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Villasis-Keever MA, Zurita-Cruz JN, Garduño-Espinosa J, López-Alarcón M, Barradas Vázquez AS, Miranda-Novales MG, Parra-Ortega I, López-Martinez B, García H, Klünder-Klünder M. Factors associated with vitamin D deficiency in health care workers exposed to SARS-CoV-2: a cross-sectional study. Front Nutr 2024; 11:1440185. [PMID: 39114123 PMCID: PMC11303295 DOI: 10.3389/fnut.2024.1440185] [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: 05/29/2024] [Accepted: 07/05/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Globally, up to 76.6% of the population may be affected by vitamin D (VD) deficiency, which has been linked to increased morbidity and mortality from COVID-19. This underscores the importance of further research into VD supplementation, particularly for health care workers, who are at higher risk due to indoor work environments and dietary challenges associated with shift schedules. Objective This study aimed to identify factors associated with VD deficiency in Mexican health care workers exposed to SARS-CoV-2. Materials and methods We conducted a cross-sectional study from June 2020 to January 2021 among frontline health care workers treating hospitalized COVID-19 patients. Blood samples were collected to measure 25-hydroxy VD levels via radioimmunoassay. We also assessed previous COVID-19 infection and comorbidities that could influence VD levels. Results The study included 468 health care workers. The median serum VD concentration was 16.6 ng/mL. VD deficiency was found in 69.4% (n = 325) of participants, while only 5.1% (n = 24) had normal levels. Those with type 2 diabetes (13.3 ng/mL vs. 17.1 ng/mL) or obesity (15.7 ng/mL vs. 17.1 ng/mL) had significantly lower VD levels than their counterparts (p < 0.001 and p = 0.049, respectively). No significant differences were found among participants with high blood pressure. Multivariate analysis revealed that type 2 diabetes was independently associated with VD deficiency. Conclusion There is a high prevalence of VD deficiency among health care workers, which is potentially linked to both personal health factors and occupational conditions.
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Affiliation(s)
- Miguel Angel Villasis-Keever
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jessie Nallely Zurita-Cruz
- Facultad de Medicina Universidad Nacional Autónoma de México, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Juan Garduño-Espinosa
- Evidence-Based Medicine Unit, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Mardya López-Alarcón
- Clinical Research Division of the Health Research Coordination, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Aly Sugey Barradas Vázquez
- Clinical Research Division of the Health Research Coordination, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María Guadalupe Miranda-Novales
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Israel Parra-Ortega
- Auxiliary Diagnostic Services, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Briseida López-Martinez
- Auxiliary Diagnostic Services, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Heladia García
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Klünder-Klünder
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico City, Mexico
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Elsheikh E, Alabdullah AI, Al-Harbi SS, Alagha AO, AlAhmed DH, Alalmaee MMA. The Relationship between Vitamin D Levels and Blood Glucose and Cholesterol Levels. Clin Pract 2024; 14:426-435. [PMID: 38525711 PMCID: PMC10961748 DOI: 10.3390/clinpract14020032] [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: 01/20/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Vitamin D deficiency has reached epidemic proportions globally. Observational data link low vitamin D status to diabetes, dyslipidemia, and metabolic syndrome, but interventional trials on the effects of supplementation are limited. OBJECTIVE We investigated associations between serum 25-hydroxyvitamin D (25(OH)D) levels and metabolic markers in Saudi adults. METHODS This retrospective cross-sectional study analyzed the clinical records of 476 patients from Saudi Arabia, aged 15-78 years. According to 25(OH)D levels, participants were stratified as vitamin D-sufficient (≥30 ng/mL), -insufficient (21-29 ng/mL), or -deficient (≤20 ng/mL). The outcomes were diabetic status (fasting glucose, HbA1c) and lipid panel results. RESULTS Higher diabetes prevalence was significantly associated with lower 25(OH)D levels (10.1% in the sufficient group, 11.6% in the insufficient group, and 18.3% in the deficient group). Similarly, worse lipid profiles were associated with more severe hypovitaminosis D, including a total cholesterol level of ≥240 mg/dL (5.3% in participants with normal vitamin D levels vs. 18.9% in those with deficient levels) and LDL ≥ 160 mg/dL (6.9% in participants with normal vitamin D levels vs. 13.2% in those with deficient levels). Vitamin D deficiency disproportionately affected women and adults > 45 years old. CONCLUSIONS Vitamin D deficiency is endemic in Saudi Arabia and strongly linked to worsened metabolic markers. Optimizing vitamin D status through screening and correcting the deficiency may provide a cost-effective approach to confronting the regional diabetes epidemic and reducing cardiovascular disease risk.
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Affiliation(s)
- Eman Elsheikh
- Internal Medicine Department, College of Medicine, King Faisal University, Alahsa 31982, Saudi Arabia
- Cardiovascular Department, College of Medicine, Tanta University Hospital, Tanta 31527, Egypt
| | | | - Sarah Saleh Al-Harbi
- Pharm.D., College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (S.S.A.-H.); (A.O.A.)
| | - Amal Omar Alagha
- Pharm.D., College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (S.S.A.-H.); (A.O.A.)
| | - Dhiyaa Hassan AlAhmed
- College of Medicine, King Faisal University, Alhasa 31982, Saudi Arabia; (A.I.A.); (D.H.A.); (M.M.A.A.)
| | - Mazen Moraya Ali Alalmaee
- College of Medicine, King Faisal University, Alhasa 31982, Saudi Arabia; (A.I.A.); (D.H.A.); (M.M.A.A.)
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Ahsan N, Imran M, Mohammed Y, Al Anouti F, Khan MI, Banerjee T, Adnan M, Ashfaq F, Kieliszek M, Ashraf SA, Haq A. Mechanistic Insight into the role of Vitamin D and Zinc in Modulating Immunity Against COVID-19: A View from an Immunological Standpoint. Biol Trace Elem Res 2023; 201:5546-5560. [PMID: 36890344 PMCID: PMC9995175 DOI: 10.1007/s12011-023-03620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023]
Abstract
The pathophysiology of coronavirus disease-19 (COVID-19) is characterized by worsened inflammation because of weakened immunity, causing the infiltration of immune cells, followed by necrosis. Consequently, these pathophysiological changes may lead to a life-threatening decline in perfusion due to hyperplasia of the lungs, instigating severe pneumonia, and causing fatalities. Additionally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause mortality due to viral septic shock, resulting from unrestrained and backfiring immune reactions to the pathogen. Sepsis can cause premature organ failure in COVID-19 patients, as well. Notably, vitamin D and its derivatives and minerals, such as zinc and magnesium, have been reported to improve the immune system against respiratory illnesses. This comprehensive review aims to provide updated mechanistic details of vitamin D and zinc as immunomodulators. Additionally, this review also focuses on their role in respiratory illnesses, while specifically delineating the plausibility of employing them as a preventive and therapeutic agent against current and future pandemics from an immunological perspective. Furthermore, this comprehensive review will attract the attention of health professionals, nutritionists, pharmaceuticals, and scientific communities, as it encourages the use of such micronutrients for therapeutic purposes, as well as promoting their health benefits for a healthy lifestyle and wellbeing.
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Affiliation(s)
- Nuzhat Ahsan
- Quantum Biphotonics Division, Quantlase Laboratory LLC, Abu Dhabi, UAE
| | - Mohammad Imran
- Therapeutic Research Group, Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - Yousuf Mohammed
- Therapeutic Research Group, Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - Fatme Al Anouti
- College of Natural and Health Sciences, Zayed University, Abu Dhabi, UAE
| | - Mohammad Idreesh Khan
- Department of Clinical Nutrition, College of Applied Health Sciences in Ar Rass, Qassim University, Ar Rass, 51921, Saudi Arabia
| | - Tanushree Banerjee
- Infosys Ltd. SEZ Unit VI, Plot No. 1, Rajiv Gandhi Infotech Park, Hinjawadi Phase I, Pune, Maharashtra, 57, India
| | - Mohd Adnan
- Department of Biology, College of Science, University of Ha'il, P.O. Box 2440, Ha'il, Saudi Arabia
| | - Fauzia Ashfaq
- Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Marek Kieliszek
- Department of Food Biotechnology and Microbiology, Institute of Food Sciences, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 C, 02-776, Warsaw, Poland.
| | - Syed Amir Ashraf
- Department of Clinical Nutrition, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.
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Dash DP, Sethi N. Pandemics, economy and health in Asia-A scenario of post 2020. MethodsX 2023; 11:102347. [PMID: 37693655 PMCID: PMC10491638 DOI: 10.1016/j.mex.2023.102347] [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: 07/15/2022] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
Utilizing a daily data of 29 Asian Economies from June 2021 to June 2022, this study investigates the impacts of economic growth, health infrastructures and Government measures on COVID-19 cases. Our results demonstrate that GDP, Government intervention, testing and vaccination exert positive impacts on COVID-19 cases. We incorporate factors like weather to know how temperature impacts COVID-19 Cases. Our results demonstrate that magnitude of COVID-19 cases goes on upward fashion in winter days more. With reference to co-morbid conditions like diabetes, we notice that people with diabetes are more vulnerable to the infections, however due to the greater behavioral response, we obtain a negative association between co-morbid conditions and new COVID-19 cases. However, the intensity of COVID-19 cases is decimated with the improvement in health facilities and behavioral changes. Besides basic regression estimates, our instrumental variable estimates hold true in the line of regression results while underlying the relation with the COVID-19 cases. Interestingly, our results from alternate specification ensures that high human development with greater openness has resulted in more COVID-19 cases. Overall, our study belies the fact that vaccination and higher govt intervention can prevent COVID-19. Rather, a comprehensive policy is recommended on cross-country basis to overcome such challenge.•The Study analyzes the relation among COVID-19, economic growth and health infrastructure on a daily basis from June 2021 to June 2022 for 29 Asian Economies•Our empirical strategy involves regression followed by robustness tests of instrumental variable regression model.•Results show that higher growth, human development, lesser vaccination and trivial govt intervention post 2020 have resulted in more COVID-19 cases.
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Affiliation(s)
- Devi Prasad Dash
- School of Management and Entrepreneurship, Indian Institute of Technology, Jodhpur, Rajasthan, India
| | - Narayan Sethi
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
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5
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Protas VV, Pogossyan GP, Li KG, Zhumina AG, Bisseneva AK, Shaikina DN. Plasma 25-Hydroxyvitamin D Level and VDR Gene Single Nucleotide Polymorphism rs2228570 Influence on COVID-19 Susceptibility among the Kazakh Ethnic Group-A Pilot Study. Nutrients 2023; 15:1781. [PMID: 37049620 PMCID: PMC10097393 DOI: 10.3390/nu15071781] [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: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Low plasma levels of the vitamin D metabolite 25-hydroxyvitamin D [25(OH)D] and the vitamin D receptor (VDR) gene single nucleotide polymorphisms (SNPs) have been associated with the body's susceptibility to infectious diseases, including COVID-19. In this pilot retrospective study, representatives of the Kazakh population (central Kazakhstan) were divided into groups based on the test for IgM and IgG for coronavirus infection. We compared the 25(OH)D plasma levels and concluded that the COVID-19-positive group values (25.17 ng/mL ± 16.65) were statistically lower (p = 0.0114) compared to the COVID-19-negative ones (35.58 ng/mL ± 20.67). There was no association between age, gender and 25(OH)D concentration within the groups (p > 0.05). The genotyping of rs2228570 was performed using a TaqMan Real-Time PCR assay. Allele C predominated among the COVID-19-negative participants and significantly reduced the likelihood of coronavirus infection (p < 0.0001; OR = 0.0804; 95% CI 0.02357-0.2798). There were no statistically significant differences in the frequencies of the A, G and T alleles in the studied groups (p > 0.05). The GG genotype of rs2228570 was associated with a 4.131-fold increased likelihood of COVID-19 infection (p = 0.0288; χ2 = 5.364; OR = 4.131; 95% CI 1.223-13.71). Comprehensive studies are required to determine whether low 25(OH)D plasma concentrations and genetic background represent a risk factor for COVID-19 infection.
