Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors

New Vaccines for Chronic Respiratory Patients

Chronic respiratory diseases (CRD) are responsible for more than four million deaths worldwide and have become especially prevalent in developed countries. Although the current therapies help manage daily symptoms and improve patients' quality of life, there is a major need to prevent exacerbations triggered mainly by respiratory infections. Therefore, CRD patients are a prime target for vaccination against infectious agents. In the present manuscript we review the state of the art of available vaccines specifically indicated in patients with CRDs. In addition to pneumococcus, influenza, pertussis, and SARS-CoV-2 vaccines, recently added immunization options like vaccines and monoclonal antibodies against respiratory syncytial virus, are particularly interesting in CRD patients. As new products reach the market, health authorities must be agile in updating immunization recommendations and in the programming of the vaccination of vulnerable populations such as patients with CRDs. Organizational and educational strategies might prove useful to increase vaccine uptake by CRD patients.

Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews

BACKGROUND

Pre-existing neurological diseases have been identified as risk factors for severe COVID-19 infection and death. There is a lack of comprehensive literature review assessing the relationship between pre-existing neurological conditions and COVID-19 outcomes. Identification of high risk groups is critical for optimal treatment and care.

METHODS

A literature review was conducted for systematic reviews, meta-analyses, and scoping reviews published between January 1, 2020 and January 1, 2023. Literature assessing individuals with pre-existing neurological diseases and COVID-19 infection was included. Information regarding infection severity was extracted, and potential limitations were identified.

RESULTS

Thirty-nine articles met inclusion criteria, with data assessing >3 million patients from 51 countries. 26/51 (50.9%) of countries analyzed were classified as high income, while the remaining represented middle-low income countries (25/51; 49.0%). A majority of evidence focused on the impact of cerebrovascular disease (17/39; 43.5%) and dementia (5/39; 12.8%) on COVID-19 severity and mortality. 92.3% of the articles (36/39) suggested a significant association between neurological conditions and increased risk of severe COVID-19 and mortality. Cerebrovascular disease, dementia, Parkinson's disease, and epilepsy were associated with increased COVID severity and mortality.

CONCLUSION

Pre-existing neurological diseases including cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, and Parkinson's disease are significant risk factors for severity of COVID-19 infection and mortality in the acute infectious period. Given that 61.5% (24/39) of the current evidence only includes data from 2020, further updated literature is crucial to identify the relationship between chronic neurological conditions and clinical characteristics of COVID-19 variants.

Impact of Inflammation-Related Genes on COVID-19: Prospective Study at Turkish Cohort

The pandemic coronavirus disease 2019 (COVID-19) has caused a high mortality rate and poses a significant threat to the population. The disease may progress with mild symptoms or may cause the need for intensive care, depending on many factors. In this study, it was aimed to determine if there is a tendency due to genetic factors in COVID-19 patients. Ninety-four of 188 patients with mild clinical and 94 with severe clinical symptoms were included in the study. The targeted panel including coagulopathy (F2, F5), viral invasion (ACE2), and inflammation (CXCL8, IFNAR2, IFNL4, IL10, IL2, IL6, IRF7, TLR3, TLR7, TNF) related genes was performed sequenced by the next generation sequencing (NGS). The variants found were classified and univariate analyses were performed to select candidate variables for logistic model. Risk factors and variants were compared. It was revealed that the presence of 2 or more risk factors caused the disease to progress severely (p < 0.001). Heterozygous IRF7:c.1357-23dup variant had a 2.5 times higher risk for mild disease compared to severe disease. Other variants were found to be more significant in mild disease. Since polymorphic variants were not evaluated in the literature, the findings of our study could not be compared with the literature. However, as variants that may be effective in the severity of infections may differ according to ethnicity. This study has the feature of being a guide for subsequent studies to be carried out especially in Turkish population. Clinical course of the COVID-19 is likely to depend on a variety of risk factors, including age, sex, clinical status, immunology and genetic factors.

Exploring Hematological Parameters and Their Prognostic Value in Adult COVID-19 Patients: Insights from Mogadishu, Somalia

There were no data on SARS-CoV-2 and hematology in Mogadishu, Somalia, despite the fact that many prior investigations of SARS-CoV-2 and hematology have already been conducted in many different parts of the world. As a result, this study aimed to assess hematological changes in COVID-19-infected patients at some selected hospitals in Mogadishu, Somalia. Methods. Outright, 433 COVID-19 patients were included in this study, which used a hospital-based cross-sectional design to investigate hematological alterations using the Mindray full automated hematological analyzer. Furthermore, ethical considerations were taken into account during the study. All individuals provided informed consent prior to participation in the study. Data were analyzed using SPSS. Results. The median age of the current study was 54.65 ± 20.486 years. People with diabetes, high blood pressure, asthma, or heart disease made up 21.2%, 21.2%, 20%, and 2.1% of the study population, respectively. According to the patients' hematological profiles, 89.5% of them had leukopenia, 86.8% had lymphopenia, and 89% had neutrophilia. Monocytes, eosinophils, basophils, and thrombocytes were typically normal although around 50.4% individuals exhibited anemia. Conclusion. Hematological indicators can predict how bad the illness is and how it will turn out, which helps guide clinical therapy. Leukopenia, neutrophilia, lymphopenia, and anemia were found in this study. At the time of admission, a thorough review of laboratory parameters can help clinicians make a treatment plan and quickly give intensive care to the patients who need it most.

A Comparative Study of Immunogenicity, Antibody Persistence, and Safety of Three Different COVID-19 Boosters between Individuals with Comorbidities and the Normal Population

Data on immunogenicity, immune response persistency, and safety of COVID-19 boosters in patients with comorbidities are limited. Therefore, we aimed to evaluate three different boosters' immunogenicity and safety in individuals with at least one underlying disease (UD) (obesity, hypertension, and diabetes mellitus) with healthy ones (HC) who were primed with two doses of the BBIBP-CorV vaccine and received a booster shot of the same priming vaccine or protein subunit vaccines, PastoCovac Plus or PastoCovac. One hundred and forty subjects including sixty-three ones with a comorbidity and seventy-seven healthy ones were enrolled. The presence of SARS-CoV-2 antibodies was assessed before the booster injection and 28, 60, 90, and 180 days after it. Moreover, the adverse events (AEs) were recorded on days 7 and 21 postbooster shot for evaluating safety outcomes. Significantly increased titers of antispike, antiRBD, and neutralizing antibodies were observed in both UD and HC groups 28 days after the booster dose. Nevertheless, the titer of antispike IgG and anti-RBD IgG was lower in the UD group compared to the HC group. The long-term assessment regarding persistence of humoral immune responses showed that the induced antibodies were detectable up to 180 days postbooster shots though with a declined titer in both groups with no significant differences (p > 0.05). Furthermore, no significant difference in antibody levels was observed between each UD subgroup and the HC group, except for neutralizing antibodies in the hypertension subgroup. PastoCovac Plus and PastoCovac boosters induced a higher fold rise in antibodies in UD individuals than BBIBP-CorV booster recipients. No serious AEs after the booster injection were recorded. The overall incidence of AEs after the booster injection was higher in the UD group than the HC group among whom the highest systemic rate of AEs was seen in the BBIBP-CorV booster recipients. In conclusion, administration of COVID-19 boosters could similarly induce robust and persistent humoral immune responses in individuals with or without UD primarily vaccinated with two doses of the BBIBP-CorV. Protein-based boosters with higher a higher fold rise in antibodies and lower AEs in individuals with comorbidities might be considered a better choice for these individuals.

