Elderly at time of COronaVIrus disease 2019 (COVID-19): possible role of immunosenescence and malnutrition

Long-term follow-up of the treatment for severe COVID-19 with qigong exercise and acupressure: A randomized controlled trial

Background

Most clinical trials have reported significant short-term effects of traditional medicine therapies on COVID-19 patients. However, there is no clinical trial to determine the long-term effects of traditional medicine therapies on severe COVID-19 patients.

Methods

A total of 128 patients with severe COVID-19, who were recruited in our previous clinical trial following hospital discharge, were monitored at months 14 and 28. This trial aims to evaluate the long-term effect of an early Qigong exercise and acupressure rehabilitation program on patients with severe COVID-19.The intervention group received qigong exercise and acupressure therapy, plus standard therapies. The control group received standard therapies.The study was a single-center, parallel, randomized, prospective follow-up study. The outcomes of the study included changes in the modified Borg dyspnea scale (MBS), the modified Medical Research Council dyspnea scale (mMRC), the patient health questionnaire-9 scale (PHQ-9), the activity of daily living (ADL), the remaining clinical symptoms and any intervention related adverse events.

Results

The intervention group showed a statistically significant improvement in the mMRC scores (-0.4, 95 % CI (-0.6, 0.2), P < 0.001) and the MBS scores (-0.6, 95 % CI (-0.9, -0.3), P < 0.001) after 14 months of discharge compared with the control group. At 28 months of discharge, the intervention group, compared with the control group alone, significantly increased their MBS scores (-0.4, 95 % CI (-0.7, -0.1), P = 0.024) and a significantly decreased positive rate of dyspnea symptoms after 14 months of discharge (P < 0.05). However, ADL and PHQ-9 scores showed no significant difference between the two groups during the follow-up (P > 0.05).

Conclusions

QARP had long-term sustained efficacy for dyspnea, chest tightness, and cough in patients with COVID-19, especially in young and middle-aged patients, and the effect was significant at the 14th month of follow-up.

Trial registration

This trial was registered at the China Clinical Trial Registry (ChiCTR2100044572).

Zinc as a Possible Critical Element to Prevent Harmful Effects of COVID-19 on Testicular Function: a Narrative Review

Research into innovative non-pharmacological therapeutic routes via the utilization of natural elements like zinc (Zn) has been motivated by the discovery of new severe acute respiratory syndrome-related coronavirus 2 (SARS-COV2) variants and the ineffectiveness of certain vaccination treatments during COVID-19 pandemic. In addition, research on SARS-COV-2's viral cellular entry and infection mechanism has shown that it may seriously harm reproductive system cells and impair testicular function in young men and adolescents, which may lead to male infertility over time. In this context, we conducted a narrative review to give an overview of the data pertaining to Zn's critical role in testicular tissue, the therapeutic use of such micronutrients to enhance male fertility, as well as in the potential mitigation of COVID-19, with the ultimate goal of elucidating the hypothesis of the potential use of Zn supplements to prevent the possible harmful effects of SARS-COV2 infection on testis physiological function, and subsequently, on male fertility.

Association of body mass index with long-term outcomes in older adults hospitalized for COVID-19: an observational study

Both underweight and obesity have been associated with poor prognosis in COVID-19. In an older populations of patients hospitalized for SARS-CoV-2 infection, we aimed to evaluate the association between body mass index (BMI) and short and long-term prognosis. Among 434 consecutive patients aged ≥ 70 years and hospitalized for suspected COVID-19 at a university hospital, 219 patients (median age of 83 years, 53% male) testing positive for COVID-19 and for whom BMI was recorded at admission, agreed to participate. Among them, 39 had a BMI < 20 kg/m2, 73 had a BMI between 20 and 24.9 kg/m2 and 107 had a BMI ≥ 25 kg/m2. After adjustment for confounders, BMI < 20 kg/m2 was associated with a higher risk of one-year mortality (hazard ratio (HR) [95% confidence interval]: 1.75 [1.00-3.05], p = 0.048), while BMI ≥ 25 kg/m2 was not (HR: 1.04 [0.64-1.69], p = 0.9). However, BMI was linearly correlated with both in-hospital acute respiratory failure (p = 0.02) and cardiovascular events (p = 0.07). In this cohort of older patients hospitalized for COVID-19, low BMI, rather than high BMI, appears as an independent risk factor for death after COVID-19. The pathophysiological patterns underlying this excess mortality remain to be elucidated.

Effective virus-specific T-cell therapy for high-risk SARS-CoV-2 infections in hematopoietic stem cell transplant recipients: initial case studies and literature review

The COVID-19 pandemic has exacerbated mortality rates among immunocompromised patients, accentuating the need for novel, targeted therapies. Transplant recipients, with their inherent immune vulnerabilities, represent a subgroup at significantly heightened risk. Current conventional therapies often demonstrate limited effectiveness in these patients, calling for innovative treatment approaches. In immunocompromised transplant recipients, several viral infections have been successfully treated by adoptive transfer of virus-specific T-cells (VST). This paper details the successful application of SARS-CoV-2-specific memory T-cell therapy, produced by an interferon-γ cytokine capture system (CliniMACS® Prodigy device), in three stem cell transplant recipients diagnosed with COVID-19 (case 1: alpha variant, cases 2 and 3: delta variants). These patients exhibited persistent SARS-CoV-2 PCR positivity accompanied by bilateral pulmonary infiltrates and demonstrated only partial response to standard treatments. Remarkably, all three patients recovered and achieved viral clearance within 3 to 9 weeks post-VST treatment. Laboratory follow-up investigations identified an increase in SARS-CoV-2-specific T-cells in two of the cases. A robust anti-SARS-CoV-2 S (S1/S2) IgG serological response was also recorded, albeit with varying titers. The induction of memory T-cells within the CD4 + compartment was confirmed, and previously elevated interleukin-6 (IL-6) and IL-8 levels normalized post-VST therapy. The treatment was well tolerated with no observed adverse effects. While the need for specialized equipment and costs associated with VST therapy present potential challenges, the limited treatment options currently available for COVID-19 within the allogeneic stem cell transplant population, combined with the risk posed by emerging SARS-CoV-2 mutations, underscore the potential of VST therapy in future clinical practice. This therapeutic approach may be particularly beneficial for elderly patients with multiple comorbidities and weakened immune systems.

Poor nutritional status is associated with the severity of omicron infection in the older adults

BACKGROUND

The Omicron wave of Coronavirus disease 2019 (COVID-19) remains the dominant strain worldwide. The studies of nutritional status in geriatric people with COVID-19 Omicron variant are limited. Thus, the aim of this study was to investigate the incidence of poor nutritional status among Omicron infected older patients, and to explore the correlation between the nutritional status and the severity of Omicron infection in older patients.

METHODS

This is a retrospective cross-sectional study. According to the clinical symptoms, patients were divided into two groups: mild and moderate to severe. Mini Nutritional Assessment short-form (MNA-SF) was conducted when patients were admitted and poor nutritional status was defined as MNA-SF score of 0-11. The inflammatory markers including neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and systemic inflammatory index (SII) were calculated and compared between two groups.

RESULTS

Total of 324 patients were enrolled, with median [interquartile range (IQR)] age of 73 (17) years. Overall, 241 cases were mild, 83 cases were moderate to severe at the time of diagnosis and that 54.3% of patients had poor nutritional status. Patients with poor nutritional status were found to be older (P < 0.001) and less vaccinated (P < 0.001), with a longer virus shedding duration (P = 0.022), more comorbidities (≥ 2) (P = 0.004) and higher value of NLR (P < 0.001), PLR (P < 0.001) and SII (P = 0.012). Vaccination, cycle threshold value in ORF1ab gene (OR CT value) and female, higher MNA-SF score was negatively connected with probability of moderate to severe infection. For every 1 score increase in MNA-SF, the odds ratio of moderate to severe infection decreased by 14.8% [adjusted odds ratio (aOR), 0.852; 95% confidence interval (CI): 0.734-0.988; P = 0.034].

