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Satjawattanavimol S, Teerapuncharoen K, Kaewlai R, Disayabutr S. Prevalence of early bacterial co-infection in hospitalized patients with COVID-19 pneumonia: a retrospective study. J Thorac Dis 2023; 15:3568-3579. [PMID: 37559639 PMCID: PMC10407494 DOI: 10.21037/jtd-22-1681] [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: 11/23/2022] [Accepted: 05/26/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Identification of bacterial co-infection is crucial in determining outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia. The present study aims to evaluate the prevalence and associated factors of early bacterial co-infection in patients with COVID-19 pneumonia. METHODS The present study is a retrospective study. Patients with COVID-19 pneumonia, who were admitted to Siriraj Hospital between April 1 and August 31, 2021, were randomly enrolled and classified as the "Early bacterial co-infection" group, defined by an infection occurring within the first 48 hours after admission, and the "Unlikely early bacterial co-infection" group. RESULTS A total of 245 patients were enrolled. The prevalence of early bacterial co-infection was 15.5%. Chest X-rays showed characteristic findings for COVID-19 pneumonia in 37.6%. The median Brixia chest X-ray scores and C-reactive protein levels were significantly higher in the Early bacterial co-infection group. The most common causative pathogens included Staphylococcus aureus, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients with early bacterial co-infection had a significantly higher all-cause mortality compared to the Unlikely early bacterial co-infection group (P=0.012). The Charlson Comorbidity Index ≥4, high level of respiratory support, and mass-liked or diffuse opacities on chest X-rays were independent factors associated with the early bacterial co-infection. CONCLUSIONS The prevalence of early bacterial co-infection in patients with COVID-19 pneumonia was low but it was associated with mortality. There is insufficient evidence to support the empirical use of antibiotics in these patients. A further prospective study is required to confirm the results of the present study.
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Affiliation(s)
- Silp Satjawattanavimol
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Krittika Teerapuncharoen
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supparerk Disayabutr
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zhang Y, Lu J, Huang S, Zhang Y, Liu J, Xu Y, Yao B, Wang X. CYP2J deficiency leads to cardiac injury and presents dual regulatory effects on cardiac function in rats. Toxicol Appl Pharmacol 2023; 473:116610. [PMID: 37385478 DOI: 10.1016/j.taap.2023.116610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Cytochrome P450 2 J2 (CYP2J2) enzyme is widely expressed in aortic endothelial cells and cardiac myocytes and affects cardiac function, but the underlying mechanism is still unclear. Based on CYP2J knockout (KO) rats, we have directly studied the metabolic regulation of CYP2J on cardiac function during aging. The results showed that CYP2J deficiency significantly reduced the content of epoxyeicosatrienoic acids (EETs) in plasma, aggravated myocarditis, myocardial hypertrophy, as well as fibrosis, and inhibited the mitochondrial energy metabolism signal network Pgc-1α/Ampk/Sirt1. With the increase of age, the levels of 11,12-EET and 14,15-EET in plasma of KO rats decreased significantly, and the heart injury was more serious. Interestingly, we found that after CYP2J deletion, the heart initiated a self-protection mechanism by upregulating cardiac mechanism factors Myh7, Dsp, Tnni3, Tnni2, and Scn5a, as well as mitochondrial fusion factors Mfn2 and Opa1. However, this protective effect disappeared with aging. In conclusion, CYP2J deficiency not only reduces the amount of EETs, but also plays a dual regulatory role in cardiac function.
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Affiliation(s)
- Yanfang Zhang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China
| | - Jian Lu
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China
| | - Shengbo Huang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China
| | - Yuanjin Zhang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China
| | - Jie Liu
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China
| | - Yuan Xu
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China
| | - Bingyi Yao
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China.
| | - Xin Wang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, China.
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Barbosa HC, Martins MAP, de Jesus JC, Meira KC, Passaglia LG, Sacioto MF, Bezerra AFB, Schwarzbold AV, Maurílio ADO, Farace BL, da Silva CTCA, Cimini CCR, Silveira DV, Carazai DDR, Ponce D, Costa EVA, Manenti ERF, Cenci EPDA, Bartolazzi F, Madeira GCDC, Nascimento GF, Velloso IVP, Batista JDL, de Morais JDP, Carvalho JDSN, Ruschel KB, Martins KPMP, Zandoná LB, Menezes LSM, Kopittke L, de Castro LC, Nasi LA, Floriani MA, Souza MD, Carneiro M, Bicalho MAC, Lima MCPB, de Godoy MF, Guimarães-Júnior MH, Mendes PM, Delfino-Pereira P, Ribeiro RJE, Finger RG, Menezes RM, Francisco SC, Araújo SF, Oliveira TF, de Oliveira TC, Polanczyk CA, Marcolino MS. Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry. Arq Bras Cardiol 2023; 120:e20220151. [PMID: 36856237 PMCID: PMC10263463 DOI: 10.36660/abc.20220151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. OBJECTIVES To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. METHODS This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. RESULTS Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. CONCLUSION Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.
