1
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Cremaschi RC, Bahi CAS, Paola AAVD, Arakaki JSO, Ferreira PRA, Bellei NCJ, Borges V, Coelho FMS. Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:146-154. [PMID: 36948200 PMCID: PMC10033191 DOI: 10.1055/s-0043-1761433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals. OBJECTIVE To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities. METHODS Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital São Paulo (Federal University of São Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not. RESULTS The mean age of the sample was 55 ± 15.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia/hypogeusia (50%), orthostatic intolerance (49%), anosmia/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85 ± 12.06 vs. 8.9 ± 8.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without). CONCLUSION A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia/hyposmia.
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Affiliation(s)
| | | | | | | | | | | | - Vanderci Borges
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Fernando Morgadinho Santos Coelho
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
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2
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Burton C, Dawes H, Goodwill S, Thelwell M, Dalton C. Within and between-day variation and associations of symptoms in Long Covid: Intensive longitudinal study. PLoS One 2023; 18:e0280343. [PMID: 36656830 PMCID: PMC9851560 DOI: 10.1371/journal.pone.0280343] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND People with Long Covid (Post Covid-19 Condition) describe multiple symptoms which vary between and within individuals over relatively short time intervals. We aimed to describe the real-time associations between different symptoms and between symptoms and physical activity at the individual patient level. METHODS AND FINDINGS Intensive longitudinal study of 82 adults with self-reported Long Covid (median duration 12-18 months). Data collection involved a smartphone app with 5 daily entries over 14 days and continuous wearing of a wrist accelerometer. Data items included 7 symptoms (Visual Analog Scales) and perceived demands in the preceding period (Likert scales). Activity was measured using mean acceleration in the 3-hour periods preceding and following app data entry. Analysis used within-person correlations of symptoms pairs and both pooled and individual symptom networks derived from graphical vector autoregression. App data was suitable for analysis from 74 participants (90%) comprising 4022 entries representing 77.6% of possible entries. Symptoms varied substantially within individuals and were only weakly autocorrelated. The strongest between-subject symptom correlations were of fatigue with pain (partial coefficient 0.5) and cognitive difficulty with light-headedness (0.41). Pooled within-subject correlations showed fatigue correlated with cognitive difficulty (partial coefficient 0.2) pain (0.19) breathlessness (0.15) and light-headedness (0.12) but not anxiety. Cognitive difficulty was correlated with anxiety and light-headedness (partial coefficients 0.16 and 0.17). Individual participant correlation heatmaps and symptom networks showed no clear patterns indicative of distinct phenotypes. Symptoms, including fatigue, were inconsistently correlated with prior or subsequent physical activity: this may reflect adjustment of activity in response to symptoms. Delayed worsening of symptoms after the highest activity peak was observed in 7 participants. CONCLUSION Symptoms of Long Covid vary within individuals over short time scales, with heterogenous patterns of symptom correlation. The findings are compatible with altered central symptom processing as an additional factor in Long Covid.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Helen Dawes
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simon Goodwill
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Michael Thelwell
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Caroline Dalton
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
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3
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Kallet RH, Branson RD, Lipnick MS. Respiratory Drive, Dyspnea, and Silent Hypoxemia: A Physiological Review in the Context of COVID-19. Respir Care 2022; 67:1343-1360. [PMID: 35501129 PMCID: PMC9994317 DOI: 10.4187/respcare.10075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infection with SARS-CoV-2 in select individuals results in viral sepsis, pneumonia, and hypoxemic respiratory failure, collectively known as COVID-19. In the early months of the pandemic, the combination of novel disease presentation, enormous surges of critically ill patients, and severity of illness lent to early observations and pronouncements regarding COVID-19 that could not be scientifically validated owing to crisis circumstances. One of these was a phenomenon referred to as "happy hypoxia." Widely discussed in the lay press, it was thought to represent a novel and perplexing phenomenon: severe hypoxemia coupled with the absence of respiratory distress and dyspnea. Silent hypoxemia is the preferred term describing an apparent lack of distress in the presence of hypoxemia. However, the phenomenon is well known among respiratory physiologists as hypoxic ventilatory decline. Silent hypoxemia can be explained by physiologic mechanisms governing the control of breathing, breathing perception, and cardiovascular compensation. This narrative review examines silent hypoxemia during COVID-19 as well as hypotheses that viral infection of the central and peripheral nervous system may be implicated. Moreover, the credulous embrace of happy hypoxia and the novel hypotheses proposed to explain it has exposed significant misunderstandings among clinicians regarding the physiologic mechanisms governing both the control of breathing and the modulation of breathing sensations. Therefore, a substantial focus of this paper is to provide an in-depth review of these topics.
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Affiliation(s)
- Richard H Kallet
- Department of Anesthesia and Perioperative Care, University of California, San Francisco at San Francisco General Hospital, San Francisco, California.
| | - Richard D Branson
- Department of Surgery, Trauma and Critical Care Division, University of Cincinnati, Cincinnati, Ohio
| | - Michael S Lipnick
- Department of Anesthesia and Perioperative Care, University of California, San Francisco at San Francisco General Hospital, San Francisco, California
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4
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Carmona-Torre F, Mínguez-Olaondo A, López-Bravo A, Tijero B, Grozeva V, Walcker M, Azkune-Galparsoro H, López de Munain A, Alcaide AB, Quiroga J, Del Pozo JL, Gómez-Esteban JC. Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies. Front Neurol 2022; 13:886609. [PMID: 35720084 PMCID: PMC9198643 DOI: 10.3389/fneur.2022.886609] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction On March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. Objective To conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. Results Autonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. Conclusion Symptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease.