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Affiliation(s)
- Valeriya V. Protas
- Department of Botany, Karaganda Buketov University, Karaganda 100028, Kazakhstan
| | - Gayane P. Pogossyan
- Department of Botany, Karaganda Buketov University, Karaganda 100028, Kazakhstan
| | - Konstantin G. Li
- Biotechnology and Eco-Monitoring Research Park, Karaganda Buketov University, Karaganda 100028, Kazakhstan
| | - Assel G. Zhumina
- Department of Botany, Karaganda Buketov University, Karaganda 100028, Kazakhstan
| | - Anar K. Bisseneva
- Department of Botany, Karaganda Buketov University, Karaganda 100028, Kazakhstan
| | - Dinara N. Shaikina
- Department of Biology, Non-Profit Limited Company “Manash Kozybayev North Kazakhstan University”, Petropavlovsk 150000, Kazakhstan
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6
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Mandal SK, Tare M, Deepa PR. COVID-19 infection and metabolic comorbidities: Mitigating role of nutritional sufficiency and drug - nutraceutical combinations of vitamin D. HUMAN NUTRITION & METABOLISM 2023; 31:200179. [PMID: 38620788 PMCID: PMC9762046 DOI: 10.1016/j.hnm.2022.200179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
The vulnerability of human health is amplified in recent times with global increase in non-communicable diseases (due to lifestyle changes and environmental insults) and infectious diseases (caused by newer pathogens and drug-resistance strains). Clinical management of diseases is further complicated by disease severity caused by other comorbid factors. Drug-based therapy may not be the sole approach, particularly in scenarios like the COVID-19 pandemic, where there is no specific drug against SARS-CoV-2. Nutritional interventions are significant in armouring human populations in disease prevention, and as adjunctive therapy for disease alleviation. Amidst ongoing clinical trials to determine the efficacy of Vit. D against infections and associated complications, this review examines the pleiotropic benefits of nutritional adequacy of vitamin D (Vit. D) in combating viral infections (COVID-19), its severity and complications due to co-morbidities (obesity, diabetes, stroke and Kawasaki disease), based on research findings and clinical studies. Supplements of Vit. D in combination with other nutrients, and drugs, are suggested as promising preventive-health and adjunct-treatment strategies in the clinical management of viral infections with metabolic comorbidities.
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Affiliation(s)
- Sumit Kumar Mandal
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India
| | - Meghana Tare
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India
| | - P R Deepa
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India
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Shrivastava AK, Sahu PK, Cecchi T, Shrestha L, Shah SK, Gupta A, Palikhey A, Joshi B, Gupta PP, Upadhyaya J, Paudel M, Koirala N. An emerging natural antioxidant therapy for COVID‐19 infection patients: Current and future directions. FOOD FRONTIERS 2023. [DOI: 10.1002/fft2.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Amit Kumar Shrivastava
- Department of Pharmacology Universal College of Medical Sciences Bhairahawa Rupandehi Nepal
| | - Prafulla Kumar Sahu
- School of Pharmacy Centurion University of Technology and Management Bhubaneswar Odisha India
| | | | - Laxmi Shrestha
- Department of Pharmacology Universal College of Medical Sciences Bhairahawa Rupandehi Nepal
| | - Sanjay Kumar Shah
- Department of Reproductive MedicineJoint Inter‐national Research Laboratory of Reproduction and DevelopmentChongquing Medical University ChongqingPeople's Republic of China
| | - Anamika Gupta
- Sharjah Institute for Medical Sciences University of Sharjah Sharjah United Arab Emirates
| | - Anjan Palikhey
- Department of Pharmacology Universal College of Medical Sciences Bhairahawa Rupandehi Nepal
| | - Bishal Joshi
- Department of Physiology, Universal College of Medical Sciences Bhairahawa Rupandehi Nepal
| | - Pramodkumar P. Gupta
- School of Biotechnology and Bioinformatics D. Y. Patil Deemed to be University, CBD Belapur Navi Mumbai India
| | - Jitendra Upadhyaya
- Institute of Agriculture and Animal Science Tribhuvan University Chitwan Nepal
| | - Mahendra Paudel
- Department of Agri‐Botany and Ecology Institute of Agriculture and Animal Science Tribhuvan University Mahendranagar Nepal
| | - Niranjan Koirala
- Natural Products Research FacilityGandaki Province Academy of Science and Technology Pokhara, Gandaki Province Nepal
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Mohammadi F, Dehbozorgi L, Akbari‐Hasanjani HR, Joz Abbasalian Z, Akbari‐Hasanjani R, Sabbaghi‐Nadooshan R, Moradi Tabriz H. Evaluation of effective features in the diagnosis of Covid-19 infection from routine blood tests with multilayer perceptron neural network: A cross-sectional study. Health Sci Rep 2023; 6:e1048. [PMID: 36620509 PMCID: PMC9817491 DOI: 10.1002/hsr2.1048] [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: 09/12/2022] [Revised: 12/04/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Aim Coronavirus is an infectious disease that is now known as an epidemic, early and accurate diagnosis helps the patient receive more care. The aim of this study is to investigate Covid-19 using blood tests and multilayer perceptron neural network and affective factors in improving and preventing Covid-19. Methods This cross-sectional study was performed on 200 patients referred to Sina Hospital, Tehran, Iran, who were confirmed cases of Covid-19 by computerized tomography-scan analysis between 2 March 2020 to 5 April 2020. After verification of lung involvement, blood sampling was done to separate the sera for C-reactive protein (CRP), magnesium (Mg), lymphocyte percentage, and vitamin D analysis in healthy and unhealthy people. Blood samples from healthy and sick people were applied to the multilayer perceptron network for 70% of the data for training and 30% for testing. Result By examining the features, it was found that in patients with Covid-19, there was a significant relationship between increased CRP and decreased lymphocyte levels, and increased Mg (p < 0.01). In these patients, the amount of CRP and Mg in women and the number of lymphocytes and vitamin D in men were significantly higher (p < 0.01). Conclusion The important advantage of using a multilayer perceptron neural network is to speed up the diagnosis and treatment.
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Affiliation(s)
- Fatemeh Mohammadi
- Department of Pathology, Sina Clinical‐Research CenterTehran University of Medical SciencesTehranIran
| | - Leila Dehbozorgi
- Department of Electrical Engineering, Central Tehran BranchIslamic Azad UniversityTehranIran
| | | | - Zahra Joz Abbasalian
- Department of Pathology, Sina Clinical‐Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Akbari‐Hasanjani
- Department of Electrical Engineering, Central Tehran BranchIslamic Azad UniversityTehranIran
| | - Reza Sabbaghi‐Nadooshan
- Department of Electrical Engineering, Central Tehran BranchIslamic Azad UniversityTehranIran
| | - Hedieh Moradi Tabriz
- Department of Pathology, Sina Clinical‐Research CenterTehran University of Medical SciencesTehranIran
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Pinzariu AC, Sova IA, Maranduca MA, Filip N, Drochioi IC, Vamesu CG, Clim A, Hurjui LL, Moscalu M, Soroceanu RP, Serban DN, Serban IL. Vitamin D Deficiency in Both Oral and Systemic Manifestations in SARS-CoV-2 Infection: Updated Review. Medicina (B Aires) 2022; 59:medicina59010068. [PMID: 36676692 PMCID: PMC9866644 DOI: 10.3390/medicina59010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
The specialized literature emphasizes the fact that vitamin D has a potentially beneficial effect in the context of the current COVID-19 pandemic. The purpose of this article is to highlight the role of vitamin D, both prophylactic and curative, in the treatment of patients diagnosed with COVID-19. Even though its relevance is still unknown and causes various controversies, there is currently no specific treatment for patients diagnosed with COVID-19. There are various prevention strategies with new vaccination schedules, but additional randomized and clinical trials are still needed to combat this pandemic. In addition to the systemic manifestations of SARS-CoV-2 infection, oral manifestations of this disease have also been described in the literature. The etiology of oral manifestations associated with COVID-19 infection and vitamin D deficiency remains controversial. In the present studies, oral manifestations such as salivary gland infections, aphthae, erythema, gingivitis, ulcers, etc. have been reported. This is a new topic, and the prevalence of manifestations is described in only a few studies, which is inconsistent with the number of COVID-19 cases reported since the beginning of the pandemic. The clinical symptomatology in patients with current COVID-19 infection is polymorphic. Whether the oral manifestation is directly caused by SARS-CoV-2 or a secondary manifestation remains an important topic to analyze and discuss.
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Affiliation(s)
- Alin Constantin Pinzariu
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ivona Andreea Sova
- IOSUD Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Minela Aida Maranduca
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
| | - Nina Filip
- Department of Morpho-Functional Sciences II, Discipline of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ilie Cristian Drochioi
- Department of Oral and Maxillofacial Surgery and Reconstructive, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania
| | - Calin George Vamesu
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Clim
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.C.); (M.M.)
| | - Loredana Liliana Hurjui
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.C.); (M.M.)
| | - Radu Petru Soroceanu
- Department of Surgery I, Discipline of Surgical Semiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragomir Nicolae Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionela Lacramioara Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Baxter BA, Ryan MG, LaVergne SM, Stromberg S, Berry K, Tipton M, Natter N, Nudell N, McFann K, Dunn J, Webb TL, Armstrong M, Reisdorph N, Ryan EP. Correlation between 25-hydroxyvitamin D/D3 Deficiency and COVID-19 Disease Severity in Adults from Northern Colorado. Nutrients 2022; 14:nu14245204. [PMID: 36558362 PMCID: PMC9782165 DOI: 10.3390/nu14245204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
Vitamin D deficiency is common in the United States and leads to altered immune function, including T cell and macrophage activity that may impact responses to SARS-CoV-2 infection. This study investigated 131 adults with a history of a positive SARS-CoV-2 nasopharyngeal PCR and 18 adults with no COVID-19 diagnosis that were recruited from the community or hospital into the Northern Colorado Coronavirus Biorepository (NoCo-COBIO). Participants consented to enrollment for a period of 6 months and provided biospecimens at multiple visits for longitudinal analysis. Plasma 25-hydroxyvitamin D levels were quantified by LC-MS/MS at the initial visit (n = 149) and after 4 months (n = 89). Adults were classified as deficient (<30 nM or <12 ng/mL), insufficient (<30−50 nM or 12−20 ng/mL), or optimal (50−75 nM or >20 ng/mL) for 25-hydroxyvitamin D status. Fisher’s exact test demonstrated an association between disease severity, gender, and body mass index (BMI) at baseline. Mixed model analyses with Tukey-Kramer were used for longitudinal analysis according to BMI. Sixty-nine percent (n = 103) of the entire cohort had optimal levels of total 25(OH)D, 22% (n = 32) had insufficient levels, and 9% (n = 14) had deficent levels. Participants with severe disease (n = 37) had significantly lower 25-hydroxyvitamin D (total 25(OH)D) when compared to adults with mild disease (p = 0.006) or no COVID-19 diagnosis (p = 0.007). There was 44% of the cohort with post-acute sequalae of COVID-19 (PASC) as defined by experiencing at least one of the following symptoms after 60 days’ post-infection: fatigue, dyspnea, joint pain, chest pain, forgetfulness or absent-mindedness, confusion, or difficulty breathing. While significant differences were detected in 25-hydroxyvitamin D status by sex and BMI, there were no correlations between 25-hydroxyvitamin D for those without and without PASC. This longitudinal study of COVID-19 survivors demonstrates an important association between sex, BMI, and disease severity for 25-hydroxyvitamin D deficiency during acute stages of infection, yet it is not clear whether supplementation efforts would influence long term outcomes such as developing PASC.
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Affiliation(s)
- Bridget A. Baxter
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Michaela G. Ryan
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Stephanie M. LaVergne
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Sophia Stromberg
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Kailey Berry
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Madison Tipton
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Nicole Natter
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Nikiah Nudell
- Medical Center of the Rockies, University of Colorado Health, Loveland, CO 80538, USA
| | - Kim McFann
- Medical Center of the Rockies, University of Colorado Health, Loveland, CO 80538, USA
| | - Julie Dunn
- Medical Center of the Rockies, University of Colorado Health, Loveland, CO 80538, USA
| | - Tracy L. Webb
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Michael Armstrong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Elizabeth P. Ryan
- Department of Environmental Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
- Correspondence: ; Tel.: +1-970-491-1936
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11
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Evaluating Risk: Benefit Ratio of Fat-Soluble Vitamin Supplementation to SARS-CoV-2-Infected Autoimmune and Cancer Patients: Do Vitamin–Drug Interactions Exist? Life (Basel) 2022; 12:life12101654. [PMID: 36295089 PMCID: PMC9604733 DOI: 10.3390/life12101654] [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: 08/29/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This review brings attention to a crucial yet under-investigated subject which is vitamin–drug interactions. Fat-soluble vitamins such as vitamins A, D, E, and K have been proven to possess many beneficial effects in the treatment and prevention of COVID-19. Moreover, it has been reported that deficiencies of fat-soluble vitamins have been directly linked to COVID-19 infection-related morbidity and mortality, especially in high-risk populations such as cancer and autoimmune patients. However, many vitamin–drug interactions exist between most of the newly COVID-19 FDA-approved medications and fat-soluble vitamins. Hence, this mandates personalizing the COVID-19 treatment protocols, especially for patients who have any deficiency in any of these vital vitamins. Weighing the risk-to-benefit ratio of supplementing any of these fat-soluble vitamins with COVID-19 medications is considered crucial to maximize the therapeutic benefit and decrease the side effects of these drugs. Abstract COVID-19 is a recent pandemic that mandated the scientific society to provide effective evidence-based therapeutic approaches for the prevention and treatment for such a global threat, especially to those patients who hold a higher risk of infection and complications, such as patients with autoimmune diseases and cancer. Recent research has examined the role of various fat-soluble vitamins (vitamins A, D, E, and K) in reducing the severity of COVID-19 infection. Studies showed that deficiency in fat-soluble vitamins abrogates the immune system, thus rendering individuals more susceptible to COVID-19 infection. Moreover, another line of evidence showed that supplementation of fat-soluble vitamins during the course of infection enhances the viral clearance episode by promoting an adequate immune response. However, more thorough research is needed to define the adequate use of vitamin supplements in cancer and autoimmune patients infected with COVID-19. Moreover, it is crucial to highlight the vitamin–drug interactions of the COVID-19 therapeutic modalities and fat-soluble vitamins. With an emphasis on cancer and autoimmune patients, the current review aims to clarify the role of fat-soluble vitamins in SARS-CoV-2 infection and to estimate the risk-to-benefit ratio of a fat-soluble supplement administered to patients taking FDA-approved COVID-19 medications such as antivirals, anti-inflammatory, receptor blockers, and monoclonal antibodies.
