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Ferrari F, Martins VM, Teixeira M, Santos RD, Stein R. COVID-19 and Thromboinflammation: Is There a Role for Statins? Clinics (Sao Paulo) 2021; 76:e2518. [PMID: 33787678 PMCID: PMC7955154 DOI: 10.6061/clinics/2021/e2518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease (COVID-19) showed increased morbidity and mortality rates and worse prognosis in individuals with underlying chronic diseases, especially cardiovascular disease and its risk factors, such as hypertension, diabetes, and obesity. There is also evidence of possible links among COVID-19, myocardial infarction, and stroke. Emerging evidence suggests a pro-inflammatory milieu and hypercoagulable state in patients with this infection. Despite anticoagulation, a large proportion of patients requiring intensive care may develop life-threatening thrombotic complications. Indeed, the levels of some markers of hemostatic activation, such as D-dimer, are commonly elevated in COVID-19, indicating potential risk of deep vein thrombosis and pulmonary thromboembolism. In this review, we critically examine and discuss aspects of hypercoagulability and inflammation in COVID-19 and the possible benefits of statins in this scenario, with emphasis on their underlying molecular mechanisms. Moreover, we present recommendations on the use of antiviral drugs in combination with statins.
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Affiliation(s)
- Filipe Ferrari
- Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | | | - Marcelo Teixeira
- Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Raul D. Santos
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Unidade Clinica de Lipides, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Stein
- Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- *Corresponding author. E-mail:
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252
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White-Dzuro G, Gibson LE, Zazzeron L, White-Dzuro C, Sullivan Z, Diiorio DA, Low SA, Chang MG, Bittner EA. Multisystem effects of COVID-19: a concise review for practitioners. Postgrad Med 2021; 133:20-27. [PMID: 32921198 PMCID: PMC7651182 DOI: 10.1080/00325481.2020.1823094] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023]
Abstract
While COVID-19 has primarily been characterized by the respiratory impact of viral pneumonia, it affects every organ system and carries a high consequent risk of death in critically ill patients. Higher sequential organ failure assessment (SOFA) scores have been associated with increased mortality in patients critically ill patients with COVID-19. It is important that clinicians managing critically ill COVID-19 patients be aware of the multisystem impact of the disease so that care can be focused on the prevention of end-organ injuries to potentially improve clinical outcomes. We review the multisystem complications of COVID-19 and associated treatment strategies to improve the care of critically ill COVID-19 patients.
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Affiliation(s)
- Gabrielle White-Dzuro
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Gibson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Luca Zazzeron
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Colin White-Dzuro
- School of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zachary Sullivan
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daren A. Diiorio
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah A. Low
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
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253
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Blood test dynamics in hospitalized COVID-19 patients: Potential utility of D-dimer for pulmonary embolism diagnosis. PLoS One 2020; 15:e0243533. [PMID: 33370304 PMCID: PMC7769556 DOI: 10.1371/journal.pone.0243533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A higher incidence of thrombotic events, mainly pulmonary embolism (PE), has been reported in hospitalized patients with COVID-19. The main objective was to assess clinical and laboratory differences in hospitalized COVID-19 patients according to occurrence of PE. METHODS This retrospective study included all consecutive patients hospitalized with COVID-19 who underwent a computed tomography (CT) angiography for PE clinical suspicion. Clinical data and median blood test results distributed into weekly periods from COVID-19 symptoms onset, were compared between PE and non-PE patients. RESULTS Ninety-two patients were included, 29 (32%) had PE. PE patients were younger (63.9 (SD 13.7) vs 69.9 (SD 12.5) years). Clinical symptoms and COVID-19 CT features were similar in both groups. PE was diagnosed after a mean of 20.0 (SD 8.6) days from the onset of COVID-19 symptoms. Corticosteroid boluses were more frequently used in PE patients (62% vs. 43%). No patients met ISTH DIC criteria. Any parameter was statistically significant or clinically relevant except for D-Dimer when comparing both groups. Median values [IQR] of D-dimer in PE vs non-PE patients were: week 2 (2010.7 [770.1-11208.9] vs 626.0 [374.0-2382.2]; p = 0.004); week 3 (3893.1 [1388.2-6694.0] vs 1184.4 [461.8-2447.8]; p = 0.003); and week 4 (2736.3 [1202.1-8514.1] vs 1129.1 [542.5-2834.6]; p = 0.01). Median fold-increase of D-dimer between week 1 and 2 differed between groups (6.64 [3.02-23.05] vs 1.57 [0.64-2.71], p = 0.003); ROC curve AUC was 0.879 (p = 0.003) with a sensitivity and specificity for PE of 86% and 80%, respectively. CONCLUSIONS Among hospitalized COVID-19 patients, D-dimer levels are higher at weeks 2, 3 and 4 after COVID-19 symptom onset in patients who develop PE. This difference is more pronounced when the fold increase between weeks 1 and 2 is compared.
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254
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Otuonye NM, Olumade TJ, Ojetunde MM, Holdbrooke SA, Ayoola JB, Nyam IY, Iwalokun B, Onwuamah C, Uwandu M, Abayomi A, Osibogun A, Bowale A, Osikomaiya B, Thomas B, Mutiu B, Odunukwe NN. Clinical and Demographic Characteristics of COVID-19 patients in Lagos, Nigeria: A Descriptive Study. J Natl Med Assoc 2020; 113:301-306. [PMID: 33358220 PMCID: PMC7759120 DOI: 10.1016/j.jnma.2020.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022]
Abstract
Introduction COVID-19 is an emerging, rapidly evolving global situation, infecting over 25 million people and causing more than 850,000 deaths. Several signs and symptoms have been described to be characteristic of the disease. However, there is a dearth of report on the description of the clinical characteristics of the disease in patients from Nigeria. This study was designed to provide a description of the clinical and demographic characteristics of COVID-19 patients in Nigeria. Methods This study is a case series that includes patients that are evaluated between May and August 2020, and diagnosed with COVID-19. Patient health records were reviewed and evaluated to describe the clinical characteristics on presentation. Results A total of 154 COVID-19 patients were included in this study, with a mean age (S.D.) of 46.16 (13.701). Most of the patients survived (mortality rate of 2.6%), and were symptomatic (89.6%). There were more males (74.7%) than females, and the most common symptoms were fever, breathing difficulty, dry cough and malaise. Co-morbidities were also present in almost half of the study participants (49.4%). Conclusion This study presents the most extensive description, to date, on the clinical and demographic characteristics of COVID-19 patients in Nigeria. Males are more likely than females to be infected with COVID-19 and the most occurring symptoms are fever, breathing difficulty, malaise, dry cough and chest pain. Old age and the presence of co-morbidities may also be associated with developing the severe disease.
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Affiliation(s)
| | - Testimony Jesupamilerin Olumade
- Department of Biological Sciences, Redeemer's University, Ede, Osun state; African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun state
| | | | | | | | - Itse Yusuf Nyam
- Central Research Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Bamidele Iwalokun
- Molecular Biological and Biotechnology Department, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Chika Onwuamah
- Centre for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Mabel Uwandu
- Centre for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Akinola Abayomi
- Lagos State Ministry of Health, Alausa, Ikeja, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine University of Lagos, Nigeria; Lagos State Primary Health Care Board, Lagos, Nigeria
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255
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Aisyah DN, Mayadewi CA, Diva H, Kozlakidis Z, Siswanto, Adisasmito W. A spatial-temporal description of the SARS-CoV-2 infections in Indonesia during the first six months of outbreak. PLoS One 2020; 15:e0243703. [PMID: 33351801 PMCID: PMC7755207 DOI: 10.1371/journal.pone.0243703] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the first cases reported in Wuhan, China, in December 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide. In Indonesia, the first case was reported in early March 2020, and the numbers of confirmed infections have been increasing until now. Efforts to contain the virus globally and in Indonesia are ongoing. This is the very first manuscript using a spatial-temporal model to describe the SARS-CoV-2 transmission in Indonesia, as well as providing a patient profile for all confirmed COVID-19 cases. METHOD Data was collected from the official website of the Indonesia National Task Force for the Acceleration of COVID-19, from the period of 02 March 2020-02 August 2020. The data from RT-PCR confirmed, SARS-CoV-2 positive patients was categorized according to demographics, symptoms and comorbidities based on case categorization (confirmed, recovered, dead). The data collected provides granular and thorough information on time and geographical location for all 34 Provinces across Indonesia. RESULTS A cumulative total of 111,450 confirmed cases of were reported in Indonesia during the study period. Of those confirmed cases 67.79% (75,551/111,450) were shown as recovered and 4.83% (5,382/111,450) of them as died. Patients were mostly male (50.52%; 56,300/111,450) and adults aged 31 to 45 years old (29.73%; 33,132/111,450). Overall patient presentation symptoms of cough and fever, as well as chronic disease comorbidities were in line with previously published data from elsewhere in South-East Asia. The data reported here, shows that from the detection of the first confirmed case and within a short time period of 40 days, all the provinces of Indonesia were affected by COVID-19. CONCLUSIONS This study is the first to provide detailed characteristics of the confirmed SARS-CoV-2 patients in Indonesia, including their demographic profile and COVID-19 presentation history. It used a spatial-temporal analysis to present the epidemic spread from the very beginning of the outbreak throughout all provinces in the country. The increase of new confirmed cases has been consistent during this time period for all provinces, with some demonstrating a sharp increase, in part due to the surge in national diagnostic capacity. This information delivers a ready resource that can be used for prediction modelling, and is utilized continuously by the current Indonesian Task Force in order to advise on potential implementation or removal of public distancing measures, and on potential availability of healthcare capacity in their efforts to ultimately manage the outbreak.
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Affiliation(s)
- Dewi Nur Aisyah
- Indonesia One Health University Network, Depok, West Java, Indonesia
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | | | - Haniena Diva
- Indonesia One Health University Network, Depok, West Java, Indonesia
| | - Zisis Kozlakidis
- World Health Organization, International Agency for Research on Cancer, Lyon, France
| | - Siswanto
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Wiku Adisasmito
- Indonesia One Health University Network, Depok, West Java, Indonesia
- Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesia National Task Force for the Acceleration of COVID-19, Jakarta, Indonesia
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256
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D'Ambrosia C, Christensen H, Aronoff-Spencer E. Computing SARS-CoV-2 Infection Risk From Symptoms, Imaging, and Test Data: Diagnostic Model Development. J Med Internet Res 2020; 22:e24478. [PMID: 33301417 PMCID: PMC7746395 DOI: 10.2196/24478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background Assigning meaningful probabilities of SARS-CoV-2 infection risk presents a diagnostic challenge across the continuum of care. Objective The aim of this study was to develop and clinically validate an adaptable, personalized diagnostic model to assist clinicians in ruling in and ruling out COVID-19 in potential patients. We compared the diagnostic performance of probabilistic, graphical, and machine learning models against a previously published benchmark model. Methods We integrated patient symptoms and test data using machine learning and Bayesian inference to quantify individual patient risk of SARS-CoV-2 infection. We trained models with 100,000 simulated patient profiles based on 13 symptoms and estimated local prevalence, imaging, and molecular diagnostic performance from published reports. We tested these models with consecutive patients who presented with a COVID-19–compatible illness at the University of California San Diego Medical Center over the course of 14 days starting in March 2020. Results We included 55 consecutive patients with fever (n=43, 78%) or cough (n=42, 77%) presenting for ambulatory (n=11, 20%) or hospital care (n=44, 80%). In total, 51% (n=28) were female and 49% (n=27) were aged <60 years. Common comorbidities included diabetes (n=12, 22%), hypertension (n=15, 27%), cancer (n=9, 16%), and cardiovascular disease (n=7, 13%). Of these, 69% (n=38) were confirmed via reverse transcription-polymerase chain reaction (RT-PCR) to be positive for SARS-CoV-2 infection, and 20% (n=11) had repeated negative nucleic acid testing and an alternate diagnosis. Bayesian inference network, distance metric learning, and ensemble models discriminated between patients with SARS-CoV-2 infection and alternate diagnoses with sensitivities of 81.6%-84.2%, specificities of 58.8%-70.6%, and accuracies of 61.4%-71.8%. After integrating imaging and laboratory test statistics with the predictions of the Bayesian inference network, changes in diagnostic uncertainty at each step in the simulated clinical evaluation process were highly sensitive to location, symptom, and diagnostic test choices. Conclusions Decision support models that incorporate symptoms and available test results can help providers diagnose SARS-CoV-2 infection in real-world settings.