CONCLUSIONS

Older patients with poor nutritional status are more likely to develop moderate to severe Omicron infection.

Vascular mechanisms leading to progression of mild cognitive impairment to dementia after COVID-19: Protocol and methodology of a prospective longitudinal observational study

INTRODUCTION

Mild cognitive impairment (MCI) is a prodromal stage to dementia, affecting up to 20% of the aging population worldwide. Patients with MCI have an annual conversion rate to dementia of 15-20%. Thus, conditions that increase the conversion from MCI to dementia are of the utmost public health concern. The COVID-19 pandemic poses a significant impact on our aging population with cognitive decline as one of the leading complications following recovery from acute infection. Recent findings suggest that COVID-19 increases the conversion rate from MCI to dementia in older adults. Hence, we aim to uncover a mechanism for COVID-19 induced cognitive impairment and progression to dementia to pave the way for future therapeutic targets that may mitigate COVID-19 induced cognitive decline.

METHODOLOGY

A prospective longitudinal study is conducted at the University of Oklahoma Health Sciences Center. Patients are screened in the Department of Neurology and must have a formal diagnosis of MCI, and MRI imaging prior to study enrollment. Patients who meet the inclusion criteria are enrolled and followed-up at 18-months after their first visit. Visit one and 18-month follow-up will include an integrated and cohesive battery of vascular and cognitive measurements, including peripheral endothelial function (flow-mediated dilation, laser speckle contrast imaging), retinal and cerebrovascular hemodynamics (dynamic vessel retinal analysis, functional near-infrared spectroscopy), and fluid and crystalized intelligence (NIH-Toolbox, n-back). Multiple logistic regression will be used for primary longitudinal data analysis to determine whether COVID-19 related impairment in neurovascular coupling and increases in white matter hyperintensity burden contribute to progression to dementia.

Preoperative prognostic nutrition index can independently predict the 6-month prognosis of elderly patients undergoing neurosurgical clipping for aneurysmal subarachnoid hemorrhage

The number of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) is increasing annually. The prognostic nutritional index (PNI) is used as a novel and valuable prognostic marker for various neoplastic diseases and other critical illnesses. This study aimed to identify the short-term prognostic value of preoperative PNI in elderly patients who underwent neurosurgical clipping for aSAH. This retrospective study included elderly patients with aSAH who underwent neurosurgical clipping from January 2018 to December 2020. Clinical variables and 6-month outcomes were collected and compared. Epidemiological data and effect factors of prognosis were evaluated. Multivariate logistic regression and receiver operating characteristics (ROC) curve analyses were used to evaluate the predictive value of preoperative PNI. Multiple logistic regression was performed to establish a nomogram. A total of 124 elderly patients were enrolled. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio (OR), 0.779; 95% confidence interval (CI), 0.689-0.881; P < 0.001), Hunt-Hess grade (OR, 3.291; 95%CI, 1.816-5.966; P < 0.001), and hydrocephalus (OR, 9.423; 95%CI, 2.696-32.935; P < 0.001) were significant predictors. The area under the ROC curve of PNI was 0.829 (95% CI, 0.755-0.903; P < 0.001) with a sensitivity and specificity of 68.4% and 83.3%, respectively, and the cutoff value was 46.36. Patients with preoperative PNI of < 46.36 had a significantly unfavorable 6-months prognosis (F = 40.768, P < 0.001). Preoperative PNI is independently correlated with the 6-month prognosis in elderly patients who undergo neurosurgical clipping for aSAH.

Basophils beyond allergic and parasitic diseases

Basophils bind IgE via FcεRI-αβγ2, which they uniquely share only with mast cells. In doing so, they can rapidly release mediators that are hallmark of allergic disease. This fundamental similarity, along with some morphological features shared by the two cell types, has long brought into question the biological significance that basophils mediate beyond that of mast cells. Unlike mast cells, which mature and reside in tissues, basophils are released into circulation from the bone marrow (constituting 1% of leukocytes), only to infiltrate tissues under specific inflammatory conditions. Evidence is emerging that basophils mediate non-redundant roles in allergic disease and, unsuspectingly, are implicated in a variety of other pathologies [e.g., myocardial infarction, autoimmunity, chronic obstructive pulmonary disease, fibrosis, cancer, etc.]. Recent findings strengthen the notion that these cells mediate protection from parasitic infections, whereas related studies implicate basophils promoting wound healing. Central to these functions is the substantial evidence that human and mouse basophils are increasingly implicated as important sources of IL-4 and IL-13. Nonetheless, much remains unclear regarding the role of basophils in pathology vs. homeostasis. In this review, we discuss the dichotomous (protective and/or harmful) roles of basophils in a wide spectrum of non-allergic disorders.

Predictors of survival in elderly patients with coronavirus disease 2019 admitted to the hospital: derivation and validation of the FLAMINCOV score

OBJECTIVE

To identify predictors of 30-day survival in elderly patients with coronavirus disease 2019 (COVID-19).

METHODS

Retrospective cohort study including patients with COVID-19 aged ≥65 years hospitalized in six European sites (January 2020 to May 2021). Data on demographics, comorbidities, clinical characteristics, and outcomes were collected. A predictive score (FLAMINCOV) was developed using logistic regression. Regression coefficients were used to calculate the score. External validation was performed in a cohort including elderly patients from a major COVID-19 centre in Israel. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC) in the derivation and validation cohorts. Survival risk groups based on the score were derived and applied to the validation cohort.

RESULTS

Among 3010 patients included in the derivation cohort, 30-day survival was 74.5% (2242/3010). The intensive care unit admission rate was 7.6% (228/3010). The model predicting survival included independent functional status (OR, 4.87; 95% CI, 3.93-6.03), a oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂₎ ratio of >235 (OR, 3.75; 95% CI, 3.04-4.63), a C-reactive protein level of <14 mg/dL (OR, 2.41; 95% CI, 1.91-3.04), a creatinine level of <1.3 (OR, 2.02; 95% CI, 1.62-2.52) mg/dL, and absence of fever (OR, 1.34; 95% CI, 1.09-1.66). The score was validated in 1174 patients. The FLAMINCOV score ranges from 0 to 15 and showed good discrimination in the derivation (AUC, 0.79; 95% CI, 0.77-0.81; p < 0.001) and validation cohorts (AUC, 0.79; 95% CI, 0.76-0.81; p < 0.001). Thirty-day survival ranged from 39.4% (203/515) to 95.3% (634/665) across four risk groups according to score quartiles in the derivation cohort. Similar proportions were observed in the validation set.

DISCUSSION

The FLAMINCOV score identifying elderly with higher or lower chances of survival may allow better triage and management, including intensive care unit admission/exclusion.

