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Iacopetta D, Catalano A, Ceramella J, Pellegrino M, Marra M, Scali E, Sinicropi MS, Aquaro S. The Ongoing Impact of COVID-19 on Pediatric Obesity. Pediatr Rep 2024; 16:135-150. [PMID: 38391001 PMCID: PMC10885050 DOI: 10.3390/pediatric16010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.
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Affiliation(s)
- Domenico Iacopetta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy
| | - Alessia Catalano
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", 70126 Bari, Italy
| | - Jessica Ceramella
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy
| | - Michele Pellegrino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy
| | - Maria Marra
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy
| | - Elisabetta Scali
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Maria Stefania Sinicropi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy
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Kirbiš S, Sobotkiewicz N, Schaubach BA, Završnik J, Kokol P, Završnik M, Blažun Vošner H. The Effects of Diabetes and Being Overweight on Patients with Post-COVID-19 Syndrome. Infect Dis Rep 2023; 15:747-757. [PMID: 38131880 PMCID: PMC10742883 DOI: 10.3390/idr15060067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
In the aftermath of the COVID-19 pandemic, post-COVID-19 syndrome (PCS) remains a challenge and may continue to pose a major health problem in the future. Moreover, the influences of type 2 diabetes and being overweight on PCS remain unclear. This study aimed to assess these influences. We performed an observational study from October 2020 to July 2022, which included 466 patients (269 males and 197 females) with a median age of 65. They were hospitalized due to COVID-19 pneumonia and had persistent symptoms after 1 month of COVID-19 infection. The patients were divided into four groups according to the study objectives: patients with type 2 diabetes, overweight patients, overweight patients with type 2 diabetes, and average-weight patients without type 2 diabetes. The clinical and demographic data collected during hospitalization and regular visits to the Community Healthcare Center dr. Adolf Drolc Maribor were analyzed. Our results showed that type 2 diabetes patients had more difficult courses of treatment and longer hospitalizations. Moreover, more type 2 diabetes patients underwent rehabilitation than the other study groups. The prevailing symptoms of our patients with PCS were dyspnea and fatigue, mostly among female patients with type 2 diabetes. Our study also showed that more women with type 2 diabetes and overweight women with type 2 diabetes suffered from secondary infections. Furthermore, more overweight patients were treated in the intensive care unit than patients from the other groups. However, our study showed an interesting result: patients with type 2 diabetes had the shortest PCS durations. Type 2 diabetes and being overweight are risk factors for PCS onset and prolonged duration. Therefore, our data that revealed a shorter duration of PCS in type 2 diabetes patients than the other investigated groups was unexpected. We believe that answering the questions arising from our unexpected results will improve PCS treatment in general.
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Affiliation(s)
- Simona Kirbiš
- Pneumophtisiology Department, General Health Organizational Unit, Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (S.K.); (N.S.); (B.A.S.)
| | - Nina Sobotkiewicz
- Pneumophtisiology Department, General Health Organizational Unit, Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (S.K.); (N.S.); (B.A.S.)
| | - Barbara Antolinc Schaubach
- Pneumophtisiology Department, General Health Organizational Unit, Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (S.K.); (N.S.); (B.A.S.)
| | - Jernej Završnik
- Paediatric Department, Children and Youth Protection Unit, Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
- Alma Mater Europaea—ECM, 2000 Maribor, Slovenia
| | - Peter Kokol
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Scientific Research Department, Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia
| | - Matej Završnik
- Department of Endocrinology and Diabetology, Internal Medicine Clinic, University Clinical Center, 2000 Maribor, Slovenia;
| | - Helena Blažun Vošner
- Scientific Research Department, Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia
- Faculty of Health and Social Sciences, 2000 Slovenj Gradec, Slovenia
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3
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Ahmed W, Feng J, Zhang Y, Chen L. SARS-CoV-2 and Brain Health: New Challenges in the Era of the Pandemic. Microorganisms 2023; 11:2511. [PMID: 37894169 PMCID: PMC10609574 DOI: 10.3390/microorganisms11102511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Respiratory viral infections have been found to have a negative impact on neurological functions, potentially leading to significant neurological impairment. The SARS-CoV-2 virus has precipitated a worldwide pandemic, posing a substantial threat to human lives. Growing evidence suggests that SARS-CoV-2 may severely affect the CNS and respiratory system. The current prevalence of clinical neurological issues associated with SARS-CoV-2 has raised significant concerns. However, there needs to be a more comprehensive understanding of the specific pathways by which SARS-CoV-2 enters the nervous system. Based on the available evidence, this review focuses on the clinical neurological manifestations of SARS-CoV-2 and the possible mechanisms by which SARS-CoV-2 invades the brain.
