Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis

Predicting COVID-19 progression in hospitalized patients in Kurdistan Province using a multi-state model

Objectives

This study aimed to implement a multi-state risk prediction model to predict the progression of COVID-19 cases among hospitalized patients in Kurdistan province by analyzing hospital care data.

Methods

This retrospective analysis consisted of data from 17,286 patients admitted to hospitals with COVID-19 from March 23, 2019, to December 19, 2021, in various areas in the Kurdistan province. A multi-state prediction model was used to show that each transition is predicted by a different set of variables. These variables include underlying diseases (like diabetes, hypertension, etc.) and sociodemographic information (like sex and age). Model aims to predict the likelihood of recovery, the need for critical care intervention (e.g., transfer to isolation units or the ICU), or exits from the hospitalization course. We performed the statistical analysis using R software and the mstate package.

Results

Of the hospitalized patients studied, 5.6% died of the disease, 6.6% were admitted to ICUs, and 38.72% were treated in isolation units. Mortality rates in general wards, isolation units, and the ICU were 3.48%, 4.56%, and 26.6%, respectively. Significant predictors for ICU admission include age over 60 years (HR: 1.46, 95% CI 1.37-1.55), kidney-related conditions (HR: 2.19, 95% CI 1.65-2.91), cardiovascular diseases (HR: 1.68, 95% CI 1.46-1.94), lung disease (HR: 1.89,‏95% CI 1.43-2.05), and cancer (HR: 2.46,‏95% CI 1.77-3.41). The likelihood of in-hospital death is significantly increased by age over 60 years (HR: 2.40, 95% CI 2.09-2.76), diabetes (HR: 1.97, 95% CI 1.45-2.68), high blood pressure (HR: 2.30, 95% CI 1.78-2.97), and history of heart disease (HR: 3.01, 95% CI 2.29-3.95).

Conclusion

The model helps the provider and policymakers to make an informed decision depending on patient management and resource allocation within the health care systems.

[Excess mortality of patients who negative for COVID-19 with proximal femoral fractures during the pandemic : What can we learn for future pandemics?]

BACKGROUND

The global COVID-19 pandemic led to excess mortality, especially for vulnerable older patients with simultaneous comorbidities. Patients with proximal femoral fractures already have a high mortality risk of up to 30% during the first postoperative year. The purpose of this study was not only to investigate the impact of COVID-19 on the mortality of patients tested positive but also of negatively tested patients with proximal femoral fractures.

METHODS

A single center cohort study of 2186 patients (mean age 79.8 years) who were surgically treated for a proximal femoral fracture at a level I trauma center was retrospectively carried out. The mortality and complication rates before the COVID-19 pandemic (January 2016-February 2020) and during the pandemic (March 2020-October 2021) were compared. A standardized treatment protocol was carried out during the total observational period. Orthogeriatric co-management was negatively impaired by the pandemic. Patient data, COVID-19 infections, surgical procedure, time from admission to surgery, postoperative complications and mortality were analyzed.

RESULTS

The pandemic group included 596 patients with an average age of 79.7 years. During the pandemic 26 patients were tested positive for COVID-19 (18 women, 8 men, average age 81.4 years, minimum 63 years, maximum 99 years, SD 9 years). Patients who tested positive for COVID-19 had more comorbidities than COVID-19 negative patients during the same period (Charlson comorbidity index, CCI 6.26 vs.5.25 points p < 0.037). The prepandemic control group consisted of 1590 patients with an average age of 79.9 years and a mean CCI of 5.86 points. Patients tested positive had a much longer hospitalization and a longer duration on the intensive care unit (p < 0.001) and a complication rate of 62.5%, especially due to the occurrence of pneumonia (p < 0.001). The mortality rate during the pandemic did not differ between patients tested positive or patients tested negative but was significantly higher for both groups in comparison to the period before the pandemic (pandemic 14% vs. 15.4%, before the pandemic 3.1%).

CONCLUSION

Patients suffering from COVID-19 infection and proximal femoral fractures have a high risk of complications and a high mortality. The total increase in mortality for all patients with critical injuries, such as hip fractures during the pandemic emphasizes the importance of early mobilization and orthogeriatric co-management, which was discontinued during the pandemic and the lockdown.

Prognostic Value of Fragmented QRS on Admission Electrocardiogram among Patients Hospitalized with COVID-19: A Single-Center Report, Systematic Review, and Meta-Analysis

Background

The novel coronavirus disease 2019 (COVID-19) is associated with life-threatening complications. Electrocardiogram (ECG) changes associated with COVID-19 have also been reported in the majority of critically ill patients.

Methods

In this study, we aimed to investigate the prevalence of fragmented QRS (fQRS) and its prognostic value in hospitalized patients with COVID-19. In addition, we performed a systematic review and meta-analysis of the literature to evaluate the effect of fQRS on the outcomes of COVID-19 patients.

Results

A total of 310 patients with a mean age of 65.7 ± 14.5 years were followed up for 3 months, of whom 139 (44.8%) had fQRS on their ECGs. The rates of in-hospital mortality (8.8% vs. 8.6%), rehospitalization during follow- up (13.7% vs. 12.3%), and 90-day mortality (6.5% vs. 5.3%) were comparable between the patients with and without fQRS, respectively. In the meta-analysis, 9 studies in addition to our study reported outcomes, with a total of 2928 patients with a mean age of 53.8 years, and 1431 (48.9%) were males. The rate of fQRS was 0.31 (95% confidence interval [CI], 0.23-0.38; I2 = 95.21%). In addition, the pooled proportion of in-hospital mortality reported by 5 studies was 0.31 (95% CI, 0.12-0.51; I2 = 98.36). The rate of in-hospital mortality was higher among patients with fQRS compared to those without fQRS (odds ratio, 2.33; 95% CI, 1.52-3.58; p = 0.0001; I2 = 74%).

Conclusions

The rate of fQRS on ECG was relatively high in COVID-19 patients, and according to the meta-analysis, it was associated with worse outcomes in hospitalized COVID-19 patients.

Assessment of PAP Device Usage and COVID-19 Related Anxiety in Patients with OSAS During COVID-19 Pandemics

OBJECTIVE

In this study, we aimed to determine the positive airway pressure (PAP) device usage and pandemic-related anxiety in obstructive sleep apnea syndrome (OSAS) patients during the pandemic.

MATERIAL AND METHODS

Five hundred twenty-seven OSAS patients were recruited into the study. A questionnaire consisting of 7 questions was filled to find out their Coronavirus disease-2019 (COVID-19)-related anxiety levels and PAP device usage.

RESULTS

The mean age of the patients was 53.3 years (±11.9). One hundred forty-one 141 (27%) of the participants were female and 382 (73%) were male. Two hundred sixteen (41%) patients reported using the PAP device regularly [PAP (+) group); 307 (59%) patients reported not using it at all or using it irregularly (PAP (-) group]. Forty-nine (23%) PAP (+) patients and 91 (29%) PAP (-) patients had COVID-19. The use of a PAP device was not significantly associated with an increased risk of COVID-19 infection (P = 0.077). The most common symptom was myalgia without a between-group difference, (P = 0.967). There was no significant difference between the PAP (+) and PAP (-) groups in the hospitalization rates for COVID-19 (P = 0.252). The presence of apnea was not considered as a cause of a higher level of COVID-19-related anxiety in patients with the PAP (+) group compared to the PAP (-) group (P = 0.095).

CONCLUSION

There was no evidence that the use of PAP devices in OSAS patients influenced the risk of getting COVID-19 and the clinical course of the disease. PAP device usage did not affect the level of anxiety associated with the pandemic in patients.

Auditing the fairness of the US COVID-19 forecast hub's case prediction models

The US COVID-19 Forecast Hub, a repository of COVID-19 forecasts from over 50 independent research groups, is used by the Centers for Disease Control and Prevention (CDC) for their official COVID-19 communications. As such, the Forecast Hub is a critical centralized resource to promote transparent decision making. While the Forecast Hub has provided valuable predictions focused on accuracy, there is an opportunity to evaluate model performance across social determinants such as race and urbanization level that have been known to play a role in the COVID-19 pandemic. In this paper, we carry out a comprehensive fairness analysis of the Forecast Hub model predictions and we show statistically significant diverse predictive performance across social determinants, with minority racial and ethnic groups as well as less urbanized areas often associated with higher prediction errors. We hope this work will encourage COVID-19 modelers and the CDC to report fairness metrics together with accuracy, and to reflect on the potential harms of the models on specific social groups and contexts.

The Mystery of Certain Lactobacillus acidophilus Strains in the Treatment of Gastrointestinal Symptoms of COVID-19: A Review

COVID-19 presents a wide range of symptoms, including gastrointestinal manifestations such as diarrhea, nausea, and abdominal pain. Lactobacillus acidophilus has been proposed as a potential adjunct therapy to alleviate these symptoms due to its probiotic properties, which help restore gut microbiota balance and modulate immune responses. This review systematically analyzed studies assessing the effects of L. acidophilus in COVID-19 patients with gastrointestinal symptoms. The literature search was conducted through PubMed and the WHO COVID-19 database using keywords such as "Lactobacillus acidophilus", "COVID-19", "gastrointestinal symptoms", and "inflammation markers". The search covered studies published until February 2025. Inclusion criteria: observational and clinical trials with L. acidophilus for symptom relief. Exclusion: animal studies and non-ethical approvals. The findings suggest that L. acidophilus supplementation may contribute to faster resolution of diarrhea, improved gut microbiota balance, and reduced inflammatory markers. However, some studies have found no significant impact on hospitalization rates or disease progression. The probiotic's mechanisms of action appear to involve microbiota modulation, intestinal barrier reinforcement, and anti-inflammatory effects rather than direct viral inhibition in COVID-19 after progression. Some L. acidophilus strains show promise, and clinical validation should follow careful preclinical studies (in vitro, cell lines, and animal models), especially in vulnerable populations such as immunocompromised individuals. Understanding the gut-lung axis and its role in immune response regulation, together with the need for a thorough characterization of the specific strains, including biochemical, genomic, and functional properties, before testing in humans, may provide deeper insights into the therapeutic potential of probiotics in viral infections.

Tutorial on Multiple Mediation Analysis Using Causal Networks: Application to Diagnosing COVID-19 From Its Early and Late Symptoms

BACKGROUND AND OBJECTIVES

There are two methods of studying multiple mediation: network-based and analysis of coefficients in regression equations.

