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Takashima K, Iwasa M, Ando W, Uemura K, Hamada H, Mae H, Maeda Y, Sugano N. Magnetic resonance imaging screening for osteonecrosis of the femoral head after coronavirus disease 2019. Mod Rheumatol 2024; 34:813-819. [PMID: 37804206 DOI: 10.1093/mr/road095] [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: 07/05/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES Systemic steroid administration has been suggested for the treatment of coronavirus disease 2019 (COVID-19), but the occurrence of osteonecrosis of the femoral head (ONFH) was one of the concerns for this treatment. This study aimed to use magnetic resonance imaging (MRI) to assess the incidence of ONFH after the treatment for COVID-19. METHODS The study included 41 patients who were hospitalized and treated for pneumonia or other COVID-19-induced diseases. We conducted interviews with these patients regarding hip pain and performed MRI screenings for ONFH. The incidence and timing of ONFH after COVID-19 treatment were investigated. RESULTS Of the 41 patients, one died of pneumonia and the remaining patients did not complain of hip pain. MRI screening was performed for 26 patients, and asymptomatic ONFH was detected in one patient (3.8%) whose ONFH appeared 1 month after the COVID-19 infection. CONCLUSIONS Our MRI screening of ONFH in post-COVID-19 patients revealed asymptomatic ONFH, which would not have been identified without active screening. Physicians should be aware that ONFH may occur in patients after treating COVID-19.
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Affiliation(s)
- Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Maeda
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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2
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Za P, Papalia GF, Russo F, Vasta S, Vadalà G, Papalia R. Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review. ANNALS OF JOINT 2024; 9:31. [PMID: 39114419 PMCID: PMC11304089 DOI: 10.21037/aoj-23-67] [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: 11/15/2023] [Accepted: 03/19/2024] [Indexed: 08/10/2024]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19). Patients with COVID-19 manifested symptoms mainly related to the respiratory system, but also the musculoskeletal system can be involved. COVID-19 has been described as a possible cause of knee osteonecrosis (ON). A systematic review was performed to investigate the hypothetical correlation between COVID-19 and knee ON. Methods Inclusion criteria were all articles reporting cases of knee ON after a diagnosis of SARS-CoV-2 infection. Considering that COVID-19 is an emerging disease, all levels of evidence studies were included. Results Finally, two case series and three case reports were included. We extracted data regarding demographic and clinical characteristics, details of magnetic resonance imaging (MRI), use of corticosteroids (CCS), temporal correlation between ON and COVID-19, treatment of the lesion and its outcomes. A total of seven cases of post-COVID knee ON have been described. Knee pain arose on average 11 weeks after the diagnosis of COVID-19. All patients had knee MRI showing ON. CCS were used to treat COVID-19-related symptoms in four cases. Conservative treatment was successful in five patients. Conclusions The correlation between COVID-19 and ON remains unclear. Probably post-COVID-19 ON has a multifactorial origin in which factors related to the patient, consequences of COVID-19 and CCS therapy add up to cause a reduction of blood supply and bone vitality until ON is triggered. A greater number of patients is needed to clarify the role of COVID-19 in the etiopathogenesis of knee ON.
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Affiliation(s)
- Pierangelo Za
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Koutalos AA, Koskiniotis A, Rountas C, Konstantinou E, Georgiadou S, Stefos A, Gatselis NK, Dalekos GN, Malizos KN. Osteonecrosis risk after steroids-related treatment of COVID-19 is not negligible: A cross sectional study. Eur J Intern Med 2024; 123:127-131. [PMID: 38281818 DOI: 10.1016/j.ejim.2024.01.006] [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: 09/20/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND & AIMS During the pandemic, steroids use at various dosages and durations for the treatment of COVID-19 patients, especially in hospitalized patients, was a common and effective strategy. However, steroid administration is associated with osteonecrosis as an adverse event. The aim of the study was to examine the prevalence of skeleton osteonecrosis in COVID-19 patients treated with or without steroids. METHODS Eighty randomly selected hospitalized COVID-19 patients were analyzed, of which 40 were managed with a published protocol including steroids and 40 did not receive steroids. Demographics and laboratory measurements including white blood cells count, C-reactive protein and ferritin were retrieved from the medical records. All patients underwent magnetic resonance imaging of the hips, shoulders, and knees. Subsequently, all patients were clinically examined and Oxford hip score (OHS) and EuroQol- 5 Dimension (EQ-5D-5 L) were documented. RESULTS Three patients (3/40; 7.5 %) treated with steroids were diagnosed with femoral head osteonecrosis. None of the patients in the non-steroid-treated group developed osteonecrosis. There were no differences between the two groups regarding OHS and EQ-5D-5 L. Patients with osteonecrosis had higher ferritin levels, received higher doses of corticosteroids (median dose 2200 mg), and had longer hospitalization. CONCLUSIONS COVID-19-related therapy with steroids resulted in lower prevalence of osteonecrosis than that previously recorded in patients with severe acute respiratory syndrome caused by coronavirus-type-1. However, this risk seems not negligible and therefore, high clinical suspicion for early diagnosis is warranted, given the fact that a great proportion of hospitalized patients received steroids during the COVID-19 pandemic.
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Affiliation(s)
- Antonios A Koutalos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, Greece
| | - Alexandros Koskiniotis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, Greece
| | - Christos Rountas
- Department of Radiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Efstathios Konstantinou
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, Greece
| | - Sarah Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Aggelos Stefos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, Greece.
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Sehrawat S, Ojha MM, Gamanagatti S, Nag HL, Kumar V. Is COVID-19 an independent risk factor for the development of avascular necrosis of the hip? A retrospective study to evaluate the factors associated with avascular necrosis of the hip in patients who had COVID-19 infection. INTERNATIONAL ORTHOPAEDICS 2024; 48:745-752. [PMID: 37923881 DOI: 10.1007/s00264-023-06028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE The cumulative effect of hyper-coagulative COVID-19 disease and using steroids leads to increased avascular necrosis (AVN) hip incidence. This study aims to correlate the various factors of COVID-19 infection with the occurrence of AVN hip. METHODS It is a retrospective cross-sectional study of non-traumatic AVN hip patients with a history of COVID-19 infection. A total number of 50 patients satisfied the inclusion criteria. The following details were obtained: (a) patient's demographics, (b) COVID-19: interval of infection and groin pain, duration of symptoms, severity, steroid intake, (c) AVN hip: involved side, Ficat-Arlet staging. RESULTS The mean age was 36.3 years (range: 20-60), and body mass index (BMI) was 25.13 kg/m2 (range: 18.50-31.50). There were 45 males and five females. Sixty percent (30) of patients managed at home, 24% (12) required admission into the ward, 2% (1) were in ICU only, and 14% (7) admitted to both ICU and ward. The mean interval of COVID-19 infection and onset of hip pain was 359.02 days (range: 10-822 days). Thirty-eight percent (19) patients required steroids (injection and oral), 46% (23) took steroids (oral only), whereas 16% (8) recovered without steroids. The stage of AVN correlated with the severity of COVID-19 infection (p-value -0.038) and significant improvement in VAS and HHS after treatment in each stage. The mean follow-up was 9.79 months (6-19 months). CONCLUSION A low-dose steroid intake with moderate to severe COVID-19 infection produces an additive effect on the development of AVN hip. Most affected individuals were adult males, and stage II AVN was the most common, managed with bisphosphonates and core decompression for short intervals.
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Affiliation(s)
| | | | | | - Hira Lal Nag
- Department of Orthopaedics, AIIMS, New Delhi, India
| | - Vijay Kumar
- Department of Orthopaedics, AIIMS, New Delhi, India
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5
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Pal S, Sharma S, Porwal K, Tiwari MC, Khan YA, Kumar S, Kumar N, Chattopadhyay N. The Role of Osteogenic Effect and Vascular Function in Bone Health in Hypertensive Rats: A Study of Anti-hypertensive and Hemorheologic Drugs. Calcif Tissue Int 2024; 114:295-309. [PMID: 38102510 DOI: 10.1007/s00223-023-01170-4] [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: 06/17/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
Vascular dysfunction contributes to the development of osteopenia in hypertensive patients, as decreased blood supply to bones results in tissue damage and dysfunction. The effect of anti-hypertensive medicines on bone mass in hypertensive individuals is inconclusive because of the varied mechanism of their action, and suggests that reducing blood pressure (BP) alone is insufficient to enhance bone mass in hypertension. Pentoxifylline (PTX), a hemorheological drug, improves blood flow by reducing blood viscosity and angiogenesis, also has an osteogenic effect. We hypothesized that improving vascular function is critical to increasing bone mass in hypertension. To test this, we screened various anti-hypertensive drugs for their in vitro osteogenic effect, from which timolol and hydralazine were selected. In adult female spontaneously hypertensive rats (SHRs), timolol and hydralazine did not improve vascular function and bone mass, but PTX improved both. In female SHR animals, PTX restored bone mass, strength and mineralization, up to the level of normotensive control rats. In addition, we observed lower blood vasculature in the femur of adult SHR animals, and PTX restored them. PTX also restored the bone vascular and angiogenesis parameters that had been impaired in OVX SHR compared to sham SHR. This study demonstrates the importance of vascular function in addition to increased bone mass for improving bone health as achieved by PTX without affecting BP, and suggests a promising treatment option for osteoporosis in hypertensive patients, particularly at-risk postmenopausal women.