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Affiliation(s)
- Waqas Ahmed
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
- School of Medicine, Southeast University, Nanjing 210009, China
| | - Jia Feng
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
- Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Yifan Zhang
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
| | - Lukui Chen
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
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4
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Monastero R, Baschi R. Persistent Cognitive Dysfunction in a Non-Hospitalized COVID-19 Long-Hauler Patient Responding to Cognitive Rehabilitation and Citicoline Treatment. Brain Sci 2023; 13:1275. [PMID: 37759876 PMCID: PMC10526954 DOI: 10.3390/brainsci13091275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is characterized by severe flu-like symptoms, which can progress to life-threatening systemic inflammation and multiorgan dysfunction. The nervous system is involved in over one-third of patients, and the most common neurological manifestations concern the central nervous system, such as headache, fatigue, and brain fog. The activation of innate, humoral, and cellular immune responses, resulting in a cytokine storm and endothelial and mitochondrial dysfunctions, are the main pathophysiological mechanisms of SARS-CoV-2 infection. Citicoline is an exogenous source of choline and cytidine involved in intracellular phospholipid synthesis, which improves blood flow, brain activity, and mitochondrial dysfunction. This report will present the case of a non-hospitalized, 59-year-old female. After a mild form of SARS-CoV-2 infection, the patient developed cognitive disturbances such as forgetfulness and anomia. The multidimensional neuropsychological assessment revealed an impairment in episodic memory with borderline performance in executive and visuospatial functioning. Cognitive rehabilitation and treatment with citicoline 1000 mg/daily led to a marked improvement in symptoms after six months. Early identification of the neurological sequelae of the Coronavirus Disease 2019 (COVID-19) and timely rehabilitation interventions are required in non-hospitalized long-hauler patients with COVID-19. Long-term treatment with citicoline should be considered as potentially effective in improving cognitive functioning in subjects with Post COVID-19 Neurological Syndrome.
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Affiliation(s)
- Roberto Monastero
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, 90121 Palermo, Italy;
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Aprile I, Bramante L, La Russa C, Germanotta M, Barletta VT, Falchini F, Brambilla L, Guglielmelli E, Rossi P. A Multiaxial Rehabilitation Programme for Workers with COVID-19 Sequelae Using a Conventional and Technological-Robotic Approach: The Proposal of INAIL and Fondazione Don Carlo Gnocchi. Healthcare (Basel) 2023; 11:1593. [PMID: 37297733 PMCID: PMC10252900 DOI: 10.3390/healthcare11111593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/11/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
The COVID-19 sequelae have been shown to affect respiratory and cardiological functions as well as neuro-psychological functions, and, in some cases, metabolic/nutritional aspects. The Italian National Institute for Insurance against Accidents at Work (Istituto Nazionale Assicurazione Infortuni sul Lavoro, INAIL) recorded that, until December 2022, 315,055 workers were affected by COVID-19; therefore, there is a need to identify an effective approach to treat such patients. Robotic and technological devices could be integrated into the rehabilitation programme of people with long COVID conditions. A review of the literature showed that telerehabilitation may improve functional capacity, dyspnoea, performance, and quality of life in these patients, but no studies were found evaluating the effects of robot-mediated therapy or virtual reality systems. Considering the above, Fondazione Don Carlo Gnocchi and INAIL propose a multi-axial rehabilitation for workers with COVID-19 sequelae. To accomplish this goal, the two institutions merged the epidemiological information gathered by INAIL, the expertise in robotic and technological rehabilitation of Fondazione Don Carlo Gnocchi, and the literature review. Our proposal aims to facilitate a multi-axial rehabilitation approach customized to meet the unique needs of each individual, with a particular emphasis on utilizing advanced technologies to address the current and future challenges of patient care.
