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Zakeri MA, Aziz AR, Rahiminezhad E, Dehghan M. Effectiveness of massage and range of motion exercises on muscle strength and intensive care unit-acquired weakness in Iranian patients with COVID-19: a randomized parallel-controlled trial. Acute Crit Care 2024; 39:78-90. [PMID: 38148038 PMCID: PMC11002629 DOI: 10.4266/acc.2023.00416] [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: 02/20/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Muscle weakness is prevalent in intensive care patients. This study focused on comparing the effects of massage and range of motion (ROM) exercises on muscle strength and intensive care unit-acquired weakness (ICU-AW) among patients with coronavirus disease 2019 (COVID-19). METHODS This study was a randomized clinical trial that recruited patients (n=45) with COVID-19 admitted to the ICU and divided them into three groups (ROM exercises, massage, and control). We evaluated muscle strength and ICU-AW in the arms and legs using a hand dynamometer. The Medical Research Council sum score was determined before and after the intervention. RESULTS The study findings were that 0%, 20%, and 100% of the participants in the ROM exercises, massage, and control groups had ICU-AW on the 7th day of ICU admission. The ROM exercise group had greater muscle strength in the hands and legs than the massage and control groups, and the massage group had greater muscle strength than the control group. CONCLUSIONS Massage and ROM exercises could improve muscle strength and reduce ICU-AW in COVID-19 patients admitted to the ICU.
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Affiliation(s)
- Mohammad Ali Zakeri
- Pistachio Safety Research Center, Rafsanjan University of
Medical Sciences, Rafsanjan, Iran
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital,
Rafsanjan University of Medical Sciences, Rafsanjan,
Iran
| | | | - Elham Rahiminezhad
- Student Research Committee, Razi Faculty of Nursing and
Midwifery, Kerman University of Medical Sciences, Kerman,
Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences,
Kerman, Iran
- Department of Critical Care, Faculty of Nursing and Midwifery,
Kerman University of Medical Sciences, Kerman, Iran
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2
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Rahiminezhad E, Zakeri MA, Dehghan M. Muscle strength/intensive care unit acquired weakness in COVID-19 and non-COVID-19 patients. Nurs Crit Care 2023; 28:1012-1021. [PMID: 35896171 PMCID: PMC9353376 DOI: 10.1111/nicc.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive care unit acquired weakness (ICU-AW) affects both coronavirus disease 19 (COVID-19) and non-COVID-19 patients. ICU-AW can result in a variety of consequences, including increased patient mortality. AIMS The current study aimed to compare muscle strength and ICU-AW in COVID-19 and non-COVID-19 patients. STUDY DESIGN This was a cross-sectional, descriptive-analytical pilot study. METHODS Fifteen conscious COVID-19 patients and 15 conscious non-COVID-19 patients admitted to the ICUs of a public hospital were selected by convenience sampling. Muscle strength in arms and legs was assessed by a hand-held dynamometer (HHD), and ICU-AW was measured with the medical research council sum score (MRC-SS) scale on the first, fourth, and seventh days of admission to ICUs. RESULTS The results showed that muscle strength in the arms and legs of the COVID-19 patients assessed by a HHD and MRC was significantly lower than that of non-COVID-19 patients. On the fourth day of ICU admission, 80% of the COVID-19 patients and 40% of the non-COVID-19 patients had ICU-AW. All COVID-19 patients and 86.8% of the non-COVID-19 patients had ICU-AW on the seventh day of ICU admission. CONCLUSIONS Decreased muscle strength and ICU-AW are more likely in COVID-19 patients who must stay in the ICU compared with non-COVID-19 patients. RELEVANCE TO CLINICAL PRACTICE Health systems should plan to provide rehabilitation facilities for COVID-19 patients and prevent prolonged complications of COVID-19.
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Affiliation(s)
- Elham Rahiminezhad
- Student Research Committee, Razi Faculty of Nursing and MidwiferyKerman University of Medical SciencesKermanIran
| | - Mohammad Ali Zakeri
- Non‐Communicable Diseases Research CenterRafsanjan University of Medical SciencesRafsanjanIran
| | - Mahlagha Dehghan
- Nursing Research CenterKerman University of Medical SciencesKermanIran
- Department of Critical Care, Faculty of Nursing and MidwiferyKerman University of Medical SciencesKermanIran
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3
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Lee ZC, Wong YJE, Ti LL, Shrikant DP, Tay TL, Santosa A. Hashimoto's thyroiditis-related myopathy in a patient with SARS-CoV-2 infection: A case report and systematic literature review. Medicine (Baltimore) 2023; 102:e35720. [PMID: 37861476 PMCID: PMC10589518 DOI: 10.1097/md.0000000000035720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
RATIONALE Hashimoto's thyroiditis (HT) is a common autoimmune disease. However, its presentation and management in the context of COVID-19 are unclear, and COVID-19-triggered HT, along with myopathy and persistent creatine kinase (CK) levels, have not been previously reported. Moreover, no literature review is currently available on HT in the context of COVID-19. This study is a case report and systematic review of the literature. PATIENT CONCERNS A 33-year-old man was admitted with acute-onset myalgia, anosmia, loss of taste, fever, and upper respiratory tract symptoms. DIAGNOSES He was diagnosed with coronavirus disease (COVID-19) during hospitalization and had abnormal CK levels. The elevated CK level persisted even after the resolution of COVID-19. After excluding myopathies and cardiac factors, HT was diagnosed. INTERVENTIONS CK levels did not decrease appreciably until 14 d after levothyroxine administration. OUTCOMES The patient was discharged from the hospital in good health. In the systematic literature review, 7 case reports on COVID-19-associated HT were observed, although no incidence of associated myopathy or persistent elevation of CK was noted. LESSONS This case report highlights the potential link between COVID-19 and autoimmune thyroid diseases. In particular, this study underscores the significance of recognizing new-onset autoimmune thyroid disease in COVID-19-positive patients with elevated CK levels that cannot be attributed to other factors. This systematic review offers additional perspectives for diagnosing and managing HT in COVID-19 settings. Overall, the findings of this study could have important clinical implications for the care of COVID-19 patients, as early identification and treatment of autoimmune thyroid disease could help prevent long-term complications. Additional research is essential to elucidate the fundamental correlations between COVID-19 and HT and assess the effectiveness of therapeutic approaches for autoimmune thyroid conditions related to COVID-19.
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Affiliation(s)
- Zheng Cong Lee
- Department of Medicine (Rheumatology Service), Changi General Hospital, Singapore
| | | | | | | | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, Singapore
| | - Anindita Santosa
- Department of Medicine (Rheumatology Service), Changi General Hospital, Singapore
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4
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Oloye FF, Xie Y, Challis JK, Femi-Oloye OP, Brinkmann M, McPhedran KN, Jones PD, Servos MR, Giesy JP. Understanding common population markers for SARS-CoV-2 RNA normalization in wastewater - A review. CHEMOSPHERE 2023; 333:138682. [PMID: 37201600 DOI: 10.1016/j.chemosphere.2023.138682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/14/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
Wastewater monitoring and epidemiology have seen renewed interest during the recent COVID-19 pandemic. As a result, there is an increasing need to normalize wastewater-derived viral loads in local populations. Chemical tracers, both exogenous and endogenous compounds, have proven to be more stable and reliable for normalization than biological indicators. However, differing instrumentation and extraction methods can make it difficult to compare results. This review examines current extraction and quantification methods for ten common population indicators: creatinine, coprostanol, nicotine, cotinine, sucralose, acesulfame, androstenedione 5-hydroindoleacetic acid (5-HIAA), caffeine, and 1,7-dimethyluric acid. Some wastewater parameters such as ammonia, total nitrogen, total phosphorus, and daily flowrate were also evaluated. The analytical methods included direct injection, dilute and shoot, liquid/liquid, and solid phase extraction (SPE). Creatine, acesulfame, nicotine, 5-HIAA and androstenedione have been analysed by direct injection into LC-MS; however, most authors prefer to include SPE steps to avoid matrix effects. Both LC-MS and GC-MS have been successfully used to quantify coprostanol in wastewater, and the other selected indicators have been quantified successfully with LC-MS. Acidification to stabilize the sample before freezing to maintain the integrity of samples has been reported to be beneficial. However, there are arguments both for and against working at acidic pHs. Wastewater parameters mentioned earlier are quick and easy to quantify, but the data does not always represent the human population effectively. A preference for population indicators originating solely from humans is apparent. This review summarises methods employed for chemical indicators in wastewater, provides a basis for choosing an appropriate extraction and analysis method, and highlights the utility of accurate chemical tracer data for wastewater-based epidemiology.
