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Luo C, Chen W, Cai J, He Y. The mechanisms of milder clinical symptoms of COVID-19 in children compared to adults. Ital J Pediatr 2024; 50:28. [PMID: 38355623 PMCID: PMC10865718 DOI: 10.1186/s13052-024-01587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
In stark contrast to adult patients, children who contract Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) typically manifest milder symptoms or remain asymptomatic. However, the precise underlying mechanisms of this pathogenesis remain elusive. In this review, we primarily retrospect the clinical characteristics of SARS-CoV-2 infection in children, and explore the factors that may contribute to the typically milder clinical presentation in pediatric Coronavirus Disease 2019 (COVID-19) patients compare with adults patients with COVID-19. The pathophysiological mechanisms that mitigate lung injury in children are as follows: the expression level of ACE2 receptor in children is lower; the binding affinity between ACE2 receptors and viral spike proteins in children was weaker; children have strong pre-activated innate immune response and appropriate adaptive immune response; children have more natural lymphocytes; children with COVID-19 can produce higher levels of IgM, IgG and interferon; children infected with SARS-CoV-2 can produce lower levels of IL-6 and IL-10; children have fewer underlying diseases and the lower risk of worsening COVID-19; children are usually exposed to other respiratory viruses and have an enhanced cross-reactive immunity. Comprehending the relative contributions of these processes to the protective phenotype in the developing lungs can help in the diagnosis, treatment and research pertaining to children with COVID-19.
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Affiliation(s)
- Caiyin Luo
- Department of Pharmacy, the First Affiliated Hospital of Guangzhou Medical University, 28 Qiaozhong Middle Road, Liwan District, 510120, Guangzhou, China
| | - Wanwen Chen
- Department of Pharmacy, the First Affiliated Hospital of Guangzhou Medical University, 28 Qiaozhong Middle Road, Liwan District, 510120, Guangzhou, China
| | - Junying Cai
- Department of Pharmacy, the First Affiliated Hospital of Guangzhou Medical University, 28 Qiaozhong Middle Road, Liwan District, 510120, Guangzhou, China
| | - Yuwen He
- Department of Pharmacy, the First Affiliated Hospital of Guangzhou Medical University, 28 Qiaozhong Middle Road, Liwan District, 510120, Guangzhou, China.
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Brown RB. Hypertension, Anxiety and Obstructive Sleep Apnea in Cardiovascular Disease and COVID-19: Mediation by Dietary Salt. Diseases 2022; 10:diseases10040089. [PMID: 36278588 PMCID: PMC9590013 DOI: 10.3390/diseases10040089] [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: 09/05/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
This perspective paper used a grounded theory method to synthesize evidence proposing that sodium toxicity from excessive dietary salt intake is a potential common pathophysiological mechanism that mediates the association of hypertension, obstructive sleep apnea, and anxiety with cardiovascular disease and COVID-19. Increased anxiety in these conditions may be linked to a high-salt diet through stimulation of the sympathetic nervous system, which increases blood pressure while releasing catecholamines, causing a "fight or flight" response. A rostral shift of fluid overload from the lower to the upper body occurs in obstructive sleep apnea associated with COVID-19 and cardiovascular disease, and may be related to sodium and fluid retention triggered by hypertonic dehydration. Chronic activation of the renin-angiotensin-aldosterone system responds to salt-induced dehydration by increasing reabsorption of sodium and fluid, potentially exacerbating fluid overload. Anxiety may also be related to angiotensin II that stimulates the sympathetic nervous system to release catecholamines. More research is needed to investigate these proposed interrelated mechanisms mediated by dietary salt. Furthermore, dietary interventions should use a whole-food plant-based diet that eliminates foods processed with salt to test the effect of very low sodium intake levels on hypertension, anxiety, and obstructive sleep apnea in cardiovascular disease and COVID-19.
