COVID-19 patients with hypertension have more severe disease: a multicenter retrospective observational study

Real-World Efficacy of Ensitrelvir in Hospitalized Patients With COVID-19 in Japan: A Retrospective Observational Study

BACKGROUND AND AIM

The coronavirus disease 2019 (COVID-19) pandemic necessitates continuously evaluating antiviral treatments, especially for high-risk groups, including older individuals. This study aimed to compare the efficacy of three antiviral drugs, including remdesivir, molnupiravir, and ensitrelvir, in hospitalized patients as measured by our own institution's antigen test, focusing on outcomes, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen levels, hospitalization duration, and fever resolution.

METHODS

This retrospective observational study was conducted at Yoshida Hospital, Asahikawa City, Japan, enrolling 154 patients who received antiviral treatment upon COVID-19 diagnosis from July 1, 2022, to September 15, 2023. The diagnosis was confirmed by proprietary antigen tests or loop-mediated isothermal amplification assays. Patients who received treatment outside the hospital or with consistently negative antigen results were excluded. Drug administration was determined by attending physicians, considering oral administration challenges and renal dysfunction. The data were statistically analyzed using an unpaired two-tailed Student's t-test and one-way analysis of variance complemented by the Tukey post-hoc test for detailed group comparisons.

RESULTS

No significant differences were observed in the initial antigen levels among the treatment groups. By day 10, the ensitrelvir group showed lower antigen levels than the other groups, but not significantly. The ensitrelvir group had a higher antigen-negative conversion rate and a significantly shorter hospital stay than the molnupiravir group. However, no significant differences were noted in the fever resolution time among the groups.

CONCLUSION

This study suggests the potential benefits of ensitrelvir in reducing antigen levels and hospitalization duration. However, the overall efficacy of the antiviral agents for symptomatic relief appears similar. These findings underscore the need for further research to optimize COVID-19 management by considering personalized treatment approaches and long-term outcomes.

Prevalence of Hypertension and Diabetes in Severe COVID-19: A Cross-Sectional Study from Single Center, Kabul

Introduction

Previous studies have reported an association between certain medical conditions, such as hypertension and diabetes, and severe COVID-19.

Objective

To determine the prevalence of hypertension and diabetes among severe COVID-19 patients who were admitted to the only specialized center for COVID-19 in Kabul, Afghan-Japan Hospital Kabul, Afghanistan.

Methods

A cross-sectional design was utilized, including 202 patients, admitted to Afghan-Japan Hospital during the first six months of 2022. Medical records of patients tested positive for COVID-19 via Polymerase chain reaction (PCR) with oxygen saturation levels below 90% at the time of admission were included in the study. Age, sex, and the presence of hypertension and diabetes were the studied variables. Descriptive statistics were used for analysis.

Results

The median age of the patients were 63 (IQR=54.75-75) years. Males and females each accounting for 50% of the total, and the majority of the patients (50.5%) were in the age group 60-79. Of 202 patients, 143 (70.8%) had hypertension, 42 (20.8%) had diabetes, 147 patients (72.77%) had at least one of these comorbidities. Fifty-five patients (27.22%) were without diabetes and without hypertension. The prevalence of hypertension and diabetes was higher among female, ie, 57.1% and 54.5% respectively. Patients in the 40-59 year old group had the highest rate of hypertension (75.6%). The highest prevalence of diabetes was seen in the 60-79 year old group.

Conclusion

The study found a higher prevalence of hypertension in severe COVID-19 cases compared to global reports and the general adult population in Afghanistan. The relationship between hypertension and COVID-19 risk needs further investigation. The prevalence of diabetes was also higher, consistent with findings from other countries.

[Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000-2022]

OBJECTIVE

To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico.

METHODS

An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000-2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied.

RESULTS

There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019-2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021-2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic.

CONCLUSIONS

The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.

Retrospective cohort study to evaluate the continuous use of anticholesterolemics and diuretics in patients with COVID-19

Purpose

The purpose of this study is to evaluate the interference of the continuous use of drug classes in the expression of biomarkers during the first week of hospitalization and in the prognosis of patients with COVID-19.

Methods

The patients diagnosed with COVID-19 and confirmed with SARS-CoV-2 by RT-qPCR assay underwent the collection of fasting whole blood samples for further analysis. Other data also extracted for this study included age, sex, clinical symptoms, related comorbidities, smoking status, and classes of continuous use. Routine serum biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, N-terminal fragment of B-type natriuretic peptide, and cardiac troponin, were measured.

Results

In this cross-sectional study, a total of 176 patients with COVID-19 hospitalizations were included. Among them, 155 patients were discharged (88.5%), and 21 patients died (12%). Among the drug classes evaluated, we verified that the continuous use of diuretic 4.800 (1.853-11.67) (p = 0.0007) and antihypercholesterolemic 3.188 (1.215-7.997) (p = 0.0171) drug classes presented a significant relative risk of death as an outcome when compared to the group of patients who were discharged. We evaluated biomarkers in patients who used continuous antihypercholesterolemic and diuretic drug classes in the first week of hospitalization. We observed significant positive correlations between the levels of CRP with cardiac troponin (r = 0.714), IL-6 (r = 0.600), and IL-10 (r = 0.900) in patients who used continuous anticholesterolemic and diuretic drug classes and were deceased. In these patients, we also evaluated the possible correlations between the biomarkers AST, NT-ProBNP, cardiac troponin, IL-6, IL-8, and IL-10. We observed a significantly negative correlations in AST levels with NT-ProBNP (r = -0.500), cardiac troponin (r = -1.00), IL-6 (r = -1.00), and IL-10 (r = -1.00) and a positive correlation with IL-8 (r = 0.500). We also observed significant negative correlation in the levels of NT-ProBNP with IL-10 (r = -0.800) and a positive correlation with cardiac troponin (r = 0.800). IL-6 levels exhibited positive correlations with cardiac troponin (r = 0.800) and IL-10 (r = 0.700).

Conclusion

In this study, we observed that hospitalized COVID-19 patients who continued using anticholesterolemic and diuretic medications showed a higher number of correlations between biomarkers, indicating a poorer clinical prognosis. These correlations suggest an imbalanced immune response to injuries caused by SARS-CoV-2.

Study on the correlation between lifestyle and negative conversion time in patients diagnosed with coronavirus disease (COVID-19): a retrospective cohort study

BACKGROUND

As of early December 2022, China eased the coronavirus disease (COVID-19) restriction, affecting over 80% of the country's population and posing a severe threat to public health. Previous studies mostly focused factors on the severity/mortality rate of hospitalized COVID-19 patients, but limited studies explored factors associated with virus-negative conversion, particularly lifestyles. Therefore, the aim of our study was to analyze the correlation between lifestyle factors and the negative conversion time in COVID-19 patients.

METHODS

We recruited individuals aged 18 years or older who had a clear time record for both the diagnosis and negative conversion of COVID-19 and completed the electronic questionnaire with no missing data. Dietary data collected from the questionnaire was analyzed using exploratory factor analysis to establish dietary patterns. Age segmentation was performed using restricted cubic spline (RCS) plots. The association between lifestyle factors and the time to negative conversion in different age groups, was assessed using Kaplan-Meier plots and Cox regression analysis.

RESULT

Out of 514 participants, all achieved viral negative conversion within a median time of 11 days. Based on nutrient intake, we identified four dietary patterns. The relationship between age and negative conversion rate, as depicted by RCS plots, exhibited an inverted "U" shape. We categorized age into three segments: <35 years, 35-45 years, and ≥ 45 years. For individuals under 35, our study indicated that a higher protein intake was linked to a faster recovery among COVID-19 patients, while medical staff or those receiving prescription treatments exhibited a slower recovery rate (P < 0.05). The 35 ~ 45 age group showed that adequate sleep and physical exercise were associated with a shorter time to negative conversion, whereas southern regions and a higher intake of carbohydrates were related with a longer conversion time (P < 0.05). Among individuals aged ≥ 45 years, the negative conversion time was primarily associated with physical exercise and being a medical staff member(P < 0.05).

CONCLUSION

Our research suggests that adequate sleep, physical exercise and a higher protein intake can help alleviate COVID-19 symptoms, while a higher level of carbohydrates intake may hinder recovery from COVID-19.

Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments

PURPOSE

Despite the extensive vaccination campaigns in many countries, COVID-19 is still a major worldwide health problem because of its associated morbidity and mortality. Therefore, finding efficient treatments as fast as possible is a pressing need. Drug repurposing constitutes a convenient alternative when the need for new drugs in an unexpected medical scenario is urgent, as is the case with COVID-19.

METHODS

Using data from a central registry of electronic health records (the Andalusian Population Health Database), the effect of prior consumption of drugs for other indications previous to the hospitalization with respect to patient outcomes, including survival and lymphocyte progression, was studied on a retrospective cohort of 15,968 individuals, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020.

RESULTS

Covariate-adjusted hazard ratios and analysis of lymphocyte progression curves support a significant association between consumption of 21 different drugs and better patient survival. Contrarily, one drug, furosemide, displayed a significant increase in patient mortality.

CONCLUSIONS

In this study we have taken advantage of the availability of a regional clinical database to study the effect of drugs, which patients were taking for other indications, on their survival. The large size of the database allowed us to control covariates effectively.

New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID-19

PURPOSE

Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated.

METHODS

All patients were selected prospectively from a multicenter registry of adults hospitalized with confirmed COVID-19. Cases had hypertension and myocardial injury, defined by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantified and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury.

RESULTS

The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fluorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38-cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR-CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated significantly with myocardial injury.

CONCLUSION

Our findings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.

The Association of Hypertension with Increased Mortality Rate During the COVID-19 Pandemic: An Update with Meta-analysis

BACKGROUND AND AIM

The impact of multiple risk factors on COVID-19 mortality has been previously reported in multiple systematic reviews and meta-analyses. The aim of this review is to provide a comprehensive update on the association between hypertension (HTN) and mortality in patients with COVID-19.

METHODS

A systematic review and meta-analysis were performed and followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. A search was achieved using PubMed, Scopus, and Cochrane Databases for research publications on hypertension, COVID-19, and mortality published between December 2019 and August 2022.

RESULTS

A total of 23 observational studies involving 611,522 patients from 5 countries (China, Korea, the UK, Australia, and the USA) were included in our study. The confirmed number of COVID-19 with HTN cases in each study ranged from 5 to 9964. The mortality ranged from 0.17% to 31% in different studies. Pooled results show that the mortality rate of COVID-19 among the included studies ranges from a minimum of 0.39 (95% CI 0.13-1.12) to a maximum of 5.74 (95% CI 3.77-8.74). Out of the 611,522 patients, 3119 died which resulted in an overall mortality prevalence of 0.5%. Subgroup analyses indicated that patients with COVID-19 who have hypertension and male patients had slightly less risk of mortality than female patients [the percentage of men > 50%; OR 1.33: 95% CI (1.01, 1.76); the percentage of men ≤ 50%: OR 2.26; and 95% CI (1.15, 4.48)]. Meta-regression analysis results also showed a statistically significant association between hypertension and COVID-19 mortality.

CONCLUSION

This systematic review and meta-analysis suggest that hypertension may not be the only risk factor associated with the increased mortality rate during the COVID-19 pandemic. In addition, a combination of other comorbidities and old age appears to increase the risk of mortality from COVID-19. The impact of hypertension on mortality rate among COVID-19 patients.

Incidence and predictors of development of new onset hypertension post COVID-19 disease

AIMS

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) affects vital organs and causes vascular injury. There are concerns that this injury may have long-term consequences on the cardiovascular system after recovery from COVID-19. We investigated the incidence and predictors of new-onset hypertension at 1-year follow-up post-COVID-19 disease.

METHODS

In this prospective observational study, 393 patients hospitalised and diagnosed with COVID-19 disease at a tertiary cardiac care hospital during 27th March 2021 to 27th May 2021. Eligible 248 patients whose baseline characteristics, laboratory findings, treatment and outcome data were received systematically. Patients were followed up at 1 year of COVID-19 disease recovery.

RESULTS

We found that 32.3% of the population had new onset of hypertension at 1 year follow-up post-COVID-19 disease recovery. More hypertensive patients had severe computed tomography (CT) score severity (28.7 vs 14.9%; P 0.02). More number of patients in the hypertensive group were treated with steroids (73.8% vs 39%; p < 0.0001) during hospital stay. In-hospital complications were higher (12.5 vs 4.2%; P 0.03) in the hypertensive group. Patients who developed new-onset hypertension had statistically significantly higher baseline values of serum ferritin and C-reactive protein (CRP) (P 0.02 and 0.03 respectively). Vascular age was found 12.5 ± 3.96 years more than chronological age in hypertensive patients.

CONCLUSION

New onset of hypertension was detected in 32.3% of patients at one-year follow-up post-COVID-19 disease recovery. Severe inflammation at the time of admission and severe CT severity score were associated with the development of new onset of hypertension on follow-up.

COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation

Background

Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico.

Methods

We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation.

Results

Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous.

Conclusions

Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.

Causal associations between type 1 diabetes and COVID-19 infection and prognosis: a two-sample Mendelian randomization study

INTRODUCTION

It has been suggested that type 1 diabetes was associated with increased COVID-19 morbidity and mortality. However, their causal relationship is still unclear. Herein, we performed a two-sample Mendelian randomization (MR) to investigate the causal effect of type 1 diabetes on COVID-19 infection and prognosis.

RESEARCH DESIGN AND METHODS

The summary statistics of type 1 diabetes were obtained from two published genome-wide association studies of European population, one as a discovery sample including 15 573 cases and 158 408 controls, and the other data as a replication sample consisting of 5913 cases and 8828 controls. We first performed a two-sample MR analysis to evaluate the causal effect of type 1 diabetes on COVID-19 infection and prognosis. Then, reverse MR analysis was conducted to determine whether reverse causality exists.

RESULTS

MR analysis results showed that the genetically predicted type 1 diabetes was associated with higher risk of severe COVID-19 (OR=1.073, 95% CI: 1.034 to 1.114, p_FDR=1.15×10^-3) and COVID-19 death (OR=1.075, 95% CI: 1.033 to 1.119, p_FDR=1.15×10^-3). Analysis of replication dataset showed similar results, namely a positive association between type 1 diabetes and severe COVID-19 (OR=1.055, 95% CI: 1.029 to 1.081, p_FDR=1.59×10^-4), and a positively correlated association with COVID-19 death (OR=1.053, 95% CI: 1.026 to 1.081, p_FDR=3.50×10^-4). No causal association was observed between type 1 diabetes and COVID-19 positive, hospitalized COVID-19, the time to the end of COVID-19 symptoms in the colchicine treatment group and placebo treatment group. Reverse MR analysis showed no reverse causality.

CONCLUSIONS

Type 1 diabetes had a causal effect on severe COVID-19 and death after COVID-19 infection. Further mechanistic studies are needed to explore the relationship between type 1 diabetes and COVID-19 infection and prognosis.

Risk Factors and Clinical Characteristics of Acute Kidney Injury in Patients with COVID-19: A Systematic Review and Meta-Analysis

Acute kidney injury (AKI) is associated with a worse prognosis in coronavirus disease 2019 (COVID-19) patients. Identification of AKI, particularly in COVID-19 patients, is important for improving patients' management. The study aims to assess risk factors and comorbidities of AKI in COVID-19 patients. We systematically searched PubMed and DOAJ databases for relevant studies involving confirmed COVID-19 patients with data on risk factors and comorbidities of AKI. The risk factors and comorbidities were compared between AKI and non-AKI patients. A total of 30 studies involving 22385 confirmed COVID-19 patients were included. Male (OR: 1.74 (1.47, 2.05)), diabetes (OR: 1.65 (1.54, 1.76)), hypertension (OR: 1.82 (1.12, 2.95)), ischemic cardiac disease (OR: 1.70 (1.48, 1.95)), heart failure (OR: 2.29 (2.01, 2.59)), chronic kidney disease (CKD) (OR: 3.24 (2.20, 4.79)), chronic obstructive pulmonary disease (COPD) (OR: 1.86 (1.35, 2.57)), peripheral vascular disease (OR: 2.34 (1.20, 4.56)), and history of nonsteroidal anti-inflammatory drugs (NSAID) (OR: 1.59 (1.29, 1.98)) were independent risk factors associated with COVID-19 patients with AKI. Patients with AKI presented with proteinuria (OR: 3.31 (2.59, 4.23)), hematuria (OR: 3.25 (2.59, 4.08)), and invasive mechanical ventilation (OR: 13.88 (8.23, 23.40)). For COVID-19 patients, male gender, diabetes, hypertension, ischemic cardiac disease, heart failure, CKD, COPD, peripheral vascular disease, and history of use of NSAIDs are associated with a higher risk of AKI.