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Affiliation(s)
- Femi F Oloye
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Yuwei Xie
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Markus Brinkmann
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada; Global Institute for Water Security, University of Saskatchewan, Saskatoon, SK, Canada; School of Environment and Sustainability, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kerry N McPhedran
- School of Environment and Sustainability, University of Saskatchewan, Saskatoon, SK, Canada; Department of Civil, Geological and Environmental Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paul D Jones
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada; Global Institute for Water Security, University of Saskatchewan, Saskatoon, SK, Canada; School of Environment and Sustainability, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Giesy
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada; Department of Environmental Sciences, Baylor University, Waco, TX, USA; Department of Integrative Biology and Center for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, USA.
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5
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Pucci G, D'Abbondanza M, Curcio R, Alcidi R, Campanella T, Chiatti L, Gandolfo V, Veca V, Casarola G, Leone MC, Rossi R, Alberti A, Sanesi L, Cavallo M, Vaudo G. Handgrip strength is associated with adverse outcomes in patients hospitalized for COVID-19-associated pneumonia. Intern Emerg Med 2022; 17:1997-2004. [PMID: 35930184 PMCID: PMC9362345 DOI: 10.1007/s11739-022-03060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/18/2022] [Indexed: 12/25/2022]
Abstract
Handgrip strength (HGS), a simple tool for the evaluation of muscular strength, is independently associated with negative prognosis in many diseases. It is unknown whether HGS is prognostically relevant in COVID-19. We evaluated the ability of HGS to predict clinical outcomes in people with COVID-19-related pneumonia. 118 patients (66% men, 63 ± 12 years), consecutively hospitalized to the "Santa Maria" Terni University Hospital for COVID-19-related pneumonia and respiratory failure, underwent HGS measurement (Jamar hand-dynamometer) at ward admission. HGS was normalized to weight2/3 (nHGS) The main end-point was the first occurrence of death and/or endotracheal intubation at 14 days. Twenty-two patients reached the main end-point. In the Kaplan-Meyer analysis, the Log rank test showed significant differences between subjects with lower than mean HGS normalized to weight2/3 (nHGS) (< 1.32 kg/Kg2/3) vs subjects with higher than mean nHGS. (p = 0.03). In a Cox-proportional hazard model, nHGS inversely predicted the main end-point (hazard ratio, HR = 1.99 each 0.5 kg/Kg2/3 decrease, p = 0.03), independently from age, sex, body mass index, ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio), hypertension, diabetes, estimated glomerular filtration rate and history of previous cardiovascular cardiovascular disease. These two latter also showed independent association with the main end-point (HR 1.30, p = 0.03 and 3.89, p < 0.01, respectively). In conclusion, nHGS measured at hospital admission, independently and inversely predicts the risk of poor outcomes in people with COVID-19-related pneumonia. The evaluation of HGS may be useful in early stratifying the risk of adverse prognosis in COVID-19.
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Affiliation(s)
- Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy.
- COVID Unit, Terni University Hospital, Terni, Italy.
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Lorenzo Chiatti
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Vito Veca
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Maria Comasia Leone
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Alessio Alberti
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Leandro Sanesi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Massimiliano Cavallo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
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6
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Silva LRG, Stefano JS, Orzari LO, Brazaca LC, Carrilho E, Marcolino-Junior LH, Bergamini MF, Munoz RAA, Janegitz BC. Electrochemical Biosensor for SARS-CoV-2 cDNA Detection Using AuPs-Modified 3D-Printed Graphene Electrodes. BIOSENSORS 2022; 12:bios12080622. [PMID: 36005018 PMCID: PMC9405530 DOI: 10.3390/bios12080622] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022]
Abstract
A low-cost and disposable graphene polylactic (G-PLA) 3D-printed electrode modified with gold particles (AuPs) was explored to detect the cDNA of SARS-CoV-2 and creatinine, a potential biomarker for COVID-19. For that, a simple, non-enzymatic electrochemical sensor, based on a Au-modified G-PLA platform was applied. The AuPs deposited on the electrode were involved in a complexation reaction with creatinine, resulting in a decrease in the analytical response, and thus providing a fast and simple electroanalytical device. Physicochemical characterizations were performed by SEM, EIS, FTIR, and cyclic voltammetry. Square wave voltammetry was employed for the creatinine detection, and the sensor presented a linear response with a detection limit of 0.016 mmol L−1. Finally, a biosensor for the detection of SARS-CoV-2 was developed based on the immobilization of a capture sequence of the viral cDNA upon the Au-modified 3D-printed electrode. The concentration, immobilization time, and hybridization time were evaluated in presence of the DNA target, resulting in a biosensor with rapid and low-cost analysis, capable of sensing the cDNA of the virus with a good limit of detection (0.30 µmol L−1), and high sensitivity (0.583 µA µmol−1 L). Reproducible results were obtained (RSD = 1.14%, n = 3), attesting to the potentiality of 3D-printed platforms for the production of biosensors.
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Affiliation(s)
- Luiz R. G. Silva
- Department of Nature Sciences, Mathematics and Education, Federal University of São Carlos, Araras 13600-970, SP, Brazil
- Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba 18052-780, SP, Brazil
| | - Jéssica S. Stefano
- Department of Nature Sciences, Mathematics and Education, Federal University of São Carlos, Araras 13600-970, SP, Brazil
- Correspondence: (J.S.S.); (B.C.J.)
| | - Luiz O. Orzari
- Department of Nature Sciences, Mathematics and Education, Federal University of São Carlos, Araras 13600-970, SP, Brazil
- Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba 18052-780, SP, Brazil
| | - Laís C. Brazaca
- São Carlos Institute of Chemistry (IQSC), University of São Paulo (USP), São Carlos 13566-590, SP, Brazil
- National Institute of Science and Technology in Bioanalysis-INCTBio, Campinas 13083-970, SP, Brazil
| | - Emanuel Carrilho
- São Carlos Institute of Chemistry (IQSC), University of São Paulo (USP), São Carlos 13566-590, SP, Brazil
- National Institute of Science and Technology in Bioanalysis-INCTBio, Campinas 13083-970, SP, Brazil
| | - Luiz H. Marcolino-Junior
- Chemistry Department, Laboratory of Electrochemical Sensors (LabSensE), Federal University of Paraná, Curitiba 81531-980, PR, Brazil
| | - Marcio F. Bergamini
- Chemistry Department, Laboratory of Electrochemical Sensors (LabSensE), Federal University of Paraná, Curitiba 81531-980, PR, Brazil
| | - Rodrigo A. A. Munoz
- National Institute of Science and Technology in Bioanalysis-INCTBio, Campinas 13083-970, SP, Brazil
- Institute of Chemistry, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
| | - Bruno C. Janegitz
- Department of Nature Sciences, Mathematics and Education, Federal University of São Carlos, Araras 13600-970, SP, Brazil
- Correspondence: (J.S.S.); (B.C.J.)
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7
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Friedman SA, Charmchi Z, Silver M, Jacoby N, Perk J, Anziska Y. Skeletal Muscle Manifestations and Creatine Kinase in COVID-19. Neurohospitalist 2022; 12:597-606. [PMID: 36147765 PMCID: PMC9160579 DOI: 10.1177/19418744221105961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose Skeletal muscle symptoms and elevated creatine kinase (CK) levels have been consistently reported as part of the COVID-19 disease process. Previous studies have yet to show a consistent relationship between CK levels and skeletal muscle symptoms, disease severity, and death from COVID-19. The purpose of this study is to determine whether elevated CK is associated with a COVID-19 course requiring intubation, intensive care, and/or causing death. Secondary objectives: To determine if there is a relationship between elevated CK and (1) skeletal muscle symptoms/signs (2) complications of COVID-19 and (3) other diagnostic laboratory values. Methods This is a retrospective, single center cohort study. Data were collected from March 13, 2020, to May 13, 2020. This study included 289 hospitalized patients with laboratory-confirmed SARS-CoV-2 and measured CK levels during admission. Results Of 289 patients (mean age 68.5 [SD 13.8] years, 145 [50.2%] were men, 262 [90.7%] were African American) with COVID-19, 52 (18.0%) reported myalgia, 92 (31.8%) reported subjective weakness, and 132 (45.7%) had elevated CK levels (defined as greater than 220 U/L). Elevated CK was found to be associated with severity of disease, even when adjusting for inflammatory marker C-reactive protein (initial CK: OR 1.006 [95% CI: 1.002-1.011]; peak CK: OR 1.006 [95% CI: 1.002-1.01]; last CK: 1.009 [95% CI: 1.002-1.016]; q = .04). Creatine kinase was not found to be associated with skeletal muscle symptoms/signs or with other laboratory markers. Conclusions Creatine kinase is of possible clinical significance and may be used as an additional data point in predicting the trajectory of the COVID-19 disease process.
