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Mahmoud IS, Jarrar YB, Febrimarsa. Modulation of IRAK enzymes as a therapeutic strategy against SARS-CoV-2 induced cytokine storm. Clin Exp Med 2023; 23:2909-2923. [PMID: 37061574 PMCID: PMC10105542 DOI: 10.1007/s10238-023-01064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the current pandemic coronavirus disease 2019 (COVID-19). Dysregulated and excessive production of cytokines and chemokines, known as cytokine storm, is frequently seen in patients with severe COVID-19 disease and it can provoke a severe systematic inflammation in the patients. The IL-1R/TLRs/IRAKs signaling network is a key pathway in immune cells that plays a central role in regulating innate immunity and inflammatory responses via stimulating the expression and production of various proinflammatory molecules including cytokines. Modulation of IRAKs activity has been proposed to be a promising strategy in the treatment of inflammatory disorders. In this review, we highlight the biochemical properties of IRAKs and their role in regulating inflammatory molecular signaling pathways and discuss the potential targeting of IRAKs to suppress the SARS-CoV-2-induced cytokine storm in COVID-19 patients.
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Affiliation(s)
- Ismail Sami Mahmoud
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133, Jordan.
| | - Yazun Bashir Jarrar
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, As-Salt, Jordan
| | - Febrimarsa
- Centre for Chromosome Biology, School of Biological and Chemical Sciences, University of Galway, Galway, Republic of Ireland
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2
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Xiao W, Liu X, Wang H, Huang Y, Dai Z, Si M, Fu J, Chen X, Jia M, Leng Z, Cui D, Mak WWS, Su X. Prevalence and risk for symptoms of PTSD among survivors of a COVID-19 infection. Psychiatry Res 2023; 326:115304. [PMID: 37352746 PMCID: PMC10275658 DOI: 10.1016/j.psychres.2023.115304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
COVID-19 pandemic has profound psychological effects worldwide and the psychological sequelae will persist for a long time among COVID-19 survivors. This cross-sectional study aimed to explore the prevalence of PTSD and its associated risk factors in COVID-19 survivors of the first wave pandemic. Demographics questionnaire, the Impact of Events Scale-Revised, the Pittsburgh Sleep Quality Index, the Fatigue Scale-14, the Resilience Style Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. The propensity score-matching (PSM) method was employed to adjust covariate or confounding variables in order to derive more accurate conclusions. After PSM, adjusted odds ratios and 95% confidence intervals were determined by binary conditional logistic regression. A total of 1541 COVID-19 survivors were included firstly and 15.2% reported PTSD symptoms, 1108 participants left after PSM. Four risk factors were identified: higher severity of COVID-19 infection, fatigue, COVID-19 related stigma and poor sleep quality. When designing psychological interventions to alleviate PTSD symptoms of COVID-19 survivors, reducing stigma and fatigue, and improve their sleep quality are suggested.
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Affiliation(s)
- Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Xiaoyang Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhiwei Leng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dan Cui
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, The 2nd Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Winnie W S Mak
- Diversity and Well-Being Laboratory, Department of Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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3
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Parlatan U, Ozen MO, Kecoglu I, Koyuncu B, Torun H, Khalafkhany D, Loc I, Ogut MG, Inci F, Akin D, Solaroglu I, Ozoren N, Unlu MB, Demirci U. Label-Free Identification of Exosomes using Raman Spectroscopy and Machine Learning. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2205519. [PMID: 36642804 DOI: 10.1002/smll.202205519] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Exosomes, nano-sized extracellular vesicles (EVs) secreted from cells, carry various cargo molecules reflecting their cells of origin. As EV content, structure, and size are highly heterogeneous, their classification via cargo molecules by determining their origin is challenging. Here, a method is presented combining surface-enhanced Raman spectroscopy (SERS) with machine learning algorithms to employ the classification of EVs derived from five different cell lines to reveal their cellular origins. Using an artificial neural network algorithm, it is shown that the label-free Raman spectroscopy method's prediction ratio correlates with the ratio of HT-1080 exosomes in the mixture. This machine learning-assisted SERS method enables a new direction through label-free investigation of EV preparations by differentiating cancer cell-derived exosomes from those of healthy. This approach will potentially open up new avenues of research for early detection and monitoring of various diseases, including cancer.
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Affiliation(s)
- Ugur Parlatan
- Department of Physics, Bogazici University, Istanbul, 34342, Turkey
- Department of Radiology Stanford School of Medicine, BioAcoustic MEMS in Medicine Lab (BAMM), Canary Center at Stanford for Cancer Early Detection, Palo Alto, CA, 94304, USA
| | - Mehmet Ozgun Ozen
- Department of Radiology Stanford School of Medicine, BioAcoustic MEMS in Medicine Lab (BAMM), Canary Center at Stanford for Cancer Early Detection, Palo Alto, CA, 94304, USA
| | - Ibrahim Kecoglu
- Department of Physics, Bogazici University, Istanbul, 34342, Turkey
| | - Batuhan Koyuncu
- Department of Computer Engineering, Bogazici University, Istanbul, 34342, Turkey
| | - Hulya Torun
- Koc University Graduate School of Sciences and Engineering, Istanbul, 34450, Turkey
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, 34450, Turkey
| | - Davod Khalafkhany
- Department of Molecular Biology and Genetics, Center for Life Sciences and Technologies, Apoptosis and Cancer Immunology Laboratory (AKiL), Bogazici University, Istanbul, 34342, Turkey
| | - Irem Loc
- Department of Physics, Bogazici University, Istanbul, 34342, Turkey
| | - Mehmet Giray Ogut
- Department of Radiology Stanford School of Medicine, BioAcoustic MEMS in Medicine Lab (BAMM), Canary Center at Stanford for Cancer Early Detection, Palo Alto, CA, 94304, USA
| | - Fatih Inci
- UNAM-National Nanotechnology Research Center, Bilkent University, Ankara, 06800, Turkey
- Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, 06800, Turkey
| | - Demir Akin
- Department of Radiology Stanford School of Medicine, BioAcoustic MEMS in Medicine Lab (BAMM), Canary Center at Stanford for Cancer Early Detection, Palo Alto, CA, 94304, USA
| | - Ihsan Solaroglu
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, 34450, Turkey
- School of Medicine, Koc University, Istanbul, 34450, Turkey
| | - Nesrin Ozoren
- Department of Molecular Biology and Genetics, Center for Life Sciences and Technologies, Apoptosis and Cancer Immunology Laboratory (AKiL), Bogazici University, Istanbul, 34342, Turkey
| | - Mehmet Burcin Unlu
- Department of Physics, Bogazici University, Istanbul, 34342, Turkey
- Faculty of Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
- Global Center for Biomedical Science and Engineering Quantum Medical Science and Engineering (GI-CoRE Cooperating Hub), Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Utkan Demirci
- Department of Radiology Stanford School of Medicine, BioAcoustic MEMS in Medicine Lab (BAMM), Canary Center at Stanford for Cancer Early Detection, Palo Alto, CA, 94304, USA
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4
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Jackson KK, Marcus RK. Rapid isolation and quantification of extracellular vesicles from suspension-adapted human embryonic kidney cells using capillary-channeled polymer fiber spin-down tips. Electrophoresis 2023; 44:190-202. [PMID: 35973415 PMCID: PMC10087738 DOI: 10.1002/elps.202200149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
Exosomes, a subset of extracellular vesicles (EVs, 30-200-nm diameter), serve as biomolecular snapshots of their cell of origin and vehicles for intercellular communication, playing roles in biological processes, including homeostasis maintenance and immune modulation. The large-scale processing of exosomes for use as therapeutic vectors has been proposed, but these applications are limited by impure, low-yield recoveries from cell culture milieu (CCM). Current isolation methods are also limited by tedious and laborious workflows, especially toward an isolation of EVs from CCM for therapeutic applications. Employed is a rapid (<10 min) EV isolation method on a capillary-channeled polymer fiber spin-down tip format. EVs are isolated from the CCM of suspension-adapted human embryonic kidney cells (HEK293), one of the candidate cell lines for commercial EV production. This batch solid-phase extraction technique allows 1012 EVs to be obtained from only 100-µl aliquots of milieu, processed using a benchtop centrifuge. The tip-isolated EVs were characterized using transmission electron microscopy, multi-angle light scattering, absorbance quantification, an enzyme-linked immunosorbent assay to tetraspanin marker proteins, and a protein purity assay. It is believed that the demonstrated approach has immediate relevance in research and analytical laboratories, with opportunities for production-level scale-up projected.
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Affiliation(s)
- Kaylan K Jackson
- Department of Chemistry, Clemson University, Clemson, South Carolina, USA
| | - R Kenneth Marcus
- Department of Chemistry, Clemson University, Clemson, South Carolina, USA
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5
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Wang N, Li E, Deng H, Yue L, Zhou L, Su R, He B, Lai C, Li G, Gao Y, Zhou W, Gao Y. Inosine: A broad-spectrum anti-inflammatory against SARS-CoV-2 infection-induced acute lung injury via suppressing TBK1 phosphorylation. J Pharm Anal 2023; 13:11-23. [PMID: 36313960 PMCID: PMC9595505 DOI: 10.1016/j.jpha.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 02/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced cytokine storms constitute the primary cause of coronavirus disease 19 (COVID-19) progression, severity, criticality, and death. Glucocorticoid and anti-cytokine therapies are frequently administered to treat COVID-19, but have limited clinical efficacy in severe and critical cases. Nevertheless, the weaknesses of these treatment modalities have prompted the development of anti-inflammatory therapy against this infection. We found that the broad-spectrum anti-inflammatory agent inosine downregulated proinflammatory interleukin (IL)-6, upregulated anti-inflammatory IL-10, and ameliorated acute inflammatory lung injury caused by multiple infectious agents. Inosine significantly improved survival in mice infected with SARS-CoV-2. It indirectly impeded TANK-binding kinase 1 (TBK1) phosphorylation by binding stimulator of interferon genes (STING) and glycogen synthase kinase-3β (GSK3β), inhibited the activation and nuclear translocation of the downstream transcription factors interferon regulatory factor (IRF3) and nuclear factor kappa B (NF-κB), and downregulated IL-6 in the sera and lung tissues of mice infected with lipopolysaccharide (LPS), H1N1, or SARS-CoV-2. Thus, inosine administration is feasible for clinical anti-inflammatory therapy against severe and critical COVID-19. Moreover, targeting TBK1 is a promising strategy for inhibiting cytokine storms and mitigating acute inflammatory lung injury induced by SARS-CoV-2 and other infectious agents.
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Affiliation(s)
- Ningning Wang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Entao Li
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130122, China
| | - Huifang Deng
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Lanxin Yue
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Lei Zhou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Rina Su
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130122, China
- College of Veterinary Medicine, Jilin Agricultural University, Changchun, 130022, China
| | - Baokun He
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Chengcai Lai
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Gaofu Li
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Yuwei Gao
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130122, China
- Corresponding author.
| | - Wei Zhou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
- Corresponding author.
| | - Yue Gao
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Corresponding author. Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China.
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Ozsurekci Y, Aykac K, Demir OO, Ilbay S, Kesici S, Karakaya J, Cengiz AB. Methylprednisolone use in children with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2. Pediatr Int 2023; 65:e15603. [PMID: 37615374 DOI: 10.1111/ped.15603] [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: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness and optimal use of corticosteroids in children with severe coronavirus disease 2019 (COVID-19) pneumonia, for which effective treatment is still lacking with respect to this population. METHODS We conducted a retrospective study and included patients (aged < 18 years) with severe COVID-19 pneumonia and/or acute respiratory distress syndrome (ARDS) who received standard doses (2-4 mg/kg/day) and high doses (>250 mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid treatments with a propensity score and compared the side effects of different MPZ doses and patient survival. RESULTS Fifty-nine patients were included: 61% were male, the median age was 8, interquartile range (IQR) 2-15) years. The overall survival was 84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and 92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p = 0.67). The demographic, clinical, and laboratory data did not differ significantly after propensity score matching, apart from bradycardia, which was a prominent feature of the high-dose group. The clinical and radiological response rates on day 7 were higher and the need for invasive mechanical ventilation (IMV) was lower in the high-dose group. CONCLUSION The patients with high-dose MPZ had better clinical and radiological responses than those with standard-dose MPZ, although the mortality rate did not differ between standard and high-dose regimens of MPZ.