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Sarhan N, Abou Warda AE, Sarhan RM, Boshra MS, Mostafa-Hedeab G, ALruwaili BF, Ibrahim HSG, Schaalan MF, Fathy S. Evidence for the Efficacy of a High Dose of Vitamin D on the Hyperinflammation State in Moderate-to-Severe COVID-19 Patients: A Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1358. [PMID: 36295519 PMCID: PMC9609310 DOI: 10.3390/medicina58101358] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Vitamin D supplementation plays a key effect in lowering cytokine storms among COVID-19 patients by influencing the activity of the renin-angiotensin system and the production of the angiotensin-2 converting enzyme. The study was conducted to explore the effect of high-dose intramuscular vitamin D in hospitalized adults infected with moderate-to-severe SARS-CoV-2 in comparison with the standard of care in the COVID-19 protocol. Materials and Methods: Two groups of patients were compared in this prospective randomized controlled trial as the vitamin D was administered orally to group 1 (alfacalcidol 1 mcg/day) and intramuscularly to group 2 (cholecalciferol 200,000 IU). One hundred and sixteen participants were recruited in total, with fifty-eight patients in each group. Following the Egyptian Ministry of Health's policy for COVID-19 management, all patients received the same treatment for a minimum of five days. Results: A significant difference was recorded in the length of hospital stay (8.6 versus 6.8 days), need for high oxygen or non-invasive mechanical ventilator (67% versus 33%), need for a mechanical ventilator (25% versus 75%), clinical improvement (45% versus 55%), the occurrence of sepsis (35% versus 65%), and in the monitored laboratory parameters in favor of high-dose vitamin D. Moreover, clinical improvement was significantly associated with the need for low/high oxygen, an invasive/non-invasive mechanical ventilator (MV/NIMV), and diabetes, while mortality was associated with the need for MV, ICU admission, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and the occurrence of secondary infection. Conclusions: Our study showed that high-dose vitamin D was considered a promising treatment in the suppression of cytokine storms among COVID-19 patients and was associated with better clinical improvement and fewer adverse outcomes compared to low-dose vitamin D.
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Affiliation(s)
- Neven Sarhan
- Clinical Pharmacy Department, Faculty of Pharmacy, Misr International University, Cairo 11828, Egypt
| | - Ahmed E. Abou Warda
- Clinical Pharmacy Department, Faculty of Pharmacy, October 6 University, P.O. Box 12585, Giza 12585, Egypt
| | - Rania M. Sarhan
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, P.O. Box 62514, Beni-Suef 62511, Egypt
| | - Marian S. Boshra
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, P.O. Box 62514, Beni-Suef 62511, Egypt
| | - Gomaa Mostafa-Hedeab
- Pharmacology Department, Medical College, Jouf University, Sakaka 72388, Saudi Arabia
| | - Bashayer F. ALruwaili
- Community and Family Medicine Department, Division of Family Medicine, Medical College, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Mona F. Schaalan
- Clinical Pharmacy Department, Faculty of Pharmacy, Misr International University, Cairo 11828, Egypt
| | - Shaimaa Fathy
- Clinical Pharmacy Department, Faculty of Pharmacy, Misr International University, Cairo 11828, Egypt
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13
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Deciphering the Potential of Pre and Pro-Vitamin D of Mushrooms against Mpro and PLpro Proteases of COVID-19: An In Silico Approach. Molecules 2022; 27:molecules27175620. [PMID: 36080385 PMCID: PMC9458008 DOI: 10.3390/molecules27175620] [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: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Vitamin D’s role in combating the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus causing COVID-19, has been established in unveiling viable inhibitors of COVID-19. The current study investigated the role of pre and pro-vitamin D bioactives from edible mushrooms against Mpro and PLpro proteases of SARS-CoV-2 by computational experiments. The bioactives of mushrooms, specifically ergosterol (provitamin D2), 7-dehydrocholesterol (provitamin-D3), 22,23-dihydroergocalciferol (provitamin-D4), cholecalciferol (vitamin-D3), and ergocalciferol (vitamin D2) were screened against Mpro and PLpro. Molecular docking analyses of the generated bioactive protease complexes unravelled the differential docking energies, which ranged from −7.5 kcal/mol to −4.5 kcal/mol. Ergosterol exhibited the lowest binding energy (−7.5 kcal/mol) against Mpro and PLpro (−5.9 kcal/mol). The Molecular Mechanics Poisson–Boltzmann Surface Area (MMPBSA) and MD simulation analyses indicated that the generated complexes were stable, thus affirming the putative binding of the bioactives to viral proteases. Considering the pivotal role of vitamin D bioactives, their direct interactions against SARS-CoV-2 proteases highlight the promising role of bioactives present in mushrooms as potent nutraceuticals against COVID-19.
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14
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Araújo TSS, Santos CS, Soares JKB, Freitas JCR. Vitamin D: a potentially important secosteroid for coping with COVID-19. AN ACAD BRAS CIENC 2022; 94:e20201545. [PMID: 36000671 DOI: 10.1590/0001-3765202220201545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is a disease that has caused a high number of deaths in the world, and despite being controlled, it requires attention and the search for new quick and economical therapeutic strategies. In this sense, vitamin D stands out, an immunomodulator that has shown beneficial effects in decreasing the risk and severity of acute respiratory tract infections, including COVID-19. Therefore, this review presents a number of experimental, observational and clinical studies on the importance of vitamin D against viral infections with an emphasis on COVID-19, highlighting the relationship between vitamin D, Renin-Angiotensin System and cytokine storms with decreased inflammatory lesions in patients with COVID-19. In addition, aspects of pathophysiology, metabolism, risk factors, sources and recommendations of vitamin D are described. We conclude that vitamin D plays a protective role against inflammatory lesions and can decrease the risk of infections and the severity of COVID-19. Therefore, it is essential to maintain adequate levels of vitamin D to avoid complications related to its deficiency.
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Affiliation(s)
- Thayanne S S Araújo
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Rua Professora Maria Anita Furtado Coelho, s/n, Sítio Olho D'água da Bica, 58175-000 Cuité, PB, Brazil
| | - Cosme S Santos
- Universidade Federal Rural de Pernambuco, Departamento de Química, Rua Dom Manoel de Medeiros, s/n, 52171-900 Recife, PE, Brazil
| | - Juliana K B Soares
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Rua Professora Maria Anita Furtado Coelho, s/n, Sítio Olho D'água da Bica, 58175-000 Cuité, PB, Brazil
| | - Juliano C R Freitas
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Rua Professora Maria Anita Furtado Coelho, s/n, Sítio Olho D'água da Bica, 58175-000 Cuité, PB, Brazil.,Universidade Federal Rural de Pernambuco, Departamento de Química, Rua Dom Manoel de Medeiros, s/n, 52171-900 Recife, PE, Brazil
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15
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Quintero-Fabián S, Bandala C, Pichardo-Macías LA, Contreras-García IJ, Gómez-Manzo S, Hernández-Ochoa B, Martínez-Orozco JA, Ignacio- Mejía I, Cárdenas-Rodríguez N. Vitamin D and its possible relationship to neuroprotection in COVID-19: evidence in the literature. Curr Top Med Chem 2022; 22:1346-1368. [DOI: 10.2174/1568026622666220401140737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Vitamin D is a hormone involved in the regulation of important biological processes such as signal transduction, immune response, metabolic regulation and also in the nervous and vascular systems. To date, coronavirus disease 2019 (COVID-19) infection does not have a specific treatment, however various drugs have been proposed, including those that attenuate the intense inflammatory response and recently the use of vitamin D, in clinical trials, as part of the treatment of COVID-19 has provided promising results. It has been observed in some clinical studies that the use of cholecalciferol (vitamin D3) and its two metabolites the circulating form, calcidiol or calcifediol (25-hydroxycalciferol, 25-(OH)-D) and the active form, calcitriol (1,25-(OH)2-D), in different doses, improve the clinical manifestations, prognosis and survival of patients infected with COVID-19 probably because of its anti-inflammatory, antiviral and lung-protective action. In relation to the central nervous system (CNS) it has been shown, in clinical studies, that vitamin D is beneficial in some neurological and psychiatric conditions because of its anti-inflammatory and antioxidant properties, modulation of neurotransmitters actions, regulation of calcium homeostasis between other mechanisms. It has been showed that COVID-19 infection induces CNS complications such as headache, anosmia, ageusia, neuropathy, encephalitis, stroke, thrombosis, cerebral hemorrhages, cytotoxic lesions and psychiatric conditions and it has been proposed that the use of dietary supplements, as vitamin and minerals, can be adjuvants in this disease. In this review the evidence of possible role of vitamin D, and its metabolites, as protector against the neurological manifestations of COVID-19 was summarized.
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Affiliation(s)
- Saray Quintero-Fabián
- Laboratorio de Medicina Traslacional, Escuela Militar de Graduados de Sanidad, UDEFA, Mexico City, 11200, Mexico
| | - Cindy Bandala
- Division de Neurociencias, Instituto Nacional de Rehabilitación, Secretaría de Salud, Mexico City, 14389, Mexico
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
| | - Luz Adriana Pichardo-Macías
- Departamento de Fisiología, Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas, Mexico City, 07738, Mexico
| | | | - Saúl Gómez-Manzo
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, 04530, Mexico
| | - Beatriz Hernández-Ochoa
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, 06720, Mexico
| | - José Arturo Martínez-Orozco
- Departmento de Infectología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Secretaría de Salud, Mexico City, 14080, Mexico
| | - Iván Ignacio- Mejía
- Laboratorio de Medicina Traslacional, Escuela Militar de Graduados de Sanidad, UDEFA, Mexico City, 11200, Mexico
| | - Noemí Cárdenas-Rodríguez
- Laboratorio de Neurociencias, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, 04530, Mexico
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Ghanei E, Baghani M, Moravvej H, Talebi A, Bahmanjahromi A, Abdollahimajd F. Low serum levels of zinc and 25-hydroxyvitmain D as potential risk factors for COVID-19 susceptibility: a pilot case-control study. Eur J Clin Nutr 2022; 76:1297-1302. [PMID: 35322170 PMCID: PMC8941827 DOI: 10.1038/s41430-022-01095-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS This study aimed to evaluate serum 25-hydroxyvitmain D and zinc levels in coronavirus disease 2019 (COVID-19) patients in comparison to healthy subjects. METHODS This was a single-center case-control study performed from March 20, 2020, to January 20, 2021, in Tehran, Iran. All patients diagnosed with COVID-19 based on a positive nasopharyngeal swab polymerase chain reaction (PCR) test were included in the case group. Controls were selected from patients referred for routine checkups who had a negative COVID-19 PCR test. Age, sex, marital and educational status, comorbidities, and serum 25-hydroxyvitmain D and zinc levels of patients were recorded. RESULTS Ninety patients in the case group and 95 subjects in the control group who were sex and age-matched were studied. 25-hydroxyvitmain D levels lower than 20 ng/ml were observed in 58 (64%) cases and 72 (76%) controls (P = 0.09). The median 25-hydroxyvitmain D level in the case group was significantly lower than controls (26 (interquartile range [IQR] = 24) ng/ml vs. 38 (IQR = 22) ng/ml, respectively, P < 0.01). The median zinc level in the case group was 56 (IQR = 23) ng/ml, while it was 110 (IQR = 27) ng/ml among the controls (P < 0.01). There was no significant difference in the level of 25-hydroxyvitmain D and zinc between cases with and without comorbidities (P > 0.05). Susceptibility to SARS-CoV-2 infection could be predicted by serum 25-hydroxyvitmain D levels below 25.2 ng/ml (81% sensitivity; 48% specificity) or zinc levels below 86.3 mmol/ml (93% sensitivity; 92% specificity). CONCLUSIONS Low serum zinc and 25-hydroxyvitmain D levels appear to be risk factors for COVID-19 affliction; thus, the treatment of individuals with such deficiencies is recommended.
