1
|
Liao Z, Wang C, Tang X, Yang M, Duan Z, Liu L, Lu S, Ma L, Cheng R, Wang G, Liu H, Yang S, Xu J, Tadese DA, Mwangi J, Kamau PM, Zhang Z, Yang L, Liao G, Zhao X, Peng X, Lai R. Human transferrin receptor can mediate SARS-CoV-2 infection. Proc Natl Acad Sci U S A 2024; 121:e2317026121. [PMID: 38408250 DOI: 10.1073/pnas.2317026121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been detected in almost all organs of coronavirus disease-19 patients, although some organs do not express angiotensin-converting enzyme-2 (ACE2), a known receptor of SARS-CoV-2, implying the presence of alternative receptors and/or co-receptors. Here, we show that the ubiquitously distributed human transferrin receptor (TfR), which binds to diferric transferrin to traffic between membrane and endosome for the iron delivery cycle, can ACE2-independently mediate SARS-CoV-2 infection. Human, not mouse TfR, interacts with Spike protein with a high affinity (KD ~2.95 nM) to mediate SARS-CoV-2 endocytosis. TfR knock-down (TfR-deficiency is lethal) and overexpression inhibit and promote SARS-CoV-2 infection, respectively. Humanized TfR expression enables SARS-CoV-2 infection in baby hamster kidney cells and C57 mice, which are known to be insusceptible to the virus infection. Soluble TfR, Tf, designed peptides blocking TfR-Spike interaction and anti-TfR antibody show significant anti-COVID-19 effects in cell and monkey models. Collectively, this report indicates that TfR is a receptor/co-receptor of SARS-CoV-2 mediating SARS-CoV-2 entry and infectivity by likely using the TfR trafficking pathway.
Collapse
Affiliation(s)
- Zhiyi Liao
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chaoming Wang
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaopeng Tang
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- School of Basic Medicine, Qingdao University, Qingdao 266071, China
| | - Mengli Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Zilei Duan
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
| | - Lei Liu
- Laboratory of Animal Tumor Models, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuaiyao Lu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Lei Ma
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Ruomei Cheng
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
| | - Gan Wang
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
| | - Hongqi Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Shuo Yang
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jingwen Xu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Dawit Adisu Tadese
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing 100049, China
| | - James Mwangi
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Peter Muiruri Kamau
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhiye Zhang
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
| | - Lian Yang
- Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650204, China
| | - Guoyang Liao
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Xudong Zhao
- Laboratory of Animal Tumor Models, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaozhong Peng
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming 650118, China
| | - Ren Lai
- Engineering Laboratory of Peptides of Chinese Academy of Sciences, Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology-Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and Sino-African Joint Research Center, New Cornerstone Science Laboratory, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming 650201, China
| |
Collapse
|
2
|
李 建, 吕 梦, 池 强, 彭 一, 刘 鹏, 吴 锐. [Early prediction of severe COVID-19 in patients with Sjögren's syndrome]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:1007-1012. [PMID: 38101781 PMCID: PMC10724002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To investigate the predictive value of blood cell ratios and inflammatory markers for adverse prognosis in patients with primary Sjögren's syndrome (PSS) combined with coronavirus disease 2019 (COVID-19). METHODS We retrospectively collected clinical data from 80 patients with PSS and COVID-19 who visited the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University from December 2022 to February 2023. Inclusion criteria were (1) meeting the American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome; (2) confirmed diagnosis of COVID-19 by real-time reverse transcription polymerase chain reaction or antigen testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); (3) availability of necessary clinical data; (4) age > 18 years. According to the clinical classification criteria of the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial the 10th Revised Edition)", the patients were divided into the mild and severe groups. Disease activity in primary Sjögren' s syndrome was assessed using the European League Against Rheumatism (EULAR) Sjögren' s syndrome disease activity index (ESSDAI). Platelet-lymphocyte ratio (PLR), C-reactive protein-lymphocyte ratio (CLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other laboratory data were compared between the two groups within 24-72 hours post-infection. RESULTS The mild group consisted of 66 cases with an average age of (51. 52±13. 16) years, and the severe group consisted of 14 cases with an average age of (52.64±10.20) years. Disease activity, CRP, platelets, PLR, and CLR were significantly higher in the severe group compared with the mild group (P < 0.05). Univariate analysis using age, disease activity, CRP, platelets, PLR, and CLR as independent variables indicated that disease activity, CRP, PLR, and CLR were correlated with the severity of COVID-19 (P < 0.05). Multivariate logistic regression analysis further confirmed that PLR (OR=1.016, P < 0.05) and CLR (OR=1.504, P < 0.05) were independent risk factors for the severity of COVID-19 in the critically ill patients. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for PLR and CLR was 0.708 (95%CI: 0.588-0.828) and 0.725 (95%CI: 0.578-0.871), respectively. The sensitivity for PLR and CLR was 0.429 and 0.803, respectively, while the highest specificity was 0.714 and 0.758, respectively. The optimal cutoff values for PLR and CLR were 166.214 and 0.870, respectively. CONCLUSION PLR and CLR, particularly the latter, may serve as simple and effective indicators for predicting the prognosis of patients with PSS and COVID-19.
Collapse
Affiliation(s)
- 建斌 李
- 南昌大学第一附属医院风湿免疫科, 南昌 330006Department of Rheumatology and Immunology, the first affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - 梦娜 吕
- 南昌大学第一临床医学院, 南昌 330006The First Clinical Medical College of Nanchang University, Nanchang 330006, China
| | - 强 池
- 南昌大学第一附属医院风湿免疫科, 南昌 330006Department of Rheumatology and Immunology, the first affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - 一琳 彭
- 南昌大学第一附属医院风湿免疫科, 南昌 330006Department of Rheumatology and Immunology, the first affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - 鹏程 刘
- 南昌大学第一附属医院风湿免疫科, 南昌 330006Department of Rheumatology and Immunology, the first affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - 锐 吴
- 南昌大学第一附属医院风湿免疫科, 南昌 330006Department of Rheumatology and Immunology, the first affiliated Hospital of Nanchang University, Nanchang 330006, China
| |
Collapse
|
3
|
Mardani M, Mohammadshahi J, Teimourpour R. Outcomes of COVID-19 in immunocompromised patients: a single center experience. Virusdisease 2023; 34:373-382. [PMID: 37780900 PMCID: PMC10533436 DOI: 10.1007/s13337-023-00832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023] Open
Abstract
Malignancy, bone marrow and organ transplantation are associated with deficient and defective immune systems. Immunocompromised patients are at risk for severe and chronic complication of COVID-19 infection. However, the pathogenesis, diagnosis and management of this comorbidity remain to be elucidated. The purpose of the present study was to describe key aspects of COVID-19 infection in immunocompromised patients. In this retrospective, cross-sectional study, lab findings and outcomes of 418 COVID-19 patients with secondary immunodeficiency disorders admitted to Taleghani Hospital in Tehran, from March 2020 to September 2022 were investigated. Of the 418 immunocompromised patients with COVID-19, 236 (56.5%) were male and the median age of all studied patients was 56.6 ± 16.4 with range of 14 to 92 years. Totally, 198 (47.4%) of the patients died during hospitalization. Remdesivir was used for treatment of all patients. Mortality rate among patients admitted to ICU ward (86.8%) was significantly higher than non ICU admission (p < 0.001). The death rate in patients with CKD was substantially higher than other underlying disease (p < 0.001). In terms of laboratory finding, there was a significant relationship between ICU admission and worse outcome with WBC count (HR = 1.94, 95% CI = 1. 46-2.59, p < 0.001), PMN count (HR = 1.93, 95% CI = 1.452.56, p < 0.001), Hb (HR = 1.49, 95% CI = 1.042.13, p = 0.028), AST (HR = 2.55, 95% CI = 1.913.41, p < 0.001), BUN (HR = 2.56, 95% CI = 2.063.69, p < 0.001), Cr (HR = 2.63, 95% CI = 1.89-3.64, p < 0.001), Comorbidities index (HR = 1.71, 95% CI = 1.29-2.27, p < 0.001) and aging (HR = 1.91, 95% CI = 1.4-2.54, p < 0.001). Immunocompromised status increased the risk of mortality or worse outcome in patients diagnosed with COVID-19. Our finding showed outcome predicting markers in whom the waned immune system encounter new emerging disease and improved our understanding of COVID-19 virus behavior in immunocompromised individuals.
Collapse
Affiliation(s)
- Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical, Tehran, Iran
| | - Jafar Mohammadshahi
- Ardabil University of medical science, Ardabil, Iran
- Department of Infectious Diseases, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Roghayeh Teimourpour
- Ardabil University of medical science, Ardabil, Iran
- Department of Microbiology, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| |
Collapse
|
4
|
Aloisio E, Colombo G, Dolci A, Panteghini M. C-reactive protein and clinical outcome in COVID-19 patients: the importance of harmonized measurements. Clin Chem Lab Med 2023; 61:1546-1551. [PMID: 37036741 DOI: 10.1515/cclm-2023-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
C-reactive protein (CRP) is a cytokine-mediated acute phase reactant with a recognized role in inflammatory conditions and infectious disease. In coronavirus disease 2019 (COVID-19), elevated CRP concentrations in serum were frequently detected and significantly associated with poor outcome in terms of disease severity, need for intensive care, and in-hospital death. For these reasons, the marker was proposed as a powerful test for prognostic classification of COVID-19 patients. In most of available publications, there was however confounding information about how interpretative criteria for CRP in COVID-19 should be derived, including quality of employed assays and optimal cut-off definition. Assuring result harmonization and controlling measurement uncertainty in terms of performance specifications are fundamental to allow worldwide application of clinical information according to specific CRP thresholds and to avoid risk of patient misclassification.
Collapse
|
5
|
Butt R, Sherwani RAK, Aslam M, Albassam M. Smoking and prevalence of COVID-19: Evidence from studies from January 2020 - May 2020. AIMS Public Health 2023; 10:538-552. [PMID: 37842271 PMCID: PMC10567969 DOI: 10.3934/publichealth.2023038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 10/17/2023] Open
Abstract
It is well-known that smoking tobacco harms the respiratory system and can lead to various health problems. Regarding COVID-19, a respiratory illness caused by the novel coronavirus SARS-CoV-2, smoking may have implications for both the risk of infection and the severity of the disease. Several studies have explored the association between smoking and COVID-19. However, findings have been somewhat inconsistent and vary from region to region for sample size. This article aims to study the prevalence of COVID-19 among those affected with their ongoing smoking history by computing pooled estimates of the published research. Fixed effect meta-analysis by following the guidelines of PRISMA has been carried out on 34 studies. The patients with confirmed RT-PCR and CT-scan were included, a total of 13,368; The studies' quality assessment was performed according to the Appraisal Checklist recommended by the Joanna Briggs Institute. The effect sizes of the published research are presented in the form of pooled estimates with their respective confidence intervals. Forest plots are used to represent the effect size graphically. Current smokers' effect sizes are 0.12 (CI = 0.11-0.12); for non-smokers, it is estimated to be 0.88 (CI = 0.88-0.89). The heterogeneity statistic I2 describes 0% of the total variation, meaning no heterogeneity among studies exists. A higher prevalence of COVID-19 among non-smokers is observed than the smokers.
