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Caciagli V, Coloretti I, Talamonti M, Farinelli C, Gatto I, Biagioni E, Sarti M, Franceschini E, Meschiari M, Mussini C, Tonelli R, Clini E, Girardis M, Busani S. Association between Pulmonary Aspergillosis and Cytomegalovirus Reactivation in Critically Ill COVID-19 Patients: A Prospective Observational Cohort Study. Viruses 2023; 15:2260. [PMID: 38005936 PMCID: PMC10675747 DOI: 10.3390/v15112260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19-associated invasive pulmonary aspergillosis (CAPA) is common and is associated with poor outcomes in critically ill patients. This prospective observational study aimed to explore the association between CAPA development and the incidence and prognosis of cytomegalovirus (CMV) reactivation in critically ill COVID-19 patients. We included all consecutive critically ill adult patients with confirmed COVID-19 infection who were admitted to three COVID-19 intensive care units (ICUs) in an Italian hospital from 25 February 2020 to 8 May 2022. A standardized procedure was employed for early detection of CAPA. Risk factors associated with CAPA and CMV reactivation and the association between CMV recurrence and mortality were estimated using adjusted Cox proportional hazard regression models. CAPA occurred in 96 patients (16.6%) of the 579 patients analyzed. Among the CAPA population, 40 (41.7%) patients developed CMV blood reactivation with a median time of 18 days (IQR 7-27). The CAPA+CMV group did not exhibit a significantly higher 90-day mortality rate (62.5% vs. 48.2%) than the CAPA alone group (p = 0.166). The CAPA+CMV group had a longer ICU stay, fewer ventilation-free days, and a higher rate of secondary bacterial infections than the control group of CAPA alone. In the CAPA population, prior immunosuppression was the only independent risk factor for CMV reactivation (HR 2.33, 95% C.I. 1.21-4.48, p = 0.011). In critically ill COVID-19 patients, CMV reactivation is common in those with a previous CAPA diagnosis. Basal immunosuppression before COVID-19 appeared to be the primary independent variable affecting CMV reactivation in patients with CAPA. Furthermore, the association of CAPA+CMV versus CAPA alone appears to impact ICU length of stay and secondary bacterial infections but not mortality.
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Affiliation(s)
- Valeria Caciagli
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Irene Coloretti
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Marta Talamonti
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Carlotta Farinelli
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Ilenia Gatto
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Mario Sarti
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy
| | - Erica Franceschini
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (M.M.)
| | - Marianna Meschiari
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (M.M.)
| | - Cristina Mussini
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (M.M.)
| | - Roberto Tonelli
- Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Stefano Busani
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
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Abenavoli L, Aquila I, Sacco MA, Scarlata GGM, Procopio AC, Boccuto L, Scarpellini E, Greco M, Foti DP, Ricci P, Luzza F. Liver Damage and Impaired Coagulation in COVID-19 Patients: A Case Series. Diseases 2023; 11:141. [PMID: 37873785 PMCID: PMC10594514 DOI: 10.3390/diseases11040141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has generated an unprecedented challenge for healthcare systems worldwide. Currently, the scientific community wonders if liver injury in patients suffering from severe forms is a direct consequence of the virus or secondary manifestations of systemic inflammation. The liver plays an essential role in the development of the inflammatory storm typical of this disease, and its involvement is associated with worse clinical outcomes and a higher risk of morbidity and mortality from Coronavirus disease 2019 (COVID-19). METHODS Ten patients suffering from severe COVID-19 disease who died between January 2020 and December 2021 were included in the present analysis. These subjects underwent a post mortem examination with a focused evaluation of the hepatic injury. Also, several laboratory parameters have been evaluated, with a primary focus on prothrombin time, partial thromboplastin time, fibrinogen, antithrombin III, and D-dimers to detect coagulative changes. RESULTS The main cause of death was represented by pulmonary thromboembolism events (50%). The analysis of coagulation laboratory parameters and liver biomarkers revealed a statistically significant rise in aPTT and ALP, and a decrease in albumin, when comparing the blood value at admission and death. We also found high levels of D-dimers in most of the subjects at the time of hospitalization. Interestingly, the post mortem analysis of the liver showed ample morphologic variability, with several disease features. In detail, the liver histology revealed the following: the presence of a variable degree of micro- and macrovacuolar steatosis, inflammation (also, hepato-cholangitis), and variable fibrosis. Of mention, we were also able to detect organized fibrinous material. CONCLUSIONS Our results indicate that in subjects with a severe form of COVID-19, liver disease is related to changes in coagulative and fibrinolytic pathways. In particular, we noted low fibrinogen levels and high D-dimer levels with histological liver findings. Our data suggest that fibrinogen and D-dimers may be used as prognostic markers to detect the severity of liver disease in patients with COVID-19. Finally, we underline the crucial role of coagulation balance in subjects with severe forms of COVID-19.
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Affiliation(s)
- Ludovico Abenavoli
- Department of Health Sciences, University “Magna Græcia”, Viale Europa, 88100 Catanzaro, Italy; (G.G.M.S.); (A.C.P.); (M.G.); (F.L.)
| | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (I.A.); (M.A.S.); (P.R.)
| | - Matteo Antonio Sacco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (I.A.); (M.A.S.); (P.R.)
| | - Giuseppe Guido Maria Scarlata
- Department of Health Sciences, University “Magna Græcia”, Viale Europa, 88100 Catanzaro, Italy; (G.G.M.S.); (A.C.P.); (M.G.); (F.L.)
| | - Anna Caterina Procopio
- Department of Health Sciences, University “Magna Græcia”, Viale Europa, 88100 Catanzaro, Italy; (G.G.M.S.); (A.C.P.); (M.G.); (F.L.)
| | - Luigi Boccuto
- Healthcare Genetics and Genomics Doctoral Program, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29631, USA;
| | - Emidio Scarpellini
- Translationeel Onderzoek van Gastroenterologische Aandoeningen (T.A.R.G.I.D.), Gasthuisberg University Hospital, KU Leuven, Herestraat 49, 3000 Leuven, Belgium;
| | - Marta Greco
- Department of Health Sciences, University “Magna Græcia”, Viale Europa, 88100 Catanzaro, Italy; (G.G.M.S.); (A.C.P.); (M.G.); (F.L.)
| | - Daniela Patrizia Foti
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, Viale Europa, 88100 Catanzaro, Italy;
| | - Pietrantonio Ricci
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (I.A.); (M.A.S.); (P.R.)
| | - Francesco Luzza
- Department of Health Sciences, University “Magna Græcia”, Viale Europa, 88100 Catanzaro, Italy; (G.G.M.S.); (A.C.P.); (M.G.); (F.L.)
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Campani S, Talamonti M, Dall’Ara L, Coloretti I, Gatto I, Biagioni E, Tosi M, Meschiari M, Tonelli R, Clini E, Cossarizza A, Guaraldi G, Mussini C, Sarti M, Trenti T, Girardis M. The Association of Procalcitonin and C-Reactive Protein with Bacterial Infections Acquired during Intensive Care Unit Stay in COVID-19 Critically Ill Patients. Antibiotics (Basel) 2023; 12:1536. [PMID: 37887237 PMCID: PMC10604665 DOI: 10.3390/antibiotics12101536] [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: 09/03/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
In COVID-19 patients, procalcitonin (PCT) and C-reactive protein (CRP) performance in identifying bacterial infections remains unclear. Our study aimed to evaluate the association of PCT and CRP with secondary infections acquired during ICU stay in critically ill COVID-19 patients. This observational study included adult patients admitted to three COVID-19 intensive care units (ICUs) from February 2020 to May 2022 with respiratory failure caused by SARS-CoV-2 infection and ICU stay ≥ 11 days. The values of PCT and CRP collected on the day of infection diagnosis were compared to those collected on day 11 after ICU admission, the median time for infection occurrence, in patients without secondary infection. The receiver operating characteristic curve (ROC) and multivariate logistic model were used to assess PCT and CRP association with secondary infections. Two hundred and seventy-nine patients were included, of whom 169 (60.6%) developed secondary infection after ICU admission. The PCT and CRP values observed on the day of the infection diagnosis were larger (p < 0.001) than those observed on day 11 after ICU admission in patients without secondary infections. The ROC analysis calculated an AUC of 0.744 (95%CI 0.685-0.803) and 0.754 (95%CI 0.695-0.812) for PCT and CRP, respectively. Multivariate logistic models showed that PCT ≥ 0.16 ng/mL and CRP ≥ 1.35 mg/dL were associated (p < 0.001) with infections acquired during ICU stay. Our results indicated that in COVID-19 patients, PCT and CRP values were associated with infections acquired during the ICU stay and can be used to support, together with clinical signs, rather than predict or rule out, the diagnosis of these infections.