Corticosteroids in COVID-19: pros and cons

The wide and rapid spread of the COVID-19 pandemic has placed an unanticipated burden on the global healthcare sector. This necessitated a swift response from the international community to reach a solution. Efforts were made in parallel to develop preventative and therapeutic modalities. Since then, drug repurposing has blossomed as a potentially rapid resolution and has included various agents with anti-viral and anti-inflammatory properties. Corticosteroids, being potent anti-inflammatory agents, have been placed under extensive investigation. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19. With the high pace of escalating events, the quality and study design of clinical trials are varied. Therefore, this study aims to explore the role of corticosteroids in COVID-19 disease. It inspects the molecular, pharmacologic, and clinical proof behind this theory.

COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease

Background

Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited.

Objectives

To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF.

Methods

Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated.

Results

Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001).

Conclusions

Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).

A nonlinear mathematical model on the Covid-19 transmission pattern among diabetic and non-diabetic population

In this paper, a three tier mathematical model describing the interactions between susceptible population, Covid-19 infected, diabetic population and Covid-19 infected, non diabetic population is proposed. Basic properties of such a dynamic model, namely, non negativity, boundedness of solutions, existence of disease-free and disease equilibria are studied and sufficient conditions are obtained. Basic reproduction number for the system is derived. Sufficient conditions on functionals and parameters of the system are obtained for the local as well as global stability of equilibria, thus, establishing the conditions for eventual prevalence of disease free or disease environment, as the case may be. The stability aspects are discussed in the context of basic reproduction number and vice versa. An important contribution of this article is that a novel technique is presented to estimate some key, influencing parameters of the system so that a pre-specified, assumed equilibrium state is approached eventually. This enables the society to prepare itself with the help of these key, influencing parameters so estimated. Several examples are provided to illustrate the results established and simulations are provided to visualize the examples.

Beyond Acute COVID-19: Investigating the Incidence of Subacute Thyroiditis in Long COVID-19 in Korea

BACKGRUOUND

The correlation between acute coronavirus disease 2019 (COVID-19) and subacute thyroiditis (SAT) has not been clearly investigated in "long COVID" patients. We aimed to investigate the incidence of SAT during convalescence and after the acute phase of COVID-19, comparing with that of the general population.

METHODS

Data from a total of 422,779 COVID-19 patients and a control group of 2,113,895 individuals were analyzed. The index date was defined as the date 3 months after confirmation of COVID-19. The incidence rate (IR) of SAT and hazard ratios (HRs) were calculated per 100,000 persons. Subgroup analysis included analysis of HRs 90-179 and 180 days post-COVID-19 diagnosis; and additional analysis was conducted according to hospitalization status, sex, and age group.

RESULTS

The IR of SAT was 17.28 per 100,000 persons (95% confidence interval [CI], 12.56 to 23.20) in the COVID-19 group and 8.63 (95% CI, 6.37 to 11.45) in the control group. The HR of COVID-19 patients was 1.76 (95% CI, 1.01 to 3.06; P=0.045). The HR of SAT was 1.39 (95% CI, 0.82 to 2.34; P=0.220) up to 6 months after the index date and 2.30 (95% CI, 1.60 to 3.30; P<0.001) beyond 6 months. The HR for SAT among COVID-19 patients was 2.00 (95% CI, 1.41 to 2.83) in hospitalized patients and 1.76 (95% CI, 1.01 to 3.06) in non-hospitalized patients compared to the control group. The IR of SAT was 27.09 (95% CI, 20.04 to 35.82) for females and 6.47 (95% CI, 3.34 to 11.30) for males. In the 19 to 64 age group, the IR of SAT was 18.19 (95% CI, 13.70 to 23.67), while the IR was 9.18 (95% CI, 7.72 to 10.84) in the 65 to 69 age group.

CONCLUSION

SAT could be a potential long-term complication of COVID-19. Long-term surveillance for thyroid dysfunction is needed especially in hospitalized, female and young-aged subjects.

Impact of comorbidities on hospitalised Syrian patients with COVID-19: a retrospective study

OBJECTIVES

This study aims to compare the clinical manifestations, laboratory findings, outcomes and overall survival time of patients with COVID-19 with and without comorbidities.

DESIGN

Retrospective design.

SETTING

This study was undertaken at two hospitals in Damascus.

PARTICIPANTS

A total of 515 Syrian patients met the inclusion criterion, laboratory-confirmed COVID-19 infection following the Centers for Disease Control and Prevention. Exclusion criteria were suspected and probable cases that were not confirmed with a positive reverse transcription-PCR assay, and patients who self-discharged from the hospital against medical advice.

PRIMARY AND SECONDARY OUTCOME MEASURES

First, assess the impacts of comorbidities on COVID-19 infection in four areas (clinical manifestations, laboratory findings, severity and outcomes). Second, calculate the overall survival time for patients with COVID-19 with comorbidities.

RESULTS

Of 515 patients included, 316 (61.4%) were male and 347 (67.4%) had at least one coexisting chronic disease. Patients with comorbidities compared with no comorbidities were more vulnerable to poor outcomes such as severe infection (32.0% vs 9.5%, p<0.001), severe complications (34.6% vs 9.5%, p<0.001), the need for mechanical ventilation (28.8% vs 7.7%, p<0.001) and death (32.0% vs 8.3%, p<0.001). Multiple logistic regression showed that age ≥65 years old, positive smoking history, having ≥2 comorbidities and chronic obstructive pulmonary disease were risk factors linked to severe COVID-19 infection in patients with comorbidities. Overall survival time was lower among patients with comorbidities (vs no comorbidities), patients with ≥2 comorbidities (vs one comorbidity), and patients with hypertension, chronic obstructive pulmonary disease, malignancy or obesity (vs other comorbidities) (p<0.05).

CONCLUSION

This study revealed that COVID-19 infection had poor outcomes among those with comorbidities. Severe complications, mechanical ventilation usage and death were more prevalent among patients with comorbidities compared with those with no comorbidities.

Blockchain-based privacy and security preserving in electronic health: a systematic review

In today's world, health and medicine play an undeniable role in human life. Traditional and current Electronic Health Records (EHR) systems that are used to exchange information between medical stakeholders (patients, physicians, insurance companies, pharmaceuticals, medical researchers, etc.) suffer weaknesses in terms of security and privacy due to having centralized architecture. Blockchain technology ensures the privacy and security of EHR systems thanks to the use of encryption. Moreover, due to its decentralized nature, this technology prevents central failure and central attack points. In this paper, a systematic literature review (SLR) is proposed to analyze the existing Blockchain-based approaches for improving privacy and security in electronic health systems. The research methodology, paper selection process, and the search query are explained. 51 papers returned from our search criteria published between 2018 and Dec 2022 are reviewed. The main ideas, type of Blockchain, evaluation metrics, and used tools of each selected paper are discussed in detail. Finally, future research directions, open challenges, and some issues are discussed.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

COVID-19 vaccination coverage in patients with chronic obstructive pulmonary disease - A cross-sectional study in Hungary

INTRODUCTION

Coronavirus infection is a particular risk for patients with chronic obstructive pulmonary disease (COPD), because they are much more likely to become severely ill due to oxygen supply problems. Primary prevention, including COVID-19 vaccination is of paramount importance in this disease group. The aim of our study was to assess COVID-19 vaccination coverage in COPD patients during the first vaccination campaign of the COVID-19 pandemic.