Collapse
Affiliation(s)
- Rafia Butt
- College of Statistical Sciences, University of the Punjab Lahore, Pakistan
| | | | - Muhammad Aslam
- Department of Statistics, Faculty of Science, King Abdulaziz University, Jeddah 21551, Saudi Arabia
| | - Mohammed Albassam
- College of Statistical Sciences, University of the Punjab Lahore, Pakistan
| |
Collapse
|
6
|
The main protease of SARS-CoV-2 cleaves histone deacetylases and DCP1A, attenuating the immune defense of the interferon-stimulated genes. J Biol Chem 2023; 299:102990. [PMID: 36758802 PMCID: PMC9907797 DOI: 10.1016/j.jbc.2023.102990] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019, constitutes an emerging human pathogen of zoonotic origin. A critical role in protecting the host against invading pathogens is carried out by interferon-stimulated genes (ISGs), the primary effectors of the type I interferon (IFN) response. All coronaviruses studied thus far have to first overcome the inhibitory effects of the IFN/ISG system before establishing efficient viral replication. However, whether SARS-CoV-2 evades IFN antiviral immunity by manipulating ISG activation remains to be elucidated. Here, we show that the SARS-CoV-2 main protease (Mpro) significantly suppresses the expression and transcription of downstream ISGs driven by IFN-stimulated response elements in a dose-dependent manner, and similar negative regulations were observed in two mammalian epithelial cell lines (simian Vero E6 and human A549). Our analysis shows that to inhibit the ISG production, Mpro cleaves histone deacetylases (HDACs) rather than directly targeting IFN signal transducers. Interestingly, Mpro also abolishes the activity of ISG effector mRNA-decapping enzyme 1a (DCP1A) by cleaving it at residue Q343. In addition, Mpro from different genera of coronaviruses has the protease activity to cleave both HDAC2 and DCP1A, even though the alphacoronaviruse Mpro exhibits weaker catalytic activity in cleaving HDAC2. In conclusion, our findings clearly demonstrate that SARS-CoV-2 Mpro constitutes a critical anti-immune effector that modulates the IFN/ISG system at multiple levels, thus providing a novel molecular explanation for viral immune evasion and allowing for new therapeutic approaches against coronavirus disease 2019 infection.
Collapse
|
7
|
Eskandari D, Ziaee A, Amirfarhangi Anbardan A, Zeinali E, Tirkan A. Primary adrenal insufficiency and myocarditis in COVID-19 disease: a case report. BMC Endocr Disord 2022; 22:336. [PMID: 36587233 PMCID: PMC9805346 DOI: 10.1186/s12902-022-01257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/16/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND COVID-19 has different manifestations from respiratory to GI problems, and some of them are more common, but some are rare. Reporting rare cases can significantly advance our understanding of the disease. CASE PRESENTATION In this case, we report an 18-year-old teenage boy with chest pain and resistant hypotension following COVID-19 infection, finally diagnosed as primary adrenal insufficiency and COVID-19 myocarditis. CONCLUSION Adrenal insufficiency can be life-threatening due to its adverse effects on hemodynamic and electrolyte equilibrium. In addition, COVID-19 induced myocarditis can make the situation more complicated.
Collapse
Affiliation(s)
- Delaram Eskandari
- Department of Endocrinology, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ziaee
- Department of Endocrinology, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdollah Amirfarhangi Anbardan
- Department of Endocrinology, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elahe Zeinali
- Department of Endocrinology, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Atefe Tirkan
- Department of Endocrinology, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Rasool Akram Medical Complex, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
DUYURAN R, GÜRBÜZ H, BAYRAKÇI S, ÇİÇEK H. Serum oxidant, antioxidant, and paraoxonase levels in COVID-19 patients. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1167711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of his study was to determine serum oxidant status (TOS), antioxidant status (TAS), and paraoxonase (PON1) levels and to determine their diagnostic values in patients diagnosed with COVID-19.
Materials and Methods: The research was carried out on patients diagnosed with COVID-19. Within the scope of the study, a total of 87 patients with a diagnosis of COVID-19, 48 (55.1%) male and 39 (44.9%) were evaluated. Total antioxidant determination was performed using a microplate reader according to the Erel method. To calculate the Oxidative stress index (OSI), TOS and TAS levels were determined.
Results: Male gender was associated with high PON1, smoking with high TOS, the presence of hypertension and Diabetes mellitus (DM) diseases with low OSI, and the presence of asthma with low PON1. High PON1 was found to be associated with shorter hospitalization duration and high TOS was associated with longer hospitalization duration. TAS and TOS levels increased significantly due to the increase in CRP, TOS levels due to the increase in neutrophil level, OSI levels due to the increase in leukocyte level, PON1 levels increased due to the increase in LDH level TAS, TOS, OSI, and PON1 cut-off values were 1.41 (AUC: 0.647), 4.56 (AUC: 0.493), 0.421 (AUC: 0.505) and 340 (AUC: 0.536), sensitivity values were 65.5, 55.2, 48.3 and 51.7; specificity values were calculated respectively as 62.1, 46.6, 34.5 and 53.4.
Conclusion: Although it is seen that oxidative stress types have diagnostic value, there is a need for more comprehensive studies with larger samples on the subject.
Collapse
Affiliation(s)
| | - Hüseyin GÜRBÜZ
- 2. Dr. Ersin Arslan Training and Research Hospital, Department of Emergency Medicine
| | - Sinem BAYRAKÇI
- 3. Dr. Ersin Arslan Training and Research Hospital, Department of Intensive Care
| | | |
Collapse
|
9
|
Lai KL, Hu FC, Wen FY, Chen JJ. Lymphocyte count is a universal predictor of health outcomes in COVID-19 patients before mass vaccination: A meta-analytical study. J Glob Health 2022; 12:05041. [PMID: 36112520 PMCID: PMC9480861 DOI: 10.7189/jogh.12.05041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Several laboratory data have been identified as predictors of disease severity or mortality in COVID-19 patients. However, the relative strength of laboratory data for the prediction of health outcomes in COVID-19 patients has not been fully explored. This meta-analytical study aimed to evaluate the prediction capabilities of laboratory data on the prognosis of COVID-19 patients during 2020 while mass vaccination has not started yet. Methods Two electronic databases, MEDLINE and EMBASE, from inception to October 10, 2020 were searched. Observational studies of laboratory-confirmed COVID-19 patients with well-defined severity or survival status, and with the desired laboratory data at initial hospital administrations, were selected. Meta-regression analysis with the generalized estimating equations (GEE) method for clustered data was performed sequentially. Primary outcome measures were to compare the level of laboratory data and their impact on different health outcomes (severe vs non-severe, critically severe vs non-critically severe, and dead vs alive). Results Meta-data of 13 clinical laboratory items at initial hospital presentations were extracted from 76 selected studies with a total of 26 627 COVID-19 patients in 16 countries. After adjusting for the effect of age, 1.03 <lymphocyte count mean or median ( × 109/L) ≤2.06 (estimated odds ratio (OR) = 0.0216; 95% confidence interval (CI) = 0.0041-0.1131; P < 0.0001), higher lymphocyte count mean or median ( × 109/L) (OR <0.0001; 95% CI: <0.0001-0.0386; P = 0.0284), and lymphocyte count mean or median ( × 109/L) >0.87 (OR = 0.0576; 95% CI = 0.0043-0.4726; P = 0.0079) had a much lower risk of severity, critical severity, and mortality from COVID-19, respectively. Conclusions Lymphocyte count was the most powerful predictor among the 13 common laboratory variables explored from COVID-19 patients to differentiate disease severity and to predict mortality. Lymphocyte count should be monitored for the prognoses of COVID-19 patients in clinical settings in particular for patients not fully vaccinated.
Collapse
Affiliation(s)
- Kuan-Lang Lai
- Graduate Institute of Public Health, School of Public Health, National Defense Medical Center, Taipei, Taiwan
- CJ Consulting-Expert Co., Ltd., Taipei, Taiwan
| | - Fu-Chang Hu
- Graduate Institute of Clinical Medicine and School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Statistical Consulting Clinic, International-Harvard (I-H) Statistical Consulting Company, Taipei, Taiwan
| | - Fang-Yu Wen
- Statistical Consulting Clinic, International-Harvard (I-H) Statistical Consulting Company, Taipei, Taiwan
| | - Ju-Ju Chen
- CJ Consulting-Expert Co., Ltd., Taipei, Taiwan
| |
Collapse
|
10
|
Rezaei Tolzali MM, Noori M, Shokri P, Rahmani S, Khanzadeh S, Nejadghaderi SA, Fazlollahi A, Sullman MJM, Singh K, Kolahi AA, Arshi S, Safiri S. Efficacy of tocilizumab in the treatment of COVID-19: An umbrella review. Rev Med Virol 2022; 32:e2388. [PMID: 36029180 PMCID: PMC9539231 DOI: 10.1002/rmv.2388] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 01/09/2023]
Abstract
Tocilizumab is an interleukin (IL)‐6 receptor inhibitor that has been proposed as a therapeutic agent for treating coronavirus disease 2019 (COVID‐19). The aim of this umbrella review was to determine the efficacy of tocilizumab in treating COVID‐19, and to provide an overview of all systematic reviews on this topic. We systematically searched PubMed, Scopus, the Web of Science collection, the Cochrane library, Epistemonikos, and Google Scholar, as well as the medRxiv preprint server. These databases were searched up to 30 September 2021, using the following keywords: ‘SARS‐CoV‐2’, ‘COVID‐19’, ‘tocilizumab’, ‘RHPM‐1’, ‘systematic review’, and ‘meta‐analysis’. Studies were included if they were systematic reviews (with or without meta‐analysis) investigating the efficacy or safety of tocilizumab in confirmed COVID‐19 patients. The AMSTAR 2 checklist was used to assess quality of the included articles, while publication bias was examined using Egger's test. A total of 50 eligible systematic reviews were included. The pooled estimates showed significant reductions in clinical failure (risk ratio (RR) 0.75; 95% confidence interval (CI), 0.61–0.93), deaths (RR 0.78; 95%CI, 0.71–0.85) and the need for mechanical ventilation (RR 0.77; 95%CI, 0.64–0.92) for those receiving tocilizumab compared with the control group. Also, an emerging survival benefit was demonstrated for those who received tocilizumab, over those in the control group (adjusted hazard ratio (aHR) 0.52; 95%CI, 0.43–0.63). In addition, tocilizumab substantially increased the number of ventilator‐free days, compared with the control treatments (weighted mean difference (WMD) 3.38; 95%CI, 0.51–6.25). Furthermore, lymphocyte count (WMD 0.26 × 109/L; 95%CI, 0.14–0.37), IL‐6 (WMD 176.99 pg/mL; 95%CI, 76.34–277.64) and D‐dimer (WMD 741.08 ng/mL; 95%CI, 109.42–1372.75) were all significantly elevated in those receiving tocilizumab. However, the level of lactate dehydrogenase (LDH) (WMD −30.88 U/L; 95%CI, −51.52, −10.24) and C‐reactive protein (CRP) (WMD ‐104.83 mg/L; 95%CI, −133.21, −76.46) were both significantly lower after treatment with tocilizumab. Tocilizumab treatment reduced the risk of intubation, mortality and the length of hospital stay, without increasing the risk of superimposed infections in COVID‐19 patients. Therefore, tocilizumab can be considered an effective therapeutic agent for treating patients with COVID‐19.