Mortality, Intensive Care Unit Admission, and Intubation among Hospitalized Patients with COVID-19: A One-Year Retrospective Study in Jordan

COVID-19 is a public health crisis that has caused numerous deaths, necessitated an increased number of hospital admissions, and led to extended inpatient stays. This study aimed to identify the factors associated with COVID-19 mortality, intensive care unit admission, intubation, and length of hospital stay among Jordanian patients. This was a one-year retrospective study of 745 COVID-19 patients admitted to Jordan University Hospital. Data regarding the patients’ demographics, clinical and co-morbid conditions, imaging, laboratory parameters, mortality, intensive care unit admission (ICU), and intubation were collected from their medical records using a coding manual. The data revealed that the overall rates of COVID-19-related mortality, ICU admission, and invasive intubation were 23.0%, 28.3%, and 10.8%, respectively. Chronic kidney disease (CKD), troponin, lactate dehydrogenase (LDH), and O2 saturation <90% were significantly associated with the mortality rate. The variables that were significantly associated with ICU admission were heart failure and the use of remdesivir. However, O2 saturation <90% and gastrointestinal (GI) symptoms were the only variables associated with invasive intubation. The findings of this study suggest that study-related health outcomes can be used to predict the severity of COVID-19, and they can inform future research aiming to identify specific populations who are at a higher risk of COVID-19 complications.

Initial mean arterial blood pressure (MABP) measurement is a risk factor for mortality in hypertensive COVID-19 positive hospitalized patients

BACKGROUND

Hypertension (HTN) is associated with severe COVID-19 infection; however, it remains unknown if the level of blood pressure (BP) predicts mortality. We tested whether the initial BP in the emergency department of hospitalized patients portends mortality in COVID-19 positive(+) patients.

METHODS

Data from COVID-19(+) and negative (-) hospitalized patients at Stony Brook University Hospital from March to July 2020 were included. The initial mean arterial BPs (MABPs) were categorized into tertiles (T) of MABP (65-85 [T1], 86-97 [T2] and ≥98 [T3] mmHg). Differences were evaluated using univariable (t-tests, chi-squared) tests. Multivariable (MV) logistic regression analyses were computed to assess links between MABP and mortality in hypertensive COVID-19 patients.

RESULTS

1549 adults were diagnosed with COVID-19 (+) and 2577 tested negative (-). Mortality of COVID-19(+) was 4.4-fold greater than COVID-19(-) patients. Though HTN prevalance did not differ between COVID-19 groups, the presenting systolic BP, diastolic BP, and MABP were lower in the COVID-19(+) vs (-) cohort. When subjects were categorized into tertiles of MABP, T2 tertile of MABP had the lowest mortality and the T1 tertile of MABP had greatest mortality compared to T2; however, no difference in mortality was noted across tertiles of MABP in COVID-19 (-). MV analysis of COVID-19 (+) subjects exposed death as a risk factor for T1 MABP. Next, the mortality of those with a historic diagnosis of hypertension or normotension were studied. On MV analysis, T1 MABP, gender, age, and first respiratory rate correlated with mortality while lymphocyte count inversely correlated with death in hypertensive COVID-19 (+) patients while neither T1 nor T3 categories of MABP predicted death in non-hypertensives.

CONCLUSIONS

Low-normal admitting MABP in COVID-19 (+) subjects with a historical diagnosis of HTN is associated with mortality and may assist in identifying those at greatest mortality risk.

Cellular and molecular features of COVID-19 associated ARDS: therapeutic relevance

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can be asymptomatic or cause a disease (COVID-19) characterized by different levels of severity. The main cause of severe COVID-19 and death is represented by acute (or acute on chronic) respiratory failure and acute respiratory distress syndrome (ARDS), often requiring hospital admission and ventilator support.The molecular pathogenesis of COVID-19-related ARDS (by now termed c-ARDS) is still poorly understood. In this review we will discuss the genetic susceptibility to COVID-19, the pathogenesis and the local and systemic biomarkers correlated with c-ARDS and the therapeutic options that target the cell signalling pathways of c-ARDS.

Association between RAAS Antagonism and COVID-19-related Mortality in Patients with Overweight/Obesity-related Hypertension: A Retrospective Cohort Study

BACKGROUND

Angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) increase the expression of ACE2, which is a receptor for entry of SARS-CoV-2 into cells. Though evidence suggests that ARB/ACEI are safe among the general population with COVID-19, their safety in patients with overweight/obesity-related hypertension deserves further evaluation.

OBJECTIVE

We assessed the association between ARB/ACEI use and COVID-19 severity in patients with overweight/obesity-related hypertension.

METHODS

This study included 439 adult patients with overweight/obesity (body mass index ≥ 25 kg/m2) and hypertension, diagnosed with COVID-19 and admitted to University of Iowa Hospitals and Clinic from March 1 to December 7, 2020. Mortality and severity of COVID-19 were evaluated based on length of stay in hospital, intensive care unit admission, use of supplemental oxygen, mechanical ventilation, and vasopressors. Multivariable logistic regression was used to examine the associations of ARB/ACEI use with mortality and other markers of COVID-19 severity, with a two-sided alpha set at 0.05.

RESULTS

Exposure to ARB (n = 91) and ACEI (n = 149) before hospitalization was significantly associated with lower mortality (odds ratio [OR] = 0.362, 95% confidence interval [CI] 0.149 to 0.880, p = 0.025) and a shorter length of stay (95% CI -0.217 to -0.025, p = 0.015). Additionally, patients using ARB/ACEI showed a non-significant trend toward lower intensive care unit admission (OR = 0.727, 95% CI 0.485 to 1.090, p = 0.123), use of supplemental oxygen (OR = 0.929, 95% CI 0.608 to 1.421, p = 0.734), mechanical ventilation (OR = 0.728, 95% CI 0.457 to 1.161, p = 0.182), and vasopressors (OR = 0.677, 95% CI 0.430 to 1.067, p = 0.093).

CONCLUSION

Results suggest that hospitalized patients with COVID-19 and overweight/obesity-related hypertension who were prescribed ARB/ACEI before admission to the hospital exhibit lower mortality and less severe COVID-19 than those who were not taking ARB/ACEI. The results also suggest that exposure to ARB/ACEI may protect patients with overweight/obesity-related hypertension from severe COVID-19 and death.

Clinical and Virological Features of SARS-CoV-2 Variants during the Four Waves of the Pandemic in the Mexican Southeast

We conducted a retrospective study using a population of patients who were hospitalized at Dr. Juan Graham Casasus Hospital in Villahermosa (Tabasco, Mexico) and had a positive RT-PCR test for SARS-CoV-2 between June 2020 and January 2022. We analyzed all medical records, including demographic data, SARS-CoV-2 exposure history, underlying comorbidities, symptoms, signs at admission, laboratory findings during the hospital stay, outcome, and whole-genome sequencing data. Finally, the data were analyzed in different sub-groups according to distribution during waves of the COVID-19 pandemic regarding Mexican reports from June 2020 to January 2022. Of the 200 patients who tested positive via PCR for SARS-CoV-2, only 197 had samples that could be sequenced. Of the samples, 58.9% (n = 116) were males and 41.1% (n = 81) females, with a median age of 61.7 ± 17.0 years. Comparisons between the waves of the pandemic revealed there were significant differences in the fourth wave: the age of patients was higher (p = 0.002); comorbidities such as obesity were lower (p = 0.000), while CKD was higher (p = 0.011); and hospital stays were shorter (p = 0.003). The SARS-CoV-2 sequences revealed the presence of 11 clades in the study population. Overall, we found that adult patients admitted to a third-level Mexican hospital had a wide range of clinical presentations. The current study provides evidence for the simultaneous circulation of SARS-CoV-2 variants during the four pandemic waves.