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Affiliation(s)
- Sarah A. Friedman
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Neurology, New York Presbyterian and Weill Cornell Medicine, New York, NY, USA
| | - Zeinab Charmchi
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael Silver
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Nuri Jacoby
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jonathan Perk
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Yaacov Anziska
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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8
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Predicting Intensive Care Unit Admission for COVID-19 Patients from Laboratory Results. DISEASE MARKERS 2022; 2022:4623901. [PMID: 35634446 PMCID: PMC9133894 DOI: 10.1155/2022/4623901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022]
Abstract
Trends in routine laboratory tests, such as high white blood cell and low platelet counts, correlate with COVID-19-related intensive care unit (ICU) admissions. Other related biomarkers include elevated troponin, alanine aminotransferase, and aspartate transaminase levels (liver function tests). To this end, the aim of this study was to investigate the effect of changes in laboratory test parameters on ward-based and ICU COVID-19 patients. A total of 280 COVID-19 patients were included in the study and were divided based on admission status into ICU (37) or ward (243) patients. ICU admission correlated significantly with higher levels of several tested parameters, including lactate dehydrogenase, creatinine, D-dimer, creatine kinase, white blood cell count, and neutrophil count. In conclusion, routine laboratory tests offer an indication of which COVID-19 patients are most likely to be admitted to the ICU. These associations can assist healthcare providers in addressing the needs of patients who are at risk of COVID-19 complications.
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Peripheral Neuropathies Derived from COVID-19: New Perspectives for Treatment. Biomedicines 2022; 10:biomedicines10051051. [PMID: 35625788 PMCID: PMC9138404 DOI: 10.3390/biomedicines10051051] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 12/15/2022] Open
Abstract
Peripheral neuropathies constitute a group of disorders affecting the peripheral nervous system. Neuropathies have multiple causes such as infections (i.e., COVID-19), diabetes, and nutritional (low vitamin levels), among others. Many micronutrients, such as vitamins (A, C, D, E, B6, B12, and folate), certain minerals (Fe, Mg, Zn, Se, and Cu), and ω-3 fatty acids have immunomodulatory effects. Therefore, they may play an instrumental role in the treatment of COVID-19 infection. However, many COVID-19 patients can undergo neuropathy. In this context, there is a wealth of information on a variety of first-, second-, and third-line treatment options. This review focuses on the application of nutraceutical strategies in order to improve the symptomatology of neuropathy and neuropathic pain in patients that suffered from COVID-19. Our aim is to provide an alternative vision to traditional medical-pharmacological treatment through nutraceuticals.
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10
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Peripheral Neuropathy in Patients Recovering from Severe COVID-19: A Case Series. Medicina (B Aires) 2022; 58:medicina58040523. [PMID: 35454362 PMCID: PMC9032555 DOI: 10.3390/medicina58040523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives: Neurological manifestations have been reported in a significant proportion of coronavirus disease 2019 (COVID-19) patients. We aimed to evaluate the prevalence and severity of peripheral nervous system (PNS) involvement in a large group of convalescent COVID-19 patients undergoing in-hospital multidisciplinary rehabilitation. Materials and Methods: Convalescent COVID-19 patients admitted to a Pulmonary Rehabilitation Unit were consecutively screened for inclusion within 48 h of discharge from an acute care setting. All included patients underwent electrophysiological examinations. Results: Among 102 enrolled patients (mean age 62.0 years, 82.4% males), PNS electrophysiological alterations were detected in 42.2%. Mononeuropathies exclusively involving the peroneal nerve were observed in 8.8% (n = 9), while multiple mononeuropathies were similarly reported in nine patients (8.8%). A symmetric sensorimotor polyneuropathy was documented in 24.5% of participants (n = 25). A significant difference was found for exercise capacity and pulmonary function in post hoc comparisons between the three study groups. Conclusions: The risk of neuropathy in the convalescent phase of COVID-19 is relevant. This should be considered when planning multidisciplinary rehabilitation strategies.
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dos Santos PK, Sigoli E, Bragança LJ, Cornachione AS. The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection. Front Physiol 2022; 13:813924. [PMID: 35492595 PMCID: PMC9040683 DOI: 10.3389/fphys.2022.813924] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.
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Affiliation(s)
- Patty K. dos Santos
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Anabelle S. Cornachione
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
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12
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Kim Y, Kim SE, Kim T, Yun KW, Lee SH, Lee E, Seo JW, Jung YH, Chong YP. Preliminary Guidelines for the Clinical Evaluation and Management of Long COVID. Infect Chemother 2022; 54:566-597. [PMID: 36196612 PMCID: PMC9533168 DOI: 10.3947/ic.2022.0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Long-lasting coronavirus disease 2019 (COVID-19) symptoms beyond 12 weeks, the so-called ‘long COVID’ have been increasingly reported worldwide. Long COVID can be manifested in various forms, and there is an increasing demand for proper assessment and management. However, it is challenging when trying to determine the best-practice standards of care based on the current evidence because there is no internationally agreed clinical definition or clear treatment pathway. Therefore, the present guidelines have been drafted to provide advice on diagnosis and management based on the latest updated available evidence and the consensus of expert opinion. So far, no standard test and drug treatment can be strongly recommended for patients with long COVID because of a lack of evidence. The present guidelines provide advice based on 12 key questions, including appropriate interventions for long COVID that can be used in clinical practice. Continuous careful observation and studies related to long COVID are needed for the long-term impact of COVID-19 and proper management for long COVID to be determined.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Seong Eun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tark Kim
- Divison of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun-Won Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Miranda J, Bringas R, Fernandez-de-Cossio J, Perera-Negrin Y. Targeting CK2 mediated signaling to impair/tackle SARS-CoV-2 infection: a computational biology approach. Mol Med 2021; 27:161. [PMID: 34930105 PMCID: PMC8686809 DOI: 10.1186/s10020-021-00424-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Similarities in the hijacking mechanisms used by SARS-CoV-2 and several types of cancer, suggest the repurposing of cancer drugs to treat Covid-19. CK2 kinase antagonists have been proposed for cancer treatment. A recent study in cells infected with SARS-CoV-2 found a significant CK2 kinase activity, and the use of a CK2 inhibitor showed antiviral responses. CIGB-300, originally designed as an anticancer peptide, is an antagonist of CK2 kinase activity that binds to the CK2 phospho-acceptor sites. Recent preliminary results show the antiviral activity of CIGB-300 using a surrogate model of coronavirus. Here we present a computational biology study that provides evidence, at the molecular level, of how CIGB-300 may interfere with the SARS-CoV-2 life cycle within infected human cells. METHODS Sequence analyses and data from phosphorylation studies were combined to predict infection-induced molecular mechanisms that can be interfered by CIGB-300. Next, we integrated data from multi-omics studies and data focusing on the antagonistic effect on the CK2 kinase activity of CIGB-300. A combination of network and functional enrichment analyses was used. RESULTS Firstly, from the SARS-CoV studies, we inferred the potential incidence of CIGB-300 in SARS-CoV-2 interference on the immune response. Afterwards, from the analysis of multiple omics data, we proposed the action of CIGB-300 from the early stages of viral infections perturbing the virus hijacking of RNA splicing machinery. We also predicted the interference of CIGB-300 in virus-host interactions that are responsible for the high infectivity and the particular immune response to SARS-CoV-2 infection. Furthermore, we provided evidence of how CIGB-300 may participate in the attenuation of phenotypes related to muscle, bleeding, coagulation and respiratory disorders. CONCLUSIONS Our computational analysis proposes putative molecular mechanisms that support the antiviral activity of CIGB-300.
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Affiliation(s)
- Jamilet Miranda
- Division of Informatics, Department of Bioinformatics, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Ricardo Bringas
- Division of Informatics, Department of Bioinformatics, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Jorge Fernandez-de-Cossio
- Division of Informatics, Department of Bioinformatics, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Yasser Perera-Negrin
- Laboratory of Molecular Oncology, Division of Biomedical Research, Department of Pharmaceuticals, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- China-Cuba Biotechnology Joint Innovation Center, Yongzhou Zhong Gu Biotechnology Co., Yongzhou, Hunan People’s Republic of China
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14
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Alikiaii B, Heidari Z, Fazeli A, Rahimi Varposhti M, Moradi Farsani D, Fattahpour S, Rafiee S, Bagherniya M. Evaluation of the effectiveness of the Nutritional Risk Screening System 2002 (NRS-2002) in COVID-19 patients admitted to the intensive care unit. Int J Clin Pract 2021; 75:e14934. [PMID: 34606153 PMCID: PMC8646661 DOI: 10.1111/ijcp.14934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nutritional status of patients with COVID-19 can affect the recovery process of patients; however, no nutritional scale was introduced to evaluate the nutritional status of the patients. Thus, the main objective of this study was to examine the usefulness of Nutritional status-2002 (NRS-2002) among COVID-19 patients admitted to the intensive care unit (ICU). MATERIAL AND METHODS In this cross-sectional study, 73 patients with definitive corona diagnosis admitted to the ICUs of Al-Zahra hospital, Isfahan, Iran in October 2020 to January 2021 were recruited. Dietary intake, NRS-2002, demographic, anthropometric and biochemical indices of patients were recorded. RESULTS The majority of patients were at risk for moderate (69.9%) to severe (12.3%) malnutrition. Daily calorie intake (P = .001) and albumin (P = .001) levels in deceased patients were significantly lower than the recovered group. A direct correlation between NRS-2002 and age (P < .001) and an inverse correlation with daily calorie intake (P = .002), albumin (P = .05) and PaO2 (P = .034) was found. Moreover, there is a strong correlation between NRS-2002 score and chance of death among COVID-19 patients (OR=34.5, 95%CI:(5.2 - 228.93), P-value<0.001). Likewise, the levels of bilirubin direct (OR=8, 95%CI:(1.30 - 49.38), P-value=0.025) and creatine-phosphokinase (OR=0.9, 95%CI:(0.99 - 1.00), P-value=0.035) have a significant direct association with chance of death. CONCLUSION Results showed patients with COVID-19 admitted to the ICU did not have appropriate nutritional status and mortality was higher among patients with lower amounts of the serum albumin and daily calorie intakes. Furthermore, there is a strong association between the NRS-2002 index and the chance of mortality in these patients.