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Affiliation(s)
- Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Kubra Aykac
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Osman Oguz Demir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Sare Ilbay
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Selman Kesici
- Hacettepe University Faculty of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Jale Karakaya
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
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7
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Sarriá-Landete AJ, Crespo-Matas JA, Domínguez-Quesada I, Castellanos-Monedero JJ, Marte-Acosta D, Arias-Arias ÁJ. Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2022; 159:557-562. [PMID: 36536623 PMCID: PMC9752105 DOI: 10.1016/j.medcle.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/23/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6 mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge. MATERIALS AND METHODS We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves. RESULTS The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. CONCLUSIONS In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.
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Affiliation(s)
- Antonio J. Sarriá-Landete
- Departamento de Medicina Interna, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain,Corresponding author
| | - José A. Crespo-Matas
- Departamento de Medicina Interna, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Dinés Marte-Acosta
- Departamento de Neumología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Ángel J. Arias-Arias
- Departamento de Investigación, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
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8
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Sarriá-Landete AJ, Crespo-Matas JA, Domínguez-Quesada I, Castellanos-Monedero JJ, Marte-Acosta D, Arias-Arias ÁJ. Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection. Med Clin (Barc) 2022; 159:557-562. [PMID: 35718548 PMCID: PMC9212640 DOI: 10.1016/j.medcli.2022.02.025] [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: 07/11/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment. Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge. MATERIALS AND METHODS We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves. RESULTS The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. CONCLUSIONS In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.
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Affiliation(s)
- Antonio J. Sarriá-Landete
- Departamento de Medicina Interna, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain,Corresponding author
| | - José A. Crespo-Matas
- Departamento de Medicina Interna, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Dinés Marte-Acosta
- Departamento de Neumología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Ángel J. Arias-Arias
- Departamento de Investigación, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
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9
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Arcellana AE, Lim KW, Arcegono M, Jimeno C. Critical Illness-Related Corticosteroid Insufficiency (CIRCI) Among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes. J ASEAN Fed Endocr Soc 2022; 38:90-99. [PMID: 37252409 PMCID: PMC10213165 DOI: 10.15605/jafes.038.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Among critically ill patients, there is usually impairment of the hypothalamic-pituitary-adrenal axis, leading to a condition known as critical illness-related corticosteroid insufficiency (CIRCI). This investigation aims to determine the incidence of and characterize CIRCI among patients with COVID-19 as well as to analyze the outcomes of these critically ill patients. METHODOLOGY This is a single-center, retrospective cohort study that investigated the occurrence of CIRCI among critically ill patients infected with COVID-19. RESULTS In this cohort, there were 145 COVID-19-positive patients with refractory shock, which reflects that 22.94% of the COVID-19 admissions have probable CIRCI.Patients who were given corticosteroids were found to have statistically significant longer median days on a ventilator (p=0.001). However, those on the corticosteroid arm were at higher risk of morbidity and mortality and a greater proportion had organ dysfunction. Multivariable logistic regression analysis revealed that SOFA score was a significant predictor of mortality in CIRCI (p=0.013). CONCLUSION CIRCI has a unique presentation among patients with COVID-19 because of the presence of a high level of inflammation in this life-threatening infection. It is possibly a harbinger of a markedly increased risk of mortality in these patients.
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Affiliation(s)
- Anna Elvira Arcellana
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Kenneth Wilson Lim
- Division of Pulmonary Medicine, University of the Philippines-Philippine General Hospital
| | - Marlon Arcegono
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital
| | - Cecilia Jimeno
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
- Department of Pharmacology and Toxicology, University of the Philippines College of Medicine
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10
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Sharun K, Tiwari R, Yatoo MI, Natesan S, Megawati D, Singh KP, Michalak I, Dhama K. A comprehensive review on pharmacologic agents, immunotherapies and supportive therapeutics for COVID-19. NARRA J 2022; 2:e92. [PMID: 38449903 PMCID: PMC10914132 DOI: 10.52225/narra.v2i3.92] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 03/08/2024]
Abstract
The emergence of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected many countries throughout the world. As urgency is a necessity, most efforts have focused on identifying small molecule drugs that can be repurposed for use as anti-SARS-CoV-2 agents. Although several drug candidates have been identified using in silico method and in vitro studies, most of these drugs require the support of in vivo data before they can be considered for clinical trials. Several drugs are considered promising therapeutic agents for COVID-19. In addition to the direct-acting antiviral drugs, supportive therapies including traditional Chinese medicine, immunotherapies, immunomodulators, and nutritional therapy could contribute a major role in treating COVID-19 patients. Some of these drugs have already been included in the treatment guidelines, recommendations, and standard operating procedures. In this article, we comprehensively review the approved and potential therapeutic drugs, immune cells-based therapies, immunomodulatory agents/drugs, herbs and plant metabolites, nutritional and dietary for COVID-19.
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Affiliation(s)
- Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Pandit Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, India
| | - Mohd I. Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Jammu and Kashmir, India
| | - Senthilkumar Natesan
- Department of Infectious Diseases, Indian Institute of Public Health Gandhinagar, Opp to Airforce station HQ, Gandhinagar, India
| | - Dewi Megawati
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia
- Department of Medical Microbiology and Immunology, University of California, Davis, California, USA
| | - Karam P. Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Izabela Michalak
- Faculty of Chemistry, Department of Advanced Material Technologies, Wrocław University of Science and Technology, Wrocław, Poland
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
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11
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Nazerian Y, Ghasemi M, Yassaghi Y, Nazerian A, Mahmoud Hashemi S. Role of SARS-CoV-2-induced Cytokine Storm in Multi-Organ Failure: Molecular Pathways and Potential Therapeutic Options. Int Immunopharmacol 2022; 113:109428. [PMCID: PMC9637536 DOI: 10.1016/j.intimp.2022.109428] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Coronavirus disease 2019 (COVID-19) outbreak has become a global public health emergency and has led to devastating results. Mounting evidence proposes that the disease causes severe pulmonary involvement and influences different organs, leading to a critical situation named multi-organ failure. It is yet to be fully clarified how the disease becomes so deadly in some patients. However, it is proven that a condition called “cytokine storm” is involved in the deterioration of COVID-19. Although beneficial, sustained production of cytokines and overabundance of inflammatory mediators causing cytokine storm can lead to collateral vital organ damages. Furthermore, cytokine storm can cause post-COVID-19 syndrome (PCS), an important cause of morbidity after the acute phase of COVID-19. Herein, we aim to explain the possible pathophysiology mechanisms involved in COVID-19-related cytokine storm and its association with multi-organ failure and PCS. We also discuss the latest advances in finding the potential therapeutic targets to control cytokine storm wishing to answer unmet clinical demands for treatment of COVID-19.
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Affiliation(s)
- Yasaman Nazerian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Ghasemi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Younes Yassaghi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mahmoud Hashemi
- Medical nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author at: Medical nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran / Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Abadi B, Aarabi Jeshvaghani AH, Fathalipour H, Dehghan L, Rahimi Sirjani K, Forootanfar H. Therapeutic Strategies in the Fight against COVID-19: From Bench to Bedside. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:517-532. [PMID: 36380976 PMCID: PMC9652495 DOI: 10.30476/ijms.2021.92662.2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 06/16/2023]
Abstract
In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China. This virus rapidly spread worldwide and was declared a global pandemic by the World Health Organization (WHO) in March 2020. High incidence, long incubation period, and diverse clinical signs of the disease posed a huge challenge globally. The efforts of health systems have been focused on repurposing existing drugs or developing innovative therapies to reduce the morbidity and mortality associated with SARS-CoV-2. In addition, most of the large pharmaceutical companies are intensely working on vaccine development to swiftly deliver safe and effective vaccines to prevent further spread of the virus. In this review, we will discuss the latest data on therapeutic strategies undergoing clinical trials. Additionally, we will provide a summary of vaccines currently under development.
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Affiliation(s)
- Banafshe Abadi
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Brain Cancer Research Core, Universal Scientific Education and Research Network, Tehran, Iran
| | | | - Hadis Fathalipour
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Leili Dehghan
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Hamid Forootanfar
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
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13
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Ilyicheva TN, Netesov SV, Gureyev VN. COVID-19, Influenza, and Other Acute Respiratory Viral Infections: Etiology, Immunopathogenesis, Diagnosis, and Treatment. Part I. COVID-19 and Influenza. MOLECULAR GENETICS, MICROBIOLOGY AND VIROLOGY : MOLEKULYARNAYA GENETIKA, MIKROBIOLOGIYA I VIRUSOLOGIYA 2022; 37:1-9. [PMID: 35936505 PMCID: PMC9342941 DOI: 10.3103/s0891416822010025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 06/08/2023]
Abstract
The paper briefly reviews pathogens causing acute respiratory viral infections (ARVIs), including influenza viruses; coronaviruses, including SARS-CoV-2; parainfluenza viruses, adenoviruses, pneumoviruses, and specifically respiratory syncytial virus and metapneumoviruses, enteroviruses, rhinoviruses, and bocaviruses. This review presents modern data on the structure and replication of viruses, epidemiology, and immunopathogenesis of diseases and on diagnostics, preventive vaccination, and antiviral drugs for the treatment of ARVIs. Special attention is paid to the SARS-CoV-2 virus caused COVID-19 pandemic with analyses of similarities and differences between COVID-19 and other ARVIs, first of all, influenza virus. Topical issues regarding ARVI vaccination and the search for new broad-spectrum antiviral drugs are discussed.
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Affiliation(s)
- T. N. Ilyicheva
- Novosibirsk State University, 630090 Novosibirsk, Russia
- Vector State Research Center of Virology and Biotechnology, 630559 Koltsovo, Russia
| | - S. V. Netesov
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | - V. N. Gureyev
- Vector State Research Center of Virology and Biotechnology, 630559 Koltsovo, Russia
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14
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Alotaibi N, Alroomi M, Aboelhassan W, Hussein S, Rajan R, AlNasrallah N, Al Saleh M, Ramadhan M, Zhanna KD, Pan J, Malhas H, Abdelnaby H, Almutairi F, Al-Bader B, Alsaber A, Abdullah M. In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid. Ann Med Surg (Lond) 2022; 80:104105. [PMID: 35784615 PMCID: PMC9239918 DOI: 10.1016/j.amsu.2022.104105] [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: 05/10/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate COVID-19 related mоrtаlity according to the use of corticosteroid therapy. Design Retrospective cohort study. Setting Two tertiary hospitals in Kuwait. Participants Overall, 962 patients with confirmed SARS-CoV-2 infection, were stratified according to whether they were treated with corticosteroids (dexamethasone or methylprednisolone). The mean age of the patients was 50.2 ± 15.9 years and 344/962 (35.9%) were female. Main outcome measures In-hospital mortality and cumulative all-cause mortality. Results Compared to non-corticosteroid therapy patients, corticosteroid therapy patients had a higher prevalence of hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease; a longer hospital stay (median [IQR]: 17.0 [5.0–57.3] days vs 14.0 [2.0–50.2] days); and a higher in-hospital mortality (51/199 [25.6%] vs 36/763 [4.7%]). Logistic regression analysis showed a higher in-hospital mortality in the corticosteroid group (adjusted odds ratio [aOR]: 4.57, 95% confidence interval [CI]: 2.64–8.02, p < 0.001). Cox proportional hazards regression showed that corticosteroid use was a significant predictor of mortality (hazard ratio [HR]: 3.96, p < 0.001). Conclusions In-hospital mortality in patients with SARS-CoV-2 on corticosteroid therapy was 4.6 times higher than in those without corticosteroid therapy. In-hospital mortality in patients with SARS-CoV-2 on corticosteroid was evaluated. Risk of mortality was 4.6 times higher in those with corticosteroid therapy. Corticosteroid therapy patients had a longer hospital stay.