This tutorial shows how multiple mediation analysis can be conducted through first constructing causal networks; and then evaluating the direct and mediated impact within the network. The proposed method is demonstrated in the context of diagnosing COVID-19 from its symptoms.

METHODS

822 individuals who had completed a COVID-19 test were recruited through listservs and via employees and patients of Virginia Commonwealth University Health Center. Participants reported their symptoms and which symptom(s) occurred first. A Causal Network model was established through a repeated chain of regressions in four steps: First, we identified the order of occurrence of symptoms. Second, COVID-19 test results were LASSO regressed on symptoms and demographic variables, establishing direct effects. Third, the direct effects were LASSO regressed on prior symptoms and demographic variables, establishing indirect effects. Fourth, the joint distribution of the variables in the network was simulated by evaluating regression equations at factorial combinations of their direct effects. Fifth, the mediated effect was calculated through twin modeling, where the model derived from the real data was compared to the counterfactual model that represented 'what if' there was no mediation.

RESULTS

The 10-fold cross-validated area under the receiver curve for the network model was 0.82, which is a moderate to high level of accuracy. The network model identified later symptoms (e.g., chills) mediated the effect of earlier symptoms (e.g. fever).

CONCLUSIONS

A network-based multiple mediation analysis led to new insights by integrating findings of 19 separate regressions into a single network model. The procedure showed how artificial intelligence can help in triage of COVID-19 patients from their symptoms, before any home or laboratory tests.

Blood Transcriptome Profiling Highlights the Role of Intestinal Bacterial Translocation in Severe COVID-19

COVID-19 has caused millions of deaths globally; however, the characterization of molecular biomarkers of severe disease remains of great scientific importance. The aim of this study was to capture the transcriptional differences of the whole blood gene expression between COVID-19 patients with mild and severe disease, using Next Generation Sequencing technologies, on admission and after 7 days. The genes which were differentially expressed in severe compared to mild patients were used for Gene Ontology (GO) enrichment analysis. Gene expression data were used to estimate the cell abundance of 22 immune cell types via digital cytometry. GO terms related to the response to molecules of bacterial origin, such as intestine-derived lipopolysaccharide (LPS), were enriched, among other dysregulated pathways, which are well described as paramount mechanisms of severe manifestations of COVID-19. The neutrophil population increased in patients with severe disease, whereas the monocyte, CD8+ T cell, and activated Natural Killer (NK) cell populations were depleted. These cell population dynamics are also indicative of severe COVID-19 and intestinal bacterial translocation. This study elucidates the molecular basis of severe COVID-19 and highlights intestinal bacterial translocation as a potential driver of severe disease.

Trajectories of sleep disturbance and self-management of chronic conditions during COVID-19 among middle-aged and older adults

The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic. To evaluate trajectories of sleep disturbance and their associations with one's capacity to self-manage chronic conditions. A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020-May 23, 2022). Adults living with chronic conditions who completed sleep questionnaires for two or more time points. Trajectories of self-reported sleep disturbance across 5 time points. Three self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease. Five hundred and forty-nine adults aged 23 to 91 years were included in the analysis. Two-thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with age < 60 (RR 1.57, 95% CI 1.09, 2.26, P = 0.016), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P = 0.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P = 0.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P = 0.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P = 0.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P < 0.001). Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.

Survival of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in public and private hospitals in Joinville: a cohort study, 2020-2021

OBJECTIVE

To compare the 90-day survival of critically ill people with COVID-19 and acute kidney injury in intensive care units (ICU) of public and private hospitals.

METHODS

This was a retrospective cohort study of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in Joinville, Santa Catarina state.

RESULTS

The 90-day survival rate in public ICU was 15.7% (95%CI 8.4; 25.1), while in private ICU it was 37.7% (95%CI 24.9; 50.5%). In the multivariate analysis adjusted for sociodemographic variables (Hazard ratio (HR) 2.01; 95%CI 1.31; 3.08) and comorbidities (HR 2.09; 95%CI 1.30; 3.37), admission to a public ICU was associated with a higher risk of death. After including severity of illness, admission to a public ICU was not associated with an increased risk of death compared to private ICU (HR 0.79; 95%CI 0.45; 1.42).

CONCLUSION

Measures implemented during the COVID-19 pandemic may have reduced inequalities between health systems for critically ill patients with acute kidney injury.

Unveiling the hidden effect of multi-morbidities on the severity of Covid-19: a latent class analysis approach

BACKGROUND

Epidemiological studies showed that Covid-19 patients with underlying diseases had higher rates of severe Covid-19. Previous studies focused on the presence of a single chronic disease but this study investigated the prevalence and patterns of multi-morbidities in patients with Covid-19 and its relationship with the severity of Covid-19.

METHODS

This retrospective study focused on patients age 30 years and older with positive polymerase chain reaction (PCR) results in 24 hospitals of Mashhad in northeastern Iran from 20-3-2020 to 21-1-2022. The number of studied confirmed patients was 318,502. The underlying diseases were identified according to the International Classification of Diseases, and the severity of Covid-19, including death, need for ventilation, and need for treatment in the intensive care unit (ICU). The pattern of multi-morbidities in these confirmed cases was investigated using latent class analysis (LCA), and the relationship between this pattern and the severity of Covid-19 was determined by multivariate logistic regression.

RESULTS

The most common coexisting diseases were hypertension in 30,100 patients (9.5%), metabolic disorders in 23,798 (7.5%) and hyperlipidemia in 22,454 (7%). Different comorbidities were grouped into three classes by the LCA model. Class 1 was patients without multi-morbidities, or 83% people., Class 2, which included 9% patients, was patients with hypertension, diabetes, respiratory diseases, and mental behavioral disorders (HRMD class). Class 3, which included patients with metabolic diseases, for whom the probability of developing hypertension, hyperlipidemia, diabetes, and metabolic disorders was high, included 7% patients. The results of multivariate logistic regression showed that having HRMD and metabolic diseases compared to no multi-morbidity adjusted for some risk factors increased the odds of developing severe Covid-19 by 81% and 55%, respectively.

CONCLUSIONS

The classes identified in this study provided a clear view of different groups of Covid-19 patients with certain multi-morbidities and underscore the importance of considering these patterns, rather than individual comorbidities, in risk assessment and management of COVID-19 patients. This approach will guide clinical decision-making and resource allocation in the ongoing management of the COVID-19 pandemic.

Association between obstructive sleep apnea (OSA) and COVID-19 severity

Obstructive sleep apnea and sleep-related hypoxia have been associated with higher rates of hospitalization and mortality among patients with Coronavirus disease 2019 (COVID-19). We further explored the association between obstructive sleep apnea, COVID-19 severity and related mortality. In addition, we examined the effects of clinical and demographic parameters on COVID-19. In this retrospective study, we included adult patients who were diagnosed with COVID-19 prior to the Omicron variant identification. We compared the severity of COVID-19 and mortality with the diagnosis of obstructive sleep apnea. The study population included 44,275 patients who tested positive for COVID-19. Of these, 97% had mild or asymptomatic disease, 1.2% had moderate disease, and 1.8% had severe disease. Obstructive sleep apnea was diagnosed in 980 (2.2%) patients. In a multivariate analysis, obstructive sleep apnea diagnosis increased the risk of severe COVID-19 by 1.6 (95% confidence interval: 1.1-2.4) compared with mild disease. However, no increase in mortality was associated with obstructive sleep apnea. Interestingly, patients with moderate and high socioeconomic status had a 1.6 times higher risk for severe COVID-19 than patients from the low socioeconomic status group (95% confidence interval: 1.2-2.1 and 95% confidence interval: 1.1-2.3, respectively). The risk of dying due to COVID-19 was 1.6 (95% confidence interval: 1.1-2.5) and 3.1 (95% confidence interval: 1.8-5.3) times higher in patients with medium and high socioeconomic status, respectively, compared with patients with low socioeconomic status. Diagnosis of obstructive sleep apnea was found to be an independent risk factor for severe COVID-19. The higher the socioeconomic status, the higher the risk of severe COVID-19 morbidity and mortality.

Impact of COVID-19 disease and vaccination on dermatological immune-mediated inflammatory diseases atopic dermatitis, psoriasis, and vitiligo: a Target2B! substudy

During the COVID-19 pandemic, the daily life of many patients with dermatological immune-mediated inflammatory diseases (DIMIDs), such as atopic dermatitis (AD), psoriasis, and vitiligo, was impacted by social restrictions caused by (fear of) morbidity, mortality associated with COVID-19, and vaccine hesitancy. This prospective observational, multicenter, multidisciplinary cohort study explored the impact of COVID-19 disease and vaccination on DIMIDs, specifically AD, psoriasis, and vitiligo. Data from patients with DIMIDs were collected as part of the Target2B! study (between February 2021 and October 2022). We analyzed the differences in baseline characteristics, risk of developing COVID-19, proportion of DIMIDs in patients reaching seroconversion upon vaccination per DIMID, and self-reported increase in DIMID activity by multivariable logistic regression and sensitivity analyses. A total of 424 patients with DIMID were included. COVID-19 disease commonly occurred in patients with vitiligo (51.1%), AD (42.0%), and psoriasis (34.3%) (p = 0.038). COVID-19 was not associated with the use of immunosuppressive therapy. Three patients (two with AD and one with vitiligo) were hospitalized due to COVID-19. Nearly all patients with DIMIDs exhibited effective seroconversion after regular vaccination regimens (vitiligo 100%, psoriasis 97.9%, AD 96.5%). Increased DIMID activity after COVID-19 (6.6%) or severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) vaccination (12.26%) was reported in a minority of patients, with baseline progressive disease (disease activity 3 months preceding baseline survey) being the only associated risk factor (COVID-19: odds ratio [OR], 4.27 [p = 0.02]; vaccination OR, 3.45 [p = 0.002]). In conclusion, no alarming signs were shown in this study regarding (severe) COVID-19 in patients with AD, psoriasis, or vitiligo. Vaccination against COVID-19 is advised in patients with DIMIDs. Moreover, patients with DIMIDs can safely continue their immunosuppressant therapy, since this does not increase the risk of COVID-19, while vaccination-induced humoral responses are adequate. In only a minority of patients, increased DIMID activity after COVID-19 or SARS-CoV-2 vaccination occurred.