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Affiliation(s)
- Subhashis Pal
- Division of Endocrinology, CSIR-Central Drug Research Institute, Council of Scientific and Industrial Research, Lucknow, 226031, India
| | - Shivani Sharma
- Division of Endocrinology, CSIR-Central Drug Research Institute, Council of Scientific and Industrial Research, Lucknow, 226031, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Konica Porwal
- Division of Endocrinology, CSIR-Central Drug Research Institute, Council of Scientific and Industrial Research, Lucknow, 226031, India
| | - Mahesh C Tiwari
- Division of Endocrinology, CSIR-Central Drug Research Institute, Council of Scientific and Industrial Research, Lucknow, 226031, India
| | - Yasir A Khan
- Division of Endocrinology, CSIR-Central Drug Research Institute, Council of Scientific and Industrial Research, Lucknow, 226031, India
| | - Saroj Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, 140001, Punjab, India
| | - Navin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, 140001, Punjab, India
| | - Naibedya Chattopadhyay
- Division of Endocrinology, CSIR-Central Drug Research Institute, Council of Scientific and Industrial Research, Lucknow, 226031, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
- Division of Endocrinology, CSIR-Central Drug Research Institute, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow, 226 031, India.
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6
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da Silva LNM, Filho AGO, Guimarães JB. Musculoskeletal manifestations of COVID-19. Skeletal Radiol 2023:10.1007/s00256-023-04549-4. [PMID: 38117308 DOI: 10.1007/s00256-023-04549-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
During the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected millions of people worldwide, with acute respiratory distress syndrome (ARDS) being the most common severe condition of pulmonary involvement. Despite its involvement in the lungs, SARS-CoV-2 causes multiple extrapulmonary manifestations, including manifestations in the musculoskeletal system. Several cases involving bone, joint, muscle, neurovascular and soft tissues were reported shortly after pandemic onset. Even after the acute infection has resolved, many patients experience persistent symptoms and a decrease in quality of life, a condition known as post-COVID syndrome or long COVID. COVID-19 vaccines have been widely available since December 2020, preventing millions of deaths during the pandemic. However, adverse reactions, including those involving the musculoskeletal system, have been reported in the literature. Therefore, the primary goal of this article is to review the main imaging findings of SARS-CoV-2 involvement in the musculoskeletal system, including acute, subacute, chronic and postvaccination manifestations.
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Affiliation(s)
- Lucas N M da Silva
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil
| | | | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil.
- Department of Radiology, Universidade Federal de Sao Paulo, UNIFESP-EPM, Sao Paulo, Brazil.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
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7
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Sinha PR, Mallick N, Sahu RL. Avascular Necrosis of the Hip after the COVID-19 Pandemic. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S661-S664. [PMID: 37654323 PMCID: PMC10466589 DOI: 10.4103/jpbs.jpbs_87_23] [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: 01/30/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background and Objectives It is clear that COVID-19 can have a wide range of effects on the body, and the musculoskeletal system is no exception. Studies are ongoing to better understand how the virus may impact the hip bone and joint tissue. However, it is known that COVID-19 can cause inflammation and damage to various parts of the body, including the bones and joints, which could lead to pain, stiffness, and other symptoms. Materials and Methods A retrospective analysis is done with ten patients admitted to the hospital due to COVID-19 and later complained of hip pain. Magnetic resonance imaging (MRI) was performed on the patients, and it was found that they had degenerative changes characterized by avascular necrosis (AVN) of the head of the femur. One of the patients had a history of previous surgery on the femur with a plate and screws and was doing well but developed AVN after contracting COVID-19. Results Observation among these groups shows a strong association between the history of COVID-19, high levels of IgG antibodies, the presence of joint abnormalities, and moderately severe symptoms. There is no evidence of identifying autoimmune, degenerative, or AVN diseases. This set of patients responded positively to supportive therapy and anti-inflammatory drugs used in empirical treatment, which subsided joint pain and acute inflammatory symptoms. Conclusions It has been determined that there are significant musculoskeletal complications in COVID-19 patients, including AVN, which may be caused by the high use of steroids and microembolism leading to bone necrosis. Therefore, further studies and long-term follow-up are recommended.
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Affiliation(s)
- Priti R. Sinha
- Department of Orthopaedics, GS Medical College and Hospital, Pilkhuwa, Hapur, Uttar Pradesh, India
| | - Nitin Mallick
- Department of Orthopaedics, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Ramjee L. Sahu
- Department of Orthopaedics, Saraswati Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India
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Bialik VE, Karateev AE, Bialik EI, Makarov MA, Makarov SA, Roskidailo AA, Nesterenko VA, Lila AM, Malygina MA. Avascular necrosis of the epiphyses of bones in patients who have had SARS-CoV-2 infection: Clinical observations and a narrative review of literature data. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-535-545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The SARS-CoV-2 coronavirus pandemic is a leading medical problem that is in the focus of attention of representatives of all medical specialties. In addition to fighting the COVID-19 infection itself, the task of preventing and treating a wide range of complications arising after the disease is becoming increasingly urgent. One of these complications is avascular necrosis (AN) of bone tissue – a severe pathology that leads to serious suffering, a decrease in the quality of life and disability of patients. For the period from 2020 to 2022 there are 9 reviews in the world literature devoted to the pathogenesis, clinical features and treatment possibilities of this complication. During the same period, 5 articles were published describing clinical observations of AN after suffering COVID-19.The purpose of this work is to demonstrate our own clinical observations, as well as to review the available literature data on the problem of AN after COVID-19 infection. Based on the analysis, it can be concluded that AN after SARS-CoV-2 infection most often develops in the femoral head (>50% of cases), occurs regardless of the severity of the disease and the cumulative dose of glucocorticoids used in the acute period of the disease. It seems advisable to perform an MRI of the hip joints at least once every 3 months for all patients who have had COVID-19 in severe and moderate form during the first year after convalescence.
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Affiliation(s)
- V. E. Bialik
- V.A. Nasonova Research Institute of Rheumatology
| | | | - E. I. Bialik
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | | | | | | | | | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - M. A. Malygina
- N.V. Sklifosovskiy Research Institute for Emergency Medicine
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Postacute sequelae of SARS-CoV-2 infection. Osteonecrosis must not be overlooked. Int J Infect Dis 2022; 121:11-13. [PMID: 35462037 PMCID: PMC9022373 DOI: 10.1016/j.ijid.2022.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022] Open
Abstract
Recovery from COVID-19 is not always uneventful, especially in critically ill hospitalized patients. Persistent symptoms including fatigue/ weakness, shortness of breath, anxiety, and depression have been described at one-year follow-up. Furthermore, symptoms from the musculoskeletal system like joint pain or stiffness are underreported in studies with long-term follow-up of up to one year. Infection with SARS-CoV-2 itself has been associated with endothelial damage, and together with high-dose corticosteroid treatment, it is predisposed to the dissemination of microthrombi and the development of femoral head osteonecrosis (FHOn), as it has been shown during the previous (2003-2004) coronavirus outbreaks. A resurgence of FHOn cases is anticipated but this is not reflected in the existing studies with long-term follow-up. Prompt diagnosis is critical for early treatment and possibly for the hip joint preservation. Patients with COVID-19 treated with corticosteroids should be screened for avascular necrosis early after discharge from the hospital. Every healthcare worker involved in the management of these patients should maintain a high level of suspicion and should be alert when patients report symptoms such as vague aches at the buttocks, hip area, adductors, and/or above the knee. Studies are needed to identify risk factors for FHOn including disease severity, type of steroid, cumulative dose, and duration of treatment.
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10
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Aggressive Presentation and Rapid Progression of Osteonecrosis of the Femoral Head After COVID-19. Indian J Orthop 2022; 56:1259-1267. [PMID: 35495964 PMCID: PMC9037053 DOI: 10.1007/s43465-022-00635-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aim to report the consecutive patients diagnosed with osteonecrosis of femoral head (ONFH) following recovery from COVID-19 disease and elucidate the unique features of ONFH associated with COVID-19. METHODS Consecutive 22 patients (39 hips) recovered from COVID-19 and presented with ONFH from November 2020 to October 2021 were included. All the patients received corticosteroids as a supportive treatment during COVID-19. Patients were classified into two types based on the type of presentation, namely classic ONFH and rapidly destructive coxarthrosis (RDC) depending on radiographs, MRI, inflammatory markers and hip aspiration findings. Harris hip score was used to evaluate the functional outcome before and after treatment. RESULTS The mean time to diagnose of ONFH from the onset of hip symptoms was 39.3 days (range 10-90 days). The average duration of onset of hip symptoms after COVID 19 infection was 7.5 months (range 3 - 11 months). The average cumulative dose of methylprednisolone equivalent was 811 mg (range 200-2100 mg) and the average duration of steroid intake was 2.8 weeks. There was significant elevation in the inflammatory markers in RDC group compared to classic ONFH (p < 0.05). The Harris hip score improved from 63.6 ± 23.2 at presentation to 82.6 ± 9.6 after treatment (p < 0.05). Three patients had features of RDC. Among the three patients with RDC, two patients had rapid progression of ONFH and underwent total hip arthroplasty (THA). The third patient is awaiting a THA. CONCLUSION ONFH after COVID-19 can have a varied presentation. While the most common presentation is like classical ONFH, some patients can have an acute and aggressive presentation with rapid destruction. They have features like elevated serological markers and extensive periarticular bone and soft tissue edema. A low cumulative dose of steroids in our patients suggests that the COVID-19-associated vasculitis may play a role in the pathogenesis of ONFH.