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Affiliation(s)
- Simone Campani
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Marta Talamonti
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Lorenzo Dall’Ara
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Irene Coloretti
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Ilenia Gatto
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Emanuela Biagioni
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Martina Tosi
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Marianna Meschiari
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Roberto Tonelli
- Respiratory Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (R.T.); (E.C.)
| | - Enrico Clini
- Respiratory Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (R.T.); (E.C.)
| | - Andrea Cossarizza
- Immunology Laboratory, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Giovanni Guaraldi
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Cristina Mussini
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Mario Sarti
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Tommaso Trenti
- Diagnostic Hematology and Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, Local Health Service and University Hospital of Modena, 41124 Modena, Italy;
| | - Massimo Girardis
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
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Kianfar S, Salimi V, Jahangirifard A, Mirtajani SB, Vaezi MA, Yavarian J, Mokhtari-Azad T, Tavakoli-Yaraki M. 15-lipoxygenase and cyclooxygenase expression profile and their related modulators in COVID-19 infection. Prostaglandins Leukot Essent Fatty Acids 2023; 197:102587. [PMID: 37716021 DOI: 10.1016/j.plefa.2023.102587] [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: 05/07/2023] [Revised: 08/13/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND The role of the lipoxygenase (LOX) and cyclooxygenase (COX) enzymes in maintaining cellular homeostasis and regulating immune responses promoted us in this study to analyze the pattern of changes in 15-lipoxygenase and cyclooxygenase isoforms and their related cytokines in SARS-CoV-2 infection. METHODS 15-LOX-1, 15-LOX-2, COX-1 and COX-2 gene expression levels were determined using qRT-PCR in nasopharynx specimens from patients with severe [N = 40] and non-severe [N = 40] confirmed SARS-CoV-2 infections and healthy controls. Circulating levels of lL-6, lL-10, PGE2, and IFN-γ were measured in patients and healthy controls using ELISA assay. The associations between the measured variables and the patient's clinic-pathological characteristics were assessed for all groups. RESULTS The expression level of 15-LOX-1 was elevated significantly in male patients with severe infection; although female patients showed a different expression profile. 15-LOX-2 expression level was considerably increased in male patients with severe infection; while changes in its expression remained inconclusive in female patients. The relationship between 15-LOX expression and the male gender was prominent. Both COX isoforms expression showed elevation in male and female patients that were correlated with disease severity. The simultaneous increase in lL-6, PGE2 and IFN-γ levels also decrease in lL-10 in patients with severe infection indicating the possible regulatory network related to the COX and 15-LOX enzymes in the output of the SARS-CoV-2 infection. CONCLUSION The results of this study determined the pattern of possible changes in key enzymes of prostaglandin and eicosanoids synthesis pathway and their mediators, which can be helpful in mapping the SARS-CoV-2 pathogenicity and pharmaceutical approaches.
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Affiliation(s)
- Sara Kianfar
- Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Salimi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Jahangirifard
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bashir Mirtajani
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Vaezi
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Antibiotic Stewardship & Antimicrobial Resistance, Tehran university of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Tavakoli-Yaraki
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Ceccarelli G, Alessandri F, Migliara G, Baccolini V, Giordano G, Galardo G, Marzuillo C, De Vito C, Russo A, Ciccozzi M, Villari P, Venditti M, Mastroianni CM, Pugliese F, d’Ettorre G. Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients-Results from a Retrospective Observational Study in Intensive Care Units. J Clin Med 2023; 12:6171. [PMID: 37834815 PMCID: PMC10573961 DOI: 10.3390/jcm12196171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients. METHODS In this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study. RESULTS Over the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18-27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25-3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04-5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51-2.52 for PCT; aOR 1.32, 95% CI 0.66-2.64 for PCT-72 h). CONCLUSION Elevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting.
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Affiliation(s)
- Giancarlo Ceccarelli
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Francesco Alessandri
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
- Intensive Care Unit, Department of General, Specialistic Surgery, University of Rome Sapienza, 00185 Rome, Italy
| | - Giuseppe Migliara
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Valentina Baccolini
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Giovanni Giordano
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
- Intensive Care Unit, Department of General, Specialistic Surgery, University of Rome Sapienza, 00185 Rome, Italy
| | - Gioacchino Galardo
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy;
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Mario Venditti
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Claudio M. Mastroianni
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Francesco Pugliese
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
- Intensive Care Unit, Department of General, Specialistic Surgery, University of Rome Sapienza, 00185 Rome, Italy
| | - Gabriella d’Ettorre
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
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DE Vito A, Saderi L, Fiore V, Geremia N, Princic E, Fanelli C, Muredda AA, Panu Napodano C, Moi G, Maida I, Fois AG, Sotgiu G, Madeddu G, Babudieri S. Early treatment with low-molecular-weight heparin reduces mortality rate in SARS-CoV-2 patients. Panminerva Med 2023; 65:286-291. [PMID: 35622392 DOI: 10.23736/s0031-0808.22.04572-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since the beginning of the SARS-CoV-2 pandemic, millions of people have been infected and died. Different therapeutic approaches have been recommended, but only a few have shown clinical advantages. Low-molecular-weight heparin (LMWH) has been recommended to prevent COVID-19-related thrombo-embolic events. We aimed to evaluate the impact of early treatment with LMWH on hospital admission and death in patients with SARS-CoV-2 infection. METHODS We conducted an observational monocentric retrospective study to evaluate the preventive role of LMWH on the mortality rate of COVID-19 patients. SARS-CoV-2 infected patients were recruited from the beginning of the Italian epidemic to March 31, 2021. We excluded patients with missing data and those chronically exposed to LMWH. Treatment prescription was based on international and national guidelines and modified depending on clinical presentation and drug-drug interactions. RESULTS Seven hundred thirty-four SARS-CoV-2 infected patients were recruited, with 357 (48.6%) males and a median (IQR) age of 77.9 (65-85.7) years. 77.5% of people developed SARS-CoV-2-related symptoms and 62.8% were admitted to the hospital, and 20.2% died. Four hundred ninety-two (67%) started LMWH. In particular, 296 (40.3%) were treated within five days since symptoms onset. At logistic regression, early LMWH therapy was associated with lower mortality. Furthermore, remdesivir treatment showed a lower risk of death. On the contrary, age, BMI>30 kg/m2, neurological diseases, fever or dyspnea were associated with an increased risk of death. CONCLUSIONS Early treatment with LMWH was associated with lower mortality in our cohort. Further studies are needed to better assess the role of wider LMWH administration in terms of timing and regimen dose.
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Affiliation(s)
- Andrea DE Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy -
| | - Laura Saderi
- Unit of Clinical Epidemiology and Medical Statistics, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Vito Fiore
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Nicholas Geremia
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Elija Princic
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Fanelli
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alberto A Muredda
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Catello Panu Napodano
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giulia Moi
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ivana Maida
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro G Fois
- Unit of Respiratory Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Unit of Clinical Epidemiology and Medical Statistics, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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7
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Mphekgwana PM, Sono-Setati ME, Mokgophi TV, Kifle YG, Madiba S, Modjadji P. Retrospective Analysis of the Outcome of Hospitalized COVID-19 Patients with Coexisting Metabolic Syndrome and HIV Using Multinomial Logistic Regression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105799. [PMID: 37239527 DOI: 10.3390/ijerph20105799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Globally, the coexistence of metabolic syndrome (MetS) and HIV has become an important public health problem, putting coronavirus disease 19 (COVID-19) hospitalized patients at risk for severe manifestations and higher mortality. A retrospective cross-sectional analysis was conducted to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients using secondary data from the Department of Health in Limpopo Province, South Africa. The study included 15,151 patient clinical records of laboratory-confirmed COVID-19 cases. Data on MetS was extracted in the form of a cluster of metabolic factors. These included abdominal obesity, high blood pressure, and impaired fasting glucose captured on an information sheet. Spatial distribution of mortality among patients was observed; overall (21-33%), hypertension (32-43%), diabetes (34-47%), and HIV (31-45%). A multinomial logistic regression model was applied to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients. Mortality among COVID-19 patients was associated with being older (≥50+ years), male, and HIV positive. Having hypertension and diabetes reduced the duration from admission to death. Being transferred from a primary health facility (PHC) to a referral hospital among COVID-19 patients was associated with ventilation and less chance of being transferred to another health facility when having HIV plus MetS. Patients with MetS had a higher mortality rate within seven days of hospitalization, followed by those with obesity as an individual component. MetS and its components such as hypertension, diabetes, and obesity should be considered a composite predictor of COVID-19 fatal outcomes, mostly, increased risk of mortality. The study increases our understanding of the common contributing variables to severe manifestations and a greater mortality risk among COVID-19 hospitalized patients by investigating the influence of MetS, its components, and HIV coexistence. Prevention remains the mainstay for both communicable and non-communicable diseases. The findings underscore the need for improvement of critical care resources across South Africa.