Socioeconomic status and adherence to COVID-19 preventative measures in Australia: A national cohort study

ISSUE ADDRESSED

The uptake of recommended preventative measures is a critical concern for protecting the public against COVID-19 outbreaks and future pandemics. However, it is unclear to what extent COVID-19 preventative measures were followed in Australia. This study aims to determine adherence level to COVID-19 preventative measures in 2021, and whether these were associated with socioeconomic status (SES).

STUDY DESIGN

This was a national cross-sectional study using data from the Household Income and Labour Dynamics in Australia (HILDA) survey.

METHODS

This study included 15 457 community-dwelling adults (18 years or older) who participated in the 2021 wave of HILDA survey. SES was assessed by the Socio-Economic Index For Areas (SEIFA) score, split into quintiles. Outcomes included self-reported adherence to COVID-19 preventative measures (mask wearing, keeping distance, staying home; sum score range 3-15) and COVID-19 status (yes/no). Linear and logistic regression were used accordingly to assess the association between SES and the sum score of adherence to COVID-19 measures, and COVID-19 vaccination status.

RESULTS

Adherence to COVID-19 preventative measures and uptake of COVID-19 vaccine in Australia in 2021 were moderate (between 60% and 70%). Regression models showed higher SES was associated with a slightly higher score of adherence (β = .08, 95% CI = .04-.12) and a higher likelihood of self-reporting receiving COVID-19 vaccination (OR 1.27, 95% CI = 1.23-1.31).

CONCLUSION

SES was positively associated with the level of adherence to COVID-19 preventative measures and the probability of receiving COVID-19 vaccine. The findings of this study highlight the potential benefits of considering SES, particularly its impact on equity and access, when designing an educational program or awareness campaign in times of crisis. SO WHAT?: The findings of this study highlight the importance of considering SES when designing an educational program or an awareness campaign in times of crisis.

Sex differences in the association between preexisting comorbidities and COVID-19-related symptoms during the COVID-19 pandemic in the Dominican Republic

Background

Sex-based differences in the impact of comorbidities on coronavirus disease 2019 (COVID-19) related symptoms remain underexplored due to the predominance of sex-aggregated data. We aimed to examine sex differences in the associations between preexisting comorbidities and COVID-19-related symptoms during the COVID-19 pandemic in the Dominican Republic.

Methods

We conducted a cross-sectional study using a questionnaire survey in the Dominican Republic between September 2021 and December 2021. Data on demographic factors, preexisting comorbidities, and self-reported COVID-19-related symptoms were collected. A multiple logistic regression model was used to separately identify associations between preexisting comorbidities and COVID-19-related symptoms in males and females.

Results

We included a total of 3,308 eligible individuals. Approximately 25% of the participants had preexisting comorbidities, and 31% of the participants experienced COVID-19-related symptoms. Multiple logistic regression analyses revealed that asthma (OR = 2.15, 95% CI = 1.20-3.85, p = 0.01) was associated with the presence of COVID-19-related symptoms in males. For females, chronic lung disease (OR = 5.39, 95% CI = 1.52-19.18, p = 0.009), hypertension (OR = 1.33, 95% CI = 1.00-1.77, p = 0.047) and diabetes mellitus (OR = 1.70, 95% CI = 1.07-2.71, p = 0.025) were correlated with COVID-19-related symptoms.

Conclusion

Our study findings observed sex-differences in the associations between preexisting comorbidities and COVID-19-related symptoms. Specifically, we observed that male individuals with asthma and females with chronic lung disease, hypertension, and diabetes mellitus had a greater likelihood of experiencing COVID-19-related symptoms. Future studies are needed to confirm the mechanism underlying these sex differences.

Geographic inequalities and factors associated with unfavorable outcomes in diabetes-tuberculosis and diabetes-covid comorbidities in Brazil

The rapid spread of COVID-19 have overwhelmed health systems, especially in the care of chronic disease such as tuberculosis and diabetes. The objective of the study was to analyze the magnitude and relevance of tuberculosis-diabetes and diabetes-COVID-19 comorbidities in spatial risk areas and their factors associated with unfavorable outcomes in the Brazilian population between 2020 and 2022. An ecological study was carried out in Brazilian municipalities. The population was composed by cases of tuberculosis-diabetes and diabetes-COVID-19 comorbidities, registered in the Influenza Epidemiological Surveillance Information System (SIVEP-GRIPE) and in DATASUS from 2020 to 2022. The Scan Statistics technique was used to identify spatial risk clusters. Binary logistic regression was then employed to understand the relationship between outcomes and comorbidities, considering clinical and sociodemographic variables. A total of 24,750 cases of tuberculosis-diabetes comorbidity were identified, which consisted of an incidence of 3.2 cases per 100,000 inhabitants. Risk clusters were identified in the Central-West and North regions. 303,210 cases of diabetes- COVID-19 comorbidity were identified, resulting in an incidence of 0.4 cases per 100,000 inhabitants. São Paulo-SP, Rio de Janeiro-RJ and Belo Horizonte-MG were the municipalities with the highest spatial risk of illness. The analysis of the spatial risk areas revealed distinct patterns in the geographic distribution of comorbidities. Based on the findings, it is concluded that comorbidities between tuberculosis and diabetes, as well as between COVID-19 and diabetes, represent significant challenges for public health in Brazil, deserving attention from health authorities and the scientific community.

Impact of single nucleotide polymorphism of IL-27P28 rs153109 and IFITM3 rs12252 on susceptibility and severity of COVID-19 in Egyptian patients: a case control study

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus disease 2019 (COVID-19), which is a huge global health threat. Interleukin27 (IL-27) gene is a cytokine that produces antiviral proteins in an IFN-independent manner and stimulates both pro- and anti-inflammatory responses. Interferon induced transmembrane protein 3 (IFITM3) inhibits SARS-CoV2 infection by blocking SARSCoV-2 spike proteins which facilitate viral entrance and cell-to-cell fusion. The association between genetic variants and COVID-19 in Egyptians is still unclear. Hence, we sought to investigate the impact of the single nucleotide polymorphism of IL-27P28 rs153109 and IFITM3 rs12252 on the susceptibility and severity of SARS-CoV-2 in Egyptian patients.

METHODS

Our study included 242 SARS-CoV-2 patients were recruited from Main University Hospital, Alexandria University, Egypt, and 187 healthy controls. We subdivided the patient group into two subgroups: group A comprised mild/moderate cases (N = 42) (17.4%), and group B included severe/critical cases (N = 200) (82.6%). Genomic DNA was extracted from blood samples using the QIAamp DNA Blood Mini kit, then the PCR products of IL27 and IFITM3 were cut by FastDigest XhoI and MScI, respectively, for detection of SNPs of IL-27P28 rs153109 (-964A/G) and IFITM3 rs12252 (T>C).

RESULTS

The present study found a significant association between IL27 rs153109 (-964A/G) and SARS-CoV-2 infection susceptibility after adjusting for the risk factor (advanced age), IL27 rs153109 (-964A/G) AG genotype (OR = 2.791, 95% CI: 1.237-6.295, P = 0.013), AA genotype (OR = 2.385, 95% CI: 1.075-5.291, P = 0.033), and (AG+AA vs. GG) genotypes (OR = 2.558, 95% CI: 1.186-5.517, P = 0.017). On the other hand, the IFITM3 rs12252(T>C) CT genotype (OR = 1.419, 95% CI: 0.843-2.391, P = 0.188), CC genotype (OR = 2.132, 95% CI: 0.436-10.415, P = 0.350), and (C/T+C/C vs. TT) genotypes (OR = 1.466, 95% CI: 0.884-2.432, P = 0.138) did not show a statistically significant association with either susceptibility or the severity of SARS-CoV-2.

CONCLUSION

IL27P28 rs153109 AG and AA genotypes of IL27 may be associated with the susceptibility of SARS-CoV-2 infection but not the severity. Concerning the IFITM3 rs12252 SNP, we could not confirm its influence on either susceptibility or the severity of SARS-CoV-2 in this Egyptian population.

Exercise in Pediatric COVID-19: A Randomized Controlled Trial

PURPOSE

This study assessed the impact of a 12-wk, home-based exercise training (HBET) program on health-related quality of life (HRQOL; primary outcome), and cardiovascular and metabolic parameters in pediatric COVID-19 patients.

METHODS

This was a single-center, randomized controlled trial conducted in a tertiary hospital in Sao Paulo, from October 2020 to January 2022. Thirty-two patients (mean age, 12 ± 3.3 yr) were randomly assigned to either HBET or standard of care (CONTROL) in a 2:1 ratio 4 months (range: 0.7-6.6 months) after COVID-19 discharge ( n = 25 mild, n = 4 moderate, n = 3 severe illness). The HBET group underwent supervised and unsupervised sessions three times a week for 12 wk emphasizing aerobic and body weight exercises, while the CONTROL group received standard care, which included general advice for a healthy lifestyle with no prescribed exercise intervention. HRQOL (evaluated by the Pediatric Quality of Life Inventory), cardiopulmonary exercise test, brachial endothelial function and echocardiography assessments were conducted in both groups. Statistical analysis was performed using an intention-to-treat approach for the primary analysis and complete case (per-protocol) as sensitivity analysis.The significance was set at P ≤ 0.05 and P ≤ 0.10 was considered as trend.

RESULTS

There was no difference in HRQOL between groups. Intention-to-treat analysis indicated a trend toward increased oxygen uptake (V̇O 2 ) at anaerobic threshold following the intervention in the HBET group. In addition, a sensitivity analysis showed significant changes in peak heart rate and 1-min recovery, respiratory exchange ratio, and chronotropic response. A trend toward significance was observed in ventilation-to-maximum voluntary ventilation ratio and chronotropic response in the HBET group. No other between-group differences were detected for the cardiopulmonary exercise test, brachial flow-mediated dilation, and echocardiography variables (all P > 0.05).

CONCLUSIONS

In this randomized controlled trial, a 12-wk HBET intervention did not impact HRQOL in pediatric COVID-19 patients. However, exercise was able to improve the V̇O 2 at the ventilatory anaerobic threshold, heart rate peak and 1-min recovery, ventilation-to-maximum voluntary ventilation ratio, and chronotropic response, with no changes observed in other cardiovascular parameters. Further studies are needed to investigate the long-term effects of exercise interventions on the recovery of pediatric COVID-19 patients with and without preexisting chronic conditions.