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Affiliation(s)
- Francisco Carmona-Torre
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ane Mínguez-Olaondo
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Alba López-Bravo
- Neurology Department, Hospital Reina Sofía de Tudela-OSASUNBIDEA, Tudela, Spain.,Aragon Institute for Health Research (IIS-A), Zaragoza, Spain
| | - Beatriz Tijero
- Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain
| | | | - Michaela Walcker
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain
| | - Harkaitz Azkune-Galparsoro
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Infectious Disease Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Adolfo López de Munain
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Belen Alcaide
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Pulmonary Department, University Clinic of Navarra, Pamplona, Spain
| | - Jorge Quiroga
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Internal Medicine Department, University Clinic of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Institute Carlos III, Madrid, Spain
| | - Jose Luis Del Pozo
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Juan Carlos Gómez-Esteban
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
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5
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Plummer NR, Fogarty A, Shaw D, Card T, West J, Crooks C. Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection. Respir Med 2022; 197:106858. [PMID: 35490510 PMCID: PMC9047547 DOI: 10.1016/j.rmed.2022.106858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusions
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6
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Sirohiya P, Vig S, Pandey K, Meena JK, Singh R, Ratre BK, Kumar B, Pandit A, Bhatnagar S. A Correlation Analysis of Peripheral Oxygen Saturation and Arterial Oxygen Saturation Among COVID-19 Patients. Cureus 2022; 14:e24005. [PMID: 35547430 PMCID: PMC9088087 DOI: 10.7759/cureus.24005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective It has been observed that peripheral oxygen saturation (SpO2) measured by pulse oximeter is consistently lower than arterial oxygen saturation (SaO2) measured directly by blood gas analysis. In this study, we aimed to evaluate the correlation between SpO2 and SaO2, and SpO2 and partial pressure of oxygen (PaO2), and compare the SpO2/FiO2 (SF) and PaO2/FiO2 (PF) ratios in patients with coronavirus disease 2019 (COVID-19). Methods In this observational study, SpO2 was recorded and arterial blood gas analysis was performed among 70 COVID-19 patients presenting on room air (FiO2 = 0.21). SaO2 and PaO2 were recorded from arterial blood gas analysis. The SF and PF ratios were then calculated. Results The strength of correlations between SpO2 and SaO2, and SpO2 and PaO2, were significant (p<0.001) and moderately positive [Pearson coefficient (r) = 0.68, 0.53]. SpO2 value (85%), i.e., SF ratio (404.7 or below), was the best estimate for mild ARDS (acute respiratory distress syndrome) [PF ratio (300 or below)] with a sensitivity of 80.6% and specificity of 53%. Conclusion A pulse oximeter is a vital tool in the diagnosis and management of COVID-19. In our study, SpO2 was found to have a positive correlation with SaO2 and PaO2 with acceptable sensitivity but low specificity in estimating mild ARDS. Therefore, pulse oximetry can be used as a tool for the early diagnosis of mild COVID-19 ARDS as per the given considerations and clinical correlation.
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Affiliation(s)
- Prashant Sirohiya
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Saurabh Vig
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Khushboo Pandey
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Jitendra K Meena
- Preventive Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | - Ram Singh
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Brajesh K Ratre
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Balbir Kumar
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Anuja Pandit
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Sushma Bhatnagar
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
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7
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Midena E, Cosmo E, Cattelan AM, Briani C, Leoni D, Capizzi A, Tabacchi V, Parrozzani R, Midena G, Frizziero L. Small Fibre Peripheral Alterations Following COVID-19 Detected by Corneal Confocal Microscopy. J Pers Med 2022; 12:jpm12040563. [PMID: 35455679 PMCID: PMC9030195 DOI: 10.3390/jpm12040563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/07/2022] Open
Abstract
A large spectrum of neurological manifestations has been associated with coronavirus disease 2019 (COVID-19), and recently, the involvement of small fibers has been suggested. This study aims to investigate the involvement of small peripheral nervous fibers in recovered COVID-19 patients using in-vivo corneal confocal microscopy (CCM). Patients recovered from COVID-19 and a control group of healthy subjects underwent in-vivo CCM. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal nerve fiber total branch density (CTBD), corneal nerve fiber area (CNFA), corneal nerve fiber width (CNFW), fiber tortuosity (FT), number of beadings (NBe), and dendritic cells (DC) density were quantified. We enrolled 302 eyes of 151 patients. CNBD and FT were significantly higher (p = 0.0131, p < 0.0001), whereas CNFW and NBe were significantly lower (p = 0.0056, p = 0.0045) in the COVID-19 group compared to controls. Only CNBD and FT resulted significantly correlated to antiviral drugs (increased) and corticosteroids (decreased). No significant relationship with disease severity parameters was found. COVID-19 may induce peripheral neuropathy in small fibers even months after recovery, regardless of systemic conditions and therapy, and CCM may be a useful tool to identify and monitor these morphological changes.
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Affiliation(s)
- Edoardo Midena
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (E.C.); (G.M.)
- Correspondence: ; Tel.: +39-049-821-2110
| | - Eleonora Cosmo
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (E.C.); (G.M.)
| | - Anna Maria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128 Padova, Italy; (A.M.C.); (D.L.)
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy;
| | - Davide Leoni
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128 Padova, Italy; (A.M.C.); (D.L.)
| | - Alfio Capizzi
- Department of Directional Hospital Management, University of Padova, 35128 Padova, Italy;
| | - Vanessa Tabacchi
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
| | - Raffaele Parrozzani
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
| | - Giulia Midena
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (E.C.); (G.M.)
| | - Luisa Frizziero
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
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8
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Putative Role of the Lung-Brain Axis in the Pathogenesis of COVID-19-Associated Respiratory Failure: A Systematic Review. Biomedicines 2022; 10:biomedicines10030729. [PMID: 35327531 PMCID: PMC8944980 DOI: 10.3390/biomedicines10030729] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
The emergence of SARS-CoV-2 and its related disease caused by coronavirus (COVID-19) has posed a huge threat to the global population, with millions of deaths and the creation of enormous social and healthcare pressure. Several studies have shown that besides respiratory illness, other organs may be damaged as well, including the heart, kidneys, and brain. Current evidence reports a high frequency of neurological manifestations in COVID-19, with significant prognostic implications. Importantly, emerging literature is showing that the virus may spread to the central nervous system through neuronal routes, hitting the brainstem and cardiorespiratory centers, potentially exacerbating the respiratory illness. In this systematic review, we searched public databases for all available evidence and discuss current clinical and pre-clinical data on the relationship between the lung and brain during COVID-19. Acknowledging the involvement of these primordial brain areas in the pathogenesis of the disease may fuel research on the topic and allow the development of new therapeutic strategies.