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Affiliation(s)
- Peter M Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0727, South Africa
| | - Musa E Sono-Setati
- Department of Public Health Medicine, University of Limpopo, Private Bag X1106, Sovenga, Polokwane 0727, South Africa
| | - Tania V Mokgophi
- Department of Statistics and Operations Research, University of Limpopo, Polokwane 0727, South Africa
| | - Yehenew G Kifle
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD 21250, USA
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0727, South Africa
| | - Perpetua Modjadji
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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Role of Selective Digestive Decontamination in the Prevention of Ventilator-Associated Pneumonia in COVID-19 Patients: A Pre-Post Observational Study. J Clin Med 2023; 12:jcm12041432. [PMID: 36835966 PMCID: PMC9964963 DOI: 10.3390/jcm12041432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
The aim of our study was to evaluate whether the introduction of SDD in a structured protocol for VAP prevention was effective in reducing the occurrence of ventilator-associated pneumonia (VAP) in COVID-19 patients without changes in the microbiological pattern of antibiotic resistance. This observational pre-post study included adult patients requiring invasive mechanical ventilation (IMV) for severe respiratory failure related to SARS-CoV-2 admitted in three COVID-19 intensive care units (ICUs) in an Italian hospital from 22 February 2020 to 8 March 2022. Selective digestive decontamination (SDD) was introduced from the end of April 2021 in the structured protocol for VAP prevention. The SDD consisted of a tobramycin sulfate, colistin sulfate, and amphotericin B suspension applied in the patient's oropharynx and the stomach via a nasogastric tube. Three-hundred-and-forty-eight patients were included in the study. In the 86 patients (32.9%) who received SDD, the occurrence of VAP decreased by 7.7% (p = 0.192) compared to the patients who did not receive SDD. The onset time of VAP, the occurrence of multidrug-resistant microorganisms AP, the length of invasive mechanical ventilation, and hospital mortality were similar in the patients who received and who did not receive SDD. The multivariate analysis adjusted for confounders showed that the use of SDD reduces the occurrence of VAP (HR 0.536, CI 0.338-0.851; p = 0.017). Our pre-post observational study indicates that the use of SDD in a structured protocol for VAP prevention seems to reduce the occurrence of VAP without changes in the incidence of multidrug-resistant bacteria in COVID-19 patients.
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Xiang M, Wu X, Jing H, Novakovic VA, Shi J. The intersection of obesity and (long) COVID-19: Hypoxia, thrombotic inflammation, and vascular endothelial injury. Front Cardiovasc Med 2023; 10:1062491. [PMID: 36824451 PMCID: PMC9941162 DOI: 10.3389/fcvm.2023.1062491] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The role of hypoxia, vascular endothelial injury, and thrombotic inflammation in worsening COVID-19 symptoms has been generally recognized. Damaged vascular endothelium plays a crucial role in forming in situ thrombosis, pulmonary dysfunction, and hypoxemia. Thrombotic inflammation can further aggravate local vascular endothelial injury and affect ventilation and blood flow ratio. According to the results of many studies, obesity is an independent risk factor for a variety of severe respiratory diseases and contributes to high mechanical ventilation rate, high mortality, and slow recovery in COVID-19 patients. This review will explore the mechanisms by which obesity may aggravate the acute phase of COVID-19 and delay long COVID recovery by affecting hypoxia, vascular endothelial injury, and thrombotic inflammation. A systematic search of PubMed database was conducted for papers published since January 2020, using the medical subject headings of "COVID-19" and "long COVID" combined with the following keywords: "obesity," "thrombosis," "endothelial injury," "inflammation," "hypoxia," "treatment," and "anticoagulation." In patients with obesity, the accumulation of central fat restricts the expansion of alveoli, exacerbating the pulmonary dysfunction caused by SARS-CoV-2 invasion, inflammatory damage, and lung edema. Abnormal fat secretion and immune impairment further aggravate the original tissue damage and inflammation diffusion. Obesity weakens baseline vascular endothelium function leading to an early injury and pre-thrombotic state after infection. Enhanced procoagulant activity and microthrombi promote early obstruction of the vascular. Obesity also prolongs the duration of symptoms and increases the risk of sequelae after hospital discharge. Persistent viral presence, long-term inflammation, microclots, and hypoxia may contribute to the development of persistent symptoms, suggesting that patients with obesity are uniquely susceptible to long COVID. Early interventions, including supplemental oxygen, comprehensive antithrombotic therapy, and anti-inflammatory drugs, show effectiveness in many studies in the prevention of serious hypoxia, thromboembolic events, and systemic inflammation, and are therefore recommended to reduce intensive care unit admission, mortality, and sequelae.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States
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Do All Critically Ill Patients with COVID-19 Disease Benefit from Adding Tocilizumab to Glucocorticoids? A Retrospective Cohort Study. Viruses 2023; 15:v15020294. [PMID: 36851508 PMCID: PMC9967307 DOI: 10.3390/v15020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Treatment guidelines recommend the tocilizumab use in patients with a CRP of >7.5 mg/dL. We aimed to estimate the causal effect of glucocorticoids + tocilizumab on mortality overall and after stratification for PaO2/FiO2 ratio and CRP levels. METHODS This was an observational cohort study of patients with severe COVID-19 pneumonia. The primary endpoint was day 28 mortality. Survival analysis was conducted to estimate the conditional and average causal effect of glucocorticoids + tocilizumab vs. glucocorticoids alone using Kaplan-Meier curves and Cox regression models with a time-varying variable for the intervention. The hypothesis of the existence of effect measure modification by CRP and PaO2/FiO2 ratio was tested by including an interaction term in the model. RESULTS In total, 992 patients, median age 69 years, 72.9% males, 597 (60.2%) treated with monotherapy, and 395 (31.8%), adding tocilizumab upon respiratory deterioration, were included. At BL, the two groups differed for median values of CRP (6 vs. 7 mg/dL; p < 0.001) and PaO2/FiO2 ratio (276 vs. 235 mmHg; p < 0.001). In the unadjusted analysis, the mortality was similar in the two groups, but after adjustment for key confounders, a significant effect of glucocorticoids + tocilizumab was observed (adjusted hazard ratio (aHR) = 0.59, 95% CI: 0.38-0.90). Although the study was not powered to detect interactions (p = 0.41), there was a signal for glucocorticoids + tocilizumab to have a larger effect in subsets, especially participants with high levels of CRP at intensification. CONCLUSIONS Our data confirm that glucocorticoids + tocilizumab vs. glucocorticoids alone confers a survival benefit only in patients with a CRP > 7.5 mg/dL prior to treatment initiation and the largest effect for a CRP > 15 mg/dL. Large randomized studies are needed to establish an exact cut-off for clinical use.
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High Incidence of Candidemia in Critically Ill COVID-19 Patients Supported by Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study. J Fungi (Basel) 2023; 9:jof9010119. [PMID: 36675940 PMCID: PMC9861971 DOI: 10.3390/jof9010119] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The incidence of candidemia in severe COVID-19 patients (0.8-14%) is two- to ten-fold higher than in non-COVID-19 patients. METHODS This retrospective analysis aimed to analyse the incidence of bloodstream infections (BSI) due to Candida in a cohort of COVID-19 patients supported with ECMO. RESULTS Among 138 intubated and ventilated patients hospitalized for ≥10 days in the intensive care unit of a teaching hospital, 45 (32.6%) patients received ECMO support, while 93 patients (67.4%) did not meet ECMO criteria and were considered the control group. In the ECMO group, 16 episodes of candidaemia were observed, while only 13 in patients of the control group (36.0% vs. 14.0%, p-value 0.004). It was confirmed at the survival analysis (SHR: 2.86, 95% CI: 1.39-5.88) and at the multivariable analyses (aSHR: 3.91, 95% CI: 1.73-8.86). A higher candida score seemed to increase the hazard for candidemia occurrence (aSHR: 3.04, 95% CI: 2.09-4.42), while vasopressor therapy was negatively associated with the outcome (aSHR: 0.15, 95% CI: 0.05-0.43). CONCLUSIONS This study confirms that the incidence of candidemia was significantly higher in critically ill COVID-19 patients supported with VV-ECMO than in critically ill COVID patients who did not meet criteria for VV-ECMO.
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De Vito A, Poliseno M, Colpani A, Zauli B, Puci MV, Santantonio T, Meloni MC, Fois M, Fanelli C, Saderi L, Fois A, Fiore V, Sotgiu G, Babudieri S, Lo Caputo S, Madeddu G. Reduced risk of death in people with SARS-CoV-2 infection treated with remdesivir: a nested case-control study. Curr Med Res Opin 2022; 38:2029-2033. [PMID: 36170020 DOI: 10.1080/03007995.2022.2129801] [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] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Since the start of the SARS-CoV-2 pandemic, several treatment options have been proposed (e.g. steroids, heparin, antivirals and monoclonal antibodies). Remdesivir was the first antiviral approved for the treatment of COVID-19, even though controversial evidence exists concerning the efficacy. Therefore, we aimed to conduct a study to evaluate whether the use of remdesivir was associated with lower mortality in patients with COVID-19. METHODS We conducted a nested case-control study of a retrospective cohort collecting medical records of people with SARS-CoV-2 infection admitted in the infectious Disease Unit of Sassari University Hospital (S.C. Clinica di Malattie Infettive, AOU di Sassari, Italy), or in the Infectious Disease Unit of Foggia (AOU "Ospedali Riuniti" Foggia), between 1 July 2020 and 10 November 2021. The outcome considered was death; thus, we matched death (cases) to survivors (controls) by sex and age (1:1). RESULTS We included in the study 342 patients, with 171 deaths (cases) and 171 survivors (controls). Remdesivir was administered to 60 people in the control group and to 18 people in the case group (35.1% vs. 10.5%, p < .0001). In the multivariate analysis, treatment with remdesivir and heparin was associated with lower mortality (OR: 0.19 [95% CI :0.10-0.38], p <.0001; OR: 0.39 [95% CI: 0.21-0.74] p = .004, respectively). On the contrary, diabetes, oxygen therapy and CPAP/NIV were associated with higher mortality. CONCLUSION Our study showed lower mortality in people with SARS-CoV-2 infection treated with remdesivir.