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11
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Shetty GM. Double Trouble-COVID-19 and the Widespread Use of Corticosteroids: Are We Staring at an Osteonecrosis Epidemic? Indian J Orthop 2022; 56:226-236. [PMID: 34720174 PMCID: PMC8547122 DOI: 10.1007/s43465-021-00546-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/10/2021] [Indexed: 02/04/2023]
Abstract
Background A combination of immune-mediated vascular damage and routine use of systemic corticosteroid (CS) therapy in COVID-19 may significantly increase the risk and burden of osteonecrosis (ON) after COVID-19. This narrative review explores the pathogenesis, risk factors, and possible preventive and early treatment measures for ON in COVID-19. Methods For this narrative review, an extensive literature search was performed using the PubMed, Medline, and Science Direct databases from January 2000 to August 2021 for relevant articles on etiopathogenesis, epidemiology, clinical manifestations, and treatment of severe acute respiratory syndrome coronavirus (SARS-CoV) infection and steroid-induced ON (SION). Results Pathogenesis of COVID-19, utility of corticosteroids in the treatment of COVID-19, pathogenesis of SION vis-a-vis SARS-CoV infection, associated risk factors, and early diagnosis and treatment of ON following CS therapy of SARS-CoV infection were discussed. Conclusion Preliminary data of COVID-19 and similar trends from the SARS 2003 epidemic indicate that the "angiocentric" pathogenesis of SARS-CoV-2 and treatment with high-dose CS may increase the risk of ON in COVID-19 patients. Risk stratification based on CS intake during COVID-19 treatment can help identify subjects at moderate to high-risk for ON where early preventive and follow-up plans can be initiated.
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Affiliation(s)
- Gautam M. Shetty
- Knee and Orthopaedic Clinic, 407B, Galleria, Hiranandani Gardens, Powai, Mumbai, 400076 India
- AIMD Research, Mumbai, India
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12
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Dar-Odeh N, Bobamuratova DT, Alnazzawi A, Babkair H, Jambi S, Abu-Hammad A, Abu-Hammad O. Jaw-related complications in COVID-19 patients; a systematic review. Cranio 2022:1-8. [PMID: 35083956 DOI: 10.1080/08869634.2022.2031438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this review was to highlight jaw-related complications in COVID-19 manifestations, their etiology, and prevention methods. METHODS A systematic review of literature was conducted. MEDLINE/PubMed, and Google Scholar were searched for the following keywords: "COVID-19" "Oral manifestations", "Musculoskeletal patients", "Mandible", "Jaw", "Osteonecrosis", "MRONJ", and "dry socket". RESULTS Only nine articles were included in this review. Jaw-related disorders associated with COVID-19 were dry socket, osteonecrosis, and orofacial pain related to temporomandibular joint disorders (TMD) and giant cell arteritis (GCA). CONCLUSION COVID-19 potentially predisposes to osteonecrosis due to thrombotic inflammatory phenomena caused by the disease itself or its therapeutic modalities. All jaw osteonecrosis cases reported so far in relation to COVID-19 affected the upper jaw. Orofacial pain in COVID-19 patients was related to TMD and GCA. Clinical evidence-based studies are required to investigate the actual prevalence and possible correlation between COVID-19 and jaw-related disorders.
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Affiliation(s)
- Najla Dar-Odeh
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
- School of Dentistry, University of Jordan, Amman, Jordan
| | | | - Ahmad Alnazzawi
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | - Hamzah Babkair
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | - Safa Jambi
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | | | - Osama Abu-Hammad
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
- School of Dentistry, University of Jordan, Amman, Jordan
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13
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Almutairi F, Alsuwaydani Z, Thekkiniyakath Ali A, M. Alraqibah M, A. Alharbi B, A. Alyahya R, N. Alrudhayman S, Albisher R. Role of dentist: COVID19 and mucormycosis. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S2-S6. [PMID: 36110677 PMCID: PMC9469452 DOI: 10.4103/jpbs.jpbs_734_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Dental practice has evolved over time and has adapted to the challenges that it has faced. The risk of infection spread via droplet and airborne routes poses a significant risk to the dentist who works close to patients. The risk of cross-infection between dental health-care personnel and patients can be very high due to the peculiar arrangements of dental settings. Dental clinics should have air purification systems with high volume excavators and negative pressure rooms for COVID-19 screening. Mucormycosis is a fungal disease that mostly occurs in immunocompromised individuals and those with uncontrolled diabetes. Dental extraction can trigger the occurrence. Increased occurrence of mucormycosis is seen in COVID-affected patients. This article gives a review on the dentistry-related transmission of COVID 19, the relation of COVID and mucormycosis.
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14
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Sulewski A, Sieroń D, Szyluk K, Dąbrowski M, Kubaszewski Ł, Lukoszek D, Christe A. Avascular Necrosis Bone Complication after Active COVID-19 Infection: Preliminary Results. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121311. [PMID: 34946256 PMCID: PMC8709043 DOI: 10.3390/medicina57121311] [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] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022]
Abstract
Background and objectives: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The adverse effect of the viral infection on bone and joint tissue has also been observed. Materials and Methods: We present a group of 10 patients with degeneration of large joints and adjacent epiphyses of long bones and the spine, with a background of bone infarctions and avascular necrosis (AVN) immediately after infection with the COVID-19 virus. In MR imaging, changes in the characteristics of AVN were documented. Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in the patients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes. No other clinically significant complications were observed following COVID-19 infection in the study group. No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The group of patients responded well to empirical treatment with steroids, which normalized acute inflammatory symptoms and pain in the joints. Conclusions: During coronavirus (COVID-19) infection, there are complications in the locomotor system, such as microembolism and the formation of AVN; hence, more research is needed.
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Affiliation(s)
- Adam Sulewski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61545 Poznan, Poland; (M.D.); (Ł.K.)
- Correspondence:
| | - Dominik Sieroń
- Division of Magnetic Resonance Imaging, Silesian Center for Heart Diseases, 41800 Zabrze, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40752 Katowice, Poland;
- I Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Str., 41940 Piekary Śląskie, Poland
| | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61545 Poznan, Poland; (M.D.); (Ł.K.)
| | - Łukasz Kubaszewski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61545 Poznan, Poland; (M.D.); (Ł.K.)
| | - Dawid Lukoszek
- Dawid Lukoszek Physiotherapy Osteopathy, 42690 Hanusek, Poland;
| | - Andreas Christe
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland;
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15
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Abstract
BACKGROUND COVID-19 is an emergent infection, the long-term complications of which are still under study. While hypercoagulability is a common feature in severe cases, the incidence of ischemic complications such as osteonecrosis remains unknown. Previous studies on SARS-CoV1 found an increase in osteonecrosis 3-36 months after infection, and it is still unclear if this was related to the use of corticosteroids or to the virus itself. METHODS We introduce a 78-year-old woman who complained of right knee pain and swelling a month after COVID-19 infection onset. Her knee radiography showed no significant changes compared to previous ones. MRI, on the other hand, found osteonecrosis in the internal femoral condyle. No coagulation abnormalities were found in blood tests. RESULTS While knee replacement should be her main treatment, it will be long delayed due to the pandemic. In the meantime, we increased her tapentadol and salicylic acid doses and gave her home exercises to improve functionality. CONCLUSION In the follow-up after COVID-19, any muscular or joint pain with unusual characteristics should be carefully examined.
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16
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Sing CW, Tan KCB, Wong ICK, Cheung BMY, Cheung CL. Long-term Outcome of Short-course High-dose Glucocorticoids for Severe Acute Respiratory Syndrome (SARS): A 17-Year Follow-up in SARS Survivors. Clin Infect Dis 2021; 72:1830-1833. [PMID: 32671407 PMCID: PMC7454482 DOI: 10.1093/cid/ciaa992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Use of high-dose glucocorticoids for coronavirus disease 2019 (COVID-19; caused by SARS-CoV-2) is controversial because of safety concerns. We examined long-term consequences in severe acute respiratory syndrome (SARS; caused by SARS-CoV-1) survivors. Results showed that high-dose glucocorticoids greatly increased long-term risk of avascular necrosis, but not other major diseases.
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Affiliation(s)
- Chor-Wing Sing
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region, China
| | - Kathryn C B Tan
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region, China
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region, China.,Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, United Kingdom
| | - Bernard M Y Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region, China
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region, China
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17
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Pauli MA, Pereira LDM, Monteiro ML, de Camargo AR, Rabelo GD. Painful palatal lesion in a patient with COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:620-625. [PMID: 33867304 PMCID: PMC8005255 DOI: 10.1016/j.oooo.2021.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Monique Abreu Pauli
- Dentistry Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Maria Luiza Monteiro
- Medical School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Gustavo Davi Rabelo
- Dentistry Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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18
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Abstract
The novel 2019 coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly transmissible and pathogenic coronavirus. Because of the novelty of the COVID-19 pandemic, few data are available on the impact of the SARS-CoV-2 on the different endocrine glands. Previous studies of severe acute respiratory syndrome (SARS) have shown a harmful effect on endocrine function. Notably, the angiotensin-converting enzyme-2 receptor, which is the entry route of coronaviruses to the host cell, is widely expressed in the endocrine organs including testis, endocrine pancreas, thyroid, and adrenal, and pituitary glands. Clinical and biochemical manifestations have been recorded in COVID-19 patients resulting in changes in endocrine activities, which were also recorded during the SARS outbreak in 2003. This review aims to explore the impact of SARS-CoV-2 infection on the function of endocrine glands, based on the latest research in the field.