T Cell Response to SARS-CoV-2 Coinfection and Comorbidities

For the past three years, COVID-19 has become an increasing global health issue. Adaptive immune cells, especially T cells, have been extensively investigated in regard to SARS-CoV-2 infection. However, human health and T cell responses are also impacted by many other pathogens and chronic diseases. We have summarized T cell performance during SARS-CoV-2 coinfection with other viruses, bacteria, and parasites. Furthermore, we distinguished if those altered T cell statuses under coinfection would affect their clinical outcomes, such as symptom severity and hospitalization demand. T cell alteration in diabetes, asthma, and hypertension patients with SARS-CoV-2 infection was also investigated in our study. We have summarized whether changes in T cell response influence the clinical outcome during comorbidities.

The turning point of COVID-19 severity is associated with a unique circulating neutrophil gene signature

COVID-19 has a broad spectrum of clinical manifestations associated with the host immune response heterogeneity. Despite the advances in COVID-19 research, it is still crucial to seek a panel of molecular markers that enable accurate stratification of COVID-19 patients. Here, we performed a study that combined analysis of blood transcriptome, demographic data, clinical aspects and laboratory findings from 66 participants classified into different degrees of COVID-19 severity and healthy subjects. We identified a perturbation in blood-leukocyte transcriptional profile associated with COVID-19 aggravation, which was mainly related to processes that disfavoured lymphocyte activation and favoured neutrophil activation. This transcriptional profile stratified patients according to COVID-19 severity. Hence, it enabled identification of a turning point in transcriptional dynamics that distinguished disease outcomes and non-hospitalized from hospitalized moderate patients. Central genes of this unique neutrophil signature were S100A9, ANXA3, CEACAM6, VNN1, OLFM4, IL1R2, TCN1 and CD177. Our study indicates the molecular changes that are linked with the differing clinical aspects presented by humans when suffering from COVID-19, which involve neutrophil activation.

Counter-regulatory renin-angiotensin system in hypertension: Review and update in the era of COVID-19 pandemic

Cardiovascular disease is the major cause of mortality and disability, with hypertension being the most prevalent risk factor. Excessive activation of the renin-angiotensin system (RAS) under pathological conditions, leading to vascular remodeling and inflammation, is closely related to cardiovascular dysfunction. The counter-regulatory axis of the RAS consists of angiotensin-converting enzyme 2 (ACE2), angiotensin (1-7), angiotensin (1-9), alamandine, proto-oncogene Mas receptor, angiotensin II type-2 receptor and Mas-related G protein-coupled receptor member D. Each of these components has been shown to counteract the effects of the overactivated RAS. In this review, we summarize the latest insights into the complexity and interplay of the counter-regulatory RAS axis in hypertension, highlight the pathophysiological functions of ACE2, a multifunctional molecule linking hypertension and COVID-19, and discuss the function and therapeutic potential of targeting this counter-regulatory RAS axis to prevent and treat hypertension in the context of the current COVID-19 pandemic.

Long-term outcomes of COVID-19 convalescents: An 18.5-month longitudinal study in Wuhan

OBJECTIVES

This study aimed to describe the full scope of long-term outcomes and the ongoing pathophysiological alterations among COVID-19 survivors.

METHODS

We established a longitudinal cohort of 208 COVID-19 convalescents and followed them at 3.3 (interquartile range [IQR]: 1.3, 4.4, visit 1), 9.2 (IQR: 9.0, 9.6, visit 2), and 18.5 (IQR: 18.2, 19.1, visit 3) months after infection, respectively. Serial changes in multiple physical and psychological outcomes were comprehensively characterized. We, in addition, explored the potential risk factors of SARS-CoV-2 antibody response and sequelae symptoms.

RESULTS

We observed continuous improvement of sequelae symptoms, lung function, chest computed tomography (CT), 6-minute walk test, and the Borg dyspnea scale, whereas sequelae symptoms (at least one) and abnormal chest CT patterns still existed in 45.2% and about 30% of participants at 18.5 months, respectively. Anxiety and depression disorders were alleviated for the convalescents, although depression status was sustained for a longer duration.

CONCLUSIONS

Most COVID-19 convalescents had an overall improved physical and psychological health status, whereas sequelae symptoms, residual lesions on lung function, exercise impairment, and mental health disorders were still observed in a small proportion of participants at 18.5 months after infection. Implementing appropriate preventive and management strategies for the ever-growing COVID-19 population is warranted.

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

BACKGROUND

Sex differences may be presented in the clinical features or symptoms of schizophrenia patients but also affect the occurrence of hospital-acquired pneumonia (HAP). Modified electroconvulsive therapy (mECT) is a common treatment method for schizophrenia, used in combination with antipsychotics. This retrospective research explores the sex difference in HAP affecting patients with schizophrenia who have received mECT treatment during hospitalization.

METHODS

We included schizophrenia inpatients treated with mECT and antipsychotics between January 2015 and April 2022. Blood-related and demographic data collected on admission were analyzed. Influencing factors of HAP in male and female groups were assessed separately.

RESULTS

A total of 951 schizophrenia patients treated with mECT were enrolled in the study, including 375 males and 576 females, of which 62 patients experienced HAP during hospitalization. The risk period of HAP in these patients was found to be the first day after each mECT treatment and the first three sessions of mECT treatment. Statistically significant differences in the incidence of HAP were identified in male vs. female groups, with an incidence in men about 2.3 times higher than that in women (P < 0.001). Lower total cholesterol (Z = -2.147, P = 0.032) and the use of anti-parkinsonian drugs (χ² = 17.973, P < 0.001) were found to be independent risk factors of HAP in male patients, while lower lymphocyte count (Z = -2.408, P = 0.016), hypertension (χ² = 9.096, P = 0.003), and use of sedative-hypnotic drugs (χ² = 13.636, P < 0.001) were identified in female patients.

CONCLUSION

Influencing factors of HAP in schizophrenia patients treated with mECT have gender differences. The first day after each mECT treatment and the first three sessions of mECT treatment were identified to have the greatest risk for HAP development. Therefore, it would be imperative to monitor clinical management and medications during this period according to these gender differences.

Evaluation of Clinical Manifestations, Pattern of Involvement, and Surgical Outcomes in Patients with Post Covid-19 Head and Neck Mucormycosis Infection among Patients Admitted To Namazi Hospital, Shiraz, Iran (2021-2022)

Background

COVID-19, caused by SARS-CoV-2, is a global pandemic that particularly affects immunocompromised individuals, leading to secondary bacterial and fungal infections. Mucormycosis, caused by Mucorales fungi, is a severe infection primarily affecting immunocompromised individuals. The COVID-19 pandemic has seen a surge in mucormycosis cases worldwide, with India experiencing a significant increase. Various factors, including diabetes mellitus, contribute to the risk of mucormycosis. This study investigated head and neck mucormycosis in patients with prior COVID-19 infection.

Methods

Data from 45 patients were analyzed, with diabetes being the most common risk factor. Visual symptoms, ethmoid bone involvement, and orbital bone involvement were also identified as significant factors.

Results

The COVID-19 pandemic has led to an increase in mucormycosis cases, particularly in the head and neck region, with high mortality. Successful management involves addressing underlying factors, surgical debridement, and antifungal therapy.

Conclusion

Timely debridement reduces morbidity and mortality.

Vaccination, regular exercise, and prevention of chronic lung disease reduce exacerbation of COVID-19 severity in northern Okinawa, Japan: A cross-sectional study

BACKGROUND

As at June 14, 2023, the coronavirus disease 2019 (COVID-19) pandemic had affected more than 767 million people and caused more than 6.9 million deaths worldwide. This study aimed to clarify the lifestyle factors that influence the exacerbation of COVID-19 severity.