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Affiliation(s)
- Hannah Cardoso Barbosa
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
| | - Maria Auxiliadora Parreiras Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
| | - Jordana Cristina de Jesus
- Universidade Federal do Rio Grande do NorteNatalRNBrasilUniversidade Federal do Rio Grande do Norte,Natal, RN – Brasil
| | - Karina Cardoso Meira
- Universidade Federal do Rio Grande do NorteNatalRNBrasilUniversidade Federal do Rio Grande do Norte,Natal, RN – Brasil
| | - Luiz Guilherme Passaglia
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
| | - Manuela Furtado Sacioto
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Adriana Falangola Benjamin Bezerra
- Hospital das ClínicasUniversidade Federal de PernambucoRecifePEBrasilHospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE – Brasil
| | - Alexandre Vargas Schwarzbold
- Hospital Universitário de Santa MariaSanta MariaRSBrasilHospital Universitário de Santa Maria,Santa Maria, RS – Brasil
| | | | - Barbara Lopes Farace
- Hospital Risoleta Tolentino NevesBelo HorizonteMGBrasilHospital Risoleta Tolentino Neves,Belo Horizonte, MG – Brasil
| | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa RosáliaTeófilo OtoniMGBrasilHospital Santa Rosália,Teófilo Otoni, MG – Brasil
- Universidade Federal dos Vales do Jequitinhonha e MucuriTeófilo OtoniMGBrasilUniversidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG – Brasil
| | | | - Daniela do Reis Carazai
- Hospital Nossa Senhora da ConceiçãoPorto AlegreRSBrasilHospital Nossa Senhora da Conceição, Cristo Redentor, Porto Alegre, RS – Brasil
| | - Daniela Ponce
- Universidade Estadual PaulistaBotucatuSPBrasilUniversidade Estadual Paulista, Botucatu, SP – Brasil
| | - Emanuel Victor Alves Costa
- Centro Universitário de Belo HorizonteBelo HorizonteMGBrasilCentro Universitário de Belo Horizonte (UniBH),Belo Horizonte, MG – Brasil
| | | | | | - Frederico Bartolazzi
- Hospital Santo AntônioCurveloMGBrasilHospital Santo Antônio,Curvelo, MG – Brasil
| | - Glícia Cristina de Castro Madeira
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil
| | | | | | - Joanna d’Arc Lyra Batista
- Universidade Federal da Fronteira SulChapecóSCBrasilUniversidade Federal da Fronteira Sul, Chapecó, SC – Brasil
- Hospital Regional do OesteChapecóSCBrasilHospital Regional do Oeste, Chapecó, SC – Brasil
| | | | - Juliana da Silva Nogueira Carvalho
- Hospital das ClínicasUniversidade Federal de PernambucoRecifePEBrasilHospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE – Brasil
| | - Karen Brasil Ruschel
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus,Porto Alegre, RS – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | - Karina Paula Medeiros Prado Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | | | - Luanna Silva Monteiro Menezes
- Hospital LuxemburgoBelo HorizonteMGBrasilHospital Luxemburgo, Belo Horizonte, MG – Brasil
- Hospital Municipal Odilon BehrensBelo HorizonteMGBrasilHospital Municipal Odilon Behrens,Belo Horizonte, MG – Brasil
| | - Luciane Kopittke
- Hospital Nossa Senhora da ConceiçãoPorto AlegreRSBrasilHospital Nossa Senhora da Conceição, Cristo Redentor, Porto Alegre, RS – Brasil
| | | | - Luiz Antônio Nasi
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento,Porto Alegre, RS – Brasil
| | - Maiara Anschau Floriani
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento,Porto Alegre, RS – Brasil
| | - Maíra Dias Souza
- Hospital Municipal Odilon BehrensBelo HorizonteMGBrasilHospital Municipal Odilon Behrens,Belo Horizonte, MG – Brasil
| | - Marcelo Carneiro
- Hospital Santa CruzSanta Cruz do SulRSBrasilHospital Santa Cruz,Santa Cruz do Sul, RS – Brasil
| | | | | | - Mariana Frizzo de Godoy
- Hospital São LucasPUCRSPorto AlegreRSBrasilHospital São Lucas (PUCRS),Porto Alegre, RS – Brasil
| | | | - Paulo Mascarenhas Mendes
- Hospitais da Rede Mater DeiBelo HorizonteMGBrasilHospitais da Rede Mater Dei,Belo Horizonte, MG – Brasil
| | - Polianna Delfino-Pereira
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | | | - Renan Goulart Finger
- Hospital Regional do OesteChapecóSCBrasilHospital Regional do Oeste, Chapecó, SC – Brasil
| | - Rochele Mosmann Menezes
- Hospital Santa CruzSanta Cruz do SulRSBrasilHospital Santa Cruz,Santa Cruz do Sul, RS – Brasil
| | - Saionara Cristina Francisco