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Affiliation(s)
- Esmat Ghanei
- Department of Internal Medicine of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moein Baghani
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Moravvej
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Talebi
- Colorectal Research Center, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ayda Bahmanjahromi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fahimeh Abdollahimajd
- Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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17
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Torpoco-Rivera D, Misra A, Sanil Y, Sabzghabaei N, Safa R, Garcia RU. Vitamin D and morbidity in children with multisystem inflammatory syndrome related to Covid-19. PROGRESS IN PEDIATRIC CARDIOLOGY 2022; 66:101507. [PMID: 35250251 PMCID: PMC8885084 DOI: 10.1016/j.ppedcard.2022.101507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
Background Multisystem inflammatory syndrome (MIS-C) is a clinical presentation reported in children related to Coronavirus-19 infection who present with a toxic shock like syndrome. Vitamin D deficiency has been postulated to play a role with severity of coronavirus infection in adult patients and other viral respiratory infections. Objective This study aims to investigate if severe vitamin D deficiency was associated with increased disease severity and cardiac involvement in MIS-C. Methods This is a retrospective and single center study. We included hospitalized patients less than 18 years of age with diagnosis of MIS-C between March and July 2020. Severe vitamin D deficiency was defined as 25-OH vitamin D level < 10 ng/ml within 48 h of admission. The composite outcome severe disease included patients requiring inotropes, mechanical ventilation, and extracorporeal membrane oxygenation. Results Of the 31 patients with MIS-C, 45% were male and 58% were African American. The median age was 8 (1–13) years. Ten patients had severe vitamin D deficiency with a mean level of 7.2 ng/ml. Ninety percent of patients with severe vitamin D deficiency had severe disease (P < 0.001). Patients with severe vitamin D deficiency had an increased risk of cardiac involvement (P < 0.001). Conclusions We describe a potential association between severe vitamin D deficiency and severe disease in children presenting with MIS-C. Severe vitamin D deficiency predisposes patients for cardiovascular involvement and may play a critical role in the host immune response to COVID-19 infection. Future prospective studies at the basic science and clinical level should be pursued to better delineate this association.
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18
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Junior AF, Azevedo E, Paes AT, Lima E, Campos Guerra JC, Ingham SJMN. Chronic diseases, chest computed tomography, and laboratory tests as predictors of severe respiratory failure and death in elderly Brazilian patients hospitalized with COVID-19: a prospective cohort study. BMC Geriatr 2022; 22:132. [PMID: 35172759 PMCID: PMC8851839 DOI: 10.1186/s12877-022-02776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/18/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID-19 remain unclear. OBJECTIVE To determine the association of chronic diseases, chest computed tomography (CT), and laboratory tests with severe respiratory failure and mortality in older adults hospitalized with COVID-19. METHOD This was a prospective cohort with 201 hospitalized older adults with COVID-19. Chronic diseases, chest CT, laboratory tests, and other data were collected within the first 48 h of hospitalization. Outcomes were progression to severe respiratory failure with the need of mechanical ventilation (SRF/MV) and death. RESULTS The mean age was 72.7 ± 9.2 years, and 63.2% were men. SRF/MV occurred in 16.9% (p < 0.001), and death occurred in 8%. In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03-9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99-8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21-33.88; 0.029)], and hemoglobin < 12 g/mL [OR: 3.32 (1.20-9.20; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation [OR: 26.72 (3.87-184.11; 0.001)], cancer history [OR:8.32 (1.28-53.91; 0.026)] and IL-6 > 40 pg/mL [OR:10.01 (1.66-60.13; 0.012)] were independent predictors of death. CONCLUSION In hospitalized older adults with COVID-19, tomographic pulmonary involvement > 50%, anemia, vitamin D below 40 ng/mL, and CRP above 80 mg/L were independent risk factors for progression to SRF/MV. The presence of chronic atrial fibrillation, previous cancer, IL-6 > 40 pg/mL, and anemia were independent predictors of death.
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Affiliation(s)
- Alberto Frisoli Junior
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627. 1° Subsolo, Bloco B, Morumbi, São Paulo, SP, Zip code : 05652-900, Brazil. .,Elderly Vulnerability Disease Research Group Unit, Cardiology Division, Federal University of São Paulo, Rua Napoleão de Barros, 715 - Térreo- Vila Clementino, São Paulo, SP, Zip code: 04024-002, Brazil.
| | - Elaine Azevedo
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627. 1° Subsolo, Bloco B, Morumbi, São Paulo, SP, Zip code : 05652-900, Brazil.,Osteometabolic Diseases Unit - Hospital do Servidor Público Estadual de São Paulo Av. Ibirapuera, 981. Vila Clementino, São Paulo, SP, Zip code: 04038, Brazil
| | - Angela Tavares Paes
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627. 1° Subsolo, Bloco B, Morumbi, São Paulo, SP, Zip code : 05652-900, Brazil.,Statistics Department, Federal University of São Paulo, Rua Diogo de Faria, 1087. 4 andar, cj 408- Vila Clementino, São Paulo, SP, Zip code: 04037003, Brazil
| | - Eliene Lima
- Elderly Vulnerability Disease Research Group Unit, Cardiology Division, Federal University of São Paulo, Rua Napoleão de Barros, 715 - Térreo- Vila Clementino, São Paulo, SP, Zip code: 04024-002, Brazil
| | - João Carlos Campos Guerra
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627. 1° Subsolo, Bloco B, Morumbi, São Paulo, SP, Zip code : 05652-900, Brazil
| | - Sheila Jean Mc Neill Ingham
- Elderly Vulnerability Disease Research Group Unit, Cardiology Division, Federal University of São Paulo, Rua Napoleão de Barros, 715 - Térreo- Vila Clementino, São Paulo, SP, Zip code: 04024-002, Brazil
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Gilani SJ, Bin-Jumah MN, Nadeem MS, Kazmi I. Vitamin D attenuates COVID-19 complications via modulation of proinflammatory cytokines, antiviral proteins, and autophagy. Expert Rev Anti Infect Ther 2022; 20:231-241. [PMID: 34112047 PMCID: PMC8477590 DOI: 10.1080/14787210.2021.1941871] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/09/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Global emergence of coronavirus disease-19 (COVID-19) has clearly shown variable severity, mortality, and frequency between and within populations worldwide. These striking differences have made many biological variables attractive for future investigations. One of these variables, vitamin D, has been implicated in COVID-19 with rapidly growing scientific evidence. AREAS COVERED The review intended to systematically explore the sources, and immunomodulatory role of vitamin D in COVID-19. Search engines and data sources including Google Scholar, PubMed, NCBI, Scopus, and Web of Science were used for data collection. The search terms used were Vitamin D, COVID-19, immune system, and antiviral mechanism. Overall, 232 sources of information were collected and 188 were included in this review. EXPERT OPINION Interaction of vitamin D and vitamin D receptor (VDR) triggers the cellular events to modulate the immune system by regulation of many genes. Vitamin D operates as a double-edged sword against COVID-19. First, in macrophages, it promotes the production of antimicrobial and antiviral proteins like β-defensin 2 and cathelicidin, and these proteins inhibit the replication of viral particles and promote the clearance of virus from the cells by autophagy. Second, it suppresses cytokine storm and inflammatory processes in COVID-19.
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Affiliation(s)
- Sadaf Jamal Gilani
- Department of Basic Health Sciences, Preparatory Year, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - May Nasser Bin-Jumah
- Biology Department, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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20
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Alberca GGF, Alberca RW. Role of vitamin D deficiency and comorbidities in COVID-19. World J Virol 2022; 11:85-89. [PMID: 35117974 PMCID: PMC8788214 DOI: 10.5501/wjv.v11.i1.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/01/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Recent manuscripts described the incidence of vitamin D hypovitaminosis in coronavirus disease 2019 (COVID-19) patients. Vitamin D deficiency is also common in patients with comorbidities that are associated with a poor COVID-19 prognosis. In this letter, we review the literature regarding the association of comorbidities, vitamin D deficiency, and COVID-19.
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Affiliation(s)
- Gabriela Gama Freire Alberca
- Department of Microbiology, Institute of Biomedical Sciences-University of São Paulo, São Paulo 04307-100, Brazil
| | - Ricardo Wesley Alberca
- Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 04307-100, Brazil
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21
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A review of natural foods consumed during the COVID-19 pandemic life. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Coronavirus 2019 (COVID-19) is an infectious disease that has brought life to a standstill around the world. Until a vaccine was found to combat COVID-19, the world conducted research and made recommendations for nutritional natural foods. Considering the risks incurred by contracting the disease, even though the production of various vaccines and vaccination of healthy people has started in some countries, individuals need useful foods to be ready for the COVID-19 pandemic. Recently, nutrient contents such as antioxidant compounds, vitamins, minerals, and probiotics that contribute to the immune system have been investigated. This paper attempts to determine the role of these dietary supplements in reducing the risk of COVID-19 and/or changing the course of the disease in COVID-19 patients and their effects on mortality. Supplements used and recommended for the COVID-19 pandemic life were investigated. In conclusion, more research is needed to determine the effectiveness of nutrients, vitamins, minerals, probiotics, prebiotics, and antioxidants used during the COVID-19 pandemic to inhibit the effect of SARS-CoV-2. In order to overcome the new global crisis, nutritional cures and treatments should be upgraded. However, additional research on the subject is needed.
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22
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A Lower 25(OH)D Level in COVID-19 Patients is Associated with Increased Mortality: An Observational Study. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.111381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Recent studies have shown that insufficient vitamin D supply is correlated with increase in COVID-19 cases and its mortality. Potentially, it may play an important role in controlling virus proliferation. Objectives: This study aimed to evaluate the association between serum vitamin D levels and clinical findings, and mortality rate in patients with COVID-19. Methods: This cross-sectional study was conducted on 200 COVID-19 patients referred or admitted to Loghman-e-Hakim Hospital of Tehran, Iran, from February to June 2020. After patient selection, demographic information of all patients was recorded. Eventually, the relationship between basic demographic and clinical findings with vitamin D levels in all patients was evaluated. Results: The mean Vit-D levels in intubated and non-intubated patients were 22.95 ± 22.23 ng/mL and 21.64 ± 29.20 ng/mL, respectively (P = 0.018). In most of the outpatients (46.7%), Vit-D levels were between 21 - 30 ng/mL, and 47.6% of admitted patients had Vit-D ≤ 20 ng/mL. The mean Vit-D level in survived patients was significantly higher than patients who died (28.2 ± 21.18 ng/mL vs. 19.91 ± 14.18 ng/mL, respectively; P = 0.021). While 34.2% (55 cases) of survived patients had Vit-D level ≥ 31 ng/mL, about 70% of death cases had Vit-D ≤ 20 ng/mL (P < 0.001). Conclusions: According to our results, vitamin D supplementation could be beneficial in COVID-19 patients. However, further comprehensive clinical trials are needed to confirm these findings.
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Figueroa-Pizano MD, Campa-Mada AC, Carvajal-Millan E, Martinez-Robinson KG, Chu AR. The underlying mechanisms for severe COVID-19 progression in people with diabetes mellitus: a critical review. AIMS Public Health 2021; 8:720-742. [PMID: 34786431 PMCID: PMC8568590 DOI: 10.3934/publichealth.2021057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) has a high incidence of comorbidities among patients with severe coronavirus disease 2019 (COVID-19). The elevated prevalence of DM in the world population makes it a significant risk factor because diabetic individuals appear to be prone to clinical complications and have increased mortality rates. Here, we review the possible underlying mechanisms involved in DM that led to worse outcomes in COVID-19. The impacts of hyperglycemia side effects, secondary comorbidities, weakened innate and adaptive immunity, chronic inflammation, and poor nutritional status, commonly present in DM, are discussed. The role of the SARS-CoV-2 receptor and its polymorphic variations on higher binding affinity to facilitate viral uptake in people with DM were also considered. Clinical differences between individuals with type 1 DM and type 2 DM affected by COVID-19 and the potential diabetogenic effect of SARS-CoV-2 infection were addressed.