METHODS

This was a cross-sectional study of patients with COVID-19 whose severity classification of "moderate or severe" (COVID-19 exacerbation) was defined as an objective variable. The 1,353 participants were selected from 4,899 patients with COVID-19 between August 10, 2020 and December 10, 2022. Participants who underwent a specific health checkup before the date for a COVID-19 consultation were included. Using binominal logistic regression analysis, we evaluated the odds ratios (ORs) for COVID-19 exacerbation according to lifestyle-related factors. Limitations were discussed using a target trial emulation framework which clarifies problems in observational studies.

RESULTS

The explanatory variables extracted as factors that exacerbated COVID-19 severity were gender (OR [man vs. woman]: 2.533, 95% confidence interval [CI] 1.484-4.322); age (OR [50s vs. 10s, 20s, or 30s]: 4.858, 95% CI 2.319-10.177; OR [60s]: 9.738, 95% CI 4.355-21.777; OR [70s + 80s + 90s]: 8.327, 95% CI 3.224-21.507); and comorbid chronic lung disease (OR ['yes' vs. 'no']: 2.892, 95% CI 1.227-6.818). The explanatory variables extracted as factors that reduce the severity of COVID-19 were hospital consultation year (OR [2022, predominantly Omicron variant prevalent vs. 2020, predominantly Alpha variant prevalent]: 0.180, 95% CI 0.058-0.559); number of vaccinations (OR [2 doses vs. 0 or one doses]: 0.223, 95% CI 0.114-0.436; OR [≥3 doses vs. 0 or one doses]: 0.090, 95% CI 0.035-0.229); regular exercise (exercising ≥2 days/week ≥30 minutes each at an intensity that causes a slight sweat for ≥1 year) (OR ['yes' vs. 'no']: 0.458, 95% CI 0.242-0.866).

CONCLUSIONS

These results suggest the importance of vaccination, regular exercise, and prevention of chronic lung disease as measures against exacerbation of COVID-19 severity.

Análisis del perfil hematológico de los pacientes con la enfermedad por coronavirus 2019 (COVID-19)

Objetivos

Se han propuesto varios parámetros hematológicos como marcadores de gravedad de la COVID-19. Aún no se han realizado estudios en Makassar (Indonesia), para evaluar potenciales diferencias en el perfil hematológico de los pacientes según la gravedad de la enfermedad y las comorbilidades que presentan. Así mismo, tampoco se ha estudiado la correlación entre perfil hematológico y umbral de número de ciclos (Ct). El objetivo de este estudio es investigar posibles diferencias en el perfil hematológico de los pacientes con COVID-19 según la gravedad de la enfermedad y sus comorbilidades, así como determinar la posible correlación entre el perfil hematológico y el Ct en estos pacientes.

Métodos

Se realizó un estudio retrospectivo transversal de pacientes con COVID-19 hospitalizados en el hospital del Dr. Wahidin Sudirohusodo en Makassar entre junio y agosto de 2020. Los datos sobre el perfil hematológico, niveles de Ct, comorbilidades y gravedad de la COVID-19 se extrajeron de la base de datos del hospital.

Resultados

De los 217 pacientes, 102 (47%) eran hombres, frente a 115 (53%) mujeres. El número de pacientes con enfermedad leve o moderada fue de 127 (58.5%) mientras que 90 pacientes presentaban enfermedad grave (41.5%). En total, 143 pacientes (65%) no tenían comorbilidades, mientras que 74 pacientes (35%) sí las tenían. La amplitud de la distribución eritrocitaria, el recuento leucocitario, neutrófilos y monocitos, y la relación neutrófilos-linfocitos fueron significativamente superiores en los pacientes con enfermedad grave que en los que presentaban enfermedad leve o moderada (p<0,05). Así mismo, los pacientes graves presentaron un recuento de glóbulos rojos, hemoglobina, hematocrito, linfocitos y trombocitos significativamente inferior al de los pacientes con enfermedad leve o moderada. No se observaron diferencias significativas en el perfil hematológico según las comorbilidades, ni correlación alguna entre este y los niveles de Ct, excepto para el recuento de eosinófilos (r=0,161; p=0,018).

Conclusiones

Nuestra hipótesis era que el perfil hematológico podría predecir la gravedad de la enfermedad en pacientes con COVID-19. Además, el recuento de eosinófilos debería tenerse en cuenta a la hora de predecir la infectividad de un paciente con COVID-19.

Clinical manifestations of COVID-19 in patients with asthma, hypertension, and diabetes mellitus

The clinical symptoms of COVID-19 infection differ from one patient to another, requiring different management. This study intended to characterize the clinical manifestation of COVID-19 in patients with asthma, hypertension, and diabetes mellitus (DM). We analyzed data from 540 medical records of patients with comorbidities like asthma, hypertension, and DM diagnosed with COVID-19, looking at vital signs upon admission, chest X-ray, and laboratory results. Most patients were male (57.0%). The most prevalent comorbidity was hypertension (46.3%) and DM (46.3%), followed by asthma (7.4%). 273 patients had improved condition (50.6%). Patients with hypertension had the most extended length of stay compared to other comorbidities groups (13.0±8.5 days). There were significant differences in the oxygen saturation and respiration rate between the three groups (p=0.002, p<0.0001, respectively). The mean lymphocyte (p=0.028) and hematocrit count (p=0.001) were significantly different between the three comorbid groups, with the hypertension group having the highest mean lymphocyte (15.1±8.9) and hematocrit (38.7±6.9) count. COVID-19 had a significant impact on patients with asthma, hypertension, and diabetes comorbidities concerning the final condition, length of stay, oxygen saturation, and respiratory rate, and also on the hematology level, mainly lymphocyte and hematocrit. Treatment, age, and infection might be determinant factors for different outcomes in each type of comorbidity.

Adherence to antihypertensive treatment during the COVID-19 pandemic: findings from a cross-sectional study

BACKGROUND

Nonadherence to antihypertensive treatment is one of the main causes of the lack of blood pressure (BP) control. The coronavirus disease (COVID-19) pandemic imposes substantial social restriction impairing the medical care routine, which may influence adherence to the antihypertensive treatment. To assess the rate of nonadherence to antihypertensive drug treatment during the COVID-19 pandemic.

METHODS

This is a cross-sectional study evaluating hypertensive adult patients from a tertiary outpatient clinic. From March to August 2020, patients were interviewed by telephone during the social distancing period of the COVID-19 pandemic. We evaluated biosocial data, habits, attitudes, and treatment adherence using the 4-item Morisky Green Levine Scale during the social distancing. Uncontrolled BP was defined by BP ≥ 140/90 mmHg. Clinical and prescription variables for drug treatment were obtained from the electronic medical record. We performed a multivariate analysis to determine the predictors of nonadherence to BP treatment.

RESULTS

We studied 281 patients (age 66 ± 14 years, 60.5% white, 62.3% women, mean education of 9.0 ± 4 years of study). We found that 41.3% of the individuals reported poor adherence to antihypertensive drug treatment and 48.4% had uncontrolled BP. Subsample data identified that adherence was worse during the pandemic than in the previous period. The variables that were independently associated with the nonadherence during the pandemic period were black skin color (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.46-4.68), and intermittent lack of access to antihypertensive medication during the pandemic (OR, 2.56; 95% CI, 1.11-5.89).

CONCLUSIONS

Beyond traditional variables associated with poor adherence, the lack of availability of antihypertensive medications during the study underscore the potential role of pandemic on hypertension burden.

Hematology profile analysis in coronavirus disease 2019 (COVID-19) patients

Objectives

Some hematological parameters were reported as markers to assess severity of COVID-19 patients. Comorbidities were risk factors for severe COVID-19. Differences in hematology profile based on severity and comorbidity, and correlation between hematology profile and Ct value were never studied at Makassar, Indonesia. The aim of this study were to know the differences of hematology profile based on severity and comorbidity, and the correlation between hematology profile and Ct value in COVID-19 patients.

Methods

This study was retrospective, cross-sectional of confirmed COVID-19 patients who had been hospitalized at Dr. Wahidin Sudirohusodo hospital, Makassar, since June to August 2020. Hematology profile, Ct value, comorbidity, and severity of COVID-19 patients were obtained from Hospital Information System Data.