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Affiliation(s)
- Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | - Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
- Corresponding author. Department of Infectious Diseases, Infectious Diseases Hospital Shuwaikh Medical Area, P. O. Box 4710, Safat, 13048, Kuwait.
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | | | | | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Division of Gastroenterology, Department of Medicine, Al Sabah Hospital, Shuwaikh Medical Area, Kuwait
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
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15
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Dijk SW, Krijkamp EM, Kunst N, Gross CP, Wong JB, Hunink MGM. Emerging Therapies for COVID-19: The Value of Information From More Clinical Trials. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1268-1280. [PMID: 35490085 PMCID: PMC9045876 DOI: 10.1016/j.jval.2022.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/14/2022] [Accepted: 03/13/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The COVID-19 pandemic necessitates time-sensitive policy and implementation decisions regarding new therapies in the face of uncertainty. This study aimed to quantify consequences of approving therapies or pursuing further research: immediate approval, use only in research, approval with research (eg, emergency use authorization), or reject. METHODS Using a cohort state-transition model for hospitalized patients with COVID-19, we estimated quality-adjusted life-years (QALYs) and costs associated with the following interventions: hydroxychloroquine, remdesivir, casirivimab-imdevimab, dexamethasone, baricitinib-remdesivir, tocilizumab, lopinavir-ritonavir, interferon beta-1a, and usual care. We used the model outcomes to conduct cost-effectiveness and value of information analyses from a US healthcare perspective and a lifetime horizon. RESULTS Assuming a $100 000-per-QALY willingness-to-pay threshold, only remdesivir, casirivimab-imdevimab, dexamethasone, baricitinib-remdesivir, and tocilizumab were (cost-) effective (incremental net health benefit 0.252, 0.164, 0.545, 0.668, and 0.524 QALYs and incremental net monetary benefit $25 249, $16 375, $54 526, $66 826, and $52 378). Our value of information analyses suggest that most value can be obtained if these 5 therapies are approved for immediate use rather than requiring additional randomized controlled trials (RCTs) (net value $20.6 billion, $13.4 billion, $7.4 billion, $54.6 billion, and $7.1 billion), hydroxychloroquine (net value $198 million) is only used in further RCTs if seeking to demonstrate decremental cost-effectiveness and otherwise rejected, and interferon beta-1a and lopinavir-ritonavir are rejected (ie, neither approved nor additional RCTs). CONCLUSIONS Estimating the real-time value of collecting additional evidence during the pandemic can inform policy makers and clinicians about the optimal moment to implement therapies and whether to perform further research.
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Affiliation(s)
- Stijntje W Dijk
- Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eline M Krijkamp
- Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natalia Kunst
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
| | - M G Myriam Hunink
- Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Institute for Health Sciences, Erasmus University Medical Center, Rotterdam, The Netherlands; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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16
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Tang J. COVID-19 Pandemic and Osteoporosis in Elderly Patients. Aging Dis 2022; 13:960-969. [PMID: 35855327 PMCID: PMC9286914 DOI: 10.14336/ad.2021.1201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by an infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly becoming a worldwide epidemic and poses a significant threat to human life and health. SARS-CoV-2 can cause damage to organs throughout the body through ACE2 receptors. It may have direct and indirect effects on osteoclasts, and osteoblasts and lead to osteoporosis. Vitamin D (VitD) is a key hormone for bone health and has immunomodulatory actions of relevance in the context of the COVID-19 pandemic. Vitamin D deficiency has a significant positive association with both infection and the mortality rate of COVID-19. Elderly patients infected by COVID-19 were more likely to develop acute respiratory distress syndrome (ARDS), which was primarily caused by an inflammation storm. The production of proinflammatory cytokines increases with COVID-19 infection and immobilization may result in bone loss and bone resorption in seriously ill patients, especially aging patients. It is well known that glucocorticoids are beneficial in the treatment of acute respiratory distress syndrome (ARDS) because they reduce inflammation and improve the functioning of the lung and extrapulmonary organs. Glucocorticoid therapy is widely used to treat patients with COVID-19 in most parts of the world. During COVID-19 clinical treatment, glucocorticoids may accelerate bone loss in elderly people, making them more susceptible to the development of osteoporosis. Therefore, it is worthwhile to draw the attention of clinicians and researchers to the linkages and interactions between COVID-19, glucocorticoids, and osteoporosis (especially in elderly patients).
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Affiliation(s)
- Jun Tang
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, China
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17
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Andaluz-Ojeda D, Vidal-Cortes P, Aparisi Sanz Á, Suberviola B, Del Río Carbajo L, Nogales Martín L, Prol Silva E, Nieto del Olmo J, Barberán J, Cusacovich I. Immunomodulatory therapy for the management of critically ill patients with COVID-19: A narrative review. World J Crit Care Med 2022; 11:269-297. [PMID: 36051937 PMCID: PMC9305685 DOI: 10.5492/wjccm.v11.i4.269] [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: 07/22/2021] [Revised: 12/01/2021] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Understanding the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies.
AIM To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets.
METHODS A comprehensive literature search was developed. Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate. Finally, a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed. This recommendation was made based on the consensus of all the authors.
RESULTS A brief rationale on the SARS-CoV-2 pathogenesis, immune response, and inflammation was developed. The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed. Finally, based on the level of scientific evidence, a recommendation was established for each of them.
CONCLUSION Although several promising therapies exist, only the use of corticosteroids and tocilizumab (or sarilumab in absence of this) have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19. Endotypes including both, clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.
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Affiliation(s)
- David Andaluz-Ojeda
- Department of Critical Care, Hospital Universitario HM Sanchinarro, Hospitales Madrid, Madrid 28050, Spain
| | - Pablo Vidal-Cortes
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | | | - Borja Suberviola
- Department of Intensive Care, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
| | - Lorena Del Río Carbajo
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | - Leonor Nogales Martín
- Department of Intensive Care, Hospital Clínico Universitario de Valladolid, Valladolid 47005, Spain
| | - Estefanía Prol Silva
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | - Jorge Nieto del Olmo
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | - José Barberán
- Department of Internal Medicine, Hospital Universitario HM Montepríncipe, Hospitales Madrid, Boadilla del Monte 28860, Madrid, Spain
| | - Ivan Cusacovich
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid 47005, Spain
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18
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Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone. Biomedicines 2022; 10:biomedicines10071548. [PMID: 35884852 PMCID: PMC9312892 DOI: 10.3390/biomedicines10071548] [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: 06/02/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including all consecutive patients admitted to two Italian University Hospitals for COVID-19 from March 2020 to December 2021. The aim of this study was to describe clinical characteristics and outcome parameters of hospitalized COVID-19 patients treated with dexamethasone 6 mg once daily (standard-dose group) or methylprednisolone 40 mg twice daily (high-dose group). The primary outcome was the impact of these different steroid treatments on 30-day mortality. During the study period, 990 patients were evaluated: 695 (70.2%) receiving standard dosage of dexamethasone and 295 (29.8%) receiving a high dose of methylprednisolone. Cox regression analysis showed that chronic obstructive pulmonary disease (HR 1.98, CI95% 1.34−9.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48−22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45−19.8, p = 0.005) and high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation oxygen therapy (HR 61.1, CI95% 5.12−511.1, p < 0.001) were independently associated with 30-day mortality; conversely, high-dose steroid therapy was associated with survival (HR 0.42, CI95% 0.38−0.86, p = 0.002) at 30 days. Kaplan−Meier curves for 30-day survival displayed a statistically significant better survival rate in patients treated with high-dose steroid therapy (p = 0.018). The results of this study highlighted that the use of high-dose methylprednisolone, compared to dexamethasone 6 mg once daily, in hospitalized patients with COVID-19 may be associated with a significant reduction in mortality.
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19
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Chen Z, Yin X, Tan X, Wang J, Jiang N, Tian M, Li H, Lu Z, Xiong N, Gong Y. Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:709-716. [PMID: 35219601 PMCID: PMC8866099 DOI: 10.1016/j.jval.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Corticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) in nonsevere patients with COVID-19. METHODS We conducted a multicenter retrospective cohort study in Hubei Province. A total of 1726 patients admitted with nonsevere type COVID-19 were included. Mixed-effect Cox model, mixed-effect Cox model with time-varying exposure, multiple linear regression, and propensity score analysis (inverse probability of treatment weight and propensity score matching) were used to explore the association between SCU and progression into severe type, all-cause mortality, and length of stay. RESULTS During the follow-up of 30 days, 29.8% of nonsevere patients with COVID-19 received treatment with systemic corticosteroids. The use of systemic corticosteroids was associated with higher probability of developing severe type (adjusted hazard ratio 1.81; 95% confidence interval 1.47-2.21), all-cause mortality (adjusted hazard ratio 2.92; 95% confidence interval 1.39-6.15) in time-varying Cox analysis, and prolonged hospitalization (β 4.14; P < .001) in multiple linear regression. Analysis with 2 propensity score cohorts displayed similar results. Besides, increased corticosteroid dose was significantly associated with elevated probability of developing severe type (P < .001) and prolonged hospitalization (P < .001). CONCLUSIONS Corticosteroid treatment against nonsevere patients with COVID-19 was significantly associated with worse clinical outcomes. The higher dose was significantly associated with elevated risk of poor disease progression. We recommend that SCU should be avoided unless necessary among nonsevere patients with COVID-19.
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Affiliation(s)
- Zhenyuan Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Xiangping Tan
- Lichuan Center for Disease Control and Prevention, Enshi Tujia and Miao Autonomous Prefecture, P. R. China
| | - Jing Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Nan Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Mengge Tian
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hui Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.
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20
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Mesenchymal stem cell-based treatments for COVID-19: status and future perspectives for clinical applications. Cell Mol Life Sci 2022; 79:142. [PMID: 35187617 PMCID: PMC8858603 DOI: 10.1007/s00018-021-04096-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023]
Abstract
As a result of cross-species transmission in December 2019, the coronavirus disease 2019 (COVID-19) became a serious endangerment to human health and the causal agent of a global pandemic. Although the number of infected people has decreased due to effective management, novel methods to treat critical COVID-19 patients are still urgently required. This review describes the origins, pathogenesis, and clinical features of COVID-19 and the potential uses of mesenchymal stem cells (MSCs) in therapeutic treatments for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. MSCs have previously been shown to have positive effects in the treatment of lung diseases, such as acute lung injury, idiopathic pulmonary fibrosis, acute respiratory distress syndrome, lung cancer, asthma, and chronic obstructive pulmonary disease. MSC mechanisms of action involve differentiation potentials, immune regulation, secretion of anti-inflammatory factors, migration and homing, anti-apoptotic properties, antiviral effects, and extracellular vesicles. Currently, 74 clinical trials are investigating the use of MSCs (predominately from the umbilical cord, bone marrow, and adipose tissue) to treat COVID-19. Although most of these trials are still in their early stages, the preliminary data are promising. However, long-term safety evaluations are still lacking, and large-scale and controlled trials are required for more conclusive judgments regarding MSC-based therapies. The main challenges and prospective directions for the use of MSCs in clinical applications are discussed herein. In summary, while the clinical use of MSCs to treat COVID-19 is still in the preliminary stages of investigation, promising results indicate that they could potentially be utilized in future treatments.
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21
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Fabião J, Sassi B, Pedrollo E, Gerchman F, Kramer C, Leitão C, Pinto L. Why do men have worse COVID-19-related outcomes? A systematic review and meta-analysis with sex adjusted for age. Braz J Med Biol Res 2022; 55:e11711. [PMID: 35195196 PMCID: PMC8856598 DOI: 10.1590/1414-431x2021e11711] [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: 08/22/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023] Open
Abstract
We aimed to study the mechanism behind worse coronavirus disease-19 (COVID-19) outcomes in men and whether the differences between sexes regarding mortality as well as disease severity are influenced by sex hormones. To do so, we used age as a covariate in the meta-regression and subgroup analyses. This was a systematic search and meta-analysis of observational cohorts reporting COVID-19 outcomes. The PubMed (Medline) and Cochrane Library databases were searched. The primary outcome was COVID-19-associated mortality and the secondary outcome was COVID-19 severity. The study was registered at PROSPERO: 42020182924. For mortality, men had a relative risk of 1.36 (95%CI: 1.17 to 1.59; I2 63%, P for heterogeneity <0.01) compared to women. Age was not a significant covariate in meta-analysis heterogeneity (P=0.393) or subgroup analysis. For disease severity, being male was associated with a relative risk of 1.29 (95%CI: 1.19 to 1.40; I2 48%, P for heterogeneity <0.01) compared to the relative risk of women. Again, age did not influence the outcomes of the meta-regression (P=0.914) or subgroup analysis. Men had a higher risk of COVID-19 mortality and severity regardless of age, decreasing the odds of hormonal influences in the described outcomes.