METHODS

A cross-sectional observational study (CHANCE) has been conducted in COPD patients in the eastern, western and central regions of Hungary from 15th November 2021. The anthropometric, respiratory function test results and vaccination status of 1,511 randomly selected patients were recorded who were aged 35 years and older.

RESULTS

The median age was 67 (61-72) years, for men: 67 (62-73) and for women: 66 (60-72) years, with 47.98 % men and 52.02 % women in our sample. The prevalence of vaccination coverage for the first COVID-19 vaccine dose was 88.62 %, whereas 86.57 % of the patients received the second vaccine dose. When unvaccinated (n = 172) and double vaccinated (n = 1308) patients were compared, the difference was significant both in quality of life (CAT: 17 (12-23) vs 14 (10-19); p < 0.001) and severity of dyspnea (mMRC: 2 (2-2) vs 2 (1-2); p = 0.048). The COVID-19 infection rate between double vaccinated and unvaccinated patients was 1.61 % vs 22.67 %; p < 0.001 six months after vaccination. The difference between unvaccinated and vaccinated patients was significant (8.14 % vs 0.08 %; p < 0.001) among those with acute COVID-19 infection hospitalized. In terms of post-COVID symptoms, single or double vaccinated patients had significantly fewer outpatient hospital admissions than unvaccinated patients (7.56 vs 0 %; p < 0.001).

CONCLUSION

The COVID-19 vaccination coverage was satisfactory in our sample. The uptake of COVID-19 vaccines by patients with COPD is of utmost importance because they are much more likely to develop severe complications.

Mediterranean diet and the risk of COVID-19 in the 'Seguimiento Universidad de Navarra' cohort

BACKGROUND & AIMS

A potential protection against COVID-19 by a high-quality dietary pattern is to be expected given the biological plausibility supporting the beneficial effects of an adequate dietary intake on the immune system. However, knowledge on the relationship between long-term maintained healthy dietary patterns, such as the Mediterranean diet, and the risk of SARS-CoV-2 infection is still sparse. We longitudinally assessed this association in a well-known Mediterranean cohort.

METHODS

We assessed 9,677 participants from the SUN Project, a prospective cohort of middle-aged university graduates in Spain. We inquired about a positive result in a COVID-19 diagnostic test during the months of February to December 2020. After excluding health professionals (HP), 5,194 participants were included in the statistical analyses (mean age: 52.6, SD: 12.4; 55.2% women). Food habits were assessed at baseline using a previously validated semiquantitative 136-item food frequency questionnaire. Adherence to the Mediterranean diet (cumulative average of 2 repeated measurements 10 years apart) was assessed using the 0-to-9 Mediterranean Diet Score (MDS). We used multivariable logistic regression models to estimate odds ratios and 95% confidence intervals for incident COVID-19 according to the MDS.

RESULTS

Among 5,194 non-HP participants, 122 reported to have received a positive COVID-19 diagnostic test. Participants with intermediate adherence to the Mediterranean diet (3 < MDS ≤ 6) had a significantly lower odds of developing COVID-19 (multivariable-adjusted OR = 0.50, 95% CI: 0.34-0.73), and those with the highest adherence (MDS > 6) exhibited the lowest risk (multivariable-adjusted OR = 0.36, 95% CI: 0.16-0.84, p for trend < 0.001) as compared with participants with MDS ≤ 3. This inverse association remained robust within subgroups and in sensitivity analyses. Notwithstanding, no significant associations were observed for health professionals (p for interaction = 0.06).

CONCLUSION

In conclusion, better adherence to the Mediterranean diet may be associated with a lower risk of COVID-19. Our results are applicable only to persons who are not health professionals.

Prevalence of hypertension and associated risks in hospitalized patients with COVID-19: a meta-analysis of meta-analyses with 1468 studies and 1,281,510 patients

BACKGROUND

Since the COVID-19 outbreak, preliminary research has shown that some risk-associated conditions increase death and severe complications of the disease, hypertension being one of them. Thus, numerous meta-analyses have been conducted to explore this issue. Therefore, this umbrella review aims to perform a meta-analysis of the meta-analyses to estimate the prevalence and associated risks of hypertension in patients with COVID-19.

METHODS

PubMed, Scopus, Web of Knowledge, Embase, and Cochrane databases were searched for the published meta-analyses up to January 1, 2022. Google Scholar, citation check, reference check, and Grey literature were also manually searched. A random-effect model approach was used for analysis.

RESULTS

The overall death rate was estimated at 12%. Hypertension was present in 25% of the patients as a comorbid disease. The overall RR for death, disease severity, and the possibility of ICU admission were estimated at 1.79 [1.68-1.89 with 95% CI], 1.74 [1.66-1.83 with 95% CI], and 1.91 [1.48-2.34 with 95% CI], respectively. The meta-regression results showed that being "male" significantly increases the risk of disease severity and ICU admission.

CONCLUSIONS

The results indicated that hypertension is a common comorbid disease in hospitalized patients with COVID-19, which significantly increases mortality risk, the severity of the disease, and the probability of ICU admission.

SYSTEMATIC REVIEW REGISTRATION

This study has been registered in PROSPERO (CRD42021231844).

Recent Advance Analysis of Recovery in Hospitalized People with COVID-19: A Systematic Review

INTRODUCTION

COVID-19 is a public health emergency all around the world. Severe illness occurred in about 14% of patients and 5% of patients developed critical illness, but the prognosis for these patients remains unclear.

OBJECTIVE

To describe the prognosis in hospitalized adults with COVID-19.

METHODS

The MEDLINE, EMBASE, AMED, and COCHRANE databases were searched for studies published up to 28 June 2021 without language restrictions. Descriptors were related to "COVID-19" and "prognosis". Prospective inception cohort studies that assessed morbidity, mortality and recovery in hospitalized people over 18 years old with COVID-19 were included. Two independent reviewers selected eligible studies and extracted the available data. Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOFS) were considered as outcomes for morbidity and discharge was considered for recovery. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Analyses were performed using Comprehensive Meta-Analysis (version 2.2.064).

RESULTS

We included 30 inception cohort studies investigating 13,717 people hospitalized with COVID-19 from different countries. The mean (SD) age was 60.90 (21.87) years, and there was high proportion of males (76.19%) and people with comorbidities (e.g., 49.44% with hypertension and 29.75% with diabetes). Findings suggested a high occurrence of morbidity, mainly related to ARDS. Morbidity rates varied across studies from 19% to 36% in hospital wards, and from 13% to 90% in Intensive Care Units-ICU. Mortality rates ranged from 4% to 38% in hospital wards and from 8% to 51% in ICU. Recovery rates ranged up to 94% and 65% in hospital wards and ICU, respectively. The included studies had high risk of bias in the confounding domain.

CONCLUSIONS

The prognosis of people hospitalized with COVID-19 is an issue for the public health system worldwide, with high morbidity and mortality rates, mainly in ICU and for patients with comorbidities. Its prognosis emphasizes the need for appropriate prevention and management strategies.

