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Redruello-Guerrero P, Ruiz-Del-Pino M, Jiménez-Gutiérrez C, Jiménez-Gutiérrez P, Carrascos-Cáliz A, Romero-Linares A, Láinez Ramos-Bossini AJ, Rivera-Izquierdo M, Cárdenas-Cruz A. COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis. Med Intensiva 2023; 47:583-593. [PMID: 37302941 PMCID: PMC10251196 DOI: 10.1016/j.medine.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/19/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). DESIGN Systematic review with meta-analysis. SETTING Intensive Care Unit (ICU). PARTICIPANTS Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19, who developed atraumatic PNX or PNMD on admission or during hospital stay. INTERVENTIONS Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD. MAIN VARIABLES OF INTEREST Mortality, mean ICU stay and mean PaO2/FiO2 at diagnosis. RESULTS Information was collected from 12 longitudinal studies. Data from a total of 4901 patients were included in the meta-analysis. A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite the finding of significantly strong associations, the great heterogeneity between studies implies that the interpretation of results should be made with caution. CONCLUSIONS Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose grouping these cases under the term COVID-19-associated lung weakness (CALW).
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Affiliation(s)
| | - Marta Ruiz-Del-Pino
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carmen Jiménez-Gutiérrez
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Anestesiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Paula Jiménez-Gutiérrez
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Ana Carrascos-Cáliz
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Alejandro Romero-Linares
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, Spain; Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio Jesús Láinez Ramos-Bossini
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Radiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mario Rivera-Izquierdo
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
| | - Antonio Cárdenas-Cruz
- Departamento de Medicina, Universidad de Granada, Granada, Spain; Servicio de Medicina Intensiva, Hospital Universitario de Poniente, Almería, Spain.
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Redruello-Guerrero P, Ruiz-Del-Pino M, Jiménez-Gutiérrez C, Jiménez-Gutiérrez P, Carrascos-Cáliz A, Romero-Linares A, Láinez Ramos-Bossini AJ, Rivera-Izquierdo M, Cárdenas-Cruz A. [COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis]. Med Intensiva 2023:S0210-5691(23)00094-3. [PMID: 37359239 PMCID: PMC10130322 DOI: 10.1016/j.medin.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/18/2023] [Indexed: 06/28/2023]
Abstract
Objectives To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). Design Systematic review with meta-analysis. Setting Intensive care unit (ICU). Participants Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19 who had developed atraumatic PNX or PNMD on admission or during their hospital stay. Interventions Data of interest were obtained from each article and analysed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed by data derived from studies including patients who developed atraumatic PNX or PNMD. Main variables of interest Mortality, mean ICU length of stay and mean PaO2/FiO2 at diagnosis. Results Data were collected from 12 longitudinal studies. Data from a total of 4,901 patients were included in the meta-analysis. A total of 1,629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite finding significantly strong associations, the high heterogeneity between studies means that interpretation of the results should be made with caution. Conclusions Mortality of COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose to group these cases under the term CAPD.