Impact of Japan's Revised Infectious Disease Control Law on Older Adults' Social Life during the COVID-19 Pandemic

BACKGROUND

In May 2023, Japan reclassified coronavirus disease 2019 (COVID-19) under the Infectious Disease Control Law. However, there have been insufficient examinations on how the change in classification has impacted citizens' lives. This study examined the impact of revisions to the Infectious Disease Control Law in Japan on the social frailty and social life of older adults in the community.

METHODS

From mid-March to mid-April 2023, a self-administered survey targeting community-dwelling older adults aged 65 years and over was conducted by mail, before the revision of the Infectious Disease Control Law. From mid-February to mid-March 2024, after the revision of the law, a second survey was conducted among those who had responded to the first one. Ultimately, data from 240 cases were collected. The survey included social information such as mask-wearing when going out, status of long-term care insurance, presence of polypharmacy, sleep status, long outings, presence of COVID-19 infection, presence of post-COVID-19 syndrome (if infected), social frailty, and the Kihon Checklist, alongside basic demographic information.

RESULTS

After the revision of the Infectious Disease Control Law, there was an increase in the number of individuals receiving benefits from long-term care insurance and those identified as socially frail. However, no significant differences were observed in the other surveyed items.

CONCLUSION

The increase in socially frail individuals and those with long-term care insurance suggests that, despite the revision of the Infectious Disease Control Law, the connections within the local community that had once weakened due to the COVID-19 pandemic have not been fully restored.

Systematic Review of COVID-19 and COVID-19 mRNA Vaccine Myocarditis in Athletes: Incidence, Diagnosis, Prognosis, and Return-to-Play Principles

OBJECTIVE

The purpose of this systematic review is to evaluate the original peer-reviewed studies on athletes who developed myocarditis after coronavirus disease (COVID-19) infection or after COVID-19 mRNA vaccination. Both entities likely have an immunologic component. We discuss elite, professional, college, and adolescent athletes. The athletes are generally young and healthy, representing a distinctive population group that differs from the general population. This review includes diagnosis of myocarditis, incidence, complications, prognosis, and return-to-play guidance for sports medicine clinicians and coaches.

DATA SOURCES

We surveyed the PUBMED, Embase, and Web of Science databases for the relevant peer-reviewed articles in the English language published from the onset of the pandemic until April 2023. Included were original observational studies and case series. Excluded were individual case reports and a small series with incomplete data. The resulting search yielded 30 original articles.

MAIN RESULTS

Reported myocardial abnormalities in athletes were rare after COVID-19 infection and even less frequent after COVID-19 mRNA vaccination. True incidence, however, may be higher because of under-reporting and frequent asymptomatic presentation. Male gender was prevalent for both manifestations; postvaccination myocarditis occurrence was the highest after the second vaccine dose. Diagnostic and return-to-play algorithms were developed and should be adopted and followed.

CONCLUSIONS

The risk of myocarditis from COVID-19 infection and COVID-19 mRNA vaccination is very low. The long-term prognosis and evolution of the observed cardiac magnetic resonance abnormalities are currently unknown. Although inferences can be made from the published data, COVID-19 and postvaccine myocarditis in athletes may represent only a small fraction of the true incidence of those who have been affected worldwide and not evaluated.

Exploring the dynamics of SARS-CoV-2 and HIV Co-infection: Mutation risks, therapeutic efficacy, and future variant prevention

High mutation rates in SARS-CoV-2, particularly among immunocompromised patients living with HIV, continue to complicate the current COVID-19 pandemic. The threshold for severe COVID-19 and a greater risk of mortality have increased in many immunocompromised individuals due to a weakened immune system. Low CD4+ T-cell counts in people living with both HIV and COVID-19 lead to prolonged disease duration and, therefore, an increased likelihood of viral infection with SARS-CoV-2 mutations in such individuals. These mutations could decrease the efficiency of ongoing vaccines and cause new outbreaks. Recently, the rise of new mutations in this patient population has created increasing concern; however, few data are currently available on the direct association of HIV infection with SARS-CoV-2 mutations. This review highlights the implications of SARS-CoV-2 and HIV co-infection, highlighting the need for extra caution and monitoring of the immune-compromised population during a pandemic. Access to HIV care and COVID-19 treatments, careful surveillance, and adapted health strategies are key to reducing risks and protecting these populations. Further research is required to elucidate the dynamics of mutations and develop intervention methods to manage COVID-19 among immunocompromised patients.

Extrarespiratory, Digestive, and Hepatic Manifestations of COVID-19 in a Moroccan Series

Background: Coronavirus disease 2019 (COVID-19) has emerged as a global human health threat. While SARS-CoV-2 infection exhibits fever and respiratory symptoms, extrarespiratory manifestations were also reported in many cases. Objectives: This study aimed to determine the prevalence of digestive and hepatic symptoms at the onset of infection and to assess whether digestive symptoms are associated with severe disease progression. Patients and Methods: Prospective study was conducted during the first COVID-19 wave (from April to October 2020). It included consenting Moroccan patients diagnosed with COVID-19 based on PCR test and chest computed tomography. Results: A total of 211 patients participated in the study. The patients mean age was 42.3 years, with a sex ratio (F/M) of 1.7. Digestive symptoms were present in 28% of cases, with the most common being nausea or vomiting (12.8%), diarrhea (11.4%), abdominal pain (5.2%), and anorexia (16.6%). These symptoms were significantly associated with diabetes and hypertension. Patients with digestive symptoms reported a significantly higher frequency of anosmia and headache. Hepatic manifestations were present in 21.3%, and digestive symptoms were significantly associated with higher prevalence of liver function disturbances, particularly cholestasis. Nearly half of the patients with digestive symptoms (49.2%) experienced moderate COVID-19, with a higher percentage observed (61.8%) among those aged 42 years or older. However, this association was not statistically significant. Conclusion: Healthcare professionals need to recognize the range of gastrointestinal and hepatic symptoms to ensure timely diagnosis and effective patient management.

The relationship between gut and nasopharyngeal microbiome composition can predict the severity of COVID-19

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that displays great variability in clinical phenotype. Many factors have been described to be correlated with its severity, and microbiota could play a key role in the infection, progression, and outcome of the disease. SARS-CoV-2 infection has been associated with nasopharyngeal and gut dysbiosis and higher abundance of opportunistic pathogens. To identify new prognostic markers for the disease, a multicentre prospective observational cohort study was carried out in COVID-19 patients divided into three cohorts based on symptomatology: mild (n = 24), moderate (n = 51), and severe/critical (n = 31). Faecal and nasopharyngeal samples were taken, and the microbiota was analysed. Linear discriminant analysis identified Mycoplasma salivarium, Prevotella dentalis, and Haemophilus parainfluenzae as biomarkers of severe COVID-19 in nasopharyngeal microbiota, while Prevotella bivia and Prevotella timonensis were defined in faecal microbiota. Additionally, a connection between faecal and nasopharyngeal microbiota was identified, with a significant ratio between P. timonensis (faeces) and P. dentalis and M. salivarium (nasopharyngeal) abundances found in critically ill patients. This ratio could serve as a novel prognostic tool for identifying severe COVID-19 cases.

COVID-19 in the years 2020 to 2022 in Germany: effects of comorbidities and co-medications based on a large-scale database analysis

BACKGROUND

The SARS-CoV-2 pandemic was a challenge for health care systems worldwide. People with pre-existing chronic diseases have been identified as vulnerable patient groups. Furthermore, some of the drugs used for these chronic diseases such as antihypertensive drugs have been discussed as possible influencing factors on the progression of COVID-19. This study examines the effect of medication- and morbidity-associated risk factors suspected to moderate the disease course and progression of COVID-19.

METHODS

The study is based on claims data of the Techniker Krankenkasse, Germany's largest statutory health insurance. The data cover the years 2020 to 2022 and include insured persons with COVID-19 diagnosis from both the outpatient and inpatient sectors and a control of insured persons without COVID-19 diagnosis. We conducted a matched case-control study and matched each patient with an inpatient diagnosis of COVID-19 to (a) 10 control patients and (b) one patient with an outpatient diagnosis of COVID-19 to form two study cohorts. We performed a descriptive analysis to describe the proportion of patients in the two cohorts who were diagnosed with comorbidities or medication use known to influence the risk of COVID-19 progression. Multiple logistic regression models were used to identify risk factors for disease progression.

RESULTS

In the first study period the first study cohort comprised a total of 150,018 patients (13,638 cases hospitalised with COVID-19 and 136,380 control patients without a COVID-19 infection). Study cohort 2 included 27,238 patients (13,619 patients hospitalised with COVID-19 and 13,619 control patients with an outpatient COVID-19 diagnosis). Immunodeficiencies and use of immunosuppressives were strongest risk modifying factors for hospitalization in both study populations. Other comorbidities associated with hospitalization were diabetes, hypertension, and depression.

CONCLUSION

We have shown that hospitalisation with COVID-19 is associated with past medical history and medication use. Furthermore, we have demonstrated the ability of claims data as a timely available data source to identify risk factors for COVID-19 severity based on large numbers of patients. Given our results, claims data have the potential to be useful as part of a surveillance protocol allowing early-stage access to epidemiological data in future pandemics.

Impact of COVID-19 on preexisting comorbidities

COVID-19 is a highly contagious viral disease caused by SARS-CoV-2, leading to a tragic global pandemic, where it was ranked in 2020 as the third leading cause of death in the USA, causing approximately 375,000 deaths, following heart disease and cancer. The CDC reports that the risk of death increases with age and preexisting comorbidities such as such as hypertension, diabetes, respiratory system disease, and cardiovascular disease. this report will delineate and analyze the paramount comorbidities and their repercussions on individuals infected with SARS-CoV-2.

Distinct phenotypes of patients and healthcare resource utilization after hospitalization for COVID-19: an observational study

BACKGROUND

Little is known about postdischarge healthcare resource use (HCU) among patients hospitalized for coronavirus disease 2019 (COVID-19). The objective was to identify distinct profiles of patients based on postdischarge cares.