- Hospital Metropolitano Doutor Célio de CastroBelo HorizonteMGBrasilHospital Metropolitano Doutor Célio de Castro,Belo Horizonte, MG – Brasil
| | | | - Talita Fischer Oliveira
- Hospital Municipal Odilon BehrensBelo HorizonteMGBrasilHospital Municipal Odilon Behrens,Belo Horizonte, MG – Brasil
| | | | - Carisi Anne Polanczyk
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | - Milena Soriano Marcolino
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
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Predictive value of cord blood myocardial enzyme and troponin levels for myocardial injury after neonatal asphyxia. Am J Transl Res 2023; 15:241-248. [PMID: 36777838 PMCID: PMC9908482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 02/14/2023]
Abstract
PURPOSES To assess the value of myocardial enzymes and troponins in cord blood in the early diagnosis of myocardial injury after neonatal asphyxia. METHODS We retrospectively analyzed the clinical data of 50 cases of perinatal asphyxia neonates and 40 normal newborns in this study. The clinical manifestation, electrocardiograph (ECG) and echocardiography result, and the cord blood myocardial enzyme and troponin levels were compared between the two groups. The receiver operating characteristic (ROC) curve analysis was used to explore the diagnostic value of cord blood myocardial enzymes and troponins for myocardial injury after neonatal asphyxia. RESULTS All cases in the asphyxia group had different degrees of clinical manifestations of myocardial injury, as well as ECG and echocardiography abnormalities. Compared with the control group, cord blood aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), cardiac troponin T (cTNT), and cardiac troponin I (cTNI) levels in the asphyxia group were all elevated (all P < 0.05). Levels of the six biomarkers were all significantly higher in asphyxiated newborns with myocardial injury than in asphyxiated newborns without myocardial injury (all P < 0.05). ROC curve analyses showed that cord blood levels of CK-MB, cTNT, and cTNI could be used to differentiate asphyxiated newborn with and without myocardial damage. Calculation of AUC (area under curve) values indicated that CK-MB, cTNT, and cTNI had significant discriminatory ability (P=0.014, 0.021, and 0.009, respectively). The optimal cutoff value of CK-MB, cTNT, and cTNI were 135.4 U/L, 112.6 ng/L, and 55.3 ng/L, respectively. CONCLUSIONS Cord blood CK-MB, cTNT, and cTNI levels could be used for early prediction of myocardial injury after neonatal asphyxia.
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5
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Semiz S. COVID19 biomarkers: What did we learn from systematic reviews? Front Cell Infect Microbiol 2022; 12:1038908. [PMID: 36583110 PMCID: PMC9792992 DOI: 10.3389/fcimb.2022.1038908] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID19) pandemic continues to represent a substantial public health concern. It can rapidly progress to severe disease, with poor prognosis and a high mortality risk. An early diagnosis and specific prognostic tools can help healthcare providers to start interventions promptly, understand the likely prognosis and to identify and treat timely individuals likely to develop severe disease with enhanced mortality risk. Here we focused on an impressive set of systematic reviews and meta-analyses that were performed since the start of the COVID19 pandemic and summarized their results related to the levels of hematologic, inflammatory, immunologic biomarkers as well as markers of cardiac, respiratory, hepatic, gastrointestinal and renal systems and their association with the disease progression, severity and mortality. The evidence outlines the significance of specific biomarkers, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, interleukin-6), hematological (lymphocytes count, neutrophil-to-lymphocyte ratio, D-dimer, ferritin, red blood cell distribution width), cardiac (troponin, CK-MB, myoglobin), liver (AST, ALT, total bilirubin, albumin) and lung injury (Krebs von den Lungen-6) that can be used as prognostic biomarkers to aid the identification of high-risk patients and the prediction of serious outcomes, including mortality, in COVID19. Thus, these parameters should be used as essential tools for an early risk stratification and adequate intervention in improving disease outcomes in COVID19 patients.