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Affiliation(s)
- Babak Alikiaii
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Zahra Heidari
- Department of Biostatistics and EpidemiologySchool of HealthIsfahan University of Medical SciencesIsfahanIran
- Isfahan Cardiac Rehabilitation Research CenterCardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
| | - Afshar Fazeli
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
| | | | - Darioush Moradi Farsani
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Shirin Fattahpour
- Craniofacial and Cleft Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Sahar Rafiee
- Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of Community NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Mohammad Bagherniya
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
- Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of Community NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
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15
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Long COVID from rheumatology perspective - a narrative review. Clin Rheumatol 2021; 41:337-348. [PMID: 34845562 PMCID: PMC8629735 DOI: 10.1007/s10067-021-06001-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 02/08/2023]
Abstract
Long-term sequel of acute COVID-19, commonly referred to as long COVID, has affected millions of patients worldwide. Long COVID patients display persistent or relapsing and remitting symptoms that include fatigue, breathlessness, cough, myalgia, arthralgia, sleep disturbance, cognitive impairment and skin rashes. Due to the shared clinical features, laboratory and imaging findings, long COVID could mimic rheumatic disease posing a diagnostic challenge. Our comprehensive literature review will help rheumatologist to be aware of long COVID manifestations and differentiating features from rheumatic diseases to ensure a timely and correct diagnosis is reached.
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16
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Farouji A, Hellou R, Peretz A. Asymptomatic Rhabdomyolysis in a Young Adult With COVID-19. Cureus 2021; 13:e18039. [PMID: 34692275 PMCID: PMC8523336 DOI: 10.7759/cureus.18039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/05/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is an ongoing pandemic. Although COVID-19 is frequently associated with respiratory symptoms and complications, multiple extrapulmonary manifestations have been identified since the beginning of the pandemic. Rhabdomyolysis has been described in the literature as one of the extrapulmonary manifestations of COVID-19. Herein, we describe a 21-year-old male patient who presented with cough and fever secondary to COVID-19 confirmed by positive reverse-transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient presented with an extremely elevated creatinine kinase (CK) of 53,886 U/L (normal 10-170) without any classical symptoms of rhabdomyolysis or deterioration in his kidney function. He was successfully managed with aggressive intravenous fluids. The aim of reporting this case is to highlight the importance of including total CK in the initial evaluation of COVID-19 patients.
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Affiliation(s)
- Abdelhadi Farouji
- Internal Medicine, Assuta Ashdod Medical Center, Ben-Gurion University of the Negev, Ashdod, ISR
| | - Rabea Hellou
- Internal Medicine, Assuta Ashdod Medical Center, Ben-Gurion University of the Negev, Ashdod, ISR
| | - Asaf Peretz
- Internal Medicine, Assuta Ashdod Medical Center, Ben-Gurion University of the Negev, Ashdod, ISR
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17
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Geng Y, Ma Q, Du YS, Peng N, Yang T, Zhang SY, Wu FF, Lin HL, Su L. Rhabdomyolysis is Associated with In-Hospital Mortality in Patients with COVID-19. Shock 2021; 56:360-367. [PMID: 33443364 PMCID: PMC8354485 DOI: 10.1097/shk.0000000000001725] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19). METHOD This was a single-center, retrospective, cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan Hospital in Wuhan, China, between February 17 and April 12, 2020. RESULTS The overall incidence of RM was 2.2%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM also constituted a greater percentage of patients admitted to the intensive care unit (90.9% vs. 5.3%, P < 0.001) and a greater percentage of patients undergoing mechanical ventilation (86.4% vs. 2.7% P < 0.001). Moreover, patients with RM had laboratory test abnormalities, including the presence of markers of inflammation, activation of coagulation, and kidney injury. Patients with RM also had a higher risk of in-hospital death (P < 0.001). Cox's proportional hazard regression model analysis confirmed that RM indicators, including peak creatine kinase levels > 1,000 IU/L (HR = 6.46, 95% CI: 3.02-13.86) and peak serum myoglobin concentrations > 1,000 ng/mL (HR = 9.85, 95% CI: 5.04-19.28), were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have delayed viral clearance. CONCLUSION RM might be an important contributing factor to adverse outcomes in COVID-19 patients. The early detection and effective intervention of RM may help reduce mortality among COVID-19 patients.
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Affiliation(s)
- Yan Geng
- Department of Gastroenterology, 923rd Hospital of PLA Joint Logistics Support Force, Nanning, China
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - Qiang Ma
- Department of Biopharmacy, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Yong-sheng Du
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - Na Peng
- Department of Intensive Care Unit, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Department of Intensive Care Unit, Huoshenshan Hospital, Wuhan, China
| | - Ting Yang
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - Shi-yu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feng-fu Wu
- 923rd Hospital of PLA Joint Logistics Support Force, Nanning, China
| | - Hua-liang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lei Su
- Department of Gastroenterology, 920th Hospital of PLA Joint Logistics Support Force, Kunming, China
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18
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Chetram VK, Ahmad AI, Farid S, Sood T. Acute Kidney Injury Secondary to Rhabdomyolysis and COVID-19: A Case Report and Literature Review. Case Rep Nephrol 2021; 2021:5528461. [PMID: 34367704 PMCID: PMC8337150 DOI: 10.1155/2021/5528461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
The viral infection causing COVID-19 most notably affects the respiratory system but can result in extrapulmonary clinical manifestations as well. Rhabdomyolysis-associated acute kidney injury (AKI) in the setting of COVID-19 is an uncommon complication of the infection. There is significant interest in this viral infection given its global spread, ease of transmission, and varied clinical manifestations and outcomes. This case report and literature review describes the symptoms, laboratory findings, and clinical course of a patient who developed AKI secondary to rhabdomyolysis and COVID-19, which will help clinicians recognize and treat this condition.
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Affiliation(s)
- Vishaka K. Chetram
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - Akram I. Ahmad
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - Saira Farid
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - Tanuj Sood
- Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA
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19
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Motavalli R, Abdelbasset WK, Rahman HS, Achmad MH, Sergeevna NK, Zekiy AO, Adili A, Khiavi FM, Marofi F, Yousefi M, Ghoreishizadeh S, Shomali N, Etemadi J, Jarahian M. The lethal internal face of the coronaviruses: Kidney tropism of the SARS, MERS, and COVID19 viruses. IUBMB Life 2021; 73:1005-1015. [PMID: 34118117 PMCID: PMC8426673 DOI: 10.1002/iub.2516] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 01/08/2023]
Abstract
The kidney is one of the main targets attacked by viruses in patients with a coronavirus infection. Until now, SARS-CoV-2 has been identified as the seventh member of the coronavirus family capable of infecting humans. In the past two decades, humankind has experienced outbreaks triggered by two other extremely infective members of the coronavirus family; the MERS-CoV and the SARS-CoV. According to several investigations, SARS-CoV causes proteinuria and renal impairment or failure. The SARS-CoV was identified in the distal convoluted tubules of the kidney of infected patients. Also, renal dysfunction was observed in numerous cases of MERS-CoV infection. And recently, during the 2019-nCoV pandemic, it was found that the novel coronavirus not only induces acute respiratory distress syndrome (ARDS) but also can induce damages in various organs including the liver, heart, and kidney. The kidney tissue and its cells are targeted massively by the coronaviruses due to the abundant presence of ACE2 and Dpp4 receptors on kidney cells. These receptors are characterized as the main route of coronavirus entry to the victim cells. Renal failure due to massive viral invasion can lead to undesirable complications and enhanced mortality rate, thus more attention should be paid to the pathology of coronaviruses in the kidney. Here, we have provided the most recent knowledge on the coronaviruses (SARS, MERS, and COVID19) pathology and the mechanisms of their impact on the kidney tissue and functions.