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Affiliation(s)
- María D Figueroa-Pizano
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Alma C Campa-Mada
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Elizabeth Carvajal-Millan
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Karla G Martinez-Robinson
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Agustin Rascon Chu
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
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24
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Shah K, Varna VP, Pandya A, Saxena D. Low vitamin D levels and prognosis in a COVID-19 pediatric population: a systematic review. QJM 2021; 114:447-453. [PMID: 34293161 DOI: 10.1093/qjmed/hcab202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/07/2021] [Indexed: 01/28/2023] Open
Abstract
We aim to study the relationship between vitamin D level, risk and severity of Coronavirus disease of 2019 (COVID-19) infection in pediatric population through systematic review. We searched PubMed, CINAHL, EMBASE, Cochrane Library and Google Scholar from December 2019 to June 2021 for retrieving articles studying association between vitamin D deficiencies with COVID-19. Qualitative details were synthesized in evidence table and quantitative data was used for deriving pooled estimate through meta-analysis. After initial search of 2261 articles, eight eligible studies (two reviews) were included in the systematic review. Meta-analysis of the quantitative data (six studies) showed pooled prevalence of vitamin D deficiency as 45.91% (95% CI: 25.148-67.450). In infected pediatric patients, low levels of vitamin D increased the risk of severe disease (odds ratio-5.5; 95% CI: 1.560-19.515; P = 0.008). It was also found that children and adolescents having vitamin D deficiency had greater risk of COVID infection as compared to patients with normal vitamin D levels. Improvement in disease severity with vitamin D supplementation was also noted. The systematic review showed that almost half of the pediatric COVID patients suffer from vitamin D deficiency. It is also clear that the low level of vitamin D is associated with greater risk of infection and poorer outcome in pediatrics.
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Affiliation(s)
- K Shah
- Indian Institute of Public Health, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Chiloda Road, Gandhinagar 382042, India
| | - V P Varna
- Indian Institute of Public Health, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Chiloda Road, Gandhinagar 382042, India
| | - A Pandya
- Indian Institute of Public Health, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Chiloda Road, Gandhinagar 382042, India
| | - D Saxena
- Indian Institute of Public Health, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Chiloda Road, Gandhinagar 382042, India
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25
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Farid N, Rola N, Koch EAT, Nakhoul N. Active vitamin D supplementation and COVID-19 infections: review. Ir J Med Sci 2021; 190:1271-1274. [PMID: 33409846 PMCID: PMC7787599 DOI: 10.1007/s11845-020-02452-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
SARS-CoV-2, causing the lethal disease COVid-19, is a public health emergency in the 2020 global pandemic. The outbreak and fast spreading of SARS-CoV-2 have a high morbidity and mortality specifically in elder patients with chronic diseases such as diabetes mellitus, arterial hypertension, chronic kidney disease, and organ transplanted patients with immunosuppressive therapy. Preliminary results support different treatments such as chloroquine and convalescent plasma infusion in severe cases, with good outcome. On the other hand, the efficacy of supplementation with active vitamin D, an immunomodulator hormone with antiinflammatory and antimicrobial effects, is unproven. A recent study reported that vitamin D attains antiviral effects, via blocking viral replication directly. SARS-CoV-2 primarily uses the immune evasion process during infection via the envelope spike glycoprotein, which is followed by a cytokine storm, causing severe acute respiratory disease syndrome and death. SARS-CoV-2, by using the well-known angiotensin-converting enzyme 2 by the protein spike, as the host receptor to enter into alveolar, myocardial, and renal epithelial cells, can be disrupted by vitamin D. However, the correlation between vitamin D levels and COVID-19 deaths in previous studies was insignificant. Retrospective studies demonstrated a correlation between vitamin D status and COVID-19 severity and mortality, while other studies did not find this correlation. Studies have shown that, vitamin D reduces the risk of acute viral respiratory tract infections and pneumonia via direct inhibition of viral replication, antiinflammatory and immunomodulatory effects. The data available today regarding the beneficial protective effect of vitamin D is unclear and with conflicting results. Large randomized control trials are necessary to test this hypothesis. In this review, we will explain the cross talk between the active vitamin D and the angiotensin-converting enzyme 2, and summarize the data from the literature.
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Affiliation(s)
- Nakhoul Farid
- Nephrology and Hypertension Division, Baruch Padeh Poriya medical Center, Erlangen, Germany.
- Diabetes and Metabolism Lab, Baruch Padeh Poriya Medical Center, Erlangen, Germany.
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat-Gan, Israel.
| | - Nakhoul Rola
- Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Elias A T Koch
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Nakhoul Nakhoul
- Ophtalmology Division, Baruch Padeh Poriya Medical Center, Ramat-Gan, Israel
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26
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Borsche L, Glauner B, von Mendel J. COVID-19 Mortality Risk Correlates Inversely with Vitamin D3 Status, and a Mortality Rate Close to Zero Could Theoretically Be Achieved at 50 ng/mL 25(OH)D3: Results of a Systematic Review and Meta-Analysis. Nutrients 2021; 13:3596. [PMID: 34684596 PMCID: PMC8541492 DOI: 10.3390/nu13103596] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Much research shows that blood calcidiol (25(OH)D3) levels correlate strongly with SARS-CoV-2 infection severity. There is open discussion regarding whether low D3 is caused by the infection or if deficiency negatively affects immune defense. The aim of this study was to collect further evidence on this topic. METHODS Systematic literature search was performed to identify retrospective cohort as well as clinical studies on COVID-19 mortality rates versus D3 blood levels. Mortality rates from clinical studies were corrected for age, sex, and diabetes. Data were analyzed using correlation and linear regression. RESULTS One population study and seven clinical studies were identified, which reported D3 blood levels preinfection or on the day of hospital admission. The two independent datasets showed a negative Pearson correlation of D3 levels and mortality risk (r(17) = -0.4154, p = 0.0770/r(13) = -0.4886, p = 0.0646). For the combined data, median (IQR) D3 levels were 23.2 ng/mL (17.4-26.8), and a significant Pearson correlation was observed (r(32) = -0.3989, p = 0.0194). Regression suggested a theoretical point of zero mortality at approximately 50 ng/mL D3. CONCLUSIONS The datasets provide strong evidence that low D3 is a predictor rather than just a side effect of the infection. Despite ongoing vaccinations, we recommend raising serum 25(OH)D levels to above 50 ng/mL to prevent or mitigate new outbreaks due to escape mutations or decreasing antibody activity.
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Affiliation(s)
| | | | - Julian von Mendel
- Artificial Intelligence, IU International University of Applied Sciences, D-99084 Erfurt, Germany;
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27
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Abdollahzadeh R, Shushizadeh MH, Barazandehrokh M, Choopani S, Azarnezhad A, Paknahad S, Pirhoushiaran M, Makani SZ, Yeganeh RZ, Al-Kateb A, Heidarzadehpilehrood R. Association of Vitamin D receptor gene polymorphisms and clinical/severe outcomes of COVID-19 patients. INFECTION GENETICS AND EVOLUTION 2021; 96:105098. [PMID: 34610433 PMCID: PMC8487094 DOI: 10.1016/j.meegid.2021.105098] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Introduction Growing evidence documented the critical impacts of vitamin D (VD) in the prognosis of COVID-19 patients. The functions of VD are dependent on the vitamin D receptor (VDR) in the VD/VDR signaling pathway. Therefore, we aimed to assess the association of VDR gene polymorphisms with COVID-19 outcomes. Methods In the present study, eight VDR single nucleotide polymorphisms (SNPs) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 500 COVID-19 patients in Iran, including 160 asymptomatic, 250 mild/moderate, and 90 severe/critical cases. The association of these polymorphisms with severity, clinical outcomes, and comorbidities were evaluated through the calculation of the Odds ratio (OR). Results Interestingly, significant associations were disclosed for some of the SNP-related alleles and/or genotypes in one or more genetic models with different clinical data in COVID-19 patients. Significant association of VDR-SNPs with signs, symptoms, and comorbidities was as follows: ApaI with shortness of breath (P ˂ 0.001) and asthma (P = 0.034) in severe/critical patients (group III); BsmI with chronic renal disease (P = 0.010) in mild/moderate patients (group II); Tru9I with vomiting (P = 0.031), shortness of breath (P = 0.04), and hypertension (P = 0.030); FokI with fever and hypertension (P = 0.027) in severe/critical patients (group III); CDX2 with shortness of breath (P = 0.022), hypertension (P = 0.036), and diabetes (P = 0.042) in severe/critical patients (group III); EcoRV with diabetes (P ˂ 0.001 and P = 0.045 in mild/moderate patients (group II) and severe/critical patients (group III), respectively). However, the association of VDR TaqI and BglI polymorphisms with clinical symptoms and comorbidities in COVID-19 patients was not significant. Conclusion VDR gene polymorphisms might play critical roles in the vulnerability to infection and severity of COVID-19, probably by altering the risk of comorbidities. However, these results require further validation in larger studies with different ethnicities and geographical regions.
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Affiliation(s)
- Rasoul Abdollahzadeh
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mina Barazandehrokh
- Faculty of Advanced Sciences and Technology, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran
| | | | - Asaad Azarnezhad
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Sahereh Paknahad
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Pirhoushiaran
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Zahra Makani
- Babol Razi Pathology and Genetic Laboratory, Babol, Iran
| | - Razieh Zarifian Yeganeh
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Al-Kateb
- Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roozbeh Heidarzadehpilehrood
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
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The Vitamin D, IL-6 and the eGFR Markers a Possible Way to Elucidate the Lung-Heart-Kidney Cross-Talk in COVID-19 Disease: A Foregone Conclusion. Microorganisms 2021; 9:microorganisms9091903. [PMID: 34576798 PMCID: PMC8464828 DOI: 10.3390/microorganisms9091903] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Based on recent findings, we speculated the existence of the lung, heart, and kidney axis as the main pathway for the COVID-19 disease progression. Methods: This paper reports on an observational study conducted by a team of researchers and doctors of the 118-Pre-Hospital and Emergency Department of SG Moscati of Taranto City in Italy. The study was conducted on a totality of 185 participants that were divided into three groups. The study group included COVID-19 affected patients (PP n = 80), the first control group included patients with different pathologies (non-COVID-19 NNp n = 62) of the SG Moscati Hospital, and the second control group included healthy individuals (NNh n = 43). The core of the current trial was focused on assessing the level of the vitamin D (serum 25(OH) D concentration), IL-6, and the renal glomerular filtrate (eGFR) in COVID-19 disease and non-COVID-19 patients in both groups. Results: It was observed that the majority of COVID-19-infected patients showed a progressive multi-organ involvement, especially in regard to the lung, kidney, and heart. The majority of the COVID-19 patients exhibited preexisting comorbidities which include cardiovascular, respiratory, and renal disorders accompanied by a severely low level of vitamin D, extremely high level of IL-6, and low glomerular filtration rate (eGFR). The significant overall damages exerted by the immune-mediated responses under the hyper-expression of proinflammatory cytokines and interleukins, such as IL-6, may be facilitated by either a decreased level of vitamin D or the ageing process. The reduced presence of vitamin D was often found together with a reduced functionality of renal activity, as revealed by the low eGFR, and both were seen to be concomitant with an increased mortality risk in patients with lung disorders and heart failure (HF), whether it is showed at baseline or it develops during manifestation of COVID-19. Therefore, the documentation of the modifiable risk factors related to SARS-CoV-2 and lung impairment in older patients with kidney and heart disease may help the clinician to better manage the situation. Conclusions: This paper addresses how a low level of vitamin D and older age may be indicative of systemic worsening in patients with COVID-19, with a goal of providing a broader context in which to view a better therapeutic approach.
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Narożna M, Rubiś B. Anti-SARS-CoV-2 Strategies and the Potential Role of miRNA in the Assessment of COVID-19 Morbidity, Recurrence, and Therapy. Int J Mol Sci 2021; 22:8663. [PMID: 34445368 PMCID: PMC8395427 DOI: 10.3390/ijms22168663] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
Recently, we have experienced a serious pandemic. Despite significant technological advances in molecular technologies, it is very challenging to slow down the infection spread. It appeared that due to globalization, SARS-CoV-2 spread easily and adapted to new environments or geographical or weather zones. Additionally, new variants are emerging that show different infection potential and clinical outcomes. On the other hand, we have some experience with other pandemics and some solutions in virus elimination that could be adapted. This is of high importance since, as the latest reports demonstrate, vaccine technology might not follow the new, mutated virus outbreaks. Thus, identification of novel strategies and markers or diagnostic methods is highly necessary. For this reason, we present some of the latest views on SARS-CoV-2/COVID-19 therapeutic strategies and raise a solution based on miRNA. We believe that in the face of the rapidly increasing global situation and based on analogical studies of other viruses, the possibility of using the biological potential of miRNA technology is very promising. It could be used as a promising diagnostic and prognostic factor, as well as a therapeutic target and tool.