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9
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Ribeiro A, Mendonça M, Sabina Sousa C, Trigueiro Barbosa M, Morais-Almeida M. Prevalence, Presentation and Outcomes of Silent Hypoxemia in COVID-19. Clin Med Insights Circ Respir Pulm Med 2022; 16:11795484221082761. [PMID: 35221741 PMCID: PMC8872812 DOI: 10.1177/11795484221082761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/07/2022] [Indexed: 01/16/2023] Open
Abstract
Dyspnea is reported in a minority of patients affected by coronavirus disease 2019 (COVID-19). Even patients with pneumonia can present hypoxemia without any respiratory distress, a phenomenon known as “silent” or “happy hypoxemia”. During the current pandemic there were only a few studies conducted on this subject and these were quite heterogeneous. Therefore, the prevalence of “silent hypoxemia” varied substantially. While studies did not show a clear tendency of “silent hypoxemia” to poorer outcomes compared to hypoxemia presenting with dyspnea, several showed that patients with “silent hypoxemia” are not protected from poor outcomes either. There is a need for a uniform definition of “silent hypoxemia”, in order to better guide clinicians and investigators. More studies are needed to shed light on the mechanisms of “silent hypoxemia”, as well as its presentation and influence in the disease's progression and outcomes, so as to better assist physicians in the care of COVID-19 patients.
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Affiliation(s)
- Amélia Ribeiro
- Pulmonology Department, Hospital Centre of Barreiro-Montijo, Barreiro, Portugal.,Allergy Centre, CUF Descobertas Hospital, Lisboa, Portugal
| | - Mauro Mendonça
- Anesthesiology Department, Central Hospital of Funchal, Funchal, Portugal
| | - Cláudia Sabina Sousa
- Allergy Centre, CUF Descobertas Hospital, Lisboa, Portugal.,Pulmonology Department, Central Hospital of Funchal, Funchal, Portugal
| | - Miguel Trigueiro Barbosa
- Pulmonology Department, Hospital Centre of Barreiro-Montijo, Barreiro, Portugal.,Allergy Centre, CUF Descobertas Hospital, Lisboa, Portugal
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10
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Mahboubi Mehrabani M, Karvandi MS, Maafi P, Doroudian M. Neurological complications associated with Covid-19; molecular mechanisms and therapeutic approaches. Rev Med Virol 2022; 32:e2334. [PMID: 35138001 PMCID: PMC9111040 DOI: 10.1002/rmv.2334] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 12/15/2022]
Abstract
With the progression of investigations on the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), neurological complications have emerged as a critical aspect of the ongoing coronavirus disease 2019 (Covid‐19) pandemic. Besides the well‐known respiratory symptoms, many neurological manifestations such as anosmia/ageusia, headaches, dizziness, seizures, and strokes have been documented in hospitalised patients. The neurotropism background of coronaviruses has led to speculation that the neurological complications are caused by the direct invasion of SARS‐CoV‐2 into the nervous system. This invasion is proposed to occur through the infection of peripheral nerves or via systemic blood circulation, termed neuronal and haematogenous routes of invasion, respectively. On the other hand, aberrant immune responses and respiratory insufficiency associated with Covid‐19 are suggested to affect the nervous system indirectly. Deleterious roles of cytokine storm and hypoxic conditions in blood‐brain barrier disruption, coagulation abnormalities, and autoimmune neuropathies are well investigated in coronavirus infections, as well as Covid‐19. Here, we review the latest discoveries focussing on possible molecular mechanisms of direct and indirect impacts of SARS‐CoV‐2 on the nervous system and try to elucidate the link between some potential therapeutic strategies and the molecular pathways.
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Affiliation(s)
- Mohammad Mahboubi Mehrabani
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Mohammad Sobhan Karvandi
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Pedram Maafi
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Mohammad Doroudian
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
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11
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Cajanding RJM. Silent Hypoxia in COVID-19 Pneumonia: State of Knowledge, Pathophysiology, Mechanisms, and Management. AACN Adv Crit Care 2022; 33:143-153. [PMID: 35113990 DOI: 10.4037/aacnacc2022448] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs of respiratory distress. Termed silent or happy hypoxia, it has puzzled clinicians and challenged and defied our understanding of normal respiratory physiology. A range of host- and pathogen-related factors appears to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes; induce endothelial damage and elicit a vascular distress response; invade cells of the central nervous system and disrupt normal interoception and response; and modulate transcription factors involved in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer survival, early detection and prompt treatment is essential to prevent potential complications. Interventions to prevent hypoxemia and improve oxygen delivery to the blood and the tissues include home pulse-oximetry monitoring, optimization of patient positioning, judicious use of supplemental oxygen, breathing control exercises, and timely and appropriate use of ventilatory modalities and adjuncts.
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Affiliation(s)
- Ruff Joseph Macale Cajanding
- Ruff Joseph Macale Cajanding is Senior Charge Nurse, Adult Critical Care Unit, 6th Floor, King George V Building, St Bartholomew's Hospital, Barts Health NHS Trust, 2 King Edward Street, London EC1A 1HQ, United Kingdom
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12
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Aggarwal M, Amjad MS, Khandelwal A, Kumar P, Dhawan R, Dass J, Ganesh KV, Khanna P, Singh AK, Soni KD, Agarwal R, Bairwa M, Selvi A, Tyagi S, Seth T, Mahapatra M, Wig N, Trikha A. COVID-19 infection in patients with haematological disease - A tertiary centre experience from north India. Indian J Med Res 2022; 155:570-574. [PMID: 35975348 PMCID: PMC9807201 DOI: 10.4103/ijmr.ijmr_1180_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population.