SARS-Cov-2 infection in cancer patients, susceptibility, outcome and care

The COVID-19 pandemic has led to many problems in cancer patients, which in part are due to insufficient knowledge of the exact implications of the virus on these individuals. Perceptions based on known facts about previous pandemics and coronaviruses might not agree with actual real-life experience and objective findings. We present a compilation of scientific facts and actual observations on different aspects of SARS-CoV-2 infection in cancer patients. These patients are at increased risk of viral contraction and have higher chances of severe disease/mortality. The latter is impacted by other factors and is still debated. In contrast to preliminary impressions, the benefits of anti-cancer treatments outweigh their risks and should be continued. Cancer patients generate antibodies in response to vaccination but in lower amounts than healthy people, especially those with hematologic cancers. Boosters, including third doses, have shown increased immune-responses in most patients. Vaccination should be prioritized in these individuals.

Do Comorbidities and Daily Medication before SARS-CoV-2 Infection Play a Role in Self-Reported Post-Infection Symptoms?

This study investigated the associations between health status before SARS-CoV-2 infection and persistent symptoms after acute infection. Data were collected from participants older than 18 years and more than 28 days after acute SARS-CoV-2 infection using an online survey. Sociodemographic data, comorbidities, and daily medication before infection, as well as acute and persistent symptoms were analysed. Among the 1050 participants (mean age 41 years, 88% women, 56% with higher education, 93% working), 538 (51%) reported being healthy and 762 (73%) reported not taking any daily medication prior to infection. Positive laboratory testing was reported by 965 (92%) participants; asymptomatic infection was reported by 30 (3%); and 999 (95%) stayed at home during their acute infection. Reduced physical capacity (40%), fatigue (39%), cognitive difficulties (30-34%), altered sense of smell (24%), headache (20%), tachycardia (20%), unstable mood (19%), hair loss (17%), and insomnia (17%) were the most often reported symptoms. Those taking daily medication before infection reported increased frequency of both acute and persistent symptoms, except for decreased frequency of persistent altered smell and taste. The presence of persistent symptoms was predicted by taking daily medication before infection and by the total number of acute symptoms. Comorbidities before infection did not predict persistent symptoms. Therefore, the role of medication needs further investigation in both acute SARS-CoV-2 infection and post-COVID-19 condition.

Economic Burden of SARS-CoV-2 Patients with Multi-Morbidity: A Systematic Review Protocol

Economic burden issues in SARS-CoV-2 patients with underlying co-morbidities are enormous resources for patient treatment and management. The uncertainty costs for clinical management render the healthcare system catatonic and incurs deficits in national annual budgets. This article focuses on systematic steps towards selecting and evaluating literature to uncover gaps and ways to help healthcare stakeholders optimize resources in treating and managing COVID-19 patients with multi-morbidity. A systematic review of all COVID-19 treatment procedures with co-morbidities or multi-morbidity for the period from 2019 to 2022 was conducted. The search includes studies describing treatment costs associated with multi- or co-morbidity cases for infected patients and, if concurrently reported, determining recurring expenses. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Galbraith plots and I² statistics will be deployed to assess heterogeneity and to identify potential sources. A backward elimination process will be applied in the regression modelling procedure. Based on the number of studies retrieved and their sample size, the subgroup analysis will be stratified on participant disease category, associated total costs, and degree of freedom in cost estimation. These studies were registered in the PROSPERO registry (ID: CRD42022323071).

The landscape of potential health benefits of carotenoids as natural supportive therapeutics in protecting against Coronavirus infection

The Coronavirus Disease-2019 (COVID-19) pandemic urges researching possibilities for prevention and management of the effects of the virus. Carotenoids are natural phytochemicals of anti-oxidant, anti-inflammatory and immunomodulatory properties and may exert potential in aiding in combatting the pandemic. This review presents the direct and indirect evidence of the health benefits of carotenoids and derivatives based on in vitro and in vivo studies, human clinical trials and epidemiological studies and proposes possible mechanisms of action via which carotenoids may have the capacity to protect against COVID-19 effects. The current evidence provides a rationale for considering carotenoids as natural supportive nutrients via antioxidant activities, including scavenging lipid-soluble radicals, reducing hypoxia-associated superoxide by activating antioxidant enzymes, or suppressing enzymes that produce reactive oxygen species (ROS). Carotenoids may regulate COVID-19 induced over-production of pro-inflammatory cytokines, chemokines, pro-inflammatory enzymes and adhesion molecules by nuclear factor kappa B (NF-κB), renin-angiotensin-aldosterone system (RAS) and interleukins-6- Janus kinase-signal transducer and activator of transcription (IL-6-JAK/STAT) pathways and suppress the polarization of pro-inflammatory M1 macrophage. Moreover, carotenoids may modulate the peroxisome proliferator-activated receptors γ by acting as agonists to alleviate COVID-19 symptoms. They also may potentially block the cellular receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human angiotensin-converting enzyme 2 (ACE2). These activities may reduce the severity of COVID-19 and flu-like diseases. Thus, carotenoid supplementation may aid in combatting the pandemic, as well as seasonal flu. However, further in vitro, in vivo and in particular long-term clinical trials in COVID-19 patients are needed to evaluate this hypothesis.

Association of Patients' Epidemiological Characteristics and Comorbidities with Severity and Related Mortality Risk of SARS-CoV-2 Infection: Results of an Umbrella Systematic Review and Meta-Analysis

The objective of this study was to assess the association between patients’ epidemiological characteristics and comorbidities with SARS-CoV-2 infection severity and related mortality risk. An umbrella systematic review, including a meta-analysis examining the association between patients’ underlying conditions and severity (defined as need for hospitalization) and mortality of COVID-19, was performed. Studies were included if they reported pooled risk estimates of at least three underlying determinants for hospitalization, critical disease (ICU admission, mechanical ventilation), and hospital mortality in patients diagnosed with SARS-CoV-2 infection. Evidence was summarized as pooled odds ratios (pOR) for disease outcomes with 95% confidence intervals (95% CI). Sixteen systematic reviews investigating the possible associations of comorbidities with severity or death from COVID-19 disease were included. Hospitalization was associated with age > 60 years (pOR 3.50; 95% CI 2.97−4.36), smoking habit (pOR 3.50; 95% CI 2.97−4.36), and chronic pulmonary disease (pOR 2.94; 95% CI 2.14−4.04). Chronic pulmonary disease (pOR 2.82; 95% CI 1.92−4.14), cerebrovascular disease (pOR 2.74; 95% CI 1.59−4.74), and cardiovascular disease (pOR 2.44; 95% CI 1.97−3.01) were likely to be associated with increased risk of critical COVID-19. The highest risk of mortality was associated with cardiovascular disease (pOR 3.59; 95% CI 2.83−4.56), cerebrovascular disease (pOR 3.11; 95% CI 2.35−4.11), and chronic renal disease (pOR 3.02; 95% CI 2.61−3.49). In conclusion, this umbrella systematic review provides a comprehensive summary of meta-analyses examining the impact of patients’ characteristics on COVID-19 outcomes. Elderly patients and those cardiovascular, cerebrovascular, and chronic renal disease should be prioritized for pre-exposure and post-exposure prophylaxis and early treatment.

Comorbidities and complications of COVID-19 associated with disease severity, progression, and mortality in China with centralized isolation and hospitalization: A systematic review and meta-analysis

Background

Coronavirus disease 2019 (COVID-19) causes life-threatening with the high-fatality rates and spreads with high-infectious disease worldwide. We aimed to systematically review the comorbidities and complications of COVID-19 that are associated with various disease severity, progression, and mortality in China, to provide contemporary and reliable estimates in settings with centralized isolation and hospitalization.