Results

From 217 patients, subjects were 102 (47%) male dan 115 (53%) female, 127 mild-moderate patients (58.5%) and 90 severe patients (41.5%), 143 patients (65%) without comorbidity, 74 patients (35%) with comorbidity. White blood cells (WBC), red cell distribution width (RDW), neutrophil and monocyte count, and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients than mild-moderate patients (p<0.05), besides RBC, hemoglobin, hematocrit, lymphocyte and thrombocyte count were significantly lower in severe patients than mild-moderate patients (p<0.05). Hematology profile was not different significantly based on comorbidity and was not correlated significantly with Ct value, except eosinophil count (r=0.161; p=0.018).

Conclusions

We suggest that hematology profile could predict the severity of COVID-19 patients. Moreover, eosinophil count could be considered to predict the infectivity of patient with COVID-19.

Leukocyte metabolism in obese type 2 diabetic individuals associated with COVID-19 severity

Recent studies show that the metabolic characteristics of different leukocytes, such as, lymphocytes, neutrophils, and macrophages, undergo changes both in the face of infection with SARS-CoV-2 and in obesity and type 2 diabetes mellitus (DM2) condition. Thus, the objective of this review is to establish a correlation between the metabolic changes caused in leukocytes in DM2 and obesity that may favor a worse prognosis during SARS-Cov-2 infection. Chronic inflammation and hyperglycemia, specific and usual characteristics of obesity and DM2, contributes for the SARS-CoV-2 replication and metabolic disturbances in different leukocytes, favoring the proinflammatory response of these cells. Thus, obesity and DM2 are important risk factors for pro-inflammatory response and metabolic dysregulation that can favor the occurrence of the cytokine storm, implicated in the severity and high mortality risk of the COVID-19 in these patients.

Bradykinin and Galectin-3 in Survived and Deceased Patients with COVID-19 Pneumonia: An Increasingly Promising Biochemical Target

Introduction

There are still no definite curative or preventive strategies for COVID-19 disease. It is crucial to fully comprehend the pathogenesis of COVID-19 infection so that we can develop expedient pharmacological protocols. While the impact of cytokine storm on COVID-19 severity has been one of the most tested hypotheses, the role of bradykinin and various other oxidative stress markers has been relatively under-researched. Their levels can be determined immediately after a hospital admission so they could be used as early predictors of the further development of the disease.

Aim

The study aims at evaluating the possibility of using bradykinin and galectin-3 levels as early predictors that COVID-19 disease will progress into a severe case. Material and methods. The study was conducted as a prospective cross-sectional study. It included 47 consecutive adult patients with confirmed SARS-CoV-2 infection and COVID-19 pneumonia. All study subjects were admitted for a hospital treatment to the tertiary Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia on June 2021. The blood samples were collected at the patients' admission. The analyses of demographic, radiological, and clinical data were later conducted for both groups (the deceased patients and those who survived). In addition, we analyzed the potential relations between the outcome and the levels of bradykinin and galectin-3 measured immediately after the patients were admitted to the hospital.

Results

The patients who passed away were predominantly older men with comorbidities. We recorded higher CT scores in the deceased patients and the significantly higher levels of urea, creatinine, CK, troponine, CRP, and other laboratory markers. They stayed at the ICU unit longer and required mechanical ventilation more frequently than the patients who survived. On the other hand, no differences were recorded in the time periods passing from the onset of the systems to the hospital admissions. Finally, we can highlight several independent predictors of mortality in patients with COVID-19 pneumonia, including the following: (1) patients who are 50 or more years old, (2) with in-hospital stays are longer that 4 days, (3) bradykinin levels surpass 220000 pg/ml, (4) D-dimer, creatinine, and CRP are elevated, and (5) comorbidities were present (such as hypertension and diabetes).

Conclusion

The present study strongly supports the bradykinin storm hypothesis. Since elevated bradykinin levels have been found in most COVID-19 cases with fatal outcomes, the future therapeutical strategies for COVID-19 have to be focused on reducing bradykinin serum concentrations.

Factors which impact the length of hospitalisation and death rate of COVID-19 patients based on initial triage using capillary blood gas tests: a single centre study

An important element in the effective treatment of patients infected with the SARS-CoV-2 virus during the pandemic is an effective early triage to determine patient allocation and in-patient therapy. This paper assesses the prognostic value of capillary blood gas tests in predicting extended hospitalisation and death due to COVID-19. This retrospective statistical research is based on a group of 200 patients, hospitalised from 15 October 2020 to 08 March 2021. The study utilised the treatment documentation of these patients hospitalised due to COVID-19 at the Pulmonology and Thoracic Surgery Centre in Bystra (Southern Poland) during this period. The hospital has 50 beds with access to oxygen for COVID-19 patients and a five-bed intensive care unit. On the basis of the obtained results, conclusions were drawn that the need for early oxygen therapy with an oxygen mask and low pH values in capillary blood are significant risk factors for prolonging hospitalisation due to COVID-19. Age, the need for early oxygen mask therapy and low oxygen saturation are important risk factors for death from COVID-19. Capillary blood gas analysis is a simple and effective method of early in-patient segregation of COVID-19 patients.

Multiple ischemic stroke with pulmonary embolism revealing severe COVID-19 infection in a young healthy patient

Coronavirus 2019 (COVID-19) disease has caused significant morbidity and mortality worldwide since its emergence in December 2019. Despite its respiratory tropism; there is a nontrivial relationship between this virus and the neurovascular system exposing patients to higher morbidity and mortality. We report the case of a young patient admitted for hemiplegia with acute respiratory failure, in whom imaging found multiple ischemic strokes with pulmonary embolism and severe involvement suggestive of COVID-19 pneumopathy. Stroke in the context of COVID-19 infection has distinct characteristics in terms of disease mechanism, patient demographics, but also clinical, biological, and neuroradiological specificities. The pathogenesis and optimal management of COVID-19-associated ischemic stroke remain unclear, but the coagulopathy and endotheliopathy triggered by the cytokine storm represent possible target mechanisms.

Racial Differences and In-Hospital Outcomes Among Hospitalized Patients with COVID-19

OBJECTIVE

There is a paucity of data on how race affects the clinical presentation and short-term outcome among hospitalized patients with SARS-CoV-2, the 2019 coronavirus (COVID-19).

METHODS

Hospitalized patients ≥ 18 years, testing positive for COVID-19 from March 13, 2020 to May 13, 2020 in a United States (U.S.) integrated healthcare system with multiple facilities in two states were evaluated. We documented racial differences in clinical presentation, disposition, and in-hospital outcomes for hospitalized patients with COIVD-19. Multivariable regression analysis was utilized to evaluate independent predictors of outcomes by race.

RESULTS

During the study period, 3678 patients tested positive for COVID-19, among which 866 were hospitalized (55.4% self-identified as Caucasian, 29.5% as Black, 3.3% as Hispanics, and 4.7% as other racial groups). Hospitalization rates were highest for Black patients (36.6%), followed by other (28.3%), Caucasian patients (24.4%), then Hispanic patients (10.7%) (p < 0.001). Caucasian patients were older, and with more comorbidities. Absolute lymphocyte count was lowest among Caucasian patients. Multivariable regression analysis revealed that compared to Caucasians, there was no significant difference in in-hospital mortality among Black patients (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI] 0.26-1.09; p = 0.08) or other races (adjusted OR 1.62; 95% CI 0.80-3.27; p = 0.18). Black and Hispanic patients were admitted less frequently to the intensive care unit (ICU), and Black patients were less likely to require pressor support or hemodialysis (HD) compared with Caucasians.

CONCLUSIONS

This observational analysis of a large integrated healthcare system early in the pandemic revealed that patients with COVID-19 did exhibit some racial variations in clinical presentation, laboratory data, and requirements for advanced monitoring and cardiopulmonary support, but these nuances did not dramatically alter in-hospital outcomes.

Assessment of hypertension and other factors associated with the severity of disease in COVID-19 pneumonia, Addis Ababa, Ethiopia: A case-control study

BACKGROUND

Various reports suggested that pre-existing medical illnesses, including hypertension and other demographic, clinical, and laboratory factors, could pose an increased risk of disease severity and mortality among COVID-19 patients. This study aimed to assess the relation of hypertension and other factors to the severity of COVID-19 pneumonia in patients discharged from Eka Kotebe Hospital in June-September, 2020.