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Affiliation(s)
- J. Fabião
- Divisão de Medicina Interna, Hospital Nossa Senhora da
Conceição, Porto Alegre, RS, Brasil
| | - B. Sassi
- Divisão de Medicina Interna, Hospital Nossa Senhora da
Conceição, Porto Alegre, RS, Brasil
| | - E.F. Pedrollo
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia,
Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - F. Gerchman
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia,
Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - C.K. Kramer
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario,
Canada
| | - C.B. Leitão
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia,
Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - L.C. Pinto
- Divisão de Medicina Interna, Hospital Nossa Senhora da
Conceição, Porto Alegre, RS, Brasil
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia,
Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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22
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Singh SP, Bhatnagar A, Singh SK, K Patra S, Kanwar N, Kanwal A, Amar S, Manna R. SARS-CoV-2 Infections, Impaired Tissue, and Metabolic Health: Pathophysiology and Potential Therapeutics. Mini Rev Med Chem 2022; 22:2102-2123. [PMID: 35105287 DOI: 10.2174/1389557522666220201154845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/09/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023]
Abstract
The SARS-CoV-2 enters the human airways and comes into contact with the mucous membranes lining the mouth, nose, and eyes. The virus enters the healthy cells and uses cell machinery to make several copies of the virus. Critically ill patients infected with SARS-CoV-2 may have damaged lungs, air sacs, lining, and walls. Since COVID-19 causes cytokine storm, it damages the alveolar cells of the lungs and fills them with fluid, making it harder to exchange oxygen and carbon dioxide. The SARS-CoV-2 infection causes a range of complications, including mild to critical breathing difficulties. It has been observed that older people suffering from health conditions like cardiomyopathies, nephropathies, metabolic syndrome, and diabetes instigate severe symptoms. Many people who died due to COVID-19 had impaired metabolic health [IMH], characterized by hypertension, dyslipidemia, and hyperglycemia, i.e., diabetes, cardiovascular system, and renal diseases making their retrieval challenging. Jeopardy stresses for increased mortality from COVID-19 include older age, COPD, ischemic heart disease, diabetes mellitus, and immunosuppression. However, no targeted therapies are available as of now. Almost two-thirds of diagnosed coronavirus patients had cardiovascular diseases and diabetes, out of which 37% were under 60. The NHS audit revealed that with a higher expression of ACE-2 receptors, viral particles could easily bind their protein spikes and get inside the cells, finally causing COVID-19 infection. Hence, people with IMH are more prone to COVID-19 and, ultimately, comorbidities. This review provides enormous information about tissue [lungs, heart and kidneys] damage, pathophysiological changes, and impaired metabolic health of SARS-CoV-2 infected patients. Moreover, it also designates the possible therapeutic targets of COVID-19 and drugs which can be used against these targets.
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Affiliation(s)
| | - Aayushi Bhatnagar
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India-305817
| | - Sujeet Kumar Singh
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India-305817
| | - Sanjib K Patra
- Department of Yoga, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India-305817
| | - Navjot Kanwar
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, Punjab, India-151001
| | - Abhinav Kanwal
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, Punjab, India-151001
| | - Salomon Amar
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595
| | - Ranata Manna
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India-305817
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23
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Ulugerger Avci G, Bektan Kanat B, Suzan V, Can G, Korkmazer B, Karaali R, Tabak F, Borekci S, Aygun G, Yavuzer H, Doventas A. Clinical outcomes of geriatric patients with COVID-19: review of one-year data. Aging Clin Exp Res 2022; 34:465-474. [PMID: 35064542 PMCID: PMC8782714 DOI: 10.1007/s40520-021-02047-y] [Citation(s) in RCA: 4] [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: 10/16/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022]
Abstract
Aims In this study, we aimed to reveal mortality rates and factors affecting survival in geriatric patients infected with COVID-19. Methods This is a retrospective study of 873 geriatric patients with COVID-19 who were hospitalized between March 11, 2020 and March 11, 2021. Demographic, clinical, laboratory data, and treatment options were obtained from electronic medical records. Multivariate logistic regression was used to explore the risk factors for in-hospital death. Results During the specified period, 643 patients were discharged, and 230 patients died in the hospital. The mean age was 75.08 ± 7.39 years (mean ± SD) and 51.8% were males. We found that older age (≥ 85), polypharmacy, dyspnea, abnormal thorax computed tomography (CT), lower doses of anticoagulation, and high values of white blood cell, aspartate aminotransferase, C-reactive protein, lactate dehydrogenase, ferritin were associated with a significant increase in mortality (P < 0.001 for all). Although all of these values were significant in multivariate logistic regression analysis, the most important ones were dyspnea (Odds ratio (OR) 57.916, 95% confidence interval (CI) 23.439–143.104, P < 0.001), polypharmacy (OR 6.782, 95% CI 3.082–14.927, P < 0.001), and thorax CT classification (typical; OR 9.633, 95% CI 2.511–37.122, P < 0.001). Conclusion Older age, polypharmacy, dyspnea, and abnormal thorax CT were the most significant mortality criteria and in addition appropriate anticoagulant use was associated with reduced mortality. Identifying the risk factors to predict mortality in older adults with COVID-19 is important to treat future cases successfully.
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Affiliation(s)
- Gulru Ulugerger Avci
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Bahar Bektan Kanat
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Veysel Suzan
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Bora Korkmazer
- Department of Radiology, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ridvan Karaali
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Sermin Borekci
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Gokhan Aygun
- Department of Medical Microbiology, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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24
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Zabana Y, Marín-Jiménez I, Rodríguez-Lago I, Vera I, Martín-Arranz MD, Guerra I, Gisbert JP, Mesonero F, Benítez O, Taxonera C, Ponferrada-Díaz Á, Piqueras M, Lucendo AJ, Caballol B, Mañosa M, Martínez-Montiel P, Bosca-Watts M, Gordillo J, Bujanda L, Manceñido N, Martínez-Pérez T, López A, Rodríguez-Gutiérrez C, García-López S, Vega P, Rivero M, Melcarne L, Calvo M, Iborra M, Barreiro de-Acosta M, Sicilia B, Barrio J, Pérez JL, Busquets D, Pérez-Martínez I, Navarro-Llavat M, Hernández V, Argüelles-Arias F, Ramírez Esteso F, Meijide S, Ramos L, Gomollón F, Muñoz F, Suris G, de Zarate JO, Huguet JM, Llaó J, García-Sepulcre MF, Sierra M, Durà M, Estrecha S, Fuentes Coronel A, Hinojosa E, Olivan L, Iglesias E, Gutiérrez A, Varela P, Rull N, Gilabert P, Hernández-Camba A, Brotons A, Ginard D, Sesé E, Carpio D, Aceituno M, Cabriada JL, González-Lama Y, Jiménez L, Chaparro M, López-San Román A, Alba C, Plaza-Santos R, Mena R, Tamarit-Sebastián S, Ricart E, Calafat M, Olivares S, Navarro P, Bertoletti F, Alonso-Galán H, Pajares R, Olcina P, Manzano P, Domènech E, Esteve M. Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry. J Clin Med 2022; 11:421. [PMID: 35054116 PMCID: PMC8781643 DOI: 10.3390/jcm11020421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD.
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Affiliation(s)
- Yamile Zabana
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
| | | | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain; (I.R.-L.); (J.L.C.)
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.V.); (Y.G.-L.)
| | | | - Iván Guerra
- Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain; (I.G.); (L.J.)
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28046 Madrid, Spain
| | - Javier P. Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - Francisco Mesonero
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (F.M.); (A.L.-S.R.)
| | - Olga Benítez
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
| | - Carlos Taxonera
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (C.T.); (C.A.)
- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], 28040 Madrid, Spain
| | | | - Marta Piqueras
- Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (M.P.); (R.M.)
| | - Alfredo J. Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
- Hospital General de Tomelloso, 13700 Tomelloso, Spain;
| | - Berta Caballol
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínic de Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Pilar Martínez-Montiel
- Fundación Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (P.M.-M.); (S.O.)
| | - Maia Bosca-Watts
- Hospital Clinic Universitari de Valencia, 46010 Valencia, Spain; (M.B.-W.); (P.N.)
| | - Jordi Gordillo
- Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.G.); (F.B.)
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitario Donostia, Instituto Biodonostia, 20014 San Sebastián, Spain;
- Universidad del País Vasco (UPV/EHU), 48940 Leioua, Spain
| | - Noemí Manceñido
- Hospital Universitario Infanta Sofía, 28703 San Sebastián de los Reyes, Spain; (N.M.); (R.P.)
| | | | - Alicia López
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain;
| | | | | | - Pablo Vega
- Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Montserrat Rivero
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Luigi Melcarne
- Hospital Universitari Parc Taulí, 08208 Sabadell, Spain;
| | - Maria Calvo
- Hospital San Pedro-Logroño, 26006 Logroño, Spain;
| | - Marisa Iborra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitario y Politécnico de la Fe de Valencia, 46026 Valencia, Spain
| | | | | | - Jesús Barrio
- Hospital Universitario Río Hortega (HURH), 47012 Valladolid, Spain;
| | - José Lázaro Pérez
- Hospital Universitario Fundación de Alcorcón, 28922 Alcorcón, Spain;
| | - David Busquets
- Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain;
| | - Isabel Pérez-Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | | | | | | | | | - Susana Meijide
- Hospital Universitario de Cruces, 48903 Barakaldo, Spain;
| | - Laura Ramos
- Hospital Universitario de Canarias, 38320 San Cristobal de la Laguna, Spain;
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínico Universitario “Lozano Blesa” and IIS Aragón, 50009 Zaragoza, Spain
| | - Fernando Muñoz
- Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Gerard Suris
- Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Spain;
| | | | - José María Huguet
- Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Jordina Llaó
- Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;
| | | | - Mónica Sierra
- Complejo Asistencial Universitario de León, 24071 León, Spain;
| | - Miguel Durà
- Hospital Clínico de Valladolid, 47003 Valladolid, Spain;
| | | | | | | | | | - Eva Iglesias
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain;
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Pilar Varela
- Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Núria Rull
- Hospital Universitario Son Llàtzer, 07198 Palma, Spain;
| | - Pau Gilabert
- Hospital de Viladecans, 08840 Viladecans, Spain;
| | | | | | - Daniel Ginard
- Hospital Universitario Son Espases, 07120 Palma, Spain;
| | - Eva Sesé
- Hospital Universitari Arnau de Vilanova de Lleida, 25198 Lleida, Spain;
| | - Daniel Carpio
- Complexo Hospitalario de Pontevedra, 36071 Pontevedra, Spain;
| | - Montserrat Aceituno
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
| | - José Luis Cabriada
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain; (I.R.-L.); (J.L.C.)
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
| | - Yago González-Lama
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.V.); (Y.G.-L.)
| | - Laura Jiménez
- Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain; (I.G.); (L.J.)
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28046 Madrid, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | | | - Cristina Alba
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (C.T.); (C.A.)
- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], 28040 Madrid, Spain
| | - Rocío Plaza-Santos
- Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (Á.P.-D.); (R.P.-S.)
| | - Raquel Mena
- Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (M.P.); (R.M.)
| | | | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínic de Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Margalida Calafat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Sonsoles Olivares
- Fundación Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (P.M.-M.); (S.O.)
| | - Pablo Navarro
- Hospital Clinic Universitari de Valencia, 46010 Valencia, Spain; (M.B.-W.); (P.N.)
| | - Federico Bertoletti
- Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.G.); (F.B.)
| | - Horacio Alonso-Galán
- Hospital Universitario Donostia, Instituto Biodonostia, 20014 San Sebastián, Spain;
- Universidad del País Vasco (UPV/EHU), 48940 Leioua, Spain
| | - Ramón Pajares
- Hospital Universitario Infanta Sofía, 28703 San Sebastián de los Reyes, Spain; (N.M.); (R.P.)
| | - Pablo Olcina
- Hospital Virgen de la Luz, 16002 Cuenca, Spain; (T.M.-P.); (P.O.)
| | - Pamela Manzano
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
| | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Maria Esteve
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
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Lin L, Xue D, Chen JH, Wei QY, Huang ZH. Methylprednisolone accelerate chest computed tomography absorption in COVID-19: A three-centered retrospective case control study from China. World J Clin Cases 2022; 10:426-436. [PMID: 35097067 PMCID: PMC8771405 DOI: 10.12998/wjcc.v10.i2.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the results of some large randomized controlled trials (RCTs) confirmed the efficacy of corticosteroids in coronavirus disease 2019 (COVID-19), corticosteroids have been included in World Health Organization guidelines, but remain controversial. AIM To investigate the efficacy and safety of low-to-moderate dose (30 to 40 mg/d) short-term methylprednisolone for COVID-19 patients. METHODS The clinical data of 70 patients diagnosed with COVID-19 who received antiviral therapy with Arbidol for 7-10 d before admission but had no obvious absorption on chest computed tomography (CT) imaging were retrospectively analyzed. Arbidol (as the control group) and methylprednisolone (as the corticosteroid group) were given respectively after admission. After treatment, chest CT was reexamined to evaluate the absorption of pulmonary lesions. Additionally, we evaluated and compared the lymphocyte count, erythrocyte sedimentation rate (ESR), interleukin-6(IL-6), serum ferritin, lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), hypersensitive C-reactive protein (hs-CRP) and D-dimer levels, and also analyzed the incidence of toxic and side effects. RESULTS All patients in the corticosteroid group had varying degrees of CT absorption, which was significantly better than that in the control group (CT obvious absorption rate: 89.47% vs 12.5%, P < 0.05). The average daily dose and course of methylprednisolone in the patients with significant improvement on chest CT was (38.55 ± 13.17) mg and (6.44 ± 1.86) d respectively. During the treatment, the lymphocyte count, ESR, IL-6, serum ferritin, LDH, CK-MB, hs-CRP and D-dimer levels all improved gradually, indicating that both Arbidol and methylprednisolone therapy were contributed to improving the condition of COVID-19 patients. The corticosteroid regimen did not prolong the clearance time of severe acute respiratory syndrome coronavirus 2. There were no severe adverse reactions such as gastrointestinal bleeding, secondary severe infection, hypertension, diabetic ketoacidosis, mental disorders or electrolyte disorders during the whole corticosteroid treatment process. CONCLUSION Low-to-moderate dose short-term methylprednisolone can accelerate the chest CT imaging absorption of COVID-19 so as to improve symptoms and alleviate the condition in a short term, reduce the hospital stay, meanwhile avoid severe COVID-19 phases. The protocol has been proven to be effective and safe in clinical use.
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Affiliation(s)
- Lan Lin
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Dan Xue
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jin-Hua Chen
- Department of Medical Administration, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Qiong-Ying Wei
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Zheng-Hui Huang
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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Mairpady Shambat S, Gómez-Mejia A, Schweizer TA, Huemer M, Chang CC, Acevedo C, Bergada-Pijuan J, Vulin C, Hofmaenner DA, Scheier TC, Hertegonne S, Parietti E, Miroshnikova N, Wendel Garcia PD, Hilty MP, Buehler PK, Schuepbach RA, Brugger SD, Zinkernagel AS. Hyperinflammatory environment drives dysfunctional myeloid cell effector response to bacterial challenge in COVID-19. PLoS Pathog 2022; 18:e1010176. [PMID: 35007290 PMCID: PMC8782468 DOI: 10.1371/journal.ppat.1010176] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/21/2022] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 displays diverse disease severities and symptoms including acute systemic inflammation and hypercytokinemia, with subsequent dysregulation of immune cells. Bacterial superinfections in COVID-19 can further complicate the disease course and are associated with increased mortality. However, there is limited understanding of how SARS-CoV-2 pathogenesis and hypercytokinemia impede the innate immune function against bacterial superinfections. We assessed the influence of COVID-19 plasma hypercytokinemia on the functional responses of myeloid immune cells upon bacterial challenges from acute-phase COVID-19 patients and their corresponding recovery-phase. We show that a severe hypercytokinemia status in COVID-19 patients correlates with the development of bacterial superinfections. Neutrophils and monocytes derived from COVID-19 patients in their acute-phase showed an impaired intracellular microbicidal capacity upon bacterial challenges. The impaired microbicidal capacity was reflected by abrogated MPO and reduced NETs production in neutrophils along with reduced ROS production in both neutrophils and monocytes. Moreover, we observed a distinct pattern of cell surface receptor expression on both neutrophils and monocytes, in line with suppressed autocrine and paracrine cytokine signaling. This phenotype was characterized by a high expression of CD66b, CXCR4 and low expression of CXCR1, CXCR2 and CD15 in neutrophils and low expression of HLA-DR, CD86 and high expression of CD163 and CD11b in monocytes. Furthermore, the impaired antibacterial effector function was mediated by synergistic effect of the cytokines TNF-α, IFN-γ and IL-4. COVID-19 patients receiving dexamethasone showed a significant reduction of overall inflammatory markers in the plasma as well as exhibited an enhanced immune response towards bacterial challenge ex vivo. Finally, broad anti-inflammatory treatment was associated with a reduction in CRP, IL-6 levels as well as length of ICU stay and ventilation-days in critically ill COVID-19 patients. Our data provides insights into the transient functional dysregulation of myeloid immune cells against subsequent bacterial infections in COVID-19 patients and describe a beneficial role for the use of dexamethasone in these patients.
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Affiliation(s)
- Srikanth Mairpady Shambat
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alejandro Gómez-Mejia
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Tiziano A. Schweizer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Huemer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Chun-Chi Chang
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Judith Bergada-Pijuan
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Clément Vulin
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel A. Hofmaenner
- Institute of Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C. Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sanne Hertegonne
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Elena Parietti
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Nataliya Miroshnikova
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Pedro D. Wendel Garcia
- Institute of Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias P. Hilty
- Institute of Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Karl Buehler
- Institute of Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Reto A. Schuepbach
- Institute of Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D. Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Drug repurposing for SARS-CoV-2 (COVID-19) treatment. CORONAVIRUS DRUG DISCOVERY 2022. [PMCID: PMC9217734 DOI: 10.1016/b978-0-323-85156-5.00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Drug repurposing involves the process of investigating already existing drugs with an aim to use them for different therapeutic purposes than the intended one. This approach is relatively faster, less costly, and reliable in terms of safety as the drug under study is already derisked and known for its other chemistry and pharmacokinetic properties. With these benefits in mind, it is a very reliable way to undertake drug development for emerging diseases such as COVID-19 which demand immediate interventions to slow or completely stop its havoc on mankind. One of the biggest challenges that drug repurposing has is the possibility of the occurrence of new mechanisms of action between the drug ligand and some proteins in the human physiology. Drug repurposing appears to have settled in the meantime in drug development, though more studies in the future will be warranted particularly in regards to resistance.
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Rando HM, Wellhausen N, Ghosh S, Lee AJ, Dattoli AA, Hu F, Byrd JB, Rafizadeh DN, Lordan R, Qi Y, Sun Y, Brueffer C, Field JM, Ben Guebila M, Jadavji NM, Skelly AN, Ramsundar B, Wang J, Goel RR, Park Y, Boca SM, Gitter A, Greene CS. Identification and Development of Therapeutics for COVID-19. mSystems 2021; 6:e0023321. [PMID: 34726496 PMCID: PMC8562484 DOI: 10.1128/msystems.00233-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
After emerging in China in late 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread worldwide, and as of mid-2021, it remains a significant threat globally. Only a few coronaviruses are known to infect humans, and only two cause infections similar in severity to SARS-CoV-2: Severe acute respiratory syndrome-related coronavirus, a species closely related to SARS-CoV-2 that emerged in 2002, and Middle East respiratory syndrome-related coronavirus, which emerged in 2012. Unlike the current pandemic, previous epidemics were controlled rapidly through public health measures, but the body of research investigating severe acute respiratory syndrome and Middle East respiratory syndrome has proven valuable for identifying approaches to treating and preventing novel coronavirus disease 2019 (COVID-19). Building on this research, the medical and scientific communities have responded rapidly to the COVID-19 crisis and identified many candidate therapeutics. The approaches used to identify candidates fall into four main categories: adaptation of clinical approaches to diseases with related pathologies, adaptation based on virological properties, adaptation based on host response, and data-driven identification (ID) of candidates based on physical properties or on pharmacological compendia. To date, a small number of therapeutics have already been authorized by regulatory agencies such as the Food and Drug Administration (FDA), while most remain under investigation. The scale of the COVID-19 crisis offers a rare opportunity to collect data on the effects of candidate therapeutics. This information provides insight not only into the management of coronavirus diseases but also into the relative success of different approaches to identifying candidate therapeutics against an emerging disease. IMPORTANCE The COVID-19 pandemic is a rapidly evolving crisis. With the worldwide scientific community shifting focus onto the SARS-CoV-2 virus and COVID-19, a large number of possible pharmaceutical approaches for treatment and prevention have been proposed. What was known about each of these potential interventions evolved rapidly throughout 2020 and 2021. This fast-paced area of research provides important insight into how the ongoing pandemic can be managed and also demonstrates the power of interdisciplinary collaboration to rapidly understand a virus and match its characteristics with existing or novel pharmaceuticals. As illustrated by the continued threat of viral epidemics during the current millennium, a rapid and strategic response to emerging viral threats can save lives. In this review, we explore how different modes of identifying candidate therapeutics have borne out during COVID-19.
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Affiliation(s)
- Halie M. Rando
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Health AI, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nils Wellhausen
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Soumita Ghosh
- Institute of Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexandra J. Lee
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Ada Dattoli
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fengling Hu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Brian Byrd
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Diane N. Rafizadeh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Chemistry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yanjun Qi
- Department of Computer Science, University of Virginia, Charlottesville, Virginia, USA
| | - Yuchen Sun
- Department of Computer Science, University of Virginia, Charlottesville, Virginia, USA
| | | | - Jeffrey M. Field
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marouen Ben Guebila
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Nafisa M. Jadavji
- Biomedical Science, Midwestern University, Glendale, Arizona, USA
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Ashwin N. Skelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Jinhui Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rishi Raj Goel
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - YoSon Park
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - COVID-19 Review Consortium
BansalVikasBartonJohn P.BocaSimina M.BoerckelJoel D.BruefferChristianByrdJames BrianCaponeStephenDasShiktaDattoliAnna AdaDziakJohn J.FieldJeffrey M.GhoshSoumitaGitterAnthonyGoelRishi RajGreeneCasey S.GuebilaMarouen BenHimmelsteinDaniel S.HuFenglingJadavjiNafisa M.KamilJeremy P.KnyazevSergeyKollaLikhithaLeeAlexandra J.LordanRonanLubianaTiagoLukanTemitayoMacLeanAdam L.MaiDavidMangulSergheiManheimDavidMcGowanLucy D’AgostinoNaikAmrutaParkYoSonPerrinDimitriQiYanjunRafizadehDiane N.RamsundarBharathRandoHalie M.RaySandipanRobsonMichael P.RubinettiVincentSellElizabethShinholsterLamonicaSkellyAshwin N.SunYuchenSunYushaSzetoGregory L.VelazquezRyanWangJinhuiWellhausenNils
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Health AI, University of Colorado School of Medicine, Aurora, Colorado, USA
- Institute of Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Chemistry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Computer Science, University of Virginia, Charlottesville, Virginia, USA
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
- Biomedical Science, Midwestern University, Glendale, Arizona, USA
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- The DeepChem Project
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
- Early Biometrics & Statistical Innovation, Data Science & Artificial Intelligence, R & D, AstraZeneca, Gaithersburg, Maryland, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin—Madison, Madison, Wisconsin, USA
- Morgridge Institute for Research, Madison, Wisconsin, USA
- Childhood Cancer Data Lab, Alex’s Lemonade Stand Foundation, Philadelphia, Pennsylvania, USA
| | - Simina M. Boca
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
- Early Biometrics & Statistical Innovation, Data Science & Artificial Intelligence, R & D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Anthony Gitter
- Department of Biostatistics and Medical Informatics, University of Wisconsin—Madison, Madison, Wisconsin, USA
- Morgridge Institute for Research, Madison, Wisconsin, USA
| | - Casey S. Greene
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Health AI, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Childhood Cancer Data Lab, Alex’s Lemonade Stand Foundation, Philadelphia, Pennsylvania, USA
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Potential benefits of precise corticosteroid therapy for critical COVID-19. Respir Physiol Neurobiol 2021; 297:103813. [PMID: 34801741 PMCID: PMC8600764 DOI: 10.1016/j.resp.2021.103813] [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: 10/08/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 12/21/2022]
Abstract
This study was aimed to explore the precise dose of corticosteroid therapy in critical COVID-19. A total of forty-five critical COVID-19 patients were enrolled. The process of critical COVID-19 was divided into alveolitis and fibrosis stages. Most nonsurvivors died in fibrosis phase. Nonsurvivors had more dyspnea symptoms, fewer days of hospitalization, shorter duration of alveolitis and fibrosis. High-dose daily corticosteroid therapy (≥150 mg/d) was associated with shorter survival time and lower lymphocyte count in fibrosis phase. Moreover, a high cumulative dose (≥604 mg) was tied to longer duration of virus shedding, lower oxygenation index (OI), higher incidence of tracheal intubation, fewer lymphocytes and higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). In alveolitis phase, the low-to-moderate-dose daily corticosteroid therapy and a small cumulative dose reduced lymphocytes. In conclusion, low-to-moderate dose corticosteroids may be beneficial in the fibrosis phase. High-dose corticosteroid therapy in the fibrosis phase aggravates the severity of critical COVID-19.