Methods

In this systematic review and meta-analysis, we searched four main English language databases, and four main Chinese language databases for observational studies published from inception to January 2022, to identify all the related comorbidities and complications of COVID-19, in the China region with centralized isolation and hospitalization, with disease severity, progression, and mortality. Literature search, data extraction, and quality assessment were independently conducted by two reviewers. We used the generalized linear mixed model to estimate pooled effect sizes for any comorbidities and complications, and subgroup in gender ratio was done to further address the potential heterogeneity.

Results

Overall, 187 studies describing 77,013 patients, namely, 54 different comorbidities and 46 various complications of COVID-19, were identified who met our inclusion criteria. The most prevalent comorbidities were hypertension [20.37% 95% CI (15.28-26.63), 19.29% (16.17-22.85), 34.72% (31.48-38.10), and 43.94% (38.94-49.06)] and diabetes [7.84% (5.78-10.54), 8.59% (7.25-10.16), 17.99% (16.29-19.84), and 22.68% (19.93-25.69)] in mild, moderate, severe, and critical cases. The most prevalent complications were liver injury [10.00% (1.39-46.72), 23.04% (14.20-35.13), and 43.48% (39.88-47.15)] in mild, moderate, and severe cases, and acute respiratory distress syndrome [ARDS; 94.17% (20.78-99.90)] and respiratory failure [90.69% (28.08-99.59)] in critical cases. Renal insufficiency [odds ratio (OR) 17.43 (6.69-45.43)] in comorbidities and respiratory failure [OR 105.12 (49.48-223.33)] in complications were strongly associated in severe/critical than in mild/moderate cases. The highest estimated risk in intensive care unit (ICU) admission, progression, and mortality was an autoimmune disease, nervous system disease, and stroke in comorbidities, shock, and ARDS in complications.

Conclusion

Comorbidities and complications in inpatients with COVID-19 were positively associated with increased risk in severe and critical cases, ICU admission, exacerbation, and death during centralized isolation and hospitalization. Prompt identification of comorbidities and complications in inpatients with COVID-19 can enhance the prevention of disease progression and death and improve the precision of risk predictions.

Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis

Objective

The objective of this study was to investigate the association between previous stroke and the risk of severe coronavirus disease 2019 (COVID-19).

Methods

We included 164 (61.8 ± 13.6 years) patients with COVID-19 in a retrospective study. We evaluated the unadjusted and adjusted associations between previous stroke and severe COVID-19, using a Cox regression model. We conducted an overall review of systematic review and meta-analysis to investigate the relationship of previous stroke with the unfavorable COVID-19 outcomes.

Results

The rate of severe COVID-19 in patients with previous stroke was 28.37 per 1,000 patient days (95% confidence interval [CI]: 10.65–75.59), compared to 3.94 per 1,000 patient days (95% CI: 2.66–5.82) in those without previous stroke (p < 0.001). Previous stroke was significantly associated with severe COVID-19 using a Cox regression model (unadjusted [hazard ratio, HR]: 6.98, 95% CI: 2.42–20.16, p < 0.001; adjusted HR [per additional 10 years]: 4.62, 95% CI: 1.52–14.04, p = 0.007). An overall review of systematic review and meta-analysis showed that previous stroke was significantly associated with severe COVID-19, mortality, need for intensive care unit admission, use of mechanical ventilation, and an unfavorable composite outcome.

Conclusion

Previous stroke seems to influence the course of COVID-19 infection; such patients are at high risk of severe COVID-19 and might benefit from early hospital treatment measures and preventive strategies.

Spatial and Temporal Analysis of COVID-19 in the Elderly Living in Residential Care Homes in Portugal

Background: The goal of this study is to identify geographic areas for priority actions in order to control COVID-19 among the elderly living in Residential Care Homes (RCH). We also describe the evolution of COVID-19 in RHC throughout the 278 municipalities of continental Portugal between March and December 2020. Methods: A spatial population analysis of positive COVID-19 cases reported by the Portuguese National Health Service (NHS) among the elderly living in RCH. The data are for COVID-19 testing, symptomatic status, comorbidities, and income level by municipalities. COVID-19 measures at the municipality level are the proportion of positive cases of elderly living in RCH, positive cases per elderly living in RCH, symptomatic to asymptomatic ratio, and the share of comorbidities cases. Spatial analysis used the Kernel density estimation (KDE), space-time statistic Scan, and geographic weighted regression (GWR) to detect and analyze clusters of infected elderly. Results: Between 3 March and 31 December 2020, the high-risk primary cluster was located in the regions of Braganca, Guarda, Vila Real, and Viseu, in the Northwest of Portugal (relative risk = 3.67), between 30 September and 13 December 2020. The priority geographic areas for attention and intervention for elderly living in care homes are the regions in the Northeast of Portugal, and around the large cities, Lisbon and Porto, which had high risk clusters. The relative risk of infection was spatially not stationary and generally positively affected by both comorbidities and low-income. Conclusion: The regions with a population with high comorbidities and low income are a priority for action in order to control COVID-19 in the elderly living in RCH. The results suggest improving both income and health levels in the southwest of Portugal, in the environs of large cities, such as Lisbon and Porto, and in the northwest of Portugal to mitigate the spread of COVID-19.

The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course-A Narrative Review

It was previously reported that subjects with diabetes mellitus (DM) are more vulnerable to several bacterial or viral infections. In the era of coronavirus disease 2019 (COVID-19) pandemic, it is reasonable to wonder whether DM is a risk factor for COVID-19 infection, too. It is not yet clear whether DM increases the risk for contracting COVID-19 infection or not. However, patients with DM when infected are more likely to develop severe or even fatal COVID-19 disease course than patients without DM. Certain characteristics of DM patients may also deteriorate prognosis. On the other hand, hyperglycemia per se is related to unfavorable outcomes, and the risk may be higher for COVID-19 subjects without pre-existing DM. In addition, individuals with DM may experience prolonged symptoms, need readmission, or develop complications such as mucormycosis long after recovery from COVID-19; close follow-up is hence necessary in some selected cases. We here present a narrative review of the literature in order to set light into the relationship between COVID-19 infection and DM/hyperglycemia.

Comparative characterisation of COVID-19 patients with hypertension comorbidity in Malawi: a 1:2 matched retrospective case-control study

OBJECTIVE

The aim of this study was to characterize COVID-19 cases and explore the risk factors associated with mortality among hypertensive patients with COVID-19 across Malawi.

METHODS

A retrospective case-control study design was used to provide a detailed account of cases and to explore the risk factors associated with mortality among hypertensive patients with COVID-19. In total, 441 patients were included in the study in a ratio of one case to two controls (1:2), matched by age.

RESULTS

Deaths due to COVID-19 varied with hypertensive condition, with more deaths registered in hypertensive patients. Clinical signs and symptoms varied greatly between hypertensive and non-hypertensive COVID-19 patients, tending to be milder in the latter group. The risk of death due to COVID-19 among hypertensive patients increased with age, and was meaningfully associated with underlining comorbidities, such as HIV, TB, cardiovascular disease, and liver disease.

CONCLUSION

Our study revealed predictive factors for mortality in hypertensive COVID-19 patients, which can be used by policy makers and healthcare practitioners to identify those at a higher risk, and to determine the appropriate treatment approach to achieve the best possible clinical outcomes.