METHODS

This was a retrospective cohort study using the French National Health System claims database. We followed up all patients hospitalized for COVID-19 between 2020/02/01 and 2020/06/30 for 6 months; the discharge date was the index date. We excluded patients who died during the index stay or within 30 days after discharge. We described patients' HCU over 5 months from day 31 after the index date to the end of follow-up, i.e., the post-COVID-19 period. We described the sociodemographic and clinical characteristics of the participants and 44 selected types of HCU, including medical and emergency room visits, medications, medical and biological tests, oxygen therapy, rehabilitation, rehospitalization, nurse visits, and sick leave. We performed Ward's ascendant hierarchical clustering (AHC) analysis to identify groups of patients with similar post-COVID-19 HCU and described HCU and clinical characteristics by cluster.

RESULTS

The study population included 68,822 patients (median age: 64.8 years, 47% women). Eight clusters of patients were identified, each comprising between 1,163 and 35,501 patients. Four clusters were characterized by older patients and high proportions of comorbidities, i.e. cancer (cluster 3), mental disorders (cluster 4), cardiac insufficiency (cluster 5) and respiratory failure (cluster 6). Cluster 8 was characterized by younger patients, often obese and with low mortality. Another cluster was characterized by complex index stays (cluster 7) and a last cluster (cluster 2) by specific medical contacts and therapy. The main cluster (cluster 1, n = 35,501) was similar to the overall study population. The duration and complexity of the index stay also varied across clusters.

CONCLUSIONS

Based on HCU data, AHC identified 8 clinically relevant profiles of patients surviving the acute episode of COVID-19 hospitalization. The clusters illustrate the many impacts of COVID on the health status of infected patients and may help anticipate future needs of care in a similar context.

Neutralizing antibody test supports booster strategy for young individuals after SARS-CoV-2 Omicron breakthrough

BACKGROUND

The SARS-CoV-2 Omicron variant, since its initial detection, has rapidly spread across the globe, becoming the dominant strain. It is important to study the immune response of SARS-CoV-2 Omicron variant due to its remarkable ability to escape the majority of existing SARS-CoV-2 neutralizing antibodies. The surge in SARS-CoV-2 Omicron infections among most Chinese residents by the end of 2022 provides a unique opportunity to understand immune system's response to Omicron in populations with limited exposure to prior SARS-CoV-2 variants.

METHODS

We tested the levels of IgG, IgA, and IgM specific to the prototype SARS-CoV-2 RBD (receptor-binding domain) in blood samples from 636 individuals by chemical luminescence assay, ELISA and pseudovirus-based neutralization assay.

RESULTS

Inoculation with inactivated prototype SARS-CoV-2 vaccines or recombinant protein vaccines showed higher IgG levels after infection than the unvaccinated individuals. Moreover, the age resulted in different IgG levels after the Omicron infection as IgG level of the patients aged > 60 years was lower than that of patients aged < 60 years. This indicates that the IgG induced by SARS-CoV-2 Omicron breakthrough infection was different between old and young individuals. We found that a booster dose of the prototype SARS-CoV-2 vaccine led to a significant increase in the neutralizing immune response against the prototype SARS-CoV-2 and helped induce neutralizing antibodies against BA.5 and BF.7 variants after an Omicron breakthrough infection in young individuals, which is different from a previous report on older people.

CONCLUSIONS

These data suggest that the prototype SARS-CoV-2 booster vaccination helps induce high levels of neutralizing antibodies against Omicron BA.5 and BF.7 variants after Omicron breakthrough infection in young individuals.

TRIAL REGISTRATION

This study is a purely observational study.

Do dynamic changes in haematological and biochemical parameters predict mortality in critically ill COVID-19 patients?

BACKGROUND

Critically ill COVID-19 patients are usually subjected to clinical, laboratory, and radiological diagnostic procedures resulting in numerous findings. Utilizing these findings as indicators for disease progression or outcome prediction is particularly intriguing.

OBJECTIVES

Exploring the significance of dynamic changes in haematological and biochemical parameters in predicting the mortality of critically ill COVID-19 patients.

METHODS

The present study was a prospective and observational study involving mechanically ventilated 75 critically ill adult COVID-19 patients with hypoxemic respiratory failure. The collected data included baseline patient characteristics, treatment options, outcome, and laboratory findings at admission and 7 days after. The dynamics of the obtained findings were compared between survivors and non-survivors.

RESULTS

The 28-day survival rate was 61.3%. In the group of non-survivors significant dynamic changes were found for C-reactive protein (p= 0.001), interleukin-6 (p< 0.001), lymphocyte (p= 0.003), neutrophil-lymphocyte ratio (p= 0.003), platelets (p< 0.001), haemoglobin (p< 0.001), iron (p= 0.012), and total iron-binding capacity (p< 0.001). Statistically significant changes over time were found for ferritin (p= 0.010), D-dimer (p< 0.001), hs-troponin T (p< 0.002), lactate dehydrogenase (p= 0.001), glucose (p= 0.023), unsaturated iron-binding capacity (p= 0.008), and vitamin D (p< 0.001).

CONCLUSION

The dynamic changes in inflammatory, haematological and biochemical parameters can predict disease severity, and outcome.

Investigating the Prevalence of Bacterial Infections in Patients with Coronavirus Disease 2019 Hospitalized in Intensive Care Unit and Determining their Antibiotic Resistance Patterns

BACKGROUND

COVID-19 patient hospitalization, particularly in intensive care units, exposes them to bacterial and fungi co-infections, which can have very serious consequences, including increased mortality. In addition, antibiotic resistance among pathogens is a hidden threat behind COVID-19.

METHODS

In the period from 2020 September to 2021 August, bacterial isolates from COVID- 19 patients admitted to the ICU of Sina Hospital in Hamadan, Iran, were collected and identified based on standard biochemical tests. COVID-19 cases were confirmed based on clinical symptoms, computed tomography, and polymerase chain reaction. Antimicrobial susceptibility tests were conducted using disc diffusion and broth microdilution methods.

RESULTS

In total, 207 bacterial isolates were collected, with Klebsiella pneumoniae accounting for 69 (33.33%) and Acinetobacter baumannii accounting for 59 (28.15%). The frequency and percentage of isolated bacteria were as follows: Alcaligenes species 28 (13.59%), Staphylococcus aureus 18 (8.73%), Pseudomonas aeruginosa 15 (7.28%), Escherichia coli 11 (5.33%), Stenotrophomonas maltophilia 3 (1.45%), Enterococcus species 3 (1.45%), and Serratia species 1 (0.48%). About 95.38% resistance to ceftazidime and cefotaxime and 92.31% resistance to ciprofloxacin and cefepime were found in K. pneumoniae isolates. A. baumannii isolates were 100% resistant to cefotaxime, ceftriaxone, and cefepime. About 22.22% resistance to vancomycin and 66.67% resistance to clindamycin, erythromycin, and cefoxitin were seen in S. aureus isolates.

CONCLUSION

Knowledge of bacterial co-infections and their antibiotic resistance pattern in COVID-19 patients can help in choosing effective antibiotics for the treatment and prevention of antibiotic resistance.

A Narrative Review of Key Risk Factors for Severe Illness Following SARS-CoV-2, Influenza Virus, and Respiratory Syncytial Virus Infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, and respiratory syncytial virus (RSV) are highly infectious respiratory viruses that affect people of all ages and are typically associated with mild symptoms and few complications in immunocompetent individuals. However, the risk of severe outcomes (e.g., hospitalization and death) following infection with these respiratory viruses is higher in certain populations, including older adults and individuals of certain race/ethnic and sociodemographic groups. Additionally, immunocompromising conditions and pre-existing comorbidities, including underlying cardiovascular (e.g., congestive heart failure) and respiratory diseases (e.g., chronic obstructive pulmonary disease), diabetes, chronic kidney disease, and obesity, are key factors that predispose individuals to SARS-CoV-2-, influenza-, and RSV-related severe outcomes. Increased risk for severe outcomes associated with advancing age and comorbidities is compounded by residence in long-term care facilities due to the enhanced spread of respiratory infections in congregate living environments. In this narrative review, risk factors associated with severe outcomes following infection with SARS-CoV-2, influenza, and RSV in adult populations are explored. Additionally, distinct clinical outcomes based on underlying comorbidities following infection are discussed in the context of high-risk populations. Factors unique to each virus that underpin distinct risk profiles are described and suggest the potential for tailored surveillance and healthcare approaches to target and ultimately mitigate SARS-CoV-2-, influenza-, and RSV-associated disease burden in vulnerable populations. Mutual risk factors for severe outcomes are also highlighted; these similarities indicate that cohesive risk reduction strategies may also be feasible, particularly since vaccines are available for each of these respiratory viruses. Ultimately, a more thorough understanding of the risk factors that predispose individuals to develop SARS-CoV-2-, influenza-, and RSV-related severe outcomes may improve risk reduction strategies, inform healthcare policy, and contribute to the expansion and refinement of existing surveillance approaches to ultimately mitigate disease burden in vulnerable populations.

Measuring influencing factors affecting mortality rates during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has revealed clear deficiencies in global public health policies and healthcare systems when confronted with the emergence of a novel and deadly infectious disease.

OBJECTIVES

With 4 years elapsed since the onset of the pandemic, ample data now exist to analyse the associations between the implementation of diverse public health policies, sociodemographic factors and COVID-19 mortality rates.

METHODS

This study utilised the dataset compiled by 'Our World in Data' spanning the period of the COVID-19 pandemic from 2020 to 2022. Stochastic frontier analysis was employed to assess the influencing factors and their relationship with mortality rates resulting from COVID-19 infections across 156 countries or regions.

RESULTS

This study yielded several key findings: (1) There remains a 33% margin for improvement in the global mortality rate concerning the COVID-19 pandemic; (2) During the initial stage of the pandemic, when an effective vaccine was not yet available, implementing public health control policies could reduce both the infection and mortality rates; (3) Areas characterised by higher population densities, a greater proportion of individuals aged 65 and over, and elevated prevalence rates of diabetes demonstrated higher mortality rates; and (4) Increasing vaccination coverage emerged as an effective strategy for reducing mortality rates.

CONCLUSIONS

As our understanding of the COVID-19 virus improves, global economies and social interactions have gradually returned to normality. It is anticipated that the findings of this study can serve as a valuable reference in combating potential future pandemics caused by unknown viruses.

Interaction Effects Between COVID-19 Outbreak and Fever on Mortality Among OHCA Patients Visiting Emergency Departments

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. Materials and Methods: Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. Results: During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11-1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24-1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2-1.5). Conclusions: Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions.