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Affiliation(s)
- Christopher D'Ambrosia
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, United States
| | - Henrik Christensen
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, United States
| | - Eliah Aronoff-Spencer
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, United States
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Korell F, Giannitsis E, Merle U, Kihm LP. Analysis of Symptoms of COVID-19 Positive Patients and Potential Effects on Initial Assessment. OPEN ACCESS EMERGENCY MEDICINE 2020; 12:451-457. [PMID: 33299361 PMCID: PMC7721290 DOI: 10.2147/oaem.s275983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background SARS-CoV-2 is a highly contagious virus, significantly impacting Germany among other countries since its emergence. Because of heterogeneous symptoms and a subset of patients even being asymptomatic at presentation, fast identification of infected patients remains challenging. Objective The goal of this study is the evaluation of different patient groups with a focus on symptoms and pre-existing illness at admission, as this is important for initial assessment and adequate emergency care. Methods COVID-19 positive patients at the University Hospital Heidelberg were retrospectively analyzed for disease history and symptoms at the initial presentation as well as mortality. The authors obtained institutional review board (IRB) approval by the Ethics Committee (Medical Faculty of Heidelberg University) prior to commencing the study. Results Dyspnea was more common in patients admitted to intermediate care/intensive care units (48 vs 13%, P<0.001) and showed a significantly higher percentage in the deceased (91 vs 48%, P=0.004). The symptoms of all presenting patients were highly variable, and many manifestations commonly associated with COVID-19 like cough, fever, and sore throat were only detected in a subset of patients, 60%, 43%, and 33%, respectively. Conclusion Dyspnea was present significantly more often in patients dying of COVID-19 compared to all patients admitted to the IMC/ICU, necessitating adequate observation and monitoring. In all presenting patients, initial symptoms showed large variation; therefore, COVID should be considered as a main differential diagnosis at every patient presentation, and patients with high pre-test probability should, if possible, be isolated until testing results are known.
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Affiliation(s)
- Felix Korell
- Casualty Department, University Hospital Heidelberg, Heidelberg, Germany.,Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Lars Philipp Kihm
- Casualty Department, University Hospital Heidelberg, Heidelberg, Germany.,Department of Internal Medicine I, University Hospital Heidelberg, Heidelberg, Germany
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258
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Katneni UK, Alexaki A, Hunt RC, Schiller T, DiCuccio M, Buehler PW, Ibla JC, Kimchi-Sarfaty C. Coagulopathy and Thrombosis as a Result of Severe COVID-19 Infection: A Microvascular Focus. Thromb Haemost 2020; 120:1668-1679. [PMID: 32838472 PMCID: PMC7869056 DOI: 10.1055/s-0040-1715841] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
Coronavirus disease of 2019 (COVID-19) is the clinical manifestation of the respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While primarily recognized as a respiratory disease, it is clear that COVID-19 is systemic illness impacting multiple organ systems. One defining clinical feature of COVID-19 has been the high incidence of thrombotic events. The underlying processes and risk factors for the occurrence of thrombotic events in COVID-19 remain inadequately understood. While severe bacterial, viral, or fungal infections are well recognized to activate the coagulation system, COVID-19-associated coagulopathy is likely to have unique mechanistic features. Inflammatory-driven processes are likely primary drivers of coagulopathy in COVID-19, but the exact mechanisms linking inflammation to dysregulated hemostasis and thrombosis are yet to be delineated. Cumulative findings of microvascular thrombosis has raised question if the endothelium and microvasculature should be a point of investigative focus. von Willebrand factor (VWF) and its protease, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13), play important role in the maintenance of microvascular hemostasis. In inflammatory conditions, imbalanced VWF-ADAMTS-13 characterized by elevated VWF levels and inhibited and/or reduced activity of ADAMTS-13 has been reported. Also, an imbalance between ADAMTS-13 activity and VWF antigen is associated with organ dysfunction and death in patients with systemic inflammation. A thorough understanding of VWF-ADAMTS-13 interactions during early and advanced phases of COVID-19 could help better define the pathophysiology, guide thromboprophylaxis and treatment, and improve clinical prognosis.
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Affiliation(s)
- Upendra K. Katneni
- Department of Pediatrics, The Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Aikaterini Alexaki
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation & Research, U.S. FDA, Silver Spring, Maryland, United States
| | - Ryan C. Hunt
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation & Research, U.S. FDA, Silver Spring, Maryland, United States
| | - Tal Schiller
- Diabetes, Endocrinology and Metabolic Disease Unit, Kaplan Medical Center, Rehovot, Israel
| | - Michael DiCuccio
- National Center of Biotechnology Information, National Institutes of Health, Bethesda, Maryland, United States
| | - Paul W. Buehler
- Department of Pediatrics, The Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Juan C. Ibla
- Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Chava Kimchi-Sarfaty
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation & Research, U.S. FDA, Silver Spring, Maryland, United States
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259
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Kumari K, Chainy GB, Subudhi U. Prospective role of thyroid disorders in monitoring COVID-19 pandemic. Heliyon 2020; 6:e05712. [PMID: 33344794 PMCID: PMC7733548 DOI: 10.1016/j.heliyon.2020.e05712] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pandemic has affected more than 200 countries and 1.3 million individuals have deceased within eleven months. Intense research on COVID-19 occurrence and prevalence enable us to understand that comorbidities play a crucial role in spread and severity of SARS-CoV-2 infection. Chronic kidney disease, diabetes, respiratory diseases and hypertension are among the various morbidities that are prevalent in symptomatic COVID-19 patients. However, the effect of altered thyroid-driven disorders cannot be ignored. Since thyroid hormone critically coordinate and regulate the major metabolism and biochemical pathways, this review is on the potential role of prevailing thyroid disorders in SARS-CoV-2 infection. Direct link of thyroid hormone with several disorders such as diabetes, vitamin D deficiency, obesity, kidney and liver disorders etc. suggests that the prevailing thyroid conditions may affect SARS-CoV-2 infection. Further, we discuss the oxidative stress-induced aging is associated with the degree of SARS-CoV-2 infection. Importantly, ACE2 protein which facilitates the host-cell entry of SARS-CoV-2 using the spike protein, are highly expressed in individuals with abnormal level of thyroid hormone. Altogether, we report that the malfunction of thyroid hormone synthesis may aggravate SARS-CoV-2 infection and thus monitoring the thyroid hormone may help in understanding the pathogenesis of COVID-19.
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Affiliation(s)
- Kanchan Kumari
- CSIR-Institute of Minerals & Materials Technology, Bhubaneswar 751013, Odisha, India
- Department of Molecular Biology, Umea University, Sweden
| | - Gagan B.N. Chainy
- Post Graduate Department of Biotechnology, Utkal University, Bhubaneswar 751004, Odisha, India
| | - Umakanta Subudhi
- CSIR-Institute of Minerals & Materials Technology, Bhubaneswar 751013, Odisha, India
- Academy of Scientific & Innovative Research (AcSIR), New Delhi 110025, India
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260
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Petersen MS, Kristiansen MF, Hanusson KD, Danielsen ME, Á Steig B, Gaini S, Strøm M, Weihe P. Long COVID in the Faroe Islands - a longitudinal study among non-hospitalized patients. Clin Infect Dis 2020; 73:e4058-e4063. [PMID: 33252665 PMCID: PMC7799340 DOI: 10.1093/cid/ciaa1792] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background Little is known about long-term recovery from COVID-19 disease, especially in non-hospitalized individuals. In this longitudinal study we present symptoms registered during the acute phase as well as long COVID, i.e. long-lasting COVID-19 symptoms, in patients from the Faroe Islands. Methods All consecutive patients with confirmed RT-PCR testing from April to June 2020 were invited to participate in this study for the assessment of long COVID. Demographic and clinical characteristics and self-reported acute and persistent symptoms were assessed using a standardized detailed questionnaire administered at enrollment and at repeated phone interviews in the period 22 th April to Aug 16 th. Results Of the 180 participants (96.3% of the 187 eligible COVID-19 patients), 53.1% reported persistence of at least one symptom after a mean of 125 days after symptoms onset, 33.3% reported one or two symptoms and 19.4% three or more symptoms. At the last follow-up, 46.7% were asymptomatic compared with 4.4 % during the acute phase. The most prevalent persistent symptoms were fatigue, loss of smell and taste, and arthralgias. Conclusions Our results show that it might take months for symptoms to resolve, even among non-hospitalized persons with mild illness course in the acute phase. Continued monitoring for long COVID is needed.
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Affiliation(s)
- Maria Skaalum Petersen
- Centre of Health Sciences, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands, FO.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands, FO
| | - Marnar Fríðheim Kristiansen
- Centre of Health Sciences, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands, FO.,Medical Department, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands, FO.,COVID-19 Task Force, Ministry of Health, Faroe Islands, FO
| | - Katrin Dahl Hanusson
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands, FO
| | - Marjun Eivindardóttir Danielsen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands, FO.,COVID-19 Task Force, Ministry of Health, Faroe Islands, FO
| | - Bjarni Á Steig
- Medical Department, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands, FO.,COVID-19 Task Force, Ministry of Health, Faroe Islands, FO
| | - Shahin Gaini
- Medical Department, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands, FO.,Department of Infectious Diseases, Odense University Hospital, J.B. Winsløwsvej, Odense, Denmark, DK.,Department of Clinical Research, University of Southern Denmark, Winsløwparken, Odense, Denmark, DK
| | - Marin Strøm
- Centre of Health Sciences, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands, FO.,Department of Epidemiology Research, Statens Serum Institut, Artillerivej, Copenhagen S, Denmark, DK
| | - Pál Weihe
- Centre of Health Sciences, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands, FO.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands, FO
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Khiali S, Rezagholizadeh A, Entezari-Maleki T. A comprehensive review on sarilumab in COVID-19. Expert Opin Biol Ther 2020; 21:615-626. [PMID: 33161757 DOI: 10.1080/14712598.2021.1847269] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic, caused by a newly discovered coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2), continues to spread all around the world. Despite the emergency of COVID-19 worldwide, remdesivir is the only treatment that has been recently approved to treat the diseases, and other effective therapies are still lacking. SARS-CoV-2 may cause severe illness in 20% of patients. Based on available data, there is an association between interleukin-6 (IL-6) and severe COVID-19. Sarilumab is a fully human immunoglobulin G1 monoclonal antibody binding to both membrane-bound and soluble IL-6 receptors with high affinity and has been considered for off-label use in the treatment of COVID-19.Areas covered: The present article reviews recently published literature focusing on the pathophysiology of COVID-19 induced cytokine storm, the potential therapeutic role, and important clinical issues of sarilumab in the treatment of COVID-19 patients.Expert opinion: The off-label treatment administration is unavoidable in the critical situation of the COVID-19 pandemic. Further efforts should be directed to determine mechanisms of SARS-CoV-2 induced immune dysregulation as well as indications of sarilumab in the patients with COVID-19 to minimize concerns regarding its off-label administration.
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Affiliation(s)
- Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afra Rezagholizadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, 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
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262
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Incidence of cerebrovascular disease as a comorbidity in patients with COVID-19: A meta-analysis. Aging (Albany NY) 2020; 12:23450-23463. [PMID: 33221757 PMCID: PMC7762481 DOI: 10.18632/aging.104086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/29/2020] [Indexed: 02/07/2023]
Abstract
It is essential to know whether COVID-19 patients have a history of cerebrovascular disease, as it may be predictive of prognosis and useful for allocation of limited medical resources. This meta-analysis was performed to assess the incidence of cerebrovascular disease as a comorbidity in COVID-19 patients. The PubMed, Cochrane Library, Embase, CNKI, WFSD, and VIP databases were systematically searched. The pooled analysis of relevant data was conducted using RevMan 5.3 software. The primary outcome was incidence of cerebrovascular disease as a comorbidity. Forty-seven studies involving 16,143 COVID-19 patients were included in this analysis. The incidences of a history of cerebrovascular disease and hypertension in COVID-19 patients were estimated to be 3.0% (95% CI, 2.0%-4.0%; P<0.00001) and 23.0% (95% CI, 16.0%-29.0%; P<0.00001), respectively. The incidence of dizziness/headache as the first symptom in COVID-19 patients was estimated to be 14.0% (95% CI, 8.0%-20.0%; P<0.00001). Subgroup analyses indicated that country, sex ratio, and sample size are potential influencing factors affecting the incidences of cerebrovascular disease, hypertension, and dizziness/headache. These findings suggest that cerebrovascular disease is an underlying comorbidity among patients with COVID-19. In addition, patients experiencing dizziness/headache as the first symptom of COVID-19 should receive a neurological examination.