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Affiliation(s)
- Roza Motavalli
- Stem Cell Research Center, Tabriz University of Medical SciencesTabrizIran
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation SciencesCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityAl KharjSaudi Arabia
- Department of Physical TherapyKasr Al‐Aini Hospital, Cairo UniversityGizaEgypt
| | | | - Muhammad Harun Achmad
- Department of Pediatric DentistryFaculty of Dentistry, Hasanuddin UniversityMakassarIndonesia
| | | | | | - Ali Adili
- Department of oncologyTabriz University of Medical SciencesTabrizIran
| | | | - Faroogh Marofi
- Department of Immunology, Division of Hematology, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
- Immunology Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mehdi Yousefi
- Department of Immunology, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | | | - Navid Shomali
- Immunology Research CenterTabriz University of Medical SciencesTabrizIran
- Department of Immunology, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Jalal Etemadi
- Kidney Research Center, Tabriz University of Medical SciencesTabrizIran
| | - Mostafa Jarahian
- Toxicology and Chemotherapy Unit (G401), German Cancer Research Center (DKFZ)HeidelbergGermany
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20
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Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, Gabrilove JL, Sacks H. Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis. BMJ Evid Based Med 2021; 26:107-108. [PMID: 32934000 PMCID: PMC7493072 DOI: 10.1136/bmjebm-2020-111536] [Citation(s) in RCA: 329] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate association between biomarkers and outcomes in COVID-19 hospitalised patients. COVID-19 pandemic has been a challenge. Biomarkers have always played an important role in clinical decision making in various infectious diseases. It is crucial to assess the role of biomarkers in evaluating severity of disease and appropriate allocation of resources. DESIGN AND SETTING Systematic review and meta-analysis. English full text observational studies describing the laboratory findings and outcomes of COVID-19 hospitalised patients were identified searching PubMed, Web of Science, Scopus, medRxiv using Medical Subject Headings (MeSH) terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from 1 December 2019 to 15 August 2020 following Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. PARTICIPANTS Studies having biomarkers, including lymphocyte, platelets, D-dimer, lactate dehydrogenase (LDH), C reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin (PCT) and creatine kinase (CK), and describing outcomes were selected with the consensus of three independent reviewers. MAIN OUTCOME MEASURES Composite poor outcomes include intensive care unit admission, oxygen saturation <90%, invasive mechanical ventilation utilisation, severe disease, in-hospital admission and mortality. The OR and 95% CI were obtained and forest plots were created using random-effects models. Publication bias and heterogeneity were assessed by sensitivity analysis. RESULTS 32 studies with 10 491 confirmed COVID-19 patients were included. We found that lymphopenia (pooled-OR: 3.33 (95% CI: 2.51-4.41); p<0.00001), thrombocytopenia (2.36 (1.64-3.40); p<0.00001), elevated D-dimer (3.39 (2.66-4.33); p<0.00001), elevated CRP (4.37 (3.37-5.68); p<0.00001), elevated PCT (6.33 (4.24-9.45); p<0.00001), elevated CK (2.42 (1.35-4.32); p=0.003), elevated AST (2.75 (2.30-3.29); p<0.00001), elevated ALT (1.71 (1.32-2.20); p<0.00001), elevated creatinine (2.84 (1.80-4.46); p<0.00001) and LDH (5.48 (3.89-7.71); p<0.00001) were independently associated with higher risk of poor outcomes. CONCLUSION Our study found a significant association between lymphopenia, thrombocytopenia and elevated levels of CRP, PCT, LDH, D-dimer and COVID-19 severity. The results have the potential to be used as an early biomarker to improve the management of COVID-19 patients, by identification of high-risk patients and appropriate allocation of healthcare resources in the pandemic.
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Affiliation(s)
- Preeti Malik
- Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Urvish Patel
- Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deep Mehta
- Clinical Research Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nidhi Patel
- MS3, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Raveena Kelkar
- Clinical Research Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Janice L Gabrilove
- Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Henry Sacks
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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21
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Bach M, Lim PP, Azok J, Ruda Wessell K, Desai AP, Dirajlal-Fargo S. Anaphylaxis and Rhabdomyolysis: A Presentation of a Pediatric Patient With COVID-19. Clin Pediatr (Phila) 2021; 60:202-204. [PMID: 33666107 DOI: 10.1177/0009922821999470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mimi Bach
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Peter Paul Lim
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Jill Azok
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | - Ankita P Desai
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Sahera Dirajlal-Fargo
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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22
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Veyseh M, Koyoda S, Ayesha B. COVID-19 IgG-related autoimmune inflammatory necrotizing myositis. BMJ Case Rep 2021; 14:14/4/e239457. [PMID: 33849864 PMCID: PMC8051403 DOI: 10.1136/bcr-2020-239457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic caused by the SARS-CoV-2 virus has affected millions of people around the globe. The most common presentation of COVID-19 is fever and upper and lower respiratory tract infection. Myalgia is fairly common in the prodromal phase of the viral illness which self-resolves. There is very scant literature on autoimmune myositis triggered by COVID-19 infection. We report a case of SARS-CoV-2 infection, who presented with progressive muscle weakness with rhabdomyolysis and necrotizing autoimmune myopathy on muscle biopsy. This case report imposes awareness of musculoskeletal autoimmune processes triggered by COVID-19 which requires clinical suspicion for early diagnosis and initiation of treatment.
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Affiliation(s)
- Maedeh Veyseh
- Medicine, Jacobi Medical Center, Bronx, New York, USA .,Rheumatology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Sai Koyoda
- Rheumatology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Bibi Ayesha
- Rheumatology, Montefiore Hospital and Medical Center, Bronx, New York, USA
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Rhabdomyolysis in Severe COVID-19: Male Sex, High Body Mass Index, and Prone Positioning Confer High Risk. J Surg Res 2021; 266:35-43. [PMID: 33975028 PMCID: PMC8023200 DOI: 10.1016/j.jss.2021.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. MATERIALS AND METHODS Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. RESULTS Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (P < 0.001), prone positioning (P < 0.001), pharmacological paralysis (P < 0.001), renal replacement therapy (P = 0.010), and extracorporeal membrane oxygenation (ECMO) (P = 0.025). They also had longer median ICU length of stay (LOS) (P < 0.001) and hospital LOS (P < 0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. CONCLUSIONS Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis.
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Mughal MS, Kaur IP, Alhashemi R, Rehman R, Du D. Acute viral myositis complicated by rhabdomyolysis: a sole manifestation of COVID-19 infection. J Community Hosp Intern Med Perspect 2021; 11:289-291. [PMID: 33889341 PMCID: PMC8043516 DOI: 10.1080/20009666.2021.1878601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Mohsin Sheraz Mughal
- Monmouth Medical Center, RWJ/Barnabas Health System, Long Branch, New Jersey, U.S
| | - Ikwinder Preet Kaur
- Monmouth Medical Center, RWJ/Barnabas Health System, Long Branch, New Jersey, U.S
| | - Reem Alhashemi
- Monmouth Medical Center, RWJ/Barnabas Health System, Long Branch, New Jersey, U.S
| | - Rameez Rehman
- Monmouth Medical Center, RWJ/Barnabas Health System, Long Branch, New Jersey, U.S
| | - Doantrang Du
- Monmouth Medical Center, RWJ/Barnabas Health System, Long Branch, New Jersey, U.S
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Fukushima EFA, Nasser A, Bhargava A, Moudgil S. Post-infectious focal encephalitis due to COVID-19. Germs 2021; 11:111-115. [PMID: 33898348 DOI: 10.18683/germs.2021.1247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/08/2022]
Abstract
Introduction Several publications described neurological manifestations caused by SARS-CoV-2. Immune-mediated neurological damages caused by COVID-19 are increasingly recognized. Case report A young male presented in March 2020 with a new-onset seizure. Later, he started to experience a severe headache. During the second admission in May, the MRI of the brain showed left frontal lesion. Nasal PCR for SARS-CoV-2 was negative, but the serology was positive, raising the suspicion of immune-mediated encephalitis. Elevated cerebrospinal fluid immunoglobulin G with two oligoclonal bands were also seen. The patient received IV immunoglobulin and showed improvement in headache. Follow-up MRIs of the brain revealed complete resolution of the lesion. Discussion Neurological complications from COVID-19 have been increasingly recognized. The proposed pathophysiology is either direct damage of neurological tissues, or indirectly through immune-mediated mechanisms. The timeline of the patient's presentation with seizure, as well as the lesion on the brain MRI with complete resolution after the IV immunoglobulin, strongly suggest that the patient had immune-mediated encephalitis after exposure to SARS-CoV-2. Conclusions Several cases of encephalitis caused by SARS-CoV-2 have been reported. Immune-mediated encephalitis as probable pathophysiology is described here.