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Yadullahi Mir WA, Siddiqui AH, Valecha G, Patel S, Ayub F, Upadhyay R, Alhajri SA, Gaire S, Shrestha DB. A Narrative Review of Existing Options for COVID-19-Specific Treatments. Adv Virol 2021; 2021:8554192. [PMID: 34804163 PMCID: PMC8604608 DOI: 10.1155/2021/8554192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022] Open
Abstract
The new coronavirus disease 2019 (COVID-19) was declared a global pandemic in early 2020. The ongoing COVID-19 pandemic has affected morbidity and mortality tremendously. Even though multiple drugs are being used throughout the world since the advent of COVID-19, only limited treatment options are available for COVID-19. Therefore, drugs targeting various pathologic aspects of the disease are being explored. Multiple studies have been published to demonstrate their clinical efficacy until now. Based on the current evidence to date, we summarized the mechanism, roles, and side effects of all existing treatment options to target this potentially fatal virus.
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Affiliation(s)
| | | | - Gautam Valecha
- Department of Oncology, Presbyterian Healthcare Services, Albuquerque, NM, USA
| | - Shawn Patel
- Department of Internal Medicine, The Carle Illinois College of Medicine, Champaign, IL, USA
| | - Fatima Ayub
- Department of Internal Medicine, The Carle Illinois College of Medicine, Champaign, IL, USA
| | - Riddhi Upadhyay
- Department of Internal Medicine, The Carle Illinois College of Medicine, Champaign, IL, USA
| | - Sana Ahmed Alhajri
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - Suman Gaire
- Department of Emergency Medicine, Palpa Hospital, Palpa, Nepal
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Hui S. Recent scientific research progress and challenges of COVID-19 pandemic: a global public health event. PROCEEDINGS OF THE INDIAN NATIONAL SCIENCE ACADEMY 2021. [PMCID: PMC8564281 DOI: 10.1007/s43538-021-00058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Liu L, Qu H, Li JJ, Yang YW, Zeng QX, Gong YW, He ZZ, Zhang YH, Zhang W, Liu B, Che LC. Effectiveness of methylprednisolone therapy in patients with a high-risk common type of COVID-19 pneumonia: a retrospective cohort study. Clin Exp Med 2021; 22:487-497. [PMID: 34677701 PMCID: PMC8532093 DOI: 10.1007/s10238-021-00765-1] [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: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
The optimal timing of glucocorticoid treatment for coronavirus disease 2019 (COVID-19) pneumonia is uncertain. We evaluated the clinical outcomes of methylprednisolone therapy (MPT) for patients with a high-risk common type (HRCT) COVID-19 pneumonia. We conducted a multicenter retrospective cohort study in Northeast China. A comparison was performed between the standard treatment (SDT) group and the SDT + MPT group to determine the efficacy of methylprednisolone in treating HRCT COVID-19 pneumonia. We collected the medical records of 403 patients with HRCT COVID-19 pneumonia (127 in the SDT + MPT group and 276 in the SDT group). None of the patients had received mechanical ventilation or died. Furthermore, there were no side effects associated with MPT. Patients in the SDT + MPT group treated with methylprednisolone received an intravenous injection for a median interval of five days (interquartile range of 3 to 7 days). The trends in lymphocyte count, C-reactive protein, interleukin 6, lactic acid dehydrogenase, respiratory rate, SpO2, PaO2, D-dimer and body temperature were similar between the SDT + MPT and SDT groups. The results for the SDT + MPT group seemed to improve faster than those for the SDT group; however, the results were not statistically significant. Clinical outcomes revealed that the average hospitalized days and the rate of progression to severe type COVID-19 pneumonia in both the SDT + MPT group and the SDT group were 14.56 ± 0.57 days versus 16.55 ± 0.3 days (p = 0.0009) and 21.26% (27/127) versus 32.4% (89/276) (p = 0.0247), respectively. The 16-day nucleic acid negative rate was higher in the SDT + MPT group than in the SDT group, 81.73% (104/127) versus 65.27% (180/276) (p = 0.0006). MPT effectively prevents patients with HRCT COVID-19 pneumonia from progressing to the severe stage.
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Affiliation(s)
- Lei Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Hang Qu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jun Jian Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan Wei Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiu Xi Zeng
- Kang'an Hospital of Mudanjiang, Mudanjiang, China
| | - Yan Wen Gong
- Kang'an Hospital of Mudanjiang, Mudanjiang, China
| | - Zhong Zhi He
- Kang'an Hospital of Mudanjiang, Mudanjiang, China
| | - Yi He Zhang
- Kang'an Hospital of Mudanjiang, Mudanjiang, China
| | - Wei Zhang
- Kang'an Hospital of Mudanjiang, Mudanjiang, China
| | - Bin Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Chun Che
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Doucet L, Hoflack S, Van Slambrouck L, Lormans P. The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study.
Background : For a long time, the use of corticosteroids in critically ill patients with coronavirus disease 2019 (COVID-19) has been a controversial treatment. How- ever, given the conflicting evidence on this topic, we studied the effects of methylprednisolone on critically ill patients and - share here our experience on laboratory findings and the Pa02/FiO2 ratio (ratio of partial oxygen concentration on arterial blood gas sample to fraction of inspired oxygen).
Methods : In a population of 68 patients hospitalized in the intensive care unit due because of COVID-19 infection, 28 patients with severe respiratory failure received methylprednisolone on a fixed 12-day regimen (125 mg IV for 2 days, followed by 2x0.5 mg/kg IV twice daily for 5 days, and then a decreasing regimen for 4 days until discontinuation). After day 5 and day 10, we analyzed the levels of CRP (C-reactive protein), lymphocytosis, D-dimer, LDH (lactate dehydrogenase) and PaO 2 /FiO 2 ratio of our patients.
Results : We observed a significant decrease in median CRP levels between day 0 (start of methylprednisolone treatment) and day 5 (p=0.001), and between day 0 and day 10 (p=0.005). No decrease was seen between day 5 and 10 (p=0.352). The same increase in PaO 2 /FiO 2 was recorded between day 0 and day 5 (p=0.009), and between 0 and day 10 (p=0.019). For D-dimer, only a significant difference was found between day 0 and day 10 (p=0.018). No significant difference could be observed for lymphocytosis and LDH levels between the beginning of the treatment and day 5 or day 10.
Conclusion : There is a strong and sustained significant decrease in CRP levels and a tilt in the PaO2/FiO2 ratio after starting methylprednisolone. A slower, but also significant decrease was found for D-dimer. Further research and control group analyses are needed to confirm that this effect is due to corticostreoid treatment. However, this indicates that methylprednisolone may play a very important role in the treatment of the severely ill COVID-19 patients requiring ICU admission.
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Ahmad B, Manzar A, Khrshid S, Ul Hassan N, Muhammad A. Methylprednisolone for COVID-19 Patients Admitted to a Tertiary Care Hospital: A Single-Centre Study. Cureus 2021; 13:e17693. [PMID: 34650867 PMCID: PMC8487664 DOI: 10.7759/cureus.17693] [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] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of various corticosteroids in the management of COVID-19 is evolving. Following an initial lack of evidence, the relatively novel data, supporting the survival benefit to severe and critical COVID-19 patients, is of limited scale. MATERIALS AND METHODS This retrospective study observed medical records and disease outcomes of 200 patients with moderate, severe and critical COVID-19 receiving methylprednisolone (MP). The dose of methylprednisolone was 0.5 to 2 mg per kg in these patients. RESULTS Median age of presentation was 59 years. The median duration of symptoms at presentation was five days. The most common presenting symptoms were cough (77.5%), fever (67.5%) and shortness of breath (63.5%). Majority of patients (85%) presented in the first week of illness. One or more comorbidities were present in 75% of patients. Complications seen in the study cohort were cytokine release syndrome (CRS) 92 (46%), acute respiratory distress syndrome (ARDS) 44 (22%) and multi-organ dysfunction 17 (8.5%). The median time for initiation of corticosteroid therapy was four hours. Overall survival (OS) in patients receiving methylprednisolone was 83.5%. The OS for patients with moderate, severe and critical diseases was 97.8%, 86.2% and 62%, respectively (p<0.001). CONCLUSION Steroids like methylprednisolone are useful in COVID-19 admitted patients and provide excellent survival outcomes.
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Affiliation(s)
- Bilal Ahmad
- Endocrinology and Diabetes, Pak-Emirates Military Hospital Rawalpindi, Rawalpindi, PAK
| | - Adnan Manzar
- Internal Medicine, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Saba Khrshid
- Internal Medicine, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Naeem Ul Hassan
- Internal Medicine, Combined Military Hospital, Rawalpindi, PAK
| | - Anjum Muhammad
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
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Fan Y, Wang Y, Yu S, Chang J, Yan Y, Wang Y, Bian Y. Natural products provide a new perspective for anti-complement treatment of severe COVID-19: a review. Chin Med 2021; 16:67. [PMID: 34321065 PMCID: PMC8318062 DOI: 10.1186/s13020-021-00478-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
Exaggerated immune response and cytokine storm are accounted for the severity of COVID-19, including organ dysfunction, especially progressive respiratory failure and generalized coagulopathy. Uncontrolled activation of complement contributes to acute and chronic inflammation, the generation of cytokine storm, intravascular coagulation and cell/tissue damage, which may be a favorable target for the treatment of multiple organ failure and reduction of mortality in critically ill patients with COVID-19. Cytokine storm suppression therapy can alleviate the symptoms of critically ill patients to some extent, but as a remedial etiological measure, its long-term efficacy is still questionable. Anti-complement therapy has undoubtedly become an important hotspot in the upstream regulation of cytokine storm. However, chemosynthetic complement inhibitors are expensive, and their drug resistance and long-term side effects require further investigation. New complement inhibitors with high efficiency and low toxicity can be obtained from natural products at low development cost. This paper puts forward some insights of the development of natural anti-complement products in traditional Chinese medicine, that may provide a bright perspective for suppressing cytokine storm in critically ill patients with COVID-19.