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Affiliation(s)
- Maria Narożna
- Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, 4 Święcickiego St., 60-781 Poznan, Poland;
| | - Błażej Rubiś
- Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland
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30
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Menshawey E, Menshawey R, Nabeh OA. Shedding light on vitamin D: the shared mechanistic and pathophysiological role between hypovitaminosis D and COVID-19 risk factors and complications. Inflammopharmacology 2021; 29:1017-1031. [PMID: 34185200 PMCID: PMC8239482 DOI: 10.1007/s10787-021-00835-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus (SARS-COV-2) is the culprit of the Coronavirus Disease (COVID-19), which has infected approximately 173 million people and killed more than 3.73 million. At risk groups including diabetic and obese patients are more vulnerable to COVID-19-related complications and poor outcomes. Substantial evidence points to hypovitaminosis D as a risk factor for severe disease, the need for ICU, and mortality. 1,25(OH)D, a key regulator of calcium homeostasis, is believed to have various immune-regulatory roles including; promoting anti-inflammatory cytokines, down regulating pro-inflammatory cytokines, dampening entry and replication of SARS-COV-2, and the production of antimicrobial peptides. In addition, there are strong connections which suggest that dysregulated 1,25(OH)D levels play a mechanistic and pathophysiologic role in several disease processes that are shared with COVID-19 including: diabetes, obesity, acute respiratory distress syndrome (ARDS), cytokine storm, and even hypercoagulable states. With evidence continuing to grow for the case that low vitamin D status is a risk factor for COVID-19 disease and poor outcomes, there is a need now to address the public health efforts set in place to minimize infection, such as lock down orders, which may have inadvertently increased hypovitaminosis D in the general population and those already at risk (elderly, obese, and disabled). Moreover, there is a need to address the implications of this evidence and how we may apply the use of cheaply available supplementation, which has yet to overcome the near global concern of hypovitaminosis D. In our review, we exhaustively scope these shared pathophysiologic connections between COVID-19 and hypovitaminosis D.
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Affiliation(s)
- Esraa Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Rahma Menshawey
- Faculty of Medicine, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
| | - Omnia Azmy Nabeh
- Faculty of Medicine, Department of Medical Pharmacology, Cairo University, Kasr al Ainy, Geziret Elroda, Manial, Cairo, 11562 Egypt
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31
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Taha R, Abureesh S, Alghamdi S, Hassan RY, Cheikh MM, Bagabir RA, Almoallim H, Abdulkhaliq A. The Relationship Between Vitamin D and Infections Including COVID-19: Any Hopes? Int J Gen Med 2021; 14:3849-3870. [PMID: 34335050 PMCID: PMC8318784 DOI: 10.2147/ijgm.s317421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
Abstract
Vitamin D is proposed to have a potential role in the pathogenicity, clinical presentation, prognosis, complications, and treatment of several diseases. In addition to its well-known role in calcium metabolism, vitamin D regulates both innate and adaptive immunity, and subsequently modulates the antiviral and antibacterial inflammatory immune responses. In view of the emerging coronavirus disease 2019 (COVID-19) pandemic, searching for potential therapeutic and protective strategies is of urgent interest, and vitamin D is one of the promising agents in this field. In this review, we present data from literature that supports the promising role of vitamin D in treatment and/or prevention of several infections including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes vitamin D metabolism and its role in inflammation, thrombosis and immune regulation. It also reviews, in short, the role of vitamin D and the impact of its deficiency in several infections namely tuberculosis, influenza, human immunodeficiency virus (HIV), and SARS-CoV-2. Considering the roles of vitamin D on immune modulation, controlling of thrombosis, and attacking several microorganisms, the current review will elaborate on the association between these salient roles of vitamin D and the pathogenicity of various infectious agents including COVID-19. Consequently, the comprehensive finding of the current review shows a possible significant impact of vitamin D supplement as a hope in preventing, treating, and/or improving the progression of certain infections, specifically during the worldwide attempts to fight against the COVID-19 pandemic and minimize the severity of health complications encountered accordingly. In addition, avoiding a status of vitamin D deficiency to obtain its positive effects on the immune system and its protective mechanism during infections will be a general benefit overall.
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Affiliation(s)
- Rbab Taha
- Department of Transplant Infectious Disease, University Health Network, Toronto, Ontario, Canada
| | - Shahd Abureesh
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Shuruq Alghamdi
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rola Y Hassan
- Department of Internal Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohamed M Cheikh
- Department of Internal Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
- Department of Medicine, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Rania A Bagabir
- Department of Immunology and Hematology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Alzaidi Chair of Research in Rheumatic Diseases, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Altaf Abdulkhaliq
- Department of Clinical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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32
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Bastolla U. Mathematical Model of SARS-Cov-2 Propagation Versus ACE2 Fits COVID-19 Lethality Across Age and Sex and Predicts That of SARS. Front Mol Biosci 2021; 8:706122. [PMID: 34322518 PMCID: PMC8311794 DOI: 10.3389/fmolb.2021.706122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
The fatality rate of Covid-19 escalates with age and is larger in men than women. I show that these variations correlate strongly with the level of the viral receptor protein ACE2 in rat lungs, which is consistent with the still limited data on human ACE2. Surprisingly, lower receptor levels correlate with higher fatality. I propose two possible explanations of this negative correlation: First, a previous mathematical model predicts that the velocity of viral progression in the organism as a function of the receptor level has a maximum and declines for abundant receptor. Secondly, degradation of ACE2 by the virus may cause the runaway inflammatory response that characterizes severe CoViD-19. I present here a mathematical model that predicts the lethality as a function of ACE2 protein level based on the two above hypothesis. The model fits Covid-19 fatality rate across age and sex in three countries with high accuracy (r 2 > 0.9 ) under the hypothesis that the speed of viral progression in the infected organism is a decreasing function of the ACE2 level. Moreover, rescaling the fitted parameters by the ratio of the binding rates of the spike proteins of SARS-CoV and SARS-CoV-2 allows predicting the fatality rate of SARS-CoV across age and sex, thus linking the molecular and epidemiological levels.
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Affiliation(s)
- Ugo Bastolla
- Centro de Biologia Molecular “Severo Ochoa”, CSIC-UAM Cantoblanco, Madrid, Spain
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Antonelli M, Kushner I. Low Serum Levels of 25-Hydroxyvitamin D Accompany Severe COVID-19 Because it is a Negative Acute Phase Reactant. Am J Med Sci 2021; 362:333-335. [PMID: 34166653 PMCID: PMC8216860 DOI: 10.1016/j.amjms.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Maria Antonelli
- Division of Rheumatology, Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA.
| | - Irving Kushner
- Division of Rheumatology, Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
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Lee J, Kwan Y, Lee JY, Shin JI, Lee KH, Hong SH, Han YJ, Kronbichler A, Smith L, Koyanagi A, Jacob L, Choi S, Ghayda RA, Park MB. Public Interest in Immunity and the Justification for Intervention in the Early Stages of the COVID-19 Pandemic: Analysis of Google Trends Data. J Med Internet Res 2021; 23:e26368. [PMID: 34038375 PMCID: PMC8216330 DOI: 10.2196/26368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/04/2021] [Accepted: 04/15/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The use of social big data is an important emerging concern in public health. Internet search volumes are useful data that can sensitively detect trends of the public's attention during a pandemic outbreak situation. OBJECTIVE Our study aimed to analyze the public's interest in COVID-19 proliferation, identify the correlation between the proliferation of COVID-19 and interest in immunity and products that have been reported to confer an enhancement of immunity, and suggest measures for interventions that should be implemented from a health and medical point of view. METHODS To assess the level of public interest in infectious diseases during the initial days of the COVID-19 outbreak, we extracted Google search data from January 20, 2020, onward and compared them to data from March 15, 2020, which was approximately 2 months after the COVID-19 outbreak began. In order to determine whether the public became interested in the immune system, we selected coronavirus, immune, and vitamin as our final search terms. RESULTS The increase in the cumulative number of confirmed COVID-19 cases that occurred after January 20, 2020, had a strong positive correlation with the search volumes for the terms coronavirus (R=0.786; P<.001), immune (R=0.745; P<.001), and vitamin (R=0.778; P<.001), and the correlations between variables were all mutually statistically significant. Moreover, these correlations were confirmed on a country basis when we restricted our analyses to the United States, the United Kingdom, Italy, and Korea. Our findings revealed that increases in search volumes for the terms coronavirus and immune preceded the actual occurrences of confirmed cases. CONCLUSIONS Our study shows that during the initial phase of the COVID-19 crisis, the public's desire and actions of strengthening their own immune systems were enhanced. Further, in the early stage of a pandemic, social media platforms have a high potential for informing the public about potentially helpful measures to prevent the spread of an infectious disease and provide relevant information about immunity, thereby increasing the public's knowledge.
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Affiliation(s)
- Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yunna Kwan
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.,Department of Psychology, Duksung Women's University, Seoul, Republic of Korea
| | - Jun Young Lee
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hwi Hong
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Han
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/Centro de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/Centro de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Paris, France
| | - SungWon Choi
- Department of Psychology, Duksung Women's University, Seoul, Republic of Korea
| | - Ramy Abou Ghayda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, United States
| | - Myung-Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Daejeon, Republic of Korea
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Abstract
The recent outbreak of COVID-19 has affected human lives severely. The human-to-human transmission of this viral disease has become deadly due to the unavailability of COVID-19 specific drugs. Here, an overview of various attempts made to design different therapeutic agents against various structural and non-structural proteins of SARS-CoV-2 has been summarized. Emphasis has been made to highlight the mechanisms of drug action and ways to design better inhibitors of these proteins. The roles of anti-oxidants and vitamins in suppressing COVID-19 are also discussed.
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Inchingolo AD, Dipalma G, Inchingolo AM, Malcangi G, Santacroce L, D’Oria MT, Isacco CG, Bordea IR, Candrea S, Scarano A, Morandi B, Del Fabbro M, Farronato M, Tartaglia GM, Balzanelli MG, Ballini A, Nucci L, Lorusso F, Taschieri S, Inchingolo F. The 15-Months Clinical Experience of SARS-CoV-2: A Literature Review of Therapies and Adjuvants. Antioxidants (Basel) 2021; 10:881. [PMID: 34072708 PMCID: PMC8226610 DOI: 10.3390/antiox10060881] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for the coronavirus disease of 2019 (COVID-19) that emerged in December 2019 in Wuhan, China, and rapidly spread worldwide, with a daily increase in confirmed cases and infection-related deaths. The World Health Organization declared a pandemic on the 11th of March 2020. COVID-19 presents flu-like symptoms that become severe in high-risk medically compromised subjects. The aim of this study was to perform an updated overview of the treatments and adjuvant protocols for COVID-19. METHODS A systematic literature search of databases was performed (MEDLINE PubMed, Google Scholar, UpToDate, Embase, and Web of Science) using the keywords: "COVID-19", "2019-nCoV", "coronavirus" and "SARS-CoV-2" (date range: 1 January 2019 to 31st October 2020), focused on clinical features and treatments. RESULTS The main treatments retrieved were antivirals, antimalarials, convalescent plasma, immunomodulators, corticosteroids, anticoagulants, and mesenchymal stem cells. Most of the described treatments may provide benefits to COVID-19 subjects, but no one protocol has definitively proven its efficacy. CONCLUSIONS While many efforts are being spent worldwide in research aimed at identifying early diagnostic methods and evidence-based effective treatments, mass vaccination is thought to be the best option against this disease in the near future.
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Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
| | - Luigi Santacroce
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
| | - Maria Teresa D’Oria
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
- Department of Medical and Biological Sciences, University of Udine, Via delle Scienze, 206, 33100 Udine, Italy
| | - Ciro Gargiulo Isacco
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
- Research at Human Stem Cells Research Center HSC, Ho Chi Minh 70000, Vietnam
- Embryology and Regenerative Medicine and Immunology, Pham Chau Trinh University of Medicine Hoi An, Hoi An 70000, Vietnam
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania;
| | - Sebastian Candrea
- Department of Oral Rehabilitation, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania;
- Department of Pedodontics, County Hospital Cluj-Napoca, 400000 Cluj-Napoca, Romania
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Benedetta Morandi
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (B.M.); (M.D.F.); (M.F.); (G.M.T.); (S.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (B.M.); (M.D.F.); (M.F.); (G.M.T.); (S.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Marco Farronato
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (B.M.); (M.D.F.); (M.F.); (G.M.T.); (S.T.)
- UOC Maxillo-Facial Surgery and Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (B.M.); (M.D.F.); (M.F.); (G.M.T.); (S.T.)
- UOC Maxillo-Facial Surgery and Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Giosuè Balzanelli
- SET-118, Department of Pre-Hospital and Emergency-San Giuseppe Moscati Hospital, 74100 Taranto, Italy;
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario, University of Bari, 70125 Bari, Italy;
- Department of Precision Medicine, University of Campania, 80138 Naples, Italy
| | - Ludovica Nucci
- Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80100 Naples, Italy;
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (B.M.); (M.D.F.); (M.F.); (G.M.T.); (S.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Oral Surgery, Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (A.D.I.); (G.D.); (A.M.I.); (L.S.); (M.T.D.); (C.G.I.); (F.I.)