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Affiliation(s)
- Pablo Redruello-Guerrero
- Departamento de Medicina, Universidad de Granada, Granada, España
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, España
| | - Marta Ruiz-Del-Pino
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Carmen Jiménez-Gutiérrez
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Servicio de Anestesiología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Paula Jiménez-Gutiérrez
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - Ana Carrascos-Cáliz
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, España
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Alejandro Romero-Linares
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, España
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Antonio Jesús Láinez Ramos-Bossini
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Servicio de Radiología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Mario Rivera-Izquierdo
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España
| | - Antonio Cárdenas-Cruz
- Departamento de Medicina, Universidad de Granada, Granada, España
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, España
- Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, España
- Servicio de Medicina Intensiva, Hospital Universitario de Poniente, Almería, España
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Esteves-Monteiro M, Menezes-Pinto D, Ferreira-Duarte M, Dias-Pereira P, Morato M, Duarte-Araújo M. Histomorphometry Changes and Decreased Reactivity to Angiotensin II in the Ileum and Colon of Streptozotocin-Induced Diabetic Rats. Int J Mol Sci 2022; 23:13233. [PMID: 36362021 PMCID: PMC9656372 DOI: 10.3390/ijms232113233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 10/15/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic progressive metabolic disorder associated with several gastrointestinal complications, affecting up to 75% of patients. Knowing that Angiotensin II (AngII) also regulates intestinal contraction, we decided to evaluate changes in ileum and colon histomorphometry and AngII reactivity in a rat model of DM. Streptozotocin (STZ, 55 mg/kg) was administered to induce DM to 24 adult male Wistar rats. Diabetic rats displayed all the characteristic signs of type 1 DM (T1DM) and fecal excretion increased about 4-fold over 14 days, while the excretion of controls remained unaltered. Compared to controls, diabetic ileum and colon presented an increase in both macroscopic (length, perimeter and weight) and microscopic (muscular wall thickness) parameters. Functionally, AngII-induced smooth muscle contraction was lower in diabetic rats, except in the distal colon. These differences in the contractile response to AngII may result from an imbalance between AngII type 1 (antagonized by candesartan, 10 nM) and type 2 receptors activation (antagonized by PD123319, 100 nM). Taken together, these results indicate that an early and refined STZ-induced T1DM rat model already shows structural remodelling of the gut wall and decreased contractile response to AngII, findings that may help to explain diabetic dysmotility.
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Affiliation(s)
- Marisa Esteves-Monteiro
- LAQV-REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Immuno-Physiology and Pharmacology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto (FFUP), 4050-313 Porto, Portugal
| | - Daniela Menezes-Pinto
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto (FFUP), 4050-313 Porto, Portugal
| | - Mariana Ferreira-Duarte
- LAQV-REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto (FFUP), 4050-313 Porto, Portugal
| | - Patrícia Dias-Pereira
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
| | - Manuela Morato
- LAQV-REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto (FFUP), 4050-313 Porto, Portugal
| | - Margarida Duarte-Araújo
- LAQV-REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Immuno-Physiology and Pharmacology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
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Malik A, Saha S, Morya RK, Bhadada SK, Rana SV. Impact of serotonin transporter gene polymorphism on gut motility in patients with type 2 Diabetes mellitus. J Neurogastroenterol Motil 2021; 27:240-247. [PMID: 33526751 PMCID: PMC8026373 DOI: 10.5056/jnm20211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims The pathogenesis of gastrointestinal (GI) symptoms in patients with type 2 diabetes mellitus (T2DM) is yet to be delineated clearly. Serotonin, a monoamine neurotransmitter, resides primarily in the gut and plays a vital role in GI system. However, no study has been documented the role of serotonin and serotonin transporter gene (SLC6A4) polymorphism in the development of GI symptoms in T2DM patients. Methods Three hundred diabetes patients attending diabetes clinic at Postgraduate Institute of Medical Education and Research, Chandigarh, and matched healthy controls were enrolled for this study. Plasma from collected blood sample was used for serotonin measurement by enzyme-linked immunosorbent assay method and buffy coat was used for isolation of DNA by phenol chloroform method. Serotonin transporter gene polymorphism was analyzed by polymerase chain reaction method. Results The frequency of short allele (S) and SS genotype was significantly higher in patients with T2DM than controls and was associated with increased risk of T2DM. The frequency of LS genotype showed an association with protection from the disease. Regarding GI symptoms, 78.2% of patients with constipation showed LL and LS genotypes, and 97.7% of patients with diarrhea had SS genotype. The patients without GI symptoms did not show any association of gut motility with genotype. Furthermore, serotonin was significantly higher in diabetic patients who belonged to SS genotype compared to LS or LL genotype and who presented with diarrhea. Conclusion SS genotypes are prone to develop diarrhea because of faster gut motility resulting from higher serotonin levels as compared to LS and LL genotype in T2DM patients.
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Affiliation(s)
- Aastha Malik
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarama Saha
- Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Rajesh K Morya
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satya V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
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