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263
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Wrotek S, LeGrand EK, Dzialuk A, Alcock J. Let fever do its job: The meaning of fever in the pandemic era. Evol Med Public Health 2020; 9:26-35. [PMID: 33738101 PMCID: PMC7717216 DOI: 10.1093/emph/eoaa044] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Although fever is one of the main presenting symptoms of COVID-19 infection, little public attention has been given to fever as an evolved defense. Fever, the regulated increase in the body temperature, is part of the evolved systemic reaction to infection known as the acute phase response. The heat of fever augments the performance of immune cells, induces stress on pathogens and infected cells directly, and combines with other stressors to provide a nonspecific immune defense. Observational trials in humans suggest a survival benefit from fever, and randomized trials published before COVID-19 do not support fever reduction in patients with infection. Like public health measures that seem burdensome and excessive, fevers involve costly trade-offs but they can prevent infection from getting out of control. For infections with novel SARS-CoV-2, the precautionary principle applies: unless evidence suggests otherwise, we advise that fever should be allowed to run its course. Lay summary: For COVID-19, many public health organizations have advised treating fever with medicines such as acetaminophen or ibuprofen. Even though this is a common practice, lowering body temperature has not improved survival in laboratory animals or in patients with infections. Blocking fever can be harmful because fever, along with other sickness symptoms, evolved as a defense against infection. Fever works by causing more damage to pathogens and infected cells than it does to healthy cells in the body. During pandemic COVID-19, the benefits of allowing fever to occur probably outweigh its harms, for individuals and for the public at large.
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Affiliation(s)
- Sylwia Wrotek
- Department of Immunology, Nicolaus Copernicus University, Torun, Poland
| | - Edmund K LeGrand
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee Knoxville, TN, USA
| | - Artur Dzialuk
- Department of Genetics, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Joe Alcock
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
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264
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Scutellaria baicalensis Flavones as Potent Drugs against Acute Respiratory Injury during SARS-CoV-2 Infection: Structural Biology Approaches. Processes (Basel) 2020. [DOI: 10.3390/pr8111468] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in severe damage to the respiratory system. With no specific treatment to date, it is crucial to identify potent inhibitors of SARS-CoV-2 Chymotrypsin-like protease (3CLpro) that could also modulate the enzymes involved in the respiratory damage that accompanies SARS-CoV-2 infection. Here, flavones isolated from Scutellaria baicalensis (baicalein, baicalin, wogonin, norwogonin, and oroxylin A) were studied as possible compounds in the treatment of SARS-CoV-2 and SARS-CoV-2-induced acute lung injuries. We used structural bioinformatics and cheminformatics to (i) identify the critical molecular features of flavones for their binding activity at human and SARS-CoV-2 enzymes; (ii) predict their drug-likeness and lead-likeness features; (iii) calculate their pharmacokinetic profile, with an emphasis on toxicology; (iv) predict their pharmacodynamic profiles, with the identification of their human body targets involved in the respiratory system injuries; and (v) dock the ligands to SARS-CoV-2 3CLpro. All flavones presented appropriate drug-like and kinetics features, except for baicalin. Flavones could bind to SARS-CoV-2 3CLpro at a similar site, but interact slightly differently with the protease. Flavones’ pharmacodynamic profiles predict that (i) wogonin strongly binds at the cyclooxygenase2 and nitric oxide synthase; (ii) baicalein and norwogonin could modulate lysine-specific demethylase 4D-like and arachidonate 15-lipoxygenase; and (iii) baicalein, wogonin, norwogonin, and oroxylin A bind to SARS-CoV-2 3CLpro. Our results propose these flavones as possible potent drugs against respiratory damage that occurs during SARS-CoV-2 infections, with a strong recommendation for baicalein.
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265
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Izquierdo-Domínguez A, Rojas-Lechuga MJ, Mullol J, Alobid I. Olfactory dysfunction during COVID-19 pandemic. MEDICINA CLINICA (ENGLISH ED.) 2020; 155:403-408. [PMID: 33072867 PMCID: PMC7546227 DOI: 10.1016/j.medcle.2020.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Adriana Izquierdo-Domínguez
- Servicio de Alergología, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain.,Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain.,Unidad de Alergología, Clínica Diagonal, Barcelona, Spain
| | - María Jesús Rojas-Lechuga
- Unidad de Rinología y Clínica del Olfato, Servicio de Otorrinolaringología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - Joaquim Mullol
- Unidad de Rinología y Clínica del Olfato, Servicio de Otorrinolaringología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - Isam Alobid
- Unidad de Rinología y Clínica del Olfato, Servicio de Otorrinolaringología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Spain
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266
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Slot E, Hogema BM, Reusken CBEM, Reimerink JH, Molier M, Karregat JHM, IJlst J, Novotný VMJ, van Lier RAW, Zaaijer HL. Low SARS-CoV-2 seroprevalence in blood donors in the early COVID-19 epidemic in the Netherlands. Nat Commun 2020; 11:5744. [PMID: 33184284 PMCID: PMC7665189 DOI: 10.1038/s41467-020-19481-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
The world is combating an ongoing COVID-19 pandemic with health-care systems, society and economies impacted in an unprecedented way. It is unclear how many people have contracted the causative coronavirus (SARS-CoV-2) unknowingly and are asymptomatic. Therefore, reported COVID-19 cases do not reflect the true scale of outbreak. Here we present the prevalence and distribution of antibodies to SARS-CoV-2 in a healthy adult population of the Netherlands, which is a highly affected country, using a high-performance immunoassay. Our results indicate that one month into the outbreak (i) the seroprevalence in the Netherlands was 2.7% with substantial regional variation, (ii) the hardest-hit areas showed a seroprevalence of up to 9.5%, (iii) the seroprevalence was sex-independent throughout age groups (18-72 years), and (iv) antibodies were significantly more often present in younger people (18-30 years). Our study provides vital information on the extent of exposure to SARS-CoV-2 in a country where social distancing is in place.
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Affiliation(s)
- Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.
- Department of Medical Affairs, Sanquin Corporate Staff, Amsterdam, The Netherlands.
| | - Boris M Hogema
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Chantal B E M Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Johan H Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michel Molier
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - Jan H M Karregat
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Johan IJlst
- National Screening Laboratory, Sanquin Laboratory Services, Amsterdam, The Netherlands
| | - Věra M J Novotný
- Department of Medical Affairs, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - René A W van Lier
- Landsteiner Laboratory, Sanquin Research, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands.
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267
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Hoang T. Systematic review and meta-analysis of factors associated with re-positive viral RNA after recovery from COVID-19. J Med Virol 2020; 93:2234-2242. [PMID: 33135788 DOI: 10.1002/jmv.26648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023]
Abstract
Previous studies reported the positive viral RNA among coronavirus disease-2019 (COVID-19) recovered patients. This study aimed to summarize the current evidence of factors associated with the risk of disease recurrence. PubMed and Embase were searched until September 2020 to identify studies assessing characteristics of recurrence and nonrecurrence subjects after discharge. Random-effect meta-analysis was used to pool estimates of odds ratio (OR) or weighted mean difference (WMD) and their 95% confidence intervals (CIs) across studies. Meta-analysis data were available for age, sex, hospital duration, disease severity, seven comorbidities, five symptoms, five indexes of blood routine, nine indexes of blood biochemistry, four treatment therapies, two antibodies, and history of high-risk contact. Among them, hospital duration of recurrence cases was significantly shorter than nonrecurrence subjects (WMD, -1.55 days; 95% CI, -2.66 to -0.45). Fatigue, positive Immunoglobulin M (IgM), and positive IgG were associated with an increased risk of recurrence cases, with ORs and 95% CIs of 4.06 (1.14-14.4), 2.95 (1.15-7.61), and 3.45 (1.58-7.54), respectively. In contrast, the odds of recurrence cases were observed to significantly lower in subjects with elevated lactate dehydrogenase and C-reactive protein, low lymphocyte count, steroid and arbidol use, with ORs (95% CIs) of 1.08 (0.27-4.37), 0.49 (0.27-0.97), 0.64 (0.42-0.97), 0.48 (0.25-0.96), and 0.48 (0.25-0.92), respectively. This study provided up-to-date evidence of several clinical and epidemiological characteristics in the association with COVID-19 recurrence cases. Further in-depth analyses for the causal effect of factors on re-positive viral RNA are needed for the management of discharged patients with COVID-19.
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Affiliation(s)
- Tung Hoang
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.,Faculty of Pharmacy, Duy Tan University, Da Nang, Vietnam
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268
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Garrido P, Cueto P, Rovira C, Garcia E, Parra A, Enriquez R, Pinos A, Sosa M, Hernández-Aguilera A, Vallverdú I. Clinical value of procalcitonin in critically ill patients infected by SARS-CoV-2. Am J Emerg Med 2020; 46:525-531. [PMID: 33221115 PMCID: PMC7648886 DOI: 10.1016/j.ajem.2020.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background Blood procalcitonin (PCT) levels usually increase during infectious diseases and might be helpful to differentiate bacterial from non-bacterial origin. COVID-19 patients could present co-infections at initial presentation in the Emergency Department and nosocomial infections during stay in the ICU. However, the published literature has not established whether PCT changes could aid in the diagnosis of infectious complication during the COVID-19 pandemic. Methods Retrospective, single-center, cohort study, including COVID-19 patients admitted between March and May 2020. The data were prospectively collected for department purposes; laboratory results were collected automatically at admission and during the whole patient admission. Results 56 patients were analyzed (female 32%, male 68%), 35 were admitted to ICU, and 21 received general ward care. 21 ICU patients underwent mechanical ventilation (88%), and 9 died during admission (26%). Non-survivors had higher initial blood PCT levels than survivors at ICU admission (p.
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Affiliation(s)
- Pedro Garrido
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Pitter Cueto
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
| | - Conxita Rovira
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Elisabet Garcia
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Ana Parra
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Raquel Enriquez
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Armando Pinos
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Manuel Sosa
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Anna Hernández-Aguilera
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Immaculada Vallverdú
- Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
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269
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Vaid A, Somani S, Russak AJ, De Freitas JK, Chaudhry FF, Paranjpe I, Johnson KW, Lee SJ, Miotto R, Richter F, Zhao S, Beckmann ND, Naik N, Kia A, Timsina P, Lala A, Paranjpe M, Golden E, Danieletto M, Singh M, Meyer D, O'Reilly PF, Huckins L, Kovatch P, Finkelstein J, Freeman RM, Argulian E, Kasarskis A, Percha B, Aberg JA, Bagiella E, Horowitz CR, Murphy B, Nestler EJ, Schadt EE, Cho JH, Cordon-Cardo C, Fuster V, Charney DS, Reich DL, Bottinger EP, Levin MA, Narula J, Fayad ZA, Just AC, Charney AW, Nadkarni GN, Glicksberg BS. Machine Learning to Predict Mortality and Critical Events in a Cohort of Patients With COVID-19 in New York City: Model Development and Validation. J Med Internet Res 2020; 22:e24018. [PMID: 33027032 PMCID: PMC7652593 DOI: 10.2196/24018] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking. OBJECTIVE The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points. METHODS We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19-positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions. RESULTS Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction. CONCLUSIONS We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes.