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Affiliation(s)
- Mukul Aggarwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mirza Saleem Amjad
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Khandelwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Dhawan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmita Dass
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Punit Khanna
- Department of Anaesthesia, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Akhil Kant Singh
- Department of Anaesthesia, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Trauma Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Agarwal
- Department of Trauma Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mohan Bairwa
- Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arul Selvi
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India,For correspondence: Dr Manoranjan Mahapatra, Department of Hematology, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail:
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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13
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Vallée A. Dysautonomia and Implications for Anosmia in Long COVID-19 Disease. J Clin Med 2021; 10:jcm10235514. [PMID: 34884216 PMCID: PMC8658706 DOI: 10.3390/jcm10235514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/25/2022] Open
Abstract
Long COVID-19 patients often reported anosmia as one of the predominant persisting symptoms. Recent findings have shown that anosmia is associated with neurological dysregulations. However, the involvement of the autonomic nervous system (ANS), which can aggregate all the long COVID-19 neurological symptoms, including anosmia, has not received much attention in the literature. Dysautonomia is characterized by the failure of the activities of components in the ANS. Long COVID-19 anosmia fatigue could result from damage to olfactory sensory neurons, leading to an augmentation in the resistance to cerebrospinal fluid outflow by the cribriform plate, and further causing congestion of the glymphatic system with subsequent toxic build-up in the brain. Studies have shown that anosmia was an important neurologic symptom described in long COVID-19 in association with potential COVID-19 neurotropism. SARS-CoV-2 can either travel via peripheral blood vessels causing endothelial dysfunction, triggering coagulation cascade and multiple organ dysfunction, or reach the systemic circulation and take a different route to the blood–brain barrier, damaging the blood–brain barrier and leading to neuroinflammation and neuronal excitotoxicity. SARS-CoV-2 entry via the olfactory epithelium and the increase in the expression of TMPRSS2 with ACE2 facilitates SARS-CoV-2 neurotropism and then dysautonomia in long COVID-19 patients. Due to this effect, patients with anosmia persisting 3 months after COVID-19 diagnosis showed extensive destruction of the olfactory epithelium. Persistent anosmia observed among long COVID-19 patients may be involved by a cascade of effects generated by dysautonomia leading to ACE2 antibodies enhancing a persistent immune activation.
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Affiliation(s)
- Alexandre Vallée
- Department of Clinical Research and Innovation, Foch Hospital, 92150 Suresnes, France
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14
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15
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Machluf Y, Rosenfeld S, Ben Shlomo I, Chaiter Y, Dekel Y. The Misattributed and Silent Causes of Poor COVID-19 Outcomes Among Pregnant Women. Front Med (Lausanne) 2021; 8:745797. [PMID: 34765620 PMCID: PMC8575767 DOI: 10.3389/fmed.2021.745797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
Abundant evidence strongly suggests that the condition of pregnancy makes women and their fetuses highly vulnerable to severe Corona-virus 2019 (COVID-19) complications. Here, two novel hypoxia-related conditions are proposed to play a pivotal role in better understanding the relationship between COVID-19, pregnancy and poor health outcomes. The first condition, "misattributed dyspnea (shortness of breath)" refers to respiratory symptoms common to both advanced pregnancy and COVID-19, which are mistakenly perceived as related to the former rather than to the latter; as a result, pregnant women with this condition receive no medical attention until the disease is in an advanced stage. The second condition, "silent hypoxia", refers to abnormally low blood oxygen saturation levels in COVID-19 patients, which occur in the absence of typical respiratory distress symptoms, such as dyspnea, thereby also leading to delayed diagnosis and treatment. The delay in diagnosis and referral to treatment, due to either "misattributed dypsnea" or "silent hypoxia", may lead to rapid deterioration and poor health outcome to both the mothers and their fetuses. This is particularly valid among women during advanced stages of pregnancy as the altered respiratory features make the consequences of the disease more challenging to cope with. Studies have demonstrated the importance of monitoring blood oxygen saturation by pulse oximetry as a reliable predictor of disease severity and outcome among COVID-19 patients. We propose the use of home pulse oximetry during pregnancy as a diagnostic measure that, together with proper medical guidance, may allow early diagnosis of hypoxia and better health outcomes.
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Affiliation(s)
- Yossy Machluf
- Unit of Agrigenomics, Shamir Research Institute, Haifa University, Kazerin, Israel
| | - Sherman Rosenfeld
- The Department of Science Teaching, Weizmann Institute of Science, Rehovot, Israel
| | - Izhar Ben Shlomo
- Emergency Medicine Program, Zefat Academic College, Safed, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-Based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Yaron Dekel
- Unit of Agrigenomics, Shamir Research Institute, Haifa University, Kazerin, Israel
- Department of Medical Laboratory Sciences, Zefat Academic College, Safed, Israel
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16
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Bagnato G, La Rosa D, Ioppolo C, De Gaetano A, Chiappalone M, Zirilli N, Viapiana V, Tringali MC, Tomeo S, Aragona CO, Napoli F, Lillo S, Irrera N, Roberts WN, Imbalzano E, Micari A, Ventura Spagnolo E, Squadrito G, Gangemi S, Versace AG. The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study. Front Med (Lausanne) 2021; 8:719976. [PMID: 34660631 PMCID: PMC8514624 DOI: 10.3389/fmed.2021.719976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/02/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care. Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality. Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%. Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality.