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Affiliation(s)
- Ronald B Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Yoo YJ, Wilkins KJ, Alakwaa F, Liu F, Torre-Healy LA, Krichevsky S, Hong SS, Sakhuja A, Potu CK, Saltz JH, Saran R, Zhu RL, Setoguchi S, Kane-Gill SL, Mallipattu SK, He Y, Ellison DH, Byrd JB, Parikh CR, Moffitt RA, Koraishy FM. COVID-19-associated AKI in hospitalized US patients: incidence, temporal trends, geographical distribution, risk factors and mortality. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.09.02.22279398. [PMID: 36093355 PMCID: PMC9460976 DOI: 10.1101/2022.09.02.22279398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Acute kidney injury (AKI) is associated with mortality in patients hospitalized with COVID-19, however, its incidence, geographic distribution, and temporal trends since the start of the pandemic are understudied. Methods Electronic health record data were obtained from 53 health systems in the United States (US) in the National COVID Cohort Collaborative (N3C). We selected hospitalized adults diagnosed with COVID-19 between March 6th, 2020, and January 6th, 2022. AKI was determined with serum creatinine (SCr) and diagnosis codes. Time were divided into 16-weeks (P1-6) periods and geographical regions into Northeast, Midwest, South, and West. Multivariable models were used to analyze the risk factors for AKI or mortality. Results Out of a total cohort of 306,061, 126,478 (41.0 %) patients had AKI. Among these, 17.9% lacked a diagnosis code but had AKI based on the change in SCr. Similar to patients coded for AKI, these patients had higher mortality compared to those without AKI. The incidence of AKI was highest in P1 (49.3%), reduced in P2 (40.6%), and relatively stable thereafter. Compared to the Midwest, the Northeast, South, and West had higher adjusted AKI incidence in P1, subsequently, the South and West regions continued to have the highest relative incidence. In multivariable models, AKI defined by either SCr or diagnostic code, and the severity of AKI was associated with mortality. Conclusions Uncoded cases of COVID-19-associated AKI are common and associated with mortality. The incidence and distribution of COVID-19-associated AKI have changed since the first wave of the pandemic in the US.
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Affiliation(s)
- Yun Jae Yoo
- Department of Biology, Stony Brook University, Stony Brook, NY
| | - Kenneth J. Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD
| | - Fadhl Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Luke A. Torre-Healy
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Spencer Krichevsky
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Stephanie S. Hong
- Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ankit Sakhuja
- Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Chetan K. Potu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Joel H. Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Richard L. Zhu
- Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Soko Setoguchi
- Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
| | - Sandeep K. Mallipattu
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Yongqun He
- Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
| | - David H. Ellison
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
| | - James Brian Byrd
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Richard A. Moffitt
- Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
| | - Farrukh M. Koraishy
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
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Ribeiro AC, Uehara SCDSA. Systemic arterial hypertension as a risk factor for the severe form of covid-19: scoping review. Rev Saude Publica 2022; 56:20. [PMID: 35416846 PMCID: PMC8973022 DOI: 10.11606/s1518-8787.2022056004311] [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: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Ana Cristina Ribeiro
- Universidade Federal de São Carlos. Departamento de Enfermagem. São Carlos, SP, Brasil
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Zhu Y, Chen X, Liu X. NETosis and Neutrophil Extracellular Traps in COVID-19: Immunothrombosis and Beyond. Front Immunol 2022; 13:838011. [PMID: 35309344 PMCID: PMC8924116 DOI: 10.3389/fimmu.2022.838011] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022] Open
Abstract
Infection with SARS-CoV-2, the causative agent of the Coronavirus disease 2019 (COVID-19) pandemic, causes respiratory problems and multifaceted organ dysfunction. A crucial mechanism of COVID-19 immunopathy is the recruitment and activation of neutrophils at the infection site, which also predicts disease severity and poor outcomes. The release of neutrophil extracellular traps (NETs), occurring during a regulated form of neutrophil cell death known as NETosis, is a key effector function that mediates harmful effects caused by neutrophils. Abundant NETosis and NET generation have been observed in the neutrophils of many COVID-19 patients, leading to unfavorable coagulopathy and immunothrombosis. Moreover, excessive NETosis and NET generation are now more widely recognized as mediators of additional pathophysiological abnormalities following SARS-CoV-2 infection. In this minireview, we introduce subtypes of NET-producing neutrophils (e.g., low-density granulocytes) and explain the biological importance of NETs and the protein cargos of NETs in COVID-19. In addition, we discuss the mechanisms by which SARS-CoV-2 causes NETosis by upregulating viral processes (e.g., viral entry and replication) as well as host pro-NET mechanisms (e.g., proinflammatory mediator release, platelet activation, and autoantibody production). Furthermore, we provide an update of the main findings of NETosis and NETs in immunothrombosis and other COVID-19-related disorders, such as aberrant immunity, neurological disorders, and post COVID-19 syndromes including lung fibrosis, neurological disorder, tumor progression, and deteriorated chronic illness. Finally, we address potential prospective COVID-19 treatment strategies that target dysregulated NETosis and NET formation via inhibition of NETosis and promotion of NET degradation, respectively.