Collapse
Affiliation(s)
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pourya Shokri
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Rahmani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Asra Fazlollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kuljit Singh
- Department of Medicine, Griffith University, Southport, Queensland, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnam Arshi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
11
|
Clinical and demographic characteristics of COVID-19 cases in Brunei Darussalam: comparison between the first and second waves, 2020 and 2021. Western Pac Surveill Response J 2022; 13:1-7. [PMID: 36688183 PMCID: PMC9831597 DOI: 10.5365/wpsar.2022.13.3.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective Differences in clinical manifestations between strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported. This retrospective descriptive study compares the clinical and demographic characteristics of all confirmed coronavirus disease (COVID-19) cases admitted to the National Isolation Centre (NIC) in the first wave and at the beginning of the second wave of the pandemic in Brunei Darussalam. Methods All COVID-19 cases admitted to the NIC between 9 March and 6 May 2020 (first wave) and 7-17 August 2021 (second wave) were included. Data were obtained from NIC databases and case characteristics compared using Student's t-tests and χ2 tests, as appropriate. Results Cases from the first wave were significantly older than those from the second wave (mean 37.2 vs 29.7 years, P < 0.001), and a higher proportion reported comorbidities (30.5% vs 20.3%, P = 0.019). Cases from the second wave were more likely to be symptomatic at admission (77.7% vs 63.1%, P < 0.001), with a higher proportion reporting cough, anosmia, sore throat and ageusia/dysgeusia; however, myalgia and nausea/vomiting were more common among symptomatic first wave cases (all P < 0.05). There was no difference in the mean number of reported symptoms (2.6 vs 2.4, P = 0.890). Discussion Our study showed clear differences in the profile of COVID-19 cases in Brunei Darussalam between the first and second waves, reflecting a shift in the predominating SARS-CoV-2 strain. Awareness of changes in COVID-19 disease manifestation can help guide adjustments to management policies such as duration of isolation, testing strategies, and criteria for admission and treatment.
Collapse
|
12
|
Contribution of Erythrocyte Sedimentation Rate to Predict Disease Severity and Outcome in COVID-19 Patients. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:6510952. [PMID: 35992514 PMCID: PMC9388309 DOI: 10.1155/2022/6510952] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022]
Abstract
Aim The use of erythrocyte sedimentation rate (ESR) in coronavirus disease 2019 (COVID-19) to determine disease severity and prognosis is limited. This study aimed to interrogate the diagnostic and prognostic role of ESR compared to other acute-phase reactants. Method This retrospective cross-sectional study included 493 confirmed and hospitalized adult COVID-19 patients. Pneumonia, radiological severity, oxygen, intensive care requirements, mortality, ESR, and other acute-phase reactant values were recorded. Logistic regression and ROC analysis identified the effect of ESR on mortality and the sensitivity and specificity of the optimal cutoff values of ESR for the prediction of pneumonia, intensive care needs, and mortality and compared these with values for CRP. Results Of patients, 346 (70.2%) had pneumonia, 98 (19.9%) required intensive care, 183 (37.1%) required oxygen support, and 62 (12.6%) died. ESR data were obtained for 278 patients. Among patients, 80.2% had ESR above 20 mm/h, with a median value of 53 (interquartile range: 49). ESR was higher among those with pneumonia (p < 0.001), requiring oxygen (p < 0.001), and requiring intensive care (p=0.003) compared to those without these, and in exitus patients (p=0.043) compared to survivors. Logistic regression analysis identified that ESR did not impact mortality. ROC analysis found the AUC, cutoff, sensitivity, and specificity results of ESR for pneumonia were 0.827, 37 mm/h, 77%, and 78%; for intensive care were 0.625, 50 mm/h, 74%, and 52; and for mortality were 0.606, 51 mm/h, 71%, and 49%, respectively. However, ROC analysis values for CRP were superior to ESR for all these categories. Conclusion ESR increased in COVID-19 patients in the presence of pneumonia and severe disease; however, it was not prognostic. Sensitivity and specificity values for pneumonia, intensive care requirements, and mortality were lower than those for CRP.
Collapse
|
13
|
Salame H, Nawfal R, Kassem J, Mckey R, Kassem A, AlKhalil N, Saleh M, Abdel Sater AH, Ibrahim A, Abou-Abbas L, Eldbouni O, Khatoun H, Matar B. Utility of hematological and inflammatory biomarkers in predicting recovery in critical Covid-19 patients: Our experience in the largest Covid-19 treating center in Lebanon. PLoS One 2022; 17:e0271393. [PMID: 35830459 PMCID: PMC9278762 DOI: 10.1371/journal.pone.0271393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background
COVID-19 pandemic has led to a catastrophic shortage of ICU beds. This has resulted in the need to identify patients that can be discharged early before full clinical recovery. We designed this study to determine if in changes routine tests like CBCD and CRP can be a useful complement to clinical status when deciding to discharge patients from ICU.
Methods
This retrospective study was conducted in Rafic Hariri University Hospital. Levels of biomarkers measured at admission (T1) and within 3 days of outcome (T2) were collected and ratios (T2/T1) were calculated. The Odds Ratios of association between the changes in these biomarkers and outcome were estimated. Multivariate analysis and AUC for the performance of these biomarkers were also conducted.
Results
We found on multivariate analysis that reduction in counts of lymphocyte and platelets and elevation in counts of neutrophils and level of CRP (T2/T1 ratio > 1) are strongly associated with mortality with respective ORs estimated at 6.74, 3.26, 5.65 and 4.34 [p-values < 0.001]. AUCs were found to lie in a range of 0.68 to 0.81 indicating fair to good performance. Other factors found to impact survival were AKI, AF and ACS [p-values < 0.01]. In contrast to other studies, risk factors didn’t show an association with survival when adjusted for effects of complications and changes in biomarker levels.
Conclusions
Our results confirm that inexpensive tests like lymphocyte count and CRP can be reliably used to follow COVID-19 patients in ICU and to support the decision to discharge patients.
Collapse
Affiliation(s)
- Hassan Salame
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
- * E-mail:
| | - Rashad Nawfal
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Jad Kassem
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Remy Mckey
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Ali Kassem
- Department of Surgery, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Nayef AlKhalil
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Mohamad Saleh
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Ali H. Abdel Sater
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Ali Ibrahim
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Oussaima Eldbouni
- Department of Infectious Diseases, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Hoda Khatoun
- Department of Diagnostic Radiology, Saint-George Hospital, Beirut, Lebanon
| | - Bassam Matar
- Department of Hematology and Oncology, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| |
Collapse
|
14
|
Simbaña-Rivera K, Jaramillo PRM, Silva JVV, Gómez-Barreno L, Campoverde ABV, Novillo Cevallos JF, Guanoquiza WEA, Guevara SLC, Castro LGI, Puerta NAM, Guayta Valladares AW, Lister A, Ortiz-Prado E. High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU. PLoS One 2022; 17:e0262423. [PMID: 35358185 PMCID: PMC8970356 DOI: 10.1371/journal.pone.0262423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes. METHODS A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15th to July 15th, 2020. RESULTS From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5-24.0), compared to 9 points (IQR: 5.0-22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group. CONCLUSION There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.
Collapse
Affiliation(s)
- Katherine Simbaña-Rivera
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito, Ecuador
| | | | | | - Lenin Gómez-Barreno
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito, Ecuador
| | | | | | | | | | | | | | | | - Alex Lister
- University Hospital Southampton NHS FT, Southampton, United Kingdom
| | - Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito, Ecuador
- Biomedicine Program, Department of Cell Biology, Physiology and Immunology Universidad de Barcelona, Barcelona, Spain
| |
Collapse
|
15
|
Araya S, Tsegay YG, Atlaw A, Aragaw M, Tadlo G, Tsegaye N, Kahase D, Gebreyohanes Z, Bitew M, Berhane N. Organ function biomarker abnormalities, associated factors and disease outcome among hospitalized patients with COVID-19. Biomark Med 2022; 16:417-426. [PMID: 35234521 PMCID: PMC8890361 DOI: 10.2217/bmm-2021-0681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this study was to determine the magnitude of abnormal organ function tests and biomarkers in hospitalized patients with confirmed COVID-19 and to define the association among markers of organ failure, disease severity and its outcome in hospitalized COVID-19 patients in Ethiopia. Methods: A prospective cohort study was conducted among COVID-19 patients admitted to Millennium COVID-19 Treatment Center from December 2020 to June 2021. Results: The median age of the 440 study participants was 60.3 ± 1.3 years, and from these 71.3% of patients were male. Disease severity: p-value: 0.032; adjusted odds ratio (AOR) (95% CI): 4.4 (0.022-0.085); and the presence of any co-morbidity; p-value: 0.012; AOR (95% CI): 0.80 (0.47-0.83) was significantly associated with mortality. Aspartate transaminase, alanine transaminase and alkaline phosphatase parameter values of patients overall, were elevated - mainly among critical patients (56.9 ± 57.7, 58.5 ± 63 and 114.6 ± 60, respectively).