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Affiliation(s)
- Andrea De Vito
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mariacristina Poliseno
- S.C. Malattie Infettive, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia, Foggia, Italy
| | - Agnese Colpani
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Beatrice Zauli
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mariangela Valentina Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Teresa Santantonio
- S.C. Malattie Infettive, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia, Foggia, Italy
| | - Maria Chiara Meloni
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Marco Fois
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Fanelli
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Fois
- Unit of Respiratory Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Vito Fiore
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Lo Caputo
- S.C. Malattie Infettive, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia, Foggia, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Exploiting Bacteria for Improving Hypoxemia of COVID-19 Patients. Biomedicines 2022; 10:biomedicines10081851. [PMID: 36009399 PMCID: PMC9405060 DOI: 10.3390/biomedicines10081851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Although useful in the time-race against COVID-19, CPAP cannot provide oxygen over the physiological limits imposed by severe pulmonary impairments. In previous studies, we reported that the administration of the SLAB51 probiotics reduced risk of developing respiratory failure in severe COVID-19 patients through the activation of oxygen sparing mechanisms providing additional oxygen to organs critical for survival. Methods: This “real life” study is a retrospective analysis of SARS-CoV-2 infected patients with hypoxaemic acute respiratory failure secondary to COVID-19 pneumonia undergoing CPAP treatment. A group of patients managed with ad interim routinely used therapy (RUT) were compared to a second group treated with RUT associated with SLAB51 oral bacteriotherapy (OB). Results: At baseline, patients receiving SLAB51 showed significantly lower blood oxygenation than controls. An opposite condition was observed after 3 days of treatment, despite the significantly reduced amount of oxygen received by patients taking SLAB51. At 7 days, a lower prevalence of COVID-19 patients needing CPAP in the group taking probiotics was observed. The administration of SLAB51 is a complementary approach for ameliorating oxygenation conditions at the systemic level. Conclusion: This study proves that probiotic administration results in an additional boost in alleviating hypoxic conditions, permitting to limit on the use of CPAP and its contraindications.
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COVID-19 as Another Trigger for HBV Reactivation: Clinical Case and Review of Literature. Pathogens 2022; 11:pathogens11070816. [PMID: 35890060 PMCID: PMC9318431 DOI: 10.3390/pathogens11070816] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023] Open
Abstract
Universal hepatitis B virus (HBV) vaccination has been applied for years in most countries, but HBV infection remains an unresolved public health problem worldwide, with over one-third of the world’s population infected during their lifetime and approximately 248 million hepatitis B surface antigen (HBsAg) chronic carriers. HBV infection may reactivate with symptomatic and sometimes life-threatening clinical manifestations due to a reduction in the immune response of various origins, due to chemotherapy or immunosuppressive therapy, treatments increasingly practiced worldwide. SARS-CoV-2 and its COVID-19 associated disease have introduced new chances for HBV reactivation due to the use of dexamethasone and tocilizumab to counteract the cytokine storm. This could and should be prevented by accurate screening of HBV serologic markers and adequate pharmacologic prophylaxis. This article describes the case of a patient with COVID-19 who developed HBV reactivation and died of liver failure and analyzes published data on this setting to provide useful information to physicians who manage these patients during the SARS-CoV-2 pandemic.
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Functional associations between polymorphic regions of the human 3'IgH locus and COVID-19 disease. Gene X 2022; 838:146698. [PMID: 35772651 PMCID: PMC9241982 DOI: 10.1016/j.gene.2022.146698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The pandemic diffusion of Coronavirus Disease 2019 (COVID-19) has highlighted significant gender-related differences in disease severity. Despite several hypotheses being proposed, how the genetic background of COVID-19 patients might impact clinical outcomes remains largely unknown. Methods We collected blood samples from 192 COVID-19 patients (115 men, 77 women, mean age 67 ± 19 years) admitted between March and June 2020 at two different hospital centers in Italy, and determined the allelic distribution of nine Single Nucleotide Polymorphisms (SNPs), located at the 3’Regulatory Region (3’RR)-1 in the immunoglobulin (Ig) heavy chain locus, including *1 and *2 alleles of polymorphic hs1.2 enhancer region. Results In COVID-19 patients, the genotyped SNPs exhibited strong Linkage Disequilibrium and produced 7 specific haplotypes, associated to different degrees of disease severity, including the occurrence of pneumonia. Additionally, the allele *2, which comprises a DNA binding site for the Estrogen receptor alpha (ERα) in the polymorphic enhancer hs1.2 of 3’RR-1, was significantly enriched in women with a less severe disease. Conclusions These findings document genetic variants associated to individual clinical severity of COVID-19 disease. Most specifically, a novel genetic protective factor was identified that might explain the sex-related differences in immune response to Sars-COV-2 infection in humans.
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Rojas D, Saavedra J, Petrova M, Pan Y, Szapocznik J. Predictors of COVID-19 Fatality: A Worldwide Analysis of the Pandemic over Time and in Latin America. J Epidemiol Glob Health 2022; 12:150-159. [PMID: 35029837 PMCID: PMC8758983 DOI: 10.1007/s44197-022-00031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022] Open
Abstract
SARS-CoV-2 has infected over one hundred million people worldwide and has affected Latin America particularly severely in terms of both cases and deaths. This study aims to determine the association between SARS-CoV-2 testing and COVID-19 fatality rate worldwide over 8 months and to examine how this relationship differs between Latin America and all other countries. This cross-sectional study used March 2021 data from 169 countries. Multivariate regressions predicted COVID-19 fatality (outcome) from the number of SARS-CoV-2 tests (exposure), while controlling for other predictors. Results for March 2021 were compared to results from June 2020. Additionally, results for Latin America were also compared to all other countries except Latin American for March 2021. SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in both June 2020 and March 2021 (RR = 0.92; 95% CI 0.87-0.96 and RR = 0.86; 95% CI 0.74-1.00, respectively). SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in Latin American countries but not in all other countries (RR = 0.45; 95% CI 0.23-0.89 and RR = 0.95; 95% CI 0.82-1.11, respectively). However, the difference between the risk ratios for June 2020 and March 2021 and between the risk ratios for Latin America and all other countries were not statistically significant. Increased SARS-CoV-2 testing may be a significant predictor of lower COVID-19 case fatality rate, specifically in Latin American countries, due to the existence of a strong association, which may have driven the worldwide results.
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Affiliation(s)
- Dayana Rojas
- Department of Public Health Sciences, Don Soffer Clinical Research Center, University of Miami, 1120 NW 14th Street, Miami, FL, 33136-2107, USA.
| | - Jorge Saavedra
- Don Soffer Clinical Research Center, AHF Global Public Health Institute, 1120 NW 14th Street, Miami, FL, 33136-2107, USA
| | - Mariya Petrova
- DeWitt Daughtry Family Department of Surgery, University of Miami, Biomedical Research Building, 1501 NW 10th Avenue, Miami, FL, 33136-1012, USA
| | - Yue Pan
- Department of Public Health Sciences, Don Soffer Clinical Research Center, University of Miami, 1120 NW 14th Street, Miami, FL, 33136-2107, USA
| | - José Szapocznik
- Department of Public Health Sciences, Don Soffer Clinical Research Center, University of Miami, 1120 NW 14th Street, Miami, FL, 33136-2107, USA
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Prevention of HBV Reactivation in Hemato-Oncologic Setting during COVID-19. Pathogens 2022; 11:pathogens11050567. [PMID: 35631088 PMCID: PMC9144674 DOI: 10.3390/pathogens11050567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
Onco-hematologic patients are highly susceptible to SARS-CoV-2 infection and, once infected, frequently develop COVID-19 due to the immunosuppression caused by tumor growth, chemotherapy and immunosuppressive therapy. In addition, COVID-19 has also been recognized as a further cause of HBV reactivation, since its treatment includes the administration of corticosteroids and some immunosuppressive drugs. Consequently, onco-hematologic patients should undergo SARS-CoV-2 vaccination and comply with the rules imposed by lockdowns or other forms of social distancing. Furthermore, onco-hematologic facilities should be adapted to new needs and provided with numerically adequate health personnel vaccinated against SARS-CoV-2 infection. Onco-hematologic patients, both HBsAg-positive and HBsAg-negative/HBcAb-positive, may develop HBV reactivation, made possible by the support of the covalently closed circular DNA (cccDNA) persisting in the hepatocytic nuclei of patients with an ongoing or past HBV infection. This occurrence must be prevented by administering high genetic barrier HBV nucleo(t)side analogues before and throughout the antineoplastic treatment, and then during a long-term post-treatment follow up. The prevention of HBV reactivation during the SARS-CoV-2 pandemic is the topic of this narrative review.