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Affiliation(s)
- Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | - Lucia Bramante
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy; (L.B.); (C.L.R.); (P.R.)
| | - Chiara La Russa
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy; (L.B.); (C.L.R.); (P.R.)
| | - Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | | | - Francesca Falchini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | - Lorenzo Brambilla
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | - Eugenio Guglielmelli
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Patrizio Rossi
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy; (L.B.); (C.L.R.); (P.R.)
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Magurano F, Micucci M, Nuzzo D, Baggieri M, Picone P, Gioacchini S, Fioravanti R, Bucci P, Kojouri M, Mari M, Retini M, Budriesi R, Mattioli LB, Corazza I, Di Liberto V, Todaro L, Giuseppetti R, D’Ugo E, Marchi A, Mecca M, D’Auria M. A potential host and virus targeting tool against COVID-19: Chemical characterization, antiviral, cytoprotective, antioxidant, respiratory smooth muscle relaxant effects of Paulownia tomentosa Steud. Biomed Pharmacother 2023; 158:114083. [PMID: 36495668 PMCID: PMC9721285 DOI: 10.1016/j.biopha.2022.114083] [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: 09/14/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
COronaVIrus Disease 2019 (COVID-19) is a newly emerging infectious disease that spread across the world, caused by the novel coronavirus Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). Despite the advancements in science that led to the creation of the vaccine, there is still an urgent need for new antiviral drugs effective against SARS-CoV-2. This study aimed to investigate the antiviral effect of Paulownia tomentosa Steud extract against SARS-CoV-2 and to evaluate its antioxidant properties, including respiratory smooth muscle relaxant effects. Our results showed that P. tomentosa extract can inhibit viral replication by directly interacting with both the 3-chymotrypsin-like protease and spike protein. In addition, the phyto complex does not reduce lung epithelial cell viability and exerts a protective action in those cells damaged by tert-butyl hydroperoxide , a toxic agent able to alter cells' functions via increased oxidative stress. These data suggest the potential role of P. tomentosa extract in COVID-19 treatment, since this extract is able to act both as an antiviral and a cytoprotective agent in vitro.
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Affiliation(s)
- Fabio Magurano
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy.
| | - Matteo Micucci
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Piazza Rinascimento 6, 61029 Urbino, PU, Italy
| | - Domenico Nuzzo
- Istituto per la Ricerca e l’Innovazione Biomedica, CNR, via U. La Malfa 153, 90146 Palermo, Italy
| | - Melissa Baggieri
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Pasquale Picone
- Istituto per la Ricerca e l’Innovazione Biomedica, CNR, via U. La Malfa 153, 90146 Palermo, Italy
| | - Silvia Gioacchini
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Raoul Fioravanti
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Paola Bucci
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Maedeh Kojouri
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Michele Mari
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Piazza Rinascimento 6, 61029 Urbino, PU, Italy
| | - Michele Retini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Piazza Rinascimento 6, 61029 Urbino, PU, Italy
| | - Roberta Budriesi
- Department of Pharmacy and Biotechnology, Food Chemistry and Nutraceutical Lab, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Laura Beatrice Mattioli
- Department of Pharmacy and Biotechnology, Food Chemistry and Nutraceutical Lab, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Ivan Corazza
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Valentina Di Liberto
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90128 Palermo, Italy
| | - Luigi Todaro
- Scuola di Scienze Agrarie, Forestali, Alimentari ed Ambientali, Università della Basilicata, Via dell’Ateneo Lucano 10, 85100 Potenza, Italy
| | - Roberto Giuseppetti
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Emilio D’Ugo
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Antonella Marchi
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Marisabel Mecca
- Dipartimento di Scienze, Università della Basilicata, Via dell’Ateneo Lucano 10, 85100 Potenza, Italy
| | - Maurizio D’Auria
- Dipartimento di Scienze, Università della Basilicata, Via dell’Ateneo Lucano 10, 85100 Potenza, Italy
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Khondakar KR, Kaushik A. Role of Wearable Sensing Technology to Manage Long COVID. BIOSENSORS 2022; 13:62. [PMID: 36671900 PMCID: PMC9855989 DOI: 10.3390/bios13010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Long COVID consequences have changed the perception towards disease management, and it is moving towards personal healthcare monitoring. In this regard, wearable devices have revolutionized the personal healthcare sector to track and monitor physiological parameters of the human body continuously. This would be largely beneficial for early detection (asymptomatic and pre-symptomatic cases of COVID-19), live patient conditions, and long COVID monitoring (COVID recovered patients and healthy individuals) for better COVID-19 management. There are multitude of wearable devices that can observe various human body parameters for remotely monitoring patients and self-monitoring mode for individuals. Smart watches, smart tattoos, rings, smart facemasks, nano-patches, etc., have emerged as the monitoring devices for key physiological parameters, such as body temperature, respiration rate, heart rate, oxygen level, etc. This review includes long COVID challenges for frequent monitoring of biometrics and its possible solution with wearable device technologies for diagnosis and post-therapy of diseases.