Collapse
Affiliation(s)
- Shambel Araya
- Addis Ababa University College of Health Science, Department of Medical Laboratory Science, Addis Ababa, Ethiopia
| | - Yakob G Tsegay
- Department of Medical Biotechnology, Institute of Biotechnology, University of Gondar, Gondar, Ethiopia.,Department of Research & Development Center, College of Health Sciences, Defense University, Addis Ababa, Ethiopia
| | - Assegdew Atlaw
- Addis Ababa University, College of Health Science, Department of Medical Microbiology, Immunology & Parasitology, Addis Ababa, Ethiopia
| | - Mintsnot Aragaw
- Addis Ababa University College of Health Science, Department of Medical Laboratory Science, Addis Ababa, Ethiopia.,Department of Medical Laboratory Science, St. Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Getachew Tadlo
- Department of Medical Laboratory Science, St. Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Nebiyu Tsegaye
- Addis Ababa University College of Health Science, Department of Medical Laboratory Science, Addis Ababa, Ethiopia.,Department of Medical Laboratory Science, St. Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Daniel Kahase
- Department of Medical Laboratory Sciences, College of Medicine & Health Sciences, Wolkite University, South Nation Nationality & Peoples, Ethiopia
| | - Zenebe Gebreyohanes
- Department of Medical Laboratory Science, St. Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | | | - Nega Berhane
- Department of Medical Biotechnology, Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
16
|
Li W, Zhao N, Yan X, Xu X, Zou S, Wang H, Li Y, Du X, Zhang L, Zhang Q, Cheung T, Ungvari GS, Ng CH, Xiang YT. Network Analysis of Depression, Anxiety, Posttraumatic Stress Symptoms, Insomnia, Pain, and Fatigue in Clinically Stable Older Patients With Psychiatric Disorders During the COVID-19 Outbreak. J Geriatr Psychiatry Neurol 2022; 35:196-205. [PMID: 35245998 PMCID: PMC8899828 DOI: 10.1177/08919887221078559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis. METHODS Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively. RESULTS A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30). CONCLUSIONS Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Wen Li
- Unit of Psychiatry, Department of Public
Health and Medicinal Administration, & Institute of Translational
Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities
and Social Sciences,
University
of Macau, Macao SAR, China
| | - Na Zhao
- Unit of Psychiatry, Department of Public
Health and Medicinal Administration, & Institute of Translational
Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Center for Cognition and Brain
Disorders,
Institutes of
Psychological Sciences,
Hangzhou Normal
University, Hangzhou, China
| | - Xiaona Yan
- Department of Psychiatry,
Xiamen
Xianyue Hospital, Xiamen, China
| | - Xiuying Xu
- Department of Psychiatry,
Xiamen
Xianyue Hospital, Xiamen, China
| | - Siyun Zou
- Guangji Hospital Affiliated to Soochow
University, Soochow, China
| | - Huan Wang
- Department of Psychiatry,
Lanzhou
University Second Hospital, Lanzhou,
China
| | - Yulong Li
- Department of Psychiatry,
Lanzhou
University Second Hospital, Lanzhou,
China
| | - Xiangdong Du
- Guangji Hospital Affiliated to Soochow
University, Soochow, China
| | - Lan Zhang
- Department of Psychiatry,
Lanzhou
University Second Hospital, Lanzhou,
China
| | - Qinge Zhang
- The National Clinical Research
Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders,
Beijing Anding Hospital & the Advanced Innovation Center for Human Brain
Protection, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of
Nursing, Hong Kong Polytechnic
University, Hong Kong SAR, China
| | - Gabor S. Ungvari
- Division of Psychiatry, School of
Medicine, University of
Western Australia, Perth, WA,
Australia
- University of Notre Dame
Australia, Fremantle, WA,
Australia
| | - Chee H. Ng
- Department of Psychiatry,
The Melbourne
Clinic and St Vincent’s Hospital,
University of
Melbourne, Richmond, VIC,
Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public
Health and Medicinal Administration, & Institute of Translational
Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities
and Social Sciences,
University
of Macau, Macao SAR, China
| |
Collapse
|
17
|
Karabulut Uzuncakmak S, Dirican E, Naldan ME, Kesmez Can F, Halıcı Z. Investigation of CYP2E1 and Caspase-3 Gene Expressions in COVID-19 patients. GENE REPORTS 2022; 26:101497. [PMID: 35071821 PMCID: PMC8760173 DOI: 10.1016/j.genrep.2022.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
Background COVID-19 pandemic spread around the world like an infectious disease that presents waved effects on patients. Some patients needed ICU and respiratory support. Some patients only had flu-like symptoms. Cytokine storm and elevated ROS were serious problems for treatment. Apoptotic genes and CYP Family are part of these mechanisms. Aim In this study, our aim was to examine the gene expression CYP2E1 and Caspase-3 in patients with COVID-19 infection. Method 60 COVID-19(+) patients (ICU and non-ICU patients) and 30 healthy volunteers were enrolled to study. To measure the level of gene expression qPCR was used. The 2-ΔΔCt method was utilized to analyze gene expression. Results The expression of CYP2E1 and Caspase-3 genes showed a significant discrepancy between patients and healthy individuals. Caspase-3 expression increased (p=0,0041) but CYP2E1 expression decreased (p=0,0214) in COVID-19 patients compared to healthy individuals. Both levels of gene expression were lower in patients with affected lungs than patients with unaffected lungs (p<0,05). Laboratory findings including d-Dimer, LDH, platelet count, lymphocyte count were related to both gene expressions (p<0,05). We found no correlation between CYP2E1 and Caspase-3 expressions. Conclusion The expression of Caspase-3 demonstrated apoptotic situations of patients but was not related to the CYP2E1 expression level. CYP2E1 gene expression is an important actor to metabolize endogens and xenobiotics however, COVID-19 patients demonstrated decreased CYP2E1 expression. CYP2E1 and Caspase-3 gene expression levels may be used as a diagnostic tool for COVID-19 patients.
Collapse
Affiliation(s)
| | - E Dirican
- Health Services Vocational School, Bayburt University, Bayburt 69000, Turkey
| | - M E Naldan
- Department of Anesthesia, Regional Education and Research Hospital, Erzurum 25240, Turkey
| | - F Kesmez Can
- Faculty of Medicine, Department of Infectious and Clinical Microbiology Diseases, Atatürk University, Erzurum 25240, Turkey
| | - Z Halıcı
- Faculty of Medicine, Department of Pharmacology, Atatürk University, Erzurum 25240, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University, 25240 Erzurum, Turkey
| |
Collapse
|
18
|
An W, Wang Q, Kim TE, Kang JS. Clinical characteristics and outcome of coronavirus disease 2019 infection in patients with solid organ transplants: A systematic review and meta-analysis. J Infect Public Health 2022; 15:365-372. [PMID: 35193818 PMCID: PMC8857642 DOI: 10.1016/j.jiph.2022.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/03/2022] [Accepted: 02/06/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, South Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, South Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, South Korea.
| |
Collapse
|
19
|
Beran J, Špajdel M, Slíva J. Inosine Pranobex Deserves Attention as a Potential Immunomodulator to Achieve Early Alteration of the COVID-19 Disease Course. Viruses 2021; 13:2246. [PMID: 34835052 PMCID: PMC8619495 DOI: 10.3390/v13112246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022] Open
Abstract
Since its licensing in 1971, the synthetic compound inosine pranobex has been effectively combating viral infections, including herpes zoster, varicella, measles, and infections caused by the herpes simplex virus, human papillomavirus, Epstein-Barr virus, cytomegalovirus, and respiratory viruses. With the emergence of SARS-CoV-2, new and existing drugs have been intensively evaluated for their potential as COVID-19 medication. Due to its potent immunomodulatory properties, inosine pranobex, an orally administered drug with pleiotropic effects, can, during early treatment, alter the course of the disease. We describe the action of inosine pranobex in the body and give an overview of existing evidence collected to support further efforts to study this drug in a rigorous clinical trial setup.
Collapse
Affiliation(s)
- Jiří Beran
- Department for Tropical, Travel Medicine and Immunization, Institute of Postgraduate Health Education, 100 05 Prague, Czech Republic
| | - Marián Špajdel
- Department of Psychology, Faculty of Philosophy and Arts, Trnava University, 918 43 Trnava, Slovakia;
| | - Jiří Slíva
- Department of Pharmacology, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
| |
Collapse
|
20
|
Deng H, Yan X, Yuan L. Human genetic basis of coronavirus disease 2019. Signal Transduct Target Ther 2021; 6:344. [PMID: 34545062 PMCID: PMC8450706 DOI: 10.1038/s41392-021-00736-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in considerable morbidity and mortality worldwide. COVID-19 incidence, severity, and mortality rates differ greatly between populations, genders, ABO blood groups, human leukocyte antigen (HLA) genotypes, ethnic groups, and geographic backgrounds. This highly heterogeneous SARS-CoV-2 infection is multifactorial. Host genetic factors such as variants in the angiotensin-converting enzyme gene (ACE), the angiotensin-converting enzyme 2 gene (ACE2), the transmembrane protease serine 2 gene (TMPRSS2), along with HLA genotype, and ABO blood group help to explain individual susceptibility, severity, and outcomes of COVID-19. This review is focused on COVID-19 clinical and viral characteristics, pathogenesis, and genetic findings, with particular attention on genetic diversity and variants. The human genetic basis could provide scientific bases for disease prediction and targeted therapy to address the COVID-19 scourge.
Collapse
Affiliation(s)
- Hao Deng
- grid.216417.70000 0001 0379 7164Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Disease Genome Research Center, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Xue Yan
- grid.216417.70000 0001 0379 7164Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Disease Genome Research Center, Central South University, Changsha, China
| | - Lamei Yuan
- grid.216417.70000 0001 0379 7164Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Disease Genome Research Center, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
21
|
Guarnera A, Santini E, Podda P. Idiopathic Interstitial Pneumonias and COVID-19 Pneumonia: Review of the Main Radiological Features and Differential Diagnosis. Tomography 2021; 7:397-411. [PMID: 34564297 PMCID: PMC8482091 DOI: 10.3390/tomography7030035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pneumonia represents a challenging health emergency, due to the disproportion between the high transmissibility, morbidity, and mortality of the virus and healthcare systems possibilities. Literature has mainly focused on COVID-19 pneumonia clinical-radiological diagnosis and therapy, and on the most common differential diagnoses, while few papers investigated rare COVID-19 pneumonia differential diagnoses or the overlapping of COVID-19 pneumonia on pre-existing lung pathologies. This article presents the main radiological characteristics of COVID-19 pneumonia and Idiopathic Interstitial Pneumonias (IIPs) to identify key radiological features for a differential diagnosis among IIPs, and between IIPs and COVID-19 pneumonia. COVID-19 pneumonia differential diagnosis with IIPs is challenging, since these entities may share common radiological findings as ground glass opacities, crazy paving patterns, and consolidations. Multidisciplinary discussion is crucial to reach a final and correct diagnosis. Radiologists have a pivotal role in identifying COVID-19 pneumonia patterns, reporting possible overlapping with long-lasting lung diseases, and suggesting potential differential diagnoses. An optimal evaluation of HRTC may help in containing the disease, in promoting better treatment for patients, and in providing an efficient allocation of human and economic resources.
Collapse
Affiliation(s)
- Alessia Guarnera
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
- Correspondence:
| | - Elena Santini
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
| | - Pierfrancesco Podda
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
| |
Collapse
|
22
|
Felemban RM, Tashkandi EM, Mohorjy DK. The willingness of the Saudi Arabian population to participate in the COVID-19 vaccine trial: A case-control study. J Taibah Univ Med Sci 2021; 16:612-618. [PMID: 33815034 PMCID: PMC8007413 DOI: 10.1016/j.jtumed.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study examines the Saudi Arabian population's willingness to participate in clinical trials for the coronavirus disease 2019 (COVID-19) vaccine, comparing recovered cases' willingness with that of healthy volunteers. METHODS A case-control study was conducted on the Saudi Arabian population during September 2020. The data were collected from recovered COVID-19 participants as the case group, and healthy volunteers as the control group. RESULTS The data showed that 42.2% (n = 315) of recovered COVID-19 cases were more willing to participate in the COVID-19 vaccine trial than healthy volunteers (299; 38.1%) with a p < 0.001. The proportion of the participants who were willing to donate plasma was significantly higher among recovered participants, 84.2% (n = 112), than healthy volunteers, 76.3% (n = 87), with a p < 0.0001. The most significant factor responsible for a willingness to participate was the belief that vaccine discovery would help scientific developments (r = 0.525 and 0.465 for case and control, respectively). In comparison, significant reasons behind the unwillingness to participate were the risk of exposure to an unproven vaccine, r = 0.377 and 0.497 for case and control, respectively (p < 0.001), and a discomfort with being treated as an experimental subject (r = 0.275 and 0.374 for case and control, respectively). CONCLUSIONS The differences in readiness toward the COVID-19 vaccine trial in our study does not indicate any passive exposure of participants to an unproven clinical trial vaccine, nor does it shed light on well-informed risk-related decisions. However, certain factors can significantly influence decision-making while contributing toward clinical research. This study's results must not be used for the individuals' recruitment bias in a COVID-19 vaccine trial.