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Affiliation(s)
- Adel Abdel-Moneim
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Hosni
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
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19
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Afsahi AM, Lombardi AF, Valizadeh S, Gholamrezanezhad A. Life after recovery from SARS, influenza, and Middle East respiratory syndrome: An insight into possible long-term consequences of COVID-19. World J Clin Infect Dis 2021; 11:1-10. [DOI: 10.5495/wjcid.v11.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Viral infectious diseases have become an increased public health issue in the past 20 years. The outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV-1) in 2002, influenza H1N1 in 2009, Middle East respiratory syndrome-CoV in 2012, and the current new coronavirus SARS-CoV-2 have shown that viral infectious diseases are a major concern in the 21st century. As the world lives under the pandemic of a new coronavirus (COVID-19), knowing the clinical characteristics from those past diseases and their long-term outcomes is important to understand the current coronavirus pandemic and its complications and consequences better and plan for possible future outbreaks. Several long-term complications have been described with these respiratory viral diseases, such as decreased pulmonary function, pulmonary fibrosis, chronic fatigue syndrome, avascular necrosis of bone, polyneuropathy, encephalitis, posttraumatic stress disorder, depression, and anxiety. This article summarizes several studies describing chronic complications and long-term outcomes of patients recovered from these viral syndromes.
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Affiliation(s)
| | | | - Sara Valizadeh
- Department of Restorative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran 1439955991, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA 90033, United States
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20
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Dulek DE, Fuhlbrigge RC, Tribble AC, Connelly JA, Loi MM, El Chebib H, Chandrakasan S, Otto WR, Diorio C, Keim G, Walkovich K, Jaggi P, Girotto JE, Yarbrough A, Behrens EM, Cron RQ, Bassiri H. Multidisciplinary Guidance Regarding the Use of Immunomodulatory Therapies for Acute Coronavirus Disease 2019 in Pediatric Patients. J Pediatric Infect Dis Soc 2020; 9:716-737. [PMID: 32808988 PMCID: PMC7454742 DOI: 10.1093/jpids/piaa098] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immune-mediated lung injury and systemic hyperinflammation are characteristic of severe and critical coronavirus disease 2019 (COVID-19) in adults. Although the majority of severe acute respiratory syndrome coronavirus 2 infections in pediatric populations result in minimal or mild COVID-19 in the acute phase of infection, a small subset of children develop severe and even critical disease in this phase with concomitant inflammation that may benefit from immunomodulation. Therefore, guidance is needed regarding immunomodulatory therapies in the setting of acute pediatric COVID-19. This document does not provide guidance regarding the recently emergent multisystem inflammatory syndrome in children (MIS-C). METHODS A multidisciplinary panel of pediatric subspecialty physicians and pharmacists with expertise in infectious diseases, rheumatology, hematology/oncology, and critical care medicine was convened. Guidance statements were developed based on best available evidence and expert opinion. RESULTS The panel devised a framework for considering the use of immunomodulatory therapy based on an assessment of clinical disease severity and degree of multiorgan involvement combined with evidence of hyperinflammation. Additionally, the known rationale for consideration of each immunomodulatory approach and the associated risks and benefits was summarized. CONCLUSIONS Immunomodulatory therapy is not recommended for the majority of pediatric patients, who typically develop mild or moderate COVID-19. For children with severe or critical illness, the use of immunomodulatory agents may be beneficial. The risks and benefits of such therapies are variable and should be evaluated on a case-by-case basis with input from appropriate specialty services. When available, the panel strongly favors immunomodulatory agent use within the context of clinical trials. The framework presented herein offers an approach to decision-making regarding immunomodulatory therapy for severe or critical pediatric COVID-19 and is informed by currently available data, while awaiting results of placebo-controlled randomized clinical trials.
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Affiliation(s)
- Daniel E Dulek
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert C Fuhlbrigge
- Section of Rheumatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alison C Tribble
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James A Connelly
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michele M Loi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Hassan El Chebib
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Connecticut Children's, Hartford, Connecticut, USA
| | - Shanmuganathan Chandrakasan
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William R Otto
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Garrett Keim
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kelly Walkovich
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Preeti Jaggi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer E Girotto
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Connecticut Children's, Hartford, Connecticut, USA.,University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
| | - April Yarbrough
- Department of Pharmacy, Children's of Alabama, Birmingham, Alabama, USA
| | - Edward M Behrens
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Randy Q Cron
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Hamid Bassiri
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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21
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Gao Y, Wang C, Kang K, Peng Y, Luo Y, Liu H, Yang W, Zhao M, Yu K. Cytokine Storm May Not Be the Chief Culprit for the Deterioration of COVID-19. Viral Immunol 2020; 34:336-341. [PMID: 33202195 DOI: 10.1089/vim.2020.0243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is spreading and ravaging all over the world, and the number of deaths is increasing day by day without downward trend. However, there is limited knowledge of pathogenesis on the deterioration of COVID-19 at present. In this study we aim to determine whether cytokine storm is really the chief culprit for the deterioration of COVID-19. The confirmed COVID-19 patients were divided into moderate group (n = 89), severe group (n = 37), and critical group (n = 41). Demographic data were collected and recorded on admission to ICU. Clinical data were obtained when moderate, severe, or critical COVID-19 was diagnosed, and then compared between groups. The proportion of enrolled COVID-19 patients was slightly higher among males (52.5%) than females (47.5%), with an average age of 64.87 years. The number of patients without comorbidities exceed one third (36.1%), and patients with 1, 2, 3, 4 kinds of comorbidities accounted for 23.0%, 23.0%, 13.1%, and 4.9%, respectively. IL-6, IL-10, TNF, and IFN-γ, including oxygenation index, sequential organ failure assessment score, white blood cell count, lymphocyte count, lymphocyte percentage, platelet, C-reaction protein, lactate dehydrogenase, creatine kinase isoenzyme, albumin, D-Dimer, and fibrinogen showed significant difference between groups. Some, but not all, cytokines and chemokines were involved in the deterioration of COVID-19, and thus cytokine storm maybe just the tip of the iceberg and should be used with caution to explain pathogenesis on the deterioration of COVID-19, which might be complex and related to inflammation, immunity, blood coagulation, and multiple organ functions. Future studies should focus on identification of specific signaling pathways and mechanisms after severe acute respiratory syndrome coronavirus 2 infections (IRB number: IRB-AF/SC-04/01.0).
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Affiliation(s)
- Yang Gao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Changsong Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.,Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yahui Peng
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yunpeng Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haitao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Wei Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Mingyan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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22
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Pharmacological and cardiovascular perspectives on the treatment of COVID-19 with chloroquine derivatives. Acta Pharmacol Sin 2020; 41:1377-1386. [PMID: 32968208 PMCID: PMC7509225 DOI: 10.1038/s41401-020-00519-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and an ongoing severe pandemic. Curative drugs specific for COVID-19 are currently lacking. Chloroquine phosphate and its derivative hydroxychloroquine, which have been used in the treatment and prevention of malaria and autoimmune diseases for decades, were found to inhibit SARS-CoV-2 infection with high potency in vitro and have shown clinical and virologic benefits in COVID-19 patients. Therefore, chloroquine phosphate was first used in the treatment of COVID-19 in China. Later, under a limited emergency-use authorization from the FDA, hydroxychloroquine in combination with azithromycin was used to treat COVID-19 patients in the USA, although the mechanisms of the anti-COVID-19 effects remain unclear. Preliminary outcomes from clinical trials in several countries have generated controversial results. The desperation to control the pandemic overrode the concerns regarding the serious adverse effects of chloroquine derivatives and combination drugs, including lethal arrhythmias and cardiomyopathy. The risks of these treatments have become more complex as a result of findings that COVID-19 is actually a multisystem disease. While respiratory symptoms are the major clinical manifestations, cardiovascular abnormalities, including arrhythmias, myocarditis, heart failure, and ischemic stroke, have been reported in a significant number of COVID-19 patients. Patients with preexisting cardiovascular conditions (hypertension, arrhythmias, etc.) are at increased risk of severe COVID-19 and death. From pharmacological and cardiovascular perspectives, therefore, the treatment of COVID-19 with chloroquine and its derivatives should be systematically evaluated, and patients should be routinely monitored for cardiovascular conditions to prevent lethal adverse events.
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23
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Mo GH, Wang ZX, Chen XS, Jiang Q. The prognosis and prevention measures for mental health in COVID-19 patients: through the experience of SARS. Biopsychosoc Med 2020; 14:22. [PMID: 32973919 PMCID: PMC7505936 DOI: 10.1186/s13030-020-00196-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 01/26/2023] Open
Abstract
Due to the high pathogenicity and mortality, the COVID-19 disaster caused global panic and anxiety. At present, diagnosis and treatment are of great concern. As time progresses, however, the sequelae caused by many other organ system complications and treatments will become increasingly obvious, and psychosomatic symptoms are one of these changes with great potential impact. Studies have shown that symptoms like poor sleep quality, anxiety and even delirium are not uncommon in patients during isolation. By summarizing the follow-up study on mental and psychological health of SARS in the past 10 years, and combining the characteristics of the existing cases of COVID-19, we will provide suggestions for the prevention and treatment of psychological diseases in clinical practice.