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Affiliation(s)
- Elisa Fumi Akagi Fukushima
- MD, Department of Internal Medicine, Division of Infectious Disease, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI 48236, USA
| | - Abdulla Nasser
- MD, Department of Internal Medicine, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI 48236, USA
| | - Ashish Bhargava
- MD, Department of Internal Medicine, Division of Infectious Disease, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI 48236, USA
| | - Shyam Moudgil
- MD, Department of Internal Medicine, Division of Neurology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI 48236, USA
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26
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Akbar MR, Pranata R, Wibowo A, Lim MA, Sihite TA, Martha JW. The prognostic value of elevated creatine kinase to predict poor outcome in patients with COVID-19 - A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:529-534. [PMID: 33668003 PMCID: PMC7877870 DOI: 10.1016/j.dsx.2021.02.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Creatine kinase (CK), a marker of muscle damage, is potentially associated with a more severe COVID-19. In this systematic review and meta-analysis, we aim to evaluate the association between the elevated CK and severity and mortality in COVID-19. METHODS We performed a systematic literature search on PubMed, Scopus, and Embase up until January 26, 2020. The main outcome was poor outcome, a composite of mortality and severe COVID-19. RESULTS There are 2471 patients from 14 studies included in this systematic review and meta-analysis. The incidence of elevated CK in this pooled analysis was 17% (11%, 22%) and the incidence of poor outcome in this pooled analysis was 27% (19%, 34%). Elevated CK was associated with poor outcome in patients with COVID-19 (OR 3.01 [2.21, 4.10], p < 0.001; I2: 10.2%). The effect estimate did not vary with age (p = 0.610), male (p = 0.449), hypertension (p = 0.490), and diabetes (p = 0.457). Elevated CK has a sensitivity of 0.24 (0.17, 0.32), specificity of 0.91 (0.86, 0.94), PLR of 2.6 (1.9, 3.7), NLR of 0.84 (0.78, 0.90), DOR of 3 (2, 5), and AUC of 0.62 (0.57, 0.66) for predicting poor outcome in patients with COVID-19. In this pooled analysis, elevated CK confers to a 49% probability for poor outcome and a non-elevated CK confers to a 24% probability. Subgroup analysis and univariate meta-regression indicates that the sensitivity and specificity does not vary with age, male, hypertension, and diabetes. CONCLUSION Elevated CK was associated with increased mortality and severity in patients with COVID-19. PROSPERO CRD42021233435.
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Affiliation(s)
- Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | | | - Teddy Arnold Sihite
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
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Alabbas A, Kirpalani A, Morgan C, Mammen C, Licht C, Phan V, Wade A, Harvey E, Zappitelli M, Clark EG, Hiremath S, Soroka SD, Wald R, Weir MA, Chanchlani R, Lemaire M. Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Guidelines for Management of Acute Kidney Injury in Children. Can J Kidney Health Dis 2021; 8:2054358121990135. [PMID: 33614056 PMCID: PMC7868478 DOI: 10.1177/2054358121990135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This article provides guidance on managing acute kidney injury (AKI) and kidney replacement therapy (KRT) in pediatrics during the COVID-19 pandemic in the Canadian context. It is adapted from recently published rapid guidelines on the management of AKI and KRT in adults, from the Canadian Society of Nephrology (CSN). The goal is to provide the best possible care for pediatric patients with kidney disease during the pandemic and ensure the health care team's safety. INFORMATION SOURCES The Canadian Association of Paediatric Nephrologists (CAPN) COVID-19 Rapid Response team derived these rapid guidelines from the CSN consensus recommendations for adult patients with AKI. We have also consulted specific documents from other national and international agencies focused on pediatric kidney health. We identified additional information by reviewing the published academic literature relevant to pediatric AKI and KRT, including recent journal articles and preprints related to COVID-19 in children. Finally, our group also sought expert opinions from pediatric nephrologists across Canada. METHODS The leadership of the CAPN, which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric AKI and acute KRT. The goal was to adapt the guidelines recently adopted for Canadian adult patients for pediatric-specific settings. These included specific COVID-19-related themes relevant to AKI and KRT in a Canadian setting, as determined by a group of kidney disease experts and leaders. An expert group of clinicians in pediatric AKI and acute KRT reviewed the revised pediatric guidelines. KEY FINDINGS (1) Current Canadian data do not suggest an imminent threat of an increase in acute KRT needs in children because of COVID-19; however, close coordination between nephrology programs and critical care programs is crucial as the pandemic continues to evolve. (2) Pediatric centers should prepare to reallocate resources to adult centers as needed based on broader health care needs during the COVID-19 pandemic. (3) Specific suggestions pertinent to the optimal management of AKI and KRT in COVID-19 patients are provided. These suggestions include but are not limited to aspects of fluid management, KRT vascular access, and KRT modality choice. (4) Considerations to ensure adequate provision of KRT if resources become scarce during the COVID-19 pandemic. LIMITATIONS We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. The local context, including how the provision of care for AKI and acute KRT is organized, may impede the implementation of many suggestions. As knowledge is advancing rapidly in the area of COVID-19, suggestions may become outdated quickly. Finally, most of the literature for AKI and KRT in COVID-19 comes from adult data, and there are few pediatric-specific studies. IMPLICATIONS Given that most acute KRT related to COVID-19 is likely to be required in the pediatric intensive care unit initial setting, close collaboration and planning between critical care and pediatric nephrology programs are needed. Our group will update these suggestions with a supplement if necessary as newer evidence becomes available that may change or add to the recommendations provided.
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Affiliation(s)
- Abdullah Alabbas
- Department of Paediatrics, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Amrit Kirpalani
- Department of Paediatrics, Division of Nephrology, Western University, London, ON, Canada
| | - Catherine Morgan
- Department of Paediatrics, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Cherry Mammen
- Department of Paediatrics, Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Christoph Licht
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Veronique Phan
- Department of Paediatrics, Division of Nephrology, Université de Montréal, Québec, Canada
| | - Andrew Wade
- Department of Paediatrics, Division of Nephrology, University of Calgary, AB, Canada
| | - Elizabeth Harvey
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Michael Zappitelli
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Steven D. Soroka
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital and Department of Medicine, University of Toronto, ON, Canada
| | - Matthew A. Weir
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
| | - Mathieu Lemaire
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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28
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Xu W, Sun NN, Gao HN, Chen ZY, Yang Y, Ju B, Tang LL. Risk factors analysis of COVID-19 patients with ARDS and prediction based on machine learning. Sci Rep 2021; 11:2933. [PMID: 33536460 PMCID: PMC7858607 DOI: 10.1038/s41598-021-82492-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a newly emerging infectious disease, which is generally susceptible to human beings and has caused huge losses to people's health. Acute respiratory distress syndrome (ARDS) is one of the common clinical manifestations of severe COVID-19 and it is also responsible for the current shortage of ventilators worldwide. This study aims to analyze the clinical characteristics of COVID-19 ARDS patients and establish a diagnostic system based on artificial intelligence (AI) method to predict the probability of ARDS in COVID-19 patients. We collected clinical data of 659 COVID-19 patients from 11 regions in China. The clinical characteristics of the ARDS group and no-ARDS group of COVID-19 patients were elaborately compared and both traditional machine learning algorithms and deep learning-based method were used to build the prediction models. Results indicated that the median age of ARDS patients was 56.5 years old, which was significantly older than those with non-ARDS by 7.5 years. Male and patients with BMI > 25 were more likely to develop ARDS. The clinical features of ARDS patients included cough (80.3%), polypnea (59.2%), lung consolidation (53.9%), secondary bacterial infection (30.3%), and comorbidities such as hypertension (48.7%). Abnormal biochemical indicators such as lymphocyte count, CK, NLR, AST, LDH, and CRP were all strongly related to the aggravation of ARDS. Furthermore, through various AI methods for modeling and prediction effect evaluation based on the above risk factors, decision tree achieved the best AUC, accuracy, sensitivity and specificity in identifying the mild patients who were easy to develop ARDS, which undoubtedly helped to deliver proper care and optimize use of limited resources.
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Affiliation(s)
- Wan Xu
- Hangzhou Xiaoshan District Center for Disease Control and Prevention, Hangzhou, China
| | - Nan-Nan Sun
- Hangzhou Wowjoy Information Technology Co., Ltd, Hangzhou, China
| | - Hai-Nv Gao
- Department of Infectious Diseases, ShuLan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Zhi-Yuan Chen
- Hangzhou Wowjoy Information Technology Co., Ltd, Hangzhou, China
| | - Ya Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Bin Ju
- Hangzhou Wowjoy Information Technology Co., Ltd, Hangzhou, China.
| | - Ling-Ling Tang
- Department of Infectious Diseases, ShuLan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China.