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Affiliation(s)
- Akhil Vaid
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sulaiman Somani
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Adam J Russak
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica K De Freitas
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fayzan F Chaudhry
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ishan Paranjpe
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kipp W Johnson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samuel J Lee
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Riccardo Miotto
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Felix Richter
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shan Zhao
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Noam D Beckmann
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nidhi Naik
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Arash Kia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Prem Timsina
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anuradha Lala
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Eddye Golden
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matteo Danieletto
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Manbir Singh
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dara Meyer
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Paul F O'Reilly
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laura Huckins
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Patricia Kovatch
- Mount Sinai Data Warehouse, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Finkelstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robert M Freeman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew Kasarskis
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Mount Sinai Data Office, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bethany Percha
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Judith A Aberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emilia Bagiella
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carol R Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Barbara Murphy
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eric J Nestler
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eric E Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Judy H Cho
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carlos Cordon-Cardo
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dennis S Charney
- Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David L Reich
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erwin P Bottinger
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Matthew A Levin
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alexander W Charney
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Girish N Nadkarni
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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270
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Müller M, Stöckle U, Trampuz A, Felix S, Kramer A, Wassilew G. Coronavirus Pandemic - SARS-CoV-2 in Orthopedics and Trauma Surgery. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:25-31. [PMID: 33152771 PMCID: PMC8043589 DOI: 10.1055/a-1208-0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The corona virus has spread worldwide since it first appeared in China and represents a pandemic of unprecedented magnitude. The pandemic has not only social and economic effects, but even more impressive effects on the health system. If the virus spreads uncontrollably and rapidly, there is a risk of an unpredictable increase of patients with COVID-19 disease requiring hospital treatment. The capacities of a hospital can quickly reach the limit and consequently patients can no longer be adequately treated. Therefore, in the acute phase of the pandemic, it is necessary to release all hospital resources for the treatment of COVID-19 patients. Strict hygiene regulations must also be observed in order to prevent the virus from spreading unexpectedly in the hospital in order to protect patients and hospital staff. Elective operations and outpatient clinics must be cancelled in the acute phase. Special hygiene measures must be observed for urgent and unpostponable operations.
These relate to the admission of the patients, the accommodation in the ward and the operative care in the operating room. In the post-acute phase, a normal surgical program can be resumed step by step. In this phase, however, clear hygiene regulations must also be observed. Regular medical meetings taking into account the current pandemic situation and the occurrence of new infections must be carried out in the hospital and the occupancy of the ward and operating room adjusted accordingly. To what extent the situation for the treatment of patients in orthopedics and trauma surgery will normalize cannot be predicted at the present time.
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Affiliation(s)
- Michael Müller
- Centrum für Muskuloskeletale Chirurgie Charité - Universitätsmedizin Berlin
| | - Ulrich Stöckle
- Centrum für Muskuloskeletale Chirurgie Charité - Universitätsmedizin Berlin
| | - Andrej Trampuz
- Centrum für Muskuloskeletale Chirurgie Charité - Universitätsmedizin Berlin
| | - Stephan Felix
- Klinik für Kardiologie, Angiologie, Pneumologie/Infektiologie und Intensivmedizin, Universitätsmedizin Greifswald
| | - Axel Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald
| | - Georgi Wassilew
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsmedizin Greifswald
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271
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Hong JM, Hu LH, Zhong QS, Zhu LC, Hang YP, Fang XY, Sun HB, Huang ZH, Xu J, Chen YH. Epidemiological Characteristics and Clinical Features of Patients Infected With the COVID-19 Virus in Nanchang, Jiangxi, China. Front Med (Lausanne) 2020; 7:571069. [PMID: 33251228 PMCID: PMC7673370 DOI: 10.3389/fmed.2020.571069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: The 2019 novel coronavirus disease (COVID-19) pandemic is the biggest public health crises in the 21st century. While most patients infected with the COVID-19 virus have no to moderate symptoms, there is currently limited clinical information about these patients. Methods: In this study, we retrospectively investigated 41 patients infected with the COVID-19 virus in Nanchang, Jiangxi province, China, from February 4 to March 2, 2020. Nanchang is about 260 km southeast of Wuhan, the initial epicenter of the COVID-19 pandemic. We retrieved information on patient demographics, physical examination results, epidemiology, clinical manifestations, underlying conditions, laboratory analyses, radiological images, and treatment outcomes. Results: Most patients (70.7%) had a history of close contact with patients with confirmed COVID-19, and 16 patients (39.0%) showed a high degree of family clustering. All 41 patients had no to moderate symptoms. The median age was 39.9 years and common symptoms of illness were fever (69.2%), cough (65.4%), and fatigue (19.2%). The dominant patient group was middle-aged women, with hypertension (14.6%) and chronic liver disease (12.2%) as the most frequent underlying conditions. All patients recovered, with the mean time of viral nucleic acid clearance at 10.6 days. Chest CT scans presented ground-glass opacities in 53.7% of patients while 26.8% had normal CT images. Laboratory results showed that lymphocyte counts, lymphocyte percentages, ESR, CRP, IgG, Fib, and cytokines were correlated to patients' conditions. Approximately 60-90% of patients had abnormally high levels of cytokines IL-4, IL-6, IL-10, and/or TNF-α. Conclusions: Our results showed variable clinical and laboratory presentations among this group of patients infected with the COVID-19 virus. Though all 41 patients recovered, our results suggest that cytokine levels and other biochemical indicators should be monitored for patients infected with the COVID-19 virus showing no to moderate symptoms to ensure quick access for critical medical attention, if needed.
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Affiliation(s)
- Jian-Ming Hong
- Clinical Laboratory, The Ninth Hospital of Nanchang, Nanchang, China
| | - Long-Hua Hu
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiao-Shi Zhong
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Long-Chuan Zhu
- Infectious Diseases Department, The Ninth Hospital of Nanchang, Nanchang, China
| | - Ya-Ping Hang
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xue-Yao Fang
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hua-Bao Sun
- Clinical Laboratory, The Ninth Hospital of Nanchang, Nanchang, China
| | - Zhi-Hua Huang
- Medical Imaging Department, The Ninth Hospital of Nanchang, Nanchang, China
| | - Jianping Xu
- Department of Biology, Michael G. DeGroote School of Medicine, Institute of Infectious Disease Research, McMaster University, Hamilton, ON, Canada
| | - Yan-Hui Chen
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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272
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Bošnjak B, Stein SC, Willenzon S, Cordes AK, Puppe W, Bernhardt G, Ravens I, Ritter C, Schultze-Florey CR, Gödecke N, Martens J, Kleine-Weber H, Hoffmann M, Cossmann A, Yilmaz M, Pink I, Hoeper MM, Behrens GMN, Pöhlmann S, Blasczyk R, Schulz TF, Förster R. Low serum neutralizing anti-SARS-CoV-2 S antibody levels in mildly affected COVID-19 convalescent patients revealed by two different detection methods. Cell Mol Immunol 2020; 18:936-944. [PMID: 33139905 PMCID: PMC7604543 DOI: 10.1038/s41423-020-00573-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
Neutralizing antibodies targeting the receptor-binding domain (RBD) of the SARS-CoV-2 spike (S) block severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry into cells via surface-expressed angiotensin-converting enzyme 2 (ACE2). We used a surrogate virus neutralization test (sVNT) and SARS-CoV-2 S protein-pseudotyped vesicular stomatitis virus (VSV) vector-based neutralization assay (pVNT) to assess the degree to which serum antibodies from coronavirus disease 2019 (COVID-19) convalescent patients interfere with the binding of SARS-CoV-2 S to ACE2. Both tests revealed neutralizing anti-SARS-CoV-2 S antibodies in the sera of ~90% of mildly and 100% of severely affected COVID-19 convalescent patients. Importantly, sVNT and pVNT results correlated strongly with each other and to the levels of anti-SARS-CoV-2 S1 IgG and IgA antibodies. Moreover, levels of neutralizing antibodies correlated with the duration and severity of clinical symptoms but not with patient age. Compared to pVNT, sVNT is less sophisticated and does not require any biosafety labs. Since this assay is also much faster and cheaper, sVNT will not only be important for evaluating the prevalence of neutralizing antibodies in a population but also for identifying promising plasma donors for successful passive antibody therapy.
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Affiliation(s)
- Berislav Bošnjak
- Institute of Immunology, Hannover Medical School, Hannover, Germany.
| | | | | | | | - Wolfram Puppe
- Institute of Virology, Hannover Medical School, Hannover, Germany
| | - Günter Bernhardt
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - Inga Ravens
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | | | - Christian R Schultze-Florey
- Institute of Immunology, Hannover Medical School, Hannover, Germany.,Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Nina Gödecke
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Jörg Martens
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Hannah Kleine-Weber
- German Primate Center-Leibniz Institute for Primate Research, Göttingen, Germany.,Faculty of Biology and Psychology, University Göttingen, Göttingen, Germany
| | - Markus Hoffmann
- German Primate Center-Leibniz Institute for Primate Research, Göttingen, Germany.,Faculty of Biology and Psychology, University Göttingen, Göttingen, Germany
| | - Anne Cossmann
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | | | - Isabelle Pink
- Department of Pneumology and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Pneumology and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Georg M N Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany
| | - Stefan Pöhlmann
- German Primate Center-Leibniz Institute for Primate Research, Göttingen, Germany.,Faculty of Biology and Psychology, University Göttingen, Göttingen, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Thomas F Schulz
- Institute of Virology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Reinhold Förster
- Institute of Immunology, Hannover Medical School, Hannover, Germany. .,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany.
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273
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Kennedy M, Helfand BKI, Gou RY, Gartaganis SL, Webb M, Moccia JM, Bruursema SN, Dokic B, McCulloch B, Ring H, Margolin JD, Zhang E, Anderson R, Babine RL, Hshieh T, Wong AH, Taylor RA, Davenport K, Teresi B, Fong TG, Inouye SK. Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Netw Open 2020; 3:e2029540. [PMID: 33211114 PMCID: PMC7677760 DOI: 10.1001/jamanetworkopen.2020.29540] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Delirium is common among older emergency department (ED) patients, is associated with high morbidity and mortality, and frequently goes unrecognized. Anecdotal evidence has described atypical presentations of coronavirus disease 2019 (COVID-19) in older adults; however, the frequency of and outcomes associated with delirium in older ED patients with COVID-19 infection have not been well described. OBJECTIVE To determine how frequently older adults with COVID-19 present to the ED with delirium and their associated hospital outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted at 7 sites in the US. Participants included consecutive older adults with COVID-19 presenting to the ED on or after March 13, 2020. EXPOSURE COVID-19 was diagnosed by positive nasal swab for severe acute respiratory syndrome coronavirus 2 (99% of cases) or classic radiological findings (1% of cases). MAIN OUTCOMES AND MEASURES The primary outcome was delirium as identified from the medical record according to a validated record review approach. RESULTS A total of 817 older patients with COVID-19 were included, of whom 386 (47%) were male, 493 (62%) were White, 215 (27%) were Black, and 54 (7%) were Hispanic or Latinx. The mean (SD) age of patients was 77.7 (8.2) years. Of included patients, 226 (28%) had delirium at presentation, and delirium was the sixth most common of all presenting symptoms and signs. Among the patients with delirium, 37 (16%) had delirium as a primary symptom and 84 (37%) had no typical COVID-19 symptoms or signs, such as fever or shortness of breath. Factors associated with delirium were age older than 75 years (adjusted relative risk [aRR], 1.51; 95% CI, 1.17-1.95), living in a nursing home or assisted living (aRR, 1.23; 95% CI, 0.98-1.55), prior use of psychoactive medication (aRR, 1.42; 95% CI, 1.11-1.81), vision impairment (aRR, 1.98; 95% CI, 1.54-2.54), hearing impairment (aRR, 1.10; 95% CI 0.78-1.55), stroke (aRR, 1.47; 95% CI, 1.15-1.88), and Parkinson disease (aRR, 1.88; 95% CI, 1.30-2.58). Delirium was associated with intensive care unit stay (aRR, 1.67; 95% CI, 1.30-2.15) and death (aRR, 1.24; 95% CI, 1.00-1.55). CONCLUSIONS AND RELEVANCE In this cohort study of 817 older adults with COVID-19 presenting to US emergency departments, delirium was common and often was seen without other typical symptoms or signs. In addition, delirium was associated with poor hospital outcomes and death. These findings suggest the clinical importance of including delirium on checklists of presenting signs and symptoms of COVID-19 that guide screening, testing, and evaluation.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Benjamin K. I. Helfand
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester
- Department of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ray Yun Gou
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Sarah L. Gartaganis
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Margaret Webb
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | | | | | - Belinda Dokic
- Emergency Medicine, St Mary Mercy Livonia Hospital, Livonia, Michigan
| | - Brigid McCulloch
- Emergency Medicine, St Mary Mercy Livonia Hospital, Livonia, Michigan
| | - Hope Ring
- Emergency Medicine, St Mary Mercy Livonia Hospital, Livonia, Michigan
| | - Justin D. Margolin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Ellen Zhang
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert Anderson
- Department of Emergency Medicine, Maine Medical Center, Portland
| | - Rhonda L. Babine
- Department of Emergency Medicine, Maine Medical Center, Portland
- Department of Clinical Nursing Resources, Maine Medical Center, Portland
| | - Tammy Hshieh
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - R. Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kathleen Davenport
- Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Brittni Teresi
- Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Tamara G. Fong
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sharon K. Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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274
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Kreidieh F, Temraz S. SARS-CoV-2 Infected Patient: from a Hematologist's Perspective. Mediterr J Hematol Infect Dis 2020; 12:e2020078. [PMID: 33194152 PMCID: PMC7643802 DOI: 10.4084/mjhid.2020.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/17/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION According to the World Health Organization (WHO), COVID-19 has become a Public Health Emergency of International Concern (PHEIC). Understanding patients' hematologic findings in SARS-CoV-2 infection is essential to doing their prognosis, so adjusting care and improving outcomes. OBJECTIVE In this review, we aim at summarizing changes in the hematopoietic system and hemostasis that occur in SARS-CoV-2 infected patients. FINDINGS COVID-19 infection is often associated with laboratory hematologic features that can have important clinical implications. Careful revision of baseline hematologic data at diagnosis can predict the severity of illness and help clinicians tailoring the approach and management of patients whose condition can be guarded or critical. The levels of hematologic markers like D-dimer, procalcitonin, C-reactive protein, viral load, inflammatory cytokines, differential blood cell count, and peripheral smear are fundamental for the prognosis. Studies have also shown an association between some of these markers and severe COVID-19 infection requiring admission to the intensive care unit or complicated by acute respiratory distress syndrome (ARDS). Since, so far, a vaccine is not available, prevention of the infection is based on the avoiding people affected and the spreading of the virus; the treatment, in the absence of an effective antiviral agent, is symptomatic, and, in addition to oxygen support, finds in the anti-inflammatory drugs and anticoagulation fundamental therapeutic lines. According to the American Society of Hematology (ASH), all hospitalized patients with COVID-19 should receive pharmacologic thromboprophylaxis with LMWH.