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Affiliation(s)
- Guo Heng Mo
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi People's Republic of China.,Queen Mary College of Nanchang University, Nanchang, Jiangxi China
| | - Zi Xuan Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi People's Republic of China.,The Fourth Clinical Medical College of Nanchang University, Nanchang, Jiangxi China
| | - Xiao Si Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi People's Republic of China.,The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi China
| | - Qunguang Jiang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi People's Republic of China
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24
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Shah SZA, Nasb M, Lu M, Huang L, Wang Y, Chen H. Scaling the Need, Benefits, and Risks Associated with COVID-19 Acute and Postacute Care Rehabilitation: A Review. Rehabil Res Pract 2020; 2020:3642143. [PMID: 32908705 PMCID: PMC7450327 DOI: 10.1155/2020/3642143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus is an RNA virus, which attacks the respiratory system causing complications including severe respiratory distress and pneumonia and many other symptoms. Recently, a novel coronavirus (COVID-19) outbreak emerged in Wuhan, which caused a significant number of infections in China and resulted in a global pandemic. The main aim of this study is to review and summarize the evidence regarding the supportive role of physical rehabilitation techniques in managing COVID-19-associated pneumonia. In this review, we also emphasize the use of rehabilitation techniques in the management of pneumonia in COVID-19-infected patients. Based on the evidence presented, we conclude that certain physical rehabilitation techniques and modalities could be of great support in the management of COVID-19-associated pneumonia. The safety of staff and patients when applying rehabilitation intervention requires attention. The combination of physical rehabilitation and medical treatment would result in improved treatment outcomes, faster recovery, and shorter hospital stay. Many rehabilitation techniques are safe and feasible and can be easily incorporated into the management protocol of COVID-19 victims. Decisions of early rehabilitation induction should be based on the patient's medical condition and tolerability.
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Affiliation(s)
- Sayed Zulfiqar Ali Shah
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mohammad Nasb
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Min Lu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liangjiang Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yizhao Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hong Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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25
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Patel MS, Gutman MJ, Abboud JA. Orthopaedic Considerations Following COVID-19: Lessons from the 2003 SARS Outbreak. JBJS Rev 2020; 8:e2000052. [PMID: 32759612 DOI: 10.2106/jbjs.rvw.20.00052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Manan S Patel
- 1Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Bandyopadhyay D, Akhtar T, Hajra A, Gupta M, Das A, Chakraborty S, Pal I, Patel N, Amgai B, Ghosh RK, Fonarow GC, Lavie CJ, Naidu SS. COVID-19 Pandemic: Cardiovascular Complications and Future Implications. Am J Cardiovasc Drugs 2020; 20:311-324. [PMID: 32578167 PMCID: PMC7310596 DOI: 10.1007/s40256-020-00420-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a global pandemic with the highest number of affected individuals in the modern era. Not only is the infection inflicting significant morbidity and mortality, but there has also been a significant strain to the health care system and the economy. COVID-19 typically presents as viral pneumonia, occasionally leading to acute respiratory distress syndrome (ARDS) and death. However, emerging evidence suggests that it has a significant impact on the cardiovascular (CV) system by direct myocardial damage, severe systemic inflammatory response, hypoxia, right heart strain secondary to ARDS and lung injury, and plaque rupture secondary to inflammation. Primary cardiac manifestations include acute myocarditis, myocardial infarction, arrhythmia, and abnormal clotting. Several consensus documents have been released to help manage CV disease during this pandemic. In this review, we summarize key cardiac manifestations, their management, and future implications.
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Affiliation(s)
| | - Tauseef Akhtar
- John’s Hopkins University School of Medicine, Baltimore, MD USA
| | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY USA
| | - Manasvi Gupta
- University of Connecticut School of Medicine, Hartford, CT USA
| | - Avash Das
- University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Ipsita Pal
- Columbia University Irving Medical Center, New York, NY USA
| | | | | | | | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA USA
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA USA
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27
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Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini AN, Edon DL, Toresdahl BG, Rodeo SA, Casey EK, Mendias CL. Musculoskeletal Consequences of COVID-19. J Bone Joint Surg Am 2020; 102:1197-1204. [PMID: 32675661 PMCID: PMC7508274 DOI: 10.2106/jbjs.20.00847] [Citation(s) in RCA: 216] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the majority of patients who become infected with SARS-CoV-2 are asymptomatic or have mild symptoms, some patients develop severe symptoms that can permanently detract from their quality of life. SARS-CoV-2 is closely related to SARS-CoV-1, which causes severe acute respiratory syndrome (SARS). Both viruses infect the respiratory system, and there are direct and indirect effects of this infection on multiple organ systems, including the musculoskeletal system. Epidemiological data from the SARS pandemic of 2002 to 2004 identified myalgias, muscle dysfunction, osteoporosis, and osteonecrosis as common sequelae in patients with moderate and severe forms of this disease. Early studies have indicated that there is also considerable musculoskeletal dysfunction in some patients with COVID-19, although long-term follow-up studies have not yet been conducted. The purpose of this article was to summarize the known musculoskeletal pathologies in patients with SARS or COVID-19 and to combine this with computational modeling and biochemical signaling studies to predict musculoskeletal cellular targets and long-term consequences of the SARS-CoV-2 infection.
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Affiliation(s)
| | - Andrea J. De Micheli
- Hospital for Special Surgery, New York, NY
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Christopher L. Mendias
- Hospital for Special Surgery, New York, NY
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY
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Iacobazzi D, Baquedano M, Madeddu P, Caputo M. COVID-19, State of the Adult and Pediatric Heart: From Myocardial Injury to Cardiac Effect of Potential Therapeutic Intervention. Front Cardiovasc Med 2020; 7:140. [PMID: 32760740 PMCID: PMC7371783 DOI: 10.3389/fcvm.2020.00140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
While the COVID-19 pandemic continues to spread rapidly, resulting in considerable morbidity and mortality worldwide, multiple efforts are being made by the international scientific community to understand the pathogenesis of the viral infection and its clinical outcome. Older age and comorbidities have consistently been reported as risk factors for unfavorable prognosis, with cardiovascular disease accounting for up to 10 % of comorbid conditions among the infected patients. An understanding of the mechanism underlying the effect of this infection on patients with cardiovascular disease is essential to manage and improve clinical strategies against the disease in that population. In this review, we summarize the impact of COVID-19 on patients with underlying cardiovascular conditions and the cardiac implications of known and emerging therapeutic strategies. Our future effort will aim to further elucidate how the type and severity of the cardiac disease, with particular regard to Congenital Heart Disease, influences the prognosis and the outcome of the viral infection.
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Affiliation(s)
| | | | | | - Massimo Caputo
- Bristol Heart Institute, Translational Health Sciences, Bristol Royal Infirmary, University of Bristol, Bristol, United Kingdom
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Chatterjee S, Ghosh R, Biswas P, Dubey S, Guria RT, Sharma CB, Kalra S. COVID-19: the endocrine opportunity in a pandemic. MINERVA ENDOCRINOL 2020; 45:204-227. [PMID: 32548995 DOI: 10.23736/s0391-1977.20.03216-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The 2019 Coronavirus disease (COVID-19) pandemic has disrupted the social, economical and medical system worldwide. Although it is strictly an infectious disease, its intricate bidirectional relationship with various non-communicable metabolic diseases and endocrinological factors has been observed. While diabetes, hypertension, obesity have been found to be independent risk factors for COVID-19 disease severity and mortality, more inclination towards sedentary lifestyle, psychosocial stress at this critical time may be the harbingers of metabolic syndrome. Thus, endocrinologists have a great opportunity to play their role to combat this pandemic. This paper examines how various endocrinological disorders influence the dynamics of COVID-19 and vice versa. Moreover, it also intends to review the clinical guidelines to be adopted in practice of endocrinology in this trying time.
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Affiliation(s)
- Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, India -
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India
| | - Payel Biswas
- Department of Radiodiagnosis, Care and Cure Hospital, Barasat, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Rishi T Guria
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Chandra B Sharma
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
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30
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Qin YY, Zhou YH, Lu YQ, Sun F, Yang S, Harypursat V, Chen YK. Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019: protocol of a randomized controlled trial. Chin Med J (Engl) 2020; 133:1080-1086. [PMID: 32149773 PMCID: PMC7147272 DOI: 10.1097/cm9.0000000000000791] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND At the end of 2019, a novel coronavirus outbreak causative organism has been subsequently designated the 2019 novel coronavirus (2019-nCoV). The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear, and warrants further investigation. METHODS The present study will be conducted as an open-labeled, randomized, controlled trial. We will enrol 48 subjects from Chongqing Public Health Medical Center. Each eligible subject will be assigned to an intervention group (methylprednisolone via intravenous injection at a dose of 1-2 mg/kg/day for 3 days) or a control group (no glucocorticoid use) randomly, at a 1:1 ratio. Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points. We will use the clinical improvement rate as our primary endpoint. Secondary endpoints include the timing of clinical improvement after intervention, duration of mechanical ventilation, duration of hospitalization, overall incidence of adverse events, as well as rate of adverse events at each visit, and mortality at 2 and 4 weeks. DISCUSSION The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades. Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past. However, there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease, or indeed in other types of severe respiratory disease. In this study, we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019. TRIAL REGISTRATION ClinicalTrials.gov, ChiCTR2000029386, http://www.chictr.org.cn/showproj.aspx?proj=48777.
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Affiliation(s)
- Yuan-Yuan Qin
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
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Abstract
Infection with the severe acute respiratory syndrome novel coronavirus produces a clinical syndrome known as 2019 novel coronavirus disease (COVID-19). When severe, COVID-19 is a systemic illness characterized by hyperinflammation, cytokine storm, and elevations of cardiac injury biomarkers. Here, we review what is known about the pathophysiology of COVID-19, its cardiovascular manifestations, and emerging therapeutic prospects. In this rapidly moving field, this review was comprehensive as of April 3, 2020.