Recent advancements in traditional Chinese medicine for COVID-19 with comorbidities across various systems: a scoping review

BACKGROUND

Traditional Chinese medicine (TCM) has developed a rich theoretical system and practical experience in fighting to infectious diseases over the past thousands of years, and has played an important role in controlling the spread owing to its unique advantages. In particular, its significant contribution to the prevention and control of Corona Virus Disease 2019 (COVID-19) is widely recognized. COVID-19 infection is mainly non-severe with a favorable overall outcome, but patients with comorbidities tend to have a poor prognosis. However, a comprehensive review of TCM for preventing and treating COVID-19 with comorbidities across various systems is still lacking. Hence, this scoping review aims to conduct a comprehensive investigation on treatment outcome of TCM for treating COVID-19 with comorbidities across various systems.

METHODS

The scoping review was conducted by searching English databases including PubMed and Web of Science, and Chinese databases including China National Knowledge Infrastructure and Wanfang between January 2020 and January 2024. We followed the inclusion and exclusion criteria to identify relevant literature. Information for inclusion in the literature were subsequently extracted and consolidated.

RESULTS

We enrolled 13 literature that met the inclusion criteria in the review finally. Our analysis revealed that research on COVID-19 with comorbidities was mostly focused on circulatory diseases, including hypertension, heart failure, and cerebrovascular diseases, most common comorbidities were hypertension. Followed by endocrine and metabolic diseases such as diabetes, respiratory diseases including pulmonary tuberculosis and chronic obstructive pulmonary disease have been also addressed. However, there were few studies on co-infectious urogenital system disease, and no studies on the rheumatic, immune, hematological, nervous, reproductive, and skin systems diseases. Based on existing studies, TCM has significantly improved the clinical symptoms of COVID-19 with comorbidities such as fever, fatigue, dry cough, anorexia and asthma, the absorption of lung lesions, shortened the duration of viral shedding and the course of disease.

CONCLUSIONS

TCM has great application prospects in treating COVID-19 with comorbidities. These findings could provide important evidence for clinicians to treat COVID-19 with comorbidities. Multi-center studies are required to confirm our results in the future.

Effect of SARS-CoV-2 infection on liver function in patients with hepatitis B

OBJECTIVE

To investigate the impact of SARS-CoV-2 infection on liver function and prognosis in patients with HBV infection.

METHODS

A total of 154 HBV-positive patients (HBV ( +) group) and 154 HBV-negative patients (HBV (-) group) diagnosed with COVID-19 at Taizhou Hospital between December 10, 2022, and January 31, 2023, were included in this study. Clinical characteristics, treatment, and laboratory findings were collected from patients at three time points: before (T1), during (T2), and at the time of discharge (T3) from SARS-CoV-2 infection.

RESULTS

Compared to the HBV (-) group, the HBV ( +) group had a longer hospital stay (15 (9-22) days vs. 9 (5-16) days). Longitudinal comparisons of laboratory indicators from T1 to T3 showed a continuous decline in TP and ALB levels and a continuous increase in PT and TT levels in the HBV ( +) group. BUN levels increased during T2 and decreased thereafter. These differences were considered statistically significant (P < 0.05). Notably, the HBV ( +) group had a higher proportion of indicators elevated > 3 ULN from T1 to T2, including ALT (1.95%/5.19%), AST (3.25%/12.99%), ALP (1.95%/3.25%), GGT (4.55%/9.09%), TBIL (6.49%/9.09%), and DBIL (18.18%/22.73%). In the HBV (-) group, the elevations were mainly concentrated within 1-2 ULN, including AST (12.99%/22.08%), DBIL (10.39%/21.43%), BUN (12.99%/22.08%), CREA (20.13%/29.22%), and PLT (7.79%/14.94%). Furthermore, the incidence of liver injury from T1 to T3 was higher in the HBV ( +) group compared to the HBV (-) group (15.7% (20/127) vs. 7.2% (11/152), P < 0.05). Multivariate analysis showed that liver cirrhosis (HR = 4.847, 95% CI: 1.224-19.20, P = 0.025) and liver cancer (HR = 8.333, 95% CI: 2.156-32.209, P = 0.002) were independent risk factors for liver injury in the presence of SARS-CoV-2 infection.

CONCLUSION

SARS-CoV-2 infection has a higher proportion of liver injury in HBV-infected patients, affecting hepatic protein synthesis function. Those with cirrhosis and hepatocellular carcinoma are at higher risk of severe liver injury.

Histopathological Evaluation of Pulmonary Arterial Remodeling in COVID-19

A positive-sense single-stranded RNA virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), caused the coronavirus disease 2019 (COVID-19) pandemic that devastated the world. While this is a respiratory virus, one feature of the SARS-CoV-2 infection was recognized to cause pathogenesis of other organs. Because the membrane fusion protein of SARS-CoV-2, the spike protein, binds to its major host cell receptor angiotensin-converting enzyme 2 (ACE2) that regulates a critical mediator of cardiovascular diseases, angiotensin II, COVID-19 is largely associated with vascular pathologies. In fact, we have previous reported that postmortem lung tissues collected from patients who died of COVID-19 exhibited thickened pulmonary vascular walls and reduced vascular lumen. The present study extended these findings by further characterizing the pulmonary vasculature of COVID-19 patients using larger sample sizes and providing mechanistic information through histological observations. The examination of 56 autopsy lung samples showed thickened vascular walls of small pulmonary arteries after 14 days of disease compared to H1N1 influenza patients who died before COVID- 19 pandemic started. Pulmonary vascular remodeling in COVID-19 patients was associated with hypertrophy of the smooth muscle layer, perivascular fibrosis, edema and lymphostasis, inflammatory infiltration, perivascular hemosiderosis and neoangiogenesis. We found a correlation between the duration of hospital stay and the thickness of the muscular layer of pulmonary arterial walls. These results further confirm that COVID-19 affects the pulmonary vasculature and warrants an evaluation of patients that survived COVID-19 for possible future development of pulmonary arterial hypertension.

Impact of SARS-CoV-2 infection on patients with myasthenia gravis: a retrospective study in a Chinese population

Background and purpose

Myasthenia gravis (MG) is characterized by fluctuating muscle weakness due to immune-mediated damage to acetylcholine receptors. Viral infections can exacerbate symptoms of muscle weakness, and the clinical status of patients with MG may influence the outcomes of such infections. Here, we identified factors of symptom exacerbation, severe SARS-CoV-2 infection, and pneumonia in patients with MG who are infected with SARS-CoV-2.

Methods

The clinical characteristics and outcomes of 341 MG patients infected with SARS-CoV-2 across multiple regions in China were determined.

Results

The median age of the patients was 49 years (range: 35-60 years) and the median disease duration was 4 years (range: 2-8 years). Among the patients, 67 (49.0%) were male and 174 (51.0%) were female. Multivariate analysis indicated that thymectomy [OR, 1.654 (95% CI, 1.036-2.643); p = 0.035], severe SARS-CoV-2 infection [OR, 4.275 (95% CI, 2.206-8.286); p < 0.001], and pyridostigmine bromide [OR, 1.955 (95% CI, 1.192-3.206); p = 0.008] were associated with exacerbation of MG symptoms in patients infected with SARS-CoV-2. Age was significantly associated with severe SARS-CoV-2 infection [OR, 1.023 (95% CI, 1.001-1.046); p = 0.008], while patients with cardiac/vascular comorbidities exhibited an increased likelihood of severe SARS-CoV-2 infection [OR, 3.276 (95% CI, 1.027-10.449); p = 0.045]. Likewise, steroid treatment [OR, 6.140 (95% CI, 2.335-16.140); p < 0.001] was associated with a significantly increased likelihood of severe SARS-CoV-2 infection compared with symptomatic treatment. Additionally, gender [OR, 0.323 (95% CI, 0.120-0.868); p = 0.025] and SARS-CoV-2 severity [OR, 6.067 (95% CI, 1.953-18.850); p = 0.002] were associated with the occurrence of pneumonia.

Conclusion

We identified factors that were associated with the exacerbation of MG symptoms in patients infected with SARS-CoV-2, including thymectomy, severe SARS-CoV-2 infection, and the use of pyridostigmine bromide. Due to the retrospective nature of the study, these findings should be interpreted as associations rather than predictive factors. However, the results confirm the established relationships between severe SARS-CoV-2 infection and age, cardiovascular comorbidities, and the use of steroid treatment, suggesting that these factors should be considered when managing MG patients during SARS-CoV-2 infection.

Prevalence of SARS-COV-2 infection and outcomes in Greek sarcoidosis patients

BACKGROUND AND AIM

There is limited data on the prevalence of SARS-COV-2 in sarcoidosis patients and the underlying parameters linked to severity. We aimed to conduct a national multicenter study to explore the prevalence of SARS-COV-2 in sarcoidosis patients and investigate its impact on hospitalization and infection rates, describe the characteristics of the infected population and assess the role of these characteristics in determining the likelihood of infection or hospitalization.

METHODS

We recruited all the adult sarcoidosis patients with who were examined across eight Greek Health Interstitial Lung Disease Referral Centers from the beginning of the pandemic until August 1, 2022. All the data was collected using structured questionnaires.

RESULTS

530 sarcoidosis patients with a mean age of 54±12 years, 60% of whom were females, were recruited. 43% of them were under corticosteroid treatment, and 39% were under additional immunosuppression. 18% of Greek sarcoidosis patients were infected by the virus, which is a lower rate than the general population. The infection was mainly mild. Only one-fifth of the infected sarcoidosis patients required hospitalization, and no deaths or ICU admissions were recorded. Vaccination was found to be associated with a reduced likelihood of infection. Younger age, a longer period since diagnosis, abnormal PET-CT findings, and immunosuppression were associated with an increased probability of infection.

CONCLUSIONS

The COVID-19 infection rate among Greek sarcoidosis patients was lower than the general population. Fewer than 20% needed hospitalization. There were no deaths or ICU admissions. Vaccination reduces the likelihood of infection. Younger age, longer diagnosis, abnormal PET-CT findings, and immunosuppression increased the chance of infection.

