between vitamin D and COVID-19, they are mostly small and observational with high risk of bias, residual confounding, and reverse causality. Extrapolation of molecular actions of 1,25(OH)2-vitamin D to an effect of increased 25(OH)-vitamin D as a result of vitamin D supplementation is generally unfounded, as is the automatic conclusion of causal mechanisms from observational studies linking low 25(OH)-vitamin D to incident disease. Efficacy is ideally demonstrated in the context of adequately powered randomised intervention studies, although such approaches may not always be feasible. CONCLUSIONS At present, evidence to support vitamin D supplementation for the prevention or treatment of COVID-19 is inconclusive. In the absence of any further compelling data, adherence to existing national guidance on vitamin D supplementation to prevent vitamin D deficiency, predicated principally on maintaining musculoskeletal health, appears appropriate.
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294
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Prevalence of vitamin D deficiency and its prognostic impact on patients hospitalized with COVID-19. Nutrition 2021; 91-92:111408. [PMID: 34388589 PMCID: PMC8247197 DOI: 10.1016/j.nut.2021.111408] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023]
Abstract
Objectives: Although hypovitaminosis D appears to be highly prevalent in patients with coronavirus disease 2019 (COVID-19), its impact on their prognosis remains unclear. Methods: In this study, serum 25-hydroxyvitamin D (Vit-D) level was measured in 200 patients hospitalized with COVID-19. The association between Vit-D and the composite endpoint of intensive care unit (ICU) admission/in-hospital death was explored using univariable and multivariable analyses. Also, serum Vit-D level in patients with COVID-19 was compared with that in age- and sex-balanced COVID-19-negative controls (i.e., 50 inpatients with sepsis). Results: Serum Vit-D level was comparable between patients with COVID-19 and COVID-19-negative inpatients with sepsis (P = 0.397). No significant differences were found in serum Vit-D level according to COVID-19 severity at the time of hospital admission (P = 0.299). Incidence rates of the composite endpoint of ICU admission/in-hospital death did not differ significantly between patients with either Vit-D deficiency (i.e., Vit-D <20 ng/mL) or severe Vit-D deficiency (i.e., Vit-D <12 ng/mL) and those without (31% vs 35% with P = 0.649, and 34% vs 30% with P = 0.593, respectively). Vit-D level and status (i.e., Vit-D deficiency and severe Vit-D deficiency) were not prospectively associated with the risk of the composite endpoint of ICU admission/in-hospital death (P > 0.05 for all Cox regression models). Conclusions: Regardless of the potential usefulness of Vit-D measurement to guide appropriate supplementation, Vit-D does not appear to provide helpful information for the stratification of in-hospital prognosis in patients with COVID-19.
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295
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Abstract
PURPOSE OF REVIEW To summarize the recent evidence on the role of vitamin D deficiency in critically ill patients and emerging data claiming a role of vitamin D in COVID-19. RECENT FINDINGS Vitamin D is a strong predictor for worse outcomes in critically ill patients, and as well in COVID-19. The vitamin D content in typical nutrition regimes is lower than what is recommended for the general population. Although its supplementation has been shown to reduce respiratory tract infections, asthma exacerbations and mortality risk in noncritically ill patients, its role in the acute setting is not yet clear. Several small intervention trials have shown interesting results in COVID-19, and larger studies are ongoing. SUMMARY Although research on this topic is still ongoing, it appears reasonable to recommend at least the standard vitamin dose for the healthy population (600--800 IU of native vitamin D3). Many questions remain on the actual role, the best metabolite, regime, and so forth. However, the role for vitamin D in bone health is clear. Elderly ICU survivors have a high risk for osteoporosis/fractures, so at least in this population, an optimal vitamin D status should be targeted.