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6
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The coronavirus disease-19 pandemic and acute coronary syndrome: a specific impact in the elderly. J Geriatr Cardiol 2022; 19:325-334. [PMID: 35722030 PMCID: PMC9170908 DOI: 10.11909/j.issn.1671-5411.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kushwaha AD, Mishra KP, Singh M, Ganju L, Saraswat D. Nanocurcumin formulation: a possible therapeutic agent for post COVID inflammatory syndrome. Immunopharmacol Immunotoxicol 2022; 44:141-146. [PMID: 35130792 DOI: 10.1080/08923973.2022.2037631] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the last twenty months, the attention of the world has been focusing on managing the unprecedented and devastating wave of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) and mitigating its impacts. Recent findings indicated that high levels of pro-inflammatory cytokines are leading cause of poor prognosis in severely ill COVID-19 patients. Presently, the multiple variants and highly contagious nature of virus makes challenge humongous. The shortage and vaccine hesitancy also prompted to develop antiviral therapeutic agents to manage this pandemic. Nanocurcumin has potential antiviral activities and also beneficial in post COVID inflammatory complications. We have developed nanocurcumin based formulation using pyrroloquinoline quinone (PQQ) which protects cardio-pulmonary function and mitochondrial homeostasis in hypobaric hypoxia induced right ventricular hypertrophy in animal model and human ventricular cardiomyocytes. Nanocurcumin based formulation (NCF) with improved bioavailability, has proven several holistic therapeutic effects including myocardial protection, and prevents edema formation, anti-inflammatory and antioxidant properties, maintaining metabolic and mitochondrial homeostasis under hypoxic condition. The post COVID-inflammatory syndrome also reported to cause impaired heart function, lung injuries and increased C-reactive protein level in severely ill patients. Thus, we speculate that NCF could be a new treatment option to manage post COVID-19 inflammatory syndrome.
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Affiliation(s)
- Asha D Kushwaha
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - K P Mishra
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Mrinalini Singh
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Lilly Ganju
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Deepika Saraswat
- Defence Institute of Physiology and Allied Sciences, Delhi, India
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Mungmunpuntipantip R, Wiwanitkit V. Correspondence on 'Coronavirus disease 2019 in patients with cardiovascular disease'. J Cardiovasc Med (Hagerstown) 2022; 23:e42. [PMID: 34874340 DOI: 10.2459/jcm.0000000000001276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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9
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Meel R, Van Blydenstein SA. Demographic, clinical, electrocardiographic and echocardiographic characteristics of patients hospitalized with COVID-19 and cardiac disease at a tertiary hospital, South Africa. Cardiovasc Diagn Ther 2021; 11:1228-1240. [PMID: 35070792 PMCID: PMC8748491 DOI: 10.21037/cdt-21-459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/29/2021] [Indexed: 04/06/2024]
Abstract
BACKGROUND Coronavirus associated disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients with cardiovascular disease. There is a paucity of data regarding COVID-19 and cardiac disease from Africa. We aimed to describe the demographic, clinical, electrocardiographic and echocardiographic characteristics of patients with COVID-19 and cardiac disease at a tertiary hospital in South Africa. METHODS This was a retrospective cross-sectional descriptive study (Aug 2020 to March 2021) of 200 patients with COVID-19 and confirmed cardiac disease, conducted at Chris Hani Baragwanath. Demographic, clinical, electrocardiographic and echocardiographic characteristics were systematically collected. RESULTS Majority (86%) of patients were Africans with mean age 56.4±15.6 years (57.5% females). Fifty three percent were unemployed and 28% were pensioners. Main comorbidities were hypertension (69.5%), diabetes mellitus (31.5%) and human immunodeficiency virus (HIV) (22.5%). Majority of the patients were overweight or obese (65.5%). All except 8 patients were on chronic medication. Dyspnoea on admission was noted in 88.5% of patients. Seventy nine percent of patients had abnormal chest X-Ray. Frequently documented electrocardiography findings were sinus tachycardia (63%) and atrial fibrillation, noted in 7% of patients. The most common indication for echocardiography was heart failure (30%). Severe left ventricular dysfunction was noted in 21.5%. Features of pulmonary hypertension were present in 45.5%. The right ventricle was enlarged in 59% of patients, and functional tricuspid regurgitation was noted in 54.5%. The most common diagnoses were hypertensive heart disease with preserved ejection fraction (35.8%), cardiomyopathies (20%), cor pulmonale (15.7%), acute coronary syndrome (6.5%), infective endocarditis (5.5%) and valvular heart disease (2.5%). Echocardiography modified management in 53% of cases. An in-hospital mortality of 17.5% was noted. On multivariate logistic regression analysis sinus tachycardia was the most important independent predictor of mortality (odds ratio, OR: 2.52, 95% confidence interval, CI: 1.08-5.85, P=0.03). CONCLUSIONS Most patients were obese females with underlying hypertension. Echocardiography altered management in about half the patients. Mortality amongst this cohort of patients was high and were predominantly males.