Impact of Metabolic Risk Factors on COVID-19 Clinical Outcomes: An Extensive Review

BACKGROUND

Cardiovascular (CV) risk factors, particularly cardiometabolic, seem to be associated with heightened severity and increased morbimortality in patients infected with the novel Coronavirus disease-2019 (COVID-19).

METHODS

A thorough scoping review was conducted to elucidate and summarize the latest evidence for the effects of adverse cardiac metabolic profiles on the severity, morbidity, and prognosis of COVID-19 infection.

RESULTS

The pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is complex, being characterized by viral-induced immune dysregulation and hypercytokinemia, particularly in patients with critical disease, evolving with profound endothelial dysfunction, systemic inflammation, and prothrombotic state. Moreover, cardiovascular comorbidities such as diabetes are the most prevalent amongst individuals requiring hospitalization, raising concerns towards the clinical evolution and prognosis of these patients. The chronic proinflammatory state observed in patients with cardiovascular risk factors may contribute to the immune dysregulation mediated by SARS-CoV-2, favoring more adverse clinical outcomes and increased severity. Cardiometabolism is defined as a combination of interrelated risk factors and metabolic dysfunctions such as dyslipidemia, insulin resistance, impaired glucose tolerance, and central adiposity, which increase the likelihood of vascular events, being imperative to specifically analyze its clinical association with COVID-19 outcomes.

CONCLUSION

DM and obesity appears to be important risk factors for severe COVID-19. The chronic proinflammatory state observed in patients with excess visceral adipose tissue (VAT) possibly augments COVID-19 immune hyperactivity leading to more adverse clinical outcomes in these patients.

Prevalence of co-morbidities and its association with mortality in Indian patients with COVID-19: A meta-analysis

Background and Aims:

Coronavirus disease 2019 (COVID 19) has spread to every corner of the world and has led to significant health consequences, especially in patients with co morbidities. This study aimed to estimate the prevalence of co morbidities among COVID 19 patients in the Indian population and their association with mortality.

Methods:

PubMed, Google Scholar, and World Health Organization website were searched for Indian studies on COVID 19 published from February 2020 up to 20 May 2021. English language publications from India, studies reporting epidemiological characteristics, prevalence of co morbidities and in hospital mortality were included in the meta analysis.

Results:

34 studies were identified with a total of 23,034 patients. The pooled prevalence for co morbidities in COVID 19 patients was 18.1% [95% confidence interval (CI), 13.3 to 24.3%] for hypertension, 17.7% (95% CI, 12.2 to 25.1%) for diabetes, 7.9% (95% CI, 4.6 to 13.4%) for hypothyroidism and 7.7%(95% CI, 4.8 to 12. 1%) for cardiovascular diseases. For chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), cerebrovascular diseases, asthma, chronic liver disease, tuberculosis and cancer, the pooled prevalence was less than 4%. Additionally, the mortality risk was increased significantly in patients with CKD [odds ratio (OR) = 4.1], COPD (OR = 3.9), diabetes (OR = 3.7), cardiovascular diseases (OR = 4.07), tuberculosis (OR = 6.11), chronic liver disease (OR = 8.5), malignancy (OR = 1.89) and hypertension (OR = 2.9). Cerebrovascular diseases, hypothyroidism and asthma were not associated with increased mortality.

Conclusion:

Co-morbidities are more prevalent in COVID 19 hospitalised patients and the presence of co morbidities is associated with increased risk of mortality in Indian COVID 19 patients.

Patho-Physiology of Aging and Immune-Senescence: Possible Correlates With Comorbidity and Mortality in Middle-Aged and Old COVID-19 Patients

During the last 2 years, the entire world has been severely devastated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) as it resulted in several million deaths across the globe. While the virus infects people indiscriminately, the casualty risk is higher mainly in old, and middle-aged COVID-19 patients. The incidences of COVID-19 associated co-morbidity and mortality have a great deal of correlation with the weakened and malfunctioning immune systems of elderly people. Presumably, due to the physiological changes associated with aging and because of possible comorbidities such as diabetes, hypertension, obesity, cardiovascular, and lung diseases, which are more common in elderly people, may be considered as the reason making the elderly vulnerable to the infection on one hand, and COVID-19 associated complications on the other. The accretion of senescent immune cells not only contributes to the deterioration of host defense, but also results in elevated inflammatory phenotype persuaded immune dysfunction. In the present review, we envisage to correlate functioning of the immune defense of older COVID-19 patients with secondary/super infection, increased susceptibility or aggravation against already existing cancer, infectious, autoimmune, and other chronic inflammatory diseases. Moreover, we have discussed how age-linked modulations in the immune system affect therapeutic response against administered drugs as well as immunological response to various prophylactic measures including vaccination in the elderly host. The present review also provides an insight into the intricate pathophysiology of the aging and the overall immune response of the host to SARS-CoV-2 infection. A better understanding of age-related immune dysfunction is likely to help us in the development of targeted preemptive strategies for deadly COVID-19 in elderly patients.

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis

BACKGROUND

We aimed to determine the characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients.

METHODS

PubMed, Embase, Web of Science, and Scopus databases were searched to retrieve articles on readmitted COVID-19 patients, available up to September 25, 2021. All studies comparing characteristics of readmitted and non-readmitted COVID-19 patients were included. We also included articles reporting the reasons for readmission in COVID-19 patients. Data were pooled and meta-analyzed using random or fixed-effect models, as appropriate. Subgroup analyses were conducted based on the place and duration of readmission.

RESULTS

Our meta-analysis included 4823 readmitted and 63,413 non-readmitted COVID-19 patients. The re-hospitalization rate was calculated at 9.3% with 95% Confidence Interval (CI) [5.5%-15.4%], mostly associated with respiratory or cardiac complications (48% and 14%, respectively). Comorbidities including cerebrovascular disease (Odds Ratio (OR) = 1.812; 95% CI [1.547-2.121]), cardiovascular (2.173 [1.545-3.057]), hypertension (1.608 [1.319-1.960]), ischemic heart disease (1.998 [1.495-2.670]), heart failure (2.556 [1.980-3.300]), diabetes (1.588 [1.443-1.747]), cancer (1.817 [1.526-2.162]), kidney disease (2.083 [1.498-2.897]), chronic pulmonary disease (1.601 [1.438-1.783]), as well as older age (1.525 [1.175-1.978]), male sex (1.155 [1.041-1.282]), and white race (1.263 [1.044-1.528]) were significantly associated with higher readmission rates (P < 0.05 for all instances). The mortality rate was significantly lower in readmitted patients (OR = 0.530 [0.329-0.855], P = 0.009).