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296
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Crafa A, Cannarella R, Condorelli RA, Mongioì LM, Barbagallo F, Aversa A, La Vignera S, Calogero AE. Influence of 25-hydroxy-cholecalciferol levels on SARS-CoV-2 infection and COVID-19 severity: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100967. [PMID: 34179737 PMCID: PMC8215557 DOI: 10.1016/j.eclinm.2021.100967] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent of coronavirus disease 19 (COVID-19), a respiratory infection that, starting from December 2019, has spread around the world in a few months, becoming a pandemic. The lack of initial knowledge on its management has led to a great effort in developing vaccines and in finding therapeutic weapons capable of improving the clinical outcome of the affected patients. In particular, the possible role of vitamin D status in the management of COVID-19 has been widely analysed, resulting in a great amount of data. This systematic review and meta-analysis aimed to assess whether hypovitaminosis D is a risk factor for developing SARS-CoV-2 infection and whether it affects the worsening of the clinical course of COVID-19. METHODS Data were extracted through extensive searches in the Pubmed, MEDLINE, Cochrane, Academic One Files, Google Scholar, and Scopus databases from December 2019 to January 2021, using the keywords: "Vitamin D", "25 hydroxy Vitamin D", "25 hydroxycholecalciferol", "cholecalciferol", "COVID 19″, "SARS-CoV-2″. We included observational cohort, cross-sectional, and case-control studies that evaluated differences in serum levels of 25‑hydroxy-cholecalciferol [25(OH)D] in patients who were positive or negative for SARS-CoV-2, in patients with mild or severe forms of COVID-19, and in patients who died or were discharged from the hospital. Finally, studies that evaluated the risk of developing severe illness or death in patients with vitamin D deficiency (VDD), defined as levels of 25(OH)D <20 ng/ml, were also included. We calculated the mean difference (MD) and the 95% confidence intervals (CI) for quantitative variables such as 25(OH)D levels in patients with or without SARS-CoV-2 infection, in those with mild vs. severe COVID-19, or those who have died vs. those who have been discharged. Instead, we calculated odds ratios and 95% CI for qualitative ones, such as the number of patients with severe illness/death in the presence of VDD vs. those with normal serum 25(OH)D levels. A p-value lower than 0.05 was considered statistically significant. The study was registered on PROSPERO (CRD42021241473). FINDINGS Out of 662 records, 30 articles met inclusion criteria and, therefore, were included in the meta-analysis. We found that the serum levels of 25(OH)D were significantly lower in patients with SARS-CoV-2 infection than in negative ones [MD -3.99 (-5.34, -2.64); p <0.00001; I2= 95%]. Furthermore, its levels were significantly lower in patients with severe disease [MD -6.88 (-9.74, -4.03); p <0.00001; I2=98%] and in those who died of COVID-19 [MD -8.01 (-12.50, -3.51); p = 0.0005; I2=86%]. Finally, patients with VDD had an increased risk of developing severe disease [OR 4.58 (2.24, 9.35); p <0.0001; I2=84%] but not a fatal outcome [OR 4.92 (0.83, 29.31); p = 0.08; I2=94%]. INTERPRETATION This meta-analysis revealed a large heterogeneity of the studies included due to the different enrolment criteria of patient samples (age, body mass index, ethnicity, comorbidities), the country where they live, all factors influencing serum 25(OH)D levels, and the different criteria used to define the severity of COVID-19. Furthermore, the observational nature of these studies does not allow to establish a cause-effect relationship, even taking into account that 25(OH)D represents a marker of acute inflammation. Treatment with vitamin D might be considered for the primary prevention of SARS-CoV-2 infection and the management of patients with COVID-19. However, further intervention studies are needed to prove this hypothesis.
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Affiliation(s)
- Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Laura M. Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, Catanzaro, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia 78, Catania 95123, Italy
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297
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Abstract
The poor prognosis in patients with diabetes mellitus who contract COVID-19 urged physicians to question routine drug treatment for people with type 2 diabetes mellitus. What treatment should we prioritize? So far only observational studies are available, although complementary interventional studies are needed to address this issue.
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Affiliation(s)
- Samy Hadjadj
- l'institut du thorax, CNRS, INSERM, CHU Nantes, Université de Nantes, Nantes, France.