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Falcone M, Suardi LR, Tiseo G, Galfo V, Occhineri S, Verdenelli S, Ceccarelli G, Poli M, Merli M, Bavaro D, Carretta A, Nunnari G, Venanzi Rullo E, Trecarichi EM, Papalini C, Franco A, Del Vecchio RF, Bianco V, Punzi R, Francisci D, Rubino R, Torti C, Puoti M, Carbonara S, Cascio A, Saracino A, Santantonio T, Venditti M, Menichetti F. Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study). JAC Antimicrob Resist 2022; 4:dlac064. [PMID: 35719203 PMCID: PMC9201238 DOI: 10.1093/jacamr/dlac064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE).
Methods
Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-β-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality.
Results
Overall, 123 patients (median age 66 years, IQR 59–75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) (n = 64, 52%), followed by urinary-tract infections (UTI) (n = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (n = 28, 22.8%), intra-abdominal infections (n = 2, 1.6%) and skin infections (n = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09–24.97, P = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33–11.77, P = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44–6.26, P = 0.003) and age (HR 1.05, 95% CI 1.02–1.08, P = 0.002) were predictors of 30 day mortality.
Conclusions
Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Valentina Galfo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Stefano Verdenelli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome , Italy
| | - Melita Poli
- Vittorio Emanuele II Hospital , Bisceglie , Italy
| | - Marco Merli
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Davide Bavaro
- University of Bari, Clinic of Infectious Diseases , Bari , Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital ‘Ospedali Riuniti’ of Foggia , Foggia , Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro-‘Mater Domini’ Teaching Hospital , Catanzaro , Italy
| | - Chiara Papalini
- Department of Medicine and Surgery, Clinic of Infectious Diseases, ‘Santa Maria della Misericordia’ Hospital, University of Perugia , Perugia , Italy
| | | | | | - Vincenzo Bianco
- Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital , Naples , Italy
| | - Rodolfo Punzi
- Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital , Naples , Italy
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, ‘Santa Maria della Misericordia’ Hospital, University of Perugia , Perugia , Italy
| | - Raffaella Rubino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo , Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro-‘Mater Domini’ Teaching Hospital , Catanzaro , Italy
| | - Massimo Puoti
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | | | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo , Italy
| | | | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital ‘Ospedali Riuniti’ of Foggia , Foggia , Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome , Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
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19
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Tonelli R, Bruzzi G, Manicardi L, Tabbì L, Fantini R, Castaniere I, Andrisani D, Gozzi F, Pellegrino MR, Trentacosti F, Dall’Ara L, Busani S, Franceschini E, Baroncini S, Manco G, Meschiari M, Mussini C, Girardis M, Beghè B, Marchioni A, Clini E. Risk Factors for Pulmonary Air Leak and Clinical Prognosis in Patients With COVID-19 Related Acute Respiratory Failure: A Retrospective Matched Control Study. Front Med (Lausanne) 2022; 9:848639. [PMID: 35433732 PMCID: PMC9008271 DOI: 10.3389/fmed.2022.848639] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The role of excessive inspiratory effort in promoting alveolar and pleural rupture resulting in air leak (AL) in patients with SARS-CoV-2 induced acute respiratory failure (ARF) while on spontaneous breathing is undetermined. Methods Among all patients with COVID-19 related ARF admitted to a respiratory intensive care unit (RICU) and receiving non-invasive respiratory support, those developing an AL were and matched 1:1 [by means of PaO2/FiO2 ratio, age, body mass index-BMI and subsequent organ failure assessment (SOFA)] with a comparable population who did not (NAL group). Esophageal pressure (ΔPes) and dynamic transpulmonary pressure (ΔPL) swings were compared between groups. Risk factors affecting AL onset were evaluated. The composite outcome of ventilator-free-days (VFD) at day 28 (including ETI, mortality, tracheostomy) was compared between groups. Results Air leak and NAL groups (n = 28) showed similar ΔPes, whereas AL had higher ΔPL (20 [16–21] and 17 [11–20], p = 0.01, respectively). Higher ΔPL (OR = 1.5 95%CI[1–1.8], p = 0.01), positive end-expiratory pressure (OR = 2.4 95%CI[1.2–5.9], p = 0.04) and pressure support (OR = 1.8 95%CI[1.1–3.5], p = 0.03), D-dimer on admission (OR = 2.1 95%CI[1.3–9.8], p = 0.03), and features suggestive of consolidation on computed tomography scan (OR = 3.8 95%CI[1.1–15], p = 0.04) were all significantly associated with AL. A lower VFD score resulted in a higher risk (HR = 3.7 95%CI [1.2–11.3], p = 0.01) in the AL group compared with NAL. RICU stay and 90-day mortality were also higher in the AL group compared with NAL. Conclusion In spontaneously breathing patients with COVID-19 related ARF, higher levels of ΔPL, blood D-dimer, NIV delivery pressures and a consolidative lung pattern were associated with AL onset.
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Affiliation(s)
- Roberto Tonelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Bruzzi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Linda Manicardi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Dario Andrisani
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Gozzi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Rosaria Pellegrino
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Fabiana Trentacosti
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Lorenzo Dall’Ara
- Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Stefano Busani
- Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | | | - Serena Baroncini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Gianrocco Manco
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Cristina Mussini
- Infectious Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Massimo Girardis
- Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Bianca Beghè
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- *Correspondence: Alessandro Marchioni,
| | - Enrico Clini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
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20
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Can O, Otunctemur A. Impact of coronavirus disease on the management of lower urinary tract symptoms and voiding dysfunction. Curr Opin Urol 2022; 32:141-145. [PMID: 34930886 PMCID: PMC8815648 DOI: 10.1097/mou.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease (COVID-19) has caused a crisis in the entire healthcare system since its emergence. The urgency and priority of various diseases have impacted the medical and surgical treatment in this period. We aim to review the impact of COVID-19 on lower urinary tract symptoms (LUTS) and management. RECENT FINDINGS There may be a relationship between COVID-19 and de novo or increased LUTS. Patients with LUTS should also be evaluated for COVID-19. Management of diseases has varied during the COVID-19 due to the density of the pandemic. Virtual consultations can mitigate patients who are postponed or cancelled, such as patients with LUTS. Patients suffering voiding dysfunction may manage with oral medications such as alpha blocker and 5-alpha reductase inhibitor via telemedicine. Minimally invasive procedures with a low risk of complications and a short hospitalization time should be considered in complicated cases such as the inability to catheterize. SUMMARY Telemedicine should be implemented on managements of noncomplicated LUTS and voiding dysfunction. Each centre can schedule its LUTS management approach according to the density of pandemic. Virtual consultations need to be developed to compete with face-to-face consultations.
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Affiliation(s)
- Osman Can
- Basaksehir Cam and Sakura City Hospital
| | - Alper Otunctemur
- Prof. Dr Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
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21
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Meschiari M, Cozzi-Lepri A, Tonelli R, Bacca E, Menozzi M, Franceschini E, Cuomo G, Bedini A, Volpi S, Milic J, Brugioni L, Romagnoli E, Pietrangelo A, Corradini E, Coloretti I, Biagioni E, Busani S, Girardis M, Cossarizza A, Clini E, Guaraldi G, Mussini C. First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy. BMJ Open 2022; 12:e054069. [PMID: 34980623 PMCID: PMC8724593 DOI: 10.1136/bmjopen-2021-054069] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The first COVID-19-19 epidemic wave was over the period of February-May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients. DESIGN Observational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed. SETTING University Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February-31 May 2020) and second (1 October-31 December 2020) waves were included. RESULTS During the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56-80), 37% women, 49% with PaO2/FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01). CONCLUSIONS In our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | | | - Roberto Tonelli
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Bacca
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Sara Volpi
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucio Brugioni
- Internal Medicine Department, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Elisa Romagnoli
- Internal Medicine Department, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Antonello Pietrangelo
- Department of Medical and Surgical Sciences for Children and Adults, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Elena Corradini
- Department of Medical and Surgical Sciences for Children and Adults, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Irene Coloretti
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Busani
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
- Anesthesia and Intensive Care, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
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22
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Falcone M, Suardi LR, Tiseo G, Barbieri C, Giusti L, Galfo V, Forniti A, Caroselli C, Sala LD, Tempini S, Okoye C, Monzani F, Menichetti F. Early use of remdesivir and risk of disease progression in hospitalized patients with mild-to moderate COVID-19. Clin Ther 2022; 44:364-373. [PMID: 35120742 PMCID: PMC8761549 DOI: 10.1016/j.clinthera.2022.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/15/2022]
Abstract
Purpose Preliminary data suggest that remdesivir may influence the course of COVID-19 according to the duration of pre-admission symptoms. We aim to evaluate whether early use of remdesivir is associated with a reduced COVID-19 progression in a homogeneous cohort of patients with mild to moderate COVID-19. Methods This prospective, observational study included patients with COVID-19 pneumonia treated with remdesivir at the University Hospital of Pisa (Italy) from September 2020 to January 2021. According to national recommendations, remdesivir was prescribed in patients with pneumonia who required oxygen supplementation by nasal cannula or mask but without the need for high-flow nasal cannula, non-invasive or invasive mechanical ventilation and had symptoms from no more than 10 days. Patients who received early (≤5 days from onset of symptoms) versus late (>5 days from onset of symptoms) remdesivir were compared. The primary outcome was a composite of high-flow nasal cannula, non-invasive or invasive mechanical ventilation, or death. A multivariate logistic regression analysis was performed to identify factors independently associated with the composite endpoint. Findings Among 312 consecutive patients with COVID-19 pneumonia who received remdesivir, 90 (28.8%) received early remdesivir, whereas 222 (71.2%) received late remdesivir. Twenty-nine patients (32.2%) in the early-remdesivir group versus 104 patients (46.8%) in the late-remdesivir group met the primary end point (P = 0.018). On multivariate analysis, a history of dyspnea at home (odds ratio = 2.53; 95% CI, 1.55–4.12; P < 0.001) was the strongest factor independently associated with the progression to severe COVID-19, whereas early-remdesivir use was a protective factor (odds ratio = 0.49; 95% CI, 0.27–0.87; P = 0.015). The delayed admission to the hospital was associated with a delayed administration of remdesivir. Implications The early use of remdesivir (<5 days from symptoms onset) may reduce COVID-19 progression. The identification of patients who need early hospitalization and early remdesivir may provide clinical benefit in patients with COVID-19.