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Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marianna Chiappalone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natalia Zirilli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Valeria Viapiana
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Simona Tomeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Francesca Napoli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sara Lillo
- BIOMORF Department, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- BIOMORF Department, University of Messina, Messina, Italy
| | - Elvira Ventura Spagnolo
- Department for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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17
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Spiess BD, Sitkovsky M, Correale P, Gravenstein N, Garvan C, Morey TE, Fahy BG, Hendeles L, Pliura TJ, Martin TD, Wu V, Astrom C, Nelson DS. Case Report: Can Inhaled Adenosine Attenuate COVID-19? Front Pharmacol 2021; 12:676577. [PMID: 34434105 PMCID: PMC8381598 DOI: 10.3389/fphar.2021.676577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/11/2021] [Indexed: 01/08/2023] Open
Abstract
This case report demonstrates a small repetition of the case series carried out in Italy wherein inhaled adenosine was administered to patients experiencing severe and worsening coronavirus disease-2019 (COVID-19). The two cases are important not only because they were the first of their type in the United States, but also because both patients were DNR/DNI and were therefore expected to die. Study repetition is vitally important in medicine. New work in pharmacology hypothesizes that adenosine-regulator proteins may play a role in the pathogenesis of COVID-19 infection. Furthermore, adenosine, by interacting with cell receptor sites, has pluripotent effects upon inflammatory cells, is anti-inflammatory, and is important in tissue hypoxia signaling. Inhaled adenosine is potentially safe; thousands have received it for asthmatic challenge testing. The effects of adenosine in these two cases were rapid, positive, and fit the pharmacologic hypotheses (as seen in prior work in this journal) and support its role as a therapeutic nucleoside.
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Affiliation(s)
- Bruce D Spiess
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Michael Sitkovsky
- New England Inflammation and Tissue Protection Institute - Northeastern University, Boston, MA, United States
| | - Pierpaolo Correale
- Medical Oncology Unit, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Nikolaus Gravenstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Timothy E Morey
- Department of Anesthesiology, University of Florida School of Medicine, Gainesville, FL, United States
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Leslie Hendeles
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Thomas J Pliura
- Private Practice Emergency Department, Champaign, IL, United States
| | - Thomas D Martin
- Department of Surgery (Cardiac Surgery), University of Florida School of Medicine, Gainesville, FL, United States
| | - Velyn Wu
- Department of Community Health and Family Medicine, University of Florida, College of Medicine, Gainesville, FL, United States
| | - Corey Astrom
- Department of Anesthesiology, University of Florida School of Medicine, Gainesville, FL, United States
| | - Danielle S Nelson
- Department of Community Health and Family Medicine, University of Florida, College of Medicine, Gainesville, FL, United States
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18
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Chandrasekhar SS. Diversity: A Necessity in the Otolaryngology Workforce. Otolaryngol Clin North Am 2021; 53:xxiii-xxiv. [PMID: 32883434 DOI: 10.1016/j.otc.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sujana S Chandrasekhar
- Consulting Editor, Otolaryngologic Clinics of North America; Past President, American Academy of Otolaryngology-Head and Neck Surgery; Secretary-Treasurer, American Otological Society; Partner, ENT & Allergy Associates LLP, 18 East 48th Street, 2nd Floor, New York, NY 10017, USA; Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA; Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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19
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García-Grimshaw M, Flores-Silva FD, Chiquete E, Cantú-Brito C, Michel-Chávez A, Vigueras-Hernández AP, Domínguez-Moreno R, Chávez-Martínez OA, Sánchez-Torres S, Marché-Fernández OA, González-Duarte A. Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients. Auton Neurosci 2021; 235:102855. [PMID: 34293703 PMCID: PMC8285214 DOI: 10.1016/j.autneu.2021.102855] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 01/16/2023]
Abstract
Background An intriguing feature recently unveiled in some COVID-19 patients is the “silent hypoxemia” phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea. Objective To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients. Methods We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia). Results We studied 470 cases (64.4% men; median age 55 years, interquartile range 46–64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101–7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024–9.89; P = 0.045). Conclusions Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alma Poema Vigueras-Hernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Domínguez-Moreno
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oswaldo Alan Chávez-Martínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samantha Sánchez-Torres
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Osvaldo Alexis Marché-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandra González-Duarte
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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20
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Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep 2021; 11:14042. [PMID: 34234251 DOI: 10.1038/s41598-021-93546-5.pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/28/2021] [Indexed: 05/22/2023] Open
Abstract
Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as "long COVID" infection. 39 participants were included from December 2020 to January 2021 for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200 pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups. A significant NOL index dissociation over time between long COVID-19 participants with fatigue and control participants was observed (p = 0.046). A trend towards significant NOL index dissociation over time was observed between long COVID-19 participants without fatigue and control participants (p = 0.109). No difference over time was observed between the two groups of long COVID-19 participants (p = 0.904). Long COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in long COVID-19 patients, such as fatigue and hypoxia. Trial registration: The study was approved by the Foch IRB: IRB00012437 (Approval Number: 20-12-02) on December 16, 2020.
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Affiliation(s)
- Nicolas Barizien
- Department of Physical Medicine and Rehabilitation, Foch Hospital, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology, Foch Hospital, Suresnes, France
| | | | - Pauline Touche
- Department of Clinical Research and Innovation, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation, Foch Hospital, 40 rue Worth, 92150, Suresnes, France.
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21
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Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep 2021; 11:14042. [PMID: 34234251 PMCID: PMC8263555 DOI: 10.1038/s41598-021-93546-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/28/2021] [Indexed: 01/07/2023] Open
Abstract
Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as “long COVID” infection. 39 participants were included from December 2020 to January 2021 for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200 pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups. A significant NOL index dissociation over time between long COVID-19 participants with fatigue and control participants was observed (p = 0.046). A trend towards significant NOL index dissociation over time was observed between long COVID-19 participants without fatigue and control participants (p = 0.109). No difference over time was observed between the two groups of long COVID-19 participants (p = 0.904). Long COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in long COVID-19 patients, such as fatigue and hypoxia.
Trial registration: The study was approved by the Foch IRB: IRB00012437 (Approval Number: 20-12-02) on December 16, 2020.