METHODS

This is a single-center case-control study of 265 adult patients discharged alive or dead, 75 with a course of severe COVID-19 for the cases arm and 190 with the non-severe disease for the control arm. Three age and sex-matched controls were selected randomly for each patient on the case arm. Chi-square, multivariable binary logistic regression, and odds ratio (OR) with a 95% confidence interval was used to assess the association between the various factors and the severity of the disease. A p-value of <0.05 is considered statistically significant.

RESULTS

Of the 265 study participants, 80% were male. The median age was 43 IQR(36-60) years. Both arms had similar demographic characteristics. Hypertension was strongly associated with the severity of COVID-19 pneumonia based on effect outcome adjustment (AOR = 2.93, 95% CI 1.489, 5.783, p-value = 0.002), similarly, having diabetes mellitus (AOR = 3.17, 95% CI 1.374, 7.313, p-value<0.007), chronic cardiac disease (AOR = 4.803, 95% CI 1.238-18.636, p<0.023), and an increase in a pulse rate (AOR = 1.041, 95% CI 1.017, 1.066, p-value = 0.001) were found to have a significant association with the severity of COVID-19 pneumonia.

CONCLUSIONS

Hypertension was associated with the severity of COVID-19 pneumonia, and so were diabetes mellitus, chronic cardiac disease, and an increase in pulse rate.

SARS-CoV-2 pre-exposure prophylaxis: A potential COVID-19 preventive strategy for high-risk populations, including healthcare workers, immunodeficient individuals, and poor vaccine responders

The unprecedented worldwide spread of SARS-CoV-2 has imposed severe challenges on global health care systems. The roll-out and widespread administration of COVID-19 vaccines has been deemed a major milestone in the race to restrict the severity of the infection. Vaccines have as yet not entirely suppressed the relentless progression of the pandemic, due mainly to the emergence of new virus variants, and also secondary to the waning of protective antibody titers over time. Encouragingly, an increasing number of antiviral drugs, such as remdesivir and the newly developed drug combination, Paxlovid® (nirmatrelvir/ritonavir), as well as molnupiravir, have shown significant benefits for COVID-19 patient outcomes. Pre-exposure prophylaxis (PrEP) has been proven to be an effective preventive strategy in high-risk uninfected people exposed to HIV. Building on knowledge from what is already known about the use of PrEP for HIV disease, and from recently gleaned knowledge of antivirals used against COVID-19, we propose that SARS-CoV-2 PrEP, using specific antiviral and adjuvant drugs against SARS-CoV-2, may represent a novel preventive strategy for high-risk populations, including healthcare workers, immunodeficient individuals, and poor vaccine responders. Herein, we critically review the risk factors for severe COVID-19 and discuss PrEP strategies against SARS-CoV-2. In addition, we outline details of candidate anti-SARS-CoV-2 PrEP drugs, thus creating a framework with respect to the development of alternative and/or complementary strategies to prevent COVID-19, and contributing to the global armamentarium that has been developed to limit SARS-CoV-2 infection, severity, and transmission.

A Review of COVID-19 in Relation to Metabolic Syndrome: Obesity, Hypertension, Diabetes, and Dyslipidemia

Although severe cases and mortality of coronavirus disease 2019 (COVID-19) are proportionally infrequent, these cases are strongly linked to patients with conditions of metabolic syndrome (obesity, hypertension, diabetes, and dyslipidemia). However, the pathophysiology of COVID-19 in relation to metabolic syndrome is not well understood. Thus, the goal of this secondary literature review was to examine the relationship between severe acute respiratory syndrome (SARS-CoV-2) infection and the individual conditions of metabolic syndrome.

The objective of this secondary literature review was achieved by examining primary studies, case studies, and other secondary studies, to obtain a comprehensive perspective of theories and observations of COVID-19 etiology with metabolic syndrome. The most extensive research was available on the topics of diabetes, hypertension, and obesity, which yielded multiple (and sometimes conflicting) hypothetical pathophysiology. The sources on dyslipidemia and COVID-19 were scarcer and failed to provide an equally comprehensive image, highlighting the need for further research.

It was concluded that hypertension had the strongest correlation with COVID-19 incidence (followed by obesity), yet the causative pathophysiology was ambiguous; most likely related to cardiovascular, angiotensin-converting enzyme 2 (ACE-2)-related complications from renin-angiotensin-aldosterone system (RAAS) imbalance. Obesity was also positively correlated to the severity of COVID-19 cases and was believed to contribute to mechanical difficulties with respiration, in addition to hypothetical connections with the expression of ACE-2 on abundant adipose tissue. Diabetes was believed to contribute to COVID-19 severity by producing a chronic inflammatory state and interfering with neutrophil and T-cell function. Furthermore, there were indications that COVID-19 may induce acute-onset diabetes and diabetic ketoacidosis. Lastly, dyslipidemia was concluded to potentially facilitate SARS-CoV-2 infection by enhancing lipid rafts and immunosuppressive functions. There were also indications that cholesterol levels may have prognostic indications and that statins may have therapeutic benefits.

The impact of chronic cardiovascular disease on COVID-19 clinical course

Background

According to previous univariate analyses, chronic cardiovascular disease (CVD) has been associated with worse prognoses in severe cases of coronavirus disease 2019 (COVID-19). However, in the presence of a complex system, such as a human organism, the use of multivariate analyses is more appropriate and there are still few studies with this approach.

Aim

Using a significant sample of patients hospitalized in a single center, this study aimed to evaluate, whether the presence of CVD was an independent factor in death due to COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We also aimed to identify the clinical and laboratory predictors of death in an isolated group of cardiac patients.

Methods

This case-control study was conducted with patients admitted to a tertiary hospital and affected by COVID-19 in 2020. Variables were collected from the Brazilian surveillance system of hospitalized cases (SIVEP-Gripe) and electronic medical records. Multivariate logistic regressions with backward elimination were performed to analyze, whether CVD was an independent risk factor for death, and variables with P < 0.05 remained in the final model.

Results

A total of 2675 patients were analyzed. The median age was 60.4 years, and 55.33% of the patients were male. Odds ratios showed that age (OR 1.059), male sex (OR 1.471), Down syndrome (OR 54.980), diabetes (OR 1.626), asthma (OR 1.995), immunosuppression (OR 2.871), obesity (OR 1.432), chronic lung disease (OR 1.803), kidney disease (OR 1.789), and neurological diseases (OR 2.515) were independently associated with death. Neither the presence of heart disease nor the isolated analysis of each chronic CVD element (systemic arterial hypertension, congenital heart disease, previous acute myocardial infarction and cardiac surgery, obstructive coronary artery disease, valvular heart disease, and pacemaker use) showed as independent risk factors for death. However, an analysis restricted to 489 patients with chronic CVD showed troponin T (TnT) as an independent predictor of death (OR 4.073).

Conclusions

Neither chronic CVD nor its subcomponents proved to be independent risk factors for death due to SARS-CoV-2 infection. A TnT level of 14 pg/mL was associated with a higher occurrence of death in the isolated group of patients with chronic heart disease.

Relevance for Patients

Patients with chronic CVD may require more attention in the context of COVID-19 due to higher proportions of these individuals having a more severe progression of disease. However, regarding mortality in these patients, further studies should be conducted concerning comorbidities and acute myocardial injury.

Hypertension Exacerbates Severity and Outcomes of COVID-19 in Elderly Patients: A Retrospective Observational Study

Objective

To evaluate the impact of hypertension on the clinical outcome of COVID-19 patients aged 60 years old and older.

Methods

This single-center retrospective cohort study enrolled consecutive COVID-19 patients aged 60 years old and older, who were admitted to Liyuan Hospital from January 1, 2020 to April 25, 2020. All included patients were divided into two groups: hypertension and nonhypertension group. The baseline demographic characteristics, laboratory test results, chest computed tomography (CT) images and clinical outcomes were collected and analyzed. The prognostic value of hypertension was determined using binary logistic regression.