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23
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Gatto I, Biagioni E, Coloretti I, Farinelli C, Avoni C, Caciagli V, Busani S, Sarti M, Pecorari M, Gennari W, Guaraldi G, Franceschini E, Meschiari M, Mussini C, Tonelli R, Clini E, Cossarizza A, Girardis M. Cytomegalovirus blood reactivation in COVID-19 critically ill patients: risk factors and impact on mortality. Intensive Care Med 2022; 48:706-713. [PMID: 35583676 PMCID: PMC9116062 DOI: 10.1007/s00134-022-06716-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Cytomegalovirus (CMV) reactivation in immunocompetent critically ill patients is common and relates to a worsening outcome. In this large observational study, we evaluated the incidence and the risk factors associated with CMV reactivation and its effects on mortality in a large cohort of patients affected by coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU). METHODS Consecutive patients with confirmed SARS-CoV-2 infection and acute respiratory distress syndrome admitted to three ICUs from February 2020 to July 2021 were included. The patients were screened at ICU admission and once or twice per week for quantitative CMV-DNAemia in the blood. The risk factors associated with CMV blood reactivation and its association with mortality were estimated by adjusted Cox proportional hazards regression models. RESULTS CMV blood reactivation was observed in 88 patients (20.4%) of the 431 patients studied. Simplified Acute Physiology Score (SAPS) II score (HR 1031, 95% CI 1010-1053, p = 0.006), platelet count (HR 0.0996, 95% CI 0.993-0.999, p = 0.004), invasive mechanical ventilation (HR 2611, 95% CI 1223-5571, p = 0.013) and secondary bacterial infection (HR 5041; 95% CI 2852-8911, p < 0.0001) during ICU stay were related to CMV reactivation. Hospital mortality was higher in patients with (67.0%) than in patients without (24.5%) CMV reactivation but the adjusted analysis did not confirm this association (HR 1141, 95% CI 0.757-1721, p = 0.528). CONCLUSION The severity of illness and the occurrence of secondary bacterial infections were associated with an increased risk of CMV blood reactivation, which, however, does not seem to influence the outcome of COVID-19 ICU patients independently.
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Affiliation(s)
- Ilenia Gatto
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Coloretti
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Farinelli
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Camilla Avoni
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Caciagli
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Busani
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Sarti
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy
| | - Monica Pecorari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy
| | - William Gennari
- Virology and Molecular Microbiology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Franceschini
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Meschiari
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy ,Intensive Care Department, University Hospital of Modena, L.go del Pozzo 71, 41125 Modena, Italy
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24
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Deng J, Zhou F, Hou W, Heybati K, Ali S, Chang O, Silver Z, Dhivagaran T, Ramaraju HB, Wong CY, Zuo QK, Lapshina E, Mellett M. Efficacy of lopinavir-ritonavir combination therapy for the treatment of hospitalized COVID-19 patients: a meta-analysis. Future Virol 2021; 17:10.2217/fvl-2021-0066. [PMID: 35145560 PMCID: PMC8815807 DOI: 10.2217/fvl-2021-0066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/08/2021] [Indexed: 12/15/2022]
Abstract
Aim: To evaluate the efficacy and safety of lopinavir-ritonavir (LPV/r) therapy in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in meta-analyses. Primary outcomes were length of stay, time for SARS-CoV-2 test conversion, mortality, incidence of mechanical ventilation, time to body temperature normalization and incidence of adverse events. Results: Twenty-four studies (n = 10,718) were included. LPV/r demonstrated no significant benefit over the control groups in all efficacy outcomes. The use of LPV/r was associated with a significant increase in the odds of adverse events. Conclusion: Given the lack of efficacy and increased incidence of adverse events, the clinical use of LPV/r in hospitalized COVID-19 patients is not recommended.
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Affiliation(s)
- Jiawen Deng
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Wenteng Hou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Kiyan Heybati
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Saif Ali
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Oswin Chang
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Zachary Silver
- Faculty of Science, Carleton University, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
| | - Thanansayan Dhivagaran
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Integrated Biomedical Engineering & Health Sciences Program, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Chi Yi Wong
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Qi Kang Zuo
- Department of Anesthesiology, Rutgers, New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Elizabeth Lapshina
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Madeline Mellett
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
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Falcone M, Tiseo G, Valoriani B, Barbieri C, Occhineri S, Mazzetti P, Vatteroni ML, Suardi LR, Riccardi N, Pistello M, Tacconi D, Menichetti F. Efficacy of Bamlanivimab/Etesevimab and Casirivimab/Imdevimab in Preventing Progression to Severe COVID-19 and Role of Variants of Concern. Infect Dis Ther 2021; 10:2479-2488. [PMID: 34435337 PMCID: PMC8386337 DOI: 10.1007/s40121-021-00525-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the risk of hospitalization or death in patients infected by SARS-CoV2 variants of concern (VOCs) receiving combinations of monoclonal antibodies (mAbs), bamlanivimab/etesevimab or casirivimab/imdevimab. METHODS Observational prospective study conducted in two Italian hospitals (University Hospital of Pisa and San Donato Hospital, Arezzo) including consecutive outpatients with COVID-19 who received bamlanivimab/etesevimab or casirivimab/imdevimab from March 20th to May 10th 2021. All patients were at high risk of COVID-19 progression according to FDA/AIFA recommendations. Patients were divided into two study groups according to the infecting viral strain (VOCs): Alpha and Gamma group. The primary endpoint was a composite of hospitalization or death within 30 days from mAbs infusion. A Cox regression multivariate analysis was performed to identify factors associated with the primary outcome in the overall population. RESULTS The study included 165 patients: 105 were infected by the VOC Alpha and 43 by the VOC Gamma. In the Alpha group, no differences in the primary endpoint were observed between patients treated with bamlanivimab/etesevimab or casirivimab/imdevimab. Conversely, in the Gamma group, a higher proportion of patients treated with bamlanivimab/etesevimab met the primary endpoint compared to those receiving casirivimab/imdevimab (55% vs. 17.4%, p = 0.013). On multivariate Cox-regression analysis, the Gamma variant and days from symptoms onset to mAbs infusion were factors independently associated with higher risk of hospitalization or death, while casirivimab/imdevimab was protective (HR 0.33, 95% CI 0.13-0.83, p = 0.019). CONCLUSIONS In patients infected by the SARS-CoV-2 Gamma variant, bamlanivimab/etesevimab should be used with caution because of the high risk of disease progression.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | | | - Chiara Barbieri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | | | | | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Mauro Pistello
- Virology Unit, Pisa University Hospital, Pisa, Italy
- Retrovirus Center, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Danilo Tacconi
- Infectious Disease Unit, San Donato Hospital Arezzo, Arezzo, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienza Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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What have we learned from the first to the second wave of COVID-19 pandemic? An international survey from the ESCMID Study Group for Infection in the Elderly (ESGIE) group. Eur J Clin Microbiol Infect Dis 2021; 41:281-288. [PMID: 34775534 PMCID: PMC8590524 DOI: 10.1007/s10096-021-04377-1] [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: 08/19/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
The purpose of this survey is to explore changes in the management of COVID-19 during the first versus the second wave, with particular emphasis on therapies, antibiotic prescriptions, and elderly care. An internet-based questionnaire survey was distributed to European Society of Clinical Microbiology and Infectious Diseases (ESCMID) members. Therapeutic approach to patients with mild-to-moderate (PiO2/FiO2 200–350) and severe (PiO2/FiO2 < 200) COVID-19, antibiotic use, and reasons for excluding patients from the intensive care unit (ICU) were investigated. A total of 463 from 21 countries participated in the study. Most representatives were infectious disease specialists (68.3%). During the second wave of pandemic, physicians abandoned the use of hydroxychloroquine, lopinavir/ritonavir, and azithromycin in favor of dexamethasone, low-molecular weight heparin (LMWH), and remdesivir in mild-to-moderate COVID-19. In critically ill patients, we detected an increased use of high-dose steroids (51%) and a decrease in tocilizumab use. The use of antibiotics at hospital admission decreased but remained high in the second wave. Age was reported to be a main consideration for exclusion of patients from ICU care by 25% of responders; a third reported that elderly were not candidates for ICU admission in their center. The decision to exclude patients from ICU care was based on the individual decision of an intensivist in 59.6% of cases. The approach of physicians to COVID-19 changed over time following evidence accumulation and guidelines. Antibiotic use at hospital admission and decision to exclude patients from ICU care remain critical aspects that should be better investigated and harmonized among clinicians.