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22
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Hyoju SK, Baral B, Jha PK. Central catecholaminergic blockade with clonidine prevent SARS-CoV-2 complication: A case series. IDCases 2021; 25:e01219. [PMID: 34249614 PMCID: PMC8258028 DOI: 10.1016/j.idcr.2021.e01219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
SAR-CoV-2 infection lead to sympathetic overactivity. People with co morbid condition due to pre-sympathetic overactivity, there will be always possible of worse outcome. FDA-approved drug clonidine reduces sympathetic activity during COVID-19 infection and prevent complication and death. Clonidine should be considered early in incremental fashion to mitigate SAR-CoV-2 related complication. This is the first case series demonstrating the effectiveness of early use of clonidine in COVID-19.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a life-threating viral infection that is highly transmissible and be lethal. Although many patients with mild symptoms recover, an acute form of the infection is characterized by rapidly evolving respiratory failure, an acute inflammatory response, organ failure, and death. Herein, we describe the use of clonidine to modulate the acute inflammatory consequences of this infection in three cases. The patients were three men between 40–50 years from Kathmandu valley, during the peak of COVID-19 (September 2020- January 2021). All three patients presented with typical COVID-19 symptoms (daily fever, loss of smell and taste, excessive fatigue, cough) and had pneumonia with typical finding in CT Scan of chest. Patient 1was able to maintain adequate oxygenation despite having pneumonia, managed at home by regular self-monitoring of vitals and treatment with oral clonidine whereas patient 2 and 3 developed significant pneumonia and had difficult in maintaining oxygenation hence admitted in hospital and treated with clonidine and supplemental oxygen. All three patients recovered completely. In this limited report, we proposed several mechanisms by which clonidine may be useful in managing rapidly evolving SARS-CoV-2 infection based on the rationale that early clonidine administration can intervene in the catecholaminergic response that characterizes rapid clinical deterioration including presumptive cytokine storm that occurs in COVID-19 infection in vulnerable populations.
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Affiliation(s)
- Sanjiv K Hyoju
- Bhomi Hospital and Institute of Medical Sciences, Banepa, Nepal
| | - Bidur Baral
- Critical Care and Anesthesiology, Bir Hospital, Nepal
| | - Prabin K Jha
- Anesthesiology Department, Koshi Zonal Hospital, Nepal
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23
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Baker J, Incognito AV, Wilson RJA, Raj SR. Syncope and silent hypoxemia in COVID-19: Implications for the autonomic field. Auton Neurosci 2021; 235:102842. [PMID: 34246957 PMCID: PMC8258030 DOI: 10.1016/j.autneu.2021.102842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/22/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus-19 (COVID-19), the infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has wreaked havoc across the globe since its emergence in December 2019. Reports of patients presenting with syncope and pre-syncope, as well as hypoxemia without symptoms of dyspnea (“silent hypoxemia”), have led researchers to speculate whether SARS-CoV-2 can alter autonomic nervous system function. As viral infections are commonly reported triggers of altered autonomic control, we must consider whether SARS-CoV-2 can also interfere with autonomic activity, at least in some patients. As we are still in the early stages of understanding COVID-19, we still do not know whether syncope and silent hypoxemia are more strongly associated with COVID-19 compared to any other viral infections that severely compromise gas exchange. Therefore, in this perspective we discuss these two intriguing clinical presentations, as they relate to autonomic nervous system function. In our discussion, we will explore COVID-specific, as well as non-COVID specific mechanisms that may affect autonomic activity and potential therapeutic targets. As we move forward in our understanding of COVID-19, well-designed prospective studies with appropriate control and comparator groups will be necessary to identify potential unique effects of COVID-19 on autonomic function.
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Affiliation(s)
- Jacquie Baker
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Anthony V Incognito
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Richard J A Wilson
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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24
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Mehta P, Sahni S, Siddiqui S, Mishra N, Sharma P, Sharma S, Tyagi A, Chattopadhyay P, Vivekanand A, Devi P, Khan A, Waghdhare S, Budhiraja S, Uppili B, Maurya R, Nangia V, Shamim U, Hazarika PP, Wadhwa S, Tyagi N, Dewan A, Tarai B, Das P, Faruq M, Agrawal A, Jha S, Pandey R. Respiratory Co-Infections: Modulators of SARS-CoV-2 Patients' Clinical Sub-Phenotype. Front Microbiol 2021; 12:653399. [PMID: 34122366 PMCID: PMC8193731 DOI: 10.3389/fmicb.2021.653399] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/27/2021] [Indexed: 12/31/2022] Open
Abstract
Co-infection with ancillary pathogens is a significant modulator of morbidity and mortality in infectious diseases. There have been limited reports of co-infections accompanying SARS-CoV-2 infections, albeit lacking India specific study. The present study has made an effort toward elucidating the prevalence, diversity and characterization of co-infecting respiratory pathogens in the nasopharyngeal tract of SARS-CoV-2 positive patients. Two complementary metagenomics based sequencing approaches, Respiratory Virus Oligo Panel (RVOP) and Holo-seq, were utilized for unbiased detection of co-infecting viruses and bacteria. The limited SARS-CoV-2 clade diversity along with differential clinical phenotype seems to be partially explained by the observed spectrum of co-infections. We found a total of 43 bacteria and 29 viruses amongst the patients, with 18 viruses commonly captured by both the approaches. In addition to SARS-CoV-2, Human Mastadenovirus, known to cause respiratory distress, was present in a majority of the samples. We also found significant differences of bacterial reads based on clinical phenotype. Of all the bacterial species identified, ∼60% have been known to be involved in respiratory distress. Among the co-pathogens present in our sample cohort, anaerobic bacteria accounted for a preponderance of bacterial diversity with possible role in respiratory distress. Clostridium botulinum, Bacillus cereus and Halomonas sp. are anaerobes found abundantly across the samples. Our findings highlight the significance of metagenomics based diagnosis and detection of SARS-CoV-2 and other respiratory co-infections in the current pandemic to enable efficient treatment administration and better clinical management. To our knowledge this is the first study from India with a focus on the role of co-infections in SARS-CoV-2 clinical sub-phenotype.