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Affiliation(s)
- Ruchika Meel
- Division of Cardiology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah A. Van Blydenstein
- Division of Pulmonology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cihakova D, Streiff MB, Menez SP, Chen TK, Gilotra NA, Michos ED, Marr KA, Karaba AH, Robinson ML, Blair PW, Dioverti MV, Post WS, Cox AL, R Antar AA. High-value laboratory testing for hospitalized COVID-19 patients: a review. Future Virol 2021. [PMID: 34567235 PMCID: PMC8457535 DOI: 10.2217/fvl-2020-0316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
We present here an evidence-based review of the utility, timing, and indications for laboratory test use in the domains of inflammation, cardiology, hematology, nephrology and co-infection for clinicians managing the care of hospitalized COVID-19 patients. Levels of IL-6, CRP, absolute lymphocyte count, neutrophils and neutrophil-to-lymphocyte ratio obtained upon admission may help predict the severity of COVID-19. Elevated LDH, ferritin, AST, and d-dimer are associated with severe illness and mortality. Elevated cardiac troponin at hospital admission can alert clinicians to patients at risk for cardiac complications. Elevated proBNP may help distinguish a cardiac complication from noncardiac etiologies. Evaluation for co-infection is typically unnecessary in nonsevere cases but is essential in severe COVID-19, intensive care unit patients, and immunocompromised patients. Doctors managing the complex care of individuals with COVID-19 need timely evidence to guide which lab tests to send to predict outcomes and prevent and treat COVID-19 complications involving the heart, blood clots, the kidney, and other infections that occur during the hospital course. Several lab tests such as IL-6, CRP and white blood cell subset counts may help predict the severity of COVID-19 during the patient’s hospital course if obtained when the patient first presents to the hospital. Other tests such as LDH, ferritin and AST are also associated with severe illness and mortality but have less evidence for their utility beyond IL-6, CRP and other tests. A test related to blood coagulation, d-dimer, is also associated with COVID-19 severity, and it may be used if the patient is suspected of having a blood clot. Two heart biomarkers – cardiac troponin and proBNP – may help doctors diagnose and manage heart-related complications of COVID-19. Patients in the hospital with COVID-19 may be susceptible to other infections, but testing for these is most useful in patients with severe disease, such as those in the intensive care unit. Specific recommendations for testing for viral, bacterial and fungal infections are presented here. The judicious use of laboratory testing can help identify patients at high risk for severe or critical COVID-19 and aid in prevention, diagnosis and treatment of common COVID-19 complications.