| | - Matthieu Wargny
- Clinique des données, INSERM CIC 1413, CHU Nantes, Nantes, France
- l'institut du thorax, CNRS, INSERM, CHU Nantes, Université de Nantes, Nantes, France
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298
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Hariyanto TI, Intan D, Hananto JE, Harapan H, Kurniawan A. Vitamin D supplementation and Covid‐19 outcomes: A systematic review, meta‐analysis and meta‐regression. Rev Med Virol 2021. [PMCID: PMC8420388 DOI: 10.1002/rmv.2269] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vitamin D has many protective properties and potential role against acute lung injury. Low serum vitamin D is associated with high risk of pneumonia and development of acute respiratory distress syndrome. This study sought to analyse the efficacy of vitamin D in improving the outcomes of coronavirus disease 2019 (Covid‐19) patients. Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC and ClinicalTrials.gov database until 8th May 2021. All published studies on Covid‐19 and vitamin D were retrieved. Statistical analysis was conducted using Review Manager 5.4 software. A total of 11 studies with 22,265 Covid‐19 patients were included in the meta‐analysis. Our data suggested that vitamin D supplementation was associated with reduction in intensive care unit admission rate (OR 0.27; 95% CI: 0.09–0.76, p = 0.010, I2 = 70%, random‐effect modelling); reduction of the need for mechanical ventilation (OR 0.34; 95% CI: 0.16–0.72, p = 0.005, I2 = 61%, random‐effect modelling) and reduction of mortality from Covid‐19 (OR 0.37; 95% CI: 0.21–0.66, p < 0.001, I2 = 50%, random‐effect modelling). Further analysis showed that the associations were influenced by age (p = 0.020). Our study suggests that vitamin D supplementation may offer beneficial effects on Covid‐19 outcomes. However, more randomized clinical trials are required to confirm this conclusion.
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Affiliation(s)
| | - Denny Intan
- Faculty of Medicine Pelita Harapan University Tangerang Indonesia
| | | | - Harapan Harapan
- Medical Research Unit School of Medicine Universitas Syiah Kuala Banda Aceh Indonesia
- Tropical Disease Center School of Medicine Universitas Syiah Kuala Banda Aceh Indonesia
- Department of Microbiology Universitas Syiah Kuala Banda Aceh Indonesia
| | - Andree Kurniawan
- Department of Internal Medicine Faculty of Medicine Pelita Harapan University Tangerang Indonesia
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299
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Antonelli M, Kushner I. Low Serum Levels of 25-Hydroxyvitamin D Accompany Severe COVID-19 Because it is a Negative Acute Phase Reactant. Am J Med Sci 2021; 362:333-335. [PMID: 34166653 PMCID: PMC8216860 DOI: 10.1016/j.amjms.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Maria Antonelli
- Division of Rheumatology, Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA.
| | - Irving Kushner
- Division of Rheumatology, Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
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300
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Quraishi SA, Bhan I, Matthay MA, Thompson BT, Camargo CA, Bajwa EK. Vitamin D Status and Clinical Outcomes in Acute Respiratory Distress Syndrome: A Secondary Analysis From the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) Trial. J Intensive Care Med 2021; 37:793-802. [PMID: 34165010 DOI: 10.1177/08850666211028139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a highly morbid condition that has limited therapeutic options. Optimal vitamin D status has been linked to immunological effects that may benefit critically ill patients. Therefore, we investigated whether admission 25-hydroxyvitamin D levels (25OHD) are associated with clinical outcomes in ARDS patients. METHODS We performed a secondary analysis of data from a randomized, controlled trial comparing oxygenation strategies in 549 patients with ARDS (NCT00000579). Baseline 25OHD was measured in stored plasma samples. We investigated the relationship between vitamin D status and ventilator-free days (VFD) as well as 90-day survival, using linear regression and Cox proportional hazard models, respectively. Analyses were adjusted for age, race, and Acute Physiology and Chronic Health Evaluation III score. RESULTS Baseline 25OHD was measured in 476 patients. 90% of these individuals had 25OHD <20 ng/ml and 40% had 25OHD <10 ng/ml. Patients with 25OHD <20 ng/ml were likely to be ventilated for 3 days longer than patients with levels ≥20 ng/ml (ß 3.41; 95%CI 0.42-6.39: P = 0.02). Patients with 25OHD <10 ng/ml were likely to be ventilated for 9 days longer (ß 9.27; 95%CI 7.24-11.02: P < 0.001) and to have a 34% higher risk of 90-day mortality (HR 1.34; 95% CI 1.06-1.71: P = 0.02) compared to patients with levels >10 ng/ml. CONCLUSIONS In patients with ARDS, vitamin D status is associated with duration of mechanical ventilation and 90-day mortality. Randomized, controlled trials are warranted to determine whether vitamin D supplementation improves clinical outcomes in ARDS patients.
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Affiliation(s)
- Sadeq A Quraishi
- Department of Anesthesiology and Perioperative Medicine, 1867Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Ishir Bhan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,10774Alnylam Pharmaceuticals Inc, Cambridge, MA, USA
| | - Michael A Matthay
- Department of Medicine, 8785University of California San Francisco, CA, USA
| | - Boyd T Thompson
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Ednan K Bajwa
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Merck & Co., Inc., Kenilworth, NJ, USA
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