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Affiliation(s)
- Priyanka Mehta
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shweta Sahni
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Samreen Siddiqui
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Neha Mishra
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Pooja Sharma
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Sachin Sharma
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Akansha Tyagi
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Partha Chattopadhyay
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - A Vivekanand
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Priti Devi
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Azka Khan
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Swati Waghdhare
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Sandeep Budhiraja
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Bharathram Uppili
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ranjeet Maurya
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Vivek Nangia
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Uzma Shamim
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Pranjal P Hazarika
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Saruchi Wadhwa
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Nishu Tyagi
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Arun Dewan
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Bansidhar Tarai
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Poonam Das
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Anurag Agrawal
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Sujeet Jha
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, New Delhi, India
| | - Rajesh Pandey
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
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25
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Azabou E, Bao G, Bounab R, Heming N, Annane D. Vagus Nerve Stimulation: A Potential Adjunct Therapy for COVID-19. Front Med (Lausanne) 2021; 8:625836. [PMID: 34026778 PMCID: PMC8137825 DOI: 10.3389/fmed.2021.625836] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) through excessive end organ inflammation. Despite improved understanding of the pathophysiology, management, and the great efforts worldwide to produce effective drugs, death rates of COVID-19 patients remain unacceptably high, and effective treatment is unfortunately lacking. Pharmacological strategies aimed at modulating inflammation in COVID-19 are being evaluated worldwide. Several drug therapies targeting this excessive inflammation, such as tocilizumab, an interleukin (IL)-6 inhibitor, corticosteroids, programmed cell death protein (PD)-1/PD-L1 checkpoint inhibition, cytokine-adsorption devices, and intravenous immunoglobulin have been identified as potentially useful and reliable approaches to counteract the cytokine storm. However, little attention is currently paid for non-drug therapeutic strategies targeting inflammatory and immunological processes that may be useful for reducing COVID-19-induced complications and improving patient outcome. Vagus nerve stimulation attenuates inflammation both in experimental models and preliminary data in human. Modulating the activity of cholinergic anti-inflammatory pathways (CAPs) described by the group of KJ Tracey has indeed become an important target of therapeutic research strategies for inflammatory diseases and sepsis. Non-invasive transcutaneous vagal nerve stimulation (t-VNS), as a non-pharmacological adjuvant, may help reduce the burden of COVID-19 and deserve to be investigated. VNS as an adjunct therapy in COVID-19 patients should be investigated in clinical trials. Two clinical trials on this topic are currently underway (NCT04382391 and NCT04368156). The results of these trials will be informative, but additional larger studies are needed.
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Affiliation(s)
- Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Guillaume Bao
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Rania Bounab
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Nicholas Heming
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Djillali Annane
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
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26
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Machado BH, Paton JFR. Relevance of carotid bodies in COVID-19: A hypothetical viewpoint. Auton Neurosci 2021; 233:102810. [PMID: 33894532 PMCID: PMC8052558 DOI: 10.1016/j.autneu.2021.102810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/27/2022]
Abstract
We have considered some of the available evidence to account for the impact of SARS-CoV on the regulatory control of the autonomic nervous and respiratory systems. Apart from stimulating general interest in the subject, our hope was to provide putative explanations for some of the patients' symptoms based on described physiological and pathophysiological mechanisms seen in other diseases. Herein, we have focused on the carotid bodies. In this hypothetical viewpoint, we have discussed the plasticity of the carotid body chemoreflex and made a comparison between acute and chronic exposures to high altitude with COVID-19. From these discussions, we have postulated that the sensitivity of the hypoxic ventilatory response may well determine the outcome of disease severity and those that live at high altitude may be more resistant. We have provided insight into silent hypoxia and attempted to explain an absence of ventilatory drive and anxiety yet maintenance of consciousness. In an attempt to discover more about the mysteries of COVID-19, we conclude with questions and some hypothetical studies that may answer them.
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Affiliation(s)
- Benedito H Machado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil.
| | - Julian F R Paton
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil.
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27
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Autonomic function test during the COVID-19 pandemic: is it safe and sound? Clin Auton Res 2021; 31:57-58. [PMID: 33528657 PMCID: PMC7851316 DOI: 10.1007/s10286-021-00776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 11/12/2022]
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28
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Garnier M, Quesnel C, Constantin JM. Atteintes pulmonaires liées à la COVID-19. LA PRESSE MÉDICALE FORMATION 2021. [PMCID: PMC7785274 DOI: 10.1016/j.lpmfor.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Le SARS-CoV-2, responsable de la COVID-19, est un nouveau bêta-coronavirus. Il engendre une réaction inflammatoire intense pouvant aller jusqu’à l’« orage cytokinique », avec des atteintes pulmonaires épithéliales sévères et un tableau de coagulopathie intravasculaire pulmonaire. Le tableau clinique est polymorphe, avec possible survenue d’un syndrome de détresse respiratoire aigu (SDRA). La ventilation non invasive et l’oxygénothérapie à haut débit permettent de traiter efficacement plus de la moitié des patients graves sans recours à l’intubation et sans risque pour le personnel soignant. Le seul traitement actuellement validé est la dexaméthasone à dose modérée (6 mg/j pendant 10 jours). Le haut risque thrombotique justifie en fonction des cas une anticoagulation préventive voire curative.
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29
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Baluja A, Ghosh A, Modi JN, Pal R, Halder A, Shrivastava A, Agrawal A. COVID-19 pandemic and safety of taxi services: Looking beyond primary care. J Family Med Prim Care 2021; 10:27-30. [PMID: 34017698 PMCID: PMC8132765 DOI: 10.4103/jfmpc.jfmpc_1729_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic is a lifetime experience of 'Living within a pandemic' for the vast majority world over. Public health principles based on equity should be at the core of world's response to it. Service professionals such as taxi/cab drivers are no exception. It is a challenge for them to establish mechanisms for making taxi services safer with regards to SARS COV2 spread, and thereby regain the confidence of stakeholders in this necessary public service. This requires a comprehensive planning taking into account the socio-economic stresses, psychosomatic health and other determinants, and yet being able to adapt and innovate for safer services. These considerations and decisions have to be based on available as well as emerging research evidence about this infection both in the lab and in the community. Targeted safety interventions that translate and apply research findings hold promise. While the course of the pandemic remains uncertain, life must find a 'new normal' and people need to get back to the business of regular living. The purpose of this review is to study the various risks to the stakeholders in taxi/cab services, and draft strategies for mitigating these risks from a theoretical and practical perspective.