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Affiliation(s)
- Akbarshakh Akhmerov
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eduardo Marbán
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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32
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Yi Y, Lagniton PNP, Ye S, Li E, Xu RH. COVID-19: what has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci 2020. [PMID: 32226295 DOI: 10.7150/ijbs.45134;select dbms_pipe.receive_message(chr(100)||chr(88)||chr(73)||chr(114),32) from dual--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The outbreak of Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), has thus far killed over 3,000 people and infected over 80,000 in China and elsewhere in the world, resulting in catastrophe for humans. Similar to its homologous virus, SARS-CoV, which caused SARS in thousands of people in 2003, SARS-CoV-2 might also be transmitted from the bats and causes similar symptoms through a similar mechanism. However, COVID-19 has lower severity and mortality than SARS but is much more transmissive and affects more elderly individuals than youth and more men than women. In response to the rapidly increasing number of publications on the emerging disease, this article attempts to provide a timely and comprehensive review of the swiftly developing research subject. We will cover the basics about the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease. Although many questions still require answers, we hope that this review helps in the understanding and eradication of the threatening disease.
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Affiliation(s)
- Ye Yi
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Philip N P Lagniton
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Sen Ye
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Enqin Li
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Ren-He Xu
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
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33
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Yi Y, Lagniton PN, Ye S, Li E, Xu RH. COVID-19: what has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci 2020; 16:1753-1766. [PMID: 32226295 PMCID: PMC7098028 DOI: 10.7150/ijbs.45134] [Citation(s) in RCA: 402] [Impact Index Per Article: 100.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 02/07/2023] Open
Abstract
The outbreak of Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), has thus far killed over 3,000 people and infected over 80,000 in China and elsewhere in the world, resulting in catastrophe for humans. Similar to its homologous virus, SARS-CoV, which caused SARS in thousands of people in 2003, SARS-CoV-2 might also be transmitted from the bats and causes similar symptoms through a similar mechanism. However, COVID-19 has lower severity and mortality than SARS but is much more transmissive and affects more elderly individuals than youth and more men than women. In response to the rapidly increasing number of publications on the emerging disease, this article attempts to provide a timely and comprehensive review of the swiftly developing research subject. We will cover the basics about the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease. Although many questions still require answers, we hope that this review helps in the understanding and eradication of the threatening disease.
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Affiliation(s)
| | | | | | | | - Ren-He Xu
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
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Abstract
Avascular necrosis tends to occur in the talus because of poor blood supply caused by the extended coverage to the articular cartilage on its surface. Treatment is conservative in the earlier stage of this disease; however, surgical treatment is usually indicated in the advanced stage. Nonunion, leg length discrepancy, or hindfoot instability may occur in patients treated with ankle or tibio-talo-calcaneal fusion. Arthroplasty using a customized total talar prosthesis designed using the computed tomography image of contralateral talus has the potential advantages of weightbearing in the earlier postoperative phase, prevention of lower extremity discrepancy, and maintenance of joint function.
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35
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Mo Y, Fisher D. A review of treatment modalities for Middle East Respiratory Syndrome. J Antimicrob Chemother 2016; 71:3340-3350. [PMID: 27585965 PMCID: PMC7109760 DOI: 10.1093/jac/dkw338] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The Middle East Respiratory Syndrome coronavirus (MERS-CoV) has been a focus of international attention since its identification in 2012. Epidemiologically it is characterized by sporadic community cases, which are amplified by hospital-based outbreaks. Healthcare facilities in 27 countries from most continents have experienced imported cases, with the most significant outbreak involving 186 cases in Korea. The mortality internationally is 36% and guidance for clinical management has yet to be developed. Most facilities and healthcare providers outside of the Middle East receiving patients have no or little experience in the clinical management of MERS. When a case does occur there is likely little time for a critical appraisal of the literature and putative pharmacological options. We identified published literature on the management of both MERS-CoV and the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) through searches of PubMed and WHO and the US CDC websites up to 30 April 2016. A total of 101 publications were retrieved for critical appraisal. Most published literature on therapeutics for MERS are in vitro experiments, animal studies and case reports. Current treatment options for MERS can be categorized as: immunotherapy with virus-specific antibodies in convalescent plasma; polyclonal and monoclonal antibodies produced in vitro or in genetically modified animals; and antiviral agents. The use of any therapeutics in MERS-CoV remains investigational. The therapeutic agents with potential benefits and warranting further investigation include convalescent plasma, interferon-β/ribavirin combination therapy and lopinavir. Corticosteroids, ribavirin monotherapy and mycophenolic acid likely have toxicities that exceed potential benefits.
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Affiliation(s)
- Yin Mo
- Ministry of Health Holdings, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore
| | - Dale Fisher
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Mont MA, Pivec R, Banerjee S, Issa K, Elmallah RK, Jones LC. High-Dose Corticosteroid Use and Risk of Hip Osteonecrosis: Meta-Analysis and Systematic Literature Review. J Arthroplasty 2015; 30:1506-1512.e5. [PMID: 25900167 PMCID: PMC7127809 DOI: 10.1016/j.arth.2015.03.036] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 02/01/2023] Open
Abstract
The effect of varying corticosteroid regimens on hip osteonecrosis incidence remains unclear. We performed a meta-analysis and systematic literature review to determine osteonecrosis occurrences in patients taking corticosteroids at varying mean and cumulative doses and treatment durations, and whether medical diagnoses affected osteonecrosis incidence. Fifty-seven studies (23,561 patients) were reviewed. Regression analysis determined significance between corticosteroid usage and osteonecrosis incidence. Osteonecrosis incidence was 6.7% with corticosteroid treatment of >2 g (prednisone-equivalent). Systemic lupus erythematosus patients had positive correlations between dose and osteonecrosis incidence. Each 10 mg/d increase was associated with a 3.6% increase in osteonecrosis rate, and >20 mg/d resulted in a higher osteonecrosis incidence. Clinicians must be wary of osteonecrosis in patients on high corticosteroid regimens, particularly in systematic lupus erythematosus.
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Affiliation(s)
- Michael A. Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland,Reprint requests: Michael A. Mont, MD, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215
| | - Robert Pivec
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Samik Banerjee
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Kimona Issa
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Randa K. Elmallah
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Lynne C. Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
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Taniguchi A, Takakura Y, Tanaka Y, Kurokawa H, Tomiwa K, Matsuda T, Kumai T, Sugimoto K. An Alumina Ceramic Total Talar Prosthesis for Osteonecrosis of the Talus. J Bone Joint Surg Am 2015; 97:1348-53. [PMID: 26290086 DOI: 10.2106/jbjs.n.01272] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of osteonecrosis of the talus is challenging. Total talar replacement has the potential to restore the function of the ankle joint without an associated leg-length discrepancy. The purpose of the present study was to investigate postoperative function and pain after total talar replacement in patients with osteonecrosis of the talus. METHODS Fifty-five ankles in fifty-one consecutive patients with osteonecrosis of the talus who were treated with a total talar replacement from 2005 to 2012 were included in the investigation. Scores according to the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the Ankle Osteoarthritis Scale (AOS) were assessed before surgery and at the final follow-up evaluation. RESULTS According to the JSSF ankle-hindfoot scale, the score for pain improved from a mean (and standard deviation) of 15 ± 9.4 points (range, 0 to 20 points) to 34 ± 5.6 points (range, 20 to 40 points); the score for function, from 21.2 ± 9.7 points (range, 4 to 38 points) to 45.1 ± 4.0 points (range, 37 to 50 points); the score for alignment, from 6.0 ± 2.8 points (range, 5 to 10 points) to 9.8 ± 0.9 points (range, 5 to 10 points); and the total score, from 43.1 ± 17.0 points (range, 11 to 68 points) to 89.4 ± 8.4 points (range, 76 to 100 points). According to the AOS scale, the score for "pain at its worst" improved from a mean of 6.1 ± 3.3 points (range, 0 to 9.9 points) to 2.0 ± 1.7 points (range, 0 to 6.3 points). CONCLUSIONS Prosthetic talar replacement is a useful procedure for patients with osteonecrosis of the talus as it maintains ankle function.
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Affiliation(s)
- Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522, Japan. E-mail address for A. Taniguchi:
| | - Yoshinori Takakura
- Department of Orthopaedic Surgery, Nishi Nara Central Hospital, 1-15 Tsurumai Nishi-cho, Nara-shi, Nara 631-0022, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522, Japan. E-mail address for A. Taniguchi:
| | - Hiroaki Kurokawa
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522, Japan. E-mail address for A. Taniguchi:
| | - Kiyonori Tomiwa
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522, Japan. E-mail address for A. Taniguchi:
| | - Takenori Matsuda
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522, Japan. E-mail address for A. Taniguchi:
| | - Tsukasa Kumai
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522, Japan. E-mail address for A. Taniguchi:
| | - Kazuya Sugimoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, 1-30-1 Hiramatsu, Nara-shi, Nara 631-0846, Nara, Japan
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Hui DSC, Lee N. Adjunctive therapies and immunomodulating agents for severe influenza. Influenza Other Respir Viruses 2014; 7 Suppl 3:52-9. [PMID: 24215382 PMCID: PMC6492653 DOI: 10.1111/irv.12171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The value of adjunctive immunomodulatory therapies in treating severe influenza and other respiratory viral infections remains uncertain. Although often used, systemic corticosteroids may increase the risk of mortality and morbidity (e.g. secondary infections) in severe influenza and other viral infections, especially if there is delay or lack of effective antiviral therapy. Non‐randomized studies suggest that convalescent plasma appears useful as add‐on therapy for patients with severe acute respiratory syndrome, avian influenza A(H5N1), and influenza A (H1N1) 2009 pandemic [A(H1N1)pdm09), but it is limited by its availability. A recent randomized controlled trial (RCT) comparing hyperimmune globulin prepared from convalescent plasma against normal intravenous gammaglobulin (IVIG) manufactured before 2009 as control in patients with severe A(H1N1)pdm09 infection on standard antiviral treatment has shown that the hyperimmune globulin group who received treatment within 5 days of symptom onset had a lower viral load and reduced mortality compared with the controls. A number of agents with immunomodulatory effects (e.g. acute use of statins, N‐acetylcysteine, macrolides, PPAR agonists, IVIG, celecoxib, mesalazine) have been proposed for influenza management. However, more animal and detailed human observational studies and preferably RCTs controlling for the effects of antiviral therapy and disease severity are needed for evaluating these agents. The role of plasmapheresis and hemoperfusion as rescue therapy also merits more investigation.