The Relationship Between Predisposing Risk Factors and COVID-19: An Observational Study

Background Numerous risk factors have been identified for developing severe COVID-19, including sociodemographic variables and concomitant diseases. Individuals with underlying comorbidities such as diabetes, hypertension, asthma, and coronary artery disease are at a greater risk of severe illness and death. This study aimed to observe the association between risk factors and the severity of COVID-19. Methodology A single-center, hospital-based, prospective, observational study was conducted at Max Smart Super Speciality Hospital in Saket, Delhi from October 2020 to December 2021. A total of 1,454 patients admitted under our care in the Department of Internal Medicine were included in this study. Patients were divided into the following three groups: patients without comorbidities, patients with a single comorbidity, and patients with multiple comorbidities. The risk factors under evaluation were age >50 years, obesity, diabetes, hypertension, chronic kidney disease (CKD), heart disease, chronic liver disease (CLD), and immunocompromised status (human immunodeficiency virus, post-transplant, malignancy undergoing chemotherapy). Results In this study, 28.1% (n = 408) of patients did not have comorbidities, 30.1% (n = 438) of patients had a single comorbidity, and 41.8% (n = 608) of patients had multiple comorbidities. Regarding risk factors, 62% (n = 872) of patients were aged >50 years, 7.4% (n = 108) were obese, 30.7% (n = 447) had diabetes, 33% (n = 480) were hypertensive, 1.2% (n = 18) had CKD, 6.8% (n = 99) had heart disease, 0.3% (n = 4) had CLD, and 5.5% (n = 80) were immunocompromised. A statistically significant association was found between increasing age and worsening severity of COVID-19 (p = 0.0001), male gender (p = 0.0001), presence of comorbidities, including diabetes, hypertension, obesity, CKD, CLD, heart disease (p = 0.0001). Patients in the immunocompromised group did not have a statistically significant association with disease severity. A statistically significant association was found between mortality and severity of COVID-19. Overall, 16.7% (n = 48) of the patients in the no comorbidity group, 35.4% (n = 102) in the single comorbidity group, and 47.9% (n = 138) in the multiple comorbidity group (p = 0.0001) presented with severe disease on admission. Conclusions The study shows that the severity of the disease increased as the number of risk factors increased. This information can help us take early and active measures in these groups of patients with multiple comorbid illnesses.

Rates, Risk Factors, and Outcomes of Nonvariceal Upper Gastrointestinal Bleeding in Patients Hospitalized for COVID-19 in the United States

OBJECTIVE

This study aimed to investigate the incidence and predictors of non-variceal upper gastrointestinal bleeding (NVUGIB) in hospitalized patients with coronavirus disease 2019 (COVID-19), as well as the inpatient outcomes associated with this complication.

METHODS

This was an analysis of the National Inpatient Sample Database from January to December 2020. Adult COVID-19 patients were categorized into two groups based on NVUGIB development during hospitalization. Multivariate logistic analysis was performed to identify predictors and outcomes associated with NVUGIB in hospitalized COVID-19 patients in the US, after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI) score, using Stata/BE 17.0.

RESULTS

Among 1 050 045 hospitalized patients, 1.87% developed NVUGIB. Asian Americans had the highest risk, followed by Native Americans, Hispanics, and African Americans, with odds ratios (ORs) of 1.70, 1.59, 1.40, and 1.14, respectively. Patients with higher CCI scores were also at greater risk (with ORs of 1.47, 2.09, and 3.45 for CCI scores of 1, 2, and 3, respectively). COVID-19 patients with NVUGIB had a higher risk of inpatient mortality (OR=3.84), acute kidney injury (OR=3.12), hypovolemic shock (OR=13.7), blood transfusion (OR=7.02), and in-hospital cardiac arrest (OR=4.02).

CONCLUSION

NVUGIB occurred in 1.87% of hospitalized COVID-19 patients and was associated with a threefold increase in mortality. Further research is necessary to identify strategies for reducing its incidence in COVID-19 patients with multiple risk factors.

The impact of osteosarcopenia and its parameters on mortality of COVID-19 in-hospitalized older patients: the findings of BEH (Bushehr elderly health) program

Background

It has been documented that old age and chronic diseases are associated with poor prognosis and mortality among COVID-19 patients. Osteosarcopenia is a geriatric syndrome with a considerable prevalence which increases morbidity and mortality. This study investigated the relationship between COVID-19 mortality and osteosarcopenia and its parameters in-hospitalized patients in Bushehr, Iran.

Methods

In this retrospective cohort study, participants of the Bushehr Elderly Health (BEH) program who were hospitalized due to COVID-19 between 1st March 2020 and 23rd September 2021 were assessed. Osteosarcopenia was considered as the presence of both osteopenia/osteoporosis and sarcopenia. We used the Cox proportional hazards model to identify the association between oteosarcopenia and the risk of COVID-mortality in 2442 person-days.

Results

Among 4173 participants,297 patients were in-hospitalized due to COVID-19. We found that 80(26.94%) patients expired due to COVID-19 during the follow-up period. Osteosarcopenia and its parameters were more prevalent in patients who expired. The incidence rate of mortality among osteosarcopenic patients was 5.04(3.43- 7.40) per 100 person-days. In the Cox proportional hazards models, osteosarcopenia and its parameters increase the risk of COVID-mortality [Osteosarcopenia: HRadjusment:1.73(1.00-3.01), sarcopenia: HRadjusment:1.72(1.00-2.99), Osteoporosis: HRadjusment:2.67(1.53-4.67), Low muscle mass: HRadjusment:1.90(1.05-3.46), low muscle strength: HRadjusment:1.80(1.03-3.16), and low gait speed: HRadj:2.39(1.31-4.38). The ORs of ICU admission and use of invasive mechanical ventilation among osteosarcopenic patients and its parameters were higher than those without it.

Conclusions

This study identified the impact of osteosarcopenia and its parameters on the mortality of in-hospitalized patients with COVID-19. Assessment of musculoskeletal disorders could help in early warning of older patients with severe COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01443-1.

Cushing's syndrome and COVID-19

PURPOSE

This review aims to present current data on the course of COVID-19 in patients with Cushing syndrome (CS) and discuss treatment for CS during to the pandemic.

METHODS

Literature review using PubMed (pubmed.ncbi.nlm.nih.gov). The search included the following terms: "COVID19" in combination with "Cushing syndrome", "Hypercortisolism" and "Glucocorticoid".

RESULTS

Chronic hypercortisolism has been reported to increase infectious risk and worsens prognostic of patients with COVID-19 potentially due to its direct impact on the immune system: lymphopenia, impairment of monocytes and neutrophils activity, diminution of complement activation. Main metabolic complications of CS - i.e. diabetes, hypertension and obesity - have been recognized as COVID-19 complications risk factors. Patients with CS treated with steroidogenesis inhibitors might experience adrenal insufficiency during COVID-19. Special attention should be paid to patients with CS and COVID-19. The pandemic has impacted - and delayed - care of chronic illnesses including CS. Specific recommendations had been provided during the pandemic: favor telemedicine consultations, limit in-hospital explorations and postpone surgery when feasible.

CONCLUSION

There are enough evidence for an increased prevalence and severity of COVID-19 to recommend a specific attention and caution in patients with CS.

Prevalence of urinary incontinence and associated factors in patients with post-COVID-19 syndrome after hospital discharge

OBJECTIVES

To assess the prevalence of urinary incontinence and the clinical and demographic factors associated with patients with Post-COVID-19 Syndrome.

METHOD

A cross-sectional study was conducted with 59 participants from Porto Alegre/RS. Data were collected via telephone interviews using a structured instrument, the Functional Status Scale, and the International Consultation on Incontinence Questionnaire - Short Form, between September 2021 and October 2022. Numerical data were analyzed for normality using the Shapiro-Wilk test. Student's t-test with Mann-Whitney's post-hoc was applied for comparison of continuous variables. Fisher's exact test was used for correlation of categorical data.

RESULTS

The sample included 32 women (56.4 ± 11.3 years) and 27 men (49.5 ± 10.7 years). Only women reported post-COVID-19 urinary incontinence (28%), as well as emotional alterations (p=0.006). Urinary incontinence was associated with insomnia (p=0.005).

CONCLUSION

Urinary incontinence was prevalent only in women and was not affected by COVID-19. Women also exhibited greater emotional alterations. Insomnia was the variable associated with the outcome. Thus far, there is incipient evidence regarding the association of the SARS-CoV-2 infection with the prevalence of urinary incontinence in individuals with Post-COVID-19 Syndrome.

Cardiovascular sequelae in symptomatic SARS-CoV-2 infection survivors

BACKGROUND

SARS-CoV-2 infection may lead to myocardial and endothelial damage. The present study sought to characterize the cardiovascular sequel in a large group of consecutive patients admitted for out-patient cardiovascular follow-up after a symptomatic COVID-19 infection.

METHODS

The aims of this study were as follows: to evaluate the presence of post-covid cardiovascular symptoms in an unselected population of outpatients referred to a post-COVID outpatient cardiology clinic and to characterize the long-term abnormalities associated with a more severe COVID-19 infection clinical course. A total of 914 patients were included in this single-center, observational, cross-sectional study, of which 163 were hospitalized and 149 required mechanical ventilation for COVID-19 pneumonia. Patients were analyzed at follow-up according to the care setting during the initial presentation.

RESULTS

The median time to follow-up was 126 days. At that time, only 3.5% of patients reported no persistent dyspnea, chest pain, or fatigue on exertion. In a follow-up echocardiographic assessment, patients who required hospitalization showed slight alterations in the pulmonary acceleration time and the tricuspid regurgitation pressure gradient, as well as reduced exercise tolerance during treadmill exercise testing when compared to patients with a benign clinical course. 24-hour Holter EKG monitoring or 24-hour blood pressure monitoring did not identify significant differences between the analyzed subgroups.

CONCLUSIONS

The current study reports on an association between COVID-19 severity and the presence of cardiovascular alterations at follow-up. A simple diagnostic protocol, comprising an exercise treadmill test and transthoracic echocardiography is useful in identifying patients who may benefit from regular, structured cardiovascular medical care.

Hyperexpression of PTAFR and PF4 as Possible Platelet Risk Biomarkers in Patients With COVID-19

BACKGROUND/AIM

SARS-CoV-2 infection presents different severity levels that suggest the influence of genetic factors on the clinical outcome of the disease. In cases of severe COVID-19, the presence of elevated coagulation markers, increased platelet activation and aggregation and the risk of thrombotic complications are described. Given the participation of these cells in several serious viral infections and their negative role when associated with a prothrombotic response, it is important to understand the mechanistic role of SARS-CoV-2 in platelet physiology. This study evaluated the hyperexpression of platelet-activating factor receptor (PTAFR) and platelet factor 4 (PF4) in unvaccinated and hospitalized patients with COVID-19.