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29
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Mehta OP, Bhandari P, Raut A, Kacimi SEO, Huy NT. Coronavirus Disease (COVID-19): Comprehensive Review of Clinical Presentation. Front Public Health 2021; 8:582932. [PMID: 33520910 PMCID: PMC7844320 DOI: 10.3389/fpubh.2020.582932] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a rapidly growing pandemic with its first case identified during December 2019 in Wuhan, Hubei Province, China. Due to the rampant rise in the number of cases in China and globally, WHO declared COVID-19 as a pandemic on 11th March 2020. The disease is transmitted via respiratory droplets of infected patients during coughing or sneezing and affects primarily the lung parenchyma. The spectrum of clinical manifestations can be seen in COVID-19 patients ranging from asymptomatic infections to severe disease resulting in mortality. Although respiratory involvement is most common in COVID-19 patients, the virus can affect other organ systems as well. The systemic inflammation induced by the disease along with multisystem expression of Angiotensin Converting Enzyme 2 (ACE2), a receptor which allows viral entry into cells, explains the manifestation of extra-pulmonary symptoms affecting the gastrointestinal, cardiovascular, hematological, renal, musculoskeletal, and endocrine system. Here, we have reviewed the extensive literature available on COVID-19 about various clinical presentations based on the organ system involved as well as clinical presentation in specific population including children, pregnant women, and immunocompromised patients. We have also briefly discussed about the Multisystemic Inflammatory Syndrome occurring in children and adults with COVID-19. Understanding the various clinical presentations can help clinicians diagnose COVID-19 in an early stage and ensure appropriate measures to be undertaken in order to prevent further spread of the disease.
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Affiliation(s)
- Om Prakash Mehta
- Department of Medicine, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
| | - Parshal Bhandari
- Department of Anesthesia and Intensive Care, Post-Graduate Medical Institute/LGH, Lahore, Pakistan
| | - Akshay Raut
- Rajarshee Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, India
| | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
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30
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Garg M, Sharma AL, Singh S. Advancement in biosensors for inflammatory biomarkers of SARS-CoV-2 during 2019-2020. Biosens Bioelectron 2021; 171:112703. [PMID: 33049563 PMCID: PMC7544635 DOI: 10.1016/j.bios.2020.112703] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 pandemic has affected everyone throughout the world and has resulted in the loss of lives of many souls. Due to the restless efforts of the researchers working hard day and night, some success has been gained for the detection of virus. As on date, the traditional polymerized chain reactions (PCR), lateral flow devices (LFID) and enzyme linked immunosorbent assays (ELISA) are being adapted for the detection of this deadly virus. However, a more exciting avenue is the detection of certain biomarkers associated with this viral infection which can be done by simply re-purposing our existing infrastructure. SARS-CoV-2 viral infection triggers various inflammatory, biochemical and hematological biomarkers. Because of the infection route that the virus follows, it causes significant inflammatory response. As a result, various inflammatory markers have been reported to be closely associated with this infection such as C-reactive proteins, interleukin-6, procalcitonin and ferritin. Sensing of these biomarkers can simultaneously help in understanding the illness level of the affected patient. Also, by monitoring these biomarkers, we can predict the viral infections in those patients who have low SARS-CoV-2 RNA and hence are missed by traditional tests. This can give more targets to the researchers and scientists, working in the area of drug development and provide better prognosis. In this review, we propose to highlight the conventional as well as the non-conventional methods for the detection of these inflammatory biomarkers which can act as a single platform of knowledge for the researchers and scientists working for the treatment of COVID-19.
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Affiliation(s)
- Mayank Garg
- CSIR- Central Scientific Instruments Organisation, Sector 30-C, Chandigarh, 160030, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Amit L Sharma
- CSIR- Central Scientific Instruments Organisation, Sector 30-C, Chandigarh, 160030, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| | - Suman Singh
- CSIR- Central Scientific Instruments Organisation, Sector 30-C, Chandigarh, 160030, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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31
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Mageriu V, Zurac S, Bastian A, Staniceanu F, Manole E. Histological findings in skeletal muscle of SARS-CoV2 infected patient. J Immunoassay Immunochem 2020; 41:1000-1009. [PMID: 33353460 DOI: 10.1080/15321819.2020.1863819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Autopsies represent medical procedures through which the causes of patients' deaths are determined or, through tissue sampling and microscopic examination of slides in usual stains or special tests, one can offer the basis for understanding the physiopathological mechanisms that contribute to the patients' death Histological findings of tissue samples from patients who have died of COVID-19 have been mainly orientated to lung, heart, liver, kidney damage with a small percent of them following other organs, but none has, to our knowledge, studied skeletal muscle.
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Affiliation(s)
- Vlad Mageriu
- Pathology, University Emergency Hospital Elias , Bucharest, Romania
| | - Sabina Zurac
- Pathology, Colentina University Hospital , Bucharest, Romania
| | - Alexandra Bastian
- Pathology, Colentina University Hospital , Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy , Bucharest, Romania
| | - Florica Staniceanu
- "Carol Davila" University of Medicine and Pharmacy , Bucharest, Romania.,Pathology, Colentina Clinical Hospital , Bucharest, Romania
| | - Emilia Manole
- Molecular Biology, "Victor Babes" National Institute of Pathology , Bucharest, Romania
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32
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Sagarra-Romero L, Viñas-Barros A. COVID-19: Short and Long-Term Effects of Hospitalization on Muscular Weakness in the Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238715. [PMID: 33255233 PMCID: PMC7727674 DOI: 10.3390/ijerph17238715] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has recently been the cause of a global public health emergency. Frequently, elderly patients experience a marked loss of muscle mass and strength during hospitalization, resulting in a significant functional decline. This paper describes the impact of prolonged immobilization and current pharmacological treatments on muscular metabolism. In addition, the scientific evidence for an early strength intervention, neuromuscular electrical stimulation or the application of heat therapy during hospitalization to help prevent COVID-19 functional sequels is analyzed. This review remarks the need to: (1) determine which potential pharmacological interventions have a negative impact on muscle quality and quantity; (2) define a feasible and reliable pharmacological protocol to achieve a balance between desired and undesired medication effects in the treatment of this novel disease; (3) implement practical strategies to reduce muscle weakness during bed rest hospitalization and (4) develop a specific, early and safe protocol-based care of functional interventions for older adults affected by COVID-19 during and after hospitalization.
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Affiliation(s)
- Lucía Sagarra-Romero
- Faculty of Health Sciences, Universidad San Jorge, 50830 Zaragoza, Spain
- Correspondence:
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Flynn N. CK - What does it stand for? Am J Emerg Med 2020; 45:647. [PMID: 33214021 PMCID: PMC7656996 DOI: 10.1016/j.ajem.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nick Flynn
- Department of Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom.
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35
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Keyhanian K, Umeton RP, Mohit B, Davoudi V, Hajighasemi F, Ghasemi M. SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation. J Neuroimmunol 2020; 350:577436. [PMID: 33212316 PMCID: PMC7647896 DOI: 10.1016/j.jneuroim.2020.577436] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide.
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Affiliation(s)
- Kiandokht Keyhanian
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Raffaella Pizzolato Umeton
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Babak Mohit
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Vahid Davoudi
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Fatemeh Hajighasemi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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36
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Severe Rhabdomyolysis Due to SARS CoV-2 Infection in a Young Adult. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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37
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Anklesaria Z, Frankman J, Gordin J, Zhan J, Liu AK. Fatal Rhabdomyolysis in a COVID-19 Patient on Rosuvastatin. Cureus 2020; 12:e11186. [PMID: 33133803 PMCID: PMC7593204 DOI: 10.7759/cureus.11186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is well-established by now that COVID-19 can have a wide variety of neuromuscular manifestations, including rhabdomyolysis. Weakness and elevated creatinine kinase (CK) have been documented as the initial presentation of COVID-19. Myopathy from statin use has also been well-established since the introduction of this class of medication, and the common pathologic mechanism of both entities may have been mitochondrial dysfunction. We present here the case of a COVID-19 patient on rosuvastatin who developed rhabdomyolysis with CK above 1,000,000 units/L. The patient did not present with any respiratory difficulty and responded poorly to treatment, resulting in his untimely demise. COVID-19 may have accentuated an otherwise survivable condition by means of extra stress on mitochondrial homeostasis. Understanding the actual mechanism will be important in the development and utilization of medications in the fight against COVID-19.
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Affiliation(s)
- Zafia Anklesaria
- Pulmonary and Critical Care, California Hospital Medical Center, Los Angeles, USA
| | - Jonathan Frankman
- Family Medicine, California Hospital Medical Center, Los Angeles, USA
| | - Jonathan Gordin
- Cardiology, California Hospital Medical Center, Los Angeles, USA
| | - Jennifer Zhan
- Emergency Medicine, California Hospital Medical Center, Los Angeles, USA
| | - Antonio K Liu
- Neurology, Adventist Health White Memorial, Los Angeles, USA
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Prakash S. A diagnostic confusion between Serotonin syndrome and Neuroleptic malignant syndrome. Am J Emerg Med 2020; 43:272-273. [PMID: 33008703 PMCID: PMC7320697 DOI: 10.1016/j.ajem.2020.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat 391760, India.