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Affiliation(s)
- Yadong Fan
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, No.10 PoYangHu Road, JingHai, District, Tianjin, 301617, People's Republic of China
| | - Ying Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, No.10 PoYangHu Road, JingHai, District, Tianjin, 301617, People's Republic of China
| | - Shuang Yu
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, No.10 PoYangHu Road, JingHai, District, Tianjin, 301617, People's Republic of China
| | - Jun Chang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, No.10 PoYangHu Road, JingHai, District, Tianjin, 301617, People's Republic of China
| | - Yiqi Yan
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yiyang Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, No.10 PoYangHu Road, JingHai, District, Tianjin, 301617, People's Republic of China
| | - Yuhong Bian
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, No.10 PoYangHu Road, JingHai, District, Tianjin, 301617, People's Republic of China.
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Rufaida, Mahmood T, Kedwai I, Ahsan F, Shamim A, Shariq M, Parveen S. A dossier on COVID-19 chronicle. J Basic Clin Physiol Pharmacol 2021; 33:45-54. [PMID: 34280963 DOI: 10.1515/jbcpp-2020-0511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/28/2021] [Indexed: 01/08/2023]
Abstract
The dissemination of the 2019 novel coronavirus (2019-nCoV) is presenting the planet with a new health emergency response or threat to health. The virus emerged in bats and was disseminated to humans in December 2019 via still unknown intermediate species in Wuhan, China. It is disseminated by inhalation or breaks out with infected droplets and the incubation period is between 2 and 14 days. The symptoms usually include high body temperature, cough, sore throat, dyspnea, low energy or tiredness, and weakness. The condition is moderate in most people; but in the elderly and those with comorbidities, it advances to pneumonia, acute respiratory distress syndrome (ARDS), and multiple organ failure. Popular research work includes normal/low WBC with upraised C-reactive protein (CRP). Treatment is generally supportive and requires home seclusion of suspected persons and rigorous infection control methods at hospitals. The Covid-19 has lower fatality than SARS and MERS. Among the proposed therapeutic regimen, hydroxychloroquine, chloroquine, remdisevir, azithromycin, toclizumab, and cromostat mesylate have shown promising results, and the limited benefit was seen with lopinavir-ritonavir treatment in hospitalized adult patients with severe COVID-19. Early development of the SARS-CoV-2 vaccine started based on the full-length genome analysis of severe acute respiratory syndrome coronavirus. Several subunit vaccines, peptides, nucleic acids, plant-derived, and recombinant vaccines are under pipeline. Research work, development of new medicines and vaccines, and efforts to reduce disease morbidity and mortality must be encouraged to improve our position in the fight against this disease and to protect human life.
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Affiliation(s)
- Rufaida
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Tarique Mahmood
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Ismail Kedwai
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Farogh Ahsan
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Arshiya Shamim
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Mohammad Shariq
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Saba Parveen
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
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Ren H, Guo X, Palazón-Bru A, Yang P, Huo N, Wang R, Sun Y, Hu Q, Yang H, Xu G. Regional Differences in Epidemiological and Clinical Characteristics, Treatment, and Clinical Outcomes of COVID-19 in Wuhan and Remote Areas of Hubei Province. Front Med (Lausanne) 2021; 8:667623. [PMID: 34336881 PMCID: PMC8319467 DOI: 10.3389/fmed.2021.667623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a major threat to global health. Regional differences in epidemiological and clinical characteristics, treatment and outcomes of patients have not yet been investigated. This study was conducted to investigate these differences amongCOVID-19 patients in Hubei Province, China. Methods: This retrospective cross-sectional study analyzed data on 289 COVID-19 patients from designated hospitals in three regions:Urban (Wuhan Union West Hospital), Suburban areas of Wuhan (Hannan Hospital) and Enshi city, between February 8 and 20, 2020. The final date of follow-up was December 14th, 2020. The outcomes were case fatality rate and epidemiological and clinical data. Results: Urban Wuhan experienced a significantly higher case fatality rate (21.5%) than suburban Wuhan (5.23%) and rural area of Enshi (3.51%). Urban Wuhan had a higher proportion of patients on mechanical ventilation (24.05%) than suburban Wuhan (0%) and rural Enshi (3.57%). Treatment with glucocorticoids was equivalent in urban and suburban Wuhan (46.84 and 45.75%, respectively) and higher than Enshi (25.00%). Urban Wuhan had a higher proportion of patients with abnormal tests including liver function and serum electrolytes and a higher rate of pneumonia (p < 0.01 for all). Urban Wuhan also had a higher incidence of respiratory failure, heart disease, liver disease and shock, compared with the other two regions (all p < 0.05). Conclusions: Our findings revealed that there are regional differences in COVID-19. These findings provide novel insights into the distribution of appropriate resources for the prevention, control and treatment of COVID-19 for the global community.
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Affiliation(s)
- Honggang Ren
- Department of Internal Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingyi Guo
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University of Elche, Elche, Spain
| | | | - Nan Huo
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Runsheng Wang
- Second Medical Center, People's Liberation Army General Hospital, Beijing, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qinyong Hu
- Renmin Hospital of Wuhan University, Wuhan, China.,Cancer Centre, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hua Yang
- Department of Respiratory Medicine, Minzu University Hospital of Hubei Minzu University, Enshi, China
| | - Guogang Xu
- The Second Medical Centre and National Clinical Research Centre for Geriatric Diseases, Chinese People's Liberation Army of China General Hospital, Beijing, China
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Abstract
Context: SARS-COV-2 is a coronavirus belonging to the beta-coronavirus group that primarily targets the human respiratory system and causes symptoms similar to those of pneumonia. It should be noted that clinical symptoms of patients with COVID-19 vary in different people. These patients do not only experience respiratory problems. In fact, COVID-19 infection may show a variety of symptoms, including fever, shortness of breath, dry cough, nasal congestion, sore throat, nausea, vomiting, myalgia, arthralgia, fatigue (muscular and mental), joint swelling, headache, diarrhea, as well as some musculoskeletal symptoms. Therefore, the aim of this article was to investigate the major musculoskeletal problems in patients with COVID-19 through a narrative review study. Evidence Acquisition: This study collected the related published studies in the PubMed, ScienceDirect, and Google Scholar sources between 2019 - 2020. The main keywords were COVID-19, coronavirus, and musculoskeletal problems such as muscle fatigue, myalgia, arthralgia, and joint swelling. Results: The major musculoskeletal symptoms included muscle fatigue (25.6%), myalgia and arthralgia (15.5%), joint swelling (as reactive arthritis), and such conditions as joint limitations, tendon shortening, and muscle weakness due to prolonged bed rest. Conclusions: Our findings revealed that attention to musculoskeletal rehabilitation of patients with COVID-19 is as essential as their respiratory rehabilitation. Besides, it would be effective in reducing the physical complications of hospitalization, returning to independence and functional activities, as well as improving the quality of the patients’ life.
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Romanou V, Koukaki E, Chantziara V, Stamou P, Kote A, Vasileiadis I, Koutsoukou A, Rovina N. Dexamethasone in the Treatment of COVID-19: Primus Inter Pares? J Pers Med 2021; 11:556. [PMID: 34203880 PMCID: PMC8232727 DOI: 10.3390/jpm11060556] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread globally, becoming a huge public health challenge. Even though the vast majority of patients are asymptomatic, some patients present with pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and death. It has been shown in several studies that the severity and clinical outcomes are related to dysregulated antiviral immunity and enhanced and persistent systemic inflammation. Corticosteroids have been used for the treatment of COVID-19 patients, as they are reported to elicit benefits by reducing lung inflammation and inflammation-induced lung injury. Dexamethasone has gained a major role in the therapeutic algorithm of patients with COVID-19 pneumonia requiring supplemental oxygen or on mechanical ventilation. Its wide anti-inflammatory action seems to form the basis for its beneficial action, taming the overwhelming "cytokine storm". Amid a plethora of scientific research on therapeutic options for COVID-19, there are still unanswered questions about the right timing, right dosing, and right duration of the corticosteroid treatment. The aim of this review article was to summarize the data on the dexamethasone treatment in COVID-19 and outline the clinical considerations of corticosteroid therapy in these patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (V.R.); (E.K.); (V.C.); (P.S.); (A.K.); (I.V.); (A.K.)
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40
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Torabi-Rahvar M, Rezaei N. Storm at the Time of Corona: A Glimpse at the Current Understanding and Therapeutic Opportunities of the SARS-CoV-2 Cytokine Storm. Curr Pharm Des 2021; 27:1549-1552. [PMID: 33238863 DOI: 10.2174/1381612826666201125102649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/21/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to severe disease in some cases, leading to acute respiratory distress syndrome, multi-organ failure, and death. This severe phenotype seems to be associated with a cytokine storm and immune dysregulation. Increased pro-inflammatory cytokines and CD14+CD16+ inflammatory monocytes, lymphopenia, and decreased levels of regulatory T cells are some of the immunological features that are seen in patients with SARS-CoV-2. As the outcome of SARS-CoV-2 is influenced by both viral virulence and dysregulated inflammatory response, a combination therapy approach using antiviral drugs plus anti-inflammatory treatments, such as corticosteroids, monoclonal antibodies against the IL-6 and IL-1β pathways, and JAK inhibitors are under clinical trials.
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Affiliation(s)
- Monireh Torabi-Rahvar
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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41
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Tian C, Xiang M. Therapeutic Agents Against COVID-19 with Clinical Evidence. Curr Pharm Des 2021; 27:1608-1617. [PMID: 33459226 DOI: 10.2174/1381612827666210114150951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/22/2020] [Accepted: 12/14/2020] [Indexed: 01/10/2023]
Abstract
Over 57 million people have been confirmed to have coronavirus disease 2019 (COVID-19) worldwide. Although several drugs have shown potential therapeutic effects, there is no specific drug against COVID-19. In this review, we summarized potential therapeutic agents against COVID-19 with clinical evidence, including antiviral agents, anti-cytokine storm syndrome agents, and vaccines, as well as other drugs. In addition, we briefly discussed their effects on COVID-19, which will contribute to developing treatment plans.
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Affiliation(s)
- Cheng Tian
- Department of Pharmacology, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ming Xiang
- Department of Pharmacology, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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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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Xiong B, He LM, Qin YY, Du H, Zhan Z, Zhou YH, Chen YK, Zhang A. Effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19: A retrospective cohort study. World J Clin Cases 2021; 9:3546-3558. [PMID: 34046454 PMCID: PMC8130064 DOI: 10.12998/wjcc.v9.i15.3546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/21/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The effectiveness of adjunctive corticosteroid use in patients with coronavirus disease 2019 (COVID-19) remains inconclusive.
AIM To investigate the effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19.
METHODS We conducted a retrospective analysis of the difference in several outcomes between patients with severe COVID-19 who received corticosteroid therapy (the corticosteroid group) and patients with severe COVID-19 who did not receive corticosteroid therapy (the non-corticosteroid group).
RESULTS Seventy-five patients were included in this study. Of these, 47 patients were in the corticosteroid group and 28 patients were in the non-corticosteroid group. There were no differences between the two groups in the total length of hospital stay, the length of intensive care unit stay, high-flow oxygen days, non-invasive ventilator days, invasive ventilation days, and mortality rate. Total lesion volume ratio, consolidation volume ratio and ground-glass opacity volume ratio in the corticosteroid group decreased significantly on day 14, while those in the non-corticosteroid group did not show a significant decrease.
CONCLUSION Our results show that adjunctive corticosteroid use did not significantly improve clinical outcomes in severe COVID-19 patients, but might promote the absorption of pulmonary lesions. Larger multicenter randomized controlled studies may be needed to confirm this.