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Affiliation(s)
- David S C Hui
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Chihrin S, Loutfy MR. Overview of antiviral and anti-inflammatory treatment for severe acute respiratory syndrome. Expert Rev Anti Infect Ther 2014; 3:251-62. [PMID: 15918782 DOI: 10.1586/14787210.3.2.251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In 2003, an outbreak of a novel respiratory virus exploded from mainland China into an international issue, catching the world by surprise. The ensuing challenges to hospital and public health workers rose to a level never before seen in healthcare, in part due to the unknown nature of the disease, the fear of the human-to-human transmission and the significant media involvement. A new coronavirus was identified as the causative agent and named the severe acute respiratory syndrome-associated virus. A number of antiviral and anti-inflammatory treatment strategies were explored during the epidemic, with varying success. Following the epidemic, in vitro antiviral analyses of numerous compounds have been conducted. This review summarizes treatment agents assessed during and after the 2003 severe acute respiratory syndrome outbreak, with the aim of guiding future decision makers should the virus return.
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Affiliation(s)
- Stephen Chihrin
- University of Western Ontario , Faculty of Medicine, London, Ontario, Canada
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40
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Cheng VC, Chan JF, To KK, Yuen K. Clinical management and infection control of SARS: lessons learned. Antiviral Res 2013; 100:407-19. [PMID: 23994190 PMCID: PMC7132413 DOI: 10.1016/j.antiviral.2013.08.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/27/2013] [Accepted: 08/18/2013] [Indexed: 02/08/2023]
Abstract
The outbreak of severe acute respiratory syndrome (SARS) in 2003 was the first emergence of an important human pathogen in the 21st century. Responding to the epidemic provided clinicians with extensive experience in diagnosing and treating a novel respiratory viral disease. In this article, we review the experience of the SARS epidemic, focusing on measures taken to identify and isolate patients, prevent the transmission of infection to healthcare workers and develop effective therapies. Lessons learned from the SARS epidemic will be especially important in responding to the current emergence of another highly pathogenic human coronavirus, the agent of Middle East respiratory syndrome (MERS), and to the recently emerging H7N9 influenza A virus in China. This paper forms part of a symposium in Antiviral Research on "From SARS to MERS: 10years of research on highly pathogenic human coronaviruses."
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Affiliation(s)
- Vincent C.C. Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Jasper F.W. Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kelvin K.W. To
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region
| | - K.Y. Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region
- Corresponding author. Tel.: +86 852 22553206; fax: +86 852 28724555.
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Hui DS. Severe acute respiratory syndrome (SARS): lessons learnt in Hong Kong. J Thorac Dis 2013; 5 Suppl 2:S122-6. [PMID: 23977432 DOI: 10.3978/j.issn.2072-1439.2013.06.18] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 06/17/2013] [Indexed: 12/22/2022]
Abstract
Many healthcare workers were infected while looking after the SARS patients on the medical wards in 2003. The high infectivity of the SARS coronavirus with peak viral load on day 10 of illness when patients were ill, overcrowding of the old medical wards with low air changes/hr (ACH), and aerosol-generating procedures while resuscitating the patients were the major factors. Procedures reported to present an increased risk of SARS transmission include tracheal intubation, non-invasive ventilation, tracheotomy and manual ventilation before intubation whereas oxygen therapy and bed distance <1 m were also implicated. Studies based on laser visualization technique with smoke particles as smokers in the human patient simulator has shown that oxygen therapy via Hudson mask and nasal cannula could disperse exhaled air of patients to 0.4 and 1 m respectively whereas jet nebulizer could disperse exhaled air >0.8 m from the patient. Bigger isolation rooms with 16 ACH are more effective than smaller isolation rooms with 12 ACH in removing exhaled air and preventing room contamination but at the expense of more noise and electricity consumption. Non-invasive ventilation via face masks and single circuit can disperse exhaled air from 0.4 to 1 m. Both higher inspiratory pressures and use of whisper swivel device (to facilitate carbon dioxide removal) could increase the exhaled air leakage and isolation room contamination during on-invasive ventilation. Addition of a viral-bacterial filter during manual ventilation by bagging may reduce the exhaled air leakage forward and yet increase the sideway leakage. N95 mask was more effective than surgical mask in preventing expelled air leakage during patient's coughing but there was still significant sideway leakage to 15 cm. Clinicians should be aware of air leakage from the various face masks and adopt strict infection control measures during resuscitation of patients with severe respiratory infections. Carefully designed clinical trials are required to determine the optimal timing and dosage of any antiviral agents, convalescent plasma, and immuno-modulating agents in the treatment of the possibly immune-mediated lung injury in SARS and newly emerged infection such as the Middle East Respiratory Syndrome.
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Affiliation(s)
- David S Hui
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
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Hui DS, Lee N, Chan PK. Adjunctive therapies and immunomodulatory agents in the management of severe influenza. Antiviral Res 2013; 98:410-6. [PMID: 23578727 PMCID: PMC7132367 DOI: 10.1016/j.antiviral.2013.03.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/20/2013] [Accepted: 03/29/2013] [Indexed: 12/18/2022]
Abstract
In addition to neuraminidase inhibitors and other drugs that directly target viral replication, a number of adjunctive and immunomodulatory therapies are currently under evaluation for the treatment of influenza. These novel treatments, which focus either on pathophysiological aspects of influenza virus infection or the neutralization of virus with antibodies, are the subject of this review. Cytokine dysregulation has been observed in patients with severe influenza, such as avian influenza A (H5N1) and pandemic 2009 influenza A (H1N1pdm09) virus infections, but the role of immunomodulatory therapy is unclear, due to lack of data from randomized controlled trials (RCTs). Convalescent plasma appears to be useful as an adjunctive therapy for the treatment of H5N1 and H1N1pdm09 infections. Until lately, data interpretation was limited to case reports and studies of non-randomized design, but a recent RCT found that patients with severe influenza A (H1N1pdm09) who were treated with hyperimmune immunoglobulin from persons who had survived the same disease had a lower peak viral load and lower mortality than controls, providing treatment was begun within 5 days of symptom onset. The efficacy of agents with potential immunomodulating effects, including intravenous immunoglobulin, N-acetylcysteine, acute use of statins, macrolides, peroxisome proliferator-activated receptors agonists, celecoxib and mesalazine, and the role of plasmapheresis and hemoperfusion as rescue therapy, deserve more investigation and where feasible, studies by RCTs. Prospective observational studies have shown that systemic corticosteroids increase morbidity (e.g., secondary infections) and mortality in H1N1pdm09 influenza. This article forms part of a symposium in Antiviral Research on "Treatment of influenza: targeting the virus or the host."
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Affiliation(s)
- David S Hui
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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Affiliation(s)
- David S C Hui
- Division of Respiratory Medicine, Stanley Ho Center for Emerging Infectious Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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Mak IWC, Chu CM, Pan PC, Yiu MGC, Ho SC, Chan VL. Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen Hosp Psychiatry 2010; 32:590-8. [PMID: 21112450 PMCID: PMC7132390 DOI: 10.1016/j.genhosppsych.2010.07.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is one of the most prevalent long-term psychiatric diagnoses among survivors of severe acute respiratory syndrome (SARS). OBJECTIVES The objective of this study was to identify the predictors of chronic PTSD in SARS survivors. DESIGN PTSD at 30 months after the SARS outbreak was assessed by the Structured Clinical Interview for the DSM-IV. Survivors' demographic data, medical information and psychosocial variables were collected for risk factor analysis. RESULTS Multivariate logistic regression analysis showed that female gender as well as the presence of chronic medical illnesses diagnosed before the onset of SARS and avascular necrosis were independent predictors of PTSD at 30 months post-SARS. Associated factors included higher-chance external locus of control, higher functional disability and higher average pain intensity. CONCLUSION The study of PTSD at 30 months post-SARS showed that the predictive value of acute medical variables may fade out. Our findings do not support some prior hypotheses that the use of high dose corticosteroids is protective against the development of PTSD. On the contrary, the adversity both before and after the SARS outbreak may be more important in hindering recovery from PTSD. The risk factor analysis can not only improve the detection of hidden psychiatric complications but also provide insight for the possible model of care delivery for the SARS survivors. With the complex interaction of the biopsychosocial challenges of SARS, an integrated multidisciplinary clinic setting may be a superior approach in the long-term management of complicated PTSD cases.