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Affiliation(s)
- Arushi Baluja
- Department of Driver Training and International Affairs Institute of Road Traffic Education, Faridabad, Haryana, India
| | - Amrita Ghosh
- Department of Biochemistry, Medical College, College Street, Kolkata, West Bengal, India
| | - Jyoti N Modi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Ranabir Pal
- Department of Community Medicine, MGM Medical College, Kishanganj, Bihar, India
| | - Ajay Halder
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
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30
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Hinduja A, Moutairou A, Calvet JH. Sudomotor dysfunction in patients recovered from COVID-19. Neurophysiol Clin 2021; 51:193-196. [PMID: 33551341 PMCID: PMC7835104 DOI: 10.1016/j.neucli.2021.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
Dysautonomia has been reported in COVID-19. Sweat function testing has been proposed to assess autonomic neuropathy. Fifty Indian patients consulting for neurological symptoms participated in this observational study. The NHS questionnaire for neurological symptoms was completed and electrochemical skin conductance was measured using Sudoscan. The 26% of patients with sweat dysfunction i) were older (p = 0.001), ii) were more frequently treated at home (p = 0.008), iii) were more likely to have received antiviral treatment (p = 0.0006), and iv) more frequently reported at least one motor, sensory or autonomic symptom (p = 0.04). This preliminary study suggests that patients with COVID-19 should be screened for dysautonomia.
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31
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Three decades of Clinical Autonomic Research and beyond. Clin Auton Res 2021; 31:1-3. [PMID: 33426613 PMCID: PMC7797191 DOI: 10.1007/s10286-020-00762-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
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32
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Elera-Fitzcarrald C, Huarcaya-Victoria J, Alarcón GS, Ugarte-Gil MF. Rheumatology and psychiatry: allies in times of COVID-19. Clin Rheumatol 2021; 40:3363-3367. [PMID: 34050441 PMCID: PMC8162488 DOI: 10.1007/s10067-021-05792-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/15/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 (coronavirus disease 2019) pandemic has had a significant global impact. Physical, emotional, and psychological health, particularly its specific mental health area, has been affected. Patients with rheumatic diseases are more likely to be concerned about COVID-19 than the public in general. Depression and anxiety are the symptoms most commonly reported by these patients. Therefore, now more than ever before, rheumatologists and psychiatrists should work together to improve the care of rheumatic disease patients, identifying the symptoms that uniquely reflect mental health problems, so the patients' quality of life can be substantially improved.
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Affiliation(s)
- Claudia Elera-Fitzcarrald
- Facultad de Medicina, Universidad Científica del Sur, Av. Panamericana Sur km 19, Villa El Salvador, 15067, Lima, Peru.
| | - Jeff Huarcaya-Victoria
- Departamento Académico de Psiquiatría, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Graciela S Alarcón
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, The University of Alabama At Birmingham, Birmingham, AL, USA
| | - Manuel F Ugarte-Gil
- Facultad de Medicina, Universidad Científica del Sur, Av. Panamericana Sur km 19, Villa El Salvador, 15067, Lima, Peru
- Servicio de Reumatología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
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33
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Otolaryngology During the COVID-19 Pandemic: What We Have Learned in Year One. Otolaryngol Clin North Am 2020; 53:xxiii-xxv. [PMID: 33039098 PMCID: PMC7492004 DOI: 10.1016/j.otc.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Tan AL, Farrow M, Biglands J, Fernandes RJ, Abraldes JA, de Souza Castro FA, de Souza HL, Arriel RA, Meireles A, Marocolo M, González-Rayas JM, Rayas-Gómez AL, Mobayed-Vega FN, González-Yáñez JM, Hirai DM, Belbis MD, Holmes MJ, Calvo N, Ferguson SK, Fernandes T, Oliveira EM, Pun M, Bhandari SS. Commentaries on Viewpoint: The interaction between SARS-CoV-2 and ACE2 may have consequences for skeletal muscle viral susceptibility and myopathies. J Appl Physiol (1985) 2020; 129:868-871. [PMID: 33027604 PMCID: PMC7839240 DOI: 10.1152/japplphysiol.00775.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Matthew Farrow
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom,School of Pharmacy and Medical Sciences, University of Bradford, United Kingdom
| | - John Biglands
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ricardo J. Fernandes
- Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal,Porto Biomechanics Laboratory, University of Porto, Porto, Portugal
| | - J. Arturo Abraldes
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Flávio Antônio de Souza Castro
- School of Physical Education, Physiotherapy and Dance, Aquatic Sports Research Group, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Hiago L.R. de Souza
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Rhai A. Arriel
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson Meireles
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - José Manuel González-Rayas
- School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, México
| | | | | | | | - Daniel M. Hirai
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Michael D. Belbis
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Michael J. Holmes
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Nainoa Calvo
- Department of Kinesiology and Exercise Science, College of Natural and Health Sciences, University of Hawaii at Hilo, Hilo, Hawaii
| | - Scott K. Ferguson
- Department of Kinesiology and Exercise Science, College of Natural and Health Sciences, University of Hawaii at Hilo, Hilo, Hawaii
| | - Tiago Fernandes
- Laboratory of Biochemistry and Molecular Biology of Exercise, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Edilamar Menezes Oliveira
- Laboratory of Biochemistry and Molecular Biology of Exercise, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Matiram Pun
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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35
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Gupta H, Nigam N, Verma S, Gautam M. Our knowledge of Covid-19 is expanding and accelerating fast. J Family Med Prim Care 2020; 9:5419-5420. [PMID: 33409239 PMCID: PMC7773119 DOI: 10.4103/jfmpc.jfmpc_1620_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/12/2022] Open
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