SARS-CoV-2 Spike Protein Activates Human Lung Macrophages

COVID-19 is a viral disease caused by SARS-CoV-2. This disease is characterized primarily, but not exclusively, by respiratory tract inflammation. SARS-CoV-2 infection relies on the binding of spike protein to ACE2 on the host cells. The virus uses the protease TMPRSS2 as an entry activator. Human lung macrophages (HLMs) are the most abundant immune cells in the lung and fulfill a variety of specialized functions mediated by the production of cytokines and chemokines. The aim of this project was to investigate the effects of spike protein on HLM activation and the expression of ACE2 and TMPRSS2 in HLMs. Spike protein induced CXCL8, IL-6, TNF-α, and IL-1β release from HLMs; promoted efficient phagocytosis; and induced dysfunction of intracellular Ca2+ concentration by increasing lysosomal Ca2+ content in HLMs. Microscopy experiments revealed that HLM tracking was affected by spike protein activation. Finally, HLMs constitutively expressed mRNAs for ACE2 and TMPRSS2. In conclusion, during SARS-CoV-2 infection, macrophages seem to play a key role in lung injury, resulting in immunological dysfunction and respiratory disease.

Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response

BACKGROUND AND AIM

Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020.

METHODS

Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death.

RESULTS

Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time.

CONCLUSION

Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Neutrophil Extracellular Traps in Asthma: Friends or Foes?

Asthma is a chronic inflammatory disease characterized by variable airflow limitation and airway hyperresponsiveness. A plethora of immune and structural cells are involved in asthma pathogenesis. The roles of neutrophils and their mediators in different asthma phenotypes are largely unknown. Neutrophil extracellular traps (NETs) are net-like structures composed of DNA scaffolds, histones and granular proteins released by activated neutrophils. NETs were originally described as a process to entrap and kill a variety of microorganisms. NET formation can be achieved through a cell-death process, termed NETosis, or in association with the release of DNA from viable neutrophils. NETs can also promote the resolution of inflammation by degrading cytokines and chemokines. NETs have been implicated in the pathogenesis of various non-infectious conditions, including autoimmunity, cancer and even allergic disorders. Putative surrogate NET biomarkers (e.g., double-strand DNA (dsDNA), myeloperoxidase-DNA (MPO-DNA), and citrullinated histone H3 (CitH3)) have been found in different sites/fluids of patients with asthma. Targeting NETs has been proposed as a therapeutic strategy in several diseases. However, different NETs and NET components may have alternate, even opposite, consequences on inflammation. Here we review recent findings emphasizing the pathogenic and therapeutic potential of NETs in asthma.

Zinc and COVID-19: Immunity, Susceptibility, Severity and Intervention

During the coronavirus disease 2019 (COVID-19) pandemic and continuing emergence of viral mutants, there has been a lack of effective treatment methods. Zinc maintains immune function, with direct and indirect antiviral activities. Zinc nutritional status is a critical factor in antiviral immune responses. Importantly, COVID-19 and zinc deficiency overlap in high-risk population. Hence, the potential effect of zinc as a preventive and adjunct therapy for COVID-19 is intriguing. Here, this review summarizes the immune and antiviral function of zinc, the relationship between zinc levels, susceptibility, and severity of COVID-19, and the effect of zinc supplementation on COVID-19. Existing studies have confirmed that zinc deficiency was associated with COVID-19 susceptibility and severity. Zinc supplementation plays a potentially protective role in enhancing immunity, decreasing susceptibility, shortening illness duration, and reducing the severity of COVID-19. We recommend that zinc levels should be monitored, particularly in COVID-19 patients, and zinc as a preventive and adjunct therapy for COVID-19 should be considered for groups at risk of zinc deficiency to reduce susceptibility and disease severity.

Drug-Disease Severity and Target-Disease Severity Interaction Networks in COVID-19 Patients

Drug interactions with other drugs are a well-known phenomenon. Similarly, however, pre-existing drug therapy can alter the course of diseases for which it has not been prescribed. We performed network analysis on drugs and their respective targets to investigate whether there are drugs or targets with protective effects in COVID-19, making them candidates for repurposing. These networks of drug-disease interactions (DDSIs) and target-disease interactions (TDSIs) revealed a greater share of patients with diabetes and cardiac co-morbidities in the non-severe cohort treated with dipeptidyl peptidase-4 (DPP4) inhibitors. A possible protective effect of DPP4 inhibitors is also plausible on pathophysiological grounds, and our results support repositioning efforts of DPP4 inhibitors against SARS-CoV-2. At target level, we observed that the target location might have an influence on disease progression. This could potentially be attributed to disruption of functional membrane micro-domains (lipid rafts), which in turn could decrease viral entry and thus disease severity.

Contemporary nutrition-based interventions to reduce risk of infection among elderly long-term care residents: A scoping review

Background

Elderly long-term care residents (ELTCRs) face considerable burden of infection, especially evident during the COVID-19 pandemic. The nutritional status of the host can influence susceptibility to infection by altering immune system integrity, therefore, nutrition-based interventions may be a viable complement to existing infection prevention measures.

Objective

This scoping review sought to identify nutritional interventions and factors that have the strongest evidence to benefit ELTCRs, and thus best poised for rigorous clinical trial evaluation and subsequent implementation.

Methods

A database search of OVID-Medline, OVID-Embase, and Web of Science was performed from 2011 to 2021 to identify nutritional intervention studies which attribute to changes in infection in contemporary ELTCR settings. Articles were screened in duplicate and data extraction completed by a single reviewer, while a second reviewer verified the data which was fitted to identify evidence for nutritional interventions related to reducing rates of infection among ELTCRs.

Results

The search identified 1018 studies, of which 11 (nine clinical trials and two observational cohort studies) satisfied screening criteria. Interventions that significantly reduced risk of infection included whey protein (any infection), Black Chokeberry (urinary tract infection), and vitamin D (acute respiratory tract infection, skin and soft tissue infection). Both zinc and a dedicated meal-plan significantly improved lymphocyte parameters. Vitamin D deficiency was associated with the development of respiratory tract infections. Probiotic and soy-based protein interventions did not significantly affect risk of infection or lymphocyte parameters, respectively.

Conclusion

The current scoping review was effective in identifying the use of nutrition-based interventions for infection prevention among ELTCRs. In this study, some nutrition-based interventions were observed to significantly influence the risk of infection among ELTCRs. Nutritional interventions such as vitamin D (preventing deficiency/insufficiency), Black Chokeberry juice, zinc gluconate, whey protein, and varied and nutrient dense meal plans may be suitable for future rigorous clinical trial evaluation.

Clinical Characteristics and Predictors of Mortality in Elderly Patients Hospitalized with COVID-19 in Bangladesh: A Multicenter, Retrospective Study

Purpose

Elderly patients are at high risk of fatality from COVID-19. The present work aims to describe the clinical characteristics of elderly inpatients with COVID-19 and identify the predictors of in-hospital mortality at admission.

Materials and Methods

In this retrospective, multicenter cohort study, we included elderly COVID-19 inpatients (n = 245) from four hospitals in Sylhet, Bangladesh, who had been discharged between October 2020 and February 2021. Demographic, clinical, and laboratory data were extracted from hospital records and compared between survivors and nonsurvivors. We used univariable and multivariable logistic regression analysis to explore the risk factors associated with in-hospital death. Principal Results. Of the included patients, 202 (82.44%) were discharged and 43 (17.55%) died in hospital. Except hypertension, other comorbidities like diabetes, chronic kidney disease, ischemic heart disease, and chronic obstructive pulmonary disease were more prevalent in nonsurvivors. Nonsurvivors had a higher prevalence of leukocytosis (51.2 versus 30.7; p=0.01), lymphopenia (72.1 versus 55; p=0.05), and thrombocytopenia (20.9 versus 9.9; p=0.07). Multivariable regression analysis showed an increasing odds ratio of in-hospital death associated with older age (odds ratio 1.05, 95% CI 1.01–1.10, per year increase; p=0.009), thrombocytopenia (OR = 3.56; 95% CI 1.22–10.33, p=0.019), and admission SpO₂ (OR 0.91, 95% CI 0.88–0.95; p=0.001).