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Samad N, Dutta S, Sodunke TE, Fairuz A, Sapkota A, Miftah ZF, Jahan I, Sharma P, Abubakar AR, Rowaiye AB, Oli AN, Charan J, Islam S, Haque M. Fat-Soluble Vitamins and the Current Global Pandemic of COVID-19: Evidence-Based Efficacy from Literature Review. J Inflamm Res 2021; 14:2091-2110. [PMID: 34045883 PMCID: PMC8149275 DOI: 10.2147/jir.s307333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
The outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later named COVID-19 by the World Health Organization (WHO), was initiated at Wuhan, Hubei, China, and there was a rapid spread of novel SARS-CoV-2 and the disease COVID-19 in late 2019. The entire world is now experiencing the challenge of COVID-19 infection. However, still very few evidence-based treatment options are available for the prevention and treatment of COVID-19 disease. The present review aims to summarize the publicly available information to give a comprehensive yet balanced scientific overview of all the fat-soluble vitamins concerning their role in SARS-CoV-2 virus infection. The roles of different fat-soluble vitamins and micronutrients in combating SARS-CoV-2 infection have been recently explored in several studies. There are various hypotheses to suggest their use to minimize the severity of COVID-19 infection. These vitamins are pivotal in the maintenance and modulation of innate and cell-mediated, and antibody-mediated immune responses. The data reported in recent literature demonstrate that deficiency in one or more of these vitamins compromises the patients' immune response and makes them more vulnerable to viral infections and perhaps worse disease prognosis. Vitamins A, D, E, and K boost the body's defense mechanism against COVID-19 infection and specifically prevent its complications such as cytokine storm and other inflammatory processes, leading to increased morbidity and mortality overemphasis. However, more detailed randomized double-blind clinical pieces of evidence are required to define the use of these supplements in preventing or reducing the severity of the COVID-19 infection.
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Affiliation(s)
- Nandeeta Samad
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Adiba Fairuz
- Department of Pharmacy, University of Dhaka, Dhaka, Bangladesh
| | - Ashmita Sapkota
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | | | - Iffat Jahan
- Department of Physiology, Eastern Medical College, Cumilla, Bangladesh
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Abdullahi Rabiu Abubakar
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Adekunle Babajide Rowaiye
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Angus Nnamdi Oli
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
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AlSafar H, Grant WB, Hijazi R, Uddin M, Alkaabi N, Tay G, Mahboub B, Al Anouti F. COVID-19 Disease Severity and Death in Relation to Vitamin D Status among SARS-CoV-2-Positive UAE Residents. Nutrients 2021; 13:1714. [PMID: 34069412 PMCID: PMC8159141 DOI: 10.3390/nu13051714] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
Insufficient blood levels of the neurohormone vitamin D are associated with increased risk of COVID-19 severity and mortality. Despite the global rollout of vaccinations and promising preliminary results, the focus remains on additional preventive measures to manage COVID-19. Results conflict on vitamin D's plausible role in preventing and treating COVID-19. We examined the relation between vitamin D status and COVID-19 severity and mortality among the multiethnic population of the United Arab Emirates. Our observational study used data for 522 participants who tested positive for SARS-CoV-2 at one of the main hospitals in Abu Dhabi and Dubai. Only 464 of those patients were included for data analysis. Demographic and clinical data were retrospectively analyzed. Serum samples immediately drawn at the first hospital visit were used to measure serum 25-hydroxyvitamin D [25(OH)D] concentrations through automated electrochemiluminescence. Levels < 12 ng/mL were significantly associated with higher risk of severe COVID-19 infection and of death. Age was the only other independent risk factor, whereas comorbidities and smoking did not contribute to the outcomes upon adjustment. Sex of patients was not an important predictor for severity or death. Our study is the first conducted in the UAE to measure 25(OH)D levels in SARS-CoV-2-positive patients and confirm the association of levels < 12 ng/mL with COVID-19 severity and mortality.
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Affiliation(s)
- Habiba AlSafar
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates; (H.A.); (G.T.)
- Department of Biomedical Engineering, College of Engineering, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Department of Genetics and Molecular Biology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
| | - William B. Grant
- Sunlight, Nutrition and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA;
| | - Rafiq Hijazi
- Department of Mathematics and Statistics, College of Natural and Health Sciences, Zayed University, Abu Dhabi 144534, United Arab Emirates;
| | - Maimunah Uddin
- Department of Pediatric Infectious Disease, Sheikh Khalifa Medical City, Abu Dhabi 51900, United Arab Emirates; (M.U.); (N.A.)
| | - Nawal Alkaabi
- Department of Pediatric Infectious Disease, Sheikh Khalifa Medical City, Abu Dhabi 51900, United Arab Emirates; (M.U.); (N.A.)
| | - Guan Tay
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates; (H.A.); (G.T.)
- Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Bassam Mahboub
- Dubai Health Authority, Rashid Hospital, Dubai, United Arab Emirates;
| | - Fatme Al Anouti
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi 144534, United Arab Emirates
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Bui L, Zhu Z, Hawkins S, Cortez-Resendiz A, Bellon A. Vitamin D regulation of the immune system and its implications for COVID-19: A mini review. SAGE Open Med 2021; 9:20503121211014073. [PMID: 34046177 PMCID: PMC8135207 DOI: 10.1177/20503121211014073] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022] Open
Abstract
The novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is at the origin of the current pandemic, predominantly manifests with severe respiratory symptoms and a heightened immune response. One characteristic of SARS-CoV-2 is its capacity to induce cytokine storm leading to acute respiratory distress syndrome. Consequently, agents with the ability to regulate the immune response, such as vitamin D, could become tools either for the prevention or the attenuation of the most severe consequences of the coronavirus disease 2019 (COVID-19). Vitamin D has shown antimicrobial as well as anti-inflammatory properties. While SARS-CoV-2 promotes the release of proinflammatory cytokines, vitamin D attenuates the release of at least some of these same molecules. Inflammatory cytokines have been associated with the clinical phenomena of COVID-19 and in particular with its most dangerous complications. Therefore, the goals of this article are as follows: first, present the numerous roles vitamin D plays in modulating the immune response; second, gather data currently available on COVID-19 clinical presentation and its relation to cytokines and similar molecules; third, expose what it is known about how coronaviruses elicit an inflammatory reaction; and fourth, discuss the potential contribution of vitamin D in reducing the risk and severity of COVID-19.
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Affiliation(s)
- Linda Bui
- Penn State College of Medicine, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Zahra Zhu
- Penn State College of Medicine, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Stephanie Hawkins
- Penn State College of Medicine, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alonso Cortez-Resendiz
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Alfredo Bellon
- Penn State College of Medicine, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
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40
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Davoudi A, Najafi N, Aarabi M, Tayebi A, Nikaeen R, Izadyar H, Salar Z, Delavarian L, Vaseghi N, Daftarian Z, Ahangarkani F. Lack of association between vitamin D insufficiency and clinical outcomes of patients with COVID-19 infection. BMC Infect Dis 2021; 21:450. [PMID: 34006228 PMCID: PMC8130780 DOI: 10.1186/s12879-021-06168-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background A protective effect of vitamin D against COVID-19 infection is under investigation. We aimed to analyze the effect of vitamin D sufficiency on the clinical outcomes of patients infected with COVID-19. Methods In this cross-sectional study we analyzed the vitamin D levels of COVID-19 patients who were admitted to Razi Hospital (an infectious disease referral center in Mazandaran province in northern Iran) from February to March 2020. Overall, a cutoff point of 30 ng/mL was used for the definition of vitamin D sufficiency. Results One hundred fifty-three patients were analyzed in this study who had laboratory documentation of a 25(OH) D level at the time of hospitalization. The vitamin D levels of the patients were 27.19 ± 20.17 ng/mL. In total, 62.7% (n = 96) of the patients had a 25(OH) D level of less than 30 ng/mL and 37.25% (n = 57) had a 25(OH) D level of more than 30 ng/mL. In total, 49% (n = 75) of the patients suffered from at least one underlying disease. The univariate and multivariable regression showed that vitamin D sufficiency was not associated with a statistically significant lower risk of adverse clinical outcomes of COVID-19 such as duration of hospitalization and severity of infection (P > 0.05). Conclusions Sufficient vitamin D levels were not found to be protective against adverse clinical outcomes in patients infected with COVID-19. Chronic disorders in COVID-19 patients were found to have greater relevance than vitamin D levels in determining the adverse outcomes of the infection. Further studies are needed to determine the role of vitamin D level in predicting the outcomes of COVID-19 infection.
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Affiliation(s)
- Alireza Davoudi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narges Najafi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohsen Aarabi
- Department of Family Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Atefeh Tayebi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roja Nikaeen
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamideh Izadyar
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Salar
- Mazandaran University of Medical Science, Ramsar International Branch, Ramsar, Iran
| | - Leila Delavarian
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narges Vaseghi
- Department of Pathobiology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Zahra Daftarian
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Ahangarkani
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Nasiri M, Khodadadi J, Molaei S. Does vitamin D serum level affect prognosis of COVID-19 patients? Int J Infect Dis 2021; 107:264-267. [PMID: 33940189 PMCID: PMC8086264 DOI: 10.1016/j.ijid.2021.04.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background Since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic there have been contradictions and speculations about the relationship between vitamin D and COVID-19. Given that there is an association between vitamin D deficiency and some diseases – including cancer, autoimmune disease and some infectious diseases – a higher incidence and mortality rate in the vitamin-D-deficient COVID-19 population was not a surprise; conversely, some research would argue this relationship. Considering these contradictions, this study aimed to determine the relationship between prognosis and vitamin D level in cases with COVID-19. Methods In this cross-sectional study, 329 confirmed cases of COVID-19 – who were admitted to Kamkar-ArabNia Hospital in Qom city, Iran from March–July 2020 – were categorized into three groups according to vitamin D serum levels (ng/ml): sufficient (>30), insufficient (20–30) and deficient (<20). Prognosis was determined across the groups. Results There was a significant difference in hospital stay between patients with sufficient and insufficient vitamin D levels (P = 0.007). Adjusting vitamin D levels for confounding variables, linear regression underscored significant differences in the association between length of hospitalization and lower vitamin D levels, with a longer stay noted in insufficient groups (P = 0.002). However, there was no significant difference in the time interval to return to normal oxygen level (from SpO2 < 93%) or death rate between groups (P > 0.05). Conclusion There was a significant association between hospital stay and lower serum vitamin D levels. However, the relationship between vitamin D status and death rate or the time interval to return to normal oxygen levels was not significant.
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Affiliation(s)
- Maryam Nasiri
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran.
| | - Javad Khodadadi
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Sedigheh Molaei
- Student Research Committee, School of Medicine, Qom University of Medical Sciences, Qom, Iran
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Abstract
The COVID-19, an acute respiratory syndrome caused by SARS-CoV2 is a major catastrophic event of the twenty first century. Relentless efforts for the development of effective pharmaco-therapeutics are in progress but the respite is the development of effective vaccines. However, monotherapy might not always exhibit complete efficacy and may culminate in the rapid evolution of drug-resistant viral strains. Hence, simultaneous modulation of multiple druggable targets not only enhances therapeutic efficacy but also quell the prospects of mutant viruses. Currently, milk peptides have bloomed beyond just being a quintessential part of nutrition to prominent therapeutic implications in human health and diseases. Hence, we have focused on colostrum/milk peptides as they have already been acknowledged for their high potency, target specificity with significantly low or no side effects and bio-toleration. The results presented provide a conceptual strategy for the rational designing of prospective multitargeted peptide inhibitors for SARS-CoV2.
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Keflie TS, Biesalski HK. Micronutrients and bioactive substances: Their potential roles in combating COVID-19. Nutrition 2021; 84:111103. [PMID: 33450678 PMCID: PMC7717879 DOI: 10.1016/j.nut.2020.111103] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic is seriously threatening public health and setting off huge economic crises across the world. In the absence of specific drugs for COVID-19, there is an urgent need to look for alternative approaches. Therefore, the aim of this paper was to review the roles of micronutrients and bioactive substances as potential alternative approaches in combating COVID-19. METHODS This review was based on the literature identified using electronic searches in different databases. RESULTS Vitamins (A, B, C, D, and E), minerals (selenium and zinc), and bioactive substances from curcumin, echinacea, propolis, garlic, soybean, green tea, and other polyphenols were identified as having potential roles in interfering with spike glycoproteins, angiotensin converting enzyme 2, and transmembrane protease serine 2 at the entry site, and inhibiting activities of papain-like protease, 3 chymotrypsin-like protease, and RNA-dependent RNA polymerase in the replication cycle of severe acute respiratory syndrome coronavirus 2. Having immunomodulating, antiinflammatory, antioxidant, and antiviral properties, such micronutrients and bioactive substances are consequently promising alterative nutritional approaches to combat COVID-19. CONCLUSIONS The roles of micronutrients and bioactive substances in the fight against COVID-19 are exciting areas of research. This review may suggest directions for further study.