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275
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Kwee TC, Kwee RM. Chest CT in COVID-19: What the Radiologist Needs to Know. Radiographics 2020; 40:1848-1865. [PMID: 33095680 PMCID: PMC7587296 DOI: 10.1148/rg.2020200159] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022]
Abstract
Chest CT has a potential role in the diagnosis, detection of complications, and prognostication of coronavirus disease 2019 (COVID-19). Implementation of appropriate precautionary safety measures, chest CT protocol optimization, and a standardized reporting system based on the pulmonary findings in this disease will enhance the clinical utility of chest CT. However, chest CT examinations may lead to both false-negative and false-positive results. Furthermore, the added value of chest CT in diagnostic decision making is dependent on several dynamic variables, most notably available resources (real-time reverse transcription-polymerase chain reaction [RT-PCR] tests, personal protective equipment, CT scanners, hospital and radiology personnel availability, and isolation room capacity) and the prevalence of both COVID-19 and other diseases with overlapping manifestations at chest CT. Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation. The authors describe imaging and managing care of patients with COVID-19, with topics including (a) chest CT protocol, (b) chest CT findings of COVID-19 and its complications, (c) the diagnostic accuracy of chest CT and its role in diagnostic decision making and prognostication, and (d) reporting and communicating chest CT findings. The authors also review other specific topics, including the pathophysiology and clinical manifestations of COVID-19, the World Health Organization case definition, the value of performing RT-PCR tests, and the radiology department and personnel impact related to performing chest CT in COVID-19. ©RSNA, 2020.
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Affiliation(s)
- Thomas C. Kwee
- From the Department of Radiology, Nuclear Medicine and Molecular
Imaging, University Medical Center Groningen, University of Groningen,
Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands (T.C.K.); and
Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard-Geleen, the
Netherlands (R.M.K.)
| | - Robert M. Kwee
- From the Department of Radiology, Nuclear Medicine and Molecular
Imaging, University Medical Center Groningen, University of Groningen,
Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands (T.C.K.); and
Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard-Geleen, the
Netherlands (R.M.K.)
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276
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Deep A, Verma K, Swaroop S, Kumar A, Rungta S. Novel coronavirus (COVID-19) and its potential G.I. manifestation: A review. J Family Med Prim Care 2020; 9:5474-5479. [PMID: 33532381 PMCID: PMC7842485 DOI: 10.4103/jfmpc.jfmpc_1082_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of the new coronavirus in Wuhan, Chinese Hubei City (COV-2) was also known as COVID-19 and has spread to more than 213 countries, zones or territories worldwide, and is an emergency of international public health with no antiviral drugs or vaccines; and, also, the presencouragement of the disease has become a global public health emergency. This novel coronavirus is now the seventh member of the coronaviridae family, known for infecting humans and showing evidence of causing gastric symptoms, and has the potential to be transmitted through the fecal-oral route according to a new report published online by physicians at Shanghai Jiao Tong University (Gastroenterology. 2020 March 3. doi: 10.1053/j.gastro. 2020.02.054). Here we identify the efforts to compile and disseminate the COVID-19 epidemiological information on Its potential G.I. Demonstration of news media and social networks, and few newspapers recently published. Physicians should know, how GI manifestation discussed in different publications to suspect CORONA virus infection in that patients who does not have any upper and lower respiratory tract symptom and intervein to discuss the disease severity and duration. It will increase the threshold of suspicion of physician toward Covid-19 disease.
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Affiliation(s)
- Amar Deep
- Experimental and Public Health Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, India
- Department of Medical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kamlendra Verma
- Department of Medical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Suchit Swaroop
- Experimental and Public Health Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sumit Rungta
- Department of Medical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
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277
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Luís ME, Hipólito-Fernandes D, Mota C, Maleita D, Xavier C, Maio T, Cunha JP, Tavares Ferreira J. A Review of Neuro-Ophthalmological Manifestations of Human Coronavirus Infection. Eye Brain 2020; 12:129-137. [PMID: 33154692 PMCID: PMC7608548 DOI: 10.2147/eb.s268828] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/05/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Human coronavirus (HCoVs) are a group of viruses with recognized neurotropic and neuroinvasive capabilities. The reports on the neurological and ocular findings are increasing day after day and several central and peripheral neurological manifestations are already described. However, none specifically describes the neuro-ophthalmological manifestation of HCoVs. This is the first article specifically reviewing neuro-ophthalmological manifestations of HCoVs infection. Methods PubMed and Google Scholar databases were searched using the keywords: coronaviridae, coronavirus, COVID-19, SARS-CoV-2, SARS-CoV-1, MERS, ocular, ophthalmology, ophthalmological, neuro-ophthalmology, neurological, manifestations. A manual search through the reference lists of relevant articles was also performed. There were no restrictions concerning language or study type and publications not yet printed but available online were considered. Results Coronavirus eye involvement is not frequent and includes mostly a typical viral follicular conjunctivitis. Recently, retinal anatomical alterations were described using optic coherence tomography. Neuro-ophthalmological symptoms and signs can appear isolated or associated with neurological syndromes. The manifestations include headache, ocular pain, visual impairment, diplopia, and cranial nerve palsies secondary to Miller Fisher syndrome, Guillain-Barré syndrome, or encephalitis, and nystagmus. Conclusion Neurological and neuro-ophthalmological syndromes, symptoms, and signs should not be neglected and a complete ophthalmological examination of these patients should be performed to fully describe ocular manifestations related to HCoVs. We believe that major ocular and neuro-ophthalmological manifestations reports lack due to safety issues concerning detailed ophthalmological examination; on the other hand, in a large number of cases, the presence of life-threatening coronavirus disease hinders ocular examination and ophthalmologist’s visit to the intensive care unit.
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Affiliation(s)
- Maria Elisa Luís
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Catarina Mota
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Diogo Maleita
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Catarina Xavier
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Tiago Maio
- Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - João Paulo Cunha
- Ophthalmology Department, Hospital CUF Cascais, Lisbon, Portugal.,Escola Superior de Tecnologia da Saúde de Lisboa do Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Joana Tavares Ferreira
- Ophthalmology Department, Hospital CUF Cascais, Lisbon, Portugal.,Escola Superior de Tecnologia da Saúde de Lisboa do Instituto Politécnico de Lisboa, Lisbon, Portugal.,Neuro-Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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278
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Vasudeva A, Patel TK. Alcohol consumption: An important epidemiological factor in COVID-19? J Glob Health 2020; 10:020335. [PMID: 33110535 PMCID: PMC7561277 DOI: 10.7189/jogh.10.020335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Abhimanyu Vasudeva
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Gorakhpur Gorakhpur, Uttar Pradesh, India
| | - Tejas K Patel
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, India
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279
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Asghar M, Hussain N, Shoaib H, Kim M, Lynch TJ. Hematological characteristics of patients in coronavirus 19 infection: a systematic review and meta-analysis. J Community Hosp Intern Med Perspect 2020; 10:508-513. [PMID: 33194119 PMCID: PMC7598996 DOI: 10.1080/20009666.2020.1808360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 infection has become a pandemic and a global health issue since its origin in Wuhan, China in December 2019. The present systematic review and meta-analysis aim to assess hematological changes seen in COVID-19 infection and their association with the severity of the disease. Methods Pooled proportions were calculated using both fixed effects model and random effects model. Weighted mean difference and 95% CI were calculated and reported. Results Initial search identified 84 reference articles, 23 relevant articles were selected and reviewed. Compared to general population, the weighted mean difference of WBC count in all COVID-19 patients was lower by 0.97 × 109 mm3 (95% CI = -1.29 to -0.66). In severe COVID-19 patients, the weighted mean difference of platelet count was lower by 23.85 × 109/liter (95% CI = -35.18 to -9.53), as compared to general population. The weighted mean difference of prothrombin time, D-Dimer, and fibrinogen in severe COVID-19 patients was higher by 1.92 seconds (95% CI = 0.01 to 3.84), 6.23 mg/liter (95% CI = 0.11 to 12.36) and 1.88 g/liter (95% CI = 1.18 to 2.48) respectively, as compared to general population. Pooled proportion showed D-Dimer to be elevated in 80.00% (95 % CI = 50.00 to 99.00) of severe patients. Conclusions Our meta-analysis shows that patients with COVID-19 have significant thrombocytopenia, leukopenia along with elevated D-dimer, fibrinogen and prothrombin time. These laboratory findings are marked in severe COVID-19 infections and could be helpful in early recognition of severe infection.
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Affiliation(s)
- Muhammad Asghar
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Nooreen Hussain
- Department of Hematology and Oncology, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Hasan Shoaib
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Minchul Kim
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Teresa J. Lynch
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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280
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Roberts KA, Colley L, Agbaedeng TA, Ellison-Hughes GM, Ross MD. Vascular Manifestations of COVID-19 - Thromboembolism and Microvascular Dysfunction. Front Cardiovasc Med 2020; 7:598400. [PMID: 33195487 PMCID: PMC7649150 DOI: 10.3389/fcvm.2020.598400,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.
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Affiliation(s)
- Kirsty A. Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Liam Colley
- School of Sport, Health & Exercise Science, Bangor University, Bangor, United Kingdom
| | - Thomas A. Agbaedeng
- Centre for Heart Rhythm Disorders, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Georgina M. Ellison-Hughes
- Centre for Human and Physiological Sciences, Faculty of Life Sciences & Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom,*Correspondence: Georgina M. Ellison-Hughes
| | - Mark D. Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom,Mark D. Ross
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281
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Roberts KA, Colley L, Agbaedeng TA, Ellison-Hughes GM, Ross MD. Vascular Manifestations of COVID-19 - Thromboembolism and Microvascular Dysfunction. Front Cardiovasc Med 2020; 7:598400. [PMID: 33195487 PMCID: PMC7649150 DOI: 10.3389/fcvm.2020.598400] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.