Conclusions

Higher age, thrombocytopenia, and lower initial level of SpO₂ at admission are predictors of in-hospital mortality in elderly patients with COVID-19.

Comorbidities and increased mortality of COVID-19 among the elderly: A systematic review

Purpose

The purpose of current review is to conduct a systematic overview of articles published between 2019 and 2021 on the relationship of comorbidities and mortality due to Coronavirus Disease 2019 (COVID-19) among the elderly population.

Methods

We conducted a systematic search on PubMed for articles published between 2019 and 2021 to identify any cohort and case-control studies that investigated the relationship of comorbidities and COVID-19 mortality among the elderly, defined as 60 years of age and above. Databases were searched independently by two authors. Disagreements were resolved by the inclusion of a third investigator. Reviews, systematic reviews, and meta-analyses were excluded from our systematic review.

Results

A total of 15 studies were selected for our systematic review. Of the included studies, 3 were case-control, 3 were prospective cohort studies and 9 were retrospective cohort studies. As for size, 10 studies were conducted on populations of <1000 participants, 3 ranging from 1001 to 10,000, and 2 on populations of >10,000 individuals. The included studies found that the presence of certain conditions, such as cardiovascular, respiratory, renal diseases, malignancies, diseases of the nervous system and diabetes are associated to increased mortality in populations that consisted of elderly patients.

Conclusion

Results of our systematic review suggest that comorbidities contribute to increased COVID-19 mortality among the elderly. The detrimental effect of comorbidities and advanced age on the immune response could lead to a more frequent occurrence of symptomatic and severe infections with COVID-19.

Modeling of nursing care-associated airborne transmission of SARS-CoV-2 in a real-world hospital setting

Respiratory transmission of SARS-CoV-2 from one older patient to another by airborne mechanisms in hospital and nursing home settings represents an important health challenge during the COVID-19 pandemic. However, the factors that influence the concentration of respiratory droplets and aerosols that potentially contribute to hospital- and nursing care-associated transmission of SARS-CoV-2 are not well understood. To assess the effect of health care professional (HCP) and patient activity on size and concentration of airborne particles, an optical particle counter was placed (for 24 h) in the head position of an empty bed in the hospital room of a patient admitted from the nursing home with confirmed COVID-19. The type and duration of the activity, as well as the number of HCPs providing patient care, were recorded. Concentration changes associated with specific activities were determined, and airway deposition modeling was performed using these data. Thirty-one activities were recorded, and six representative ones were selected for deposition modeling, including patient's activities (coughing, movements, etc.), diagnostic and therapeutic interventions (e.g., diagnostic tests and drug administration), as well as nursing patient care (e.g., bedding and hygiene). The increase in particle concentration of all sizes was sensitive to the type of activity. Increases in supermicron particle concentration were associated with the number of HCPs (r = 0.66; p < 0.05) and the duration of activity (r = 0.82; p < 0.05), while submicron particles increased with all activities, mainly during the daytime. Based on simulations, the number of particles deposited in unit time was the highest in the acinar region, while deposition density rate (number/cm2/min) was the highest in the upper airways. In conclusion, even short periods of HCP-patient interaction and minimal patient activity in a hospital room or nursing home bedroom may significantly increase the concentration of submicron particles mainly depositing in the acinar regions, while mainly nursing activities increase the concentration of supermicron particles depositing in larger airways of the adjacent bed patient. Our data emphasize the need for effective interventions to limit hospital- and nursing care-associated transmission of SARS-CoV-2 and other respiratory pathogens (including viral pathogens, such as rhinoviruses, respiratory syncytial virus, influenza virus, parainfluenza virus and adenoviruses, and bacterial and fungal pathogens).

Obesity and Leptin Resistance in the Regulation of the Type I Interferon Early Response and the Increased Risk for Severe COVID-19

Obesity, and obesity-associated conditions such as hypertension, chronic kidney disease, type 2 diabetes, and cardiovascular disease, are important risk factors for severe Coronavirus disease-2019 (COVID-19). The common denominator is metaflammation, a portmanteau of metabolism and inflammation, which is characterized by chronically elevated levels of leptin and pro-inflammatory cytokines. These induce the “Suppressor Of Cytokine Signaling 1 and 3” (SOCS1/3), which deactivates the leptin receptor and also other SOCS1/3 sensitive cytokine receptors in immune cells, impairing the type I and III interferon early responses. By also upregulating SOCS1/3, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 adds a significant boost to this. The ensuing consequence is a delayed but over-reactive immune response, characterized by high-grade inflammation (e.g., cytokine storm), endothelial damage, and hypercoagulation, thus leading to severe COVID-19. Superimposing an acute disturbance, such as a SARS-CoV-2 infection, on metaflammation severely tests resilience. In the long run, metaflammation causes the “typical western” conditions associated with metabolic syndrome. Severe COVID-19 and other serious infectious diseases can be added to the list of its short-term consequences. Therefore, preventive measures should include not only vaccination and the well-established actions intended to avoid infection, but also dietary and lifestyle interventions aimed at improving body composition and preventing or reversing metaflammation.

Durability of Humoral Responses after the Second Dose of mRNA BNT162b2 Vaccine in Residents of a Long Term Care Facility

Residents of long-term care facilities (LTCFs) have been dramatically hit by the COVID-19 pandemic on a global scale as older age and comorbidities pose an increased risk of severe disease and death. The aim of the study was to assess the quantity and durability of specific antibody responses to SARS-CoV-2 after the first cycle (two doses) of BNT162b2 vaccine. To achieve this, SARS-CoV-2 Spike-specific IgG (S-IgG) titers was evaluated in 432 residents of the largest Italian LTCF at months 2 and 6 after vaccination. By stratifying levels of humoral responses as high, medium, low and null, we did not find any difference when comparing the two time points; however, the median levels of antibodies halved overtime. As positive nucleocapsid serology was associated with a reduced risk of a suboptimal response at both time points, we conducted separate analyses accordingly. In subjects with positive serology, the median level of anti-S IgG slightly increased at the second time point, while a significant reduction was observed in patients without previous exposure to the virus. At month 6, diabetes alone was associated with an increased risk of impaired response. Our data provide additional insights into the longitudinal dynamics of the immune response to BNT162b2 vaccination in the elderly, highlighting the need for SARS-CoV-2 antibody monitoring following third-dose administration.

Nutrition and a Balanced Diet in the Elderly During the COVID-19 Pandemic

Background:

Age is an important risk factor in the mortality ratio of the COVID-19 disease and mostly, the hospitalised patients over 60 years with chronic diseases are at high risk of death. With preventive measures, proper nutrient intake might be helpful to maintain a healthy state or reduce the severity of the COVID-19 disease in the elderly.

Methods:

Database searches of PubMed, Scopus, Medline, Google Scholar and Web of Science were performed by the following terms of pandemic; COVID-19; coronavirus; elderly; elderly nutrition.

Results:

The requirement of some macro and micro nutrients increases especially the nutrients that support the immune activity. During the pandemic, the daily energy requirement for the elderly is stated as 27-30 kcal/kg while the protein intake is recommended as at least 1g/kg, and the ratio of fat and carbohydrate is 30:70 or 50:50. The daily intake of Vitamin A, B6, B12, C, D, zinc and selenium can also be increased due to their supporting function in the immune system. Probiotics such as Bifidobacterium longum MM-2, Lactobacillus plantarum 06CC2, Lactobacillus bulgaricus OLL1073R-1 and Lactobacillus rhamnosus M21 and the consumption of prebiotics in diet enhance the immune function. Additionally, flavonoids such as baicalin, epigallocatechin gallate, gallocatechin gallate, kaempferol, luteolin, resveratrol and quercetin improve immunity by reducing oxidative stress in the elderly.