Collapse
Affiliation(s)
| | - Emad M. Tashkandi
- Department of Medicine, College of Medicine, Umm AlQura University, Makkah, KSA
| | - Doaa K. Mohorjy
- Research Center, King Abdullah Medical City, Holy Capital, KSA
| |
Collapse
|
23
|
Ghanei M, Keyvani H, Haghdoost A, Abolghasemi H, Janbabaei G, Reza Jamshidi H, Hosein Ghazale A, Hassan Saadat S, Gholami Fesharaki M, Raei M. The risk factors and related hospitalizations for cases with positive and negative COVID-19 tests: A case-control study. Int Immunopharmacol 2021; 98:107894. [PMID: 34186280 PMCID: PMC8205271 DOI: 10.1016/j.intimp.2021.107894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the risk factors for hospitalizations of cases with positive and negative COVID-19 tests. METHODS In this case-control study, the case and control groups consisted of 292 COVID-19 patients and 296 non-COVID-19 patients. Patients who referred to a reference laboratory in Tehran (Iran) in March 2020 were selected and interviewed. The patients were contacted by telephone and data were recorded through a questionnaire. RESULTS The sample of this study consisted of 588 patients (349 [59%] females, 239 [41%] males) with a mean age of 42 ± 15. The results of this study showed that comorbidities like diabetes (OR = 7.42), hypertension (OR = 4.85), asthma and respiratory diseases (OR = 5.64) in addition to symptoms including fever (OR = 6.67), chills (OR = 11.2), anorexia (OR = 11.3), dyspnea (OR = 4.8), weakness and lethargy (OR = 5.7) were the most predictive variables for hospitalization of non-COVID-19 cases. Furthermore, demographical variables like male gender (OR = 3.71), high age (>50; OR = 3.12), BMI (>25; OR = 2.37), travel (OR = 2.79), comorbidities including diabetes (OR = 5.26), hypertension (OR = 3.7) and underlying immunosuppressant patients receiving corticosteroid therapy (OR = 3.62) in addition to symptoms like anorexia [OR = 2.55] and dyspnea (OR = 6.99) tend to increase the risk of hospital admission in COVID-19 patients, suggesting their predictive values for hospitalization of COVID-19 patients. CONCLUSION Our results indicated that different factors tend to increase the odds of hospital admission in patients with positive and negative COVID-19 tests, suggesting their predictive values for hospitalization.
Collapse
Affiliation(s)
- Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Hossein Keyvani
- Department of Virology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Aliakbar Haghdoost
- Associate Professor of Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Abolghasemi
- Chemical Injuries Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; Department of Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ghasem Janbabaei
- Gasterointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Amir Hosein Ghazale
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Hassan Saadat
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiatallah University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Raei
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
24
|
Manoharan L, Cattrall JWS, Harris C, Newell K, Thomson B, Pritchard MG, Bannister PG, Sigfrid L, Solomon T, Horby PW, Carson G, Olliaro P. Evaluating clinical characteristics studies produced early in the Covid-19 pandemic: A systematic review. PLoS One 2021; 16:e0251250. [PMID: 34003850 PMCID: PMC8130955 DOI: 10.1371/journal.pone.0251250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Clinical characterisation studies have been essential in helping inform research, diagnosis and clinical management efforts, particularly early in a pandemic. This systematic review summarises the early literature on clinical characteristics of patients admitted to hospital, and evaluates the quality of evidence produced during the initial stages of the pandemic. METHODS MEDLINE, EMBASE and Global Health databases were searched for studies published from January 1st 2020 to April 28th 2020. Studies which reported on at least 100 hospitalised patients with Covid-19 of any age were included. Data on clinical characteristics were independently extracted by two review authors. Study design specific critical appraisal tools were used to evaluate included studies: the Newcastle Ottawa scale for cohort and cross sectional studies, Joanna Briggs Institute checklist for case series and the Cochrane collaboration tool for assessing risk of bias in randomised trials. RESULTS The search yielded 78 studies presenting data on 77,443 people. Most studies (82%) were conducted in China. No studies included patients from low- and middle-income countries. The overall quality of included studies was low to moderate, and the majority of studies did not include a control group. Fever and cough were the most commonly reported symptoms early in the pandemic. Laboratory and imaging findings were diverse with lymphocytopenia and ground glass opacities the most common findings respectively. Clinical data in children and vulnerable populations were limited. CONCLUSIONS The early Covid-19 literature had moderate to high risk of bias and presented several methodological issues. Early clinical characterisation studies should aim to include different at-risk populations, including patients in non-hospital settings. Pandemic preparedness requires collection tools to ensure observational studies are methodologically robust and will help produce high-quality data early on in the pandemic to guide clinical practice and public health policy. REVIEW REGISTRATION Available at https://osf.io/mpafn.
Collapse
Affiliation(s)
- Lakshmi Manoharan
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jonathan W. S. Cattrall
- Liverpool University Hospitals NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Carlyn Harris
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Katherine Newell
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Blake Thomson
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
| | - Mark G. Pritchard
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Peter G. Bannister
- School of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Louise Sigfrid
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tom Solomon
- National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Walton Centre National Health Service, Foundation Trust, Liverpool, United Kingdom
| | - Peter W. Horby
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gail Carson
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
25
|
Qaisieh R, Al-Tamimi M, El-Hammuri N, Shalabi M, Kilani MM, Taha H, Al-Muhtaseb A, Alfarrajin I, Abu Shaqra M, Hamdan A. Comparative study of Clinical, Laboratory, and Imaging Features of COVID-19. JMIR Public Health Surveill 2021; 7:e28005. [PMID: 34081600 PMCID: PMC8457339 DOI: 10.2196/28005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/31/2022] Open
Abstract
Background The clinical, laboratory, and imaging features of COVID-19 disease are variable. Multiple factors can affect the disease progression and outcome. Objective This study aimed to analyze the clinical, laboratory, and imaging features of COVID-19 in Jordan. Methods Clinical, laboratory, and imaging data were collected for 557 confirmed COVID-19 patients admitted to Prince Hamzah Hospital (PHH), Jordan. Analysis was performed using appropriate statistical tests with SPSS version 24. Results Of the 557 COVID-19 polymerase chain reaction (PCR)-positive cases admitted to PHH, the mean age was 34.4 years (SD 18.95 years; range 5 weeks to 87 years), 86.0% (479/557) were male, 41% (29/70) were blood group A+, and 57.1% (93/163) were overweight or obese. Significant past medical history was documented in 25.9% (144/557), significant surgical history in 12.6% (70/557), current smoking in 14.9% (83/557), and pregnancy in 0.5% (3/557). The mean duration of hospitalization was 16.4 (SD 9.3; range 5 to 70) days; 52.6% (293/557) were asymptomatic, and 12.9% (72/557) had more than 5 symptoms, with generalized malaise and dry cough the most common symptoms. Only 2.5% (14/557) had a respiratory rate over 25 breaths/minute, and 1.8% (10/557) had an oxygen saturation below 85%. Laboratory investigations showed a wide range of abnormalities, with lymphocytosis and elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer the most common abnormalities. Ground glass opacity was the most common imaging finding. Men had a significantly higher frequency of symptoms, incidence of smoking, reduced hemoglobin, increased monocyte %, elevated creatinine levels, and intensive care unit admissions compared with women (P<.05). Hospitalization duration was associated with increased age, male gender, symptom score, history of smoking, elevated systolic blood pressure, elevated respiratory rate, and elevated monocyte %, CRP, ESR, creatinine, and D-dimer (P<.05). Conclusions Most COVID-19 cases admitted to PHH were asymptomatic. Variabilities in symptoms, signs, laboratory results, and imaging findings should be noted. Increased age, male gender, smoking history, and elevated inflammatory markers were significantly associated with longer duration of hospitalization.
Collapse
Affiliation(s)
- Rami Qaisieh
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, JO
| | - Mohammad Al-Tamimi
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, JO
| | - Naser El-Hammuri
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, JO
| | - Marwan Shalabi
- Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, JO
| | - Muna M Kilani
- Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, JO
| | - Hana Taha
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, JO.,Global Health Development- Eastern Mediterranean Public health Network, Amman, JO.,Department of Neuroscience, caring science and society, Karolinska Institute,, Stockholm, SE
| | - Abdallah Al-Muhtaseb
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, JO
| | - Ibrahim Alfarrajin
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, JO
| | - Marwan Abu Shaqra
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, JO
| | - Almothana Hamdan
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, JO
| |
Collapse
|
26
|
Hong LZ, Shou ZX, Zheng DM, Jin X. The most important biomarker associated with coagulation and inflammation among COVID-19 patients. Mol Cell Biochem 2021; 476:2877-2885. [PMID: 33742367 PMCID: PMC7978444 DOI: 10.1007/s11010-021-04122-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) induced by SARS-Cov-2 can be related to coagulopathy. Also, the infection-induced inflammatory changes are found in patients with disseminated intravascular coagulopathy (DIC). The lack of previous immunity to COVID-19 has caused infection of a large number of patients worldwide and unpredictability regarding the management of the complications that appear in the course of this viral illness. Lungs are the most important target organ of the SARS-COV-2. In COVID-19 patients, acute lung injury leads to respiratory failure. However, multiorgan failure can also occur in these patients. The primary coagulopathy of COVID-19 is marked by a considerable elevation of D-dimer, ferritin, and fibrinogen degradation products. In comparison, abnormalities in platelet count, prothrombin time, and partial thromboplastin time are partly uncommon in initial presentations. Inflammatory biomarkers including CRP, LDH, and IL-6 are significantly elevated in the early stages of the disease. In this regard, inflammation-associated biomarkers and coagulation test screening, including the assessment of IL-6, CRP, LDH, D-dimer, platelet count, PT&PTT time, ferritin, and fibrinogen levels are suggested for detecting infection by this virus. Overall, COVID-19-associated coagulopathy should be managed like other patients with critical conditions, and supportive care and thromboembolic prophylaxis should be used for severe patients.
Collapse
Affiliation(s)
- Ling-Zhi Hong
- Emergency Department, Chun'an First People's Hospital (Zhejiang Provincial People's Hospital Chun'an Branch), Hangzhou, 311700, Zhejiang, China
| | - Zhang-Xuan Shou
- Department of Pharmacy, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - De-Ming Zheng
- Infectious Diseases Department, Chun'an First People's Hospital (Zhejiang Provincial People's Hospital Chun'an Branch), Hangzhou, 311700, Zhejiang, China
| | - Xue Jin
- Department of Pharmacy, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
| |
Collapse
|
27
|
Sayegh MJ, Larsen CG, Pinpin C, Intravia JM, Nellans KW. Ulnar Neuropathy After Intermittent Prone Positioning for COVID-19 Infection: A Preliminary Report of 3 Cases. JBJS Case Connect 2021; 11:01709767-202103000-00055. [PMID: 33739958 DOI: 10.2106/jbjs.cc.20.00729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a preliminary report of 3 cases of ulnar neuropathy after coronavirus disease 2019 (COVID-19) infection and treatment with intermittent prone positioning. CONCLUSION Ulnar neuropathy may be associated with recent COVID-19 infection. The natural process of the disease and intermittent prone positioning are likely risk factors contributing to this finding. Conservative management seems to lead to improvement of symptoms.