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Affiliation(s)
- Kirsty A Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Liam Colley
- School of Sport, Health & Exercise Science, Bangor University, Bangor, United Kingdom
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm Disorders, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Georgina M Ellison-Hughes
- Centre for Human and Physiological Sciences, Faculty of Life Sciences & Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Mark D Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
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282
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Luo HC, You CY, Lu SW, Fu YQ. Characteristics of coagulation alteration in patients with COVID-19. Ann Hematol 2020; 100:45-52. [PMID: 33079220 PMCID: PMC7572245 DOI: 10.1007/s00277-020-04305-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
Abnormal blood coagulation often occurs in critically ill patients, which seriously affects their prognosis. This retrospective study investigated the implications of changes in blood coagulation in patients with coronavirus disease 2019 (COVID-19). Records were reviewed for patients admitted with COVID-19 between February 4 and 16, 2020. The primary outcome was in-hospital death. A total of 85 patients were included, of whom 12 died in the hospital. The admission prothrombin time (PT), international normalized ratio (INR), and levels of D-dimer and fibrin/fibrinogen degradation products (FDP) were significantly higher in non-survivors than in survivors, while the reverse was true for prothrombin time activity (PT-act) and PaO2/FiO2. Multivariate logistic regression showed that PT-act < 75% was independently associated with mortality. The area under the receiver operating characteristic curves for PT-act, D-dimer, and FDP at admission could significantly predict mortality. The AUCs for PT-act were larger than those for D-dimer and FDP; however, there was no significant difference. After 2 weeks of treatment, the coagulation parameters of the surviving patients improved. COVID-19 is often accompanied by abnormal coagulation. PT-act at admission is able to predict mortality in patients with COVID-19 as can D-dimer and FDP levels. PT-act < 75% is independently associated with mortality.
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Affiliation(s)
- Hong-Chun Luo
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Cheng-Yan You
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China
| | - Si-Wei Lu
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China
| | - Yue-Qiang Fu
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China. .,Third Batch Chongqing Medical Aid Team to Wuhan City of Hubei Province, Chongqing, People's Republic of China.
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283
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Eggmann S, Kindler A, Perren A, Ott N, Johannes F, Vollenweider R, Balma T, Bennett C, Silva IN, Jakob SM. Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series. Phys Ther 2020; 101:5930365. [PMID: 33492400 PMCID: PMC7665777 DOI: 10.1093/ptj/pzaa194] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/27/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. METHODS We report 11 cases of patients with COVID-19 from 5 Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods, and short-term response to treatment. RESULTS Physical therapists actively treated patients with COVID-19 on wards and in the intensive care unit. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who were critically ill developed severe weakness, postextubation dysphagia, weaning failure, or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies, and lung function and physical strength improved over time. CONCLUSION Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning and early breathing exercises as well as post-COVID rehabilitation. IMPACT To date, there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.
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Affiliation(s)
- Sabrina Eggmann
- Address all correspondence to Ms Eggmann at: , @SabrinaEggmann
| | - Angela Kindler
- Department of Physiotherapy, Insel Group, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Perren
- Department of Physiotherapy, Insel Group, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Natalie Ott
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Frauke Johannes
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Vollenweider
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Théophile Balma
- Department of Surgery and Anesthesia, Cardio-Respiratory Physiotherapy, Lausanne University Hospital, Lausanne, Switzerland
| | - Claire Bennett
- Intensive Care Unit, Department of Acute Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Ivo Neto Silva
- Intensive Care Unit, Department of Acute Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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284
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Sanguedolce F, Zanelli M, Ascani S, Zizzo M, Tortorella S, Soriano A, Cavazza A, Sollitto F, Loizzi D. SARS-CoV-2-related lung pathology: macroscopic and histologic features and their clinical implications. Panminerva Med 2020; 64:80-95. [PMID: 33073555 DOI: 10.23736/s0031-0808.20.04157-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ongoing global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been posing challenges to proper patients' management. Lungs are the first, and often the most affected organ by SARS-CoV-2; viral infection involves and damages both epithelial and vascular compartments, sometimes leading to severe and even fatal acute respiratory distress syndrome. Histopathological findings, mainly from postmortem examination of COVID-19 deceased patients, have been increasingly published in the last few months, helping to elucidate the sequence of events resulting in organ injury, and the complex multifactorial pathogenesis of this novel disease. A multidisciplinary approach to autopsy, including light microscopy examination along with the detection of viral proteins and/or RNA in tissue samples through ancillary techniques, provided crucial information on the mechanisms underlying the often-heterogeneous clinical picture of COVID-19.
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Affiliation(s)
- Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy -
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Tortorella
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Alessandra Soriano
- Gastroenterology, Division and Inflammatory Bowel Disease Center Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Domenico Loizzi
- Institute of Thoracic Surgery, University of Foggia, Foggia, Italy
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285
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Sauter JL, Baine MK, Butnor KJ, Buonocore DJ, Chang JC, Jungbluth AA, Szabolcs MJ, Morjaria S, Mount SL, Rekhtman N, Selbs E, Sheng ZM, Xiao Y, Kleiner DE, Pittaluga S, Taubenberger JK, Rapkiewicz AV, Travis WD. Insights into pathogenesis of fatal COVID-19 pneumonia from histopathology with immunohistochemical and viral RNA studies. Histopathology 2020; 77:915-925. [PMID: 32614086 PMCID: PMC7361244 DOI: 10.1111/his.14201] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/27/2020] [Indexed: 01/08/2023]
Abstract
Introduction We describe post‐mortem pulmonary histopathologic findings of COVID‐19 pneumonia in patients with a spectrum of disease course, from rapid demise to prolonged hospitalisation. Methods and results Histopathologic findings in post‐mortem lung tissue from eight patients who died from COVID‐19 pneumonia were reviewed. Immunohistochemistry (IHC) and next‐generation sequencing (NGS) were performed to detect virus. Diffuse alveolar damage (DAD) was seen in all cases with a spectrum of acute phase and/or organising phase. IHC with monoclonal antibodies against SARS‐CoV‐2 viral nucleoprotein and spike protein detected virus in areas of acute but not organising DAD, with intracellular viral antigen and RNA expression seen predominantly in patients with duration of illness less than 10 days. Major vascular findings included thrombi in medium‐ and large‐calibre vessels, platelet microthrombi detected by CD61 IHC and fibrin microthrombi. Conclusions Presence of SARS‐CoV‐2 viral RNA by NGS early in the disease course and expression of viral antigen by IHC exclusively in the acute, but not in the organising phase of DAD, suggests that the virus may play a major role in initiating the acute lung injury of DAD, but when DAD progresses to the organising phase the virus may have been cleared from the lung by the patient's immune response. These findings suggest the possibility of a major change during the disease course of COVID‐19 pneumonia that may have therapeutic implications. Frequent thrombi and microthrombi may also present potential targets for therapeutic intervention.
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Affiliation(s)
- Jennifer L Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marina K Baine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly J Butnor
- Department of Laboratory Medicine and Pathology, University of Vermont Medical Center, Burlington, VT, USA
| | - Darren J Buonocore
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason C Chang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthias J Szabolcs
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Sejal Morjaria
- Infectious Disease, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sharon L Mount
- Department of Laboratory Medicine and Pathology, University of Vermont Medical Center, Burlington, VT, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elena Selbs
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY, USA
| | - Zong-Mei Sheng
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Yongli Xiao
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David E Kleiner
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefania Pittaluga
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffery K Taubenberger
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Amy V Rapkiewicz
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY, USA
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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286
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Abdel-Aziz M, Abdel-Aziz NM, Abdel-Aziz DM, Azab N. Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course. JOURNAL OF CHILD SCIENCE 2020. [DOI: doi https://doi.org/10.1055/s-0040-1717077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nada M. Abdel-Aziz
- Faculty of Dentistry, October University of Modern Science and Arts (MSA), October City, Egypt
| | - Dina M. Abdel-Aziz
- Faculty of Medicine, Misr University for Science and Technology (MUST), Misr, Egypt
| | - Noha Azab
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
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287
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Kidane B, Levin DP. Identification and Resolution of Asymptomatic COVID-19 Pneumonitis and Colitis: Serial Assessment of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography for Evaluation of Lung Cancer. J Thorac Oncol 2020; 16:e1-e3. [PMID: 33067146 PMCID: PMC7534599 DOI: 10.1016/j.jtho.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/20/2020] [Accepted: 09/12/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.
| | - Daniel P Levin
- Department of Diagnostic Imaging, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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288
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Tolebeyan AS, Zhang N, Cooper V, Kuruvilla DE. Headache in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Narrative Review. Headache 2020; 60:2131-2138. [PMID: 33017479 PMCID: PMC7675458 DOI: 10.1111/head.13980] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To summarize available literature regarding headache as a manifestation of coronaviruses and to describe potential underlying mechanisms. REVIEW METHODS References for this review were identified by searches within PubMed without any date restrictions. The search terms used were coronavirus disease 2019 (COVID-19) clinical manifestation, COVID-19 epidemiology, neurologic findings in COVID-19, headache in COVID-19, neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and headache in SARS-CoV-2. RESULTS Headache is one of the most common neurologic complaints in patients with SARS-CoV-2. While the pathophysiological connection between headache and SARS-CoV-2 is unclear, inflammatory mechanisms may play a key role. One of the mechanisms cited in the literature of migraine and other headache disorders is the activation of nociceptive sensory neurons by cytokines and chemokines. A similar mechanism has been reported in SARS-CoV-2 with the release of cytokines and chemokines by macrophages throughout the course of infection. Other mechanisms for headache in SARS-CoV-2 include (1) viral neuroinvasion as seen with viral encephalitis; (2) hypoxemia due to the well-described pulmonary manifestations of the disease; and (3) thrombosis secondary to COVID-19 induced hypercoagulable states. CONCLUSION According to the Centers for Disease Control, common symptoms of human coronavirus include fever, cough, runny nose, sore throat, and headache. In the case of SARS-CoV-2, there are limited reports about headaches, one of the most common clinical manifestations. There are currently no studies that focus specifically on headache among patients with SARS-CoV-2 infection.
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Affiliation(s)
- Amir Soheil Tolebeyan
- Fellow in Headache and Facial Pain, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Niushen Zhang
- Neurology & Neurological Sciences, Stanford Medicine, Palo Alto, CA, USA
| | - Vanessa Cooper
- Fellow in Headache and Facial Pain, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Deena E Kuruvilla
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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289
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Abstract
Severe Acute Respiratory Syndrome-Coronavirus-2 is responsible for the current pandemic that has led to more than 10 million confirmed cases of Coronavirus Disease-19 (COVID-19) and over 500,000 deaths worldwide (4 July 2020). Virus-mediated injury to multiple organs, mainly the respiratory tract, activation of immune response with the release of pro-inflammatory cytokines, and overactivation of the coagulation cascade and platelet aggregation leading to micro- and macrovascular thrombosis are the main pathological features of COVID-19. Empirical multidrug therapeutic approaches to treat COVID-19 are currently used with extremely uncertain outcomes, and many others are being tested in clinical trials. Acetylsalicylic acid (ASA) has both anti-inflammatory and antithrombotic effects. In addition, a significant ASA-mediated antiviral activity against DNA and RNA viruses, including different human coronaviruses, has been documented. The use of ASA in patients with different types of infections has been associated with reduced thrombo-inflammation and lower rates of clinical complications and in-hospital mortality. However, safety issues related both to the risk of bleeding and to that of developing rare but serious liver and brain damage mostly among children (i.e., Reye's syndrome) should be considered. Hence, whether ASA might be a safe and reasonable therapeutic candidate to be tested in clinical trials involving adults with COVID-19 deserves further attention. In this review we provide a critical appraisal of current evidence on the anti-inflammatory, antithrombotic, and antiviral effects of ASA, from both a pre-clinical and a clinical perspective. In addition, the potential benefits and risks of use of ASA have been put in the context of the adult-restricted COVID-19 population.