Conclusion:

Adequate and balanced nutrition should be provided during the pandemic; in addition to this, micronutrient deficiencies should also be prevented in this period in the elderly at every stage of life.

Co-infections in COVID-19 patients and correlation with mortality rate. Minireview

PURPOSE

The goal of our review was to gather information on the most important community-acquired and hospital-acquired co-infections among coronavirus disease 2019 (COVID-19) patients, and to examine not only the effect of these co-infections on disease outcomes but also to identify the possible risk factors that predispose COVID-19 patients to co-infections.

METHODS

Medline (PubMed) and Google Scholar were searched for relevant articles published between January 1st, 2020, and September 31st, 2021, on the topic of co-infections among COVID-19 patients.

RESULTS

Among community-acquired and hospital-acquired co-infections, bacterial and fungal co-infections are equally frequent, followed by viral co-infections that affected a relatively smaller portion of patients. Overall, co-infections were more frequent in the hospital than at the community level. Risk factors for acquiring co-infections include male gender, longer length of hospital stay, presence of supportive treatment, such as ventilation, the admission to intensive care units, the administration of medications, such as steroids or antibiotics, and certain blood parameters, such as high C-reactive protein or lymphopenia. The presence of co-infections could aggravate the COVID-19 disease severity, prolong the healing time of patients, and lead to worse disease outcomes overall.

CONCLUSION

Co-infections may increase the mortality of COVID-19 patients, especially in the hospital setting. Paying closer attention to hygiene, adhering to diagnostic and therapeutic protocols, implementing antimicrobial stewardship programs could decrease the occurrence of co-infections and lead to improved outcomes for COVID-19 patients.

Zinc deficiency as a possible risk factor for increased susceptibility and severe progression of Corona Virus Disease 19

The importance of Zn for human health becomes obvious during Zn deficiency. Even mild insufficiencies of Zn cause alterations in haematopoiesis and immune functions, resulting in a proinflammatory phenotype and a disturbed redox metabolism. Although immune system malfunction has the most obvious effect, the functions of several tissue cell types are disturbed if Zn supply is limiting. Adhesion molecules and tight junction proteins decrease, while cell death increases, generating barrier dysfunction and possibly organ failure. Taken together, Zn deficiency both weakens the resistance of the human body towards pathogens and at the same time increases the danger of an overactive immune response that may cause tissue damage. The case numbers of Corona Virus Disease 19 (COVID-19) are still increasing, which is causing enormous problems for health systems and economies. There is an urgent need to reduce both the number of severe cases and the resulting deaths. While therapeutic options are still under investigation, and first vaccines have been approved, cost-effective ways to reduce the likelihood of or even prevent infection, and the transition from mild symptoms to more serious detrimental disease, are highly desirable. Nutritional supplementation might be an effective option to achieve these aims. In this review, we discuss known Zn deficiency effects in the context of an infection with Severe Acute Respiratory Syndrome-Coronavirus-2 and its currently known pathogenic mechanisms and elaborate on how severe pre-existing Zn deficiency may pre-dispose patients to a severe progression of COVID-19. First published clinical data on the association of Zn homoeostasis with COVID-19 and registered studies in progress are listed.

Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults

BACKGROUND

The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies.

AIM

To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies.

METHODS

Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan-Meier curves were performed.

RESULTS

The present study included 241 participants [median age 75.6 (73.0-80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26-5.07)] and sarcopenia [adjusted HR 1.25 (0.35-4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69-18.25)], which was confirmed by the Kaplan-Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37-19.54)].

CONCLUSION

Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful  consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings.

Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults

BACKGROUND

The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies.

AIM

To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies.

METHODS

Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan-Meier curves were performed.

RESULTS

The present study included 241 participants [median age 75.6 (73.0-80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26-5.07)] and sarcopenia [adjusted HR 1.25 (0.35-4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69-18.25)], which was confirmed by the Kaplan-Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37-19.54)].

CONCLUSION

Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful  consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings.

Immunosenescence evaluation of peripheral blood lymphocyte subsets in 957 healthy adults from 20 to 95 years old

Immunosenescence is characterized by an age-related decline in immune system function. Major efforts have been made to identify changes in peripheral blood lymphocyte subsets accompanying immunosenescence in elderly adults. However, the change trends of some lymphocyte subsets with age are still controversial, and populations of advanced ages, such as people in their 80s or 90s, have not yet been thoroughly investigated. To provide further insight, we recruited 957 healthy donors without certain diseases with ages ranging from 20 to 95 years. Peripheral lymphocyte subsets, including T cells, CD4 T cells, CD8 T cells, B cells and NK cells, and the CD4/CD8 ratio were measured by flow cytometry. Additionally, regulatory CD4 T cells with inhibitory functions marked by CD3⁺CD4⁺CD25^hi and the expression of the costimulatory molecule CD28 on CD8 T cells were evaluated. Sex was considered at the same time. The data indicated that in elderly people, peripheral T (p < 0.001), CD4 T (p < 0.001) and B (p < 0.001) lymphocyte subsets decreased, but the NK cell population (p < 0.001) increased. More regulatory CD4 T cells may imply stronger inhibition in the elderly population. The decreased CD28 expression with age in females verified CD28 to be an immunosenescence marker and the sharply decreased CD28 expression after 75 years in males indicated a rapid immunosenescence at the late life span of the male populations. In addition, our study established reference values for peripheral lymphocyte subsets at different age stages in males and females, which are urgently needed for the clinical management and treatment of geriatric diseases.

Elderly Patient Care: A New Reality of the SARS-CoV-2 Pandemic

Poland is among the European countries currently facing the second wave of the SARS-CoV-2 pandemic. A lot of studies confirm the mortality rate of COVID-19 increases with age. Considering the particularly adverse outcomes of a SARS-CoV-2 infection, preventing infections should be the priority for public health professionals. One method for preventing SARS-CoV-2 infections among eldery people may involve implementing procedures for limiting the spread of the pathogen, and providing education to medical staff, so as to bridge any gaps in knowledge on virus spread and post-infection or post-exposure management. Three residential medical centers in Poland were selected for evaluation of existing medical procedures to identify any errors in the current procedures applied for the prevention of SARS-CoV-2 spread in the facility. The project involved 4 steps: (1) Audit of the existing medical procedures; (2) Knowledge evaluation for the staff (n=185) in the senior- and disabled care facilities, administration of a knowledge test developed by the authors to assess knowledge on SARS-CoV-2 prevention; (3) Training for medical staff; (4) Updates and implementation of procedures. The knowledge test conducted revealed a lack of knowledge of medical personnel about SARS-CoV-2. The deficiencies of the surveyed group varied depending on the place of employment. Almost half of the surveyed medical centers (center No. 1 (52%) vs. center No. 2 (44%) vs. center No. 3(59%)) believed that elderly people usually do not show symptoms of SARS-CoV-2 infection. In the facility No. 1, 70% of respondents did know that SARS-CoV-2 can be transmitted via the alimentary route compared to center No. 2 and No. 3 where knowledge about it showed only 28,9% and 24,8% responders, respectively. Also, in facility No. 1, the least among the studied group (67%) knew that people with comorbidities were at risk of covid-19 compared to respondents from facility No. 2 and 3, where, respectively, 100% and 93% had such knowledge. Only 33.3% of the staff of facility No. 1 knew how to deal with a patient who will present symptoms such as temp >38 degrees with coughing or dyspnea while in institution No. 2 and 3, this knowledge was slightly higher at 44% and 60% respectively. The audit of the existing hygiene procedures used to limit the risk of SARS-CoV-2 spread demonstrated a number of shortcomings. Employees at the residential medical care centers included in the study had gaps in knowledge on the spread of SARS-CoV-2. The training sessions implemented at the next stage improved knowledge on SARS-CoV-2 infections. Additionally, decisions were made to modify certain procedures and introduce new ones to better prevent the spread of SARS-CoV-2.