Collapse
Affiliation(s)
- Michael J Sayegh
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Christopher G Larsen
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Camille Pinpin
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jessica M Intravia
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Kate W Nellans
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| |
Collapse
|
28
|
Kazemi E, Soldoozi Nejat R, Ashkan F, Sheibani H. The laboratory findings and different COVID-19 severities: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2021; 20:17. [PMID: 33726761 PMCID: PMC7962428 DOI: 10.1186/s12941-021-00420-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Abnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to investigate the effect of the level of some laboratory factors (C-reactive protein (CRP), creatinine, leukocyte count, hemoglobin, and platelet count) on the severity and outcome of coronavirus disease 2019 (COVID-19). Methods We searched PubMed, Web of Science, Scopus, and Google Scholar. We collected the articles published before May 26, 2020. We gathered the laboratory factors in groups of patients with COVID-19, and studied the relation between level of these factors with severity and outcome of the disease. Results Mean CRP level, creatinine, hemoglobin, and the leukocytes count in the critically ill patients were significantly higher than those of the other groups (non-critical patients); mean CRP = 54.81 mg/l, mean creatinine = 86.82 μmol/l, mean hemoglobin = 144.05 g/l, and mean leukocyte count = 7.41 × 109. The lymphocyte count was higher in patients with mild/moderate disease (mean: 1.32 × 109) and in the invasive ventilation group (mean value of 0.72 × 109), but it was considerably lower than those of the other two groups. The results showed that the platelet count was higher in critically ill patients (mean value of 205.96 × 109). However, the amount was lower in the invasive ventilation group compared with the other groups (mean level = 185.67 × 109). Conclusion With increasing disease severity, the leukocyte count and the level of CRP increase significantly and the lymphocyte count decreases. There seems to be a significant relation between platelet level, hemoglobin, and creatinine level with severity of the disease. However, more studies are required to confirm this.
Collapse
Affiliation(s)
- Erfan Kazemi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Reihane Soldoozi Nejat
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fatemeh Ashkan
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hossein Sheibani
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
| |
Collapse
|
29
|
Amin-Chowdhury Z, Aiano F, Mensah A, Sheppard CL, Litt D, Fry NK, Andrews N, Ramsay ME, Ladhani SN. Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Invasive Pneumococcal Disease and Risk of Pneumococcal Coinfection With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Prospective National Cohort Study, England. Clin Infect Dis 2021; 72:e65-e75. [PMID: 33196783 PMCID: PMC7717180 DOI: 10.1093/cid/ciaa1728] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae coinfection with influenza results in synergistic lethality, but there are limited data on pneumococcal coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS Public Health England conducts invasive pneumococcal disease (IPD) and SARS-CoV-2 surveillance in England. IPD trends during 2000/2001-2019/2020 epidemiological years were analyzed and cases during February-June 2020 linked with laboratory-confirmed SARS-CoV-2 infections. Multivariable logistic regression was used to assess risk factors for death. RESULTS IPD incidence in 2019/2020 (7.6/100 000; n = 3964) was 30% (IRR, .70; 95% CI, .18-2.67) lower compared with 2018/2019 (10.9/100 000; n = 5666), with large reductions observed across all age groups during March-June 2020. There were 160 886 SARS-CoV-2 and 1137 IPD cases during February-June 2020, including 40 IPD/coronavirus disease 2019 (COVID-19) co-infections (.025% [95% CI, .018-.034] of SARS-CoV-2 infections; 3.5% [2.5-4.8] of IPD cases), 21 with COVID-19 diagnosed 3-27 days after IPD, and 27 who developed COVID-19 ≥28 days after IPD. Case-fatality rates (CFRs) were 62.5 (25/40), 47.6% (10/21), and 33.3% (9/27), respectively (P < .001). In addition to an independent association with increasing age and serotype group, CFR was 7.8-fold (95% CI, 3.8-15.8) higher in those with IPD/COVID-19 coinfection and 3.9-fold (95% CI, 1.4-10.7) higher in patients who developed COVID-19 3-27 days after IPD compared with patients with IPD only. CONCLUSIONS Large declines in IPD were observed following COVID-19 lockdown. IPD/COVID-19 coinfections were rare but associated with high CFR, mainly in older adults. The rarity, age and serotype distribution of IPD/COVID-19 coinfections do not support wider extension of pneumococcal vaccination.
Collapse
Affiliation(s)
- Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Anna Mensah
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Carmen L Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVBRU), Public Health England, London, United Kingdom
| | - David Litt
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVBRU), Public Health England, London, United Kingdom
| | - Norman K Fry
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom.,Respiratory and Vaccine Preventable Bacterial Reference Unit (RVBRU), Public Health England, London, United Kingdom
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, London, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom.,Paediatric Infectious Diseases Research Group (PIDRG), St George's University of London, London, United Kingdom
| |
Collapse
|
30
|
Belsky JA, Tullius BP, Lamb MG, Sayegh R, Stanek JR, Auletta JJ. COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients. J Infect 2021; 82:329-338. [PMID: 33549624 PMCID: PMC7859698 DOI: 10.1016/j.jinf.2021.01.022] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/03/2020] [Accepted: 01/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical impact of severe coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in immunocompromised patients has not been systematically evaluated. METHODS We reviewed current literature reporting on COVID-19 in cancer (CA), hematopoietic cell (HCT), and solid organ transplant (SOT) patients and compared their clinical data and outcomes to the general population. For adult CA, HCT and SOT patients, an extensive search strategy retrieved all articles published until July 20, 2020 by combining the terms coronavirus, coronavirus infection, COVID-19, and SARS-CoV-2 in PubMed, Cochrane, and Web of Science, and following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. For the pediatric CA cohort, a global COVID-19 registry was used. For the general population cohort, a large meta-analysis was used to compare pooled prevalence estimates, and two large meta-analyses were utilized to serve as pooled comparators for hospitalized COVID-19 patients. FINDINGS Compared to the general population, adult CA and SOT patients with COVID-19 had higher comorbidities, greater levels of inflammatory markers at diagnosis, and higher rates of intensive care and hospital mortality. Pediatric CA patients and HCT patients with COVID-19 tended to have clinical presentations and outcomes similar to the general population. INTERPRETATION To our knowledge, this is the first systematic review evaluating COVID-19 phenotype and outcomes in immunocompromised patients and comparing them to the general population, which shows that hospital outcomes appear to be worse in adult CA and SOT patients, potentially due to their higher co-morbidity burden. FUNDING None.
Collapse
Affiliation(s)
- Jennifer A Belsky
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States
| | - Brian P Tullius
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States.
| | - Margaret G Lamb
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States
| | - Rouba Sayegh
- Division of Infectious Diseases, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States
| | - Jeffery J Auletta
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States; Division of Infectious Diseases, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| |
Collapse
|
31
|
Bansod S, Ahirwar AK, Sakarde A, Asia P, Gopal N, Alam S, Kaim K, Ahirwar P, Sorte SR. COVID-19 and geriatric population: from pathophysiology to clinical perspectives. Horm Mol Biol Clin Investig 2021; 42:87-98. [PMID: 33544506 DOI: 10.1515/hmbci-2020-0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/19/2021] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic has not only led to a worldwide socio-economic depression, but has also had the highest health impact on the geriatric population. Elderly population, due to various reasons such as low immunity, pre-existing co-morbidities such as hypertension, cardiovascular diseases or diabetes, are obviously predisposed to develop severe infections and exhibit a high mortality rate. This is because of many reasons which include the atypical presentation in the geriatric population which might have led to diagnostic delay. As per the WHO guidelines to perform RT-PCR only on the symptomatic individuals, a very small portion of individuals were tested, leaving a fraction of population undiagnosed. Therefore, there remained a chance that many asymptomatic individuals such caregivers, healthcare professionals, family members were undiagnosed and might have carried this virus to the geriatric patients. Also, many countries were not prepared to handle the burden on their healthcare system which included sudden increased demand of ICU beds, mechanical ventilation etc. As a result, they had to make decision on who to be admitted. Atypical presentation in geriatric population may include afebrile or low-grade fever, absence of cough, malaise, muscle pains, dyspnoea etc. Geriatric population shows a more severe type of pneumonia, significantly higher number of neutrophils and C-reactive protein, less lymphocytes and a higher proportion of multiple lobe involvement. Extreme social suppression during COVID-19 pandemic has increased the risk of mental and physical adverse effects that has made older adults more vulnerable to depression and anxiety.
Collapse
Affiliation(s)
- Swanjal Bansod
- All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ashok Kumar Ahirwar
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Apurva Sakarde
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Priyanka Asia
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Niranjan Gopal
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Sana Alam
- Department of Biochemistry, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Kirti Kaim
- Department of Ophthalmology, Indira Gandhi ESI Hospital, New Delhi, India
| | | | - Smita R Sorte
- Department of Physiology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| |
Collapse
|
32
|
Mohamadian M, Chiti H, Shoghli A, Biglari S, Parsamanesh N, Esmaeilzadeh A. COVID-19: Virology, biology and novel laboratory diagnosis. J Gene Med 2021; 23:e3303. [PMID: 33305456 PMCID: PMC7883242 DOI: 10.1002/jgm.3303] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND At the end of December 2019, a novel coronavirus tentatively named SARS-CoV-2 in Wuhan, a central city in China, was announced by the World Health Organization. SARS-CoV-2 is an RNA virus that has become a major public health concern after the outbreak of the Middle East Respiratory Syndrome-CoV (MERS-CoV) and Severe Acute Respiratory Syndrome-CoV (SARS-CoV) in 2002 and 2012, respectively. As of 29 October 2020, the total number of COVID-19 cases had reached over 44 million worldwide, with more than 1.17 million confirmed deaths. DISCUSSION SARS-CoV-2 infected patients usually present with severe viral pneumonia. Similar to SARS-CoV, the virus enters respiratory tract cells via the angiotensin-converting enzyme receptor 2. The structural proteins play an essential role in budding the virus particles released from different host cells. To date, an approved vaccine or treatment option of a preventive character to avoid severe courses of COVID-19 is still not available. CONCLUSIONS In the present study, we provide a brief review of the general biological features of CoVs and explain the pathogenesis, clinical symptoms and diagnostic approaches regarding monitoring future infectivity and prevent emerging COVID-19 infections.