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Affiliation(s)
- Kamil Reza Khondakar
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun 248007, Uttarakhand, India
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Environmental Engineering, Florida Polytechnic University, Lakeland, FL 33805-8531, USA
- Department of Chemical Engineering, University of Johannesburg, Johannesburg 2094, South Africa
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Manique I, Abegão Matias A, Bouça B, Rego T, Cortez L, Sabino T, Panarra A, Rizzo M, Silva-Nunes J. Does the Hyperglycemia Impact on COVID-19 Outcomes Depend upon the Presence of Diabetes?-An Observational Study. Metabolites 2022; 12:1116. [PMID: 36422255 PMCID: PMC9693757 DOI: 10.3390/metabo12111116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 07/30/2023] Open
Abstract
Diabetes mellitus (DM) has emerged as a major risk factor for COVID-19 severity and SARS-CoV-2 infection can worsen glycemic control and may precipitate new-onset diabetes. At-admission hyperglycemia (AH) is a known predictor for worse outcomes in many diseases and seems to have a similar effect in COVID-19 patients. In this study, we aimed to assess the impact of AH regardless of pre-existing diabetes mellitus and new-onset diabetes diagnosis in the clinical severity of COVID-19 inpatients in the first months of the pandemic. A retrospective monocentric study on 374 COVID-19 inpatients (209 males) was developed to assess associations between AH (blood glucose levels in the Emergency Department or the first 24 h of hospitalization greater than 140 mg/dL) and severity outcomes (disease severity, respiratory support, admission to Intensive Care Unit (ICU) and mortality) in patients with and without diabetes. Considering diabetic patients with AH (N = 68;18.1%) there was a correlation with COVID-19 severity (p = 0.03), invasive mechanical ventilation (p = 0.008), and ICU admission (p = 0.026). No correlation was present with any severity outcomes in diabetic patients without AH (N = 33; 8.8%). All of the New-onset Diabetes patients (N = 15; 4%) had AH, and 12 had severe COVID-19; additionally, five patients were admitted to the ICU and three patients died. However, severity outcomes did not reach statistical correlation significance in this group. In nondiabetic patients with AH (N = 51; 13.6%), there was a statistically significant association with the need for oxygen therapy (p = 0.001), invasive mechanical ventilation (p = 0.01), and ICU admission (p = 0.03). Our results support data regarding the impact of AH on severity outcomes. It also suggests an effect of AH on the prognosis of COVID-19 inpatients, regardless of the presence of pre-existing diabetes or new-onset diabetes. We reinforce the importance to assess at admission glycemia in all patients admitted with COVID-19.
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Affiliation(s)
- Inês Manique
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - Alexandra Abegão Matias
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - Bruno Bouça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - Teresa Rego
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - Luísa Cortez
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - Teresa Sabino
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - António Panarra
- Functional Unit of Internal Medicine 7.2, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, School of Medicine, University of Palermo, 90100 Palermo, Italy
| | - José Silva-Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saúde de Lisboa, 1990-096 Lisbon, Portugal
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