COVID-19 and the excess of mortality in Italy from January to April 2020: what are the risks for oldest old?

In February 2020, Italy has been the first country in Europe fighting against COVID-19. In March 2020, Italian government declared national lockdown. Until May 4^th, people stayed in home confinement and only the so-called essential works and activities were continued. Like in other countries, both for the disease severity and for the risk of death, the higher the age of people the higher the risk. In the first months of 2020, Italy saw a very high number of deaths related to COVID-19, with a huge age effect. There is an agreement on the view that there had been also an excess of mortality and on the role of mortality as a correct way to reflect the dynamics of the virus’s spread. In this paper we briefly discuss the trends of mortality during the first 4 months of 2020 according to the data by the Italian National Institute of Statistics.

Is It "Aging" or Immunosenescence? The COVID-19 Biopsychosocial Risk Factors Aggravating Immunosenescence as Another Risk Factor of the Morbus. A Developmental-clinical Social Work Perspective

COVID-19 has proliferated ageism. The impetus of this article is to show that immunosenescence is a risk factor to COVID-19 and not aging per se. Based on the idea that some older people are also healthier than younger ones, the emphasis of this article is on immunosenescence and not aging as a risk factor of COVID-19 complications. The paper utilizes a biopsychosocial approach to expound on the link between immunosenescence and COVID-19 risk factors. The article explores biological factors such as malnutrition, comorbidities, substance abuse, and sex. It also expands on psychosocial factors such as mental health disorders, homelessness, unemployment, lack of physical exercises, stigma, and discrimination. The article calls for gerontological social work to assume a developmental-clinical social work perspective to prevent the early onset and progression of immunosenescence. It calls for gerontological social work to prevent factors that promote unhealthy aging. The article promotes a preventative stance to practice and not just curative approaches. Treatment involves primary prevention which emphasizes on avoiding the onset of unhealthy aging. It is this approach that gerontological social work should aim also to address in building resilience in the face of pandemics.

Aging & COVID-19 susceptibility, disease severity, and clinical outcomes: The role of entangled risk factors

The emergence of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) in late 2019 has been associated with a high rate of mortality and morbidity. It has been determined that the old population are not only at an increased risk for affliction with COVID-19 infection, but also atypical presentations, severe forms of the disease, and mortality are more common in this population. A plethora of mechanisms and risk factors contribute to the higher risk of infection in the old population. For instance, aging is associated with an increment in the expression of Angiotensin-Converting Enzyme-2 (ACE-2), the receptor for SARS-CoV-2 spike protein, which precipitates replication of the virus in the old population. On the other hand, immune dysregulation and changes in gut microbiota as a result of aging can contribute to the cytokine storm, one of the main indicators of disease severity. Decrement in sex steroids, especially in women, as well as growth hormone, both of which have crucial roles in immune regulation, is a key contributor to disease severity in old age. Senescence-associated oxidative stress and mitochondrial dysfunction in both pneumocytes and immune cells contribute to the severity of infection in an exacerbative manner. In addition, lifestyle-associated factors such as nutrition and physical activity, which are compromised in old age, are known as important factors in COVID-19 infection. Aging-associated comorbidities, especially cardiovascular diseases and diabetes mellitus, also put older adults at an increased risk of complications, and disease severity.

Caractéristiques et mortalité des patients gériatriques infectés au Sars-CoV2 : description et comparaison des patients hospitalisés en unité dédiée COVID et de ceux en unités Alzheimer

Introduction

Objectif

Matériel et méthode

Résultats

Conclusion

Rehabilitation guidance for hip fracture patients during the COVID-19 pandemic using chat software: A new model

BACKGROUND

Hip fractures are serious fractures for the elderly. The rehabilitation of patients with hip fractures has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

We have piloted a new model for tracking patients and providing rehabilitation guidance that uses WeChat. The purpose of this study is to explore the role of chat software in rehabilitation guidance for hip fracture patients during COVID-19.

METHODS

Patients treated for hip fractures from February 1 to April 30, 2020 were randomly divided into a control group and an observation group. The control group was given conventional discharge guidance, while the observation group also followed up the patients using WeChat to guide the exercise. Satisfaction, the Harris Hip Score, complications and the mortality of the two groups after discharge were compared.

RESULTS

The incidence of complications and mortality in the observation group were significantly lower than in the control group: p= 0.022 and p= 0.048, respectively. The Harris Hip Score and satisfaction were significantly better than the control group's: p= 0.000 and p= 0.007, respectively.

CONCLUSION

During the COVID-19 pandemic, it is very helpful to use WeChat software or other social software with similar functions (such as WhatsApp and Facebook) to guide the rehabilitation of hip fractures.

An update in toxicology of ageing

The field of ageing research has been rapidly advancing in recent decades and it had provided insight into the complexity of ageing phenomenon. However, as the organism-environment interaction appears to significantly affect the organismal pace of ageing, the systematic approach for gerontogenic risk assessment of environmental factors has yet to be established. This puts demand on development of effective biomarker of ageing, as a relevant tool to quantify effects of gerontogenic exposures, contingent on multidisciplinary research approach. Here we review the current knowledge regarding the main endogenous gerontogenic pathways involved in acceleration of ageing through environmental exposures. These include inflammatory and oxidative stress-triggered processes, dysregulation of maintenance of cellular anabolism and catabolism and loss of protein homeostasis. The most effective biomarkers showing specificity and relevancy to ageing phenotypes are summarized, as well. The crucial part of this review was dedicated to the comprehensive overview of environmental gerontogens including various types of radiation, certain types of pesticides, heavy metals, drugs and addictive substances, unhealthy dietary patterns, and sedentary life as well as psychosocial stress. The reported effects in vitro and in vivo of both recognized and potential gerontogens are described with respect to the up-to-date knowledge in geroscience. Finally, hormetic and ageing decelerating effects of environmental factors are briefly discussed, as well.

Coronavirus Disease 19 from the Perspective of Ageing with Focus on Nutritional Status and Nutrition Management-A Narrative Review

The novel severe acute respiratory syndrome coronavirus (COVID-19) has hit older adults harder due to a combination of age-related immunological and metabolic alterations. The aim of this review was to analyze the COVID-19 literature with respect to nutritional status and nutrition management in older adults. No studies only on people aged 65+ years were found, and documentation on those 80+ was rare. Age was found to be strongly associated with worse outcomes, and with poor nutritional status. Prevalence of malnutrition was high among severely and critically ill patients. The studies found a need for nutrition screening and management, and for nutrition support as part of follow-up after a hospital stay. Most tested screening tools showed high sensitivity in identifying nutritional risk, but none were recognized as best for screening older adults with COVID-19. For diagnosing malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended but were not used in the studies found. Documentation of olfactory and gustatory dysfunction in relation to nutritional status is missing in older adults. Other COVID-19-associated factors with a possible impact on nutritional status are poor appetite and gastrointestinal symptoms. Vitamin D is the nutrient that has attracted the most interest. However, evidence for supplementation of COVID-19 patients is still limited and inconclusive.

Is butyrate a natural alternative to dexamethasone in the management of CoVID-19?