Results

Among the 232 patients included in the analysis, 105 (45.3%) patients had comorbid hypertension. Compared to the nonhypertension group, patients in the hypertension group had higher neutrophil-to-lymphocyte ratios, red cell distribution widths, lactate dehydrogenase, high-sensitivity C-reactive protein, D-dimer and severity of lung lesion, and lower lymphocyte counts (all P<0.05). Furthermore, the hypertension group had a higher proportion of intensive care unit admissions [24 (22.9%) vs. 14 (11.0%), P=0.02) and deaths [16 (15.2%) vs. 3 (2.4%), P<0.001] and a significantly lower probability of survival (P<0.001) than the nonhypertension group. Hypertension (OR: 4.540, 95% CI: 1.203–17.129, P=0.026) was independently correlated with all-cause in-hospital death in elderly patients with COVID-19.

Conclusion

The elderly COVID-19 patients with hypertension tend to have worse conditions at baseline than those without hypertension. Hypertension may be an independent prognostic factor of poor clinical outcome in elderly COVID-19 patients.

Health related behaviours and physical activity level of hypertensive individuals during COVID-19 pandemic

During the COVID-19 pandemic, all countries implemented lockdown to prevent transmission of coronavirus. The prolonged stay-at-home process created some unfavourable effects like unhealthy lifestyle, physical inactivity and sedentary behaviour especially in patients with cardiovascular risk. Hypertensive individuals are also affected in the pandemic because of limited access to healthcare services, screening, and altered lifestyles. We aimed to investigate physical activity (PA) level, sedentary behaviour, mental health and healthy lifestyle behaviours in patients with hypertension and compare these parameters with healthy controls. This prospective, cross-sectional study included 40 hypertensive and 40 age-sex matched healthy controls. We assessed PA with the International Physical Activity Questionnaire long-form, quality of life with Short-Form 36 (SF-36) questionnaire, anxiety and depression with Hospital Anxiety and Depression Scale (HADS) and lifestyle behaviours with Health-Promoting Lifestyle Profile Scale-II (HPLP-II). Moderate and vigorous PA levels of hypertensives' were statistically lower than healthy controls (P = 0.001; P = 0.003, respectively). Hypertensive patients exhibited lower SF-36 physical function (P = 0.001), energy/vitality (P = 0.042), body pain scores than those of healthy controls (P = 0.007). Although HADS-anxiety, depression scores were similar (P > 0.05), the depression ratio (45%) was more common in the hypertensive group during the lockdown. The main findings are that hypertensive patients have lower PA levels and worse quality of life than healthy controls during the pandemic. In addition, the presence of depression is more common among hypertensive patients. Considering unhealthy lifestyles, governments, and health professionals should take some precautions and plan interventions against physical inactivity. As known, providing regular physical activity is a keystone to fighting against cardiovascular disease.

Immune system changes in those with hypertension when infected with SARS-CoV-2

The coronavirus disease 2019 (COVID-19) outbreak has become an evolving global health crisis. With an increasing incidence of primary hypertension, there is greater awareness of the relationship between primary hypertension and the immune system [including CD4+, CD8+ T cells, interleukin-17 (IL-17)/T regulatory cells (Treg) balance, macrophages, natural killer (NK) cells, neutrophils, B cells, and cytokines]. Hypertension is associated with an increased risk of various infections, post-infection complications, and increased mortality from severe infections. Despite ongoing reports on the epidemiological and clinical features of COVID-19, no articles have systematically addressed the role of primary hypertension in COVID-19 or how COVID-19 affects hypertension or specific treatment in these high-risk groups. Here, we synthesize recent advances in understanding the relationship between primary hypertension and COVID-19 and its underlying mechanisms and provide specific treatment guidelines for these high-risk groups.

Risk Factors Associated with Mortality among Patients with COVID-19: Analysis of a Cohort of 1213 Patients in a Tertiary Healthcare Center

The presence of cardio-metabolic and respiratory comorbidities, immunosuppression, and chronic kidney disease have been associated with an increase in mortality from COVID-19. The objective of this study is to establish the risk factors associated with 30-day mortality in a cohort of hospitalized patients with COVID-19. This paper conducts a retrospective and analytical study of patients hospitalized for COVID-19 in a tertiary care center. A Cox proportional hazard analysis was performed to estimate the association of comorbidities with 30-day mortality. A total of 1215 patients with a median age of 59 years were included. In the adjusted Cox proportional hazards regression model, hypothyroidism, D-dimer ≥ 0.8 μg/mL, LHD ≥ 430 IU/L, CRP ≥ 4.83 ng/mL, and triglycerides ≥ 214 mg/dL were associated with an increased risk of death. The presence of a history of hypothyroidism and biomarkers (D-dimer, lactic dehydrogenase, CRP, and triglycerides) were associated with an increase in mortality in the studied cohort.

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.

Course of disease and risk factors for hospitalization in outpatients with a SARS-CoV-2 infection

We analyzed symptoms and comorbidities as predictors of hospitalization in 710 outpatients in North-East Germany with PCR-confirmed SARS-CoV-2 infection. During the first 3 days of infection, commonly reported symptoms were fatigue (71.8%), arthralgia/myalgia (56.8%), headache (55.1%), and dry cough (51.8%). Loss of smell (anosmia), loss of taste (ageusia), dyspnea, and productive cough were reported with an onset of 4 days. Anosmia or ageusia were reported by only 18% of the participants at day one, but up to 49% between days 7 and 9. Not all participants who reported ageusia also reported anosmia. Individuals suffering from ageusia without anosmia were at highest risk of hospitalization (OR 6.8, 95% CI 2.5–18.1). They also experienced more commonly dyspnea and nausea (OR of 3.0, 2.9, respectively) suggesting pathophysiological connections between these symptoms. Other symptoms significantly associated with increased risk of hospitalization were dyspnea, vomiting, and fever. Among basic parameters and comorbidities, age > 60 years, COPD, prior stroke, diabetes, kidney and cardiac diseases were also associated with increased risk of hospitalization. In conclusion, due to the delayed onset, ageusia and anosmia may be of limited use in differential diagnosis of SARS-CoV-2. However, differentiation between ageusia and anosmia may be useful for evaluating risk for hospitalization.

Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study

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.

Systemic arterial hypertension as a risk factor for the severe form of covid-19: scoping review

OBJECTIVE

Identify whether systemic arterial hypertension is a risk factor for the severe form of covid-19.

METHODS

This is a scoping review, searches were performed on the Lilacs, PubMed, SciELO and Web of Science databases.

RESULTS

Thirteen articles were selected. The studies presented systemic arterial hypertension as the most common chronic disease in subjects diagnosed with covid-19. Hypertensive subjects were older, and men were more likely to develop severe covid-19. Hypertensive subjects without antihypertensive treatment were associated with a higher risk of mortality.

CONCLUSIONS

subjects with chronic diseases tend to have a different clinical profile. Blood pressure should be controlled in hypertensive subjects that should be continuously monitored during the covid-19 infection.

A critical evaluation of risk to reward ratio of quercetin supplementation for COVID-19 and associated comorbid conditions

The interim results of the large, multinational trials on coronavirus disease 2019 (COVID‐19) using a combination of antiviral drugs appear to have little to no effect on the 28‐day mortality or the in‐hospital course. Therefore, there is a still vivid interest in finding alternate re‐purposed drugs and nutrition supplements, which can halt or slow the disease severity. We review here the multiple preclinical studies, partially supported by clinical evidence showing the quercetin's possible therapeutic/prophylaxis efficacy against severe acute respiratory syndrome coronavirus (SARS‐CoV) as well as comorbidities like chronic obstructive pulmonary disease (COPD), diabetes mellitus, obesity, coagulopathy, and hypertension. Currently, 14 interventional clinical trials are underway assessing the efficacy of quercetin along with other antiviral drugs/nutritional supplements as prophylaxis/treatment option against COVID‐19. The present review is tempting to suggest that, based on circumstantial scientific evidence and preliminary clinical data, the flavonoid quercetin can ameliorate COVID‐19 infection and symptoms acting in concert on two parallel and independent paths: inhibiting key factors responsible for SARS‐CoV‐2 infections and mitigating the clinical manifestations of the disease in patients with comorbid conditions. Despite the broad therapeutic properties of quercetin, further high power randomized clinical trials are needed to firmly establish its clinical efficacy against COVID‐19.