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290
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Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, Shin JI, Sullivan S, Brondino N, Solmi M, Fusar-Poli P. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. J Affect Disord 2020; 275:48-57. [PMID: 32658823 PMCID: PMC7314697 DOI: 10.1016/j.jad.2020.06.022] [Citation(s) in RCA: 365] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Health care workers (HCW) are at high risk of developing physical/mental health outcomes related to coronavirus syndromes. Nature and frequency of these outcomes are undetermined. METHODS PRISMA/MOOSE-compliant (PROSPERO-CRD42020180205) systematic review of Web of Science/grey literature until 15th April 2020, to identify studies reporting physical/mental health outcomes in HCW infected/exposed to Severe Acute Respiratory Syndrome -SARS-, Middle East Respiratory Syndrome -MERS-, Novel coronavirus -COVID-19-. Proportion random effect meta-analyses, I2 statistic, quality assessment and sensitivity analysis. RESULTS 115 articles were included (n=60,458 HCW, age 36.1±7.1, 77.1% female). Physical health outcomes: 75.9% HCW infected by SARS/MERS/COVID-19 reported fever (95%CI=65.9-83.7%, k=12, n=949), 47.9% cough (95%CI=39.2-56.8%, k=14, n=970), 43.6% myalgias (95%CI=31.9-56.0%, k=13, n=898), 42.3% chills (95%CI=20.2-67.9%, k=7, n=716), 41.2% fatigue (95%CI=18.2-68.8%, k=6, n=386), 34.6% headaches (95%CI=23.1-48.2%, k=11, n=893), 31.2% dyspnoea (95%CI=23.2-40.5%, k=12, n=1003), 25.3% sore throat (95%CI=18.8-33.2%, k=8, n=747), 22.2% nausea/vomiting (95%CI=14.9-31.8%, k=6, n=662), 18.8% diarrhoea (95%CI=11.9-28.4%, k=9, n=824). Mental health outcomes: 62.5% HCW exposed to SARS/MERS/COVID-19 reported general health concerns (95%CI=57.0-67,8%, k=2, n=2254), 43.7% fear (95%CI=33.9-54.0%, k=4, n=584), 37.9% insomnia (95%CI=30.9-45.5%, k=6, n=5067), 37.8% psychological distress (95%CI=28.4-48.2%, k=15, n=24,346), 34.4% burnout (95%CI=19.3-53.5%, k=3, n=1337), 29.0% anxiety features (95%CI=14.2-50.3%, k=6, n=9191), 26.3% depressive symptoms (95%CI=12.5-47.1%, k=8, n=9893), 20.7% post-traumatic stress disorder features (95%CI=13.2-31%, k=11, n=3826), 16.1% somatisation (95%CI=0.2-96.0%, k=2, n=2184), 14.0% stigmatisation feelings (95%CI=6.4-28.1%, k=2, n=411). LIMITATIONS Limited amount of evidence for some outcomes and suboptimal design in several studies included. CONCLUSIONS SARS/MERS/COVID-19 have a substantial impact on the physical and mental health of HCW, which should become a priority for public health strategies.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
| | - Julio Vaquerizo-Serrano
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital. Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Bizkaia, Spain
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Carmen Moreno
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Francisco Ferre
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Madrid, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah Sullivan
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natascia Brondino
- Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neurosciences Department, University of Padua, Padua, Italy; Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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291
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Luo CY, Li Y, Li X, Liang X, Wang Q, Ma YH, Xiong CH, Zeng YP, Sun W, Wang X. Alleviation of Lipopolysaccharide-Induced Acute Respiratory Distress Syndrome in Rats by Yiqi Huayu Jiedu Decoction: A Tandem Mass Tag-Based Proteomics Study. Front Pharmacol 2020; 11:1215. [PMID: 32982719 PMCID: PMC7485520 DOI: 10.3389/fphar.2020.01215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/24/2020] [Indexed: 01/01/2023] Open
Abstract
Background To study the effect of Yiqi Huayu Jiedu Decoction (YQHYJD) on protein expression in the lung tissue of acute respiratory distress syndrome (ARDS) rats and to explore the underlying molecular therapeutic mechanism of YQHYJD. Methods Sprague Dawley rats were administered with YQHYJD by oral gavage for 1 week. The rats were injected with lipopolysaccharide (LPS) to induce ARDS. The lung injury was assessed pathologically. Differentially expressed proteins (DEPs) were screened by quantitative proteomics and analyzed using bioinformatic tools, such as Metascape and Kyoto Encyclopedia of Genes and Genomes (KEGG) mapper. DEPs were verified by parallel reaction monitoring (PRM). Results YQHYJD alleviated the LPS-induced pathological damage of lung tissue in rats. There were 134 DEPs among the YQHYJD treatment and model groups. The Genomes pathway analyses revealed that the DEPs were closely related to immune system pathway. The mass spectrometry analysis revealed that YQHYJD exhibits a protective effect on lung tissue by significantly upregulating hematopoietic cell kinase (Hck), phospholipid phosphatase 3 (Plpp3), myristoylated-alanine rich C-kinase substrate (Marcks), and Actin-related protein 2/3 complex subunit 2 (Arpc2), which are related to Fc gamma receptor-mediated phagocytosis pathway. Conclusion YQHYJD can alleviate the lung injury of ARDS rats by regulating the Fc gamma receptor-mediated phagocytosis pathway, which is related to immune system.
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Affiliation(s)
- Chang-Yong Luo
- College of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Li
- Education Section, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xin Li
- Education Section, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xu Liang
- Education Section, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Qian Wang
- College of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yuan-Hong Ma
- Education Section, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Cai-Hua Xiong
- Education Section, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yan-Peng Zeng
- Education Section, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Wei Sun
- Institute of Basic Medical Sciences, Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Xin Wang
- Biological Spectrum Institute, Guangdong Junfeng BFS Technology CO, Guangzhou, China
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292
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Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J, Zhang J, Dong C, Na R, Zheng L, Li W, Liu Z, Ma J, Wang J, He S, Xu Y, Si P, Shen Y, Cai C. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol 2020; 93:1057-1069. [PMID: 32761898 PMCID: PMC7436402 DOI: 10.1002/jmv.26398] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
Abstract
To provide a comprehensive and systematic analysis of demographic characteristics, clinical symptoms, laboratory findings, and imaging features of coronavirus disease 2019 (COVID-19) in pediatric patients. A meta-analysis was carried out to identify studies on COVID-19 from 25 December 2019 to 30 April 2020. A total of 48 studies with 5829 pediatric patients were included. Children of all ages were at risk for COVID-19. The main illness classification ranged as: 20% (95% confidence interval [CI]: 14%-26%; I2 = 91.4%) asymptomatic, 33% (95% CI: 23%-43%; I2 = 95.6%) mild and 51% (95% CI: 42%-61%; I2 = 93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45%-57%; I2 = 78.9%) and cough 41% (95% CI: 35%-47%, I2 = 81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64%-75%; I2 = 58.5%), lymphopenia 16% (95% CI: 11%-21%; I2 = 76.9%) and elevated creatine-kinase MB 37% (95% CI: 25%-48%; I2 = 59.0%). The frequent imaging features were normal images 41% (95% CI: 30%-52%; I2 = 93.4%) and ground-glass opacity 36% (95% CI: 25%-47%; I2 = 92.9%). Among children under 1 year old, critical cases account for 14% (95% CI: 13%-34%; I2 = 37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18%-67%; I2 = 0.0%) cases that may also need attention. Pediatric patients with COVID-19 may experience milder illness with atypical clinical manifestations and rare lymphopenia. High incidence of critical illness and vomiting symptoms reward attention in children under 1 year old.
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Affiliation(s)
- Xiaojian Cui
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Zhihu Zhao
- Department of Orthopaedic, Tianjin Hospital, Tianjin, PR China
| | - Tongqiang Zhang
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China.,Department of Pediatrics, Graduate School of Tianjin Medical University, Tianjin, PR China
| | - Wei Guo
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Wenwei Guo
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jiafeng Zheng
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jiayi Zhang
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Cuicui Dong
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Ren Na
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Lisheng Zheng
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Wenliang Li
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Zihui Liu
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jia Ma
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jinhu Wang
- Department of Neonatal Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Sijia He
- Department of National Center for Biodefense and Infectious Diseases, School of Systems Biology, George Mason University, Manassas, Virginia
| | - Yongsheng Xu
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Ping Si
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Yongming Shen
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Chunquan Cai
- Department of Neurosurgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China.,Institute of Pediatrics, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, PR China
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293
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Membrilla JA, de Lorenzo Í, Sastre M, Díaz de Terán J. Headache as a Cardinal Symptom of Coronavirus Disease 2019: A Cross-Sectional Study. Headache 2020; 60:2176-2191. [PMID: 32989732 PMCID: PMC7646273 DOI: 10.1111/head.13967] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/13/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Abstract
Objective To describe the semiology of pain and its associated features in patients with coronavirus disease 2019 (COVID‐19) and headache presenting to the emergency department who do not require urgent services. Background Headache is one of the most frequent neurological symptoms reported in case series, epidemiological studies, and meta‐analyses of COVID‐19, with a prevalence ranging from 8 to 71.1%. Studies addressing the semiology of these headaches are lacking. Methods We conducted a cross‐sectional study in the emergency department of a tertiary hospital. Patients classified according to the Manchester Triage System as standard and non‐urgent and those fulfilling the criteria for probable or confirmed COVID‐19 according to World Health Organization guidelines who presented with headache were included. A standardized questionnaire was used for data collection. Results Of the 145 confirmed and probable COVID‐19 patients, 99 (68.3%) reported headache. A total of 54/99 (54.5%) were classified with probable COVID‐19 and 45/99 (45.5%) with confirmed COVID‐19. The mean age (44.7 ± 11.8 vs 40.4 ± 10.7, P = .061), sex distribution (35/54 [64.8%] vs 28/45 [62.2%] female, P = .768), and headache comorbidity (19/54 [35.2%] vs 17/45 [37.8%], P = .789) were similar between the probable and confirmed COVID‐19 groups, along with other medical comorbidities and laboratory data. Patients with confirmed COVID‐19 showed a higher incidence of anosmia (21/54 [38.9%] vs 28/45 [62.2%], P = .021) and pneumonia (10/54 [18.5%] vs 18/45 [40%], P = .018), headache at onset (32/54 [59.3%] vs 39/45 [86.7%], P = .002), and hospital admission (0/54 [0%] vs 2/45 [11.1%], P = .017). In most cases, the headache appeared simultaneously with other COVID‐19 symptoms (57/99, 57.6%). It was bilateral (86/99, 86.9%), frontal or holocranial (34/99, 34.3% each) in location and intense (60/99, 60.6%, reported a visual analog scale [VAS] score ≥7). A total of 39/99 (39.4%) identified triggers, most commonly fever. The most frequent aggravating factors were physical activity (45/99, 45.5%) and coughing (43/99, 43.4%). Patients showed a propensity toward prostration (41/99, 41.4%), photophobia (29/99, 29.3%), and phonophobia (27/99, 27.3%). Partial (53/99, 53.5%) or total (26/99, 26.3%) responses to first‐step analgesics were reported. A total of 25/99 (25.3%) patients had a prior history of migraine, presenting with headache different from the usual in 23/25 (92.0%) patients. Individuals with migraine were more likely to have earlier (headache at onset of the respiratory symptoms in 24/25 [96.0%] vs 57/74 [77.0%], P = .023 [95% CI: 0.067, 0.313]), longer (>24 hours of pain in 20/25 [80%] vs 25/74 [33.8%], P < .001 [95% CI: 0.272, 0.652]), and more intense (VAS score ≥5 in 25/25 [100%] vs 63/74 [85.1%], P = .043 [95% CI: 0.057, 0.213]) headaches than patients without migraine. Conclusions Headache is a very prevalent COVID‐19 symptom among patients presenting to the emergency room, most frequently presenting as holocranial or bifrontal moderate to severe, and pressing quality headache. Individuals with migraine tend to present with earlier, longer, and more intense headaches.