PATIENTS AND METHODS

The study included 43 COVID-19 patients stratified according to WHO guidelines. Subsequently, the expression of the PTAFR and PF4 genes were evaluated using the real-time quantitative PCR and their possible correlation with the severity of the disease and clinical variables including hospitalization, outcome, sex, age and laboratory parameters (platelet count, INR and D-dimer).

RESULTS

The analysis demonstrated a significant (p<0.05) hyperexpression of these genes COVID-19 patients (n=43) compared to healthy controls. Expression of these genes in patients was not statistically significant (p>0.05) different between patients stratified according to clinical variables.

CONCLUSION

The expression of PTAFR and PF4 suggests an important molecular pathway in the pathophysiology of the disease and may be valuable platelet biomarkers to indicate increased risk in patients with COVID-19 who require hospital care, contributing to personalized intervention strategies and improving their clinical management.

Surfactant-derived protein type B: a new biomarker linked to respiratory failure and lung damage in mild to moderate SARS-CoV-2 pneumonia

Background

The COVID-19 pandemic has led to significant concern due to its impact on human health, particularly through pneumonia-induced lung damage. Surfactant proteins A and D (SP-A and SP-D) are implicated in COVID-19 lung damage, but the role of surfactant protein B (SP-B) remains unclear.

Methods

We conducted a single-centre, prospective observational study involving 73 hospitalised COVID-19 pneumonia patients. SP-B levels were measured within 48 h of admission, alongside SP-A and SP-D in a subset. Clinical data were collected, and follow-up visits were conducted after 6 months.

Results

At hospitalisation, circulating immature SP-B levels measured in 73 patients (median 26.31 arbitrary units (AU) (interquartile range 14.27-41.31)) correlated significantly with lung involvement (r=0.447, p<0.001) and oxygen support requirement (p=0.005). SP-B levels did not predict mechanical ventilation or intensive care unit admission. SP-B decreased significantly (p<0.001) from 25.53 AU (14.36-41.46) at the acute hospitalisation to 12.73 AU (9.12-20.23) at the 6-month follow-up, whereas SP-A and SP-D did not change significantly. Immature SP-B (but not SP-A and SP-D) was confirmed to be significantly associated with the need for oxygen support (n=26, 58%) during the hospitalisation (p<0.05).

Conclusion

Immature SP-B emerges as a potential biomarker for COVID-19 pneumonia severity and prognosis. Its dynamic changes suggest utility in monitoring disease progression and long-term outcomes, despite limitations in predicting hard end-points. Larger studies are needed to validate these findings and understand the underlying mechanisms of surfactant protein dysregulation in COVID-19 pathogenesis.

Association of iron deficiency anaemia with the hospitalization and mortality rate of patients with COVID‑19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness led to the coronavirus disease 2019 (COVID-19) pandemic, which has caused enormous health and financial losses, as well as challenges to global health. Iron deficiency anaemia (IDA) has been linked to adverse outcomes in patients infected with SARS-COV-2. The present study aimed to assess the association between IDA and the severity of COVID-19 in hospitalized patients. For this purpose, a retrospective data analysis of 100 patients with COVID-19 was conducted. Data of patients hospitalized with SARS-COV-2 infection confirmed by RT-PCR were collected between June, 2021 and March, 2022. The collected data included patient demographics, comorbidities, clinical signs, symptoms and IDA medical laboratory findings, including complete blood count and iron profiles. The results revealed that patients with COVID-19 admitted to the isolation unit represented 61.0% of the study sample, whereas 39.0% were admitted to the intensive care unit (ICU). No patients had stage I IDA, whereas 4 patients (4%) had stage II IDA. Furthermore, 19 patients (19.0%) had stage III IDA. A significantly higher proportion of patients with IDA (69.6%) were admitted to the ICU compared with those without IDA (29.9%, P<0.001). Additionally, patients with IDA had a higher proportion of a history of stroke compared with those without IDA (17.4 vs. 2.6%, respectively, P=0.024). The most common comorbidities identified were hypertension (29%), diabetes (23%) and heart problems (17%). On the whole, the present study demonstrates significant associations between IDA and a longer hospitalization period. A greater incidence of complications was observed in the hospitalized patients who were SARS-COV-2-positive. Although further studies with larger sample sizes are required to confirm these findings, the results presented herein may provide insight for physicians as regards the prevention and treatment of patients with IDA who are infected with coronavirus.

Predictors of dropping out from a home tele-exercise programme: A cohort study derived from a randomised controlled trial

Background

Online home exercises represent opportunities to increase physical activity levels. However, high dropout rates are commonly reported in such programmes. This study aimed to investigate the predictors of dropping out from an online home exercise programme.

Methods

A total of 760 individuals from nine countries participated in this 8-week prospective cohort study derived from a randomised controlled trial. The participants were randomised into "4-week live-streamed exercise ->4-week recorded exercise" or "4-week no intervention ->4-week recorded exercise" group. Repeated measurements using weekly questionnaires were performed. Pain intensity, disability, mental well-being score, exercise motivation, sleep quality, impulsiveness/anxiety, and physical activity level were analysed.

Results

A total of 53.8% (95% confidence interval [CI] 50.3%-57.3%) participants dropped out from the programme. The identified predictors of dropping out from the programme were: well-being (odds ratio [OR] 0.94, 95% CI 0.91-0.97) and disability (OR 1.02, 95% CI 1.002-1.04) at baseline considering the first 4 weeks; age (0.98; 95% CI 0.96-1.00) and baseline well-being (0.93; 95% CI 0.89-0.97) considering the entire follow-up (8 weeks); exercise motivation (0.92; 95% CI 0.87 to 0.97) and general impulsiveness/anxiety (1.04; 95% CI 1.01-1.07) repeated measured over time.

Conclusion

About half of the participants dropped out from the online home exercise programme. Higher baseline scores in mental well-being and age predicted a reduction in dropping out. Higher baseline disability predicted an increase in dropping out. During the follow-up, higher exercise motivation was associated with a reduction in dropping out, and higher impulsiveness and anxiety were associated with an increase in dropping out.

Stratified analyses refine association between TLR7 rare variants and severe COVID-19

Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (<60 years) cases with no reported clinical risk factors (n = 378), compared to 0.24% of controls (odds ratio [OR] = 12.3, p = 1.27 × 10-10). Incorporation of the results of either functional assays or protein modeling led to a pronounced increase in effect size (ORmax = 46.5, p = 1.74 × 10-15). Association signals for the X-chromosomal gene TLR7 were also detected in the female-only subgroup, suggesting the existence of additional mechanisms beyond X-linked recessive inheritance in males. Additionally, supporting evidence was generated for a contribution to severe COVID-19 of the previously implicated genes IFNAR2, IFIH1, and TBK1. Our results refine the genetic contribution of rare TLR7 variants to severe COVID-19 and strengthen evidence for the etiological relevance of genes in the interferon signaling pathway.

Death from COVID-19 in contexts of social deprivation in Mexico

Introduction

Poverty is one of the macro factors that has been little studied in terms of its effect on death from COVID-19 since most studies have focused only on investigating whether the pandemic increased poverty or not. With that on mind, the present study aims to analyze how the social deprivations that comprise the measurement of municipal poverty in interaction with health comorbidities and sociodemographic characteristics, increased the probability of death from COVID-19.

Methods

The study is cross-sectional and covers daily reports on the conditions of COVID-19 in the Mexican population for almost 2 years. Using data from the National Epidemiological Surveillance System and the National Council for Evaluation of the Social Development Policy (N = 5,387,981), we employ a Generalized Linear Mixed Model (GLMM), specifically a binomial generalized linear mixed model.

Results

The findings indicate that, besides comorbidities, sociodemographic traits, and clinical aspects, living in a municipality where one or more of the social deprivations exist increases the probability of death. Specifically, in those municipalities where there is deprivation in education, social security, and food, as well as deprivation due to access to health services and deprivation in household services, the probability of death was greater.

Discussion

Living in a municipality with one or more of the social deprivations that compose poverty generated a greater probability of death. Each one of them or together, shows that poverty is a substantial factor for a pandemic like COVID-19 to worsen contagion and death, becoming a circle from which it is difficult to escape.

Evaluation of Inflammation and Platelet Apoptosis Parameters in Obese Patients in Various Types of Anticoagulant Prophylaxis of Venous Thromboembolic Complications in Context of COVID-19

INTRODUCTION: The physical inactivity, hypoventilation, as well as chronic inflammation in obese patients aggravates their condition in various diseases. These features have become important with the advent of the COVID-19 pandemic, in which inflammation and platelet-activated coagulopathy are closely linked. AIM: To study laboratory parameters of inflammation and platelet apoptosis in obese patients using various types of anticoagulant prophylaxis of venous thromboembolic complications with the underlying COVID-19. MATERIALS AND METHODS: The study included 370 patients with COVID-19. Depending on the presence or absence of obesity and the type of parenteral anticoagulant, patients in our study were divided into groups: group 1 — non-obese + low molecular weight heparin (LMWH) (n = 114), group 2 — non-obese + unfractionated heparin (UFH) (n = 58), group 3 — obesity + LMWH (n = 76), group 4 — obesity + UFH (n = 66). The incidence of venous thromboembolic complications (VTEC), bleeding, general markers of the acute phase of inflammation, and specific markers of platelet apoptosis (phosphatidylserine and calreticulin) have been analyzed. RESULTS: At the end of hospital treatment, a decrease in ferritin levels was noted in patients both with and without obesity receiving LMWH. The concentration of calreticulin was higher in patients taking LMWH (groups 1 and 3). Phosphatidylserine levels were high in patients receiving LMWH only if they were obese. In patients taking UFH compared to LMWH, a high incidence of pulmonary embolism (PE) without a source (13.6% of cases versus 2.6%, respectively, p = 0.029) and PE with a source in the lower extremities (9.1% of cases versus 0%, respectively, p = 0.018) was found. When using LMWH, a lower incidence of bleeding was observed compared to using UFH (5.3% of cases versus 16.7%, respectively, p = 0.056). CONCLUSION: The levels of phosphatidylserine and calreticulin are higher in obese patients receiving LMWH. At the same time, patients in this group have a low incidence of VTEC and hemorrhagic complications compared to the group of patients taking UFH.