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Affiliation(s)
- Yuanfeng Zhu
- Clinical Medical Research Center, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Xiaoli Chen
- Clinical Medical Research Center, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Xin Liu
- Clinical Medical Research Center, Southwest Hospital, Army Military Medical University, Chongqing, China
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Haji Aghajani M, Asadpoordezaki Z, Haghighi M, Pourhoseingoli A, Taherpour N, Toloui A, Sistanizad M. Effect of Underlying Cardiovascular Disease on the Prognosis of COVID-19 Patients; a Sex and Age-Dependent Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e65. [PMID: 34870231 PMCID: PMC8628643 DOI: 10.22037/aaem.v9i1.1363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Adults with underlying medical disorders are at increased risk for severe illness from the virus that causes COVID-19. This study aimed to compare the effect of underlying diseases on the mortality of male and female patients as a primary objective. We also evaluated the effect of drugs previously used by COVID-19 patients on their outcome. Methods: This retrospective cohort study was carried out on confirmed cases of COVID-19 who were admitted to a teaching hospital in Tehran, Iran. Data was gathered from patients’ files. Log binomial model was used for investigating the association of underlying diseases and in-hospital mortality of these patients. Results: A total of 991 patients (mean age 61.62±17.02; 54.9% male) were recruited. Hypertension (41.1%), diabetes mellitus (30.6%), and coronary artery disease (19.6%) were the most common underlying diseases. The multivariable model showed that hypertension (RR = 1.62; 95% CI: 1.22-2.14, p = 0.001) in male patients over 55 years old and coronary artery disease (RR = 2.40; 95% CI: 1.24-4.46, p = 0.009) in female patients under 65 years old were risk factors of mortality. In females over 65 years old, the history of taking Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) (RR = 0.272; 95% CI: 0.17-0.41, p = 0.001) was a significant protective factor for death. Conclusions: COVID-19 patients with a history of cardiovascular diseases such as hypertension and coronary artery disease, especially those in specific age and sex groups, are high-risk patients for in-hospital mortality. Additionally, a previous history of taking ACEi and ARB medications in females over 65 tears old was a protective factor against in-hospital mortality of COVID-19 patients.
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Affiliation(s)
- Mohammad Haji Aghajani
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ziba Asadpoordezaki
- Department of Psychology, Maynooth University, Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Kildare, Ireland
| | - Mehrdad Haghighi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asma Pourhoseingoli
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Taherpour
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Mohammad Sistanizad
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Long-term sequelae are highly prevalent one year after hospitalization for severe COVID-19. Sci Rep 2021; 11:22666. [PMID: 34811387 PMCID: PMC8608998 DOI: 10.1038/s41598-021-01215-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/07/2021] [Indexed: 12/22/2022] Open
Abstract
Many coronavirus disease 2019 (Covid-19) survivors show symptoms months after acute illness. The aim of this work is to describe the clinical evolution of Covid-19, one year after discharge. We performed a prospective cohort study on 238 patients previously hospitalized for Covid-19 pneumonia in 2020 who already underwent clinical follow-up 4 months post-Covid-19. 200 consented to participate to a 12-months clinical assessment, including: pulmonary function tests with diffusing lung capacity for carbon monoxide (DLCO); post-traumatic stress (PTS) symptoms evaluation by the Impact of Event Scale (IES); motor function evaluation (by Short Physical Performance Battery and 2 min walking test); chest Computed Tomography (CT). After 366 [363–369] days, 79 patients (39.5%) reported at least one symptom. A DLCO < 80% was observed in 96 patients (49.0%). Severe DLCO impairment (< 60%) was reported in 20 patients (10.2%), related to extent of CT scan abnormalities. Some degree of motor impairment was observed in 25.8% of subjects. 37/200 patients (18.5%) showed moderate-to-severe PTS symptoms. In the time elapsed from 4 to 12 months after hospital discharge, motor function improves, while respiratory function does not, being accompanied by evidence of lung structural damage. Symptoms remain highly prevalent one year after acute illness.
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