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Cozzi-Lepri A, Smith C, Mussini C. Signals were broadly positive for months, but never definitive: the tocilizumab story. Clin Microbiol Infect 2021; 28:371-374. [PMID: 34768021 PMCID: PMC8576060 DOI: 10.1016/j.cmi.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022]
Abstract
Background Most treatment guidelines for coronavirus disease 2019 (COVID-19) currently recommend tocilizumab in combination with dexamethasone in critically ill patients who are exhibiting rapid respiratory decompensation. Aims To produce a critical review and summary of the pathway which led to the repurposing of tocilizumab for COVID-19 treatment, from in vitro observations to guidelines recommendations. Sources All studies evaluating the effectiveness of tocilizumab to treat COVID-19 disease published between July 2020 and July 2021. Content Two large and methodologically well conducted observational studies, the TESEO and the STOP COVID cohorts, showed a reduction in the risk of invasive mechanical ventilation or death in patients treated with tocilizumab as compared to standard of care in 2020. Concomitantly, and up to February 2021, a number of randomized trials (RCTs) with small sample sizes were showing discrepant results. These RCTs had a number of issues: small sample size, various designs and inclusion criteria, and different dosages of tocilizumab used. The confidence interval of the meta-analytic estimate for the RCT results was consistent with the hypothesis of no efficacy of tocilizumab. In our opinion, this was mainly because the meta-analysis included small and heterogeneous studies. These results led to a delay in the inclusion of tocilizumab in guidelines which occurred only in the summer of 2021. Implications Although observational studies are unable to control for unmeasured confounding, they can be put together quickly during a pandemic and promptly provide important information. The large sample size allows us to investigate effect measure modifiers and to better target interventions. It is key that the effect size is somewhat large (RR > 2), all sources of bias are properly accounted for, and the direct evidence is weighted against these factors. It appears to us that for tocilizumab, not having dismissed the results of carefully designed and analysed observational studies in 2020 could have prevented many deaths over those months.
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Affiliation(s)
- Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK.
| | - Colette Smith
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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Franceschini E, Cozzi-Lepri A, Santoro A, Bacca E, Lancellotti G, Menozzi M, Gennari W, Meschiari M, Bedini A, Orlando G, Puzzolante C, Digaetano M, Milic J, Codeluppi M, Pecorari M, Carli F, Cuomo G, Alfano G, Corradi L, Tonelli R, De Maria N, Busani S, Biagioni E, Coloretti I, Guaraldi G, Sarti M, Luppi M, Clini E, Girardis M, Gyssens IC, Mussini C. Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study. Microorganisms 2021; 9:microorganisms9091896. [PMID: 34576791 PMCID: PMC8465957 DOI: 10.3390/microorganisms9091896] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Herpes simplex 1 co-infections in patients with COVID-19 are considered relatively uncommon; some reports on re-activations in patients in intensive-care units were published. The aim of the study was to analyze herpetic re-activations and their clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 PCR on plasma twice a week. Methods: we conducted a prospective, observational, single-center study involving 70 consecutive patients with severe/critical SARS-CoV-2 pneumonia tested for HSV-1 hospitalized at Azienda Ospedaliero-Universitaria of Modena. Results: of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations of HSV-1 infection corresponding to 15 events (4 pneumonia, 5 herpes labialis, 3 gingivostomatitis, one encephalitis and two hepatitis). HSV-1 positive patients were more frequently treated with steroids than HSV-1 negative patients (76.2% vs. 49.0%, p = 0.036) and more often underwent mechanical ventilation (IMV) (57.1% vs. 22.4%, p = 0.005). In the unadjusted logistic regression analysis, steroid treatment, IMV, and higher LDH were significantly associated with an increased risk of HSV1 re-activation (odds ratio 3.33, 4.61, and 16.9, respectively). The association with the use of steroids was even stronger after controlling for previous use of both tocilizumab and IMV (OR = 5.13, 95% CI:1.36–19.32, p = 0.016). The effect size was larger when restricting to participants who were treated with high doses of steroids while there was no evidence to support an association with the use of tocilizumab Conclusions: our study shows a high incidence of HSV-1 re-activation both virologically and clinically in patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids.
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Affiliation(s)
- Erica Franceschini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
- Correspondence: (E.F.); (C.M.)
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK;
| | - Antonella Santoro
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Erica Bacca
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Guido Lancellotti
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Marianna Menozzi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - William Gennari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Andrea Bedini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gabriella Orlando
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Cinzia Puzzolante
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Margherita Digaetano
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Jovana Milic
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Mauro Codeluppi
- Infectious Diseases Unit, G. da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Monica Pecorari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Federica Carli
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gianluca Cuomo
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gaetano Alfano
- Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy;
| | - Luca Corradi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Roberto Tonelli
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.T.); (E.C.)
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy;
| | - Stefano Busani
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Emanuela Biagioni
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Irene Coloretti
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Giovanni Guaraldi
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Mario Sarti
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Mario Luppi
- Hematology Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Enrico Clini
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.T.); (E.C.)
| | - Massimo Girardis
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Inge C. Gyssens
- Radboud Center for Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Cristina Mussini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
- Correspondence: (E.F.); (C.M.)
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Safarchi A, Fatima S, Ayati Z, Vafaee F. An update on novel approaches for diagnosis and treatment of SARS-CoV-2 infection. Cell Biosci 2021; 11:164. [PMID: 34420513 PMCID: PMC8380468 DOI: 10.1186/s13578-021-00674-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022] Open
Abstract
The ongoing pandemic of coronavirus disease 2019 (COVID-19) has made a serious public health and economic crisis worldwide which united global efforts to develop rapid, precise, and cost-efficient diagnostics, vaccines, and therapeutics. Numerous multi-disciplinary studies and techniques have been designed to investigate and develop various approaches to help frontline health workers, policymakers, and populations to overcome the disease. While these techniques have been reviewed within individual disciplines, it is now timely to provide a cross-disciplinary overview of novel diagnostic and therapeutic approaches summarizing complementary efforts across multiple fields of research and technology. Accordingly, we reviewed and summarized various advanced novel approaches used for diagnosis and treatment of COVID-19 to help researchers across diverse disciplines on their prioritization of resources for research and development and to give them better a picture of the latest techniques. These include artificial intelligence, nano-based, CRISPR-based, and mass spectrometry technologies as well as neutralizing factors and traditional medicines. We also reviewed new approaches for vaccine development and developed a dashboard to provide frequent updates on the current and future approved vaccines.
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Affiliation(s)
- Azadeh Safarchi
- School of Biotechnology and Biomolecular Science, University of New South Wales, NSW Sydney, Australia
| | - Shadma Fatima
- School of Biotechnology and Biomolecular Science, University of New South Wales, NSW Sydney, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Zahra Ayati
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Fatemeh Vafaee
- School of Biotechnology and Biomolecular Science, University of New South Wales, NSW Sydney, Australia
- UNSW Data Science Hub University of New South Wales, NSW Sydney, Australia
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Putot A, Bouiller K, Laborde C, Gilis M, Févre A, Hacquin A, Manckoundia P, Hoefler F, Bermejo M, Mendes A, Serratrice C, Prendki V, Sanchez S. Association between Early Antibiotic Therapy and In-Hospital Mortality among Older Patients with SARS-CoV-2 Pneumonia. J Gerontol A Biol Sci Med Sci 2021; 77:e115-e123. [PMID: 34272847 PMCID: PMC8406862 DOI: 10.1093/gerona/glab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is uncertain whether antibiotic therapy should be started in SARS CoV-2 pneumonia. We aimed to investigate the association between early antibiotic therapy and the risk of in-hospital mortality in older patients. Methods We performed a retrospective international cohort study (ANTIBIOVID) in five COVID-19 geriatric units in France and Switzerland. Among 1,357 consecutive patients aged 75 or more hospitalised and testing positive for SARS-CoV-2, 1072 had a radiologically confirmed pneumonia, of which 914 patients were still alive and hospitalized at 48 hours. To adjust for confounders, a propensity score for treatment was created, and stabilized inverse probability of treatment weighting (SIPTW) was applied. To assess the association between early antibiotic therapy and in-hospital 30-day mortality, SIPTW-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed. Results Of the 914 patients with SARS-CoV-2 pneumonia, median age of 86, 428 (46.8%) received antibiotics in the first 48 hours after diagnosis. Among these patients, 147 (34.3%) died in hospital within one month vs 118 patients (24.3%) with no early antibiotic treatment. After SIPTW, early antibiotic treatment was not significantly associated with mortality (adjusted hazard ratio, 1.23; 95% CI, 0.92-1.63; P = .160). Microbiologically confirmed superinfections occurred rarely in both groups (bacterial pneumonia: 2.5% vs 1.5%, P = .220; blood stream infection: 8.2% vs 5.2%, P = .120; Clostridioides difficile colitis: 2.4% vs 1.0%, P = .222). Conclusions In a large multicentre cohort of older inpatients with SARS-CoV-2 pneumonia, early antibiotic treatment did not appear to be associated with an improved prognosis.