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Affiliation(s)
| | - Íñigo de Lorenzo
- Neurology Department, University Hospital "La Paz", Madrid, Spain
| | - María Sastre
- Neurology Department, University Hospital "La Paz", Madrid, Spain
| | - Javier Díaz de Terán
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Physiotherapy Department, CranioSPain Research Group, La Salle Higher Center for University Studies, Autonomous University of Madrid, Madrid, Spain
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294
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Falcão LF, da Silva Pontes L, Afonso da Silva BG, Vieira da Silva Franco KM, Costa LA, Barbosa Rocha RS, Simões Quaresma JA. The complexity of respiratory disease associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection: From immunopathogenesis to respiratory therapy. Rev Med Virol 2020. [DOI: 10.1002/rmv.2167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Luiz Fábio Falcão
- Center for Biological and Health Sciences State University of Pará Belém Pará Brazil
| | | | | | | | - Luiz Adriano Costa
- Center for Biological and Health Sciences State University of Pará Belém Pará Brazil
| | | | - Juarez Antônio Simões Quaresma
- Center for Biological and Health Sciences State University of Pará Belém Pará Brazil
- Evandro Chagas Institute Ministry of Health Ananindeua Pará Brazil
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295
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Kiely P, Hoad VC, Seed CR, Gosbell IB. Severe acute respiratory syndrome coronavirus-2: implications for blood safety and sufficiency. Vox Sang 2020; 116:155-166. [PMID: 32965726 PMCID: PMC7537511 DOI: 10.1111/vox.13009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Background and Objective Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) is a novel coronavirus, first identified in China at the end of 2019 and has now caused a worldwide pandemic. In this review, we provide an overview of the implications of SARS‐CoV‐2 for blood safety and sufficiency. Material and Method We searched the PubMed database, the preprint sites bioRxiv and medRxiv, the websites of the World Health Organization, European Centre for Disease Prevention and Control, the US Communicable Diseases Center and monitored ProMed updates. Results An estimated 15%–46% of SARS‐CoV‐2 infections are asymptomatic. The reported mean incubation period is 3 to 7 days with a range of 1–14 days. The blood phase of SARS‐CoV‐2 appears to be brief and low level, with RNAaemia detectable in only a small proportion of patients, typically associated with more severe disease and not demonstrated to be infectious virus. An asymptomatic blood phase has not been demonstrated. Given these characteristics of SARS‐CoV‐2 infection and the absence of reported transfusion transmission (TT), the TT risk is currently theoretical. To mitigate any potential TT risk, but more importantly to prevent respiratory transmission in donor centres, blood centres can implement donor deferral policies based on travel, disease status or potential risk of exposure. Conclusion The TT risk of SARS‐CoV‐2 appears to be low. The biggest risk to blood services in the current COVID‐19 pandemic is to maintain the sufficiency of the blood supply while minimizing respiratory transmission of SARS‐CoV‐19 to donors and staff while donating blood.
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Affiliation(s)
- Philip Kiely
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia.,Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Veronica C Hoad
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia
| | - Clive R Seed
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia
| | - Iain B Gosbell
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia.,Western Sydney University, Penrith, NSW, Australia
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296
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Vilke GM, Brennan JJ, Cronin AO, Castillo EM. Clinical Features of Patients with COVID-19: is Temperature Screening Useful? J Emerg Med 2020; 59:952-956. [PMID: 33139117 PMCID: PMC7505592 DOI: 10.1016/j.jemermed.2020.09.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 12/22/2022]
Abstract
Background As many businesses reopen after government-induced restrictions, many public agencies and private companies, such as banks, golf courses, and stores, are using temperature screening to assess for possible coronavirus disease 2019 (COVID-19) infection both for patrons and for employees. Objective We assessed the frequency of a fever ≥100.4°F and other symptoms associated with COVID-19 among patients in the emergency department (ED) who were tested in the ED for the illness. Methods This is a retrospective review of data from patients who were tested for acute COVID-19 infection from March 10, 2020 through June 30, 2020 at two EDs within the same health care system. Data collected included temperature, the presence or recent history of COVID-19–related symptoms, and COVID-19 test results. Descriptive statistics are reported for presenting fever and other COVID-19–related symptoms alone and in combination with presenting fever. Results A total of 6894 patients were tested for COVID-19. Among these, 330 (4.8%) tested positive for active infection. Of these patients, 64 (19.4%) presented with a fever ≥100.4°F (≥38.0°C). Increasing the number of COVID-19–related symptoms in combination with a presenting fever ≥100.4°F increased the number of people who could be identified as having a COVID-19 infection. Conclusions About a quarter of patients who were tested positive for COVID-19 in our ED did not have a fever at presentation ≥100.4°F. Using only temperature to screen for COVID-19 in the community setting will likely miss the majority of patients with active disease.
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Affiliation(s)
- Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Jesse J Brennan
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Alexandrea O Cronin
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Edward M Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, California
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297
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Ashinyo ME, Duti V, Dubik SD, Amegah KE, Kutsoati S, Oduro-Mensah E, Puplampu P, Gyansa-Lutterodt M, Darko DM, Buabeng KO, Ashinyo A, Ofosu AA, Baddoo NA, Akoriyea SK, Ofei F, Kuma-Aboagye P. Clinical characteristics, treatment regimen and duration of hospitalization among COVID-19 patients in Ghana: a retrospective cohort study. Pan Afr Med J 2020; 37:9. [PMID: 33294110 PMCID: PMC7704352 DOI: 10.11604/pamj.supp.2020.37.9.25718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION COVID-19 is a global pandemic seen in modern times. The clinical characteristics, treatment regimen and duration of hospitalization of COVID-19 patients remain unclear in Ghana. METHODS we retrospectively reviewed the secondary data of 307 discharged COVID-19 patients to characterize their demographics, clinical symptoms, treatment regimen given and duration of hospitalization. RESULTS the mean age and temperature of the patients were 37.9 years and 36.3°C, respectively. The majority (85.7%) of the cases reviewed were asymptomatic; for those presenting with symptoms, the main ones were cough (50%), fever (29.6%), headache (27.3%), and sore throat (22.7%). Comorbidities were present in 25.1% of the patients; the popularly reported comorbidities were hypertension (71.4%), asthma (7.8%) and diabetes (6.5%). The average duration of hospitalization was 13.8 days, and the duration of hospitalization for patients managed with azithromycin + chloroquine (AZ+CQ) was 10.4 days, followed closely by those managed with hydroxychloroquine (HCQ) only, 11.0 days. There was longer duration of hospitalization among patients who received AZ only compared to patients receiving AZ + CQ (3.24 ± 1.10 days, p=0.037; 95% CI 0.11, 6.37). Linear regression analysis showed that the duration of hospitalization for patients who received AZ only was 2.7 days, which was higher than that of patients who received AZ+CQ and HCQ only (95% CI 0.44, 4.93; p=0.019). CONCLUSION in this cohort of COVID-19 patients, the common symptoms were cough, fever, headache, and sore throat. The use of AZ+CQ or HCQ only as a therapy for managing COVID-19 patients shortened the duration of hospitalization.
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Affiliation(s)
- Mary Eyram Ashinyo
- Institutional Care Division, Ghana Health Service Headquarters, Private Mail Bag, Accra, Ghana
| | | | - Stephen Dajaan Dubik
- School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | | | | | | | - Peter Puplampu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | | | - Samuel Kaba Akoriyea
- Institutional Care Division, Ghana Health Service Headquarters, Private Mail Bag, Accra, Ghana
| | - Francis Ofei
- Department of Medicines, School of Medicine and Dentistry, University of Cape Coast
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298
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Ashinyo ME, Duti V, Dubik SD, Amegah KE, Kutsoati S, Oduro-Mensah E, Puplampu P, Gyansa-Lutterodt M, Darko DM, Buabeng KO, Ashinyo A, Ofosu AA, Baddoo NA, Akoriyea SK, Ofei F, Kuma-Aboagye P. Clinical characteristics, treatment regimen and duration of hospitalization among COVID-19 patients in Ghana: a retrospective cohort study. Pan Afr Med J 2020. [PMID: 33294110 PMCID: PMC7704352 DOI: 10.11604/pamj.supp.2020.37.1.25718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction COVID-19 is a global pandemic seen in modern times. The clinical characteristics, treatment regimen and duration of hospitalization of COVID-19 patients remain unclear in Ghana. Methods we retrospectively reviewed the secondary data of 307 discharged COVID-19 patients to characterize their demographics, clinical symptoms, treatment regimen given and duration of hospitalization. Results the mean age and temperature of the patients were 37.9 years and 36.3°C, respectively. The majority (85.7%) of the cases reviewed were asymptomatic; for those presenting with symptoms, the main ones were cough (50%), fever (29.6%), headache (27.3%), and sore throat (22.7%). Comorbidities were present in 25.1% of the patients; the popularly reported comorbidities were hypertension (71.4%), asthma (7.8%) and diabetes (6.5%). The average duration of hospitalization was 13.8 days, and the duration of hospitalization for patients managed with azithromycin + chloroquine (AZ+CQ) was 10.4 days, followed closely by those managed with hydroxychloroquine (HCQ) only, 11.0 days. There was longer duration of hospitalization among patients who received AZ only compared to patients receiving AZ + CQ (3.24 ± 1.10 days, p=0.037; 95% CI 0.11, 6.37). Linear regression analysis showed that the duration of hospitalization for patients who received AZ only was 2.7 days, which was higher than that of patients who received AZ+CQ and HCQ only (95% CI 0.44, 4.93; p=0.019). Conclusion in this cohort of COVID-19 patients, the common symptoms were cough, fever, headache, and sore throat. The use of AZ+CQ or HCQ only as a therapy for managing COVID-19 patients shortened the duration of hospitalization.
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Affiliation(s)
- Mary Eyram Ashinyo
- Institutional Care Division, Ghana Health Service Headquarters, Private Mail Bag, Accra, Ghana
| | | | - Stephen Dajaan Dubik
- School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | | | | | | | - Peter Puplampu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | | | - Samuel Kaba Akoriyea
- Institutional Care Division, Ghana Health Service Headquarters, Private Mail Bag, Accra, Ghana
| | - Francis Ofei
- Department of Medicines, School of Medicine and Dentistry, University of Cape Coast
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299
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Associations of procalcitonin, C-reaction protein and neutrophil-to-lymphocyte ratio with mortality in hospitalized COVID-19 patients in China. Sci Rep 2020; 10:15058. [PMID: 32929124 PMCID: PMC7490259 DOI: 10.1038/s41598-020-72164-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an important and urgent threat to global health. Inflammation factors are important for COVID-19 mortality, and we aim to explore whether the baseline levels of procalcitonin (PCT), C-reaction protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are associated with an increased risk of mortality in patients with COVID-19. A retrospective study was conducted and a total of 76 patients with confirmed COVID-19 were included between January 17, 2020 to March 2, 2020, of these cases, 17 patients were dead. After adjusting covariates, PCT (≥ 0.10 ng/mL) and CRP (≥ 52.14 mg/L) exhibited independent increasing risks of mortality were used hazard ratio (HR) of 52.68 (95% confidence interval [CI]: 1.77–1571.66) and 5.47 (95% CI: 1.04–28.72), respectively. However, NRL (≥ 3.59) was not found to be an independent risk factor for death in our study. Furthermore, the elevated PCT levels were still associated with increasing risk of mortality in the old age group (age ≥ 60 y), and in the critically severe and severe patients after adjustment for complications. Thu Baseline levels of PCT and CRP have been addressed as independent predictors of mortality in patients with COVID-19.
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300
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Kumaran NK, Karmakar BK, Taylor OM. Coronavirus disease-19 (COVID-19) associated with acute necrotising pancreatitis (ANP). BMJ Case Rep 2020; 13:13/9/e237903. [PMID: 32900752 PMCID: PMC7477985 DOI: 10.1136/bcr-2020-237903] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus is a severe infectious disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has led to increased mortality worldwide. Multiple reports have been published citing that gastrointestinal symptoms are common in patients with COVID-19 infection. It has also been found that the ACE2 receptor of SARS-CoV-2 is expressed more in the pancreas than the lungs. Despite this, little attention has been paid to the extent and details of pancreatic injury caused by COVID-19. Lack of awareness regarding the COVID-19 status of patients presenting with pancreatitis may expose healthcare workers to SARS-CoV-2 while performing interventions to manage complications of pancreatitis such as necrosis. We report a case of COVID-19-induced acute necrotising pancreatitis in the absence of any known risk factors.
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Affiliation(s)
- Naren K Kumaran
- Department of General Surgery, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Biraj K Karmakar
- Department of General Surgery, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Ormond M Taylor
- Department of General Surgery, Kettering General Hospital NHS Foundation Trust, Kettering, UK
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