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Affiliation(s)
- Bin Xiong
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Li-Min He
- Department of Cardiology, The First Branch of The First Affiliated Hospital, Chongqing Medical University, Chongqing 400015, China
| | - Yuan-Yuan Qin
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Hu Du
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Zhu Zhan
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Yi-Hong Zhou
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - An Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Does methylprednisolone affect time to recovery in COVID–19 Pneumonia? MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.942800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mei M, Tan X. Current Strategies of Antiviral Drug Discovery for COVID-19. Front Mol Biosci 2021; 8:671263. [PMID: 34055887 PMCID: PMC8155633 DOI: 10.3389/fmolb.2021.671263] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 belongs to the family of enveloped, single-strand RNA viruses known as Betacoronavirus in Coronaviridae, first reported late 2019 in China. It has since been circulating world-wide, causing the COVID-19 epidemic with high infectivity and fatality rates. As of the beginning of April 2021, pandemic SARS-CoV-2 has infected more than 130 million people and led to more than 2.84 million deaths. Given the severity of the epidemic, scientists from academia and industry are rushing to identify antiviral strategies to combat the disease. There are several strategies in antiviral drugs for coronaviruses including empirical testing of known antiviral drugs, large-scale phenotypic screening of compound libraries and target-based drug discovery. To date, an increasing number of drugs have been shown to have anti-coronavirus activities in vitro and in vivo, but only remdesivir and several neutralizing antibodies have been approved by the US FDA for treating COVID-19. However, remdesivir's clinical effects are controversial and new antiviral drugs are still urgently needed. We will discuss the current status of the drug discovery efforts against COVID-19 and potential future directions. With the ever-increasing movability of human population and globalization of world economy, emerging and reemerging viral infectious diseases seriously threaten public health. Particularly the past and ongoing outbreaks of coronaviruses cause respiratory, enteric, hepatic and neurological diseases in infected animals and human (Woo et al., 2009). The human coronavirus (HCoV) strains (HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1) usually cause common cold with mild, self-limiting upper respiratory tract infections. By contrast, the emergence of three deadly human betacoronaviruses, middle east respiratory syndrome coronavirus (MERS) (Zaki et al., 2012), severe acute respiratory syndrome coronavirus (SARS-CoV) (Lee et al., 2003), the SARS-CoV-2 (Jin et al., 2020a) highlight the need to identify new treatment strategies for viral infections. SARS-CoV-2 is the etiological agent of COVID-19 disease named by World Health Organization (WHO) (Zhu N. et al., 2020). This disease manifests as either an asymptomatic infection or a mild to severe pneumonia. This pandemic disease causes extent morbidity and mortality in the whole world, especially regions out of China. Similar to SARS and MERS, the SARS CoV-2 genome encodes four structural proteins, sixteen non-structural proteins (nsp) and accessory proteins. The structural proteins include spike (S), envelope (E), membrane (M), nucleoprotein (N). The spike glycoprotein directly recognizes and engages cellular receptors during viral entry. The four non-structural proteins including papain-like protease (PLpro), 3-chymotrypsin-like protease (3CLpro), helicase, and RNA-dependent RNA polymerase (RdRp) are key enzymes involved in viral transcription and replication. The spike and the four key enzymes were considered attractive targets to develop antiviral agents (Zumla et al., 2016). The catalytic sites of the four enzymes of SARS-CoV2 share high similarities with SARS CoV and MERS in genomic sequences (Morse et al., 2020). Besides, the structures of the key drug-binding pockets are highly conserved among the three coronaviruses (Morse et al., 2020). Therefore, it follows naturally that existing anti-SARS-CoV and anti-MERS drugs targeting these enzymes can be repurposed for SARS-CoV-2. Based on previous studies in SARS-CoV and MERS-CoV, it is anticipated a number of therapeutics can be used to control or prevent emerging infectious disease COVID-19 (Li and de Clercq, 2020; Wang et al., 2020c; Ita, 2021), these include small-molecule drugs, peptides, and monoclonal antibodies. Given the urgency of the SARS-CoV-2 outbreak, here we discuss the discovery and development of new therapeutics for SARS-CoV-2 infection based on the strategies from which the new drugs are derived.
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Affiliation(s)
- Miao Mei
- Tsinghua-Peking Center for Life Sciences, Beijing Advanced Innovation Center for Structural Biology, Beijing Frontier Research Center for Biological Structure, MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, School of Pharmaceutical Sciences, Center for infectious Disease Research, School of Medicine, Tsinghua University, Beijing, China
| | - Xu Tan
- Beijing Advanced Innovation Center for Structural Biology, Beijing Frontier Research Center for Biological Structure, MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, School of Pharmaceutical Sciences, Center for Infectious Disease Research, School of Medicine, Tsinghua University, Beijing, China
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Jeronimo CMP, Farias MEL, Val FFA, Sampaio VS, Alexandre MAA, Melo GC, Safe IP, Borba MGS, Netto RLA, Maciel ABS, Neto JRS, Oliveira LB, Figueiredo EFG, Oliveira Dinelly KM, de Almeida Rodrigues MG, Brito M, Mourão MPG, Pivoto João GA, Hajjar LA, Bassat Q, Romero GAS, Naveca FG, Vasconcelos HL, de Araújo Tavares M, Brito-Sousa JD, Costa FTM, Nogueira ML, Baía-da-Silva DC, Xavier MS, Monteiro WM, Lacerda MVG. Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With Coronavirus Disease 2019 (COVID-19; Metcovid): A Randomized, Double-blind, Phase IIb, Placebo-controlled Trial. Clin Infect Dis 2021; 72:e373-e381. [PMID: 32785710 PMCID: PMC7454320 DOI: 10.1093/cid/ciaa1177] [Citation(s) in RCA: 281] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background Steroid use for COVID-19 is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by SARS-CoV-2. This study aimed at evaluating at evaluating the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. Methods Parallel, double-blind, placebo-controlled, randomized, phase IIb clinical trial was performed with hospitalized patients aged ≥ 18 years with clinical, epidemiological and/or radiological suspected COVID-19, at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution), twice daily, for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality. ClinicalTrials Identifier NCT04343729. Findings From April 18 to June 16, 2020, 647 patients were screened, 416 randomized, and 393 analyzed as mITT, MP in 194 and placebo in 199 individuals. SARS-CoV-2 infection was confirmed by RT-PCR in 81.3%. Mortality at day 28 was not different between groups. A subgroup analysis showed that patients over 60 years in the MP group had a lower mortality rate at day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until day 7. Conclusion The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population.
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Affiliation(s)
| | - Maria Eduarda Leão Farias
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto Leônidas and Maria Deane, Fiocruz Amazonas, Manaus, Brazil
| | - Fernando Fonseca Almeida Val
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson Souza Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil.,Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | | | - Gisely Cardoso Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Mayla Gabriela Silva Borba
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Rebeca Linhares Abreu Netto
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Alex Bezerra Silva Maciel
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Lucas Barbosa Oliveira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Erick Frota Gomes Figueiredo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | | | | | - Marcelo Brito
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Guilherme Augusto Pivoto João
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Quique Bassat
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | | | | | | | | | - José Diego Brito-Sousa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | | | | | - Djane Clarys Baía-da-Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Mariana Simão Xavier
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto Nacional de Infectologia Carlos Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto Leônidas and Maria Deane, Fiocruz Amazonas, Manaus, Brazil
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Coronavirus Disease 2019: An Overview of the Complications and Management. Pharmacol Ther 2021. [DOI: 10.36922/itps.v4i1.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Since the first report of COVID-19 emerging in Wuhan, China, authorities in 216 countries and territories have reported about 47.3 million COVID-19 cases and 1.2 million deaths. The WHO guidelines for the management of COVID-19 are very limited to recommendations for managing symptoms and advice on careful management of pediatric patients, pregnant women, and patients with underlying comorbidities. There is no approved treatment for COVID-19 and guidelines vary between countries. In this review, first, a brief overview is provided on the basic knowledge about the virus, clinical features of the disease, and different diagnostic methods. Then, the relationship between COVID-19, various body systems, and other complications is discussed. Finallly, different management strategies are discussed, including those drawn on computational chemistry analyses, pre-clinical investigations, and clinical trials which involve pharmacological and non-pharmacological interventions. In conclusion, despite the recent approval of different vaccine candidates, more virological characteristics of SARS-CoV-2 are required to be explored, which may result in the discovery of more potential therapeutic targets leading to safer and more effective treatment to COVID-19.
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Fernández-Cruz A, Ruiz-Antorán B, Múñez-Rubio E, Sancho-López A, Callejas-Díaz A, Avendaño-Solá C, Ramos-Martínez A. The Right Time for Steroids in COVID-19. Clin Infect Dis 2021; 72:1486-1487. [PMID: 32585016 PMCID: PMC7337659 DOI: 10.1093/cid/ciaa865] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ana Fernández-Cruz
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Belén Ruiz-Antorán
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Elena Múñez-Rubio
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Aránzazu Sancho-López
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Alejandro Callejas-Díaz
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Cristina Avendaño-Solá
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Antonio Ramos-Martínez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Chen R, Lan Z, Ye J, Pang L, Liu Y, Wu W, Qin X, Guo Y, Zhang P. Cytokine Storm: The Primary Determinant for the Pathophysiological Evolution of COVID-19 Deterioration. Front Immunol 2021; 12:589095. [PMID: 33995341 PMCID: PMC8115911 DOI: 10.3389/fimmu.2021.589095] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing major threat to global health and has posed significant challenges for the treatment of severely ill COVID-19 patients. Several studies have reported that cytokine storms are an important cause of disease deterioration and death in COVID-19 patients. Consequently, it is important to understand the specific pathophysiological processes underlying how cytokine storms promote the deterioration of COVID-19. Here, we outline the pathophysiological processes through which cytokine storms contribute to the deterioration of SARS-CoV-2 infection and describe the interaction between SARS-CoV-2 and the immune system, as well as the pathophysiology of immune response dysfunction that leads to acute respiratory distress syndrome (ARDS), multi-organ dysfunction syndrome (MODS), and coagulation impairment. Treatments based on inhibiting cytokine storm-induced deterioration and occurrence are also described.
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Affiliation(s)
- Ruirong Chen
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhien Lan
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jujian Ye
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Limin Pang
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yi Liu
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei Wu
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaohuan Qin
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peidong Zhang
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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The proportion and effect of corticosteroid therapy in patients with COVID-19 infection: A systematic review and meta-analysis. PLoS One 2021; 16:e0249481. [PMID: 33882090 PMCID: PMC8059814 DOI: 10.1371/journal.pone.0249481] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives Coronavirus disease 2019 (COVID-19) remains a global challenge. Corticosteroids constitute a group of anti-inflammatory and immunosuppressive drugs that are widely used in the treatment of COVID-19. Comprehensive reviews investigating the comparative proportion and efficacy of corticosteroid use are scarce. Therefore, we conducted a systematic review and meta-analysis of clinical trials to evaluate the proportion and efficacy of corticosteroid use for the treatment of COVID-19. Methods We conducted a comprehensive literature review and meta-analysis of research articles, including observational studies and clinical trials, by searching the PubMed, EMBASE, Cochrane Controlled Trials Registry, and China Academic Journal Network Publishing databases. Patients treated between December 1, 2019, and January 1, 2021, were included. The outcome measures were the proportion of patients treated with corticosteroids, viral clearance and mortality. The effect size with the associated 95% confidence interval is reported as the weighted mean difference for continuous outcomes and the odds ratio for dichotomous outcomes. Results Fifty-two trials involving 15710 patients were included. The meta-analysis demonstrated that the proportion of COVID-19 patients who received corticosteroids was significantly lower than that of patients who did not receive corticosteroids (35.19% vs. 64.49%). In addition, our meta-analysis demonstrated no significant difference in the proportions of severe and nonsevere cases treated with corticosteroids (27.91% vs. 20.91%). We also performed subgroup analyses stratified by whether patients stayed in the intensive care unit (ICU) and found that the proportion of patients who received corticosteroids was significantly higher among those who stayed in the ICU than among those who did not. The results of our meta-analysis indicate that corticosteroid treatment significantly delayed the viral clearance time. Finally, our meta-analysis demonstrated no significant difference in the use of corticosteroids for COVID-19 between patients who died and those who survived. This result indicates that mortality is not correlated with corticosteroid therapy. Conclusion The proportion of COVID-19 patients who received corticosteroids was significantly lower than that of patients who did not receive corticosteroids. Corticosteroid use in subjects with severe acute respiratory syndrome coronavirus 2 infections delayed viral clearance and did not convincingly improve survival; therefore, corticosteroids should be used with extreme caution in the treatment of COVID-19.
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