Collapse
Affiliation(s)
- Malihe Mohamadian
- Department of Molecular MedicineBirjand University of Medical SciencesBirjandIran
- Cellular and Molecular Research CenterBirjand University of Medical SciencesBirjandIran
| | - Hossein Chiti
- Zanjan Metabolic Diseases Research CenterZanjan University of Medical SciencesZanjanIran
| | - Alireza Shoghli
- Social Determinants of Health Research CenterZanjan University of Medical SciencesZanjanIran
| | - Sajjad Biglari
- School of MedicineZanjan University of Medical SciencesZanjanIran
| | - Negin Parsamanesh
- Zanjan Metabolic Diseases Research CenterZanjan University of Medical SciencesZanjanIran
| | - Abdolreza Esmaeilzadeh
- Department of ImmunologyZanjan University of Medical ScienceZanjanIran
- Cancer Gene Therapy Research CenterZanjan University of Medical ScienceZanjanIran
| |
Collapse
|
33
|
The prevalence of depressive and anxiety symptoms and their associations with quality of life among clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Transl Psychiatry 2021; 11:75. [PMID: 33500389 PMCID: PMC7835649 DOI: 10.1038/s41398-021-01196-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
The impact of the COVID-19 pandemic on clinically stable older patients with psychiatric disorders is unclear. This study examined the prevalence of depressive and anxiety symptoms, and their associations with quality of life (QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. This was a multicenter, cross-sectional study. Depressive and anxiety symptoms, insomnia, pain, and QOL were assessed with standardized instruments. A total of 1063 patients were included. The prevalence of depressive and anxiety symptoms, and combined depressive and anxiety symptoms were 62.3% (95%CI = 59.4-65.2%), 52.4% (95%CI = 49.3-55.4%), and 45.9% (95%CI = 42.9-48.9%), respectively. Patients with depressive and anxiety symptoms had significantly lower QOL than those without (P < 0.01). Binary logistic regression analyses revealed that having depressive symptoms was positively associated with more severe insomnia (OR = 1.29, P < 0.01) and pain (OR = 1.14, P < 0.01), and was negatively associated with other psychiatric diagnoses (except for major depressive disorder, schizophrenia, and organic mental disorder; OR = 0.50, P < 0.01), while having anxiety symptoms was positively associated with severe physical diseases (OR = 1.57, P = 0.02), poor adherence to treatment (OR = 1.50, P < 0.01), and more severe insomnia (OR = 1.15, P < 0.01) and pain (OR = 1.11, P < 0.01). Having combined depression and anxiety symptoms was positively associated with poor adherence to treatment (OR = 1.42, P = 0.02) and more severe insomnia (OR = 1.19, P < 0.01) and pain (OR = 1.15, P < 0.01), and was negatively associated with the diagnosis of schizophrenia (OR = 0.50, P = 0.04) and others (OR = 0.53, P < 0.01). Depressive and anxiety symptoms were common in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Considering the negative impact of these symptoms on QOL, regular screening and appropriate treatment are recommended for this population.
Collapse
|
34
|
Singh AK, Jena A, Kumar-M P, Jha DK, Sharma V. Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis. Intest Res 2021; 20:134-143. [PMID: 33440918 PMCID: PMC8831773 DOI: 10.5217/ir.2020.00108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. Methods We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. Results Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively. Conclusions The clinical presentation of COVID-19 in IBD patients is similar to the general population.
Collapse
Affiliation(s)
- Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daya Krishna Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
35
|
Yin X, Riva L, Pu Y, Martin-Sancho L, Kanamune J, Yamamoto Y, Sakai K, Gotoh S, Miorin L, De Jesus PD, Yang CC, Herbert KM, Yoh S, Hultquist JF, García-Sastre A, Chanda SK. MDA5 Governs the Innate Immune Response to SARS-CoV-2 in Lung Epithelial Cells. Cell Rep 2021; 34:108628. [PMID: 33440148 PMCID: PMC7832566 DOI: 10.1016/j.celrep.2020.108628] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/12/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022] Open
Abstract
Recent studies have profiled the innate immune signatures in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and suggest that cellular responses to viral challenge may affect disease severity. Yet the molecular events that underlie cellular recognition and response to SARS-CoV-2 infection remain to be elucidated. Here, we find that SARS-CoV-2 replication induces a delayed interferon (IFN) response in lung epithelial cells. By screening 16 putative sensors involved in sensing of RNA virus infection, we found that MDA5 and LGP2 primarily regulate IFN induction in response to SARS-CoV-2 infection. Further analyses revealed that viral intermediates specifically activate the IFN response through MDA5-mediated sensing. Additionally, we find that IRF3, IRF5, and NF-κB/p65 are the key transcription factors regulating the IFN response during SARS-CoV-2 infection. In summary, these findings provide critical insights into the molecular basis of the innate immune recognition and signaling response to SARS-CoV-2.
Collapse
Affiliation(s)
- Xin Yin
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA; State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin 150069, P.R. China
| | - Laura Riva
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Yuan Pu
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Laura Martin-Sancho
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Jun Kanamune
- Department of Drug Discovery for Lung Diseases, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Yuki Yamamoto
- Department of Drug Discovery for Lung Diseases, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Kouji Sakai
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
| | - Shimpei Gotoh
- Department of Drug Discovery for Lung Diseases, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Lisa Miorin
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Paul D De Jesus
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Chih-Cheng Yang
- Functional Genomics Core, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Kristina M Herbert
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Sunnie Yoh
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Judd F Hultquist
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL 60201, USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sumit K Chanda
- Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA.
| |
Collapse
|
36
|
Minaeian S, Bahadorizadeh L, Fard S, Behnagh A, Hashemi Kiapey S, Saneii S. Risk factors for mortality in hospitalized moderate-to-severe COVID-19 patients: A single-center retrospective study. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Pujari S, Gugale P, Shah D, Patel D, Gaikwad S, Desouza C, Atre A. Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression. AIDS 2020; 34:2165-2168. [PMID: 32910070 DOI: 10.1097/qad.0000000000002676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
38
|
Mirza FN, Malik AA, Couzens C, Omer SB. Influenza-negative influenza-like illness (fnILI) Z-score as a proxy for incidence and mortality of COVID-19. J Infect 2020; 81:793-796. [PMID: 32888977 PMCID: PMC7462572 DOI: 10.1016/j.jinf.2020.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Abstract
Although direct detection of SARS-CoV2 in symptomatic or asymptomatic individuals is the ideal epidemiological tool for determining the burden of disease, the lack of availability of testing can preclude its wider implementation as a robust surveillance system. We correlated the use of the derivative influenza-negative influenza-like illness (fnILI) z-score from the US Centers for Disease Control and Prevention as a proxy for incident cases and disease-specific deaths. For every unit increase of fnILI z-score, the number of cases increased by 376.5 (95% CI [202.5, 550.5]) and number of deaths increased by 10.2 (95% CI [5.4, 15.0]). FnILI data may serve as an accurate outcome measurement to track the spread of COVID-19 infection and disease, and allow for informed and timely decision-making on public health interventions.
Collapse
Affiliation(s)
- Fatima N Mirza
- Yale Institute for Global Health, Yale University, 1 Church St, New Haven, CT 06510, United States; Yale School of Medicine, Yale University, New Haven, CT 06510, United States.
| | - Amyn A Malik
- Yale Institute for Global Health, Yale University, 1 Church St, New Haven, CT 06510, United States; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, United States
| | - Chandra Couzens
- Yale Institute for Global Health, Yale University, 1 Church St, New Haven, CT 06510, United States
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, 1 Church St, New Haven, CT 06510, United States; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, United States; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT 06510, United States; Yale School of Nursing, Yale University, Orange, CT 06477, United States
| |
Collapse
|
39
|
Brábek J, Jakubek M, Vellieux F, Novotný J, Kolář M, Lacina L, Szabo P, Strnadová K, Rösel D, Dvořánková B, Smetana K. Interleukin-6: Molecule in the Intersection of Cancer, Ageing and COVID-19. Int J Mol Sci 2020; 21:ijms21217937. [PMID: 33114676 PMCID: PMC7662856 DOI: 10.3390/ijms21217937] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
Interleukin-6 (IL-6) is a cytokine with multifaceted effects playing a remarkable role in the initiation of the immune response. The increased level of this cytokine in the elderly seems to be associated with the chronic inflammatory setting of the microenvironment in aged individuals. IL-6 also represents one of the main signals in communication between cancer cells and their non-malignant neighbours within the tumour niche. IL-6 also participates in the development of a premetastatic niche and in the adjustment of the metabolism in terminal-stage patients suffering from a malignant disease. IL-6 is a fundamental factor of the cytokine storm in patients with severe COVID-19, where it is responsible for the fatal outcome of the disease. A better understanding of the role of IL-6 under physiological as well as pathological conditions and the preparation of new strategies for the therapeutic control of the IL-6 axis may help to manage the problems associated with the elderly, cancer, and serious viral infections.
Collapse
Affiliation(s)
- Jan Brábek
- Department of Cell Biology, Faculty of Science, Charles University, 120 00 Prague 2, Czech Republic; (J.B.); (D.R.)
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
| | - Milan Jakubek
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague, Czech Republic
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, 166 28 Praha 6, Czech Republic
| | - Fréderic Vellieux
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
| | - Jiří Novotný
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics, Czech Academy of Sciences, 140 00 Prague 4, Czech Republic
| | - Michal Kolář
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics, Czech Academy of Sciences, 140 00 Prague 4, Czech Republic
| | - Lukáš Lacina
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, Fist Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic;
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague 2, Czech Republic
| | - Pavol Szabo
- Institute of Anatomy, Fist Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic;
| | - Karolína Strnadová
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, Fist Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic;
| | - Daniel Rösel
- Department of Cell Biology, Faculty of Science, Charles University, 120 00 Prague 2, Czech Republic; (J.B.); (D.R.)
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
| | - Barbora Dvořánková
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, Fist Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic;
| | - Karel Smetana
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic; (M.J.); (F.V.); (J.N.); (M.K.); (L.L.); (K.S.); (B.D.)
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, Fist Faculty of Medicine, Charles University, 120 00 Prague 2, Czech Republic;
- Correspondence: ; Tel.: +420-224-965-873
| |
Collapse
|
40
|
Pourabdollah Toutkaboni M, Askari E, Khalili N, Tabarsi P, Jamaati H, Velayati AA, Dorudinia A, Rezaei M, Nadji SA, Mohamadnia A, Khalili N. Demographics, laboratory parameters and outcomes of 1061 patients with coronavirus disease 2019: a report from Tehran, Iran. New Microbes New Infect 2020; 38:100777. [PMID: 33042553 PMCID: PMC7534790 DOI: 10.1016/j.nmni.2020.100777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 01/08/2023] Open
Abstract
We aimed to determine the characteristics of coronavirus disease 2019 (COVID-2019) among the Iranian population. In this study, we collected and analysed the demographics, laboratory findings and outcomes of patients with COVID-19 who were admitted to Masih Daneshvari Hospital in Tehran, Iran between 20 February 2020 and 2 April 2020. Among 1061 patients, 692 (65.2%) were male and the median age was 55 years (interquartile range (IQR), 44–66 years). Totally, 129 (12.2%) patients died during hospitalization in the ward or intensive care unit. From the remaining 932 individuals, 46 (5.0%) were admitted to the intensive care unit and 886 (95.0%) were hospitalized in the ward. Those patients who died were significantly older than those hospitalized in the ward (p < 0.001). The median absolute number of lymphocytes was 1.2 × 103/μL (IQR 0.9 × 103 to 1.6 × 103/μL) and 708 (66.7%) patients had lymphopenia (absolute lymphocyte count <1500/μL). Among the laboratory tests, D-dimer, serum ferritin and albumin had the strongest correlations with mortality (r = 0.455, r = 0.412, r = –0.406, respectively; p < 0.001 for each one). In conclusion, laboratory findings could provide useful information with regard to the management of individuals with COVID-19.