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Affiliation(s)
- Ivan Wing Chit Mak
- Integrated Post-SARS Clinic, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
| | - Chung Ming Chu
- Integrated Post-SARS Clinic, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong,Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Pey Chyou Pan
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | | | - Suzanne C. Ho
- School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong
| | - Veronica Lee Chan
- Integrated Post-SARS Clinic, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong,Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Lau EH, Cowling BJ, Muller MP, Ho LM, Tsang T, Lo SV, Louie M, Leung GM. Effectiveness of ribavirin and corticosteroids for severe acute respiratory syndrome. Am J Med 2009; 122:1150.e11-21. [PMID: 19958895 PMCID: PMC7093860 DOI: 10.1016/j.amjmed.2009.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/23/2009] [Accepted: 07/24/2009] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Ribavirin and corticosteroids were used widely as front-line treatments for severe acute respiratory syndrome; however, previous evaluations were inconclusive. We assessed the effectiveness of ribavirin and corticosteroids as the initial treatment for severe acute respiratory syndrome using propensity score analysis. METHODS We analyzed data on 1755 patients in Hong Kong and 191 patients in Toronto with severe acute respiratory syndrome using a generalized propensity score approach. RESULTS The adjusted excess case fatality ratios of patients with severe acute respiratory syndrome receiving the combined therapy of ribavirin and corticosteroids within 2 days of admission, compared with those receiving neither treatment within 2 days of admission, were 3.8% (95% confidence interval, -1.5 to 9.2) in Hong Kong and 2.1% (95% confidence interval, -44.3 to 48.5) in Toronto. CONCLUSIONS Our results add strength to the hypothesis that the combination of ribavirin and corticosteroids has no therapeutic benefit when given early during severe acute respiratory syndrome infection. Further studies may investigate the effects of these treatments later in disease course.
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Affiliation(s)
- Eric H.Y. Lau
- School of Public Health, The University of Hong Kong, Hong Kong
| | | | - Matthew P. Muller
- St Michael's Hospital, Toronto, Ontario, Canada
- Canadian Severe Acute Respiratory Syndrome Research Network, Toronto, Ontario, Canada
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Thomas Tsang
- Center for Health Protection, Department of Health, Hong Kong
| | | | - Marie Louie
- Canadian Severe Acute Respiratory Syndrome Research Network, Toronto, Ontario, Canada
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Abstract
BACKGROUND TO THE DEBATE In a 2007 article in PLoS Medicine[10], Holger J. Schünemann and colleagues described a new process used by the World Health Organization for rapidly developing clinical management guidelines in emergency situations. These situations include outbreaks of emerging infectious diseases. The authors discussed how they developed such a "rapid advice" guideline for the pharmacological management of avian influenza A (H5N1) virus infection. The guideline recommends giving the antiviral drug oseltamivir at a dose of 75 mg twice daily for five days. In this Debate, Nicholas White argues that such dosing is inadequate, Robert Webster and Elena Govorkova say that combination antiviral therapy should be used, and Tim Uyeki reminds us that clinical care of patients with H5N1 entails much more than antiviral treatment. These issues may also apply to therapy of patients hospitalized with severe disease due to novel swine-origin influenza A (H1N1) virus infection.
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Affiliation(s)
| | - Robert G. Webster
- Department of Infectious Diseases, Division of Virology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
| | - Elena A. Govorkova
- Department of Infectious Diseases, Division of Virology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
| | - Timothy M. Uyeki
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Lv H, de Vlas SJ, Liu W, Wang TB, Cao ZY, Li CP, Cao WC, Richardus JH. Avascular osteonecrosis after treatment of SARS: a 3-year longitudinal study. Trop Med Int Health 2009; 14 Suppl 1:79-84. [PMID: 19508438 PMCID: PMC7169846 DOI: 10.1111/j.1365-3156.2008.02187.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the relationship between avascular osteonecrosis (AVN) and corticosteroid treatment given to patients with severe acute respiratory syndrome (SARS). METHODS Longitudinal study of 71 former SARS patients (mainly health care workers) who had been treated with corticosteroids, with an observation time of 36 months. Magnetic resonance images (MRI) and X-rays of hips, knees, shoulders, ankles and wrists were taken as part of the post-SARS follow-up assessments. RESULTS Thirty-nine per cent developed AVN of the hips within 3-4 months after starting treatment. Two more cases of hip necrosis were seen after 1 year and another 11 cases of AVN were diagnosed after 3 years, one with hip necrosis and 10 with necrosis in other joints. In total, 58% of the cohort had developed AVN after 3 years of observation. The sole factor explaining AVN in the hip was the total dose of corticosteroids received. CONCLUSION The use of corticosteroids in SARS has been debated; opinions conflict about whether the immediate benefits in terms of saving lives compensate for the adverse effects, including AVN.
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Affiliation(s)
- Hui Lv
- Chinese People's Armed Forces (CPAF) Hospital of Beijing, P.R. China
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Yildiz N, Ardic F, Deniz S. Very early onset steroid-induced avascular necrosis of the hip and knee in a patient with idiopathic thrombocytopenic purpura. Intern Med 2008; 47:1989-92. [PMID: 19015614 DOI: 10.2169/internalmedicine.47.1038] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Avascular necrosis (AVN) is a devastating adverse effect of steroid therapy rarely reported in idiopathic thrombocytopenic purpura (ITP). We describe a 64-year-old woman with progressive left knee and hip pain for 30 days resulting with the inability to ambulate. After she had been diagnosed ITP pulse steroid treatment was started in the department of Hematology. Two weeks later she described left knee and left hip pain. On physical examination, motion in her left knee and hip was severely painful without inflammation but range of motion was not limited. Magnetic resonance imaging showed multiple bony infarcts in the proximal femur, distal femur and proximal tibia, consistent with AVN. This case report is the first to define concurrent hip and knee AVN at a very early stage due to steroid use in a patient with ITP.
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Affiliation(s)
- Necmettin Yildiz
- Physical Medicine and Rehabilitation, Pamukkale University, Denizli, Turkey
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Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev 2007; 20:660-94. [PMID: 17934078 DOI: 10.1128/cmr.00023-07] [Citation(s) in RCA: 657] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Before the emergence of severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) in 2003, only 12 other animal or human coronaviruses were known. The discovery of this virus was soon followed by the discovery of the civet and bat SARS-CoV and the human coronaviruses NL63 and HKU1. Surveillance of coronaviruses in many animal species has increased the number on the list of coronaviruses to at least 36. The explosive nature of the first SARS epidemic, the high mortality, its transient reemergence a year later, and economic disruptions led to a rush on research of the epidemiological, clinical, pathological, immunological, virological, and other basic scientific aspects of the virus and the disease. This research resulted in over 4,000 publications, only some of the most representative works of which could be reviewed in this article. The marked increase in the understanding of the virus and the disease within such a short time has allowed the development of diagnostic tests, animal models, antivirals, vaccines, and epidemiological and infection control measures, which could prove to be useful in randomized control trials if SARS should return. The findings that horseshoe bats are the natural reservoir for SARS-CoV-like virus and that civets are the amplification host highlight the importance of wildlife and biosecurity in farms and wet markets, which can serve as the source and amplification centers for emerging infections.
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Altered pathogenesis of porcine respiratory coronavirus in pigs due to immunosuppressive effects of dexamethasone: implications for corticosteroid use in treatment of severe acute respiratory syndrome coronavirus. J Virol 2007; 81:13681-93. [PMID: 17942563 DOI: 10.1128/jvi.01702-07] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The pathogenesis and optimal treatments for severe acute respiratory syndrome (SARS) are unclear, although corticosteroids were used to reduce lung and systemic inflammation. Because the pulmonary pathology of porcine respiratory coronavirus (PRCV) in pigs resembles SARS, we used PRCV as a model to clarify the effects of the corticosteroid dexamethasone (DEX) on coronavirus (CoV)-induced pneumonia. Conventional weaned pigs (n = 130) in one of four groups (PRCV/phosphate-buffered saline [PBS] [n = 41], PRCV/DEX [n = 41], mock/PBS [n = 23], and mock/DEX [n = 25]) were inoculated intranasally and intratracheally with the ISU-1 strain of PRCV (1 x 10(7) PFU) or cell culture medium. DEX was administered (once daily, 2 mg/kg of body weight/day, intramuscularly) from postinoculation day (PID) 1 to 6. In PRCV/DEX pigs, significantly milder pneumonia, fewer PRCV-positive cells, and lower viral RNA titers were present in lungs early at PID 2; however, at PID 4, 10, and 21, severe bronchointerstitial pneumonia, significantly higher numbers of PRCV-positive cells, and higher viral RNA titers were observed compared to results for PRCV/PBS pigs. Significantly lower numbers of CD2(+), CD3(+), CD4(+), and CD8(+) T cells were also observed in lungs of PRCV/DEX pigs than in those of PRCV/PBS pigs at PID 8 and 10, coincident with fewer gamma interferon (IFN-gamma)-secreting cells in the tracheobronchial lymph nodes as determined by enzyme-linked immunospot assay. Our results confirm that DEX treatment alleviates PRCV pneumonia early (PID 2) in the infection but continued use through PID 6 exacerbates later stages of infection (PID 4, 10, and 21), possibly by decreasing cellular immune responses in the lungs (IFN-gamma-secreting T cells), thereby creating an environment for more-extensive viral replication. These data have potential implications for corticosteroid use with SARS-CoV patients and suggest a precaution against prolonged use based on their unproven efficacy in humans, including possible detrimental secondary effects.
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