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Pea Protein Nanoemulsion Effectively Stabilizes Vitamin D in Food Products: A Potential Supplementation during the COVID-19 Pandemic. NANOMATERIALS 2021; 11:nano11040887. [PMID: 33807206 PMCID: PMC8065392 DOI: 10.3390/nano11040887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
Vitamin D deficiency is a global issue which has been exacerbated by the COVID-19 pandemic-related lockdowns. Fortification of food staples with vitamin D provides a solution to alleviate this problem. This research explored the use of pea protein nanoemulsion (PPN) to improve the stability of vitamin D in various food products. PPN was created using a pH-shifting and ultrasonication combined method. The physicochemical properties were studied, including particle size, foaming ability, water holding capacity, antioxidant activity, and total phenolic contents. The fortification of several food formulations (non-fat cow milk, canned orange juice, orange juice powder, banana milk, and infant formula) with vitamin D–PPN was investigated and compared to raw untreated pea protein (UPP) regarding their color, viscosity, moisture content, chemical composition, vitamin D stability, antioxidant activity, and morphology. Finally, a sensory evaluation (quantitative descriptive analysis, and consumer testing) was conducted. The results show that PPN with a size of 21.8 nm protected the vitamin D in all tested products. PPN may serve as a potential carrier and stabilizer of vitamin D in food products with minimum effects on the taste and color. Hence, PPN may serve as a green and safe method for food fortification during the COVID-19 pandemic.
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Brandão CMÁ, Chiamolera MI, Biscolla RPM, Lima JV, De Francischi Ferrer CM, Prieto WH, de Sá Tavares Russo P, de Sá J, Dos Santos Lazari C, Granato CFH, Vieira JGH. No association between vitamin D status and COVID-19 infection in São Paulo, Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:381-385. [PMID: 33740339 PMCID: PMC10065340 DOI: 10.20945/2359-3997000000343] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In recent years the immunomodulatory actions of vitamin D, a steroid hormone, have been extensively studied. In 2020, due to the COVID-19 pandemic, the question arose as to 25(OH)D status would be related to susceptibility to SARS-CoV-2 infection, since several studies pointed out a higher prevalence and severity of the disease in populations with low levels of 25(OH)D. Thus, we investigated the 25(OH)D levels in adults "Detected" positive for SARS CoV-2 by RT-PCR (reverse transcriptase polymerase chain reaction) test, and in negative controls, "not Detected", using the Fleury Group's examination database, in Sao Paulo, Brazil. Of a total of 14.692 people with recent assessments of 25(OH)D and RT-PCR tests for COVID-19, 2.345 were positive and 11.585 were negative for the infection. The groups did not differ in the percentage of men and women, or in the age distribution. There were no differences in the distribution of 25(OH)D between the two groups (p = 0.08); mean 25(OH)D of 28.8 ± 21.4 ng/mL and 29.6 ± 18.1 ng/mL, respectively. In the specific population studied, clinical, environmental, socioeconomic and cultural factors should have greater relevance than 25(OH)D in determining the susceptibility to COVID-19.
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Chen MR, Kuo HC, Lee YJ, Chi H, Li SC, Lee HC, Yang KD. Phenotype, Susceptibility, Autoimmunity, and Immunotherapy Between Kawasaki Disease and Coronavirus Disease-19 Associated Multisystem Inflammatory Syndrome in Children. Front Immunol 2021; 12:632890. [PMID: 33732254 PMCID: PMC7959769 DOI: 10.3389/fimmu.2021.632890] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) in children is usually mild but some are susceptible to a Kawasaki disease (KD)-like multisystem inflammatory syndrome in children (MIS-C) in the convalescent stage, posing a need to differentiate the phenotype, susceptibility, autoimmunity, and immunotherapy between KD and MIS-C, particularly in the upcoming mass vaccination of COVID-19. Patients with MIS-C are prone to gastrointestinal symptoms, coagulopathy, and shock in addition to atypical KD syndrome with fever, mucocutaneous lesions, lymphadenopathy, and/or cardiovascular events. MIS-C manifests KD-like symptoms that alert physicians to early recognize and adopt the KD treatment regimen for patients with MIS-C. MIS-C linked to COVID-19 teaches us infection-associated autoimmune vasculitis and vice versa. Studies on genetic susceptibility have identified certain human leukocyte antigen (HLA) locus and toll-like receptor (TLR) associated with KD and/or COVID-19. Certain HLA subtypes, such as HLA-DRB1 and HLA-MICA A4 are associated with KD. HLA-B*46:01 is proposed to be the risk allele of severe COVID-19 infection, and blood group O type is a protective factor of COVID-19. The autoimmune vasculitis of KD, KD shock syndrome (KDSS), or MIS-C is mediated by a genetic variant of HLA, FcγR, and/or antibody-dependent enhancement (ADE) resulting in hyperinflammation with T helper 17 (Th17)/Treg imbalance with augmented Th17/Th1 mediators: interleukin-6 (IL-6), IL-10, inducible protein-10 (IP-10), Interferon (IFNγ), and IL-17A, and lower expression of Treg-signaling molecules, FoxP3, and transforming growth factor (TGF-β). There are certain similarities and differences in phenotypes, susceptibility, and pathogenesis of KD, KDSS, and MIS-C, by which a physician can make early protection, prevention, and precision treatment of the diseases. The evolution of immunotherapies for the diseases has shown that intravenous immunoglobulin (IVIG) alone or combined with corticosteroids is the standard treatment for KD, KDSS, and MIS-C. However, a certain portion of patients who revealed a treatment resistance to IVIG or IVIG plus corticosteroids, posing a need to early identify the immunopathogenesis, to protect hosts with genetic susceptibility, and to combat Th17/Treg imbalance by anti-cytokine or pro-Treg for reversal of the hyperinflammation and IVIG resistance. Based on physiological and pathological immunity of the diseases under genetic susceptibility and host milieu conditions, a series of sequential regimens are provided to develop a so-called "Know thyself, enemy (pathogen), and ever-victorious" strategy for the prevention and immunotherapy of KD and/or MIS-C.
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Affiliation(s)
- Ming-Ren Chen
- MacKay Children's Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Hsin Chi
- MacKay Children's Hospital, Taipei, Taiwan
| | - Sung Chou Li
- Genomic and Proteomic Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Kuender D. Yang
- MacKay Children's Hospital, Taipei, Taiwan
- Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
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Lordan R. Notable Developments for Vitamin D Amid the COVID-19 Pandemic, but Caution Warranted Overall: A Narrative Review. Nutrients 2021; 13:740. [PMID: 33652653 PMCID: PMC7996924 DOI: 10.3390/nu13030740] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel contagion that has infected over 113 million people worldwide. It is responsible for the coronavirus disease (COVID-19), which has cost the lives of 2.5 million people. Ergo, the global scientific community has been scrambling to repurpose or develop therapeutics to treat COVID-19. Dietary supplements and nutraceuticals are among those under consideration due to the link between nutritional status and patient outcomes. Overall, poor vitamin D status seems to be associated with an increased risk of COVID-19. Severely ill COVID-19 patients appear to be deficient or have suboptimal levels of serum 25-hydroxyvitamin D, a measure of vitamin D status. Consequently, vitamin D is now the subject of several prophylactic and therapeutic clinical trials. In this review, the general status of nutraceuticals and dietary supplements amid the pandemic is appraised, with a particular focus on vitamin D. Consumers should be aware of misinformation and unsubstantiated promises for products marketed for COVID-19 protection. However, maintaining a healthy diet and lifestyle will likely maintain health including optimum immune function that may affect patient outcomes. Those who are deficient in key nutrients such as vitamin D should consider lifestyle changes and potentially supplementation in consultation with their physician and/or registered dieticians.
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Affiliation(s)
- Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-5158, USA
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Gröber U, Holick MF. The coronavirus disease (COVID-19) - A supportive approach with selected micronutrients. INT J VITAM NUTR RES 2021; 92:13-34. [PMID: 33487035 DOI: 10.1024/0300-9831/a000693] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Worldwide the pandemic of COVID-19 spreads rapidly and has had an enormous public health impact with substantial morbidity and mortality especially in high-risk groups, such as older people and patients with comorbidities like diabetes, dementia or cancer. In the absence of a vaccine against COVID-19 there is an urgent need to find supportive therapies that can stabilize the immune system and can help to deal with the infection, especially for vulnerable groups such as the elderly. This is especially relevant for our geriatric institutions and nursing homes. A major potential contributing factor for elderly is due to their high incidence of malnutrition: up to 80% among the hospitalized elderly. Malnutrition results when adequate macronutrients and micronutrients are lacking in the diet. Often missing in public health discussions around preventing and treating COVID-19 patients are nutritional strategies to support optimal function of their immune system. This is surprising, given the importance that nutrients play a significant role for immune function. Several micronutrients, such as vitamin D, retinol, vitamin C, selenium and zinc are of special importance supporting both the adaptive and innate immune systems. As suboptimal status or deficiencies in these immune-relevant micronutrients impair immune function and reduces the resistance to infections, micronutrient deficiencies should therefore be corrected as soon as possible, especially in the elderly and other vulnerable groups. According to epidemiological, experimental and observational studies, some case reports and a few intervention studies the supplementation of vitamin D and/or zinc are promising. The multiple anti-inflammatory and immunomodulatory effects of Vitamin D could explain its protective role against immune hyper reaction and cytokine storm in patients with severe COVID-19. A randomized, placebo-controlled intervention study even shows that high dose vitamin D supplementation promotes viral clearance in asymptomatic and mildly symptomatic SARS-CoV-2 positive individuals. Besides, the data of a recent prospective study with COVID-19 patients reveal that a significant number of them were zinc deficient. The zinc deficient patients had more complications and the deficiency was associated with a prolonged hospital stay and increased mortality. Thus, immune-relevant micronutrients may help to increase the physiological resilience against COVID-19.
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Affiliation(s)
- Uwe Gröber
- Academy for Micronutrient medicine (AMM), Essen, Germany
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Giannini S, Passeri G, Tripepi G, Sella S, Fusaro M, Arcidiacono G, Torres MO, Michielin A, Prandini T, Baffa V, Aghi A, Egan CG, Brigo M, Zaninotto M, Plebani M, Vettor R, Fioretto P, Rossini M, Vignali A, Fabris F, Bertoldo F. Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study. Nutrients 2021; 13:219. [PMID: 33466642 PMCID: PMC7828675 DOI: 10.3390/nu13010219] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67-0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.
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Affiliation(s)
- Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Giovanni Passeri
- Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (A.V.)
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy;
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Maria Fusaro
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
| | - Gaetano Arcidiacono
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Marco Onofrio Torres
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Alberto Michielin
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Tancredi Prandini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Valeria Baffa
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | | | - Martina Brigo
- Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy; (M.B.); (F.B.)
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.Z.); (M.P.)
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.Z.); (M.P.)
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine, University of Padova, 35128 Padova, Italy; (R.V.); (P.F.)
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine, University of Padova, 35128 Padova, Italy; (R.V.); (P.F.)
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Alessandro Vignali
- Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (A.V.)
| | - Fabrizio Fabris
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Francesco Bertoldo
- Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy; (M.B.); (F.B.)
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Bennouar S, Cherif AB, Kessira A, Bennouar DE, Abdi S. Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19. J Am Coll Nutr 2021; 40:104-110. [PMID: 33434117 PMCID: PMC7814570 DOI: 10.1080/07315724.2020.1856013] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality. Materials This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve. Results Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (pLog-Rank = 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR = 6.9, 95% CI [2.0–24.1], p = 0.002 and HR = 6.2, 95% CI [2.1–18.3], p = 0.001) respectively. Conclusion This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.
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Affiliation(s)
- Salam Bennouar
- Central Laboratory of Clinical Biology, University Hospital Center of Blida, Blida, Algeria
| | - Abdelghani Bachir Cherif
- Department of Internal Medicine and Cardiology, University Hospital Center of Blida, Blida, Algeria
| | - Amel Kessira
- Department of Hemobiology and Blood Transfusion, University Hospital Center of Annaba, Annaba, Algeria
| | - Djamel-Eddine Bennouar
- Department of Hemobiology and Blood Transfusion, University Hospital Center of Annaba, Annaba, Algeria
| | - Samia Abdi
- Central Laboratory of Clinical Biology, University Hospital Center of Blida, Blida, Algeria
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