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Affiliation(s)
- Daniela Cihakova
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Michael B Streiff
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Steven P Menez
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Teresa K Chen
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Nisha A Gilotra
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Kieren A Marr
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Matthew L Robinson
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Paul W Blair
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.,Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, 6700 Rockledge Drive, Bethesda, MD 20817, USA
| | - Maria V Dioverti
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Annukka A R Antar
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
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11
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Specific Risk Factors for Fatal Outcome in Critically Ill COVID-19 Patients: Results from a European Multicenter Study. J Clin Med 2021; 10:jcm10173855. [PMID: 34501301 PMCID: PMC8432209 DOI: 10.3390/jcm10173855] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The aim of our study was to identify specific risk factors for fatal outcome in critically ill COVID-19 patients. (2) Methods: Our data set consisted of 840 patients enclosed in the LEOSS registry. Using lasso regression for variable selection, a multifactorial logistic regression model was fitted to the response variable survival. Specific risk factors and their odds ratios were derived. A nomogram was developed as a graphical representation of the model. (3) Results: 14 variables were identified as independent factors contributing to the risk of death for critically ill COVID-19 patients: age (OR 1.08, CI 1.06–1.10), cardiovascular disease (OR 1.64, CI 1.06–2.55), pulmonary disease (OR 1.87, CI 1.16–3.03), baseline Statin treatment (0.54, CI 0.33–0.87), oxygen saturation (unit = 1%, OR 0.94, CI 0.92–0.96), leukocytes (unit 1000/μL, OR 1.04, CI 1.01–1.07), lymphocytes (unit 100/μL, OR 0.96, CI 0.94–0.99), platelets (unit 100,000/μL, OR 0.70, CI 0.62–0.80), procalcitonin (unit ng/mL, OR 1.11, CI 1.05–1.18), kidney failure (OR 1.68, CI 1.05–2.70), congestive heart failure (OR 2.62, CI 1.11–6.21), severe liver failure (OR 4.93, CI 1.94–12.52), and a quick SOFA score of 3 (OR 1.78, CI 1.14–2.78). The nomogram graphically displays the importance of these 14 factors for mortality. (4) Conclusions: There are risk factors that are specific to the subpopulation of critically ill COVID-19 patients.
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12
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Abate SM, Mantefardo B, Nega S, Chekole YA, Basu B, Ali SA, Taddesse M. Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression. Ann Med Surg (Lond) 2021; 68:102594. [PMID: 34336202 PMCID: PMC8316689 DOI: 10.1016/j.amsu.2021.102594] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background The body of evidence showed that there is a strong correlation between acute myocardial Injury and COVID-19 infection. However, the link between acute myocardial infection and COVID-19, the prevalence, reliability of diagnostic modalities, independent predictors, and clinical outcomes are still uncertain and a topic of debate. The current study was designed to determine the prevalence, determinants, and outcomes of acute myocardial injury based on a systematic review and meta-analysis the global published peer-reviewed works of literature. Methods A comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2019 to May 2021. All observational studies reporting the prevalence of AMI were included while case reports and reviews were excluded. The data were extracted with two independent authors in a customized format. The methodological quality of included studies was evaluated using the Newcastle-Ottawa appraisal tool. Results A total of 397 articles were identified from different databases. Thirty-seven Articles with 21, 204 participants were included while seven studies were excluded. The meta-analysis revealed that the pooled prevalence of myocardial injury during the COVID-19 pandemic was 22.33 % (95 % CI: 17.86 to 26.81, 37). Conclusion Our meta-analysis showed that mortality among patients with an acute myocardial injury during COVID-19 was more than four times more likely as compared to those without AMI. This necessitates a mitigating strategy to prevent and manage before its clinical outcomes getting worse. The meta-analysis revealed that more than one-fifth of patients with COVID-19 sustained AMI ∙The incidence of mortality among patients with AMI during COVID-19 pandemic was four times more likely as compared those without AMI ∙Prevalence of AMI was three times more likely in patients with history of Coronary artery disease ∙Smoking and hypertension were the independent predictors of acute myocardial Injury
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bahiru Mantefardo
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Solomon Nega
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Yigrem Ali Chekole
- Departemnt of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Siraj Ahmed Ali
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Moges Taddesse
- Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
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13
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Sarabia De Ardanaz L, Andreu-Ubero JM, Navidad-Fuentes M, Ferrer-González MÁ, Ruíz Del Valle V, Salcedo-Bellido I, Barrios-Rodríguez R, Cáliz-Cáliz R, Requena P. Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment. Front Pharmacol 2021; 12:620187. [PMID: 34276355 PMCID: PMC8281134 DOI: 10.3389/fphar.2021.620187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/14/2021] [Indexed: 01/08/2023] Open
Abstract
Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23-5.64), age (HR 1.05; 95% CI 1.02-1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00-1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p = 0.013), troponin I (p = 0.013), C-reactive protein (p = 0.013), neutrophils (p = 0.024), and fewer platelets (p = 0.013) and lymphocytes (p = 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters.
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Affiliation(s)
| | - Jose M Andreu-Ubero
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Miriam Navidad-Fuentes
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Victor Ruíz Del Valle
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Inmaculada Salcedo-Bellido
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España.,Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España.,Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rafael Cáliz-Cáliz
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pilar Requena
- Departamento de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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