Coronavirus disease 2019 (CoVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 has affected more than 100 million lives. Severe CoVID-19 infection may lead to acute respiratory distress syndrome and death of the patient, and is associated with hyperinflammation and cytokine storm. The broad spectrum immunosuppressant corticosteroid, dexamethasone, is being used to manage the cytokine storm and hyperinflammation in CoVID-19 patients. However, the extensive use of corticosteroids leads to serious adverse events and disruption of the gut-lung axis. Various micronutrients and probiotic supplementations are known to aid in the reduction of hyperinflammation and restoration of gut microbiota. The attenuation of the deleterious immune response and hyperinflammation could be mediated by short chain fatty acids produced by the gut microbiota. Butyric acid, the most extensively studied short chain fatty acid, is known for its anti-inflammatory properties. Additionally, butyric acid has been shown to ameliorate hyperinflammation and reduce oxidative stress in various pathologies, including respiratory viral infections. In this review, the potential anti-inflammatory effects of butyric acid that aid in cytokine storm depletion, and its usefulness in effective management of critical illness related to CoVID-19 have been discussed.

The prognostic role of functional dependency in older inpatients with COVID-19

Background

Coronavirus disease 2019 (COVID-19) is a pandemic infection with substantial risk of death, especially in elderly persons. Information about the prognostic significance of functional status in older patients with COVID-19 is scarce.

Methods

Demographic, clinical, laboratory and short-term mortality data were collected of 186 consecutive patients aged ≥ 65 years hospitalized with COVID-19. The data were compared between 4 study groups: (1) age 65–79 years without severe functional dependency; (2) age ≥ 80 years without severe functional dependency; (3) age 65–79 years with severe functional dependency; and (4) age ≥ 80 years with severe functional dependency. Multivariate logistic regressions were performed to evaluate the variables that were most significantly associated with mortality in the entire sample.

Results

Statistically significant differences were observed between the groups in the proportions of males (p = 0.007); of patients with diabetes mellitus (p = 0.025), cerebrovascular disease (p < 0.001), renal failure (p = 0.003), dementia (p < 0.001), heart failure (p = 0.005), pressure sores (p < 0.001) and malignant disorders (p = 0.007); and of patients residing in nursing homes (p < 0.001). Compared to groups 1 (n = 69) and 2 (n = 28), patients in groups 3 (n = 32) and 4 (n = 57) presented with lower mean serum albumin levels on admission (p < 0.001), and were less often treated with convalescent plasma (p < 0.001), tocilizumab (p < 0.001) and remdesivir (p < 0.001). The overall mortality rate was 23.1 %. The mortality rate was higher in group 4 than in groups 1 − 3: 45.6 % vs. 8.7 %, 17.9% and 18.3 %, respectively (p < 0.001). On multivariate analysis, both age ≥ 80 years and severe functional dependency were among the variables most significantly associated with mortality in the entire cohort (odds ratio [OR] 4.83, 95 % confidence interval [CI] 1.88 − 12.40, p < 0.001 and OR 2.51, 95 % CI 1.02 − 6.15, p = 0.044, respectively). Age ≥ 80 years with severe functional dependency (group 4) remained one of the variables most significantly associated with mortality (OR 10.42, 95 % CI 3.27–33.24 and p < 0.001).

Conclusions

Among patients with COVID-19, the association of severe functional dependency with mortality is stronger among those aged ≥ 80 years than aged 65–79 years. Assessment of functional status may contribute to decision making for care of older inpatients with COVID-19.

Nutritional determinants and COVID-19 outcomes of older patients with COVID-19: A systematic review

Background

Malnutrition among older people is one of the serious public health problem worldwide. Nutritional status and levels of nutrients of older patients with COVID-19 effect on COVID-19 outcomes. The purpose of this systematic review was to identify the prevalence of malnutrition and levels of nutrients associated with outcomes of the older patients with COVID-19.

Materials and Methods

A literature search was performed using PubMed, Science direct and Google scholar database using specific keywords related to the aims. All related articles published on COVID-19 during 2020 were retrieved. PRISMA Statement was followed. The quality of the study was assessed using the quality assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Results

Of the 2979 studies found, a total of eight studies were included in this review. Of these studies, three provided data on nutritional status and outcomes of COVID-19 among older patients with COVID-19. The prevalence of malnutrition among older patients with COVID-19 was high and it was associated with negative outcomes including hospital deaths and transfer to intensive care units. Five studies provided data on nutrients and outcomes of COVID-19. Low albumin, vitamin D, magnesium ,vitamin B12, Se status were associated with malnutrition, oxygen therapy and/or intensive care support of the patients, survival of COVID -19.

Conclusions

Extra care should be provided to older patients with COVID-19 to minimize the prevalence of malnutrition and negative outcomes of COVID-19.

Royal jelly alleviates the detrimental effects of aging on immune functions by enhancing the in vitro cellular proliferation, cytokines, and nitric oxide release in aged human PBMCS

Aging strongly delays the immunity. Our research aims to assess the in vitro effects of royal jelly (RJ) on the immune function of aged PBMCs. PBMCs were obtained from 10 healthy aged and young donors by the gradient density centrifugation method and further cultured in RPMI-1640 medium supplemented with or without RJ in the presence of Con A. Cell proliferation was assessed by MTT assay along with the measurement of interleukins, Nitric oxide (NO), Glutathione (GSH), and Malondialdehydes (MDA). Our results showed that RJ improved PBMCs proliferation significantly in the elderly subjects, accompanied by the increase in NO (p = .001) and the release of IL-2, IL-4, and IL-6 cytokines. RJ also increased the intracellular GSH (p = .001) and MDA (p = .001) levels in aged PBMCs. In young subjects, RJ enhanced PBMCs proliferation potency, IL-4, IL-6, GSH, and intracellular MDA levels but with a concomitant decrease in NO and IL-2 cytokine secretion as compared with non RJ-treated cells. In conclusion, RJ restored functions of the aged PBMCs as well as the young control subjects, indicating a beneficial effect on immune status during the aging process. PRACTICAL APPLICATIONS: Royal jelly is a well-known edible dietary compound, used traditionally to treat many diseases throughout the world. Since antiquity, it was shown to have medicinal importance. The immuno-enhancing potential of this food was largely and scientifically established by the lipid and protein fractions. The present study illustrates the anti-aging and stimulatory effects of the fresh RJ whole extract, from local Algerian honey bee: Apis mellifera intermissa, on the immunity of aged men. This study provides the experimental evidence supporting anti-immunosenesence effects of royal jelly. RJ supplementation can be used in the old age management and human age-related complications, especially, associated with the weaknesses of the immune response.