CONCLUSIONS

Male sex, white race, comorbidities, and older age were associated with a higher risk of readmission among previously admitted COVID-19 patients. These factors can help clinicians and policy-makers predict, and conceivably reduce the risk of readmission in COVID-19 patients.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and During COVID-19 Pandemic: A Longitudinal Mediation Model

Background: The outbreak of the COVID-19 pandemic has had a profound influence on the mental health and well-being of individuals across the globe. Emotional competence, defined as one's ability to recognize, understand, and manage their emotions, has been found linked with mental health problems (e.g., depression and anxiety) in previous studies. However, there is limited knowledge about the direction of the association between these factors among populations exposed to COVID-19. This study examined the possible mediation relationships between depression, anxiety, emotional competence, and COVID-19 exposure among Chinese adolescents. Methods: Responses from 7,958 Chinese adolescents who had previously taken part in a two-wave study before (December 23, 2019-January 13, 2020) and during COVID-19 (June 16, 2020-July 8, 2020) were analyzed (51.67% males, mean age = 11.74, SD = 2.15). Structural equation modeling with three covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal mediation relationships between COVID-19 exposure and depression, anxiety via emotional competence. Results: Results indicated that the prevalence of depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 to Time 2. The T2 emotional competence significantly mediated the relationship between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 [0.004-0.019], p < 0.05). T2 emotional competence also significantly mediated the relationship between T2 COVID-19 exposure and T2 depression (indirect effect [95% CI] = 0.013 [0.005-0.022], p < 0.05). The results indicated that T2 emotional competence had a significant and negative influence on T2 anxiety (β = -0.266, SE = 0.005, p < 0.001), and T2 depression (β = -0.326, SE = 0.029, p < 0.001). Conclusions: This longitudinal research study demonstrated the crucial role of emotional competence in influencing the severity of long-term mental health problems, and suggested that emotional competence interventions can be conducted to improve mental well-being among Chinese adolescents exposed to COVID-19.

Syndemics at play: chronic kidney disease, diabetes and COVID-19 in Pakistan

Although coronavirus disease 2019 (COVID-19) is a pandemic, it has several specificities influencing its outcomes due to the entwinement of several factors, which anthropologists have called "syndemics". Drawing upon Singer and Clair's syndemics model, I focus on synergistic interaction among chronic kidney disease (CKD), diabetes, and COVID-19 in Pakistan. I argue that over 36 million people in Pakistan are standing at a higher risk of contracting COVID-19, developing severe complications, and losing their lives. These two diseases, but several other socio-cultural, economic, and political factors contributing to structured vulnerabilities, would function as confounders. To deal with the critical effects of these syndemics the government needs appropriate policies and their implementation during the pandemic and post-pandemic. To eliminate or at least minimize various vulnerabilities, Pakistan needs drastic changes, especially to overcome (formal) illiteracy, unemployment, poverty, gender difference, and rural and urban difference.

Evaluation of Treatment Outcome for Pneumonia among Pre-Vaccinated COVID-19 Patients with/without Comorbidity in a Public Hospital in Bengkulu, Indonesia

Pneumonia is one of the common complications of SARS-CoV-2 infection where most patients have moderate to severe symptoms that pose a higher risk for death. This study aims to evaluate the treatment outcome of COVID-19-associated Pneumonia among patients with/without comorbidity in a public hospital in Indonesia. This is a retrospective cohort study involving unvaccinated confirmed COVID-19 patients admitted to the hospital between March and December 2020. All confirmed COVID-19 patients with Pneumonia (n = 1522) treated at the hospital were included. The majority of patients (99%) had mild COVID-19 symptoms while the remaining had moderate symptoms. The median age was about 32 years old and the average treatment duration was 6.25 ± 1.83 days. Most patients (88.8%) received a combination of azithromycin and oseltamivir. There was a very significant relationship (p < 0.001) between comorbidities with treatment and duration of treatment of Pneumonia in COVID-19 patients. Although most patients had Pneumonia and comorbidities, they were successfully treated with azithromycin and oseltamivir combination following approximately five days of treatment.

SARS-CoV-2 infection and oxidative stress: Pathophysiological insight into thrombosis and therapeutic opportunities

The current coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges to global health. Although the majority of COVID-19 patients exhibit mild-to-no symptoms, many patients develop severe disease and need immediate hospitalization, with most severe infections associated with a dysregulated immune response attributed to a cytokine storm. Epidemiological studies suggest that overall COVID-19 severity and morbidity correlate with underlying comorbidities, including diabetes, obesity, cardiovascular diseases, and immunosuppressive conditions. Patients with such comorbidities exhibit elevated levels of reactive oxygen species (ROS) and oxidative stress caused by an increased accumulation of angiotensin II and by activation of the NADPH oxidase pathway. Moreover, accumulating evidence suggests that oxidative stress coupled with the cytokine storm contribute to COVID-19 pathogenesis and immunopathogenesis by causing endotheliitis and endothelial cell dysfunction and by activating the blood clotting cascade that results in blood coagulation and microvascular thrombosis. In this review, we survey the mechanisms of how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces oxidative stress and the consequences of this stress on patient health. We further shed light on aspects of the host immunity that are crucial to prevent the disease during the early phase of infection. A better understanding of the disease pathophysiology as well as preventive measures aimed at lowering ROS levels may pave the way to mitigate SARS-CoV-2-induced complications and decrease mortality.

Comparison of comorbidities among severe and non-severe COVID-19 patients in Asian versus non-Asian populations: A systematic review and meta-analysis

OBJECTIVES

This study aimed to evaluate the comorbidities among severe and non-severe COVID-19 patients in Asian versus non-Asian populations.

DESIGN

Systemic review and Meta-analysis.

METHODS

A systematic literature search was conducted using PubMed, Embase, Scopus and the web of science Database up to 24 March 2021. Odds ratios were calculated using a random-effects model.

RESULTS

We identified 66 studies including 39 Asian and 27 non-Asian studies. This study demonstrated that the proportion of hypertension was significantly higher in severe group than in non-severe group for Asian (OR = 2.46) and non-Asian (OR = 1.60, 95% CI: 1.37-1.86, I²  = 84%; p < .00001) patients. Similarly, the proportion of diabetes, cardiovascular disease and chronic kidney disease was significantly higher in severe group than in non-severe group for both Asian and non-Asian studies. We found no statistically significant difference between the severe versus non-severe group for cancer (OR = 1.26) and chronic obstructive pulmonary disease (OR = 1.32) among non-Asian patients.

Risk of SARS-CoV-2 exposure among hospital healthcare workers in relation to patient contact and type of care

AIM

We aimed to assess prevalence of IgG antibodies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and factors associated with seropositivity in a large cohort of healthcare workers (HCWs).

METHODS

From 11 May until 11 June 2020, 3981 HCWs at a large Swedish emergency care hospital provided serum samples and questionnaire data. Presence of IgG antibodies to SARS-CoV-2 was measured as an indicator of SARS-CoV-2 exposure.

RESULTS

The total seroprevalence was 18% and increased during the study period. Among the seropositive HCWs, 11% had been entirely asymptomatic. Participants who worked with COVID-19 patients had higher odds for seropositivity: adjusted odds ratio 1.96 (95% confidence intervals 1.59-2.42). HCWs from three of the departments managing COVID-19 patients had significantly higher seroprevalences, whereas the prevalence among HCWs from the intensive care unit (also managing COVID-19 patients) was significantly lower.

CONCLUSIONS

HCWs in contact with SARS-CoV-2 infected patients had a variable, but on average higher, likelihood for SARS-CoV-2 infections.