Collapse
Affiliation(s)
- M Pourabdollah Toutkaboni
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - E Askari
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - P Tabarsi
- Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Jamaati
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A A Velayati
- Mycobacteriology Research Centre (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Dorudinia
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Rezaei
- Virology Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S A Nadji
- Virology Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Mohamadnia
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| |
Collapse
|
41
|
Kiely P, Hoad VC, Seed CR, Gosbell IB. Severe acute respiratory syndrome coronavirus-2: implications for blood safety and sufficiency. Vox Sang 2020; 116:155-166. [PMID: 32965726 PMCID: PMC7537511 DOI: 10.1111/vox.13009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Background and Objective Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) is a novel coronavirus, first identified in China at the end of 2019 and has now caused a worldwide pandemic. In this review, we provide an overview of the implications of SARS‐CoV‐2 for blood safety and sufficiency. Material and Method We searched the PubMed database, the preprint sites bioRxiv and medRxiv, the websites of the World Health Organization, European Centre for Disease Prevention and Control, the US Communicable Diseases Center and monitored ProMed updates. Results An estimated 15%–46% of SARS‐CoV‐2 infections are asymptomatic. The reported mean incubation period is 3 to 7 days with a range of 1–14 days. The blood phase of SARS‐CoV‐2 appears to be brief and low level, with RNAaemia detectable in only a small proportion of patients, typically associated with more severe disease and not demonstrated to be infectious virus. An asymptomatic blood phase has not been demonstrated. Given these characteristics of SARS‐CoV‐2 infection and the absence of reported transfusion transmission (TT), the TT risk is currently theoretical. To mitigate any potential TT risk, but more importantly to prevent respiratory transmission in donor centres, blood centres can implement donor deferral policies based on travel, disease status or potential risk of exposure. Conclusion The TT risk of SARS‐CoV‐2 appears to be low. The biggest risk to blood services in the current COVID‐19 pandemic is to maintain the sufficiency of the blood supply while minimizing respiratory transmission of SARS‐CoV‐19 to donors and staff while donating blood.
Collapse
Affiliation(s)
- Philip Kiely
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia.,Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Veronica C Hoad
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia
| | - Clive R Seed
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia
| | - Iain B Gosbell
- Cinical Services and Research, Australian Red Cross Lifeblood, Melbourne, VIC, Australia.,Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
42
|
Shanbehzadeh M, Kazemi-Arpanahi H. Development of minimal basic data set to report COVID-19. Med J Islam Repub Iran 2020; 34:111. [PMID: 33315989 PMCID: PMC7722954 DOI: 10.34171/mjiri.34.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Effective surveillance of COVID-19 highlights the importance of rapid, valid, and standardized information to crisis monitoring and prompts clinical interventions. Minimal basic data set (MBDS) is a set of metrics to be collated in a standard approach to allow aggregated use of data for clinical purposes and research. Data standardization enables accurate comparability of collected data, and accordingly, enhanced generalization of findings. The aim of this study is to establish a core set of data to characterize COVID-19 to consolidate clinical practice. Methods: A 3-step sequential approach was used in this study: (1) an elementary list of data were collected from the existing information systems and data sets; (2) a systematic literature review was conducted to extract evidence supporting the development of MBDS; and (3) a 2-round Delphi survey was done for reaching consensus on data elements to include in COVID-19 MBDS and for its robust validation. Results: In total, 643 studies were identified, of which 38 met the inclusion criteria, where a total of 149 items were identified in the data sources. The data elements were classified by 3 experts and validated via a 2-round Delphi procedure. Finally, 125 data elements were confirmed as the MBDS. Conclusion: The development of COVID-19 MBDS could provide a basis for meaningful evaluations, reporting, and benchmarking COVID-19 disease across regions and countries. It could also provide scientific collaboration for care providers in the field, which may lead to improved quality of documentation, clinical care, and research outcomes.
Collapse
Affiliation(s)
- Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan Faculty of Medical Sciences, Abadan, Iran
| |
Collapse
|
43
|
Aziz S, Arabi YM, Alhazzani W, Evans L, Citerio G, Fischkoff K, Salluh J, Meyfroidt G, Alshamsi F, Oczkowski S, Azoulay E, Price A, Burry L, Dzierba A, Benintende A, Morgan J, Grasselli G, Rhodes A, Møller MH, Chu L, Schwedhelm S, Lowe JJ, Bin D, Christian MD. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020; 46:1303-1325. [PMID: 32514598 PMCID: PMC7276667 DOI: 10.1007/s00134-020-06092-5] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.
Collapse
Affiliation(s)
- Shadman Aziz
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Alhazzani
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Laura Evans
- Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA
| | | | | | - Jorge Salluh
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | | | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
| | - Simon Oczkowski
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Elie Azoulay
- Assistance publique - Hôpitaux de Paris, Paris, France
| | - Amy Price
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | - Lisa Burry
- Sinai Health System, University of Toronto, Toronto, Canada
| | - Amy Dzierba
- New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | | | | | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrew Rhodes
- St Georges Hospitals NHS Foundation Trust, London, UK
| | - Morten H Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Larry Chu
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | | | - John J Lowe
- Department of Environmental and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Du Bin
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK.
| |
Collapse
|
44
|
Khalili M, Karamouzian M, Nasiri N, Javadi S, Mirzazadeh A, Sharifi H. Epidemiological characteristics of COVID-19: a systematic review and meta-analysis. Epidemiol Infect 2020; 148:e130. [PMID: 32594937 PMCID: PMC7343974 DOI: 10.1017/s0950268820001430] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Abstract
Our understanding of the Coronavirus disease 2019 (COVID-19) continues to evolve and there are many unknowns about its epidemiology. This study aims to synthesise case fatality rate (CFR) among confirmed COVID-19 patients, incubation period and time from onset of COVID-19 symptoms to first medical visit, intensive care unit (ICU) admission, recovery, and death. We searched MEDLINE, Embase, Google Scholar, and bibliographies of relevant articles from 01 December 2019 to 11 March 2020 without any language restrictions. Quantitative studies that recruited people with confirmed COVID-19 diagnosis were included. Two independent reviewers extracted the data. Out of 1675 non-duplicate studies, 43 were included in the meta-analysis. The pooled mean incubation period was 5.68 (99% confidence interval [CI]: 4.78, 6.59) days. The pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.92 (95% CI: 3.95, 5.90), ICU admission was 9.84 (95% CI: 8.78, 10.90), recovery was 18.55 (95% CI: 13.69, 23.41), and death was 15.93 (95% CI: 13.07, 18.79). Pooled CFR among confirmed COVID-19 patients was 0.02 (95% CI: 0.02, 0.03). We found that the incubation period and lag between the onset of symptoms and first clinical visit for COVID-19 are longer than other respiratory viral infections including Middle East respiratory syndrome and severe acute respiratory syndrome; however, the current policy of 14 days of mandatory quarantine for everyone potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be too conservative. Longer quarantine periods might be more justified for extreme cases.
Collapse
Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Javadi
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
45
|
Kazemi-Arpanahi H, Moulaei K, Shanbehzadeh M. Design and development of a web-based registry for Coronavirus (COVID-19) disease. Med J Islam Repub Iran 2020; 34:68. [PMID: 32974234 PMCID: PMC7500427 DOI: 10.34171/mjiri.34.68] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The 2019 coronavirus (COVID-19) is a highly contagious disease associated with a high morbidity and mortality worldwide. The accumulation of data through a prospective clinical registry enables public health authorities to make informed decisions based on real evidence obtained from surveillance of COVID-19. This registry is also fundamental to providing robust infrastructure for future research surveys. The purpose of this study was to design a registry and its minimum data set (MDS), as a valid and reliable data source for reporting and benchmarking COVID-19. Methods: This cross sectional and descriptive study provides a template for the required MDS to be included in COVID-19 registry. This was done by an extensive literature review and 2 round Delphi survey to validate the content, which resulted in a web-based registry created by Visual Studio 2019 and a database designed by Structured Query Language (SQL). Results: The MDS of COVID-19 registry was categorized into the administrative part with 3 sections, including 30 data elements, and the clinical part with 4 sections, including 26 data elements. Furthermore, a web-based registry with modular and layered architecture was designed based on final data classes and elements. Conclusion: To the best of our knowledge, COVID-19 registry is the first designed instrument from information management perspectives in Iran and can become a homogenous and reliable infrastructure for collecting data on COVID-19. We hope this approach will facilitate epidemiological surveys and support policymakers to better plan for monitoring patients with COVID-19.
Collapse
Affiliation(s)
- Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan Faculty of Medical Sciences, Abadan, Iran
| | - Khadijeh Moulaei
- Department of Health Information Management, School of Health Management and Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| |
Collapse
|
46
|
Tahmasebi S, Khosh E, Esmaeilzadeh A. The outlook for diagnostic purposes of the 2019-novel coronavirus disease. J Cell Physiol 2020; 235:9211-9229. [PMID: 32452050 PMCID: PMC7283732 DOI: 10.1002/jcp.29804] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023]
Abstract
At the end of December 2019, a novel acute respiratory syndrome coronavirus 2 (SARS‐CoV2) appeared as the third unheard of outbreak of human coronavirus infection in the 21st century. First, in Wuhan, China, the novel SARS‐CoV2 was named by the World Health Organization (WHO), as 2019‐nCOV (COVID‐19), and spread extremely all over the world. SARS‐CoV2 is transmitted to individuals by human‐to‐human transmission leading to severe viral pneumonia and respiratory system injury. SARS‐CoV2 elicits infections from the common cold to severe conditions accompanied by lung injury, acute respiratory distress syndrome, and other organ destruction. There is a possibility of virus transmission from asymptomatic cases as active carriers, in addition to symptomatic ones, which is a crucial crisis of COVID‐19 that should be considered. Hence, paying more attention to the accurate and immediate diagnosis of suspected and infected cases can be a great help in preventing the rapid spread of the virus, improving the disease prognosis, and controlling the pandemic. In this review, we provide a comprehensive and up‐to‐date overview of the different types of Clinical and Para‐clinical diagnostic methods and their practical features, which can help understand better the applications and capacities of various diagnostic approaches for COVID‐19 infected cases.
Collapse
Affiliation(s)
- Safa Tahmasebi
- Department of Immunology, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Khosh
- Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Abdolreza Esmaeilzadeh
- Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran.,Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
47
|
Mahajan A, Pande P, Sharma P, Goyal D, Kulkarni T, Rane S. COVID-19: A review of the ongoing pandemic. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_174_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|