Nutritional Status and COVID-19 among Older Persons in Kerala, India

Background and Aims: The COVID-19 pandemic has posed an unprecedented public health crisis globally irrespective of age. There is no doubt that the older population (above the age of 60) is the most vulnerable age category due to multiple co-morbidities, which often is not in their favour. Age category, types of co-morbidities and nutritional levels indeed play a pivotal role in determining mortality rates. This paper focuses on Kerala, a southern Indian state and how it maintained low mortality levels due to COVID-19 during the first wave despite being the state with the highest proportion of the older population. The present study argues although the state possessed a robust health system and had an active engagement of the public health sector with its citizens through local governments, it was the state's meticulous planning, innovative schemes centred around older persons such as reverse quarantine, the prevailing excellent nutritional status among its population and initiatives to ensure good nutrition through food security schemes like 'essential grocery kits' and 'community kitchens' that helped to develop the body's resistance to infection and thus played a significant role in flattening the curve for Kerala's older adult COVID-19 deaths effectively, thereby achieving a high recovery rate and low rates of fatality during the first wave of COVID-19 in Kerala. Methods: Pre-COVID-19 health conditions of older adults in Kerala were analysed through Kerala Ageing Survey (KAS) panel data and Longitudinal Ageing Survey in India (LASI) data. Percentage analysis, Logistic regression method and Cox hazard regression methods were used to analyse the effect of nutritional levels on health and mortality among older adults in Kerala. Publically available COVID-19 data from the Government of Kerala and the Government of India were used to analyse the COVID-19 death rates. In addition, changes in dietary patterns and other preventive measures taken to fight against COVID-19 were investigated through qualitative response. Result: The study found that nutritional status influences mortality and co-morbidities among older adults in Kerala in the pre-COVID situation. Furthermore, the study found that though nutritional indicators, that is, overweight or obese, significantly increases the risk of comorbid conditions among older adults, good nourishment reduces the risk of all-cause mortality. The study also found that Kerala's COVID-19 fatality was much lower when compared to India and developed nations like the US, UK and Italy. Even if Kerala is one of the highly COVID-19 affected states, the effective nutritional intervention by the Government of Kerala through its various schemes to build up the general immunity of the state's citizens, especially high-risk groups; thereby achieving low COVID fatality in the state.Conclusion: Based on Kerala's experience, nutritional factors influence the population in building up the body's resistance to infection against COVID-19. Even though the fatality rate is very low, obesity coupled with non-communicable diseases affects preventive measures of the state. There is an immediate and persuasive need to find new and more efficient clinical studies apart from socio-epidemiological studies, which could play a pivotal role in determining COVID-19 health outcomes.

COVID-19 in ESRD and Acute Kidney Injury

The COVID-19 pandemic has greatly affected nephrology. Firstly, dialysis patients appear to be at increased risk for infection due to viral transmission next to an enhanced risk for mortality as compared to the general population, even in the face of an often apparently mild clinical presentation. Derangements in the innate and adaptive immune systems may be responsible for a reduced antiviral response, whereas chronic activation of the innate immune system and endothelial dysfunction provide a background for a more severe course. The presence of severe comorbidity, older age, and a reduction of organ reserve may lead to a rapid deterioration of the clinical situation of the patients in case of severe infection. Secondly, patients with COVID-19 are at increased risk of acute kidney injury (AKI), which is related to the severity of the clinical disease. The presence of AKI, and especially the need for renal replacement therapy (RRT), is associated with an increased risk of mortality. AKI in COVID-19 has a multifactorial origin, in which direct viral invasion of kidney cells, activation of the renin-angiotensin aldosterone system, a hyperinflammatory response, hypercoagulability, and nonspecific factors such as hypotension and hypoxemia may be involved. Apart from logistic challenges and the need for strict hygiene within units, treatment of patients with ESRD and COVID-19 is not different from that of the general population. Extracorporeal treatment of patients with AKI with RRT can be complicated by frequent filter clotting due to the hypercoagulable state, for which regional citrate coagulation provides a reasonable solution. Also, acute peritoneal dialysis may be a reasonable option in these patients. Whether adjuncts to extracorporeal therapies, such as hemoadsorption, provide additional benefits in the case of severely ill COVID-19 patients needs to be addressed in controlled studies.

Clinical characteristics on admission predict in-hospital fatal outcome in patients aged ≥75 years with novel coronavirus disease (COVID-19): a retrospective cohort study

BACKGROUND

Novel coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and precise fatality data by age group is needed urgently. This study to delineate the clinical characteristics and outcome of COVID-19 patients aged ≥75 years and identify the risk factors of in-hospital death.

METHODS

A total of 141 consecutive patients aged ≥75 years who were admitted to the hospital between 12th and 19th February 2020. In-hospital death, clinical characteristics and laboratory findings on admission were obtained from medical records. The final follow-up observation was on the 31st March 2020.

RESULTS

The median age was 81 years (84 female, 59.6%). Thirty-eight (27%) patients were classified as severe or critical cases. 18 (12.8%) patients had died in hospital and the remaining 123 were discharged. Patients who died were more likely to present with fever (38.9% vs. 7.3%); low percutaneous oxygen saturation (SpO2) (55.6% vs. 7.3%); reduced lymphocytes (72.2% vs. 35.8%) and platelets (27.8% vs. 4.1%); and increased D-dimer (94.4% vs. 42.3%), creatinine (50.0% vs. 22.0%), lactic dehydrogenase (LDH) (77.8% vs. 30.1%), high sensitivity troponin I (hs-TnI) (72.2% vs. 14.6%), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (72.2% vs. 6.5%; all P < 0.05) than patients who recovered. Male sex (odds ratio [OR] = 13.1, 95% confidence interval [CI] 1.1 to 160.1, P = 0.044), body temperature > 37.3 °C (OR = 80.5, 95% CI 4.6 to 1407.6, P = 0.003), SpO2 ≤ 90% (OR = 70.1, 95% CI 4.6 to 1060.4, P = 0.002), and NT-proBNP> 1800 ng/L (OR = 273.5, 95% CI 14.7 to 5104.8, P < 0.0001) were independent risk factors of in-hospital death.

CONCLUSIONS

In-hospital fatality among elderly COVID-19 patients can be estimated by sex and on-admission measurements of body temperature, SpO2, and NT-proBNP.

High prevalence of SARS-CoV-2 antibodies in care homes affected by COVID-19: Prospective cohort study, England

BACKGROUND

We investigated six London care homes experiencing a COVID-19 outbreak and found high rates of SARS-CoV-2 infection among residents and staff. Here we report follow-up investigations including antibody testing in the same care homes five weeks later.

METHODS

Residents and staff in the initial investigation had a repeat nasal swab for SARS-CoV-2 RT-PCR and a blood test for SARS CoV-2 antibodies using ELISA based on SARS-CoV-2 native viral antigens derived from infected cells and virus neutralisation.

FINDINGS

Of the 518 residents and staff in the initial investigation, 186/241 (77.2%) surviving residents and 208/254 (81.9%) staff underwent serological testing. Almost all SARS-CoV-2 RT-PCR positive residents and staff were seropositive five weeks later, whether symptomatic (residents 35/35, 100%; staff, 22/22, 100%) or asymptomatic (residents 32/33, 97.0%; staff 21/22, 95.5%). Symptomatic but SARS-CoV-2 RT-PCR negative residents and staff also had high seropositivity rates (residents 23/27, 85.2%; staff 18/21, 85.7%), as did asymptomatic RT-PCR negative individuals (residents 61/91, 67.0%; staff 95/143, 66.4%). Neutralising antibody was detected in 118/132 (89.4%) seropositive individuals and was not associated with age or symptoms. Ten residents (10/79 re-tested, 12.7%) remained RT-PCR positive but with higher RT-PCR cycle threshold values; 7/10 had serological testing and all were seropositive. New infections were detected in three residents and one staff.

INTERPRETATION

RT-PCR provides a point prevalence of SARS-CoV-2 infection but significantly underestimates total exposure in outbreak settings. In care homes experiencing large COVID-19 outbreaks, most residents and staff had neutralising SARS-CoV-2 antibodies, which was not associated with age or symptoms.

FUNDING

PHE.

The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases

BACKGROUND

It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal.

METHODS

A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator.

RESULTS

A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56-60) years, OR = 6.01; (61-65) years, OR = 10.5; (66-70) years, OR = 20.4; (71-75) years, OR = 34; (76-80) years, OR = 50.9; (81-85) years, OR = 70.7; (86-90) years, OR = 83.2; (91-95) years, OR = 91.8; (96-104) years, OR = 140.2, ref = (0-55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest.

CONCLUSIONS

Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.