COVID-19 patients age, comorbidity profiles and clinical presentation related to the SARS-CoV-2 UK-variant spread in the Southeast of France

The variant 20I/501Y.V1, associated to a higher risk of transmissibility, emerged in Nice city (Southeast of France, French Riviera) during January 2021. The pandemic has resumed late December 2020 in this area. A high incidence rate together with a fast turn-over of the main circulating variants, provided us the opportunity to analyze modifications in clinical profile and outcome traits. We performed an observational study in the University hospital of Nice from December 2020 to February 2021. We analyzed data of sequencing of SARS-CoV-2 from the sewage collector and PCR screening from all positive samples at the hospital. Then, we described the characteristics of all COVID-19 patients admitted in the emergency department (ED) (n = 1247) and those hospitalized in the infectious diseases ward or ICU (n = 232). The UK-variant was absent in this area in December, then increasingly spread in January representing 59% of the PCR screening performed mid-February. The rate of patients over 65 years admitted to the ED decreased from 63 to 50% (p = 0.001). The mean age of hospitalized patients in the infectious diseases ward decreased from 70.7 to 59.2 (p < 0.001) while the proportion of patients without comorbidity increased from 16 to 42% (p = 0.007). Spread of the UK-variant in the Southeast of France affects younger and healthier patients.

Factors Associated with the Incidence and Mortality of Coronavirus Disease 2019 (COVID-19) after 126-million Cases: A Meta-analysis

OBJECTIVES

This meta-analysis was conducted to investigate the current global incidence and mortality of COVID-19 and also explored the associated factors including geographic variations, transmission scenarios, country economic status, and healthcare performance.

METHODS

The search was conducted in online databases based on reports from national authorities by March 28, 2021. Random-effects model meta-analyses and meta-regression analyses were used to generate summary estimates and explored sources of heterogeneity.

RESULTS

The cumulative number of confirmed COVID-19 cases was 125,704,789 reported by 216 countries. The pooled Daily Cumulative Index (DCI) was 1423.87 cases/day which was highest in South America (2759.15 cases/day) followed by North America (2252.49 cases/day), Europe (1858.44 cases/day), Asia (1484.84 cases/day), Africa (193.09 cases/day), and Australia/Oceania (18.55 cases/day). The overall pooled mortality rate of COVID-19 was 1.53%. Higher income countries and countries with community transmission had higher DCI. By meta-regression, country total health expenditure per capita, percentage of universal health coverage, and total number of tests were associated with higher DCI. On the contrary, country Gross Domestic Product (GDP) per capita were negatively correlated with mortality rate.

CONCLUSION

To date, 216 countries around the world are affected by COVID-19. Higher income, GDP, and countries' investments on heath are associated with higher DCI while higher GDP correlates with lower mortality. Community transmission route have more impact on the incidence and mortality of COVID-19.

COVID-19 and mucormycosis superinfection: the perfect storm

BACKGROUND

The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19.

PURPOSE

In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome.

RESULTS

Many  of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients  were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis.  In addition, the presence of spores and other factors might play a role as well.

CONCLUSION

With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

Seroprevalence of anti-SARS-CoV-2 antibodies in Africa: A systematic review and meta-analysis

We estimated the seroprevalence of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in residents of African countries and explored its associated factors. We searched PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases for peer reviewed articles and pre‐prints that reported anti‐SARS‐CoV‐2 antibody seroprevalence of general or specific human populations resident in Africa. The eligible studies were evaluated using Joana Briggs Institute prevalence critical appraisal tool. Twenty‐three studies involving 27,735 individuals were included in our paper. The pooled seroprevalence of anti‐SARS‐CoV‐2 antibodies in Africa was 22% (95%CI: 14–31) with very high heterogeneity (I² = 100%, p < 0.001). Seroprevalence was highest in studies conducted in Central Africa compared to Southern Africa, West Africa, North Africa and East Africa respectively. The number of days between the first reported coronavirus disease 2019 case in each country and when a seroprevalence study was conducted was a significant moderator of seroprevalence. Seropositivity was numerically influenced by gender and age of the participants with males and those aged below 50 years being most affected with SARS‐CoV‐2 infection. The highest pooled seroprevalence in Africa reported in this review should be interpreted cautiously due to high heterogeneity between studies. Continued seroprevalence surveillance is warranted to establish Africa's transition towards herd immunity.

COVID-19 and the Endocrine System: A Comprehensive Review on the Theme

Background and aim. The review aimed to summarize advances in the topic of endocrine diseases and coronavirus disease 2019 (COVID-19). Methods. Scientific and institutional websites and databases were searched and data were collected and organized, when plausible, to angle the discussion toward the following clinical issues. (1) Are patients with COVID-19 at higher risk of developing acute or late-onset endocrine diseases or dysfunction? (2) May the underlying endocrine diseases or dysfunctions be considered risk factors for poor prognosis once the infection has occurred? (3) Are there defined strategies to manage endocrine diseases despite pandemic-related constraints? Herein, the authors considered only relevant and more frequently observed endocrine diseases and disorders related to the hypothalamic-pituitary region, thyroid and parathyroid glands, calcium-phosphorus homeostasis and osteoporosis, adrenal glands, and gonads. Main. Data highlight the basis of some pathophysiological mechanisms and anatomical alterations of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-induced endocrine dysfunctions. Some conditions, such as adrenal insufficiency and cortisol excess, may be risk factors of worse clinical progression once the infection has occurred. These at-risk populations may require adequate education to avoid the SARS-CoV-2 infection and adequately manage medical therapy during the pandemic, even in emergencies. Endocrine disease management underwent a palpable restraint, especially procedures requiring obligate access to healthcare facilities for diagnostic and therapeutic purposes. Strategies of clinical triage to prioritize medical consultations, laboratory, instrumental evaluations, and digital telehealth solutions should be implemented to better deal with this probably long-term situation.

Immunothrombotic dysregulation in chagas disease and COVID-19: a comparative study of anticoagulation

Chagas and COVID-19 are diseases caused by Trypanosoma cruzi and SARS-CoV-2, respectively. These diseases present very different etiological agents despite showing similarities such as susceptibility/risk factors, pathogen-associated molecular patterns (PAMPs), recognition of glycosaminoglycans, inflammation, vascular leakage hypercoagulability, microthrombosis, and endotheliopathy; all of which suggest, in part, treatments with similar principles. Here, both diseases are compared, focusing mainly on the characteristics related to dysregulated immunothrombosis. Given the in-depth investigation of molecules and mechanisms related to microthrombosis in COVID-19, it is necessary to reconsider a prompt treatment of Chagas disease with oral anticoagulants.

Diseased lungs may hinder COVID-19 development: A possible reason for the low prevalence of COPD in COVID-19 patients

Presently, it remains unclear why the prevalence of lung diseases, namely chronic obstructive pulmonary disease (COPD), is much lower than other medical comorbidities and the general population among patients with coronavirus disease 2019 (COVID-19). If COVID-19 is a respiratory disease, why is COPD not the leading risk factor for contracting COVID-19? The same odd phenomenon was also observed with other pathogenic human coronaviruses causing severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS), but not other respiratory viral infections such as influenza and respiratory syncytial viruses. One commonly proposed reason for the low COPD rates among COVID-19 patients is the usage of inhaled corticosteroids or bronchodilators that may protect against COVID-19. However, another possible reason not discussed elsewhere is that lungs in a diseased state may not be conducive for the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) to establish COVID-19. For one, COPD causes mucous plugging in large and small airways, which may hinder SARS-CoV-2 from reaching deeper parts of the lungs (i.e., alveoli). Thus, SARS-CoV-2 may only localize to the upper respiratory tract of persons with COPD, causing mild or asymptomatic infections requiring no hospital attention. Even if SARS-CoV-2 reaches the alveoli, cells therein are probably under a heavy burden of endoplasmic reticulum (ER) stress and extensively damaged where it may not support efficient viral replication. As a result, limited SARS-CoV-2 virions would be produced in diseased lungs, preventing the development of COVID-19.