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Affiliation(s)
- Alain Putot
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Kevin Bouiller
- Department of Infectious Diseases, Besançon University Hospital, Besançon, France
| | - Caroline Laborde
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Marine Gilis
- Department of Geriatrics, Besançon University Hospital, Besançon, France
| | - Amélie Févre
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Arthur Hacquin
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Florence Hoefler
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Messaline Bermejo
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christine Serratrice
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Sanchez
- Department of Clinical Research, Troyes Hospital Centre, Troyes, France
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Vicenti I, Gatti F, Scaggiante R, Boccuto A, Modolo E, Zago D, Basso M, Dragoni F, Bartolini N, Zazzi M, Parisi SG. Time Course of Neutralizing Antibody in Health Care Workers With Mild or Asymptomatic COVID-19 Infection. Open Forum Infect Dis 2021; 8:ofab312. [PMID: 34295945 PMCID: PMC8291533 DOI: 10.1093/ofid/ofab312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
We describe the time course of neutralizing antibody (NtAb) titer in a cohort of health care workers with mild or asymptomatic severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. NtAb levels decreased over time; however, serum neutralizing activity remained detectable after a median of 7 months from SARS-CoV-2 diagnosis in the majority of cases.
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Affiliation(s)
- Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Francesca Gatti
- Department of Molecular Medicine University of Padova, Padova, Italy
| | | | - Adele Boccuto
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Daniela Zago
- Department of Molecular Medicine University of Padova, Padova, Italy
| | - Monica Basso
- Department of Molecular Medicine University of Padova, Padova, Italy
| | - Filippo Dragoni
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Niccolo’ Bartolini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Wang YY, Huang Q, Shen Q, Zi H, Li BH, Li MZ, He SH, Zeng XT, Yao X, Jin YH. Quality of and Recommendations for Relevant Clinical Practice Guidelines for COVID-19 Management: A Systematic Review and Critical Appraisal. Front Med (Lausanne) 2021; 8:630765. [PMID: 34222270 PMCID: PMC8248791 DOI: 10.3389/fmed.2021.630765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The morbidity and mortality of coronavirus disease 2019 (COVID-19) are still increasing. This study aimed to assess the quality of relevant COVID-19 clinical practice guidelines (CPGs) and to compare the similarities and differences between recommendations. Methods: A comprehensive search was conducted using electronic databases (PubMed, Embase, and Web of Science) and representative guidelines repositories from December 1, 2019, to August 11, 2020 (updated to April 5, 2021), to obtain eligible CPGs. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the quality of CPGs. Four authors extracted relevant information and completed data extraction forms. All data were analyzed using R version 3.6.0 software. Results: In total, 39 CPGs were identified and the quality was not encouragingly high. The median score (interquartile range, IQR) of every domain from AGREE II for evidence-based CPGs (EB-CPGs) versus (vs.) consensus-based CPG (CB-CPGs) was 81.94% (75.00-84.72) vs. 58.33% (52.78-68.06) in scope and purpose, 59.72% (38.89-75.00) vs. 36.11% (33.33-36.11) in stakeholder involvement, 64.58% (32.29-71.88) vs. 22.92% (16.67-26.56) in rigor of development, 75.00% (52.78-86.81) vs. 52.78% (50.00-63.89) in clarity of presentation, 40.63% (22.40-62.50) vs. 20.83% (13.54-25.00) in applicability, and 58.33% (50.00-100.00) vs. 50.00% (50.00-77.08) in editorial independence, respectively. The methodological quality of EB-CPGs were significantly superior to the CB-CPGs in the majority of domains (P < 0.05). There was no agreement on diagnosis criteria of COVID-19. But a few guidelines show Remdesivir may be beneficial for the patients, hydroxychloroquine +/- azithromycin may not, and there were more consistent suggestions regarding discharge management. For instance, after discharge, isolation management and health status monitoring may be continued. Conclusions: In general, the methodological quality of EB-CPGs is greater than CB-CPGs. However, it is still required to be further improved. Besides, the consistency of COVID-19 recommendations on topics such as diagnosis criteria is different. Of them, hydroxychloroquine +/- azithromycin may be not beneficial to treat patients with COVID-19, but remdesivir may be a favorable risk-benefit in severe COVID-19 infection; isolation management and health status monitoring after discharge may be still necessary. Chemoprophylaxis, including SARS-CoV 2 vaccines and antiviral drugs of COVID-19, still require more trials to confirm this.
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Affiliation(s)
- Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Quan Shen
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Ming-Zhen Li
- Precision Medicine Center, Second People's Hospital of Huaihua, Huaihua, China
| | - Shao-Hua He
- Precision Medicine Center, Second People's Hospital of Huaihua, Huaihua, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Xiaomei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
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Eberle RJ, Olivier DS, Amaral MS, Gering I, Willbold D, Arni RK, Coronado MA. The Repurposed Drugs Suramin and Quinacrine Cooperatively Inhibit SARS-CoV-2 3CL pro In Vitro. Viruses 2021; 13:873. [PMID: 34068686 PMCID: PMC8170883 DOI: 10.3390/v13050873] [Citation(s) in RCA: 15] [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: 04/02/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Since the first report of a new pneumonia disease in December 2019 (Wuhan, China) the WHO reported more than 148 million confirmed cases and 3.1 million losses globally up to now. The causative agent of COVID-19 (SARS-CoV-2) has spread worldwide, resulting in a pandemic of unprecedented magnitude. To date, several clinically safe and efficient vaccines (e.g., Pfizer-BioNTech, Moderna, Johnson & Johnson, and AstraZeneca COVID-19 vaccines) as well as drugs for emergency use have been approved. However, increasing numbers of SARS-Cov-2 variants make it imminent to identify an alternative way to treat SARS-CoV-2 infections. A well-known strategy to identify molecules with inhibitory potential against SARS-CoV-2 proteins is repurposing clinically developed drugs, e.g., antiparasitic drugs. The results described in this study demonstrated the inhibitory potential of quinacrine and suramin against SARS-CoV-2 main protease (3CLpro). Quinacrine and suramin molecules presented a competitive and noncompetitive inhibition mode, respectively, with IC50 values in the low micromolar range. Surface plasmon resonance (SPR) experiments demonstrated that quinacrine and suramin alone possessed a moderate or weak affinity with SARS-CoV-2 3CLpro but suramin binding increased quinacrine interaction by around a factor of eight. Using docking and molecular dynamics simulations, we identified a possible binding mode and the amino acids involved in these interactions. Our results suggested that suramin, in combination with quinacrine, showed promising synergistic efficacy to inhibit SARS-CoV-2 3CLpro. We suppose that the identification of effective, synergistic drug combinations could lead to the design of better treatments for the COVID-19 disease and repurposable drug candidates offer fast therapeutic breakthroughs, mainly in a pandemic moment.
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Affiliation(s)
- Raphael J. Eberle
- Institute of Biological Information Processing (IBI-7: Structural Biochemistry), Forschungszentrum Jülich, 52428 Jülich, Germany; (I.G.); (D.W.)
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße, 40225 Düsseldorf, Germany
| | - Danilo S. Olivier
- Campus Cimba, Federal University of Tocantins, Araguaína, TO 77824-838, Brazil;
| | - Marcos S. Amaral
- Institute of Physics, Federal University of Mato Grosso do Sul, Campo Grande, MS 79070-900, Brazil;
| | - Ian Gering
- Institute of Biological Information Processing (IBI-7: Structural Biochemistry), Forschungszentrum Jülich, 52428 Jülich, Germany; (I.G.); (D.W.)
| | - Dieter Willbold
- Institute of Biological Information Processing (IBI-7: Structural Biochemistry), Forschungszentrum Jülich, 52428 Jülich, Germany; (I.G.); (D.W.)
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße, 40225 Düsseldorf, Germany
- JuStruct: Jülich Centre for Structural Biology, Forchungszentrum Jülich, 52428 Jülich, Germany
| | - Raghuvir K. Arni
- Multiuser Center for Biomolecular Innovation, IBILCE, Universidade Estadual Paulista (UNESP), São Jose do Rio Preto, SP 15054-000, Brazil;
| | - Monika A. Coronado
- Institute of Biological Information Processing (IBI-7: Structural Biochemistry), Forschungszentrum Jülich, 52428 Jülich, Germany; (I.G.); (D.W.)
- Multiuser Center for Biomolecular Innovation, IBILCE, Universidade Estadual Paulista (UNESP), São Jose do Rio Preto, SP 15054-000, Brazil;
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Successful Treatment of Embolic Aortic Valve Endocarditis in a Patient Affected by COVID-19 Pneumonia. SURGERIES 2021. [DOI: 10.3390/surgeries2010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has required reorganization of the cardiac surgery system in the Italian region of Lombardy during early 2020. As a consequence, the hub-and-spoke (H&S) model was introduced to manage emergent/urgent cardiac surgery cases. In this challenging scenario, in which thousands of people were affected by the novel coronavirus, we present the case of a successful treatment of a middle-aged patient affected by both COVID-19 pneumonia and subacute aortic endocarditis. Learning objective: How to treat endocarditis during the COVID-19 pandemic.
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