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Fulminant hepatic failure: A rare and devastating manifestation of Coronavirus disease 2019 in an 11-year-old boy. Arch Pediatr 2020; 27:502-505. [PMID: 33069564 PMCID: PMC7522641 DOI: 10.1016/j.arcped.2020.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/13/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Abstract
Although several typical manifestation of novel coronavirus disease 2019 (COVID-19) including respiratory symptoms, weakness, fever, and fatigue have been reported, some rare and novel manifestations have also been observed, particularly in children. We report a pediatric case of fulminant hepatic failure associated with COVID-19. Although the patient was treated for acute fulminant hepatic failure in the context of COVID-19, he died following the progression of the disease to stage 4 hepatic failure with encephalopathy and brain death.
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Solís JG, Esquivel Pineda A, Alberti Minutti P, Albarrán Sánchez A. Case Report: Rhabdomyolysis in a Patient with COVID-19: A Proposed Diagnostic-Therapeutic Algorithm. Am J Trop Med Hyg 2020; 103:1158-1161. [PMID: 32729460 PMCID: PMC7470529 DOI: 10.4269/ajtmh.20-0692] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
COVID-19 represents the greatest health challenge of modern years. The spectrum of illness comprises respiratory and non-respiratory manifestations. We report the case of an adult man with COVID-19 who presented with rhabdomyolysis as a principal extrapulmonary manifestation. Our patient presented with dyspnea, fever, and muscle pain. After a comprehensive approach, the diagnosis of COVID-19 and rhabdomyolysis was made. He developed acute kidney injury requiring renal replacement therapy without reversibility, despite optimal treatment. We performed a literature search for similar cases, discuss the potential mechanisms implied, and propose a diagnostic-therapeutic algorithm.
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Affiliation(s)
- José Gabriel Solís
- Internal Medicine Department, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Alejandra Esquivel Pineda
- Internal Medicine Department, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Paolo Alberti Minutti
- Internal Medicine Department, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Alejandra Albarrán Sánchez
- Internal Medicine Department, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
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Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci 2020; 41:3039-3056. [PMID: 32935156 PMCID: PMC7491599 DOI: 10.1007/s10072-020-04708-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.
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Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | | | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
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Shanbhag A, Manaktala PS, Rizvi H, Frey K, Narayanan R. COVID-19 Presenting as Severe Rhabdomyolysis With Normal Renal Function. Cureus 2020; 12:e9556. [PMID: 32905464 PMCID: PMC7470654 DOI: 10.7759/cureus.9556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues to increase morbidity and mortality. Early recognition of symptoms, along with prompt intervention, is required to improve patient outcomes. COVID-19 can have a multifaceted presentation, which can be a diagnostic challenge. Here, we report the first case of COVID-19 presenting as severe rhabdomyolysis with creatine kinase > 500,000 U/L with normal renal function in a young adult.
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Affiliation(s)
- Akshay Shanbhag
- Internal Medicine/Geriatrics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Hira Rizvi
- Internal Medicine, Canton Medical Education Foundation, Canton, USA
| | - Kevin Frey
- Internal Medicine, Canton Medical Education Foundation, Canton, USA
| | - Rama Narayanan
- Internal Medicine, Canton Medical Education Foundation, Canton, USA
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Fakhouri EW, Peterson SJ, Kothari J, Alex R, Shapiro JI, Abraham NG. Genetic Polymorphisms Complicate COVID-19 Therapy: Pivotal Role of HO-1 in Cytokine Storm. Antioxidants (Basel) 2020; 9:E636. [PMID: 32708430 PMCID: PMC7402116 DOI: 10.3390/antiox9070636] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Coronaviruses are very large RNA viruses that originate in animal reservoirs and include severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS) and other inconsequential coronaviruses from human reservoirs like the common cold. SARS-CoV-2, the virus that causes COVID-19 and is believed to originate from bat, quickly spread into a global pandemic. This RNA virus has a special affinity for porphyrins. It invades the cell at the angiotensin converting enzyme-2 (ACE-2) receptor and binds to hemoproteins, resulting in a severe systemic inflammatory response, particularly in high ACE-2 organs like the lungs, heart, and kidney, resulting in systemic disease. The inflammatory response manifested by increased cytokine levels and reactive oxygen species results in inhibition of heme oxygenase (HO-1), with a subsequent loss of cytoprotection. This has been seen in other viral illness like human immunodeficiency virus (HIV), Ebola, and SARS/MERS. There are a number of medications that have been tried with some showing early clinical promise. This illness disproportionately affects patients with obesity, a chronic inflammatory disease with a baseline excess of cytokines. The majority of the medications used in the treatment of COVID-19 are metabolized by cytochrome P450 (CYP) enzymes, primarily CYP2D6. This is further complicated by genetic polymorphisms of CYP2D6, HO-1, ACE, and ACE-2. There is a potential role for HO-1 upregulation to treat/prevent cytokine storm. Current therapy must focus on antivirals and heme oxygenase upregulation. Vaccine development will be the only magic bullet.
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Affiliation(s)
- Eddie W. Fakhouri
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA; (E.W.F.); (J.K.)
| | - Stephen J. Peterson
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA; (E.W.F.); (J.K.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Janish Kothari
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA; (E.W.F.); (J.K.)
| | - Ragin Alex
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595, USA;
| | - Joseph I. Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA;
| | - Nader G. Abraham
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595, USA;
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA;
- Department of Medicine, New York Medical College, Valhalla, New York, NY 10595, USA
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Samies NL, Pinninti S, James SH. Rhabdomyolysis and Acute Renal Failure in an Adolescent With Coronavirus Disease 2019. J Pediatric Infect Dis Soc 2020; 9:507-509. [PMID: 32645174 PMCID: PMC7454745 DOI: 10.1093/jpids/piaa083] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022]
Abstract
There is growing appreciation of the wide range of clinical presentations seen in pediatric patients with coronavirus disease 2019 (COVID-19). Rhabdomyolysis appears to be a rare, but potentially serious, manifestation of COVID-19. Here, we report an adolescent with COVID-19-associated rhabdomyolysis who required hemodialysis due to acute kidney injury. Pediatric providers should consider rhabdomyolysis and the possibility of acute renal failure in children with COVID-19.
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Affiliation(s)
- Nicole L Samies
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Swetha Pinninti
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Scott H James
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA,Correspondence: Scott H. James, MD, Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, 1600 Seventh Ave S, CHB 308, Birmingham, AL 35233-1711. E-mail:
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Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol 2020; 267:3135-3153. [PMID: 32561990 PMCID: PMC7304377 DOI: 10.1007/s00415-020-09990-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
Background In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Objective To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. Methods We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. Results We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. Conclusions Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain–Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic. Electronic supplementary material The online version of this article (10.1007/s00415-020-09990-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malik Ghannam
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| | - Qasem Alshaer
- Department of Neurology, Emory University, Atlanta, GA USA
| | | | - Lara Zakarna
- Department of Neuroscience, An-Najah National University, Nablus, Palestine
| | - Jetter Robertson
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
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Wagener FADTG, Pickkers P, Peterson SJ, Immenschuh S, Abraham NG. Targeting the Heme-Heme Oxygenase System to Prevent Severe Complications Following COVID-19 Infections. Antioxidants (Basel) 2020; 9:E540. [PMID: 32575554 PMCID: PMC7346191 DOI: 10.3390/antiox9060540] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 is causing a pandemic resulting in high morbidity and mortality. COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) are often critically ill and show lung injury and hemolysis. Heme is a prosthetic moiety crucial for the function of a wide variety of heme-proteins, including hemoglobin and cytochromes. However, injury-derived free heme promotes adhesion molecule expression, leukocyte recruitment, vascular permeabilization, platelet activation, complement activation, thrombosis, and fibrosis. Heme can be degraded by the anti-inflammatory enzyme heme oxygenase (HO) generating biliverdin/bilirubin, iron/ferritin, and carbon monoxide. We therefore postulate that free heme contributes to many of the inflammatory phenomena witnessed in critically ill COVID-19 patients, whilst induction of HO-1 or harnessing heme may provide protection. HO-activity not only degrades injurious heme, but its effector molecules possess also potent salutary anti-oxidative and anti-inflammatory properties. Until a vaccine against SARS-CoV-2 becomes available, we need to explore novel strategies to attenuate the pro-inflammatory, pro-thrombotic, and pro-fibrotic consequences of SARS-CoV-2 leading to morbidity and mortality. The heme-HO system represents an interesting target for novel "proof of concept" studies in the context of COVID-19.
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Affiliation(s)
- Frank A. D. T. G. Wagener
- Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Philips van Leydenlaan 25, 6525EX Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands;
| | | | - Stephan Immenschuh
- Institute for Transfusion Medicine, Hannover Medical School, 30625 Hannover, Germany;
| | - Nader G. Abraham
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, NY 10595, USA;
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