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López-Jiménez C, Gutiérrez A, Juliao Caamaño DS, Soto Alsar J, Catoya Villa JL, Blanco Abad C, Morón B, Ortega Morán L, Martín M, Muñoz Martín AJ. Impact of COVID-19 in the incidence of venous thromboembolism (VTE) and clinical outcomes in cancer patients: a cohort study. Clin Transl Oncol 2024:10.1007/s12094-024-03635-w. [PMID: 39090424 DOI: 10.1007/s12094-024-03635-w] [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: 02/20/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To determine the incidence of VTE and clinical outcomes in a cohort of cancer patients and COVID-19 infection, and to establish possible predictive factors of VTE. METHODS/PATIENTS A single-center retrospective cohort study was performed to determine the incidence of VTE and mortality in 118 cancer patients with SARS-CoV-2 infection from March to August 2020. We calculated individual Khorana Risk and CATS-MICA scores in order to evaluate their utility to identify risk of VTE or death. Continuous variables were compared using Wilcoxon or Student's T test, and categorical variables were compared using the Chi-Square or Fisher's exact text among patients with and without VTE. A Log-Rank test was performed to detect mortality differences between the groups. RESULTS A total of 118 patients were included. VTE global incidence was 4.2% (n = 5), and mortality 25.4% (n = 30). Obesity (p = 0.05), recent chemotherapy (p = 0.049) and use of steroids (p = 0.006) were related to higher risk of VTE in the univariate analysis, although they were not confirmed in the multivariate analysis as independent risk factors. Statistically significant differences in all-cause, COVID-19-related and cancer-related mortality according to the Khorana risk score (KRS) were observed. CATS-MICA score (CMS) also showed statistically significant differences in mortality between low- and high-risk patients. Prediction of risk of VTE development with these scores showed a tendency towards significance. CONCLUSIONS In this cohort, VTE incidence was similar to previously reported in the general population with SARS-CoV-2 infection. KRS was associated with overall and specific-cause mortality, and might be a useful prognostic tool in this setting.
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Affiliation(s)
- Carlos López-Jiménez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Ana Gutiérrez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - David Salomón Juliao Caamaño
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Javier Soto Alsar
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | | | - Carmen Blanco Abad
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Blanca Morón
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Laura Ortega Morán
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Miguel Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Andrés Jesús Muñoz Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
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Alshahrani AM, Bakheet OS, Makkawi MH, Alasmari SZ. Hematological malignancies: Prevalence and hematological characteristics in a single center in southern Saudi Arabia. Saudi Med J 2024; 45:295-306. [PMID: 38438211 PMCID: PMC11115396 DOI: 10.15537/smj.2024.45.3.20230776] [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: 10/10/2023] [Accepted: 02/04/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To determine the prevalence of leukemia in the Aseer region of Saudi Arabia and the importance of hematological, biochemical and coagulation profiles for leukemic patients in the context of disease management. METHODS This retrospective study comprised 210 patients between 2012 and 2022 who had been diagnosed with leukemia at different ages. The multiple unpaired t-test was used to compare leukemic patients with control samples, which consisted of healthy individuals, and p<0.05 was taken as significant. The data was compiled from Aseer Central Hospital in the Aseer region and collected through peripheral blood smear and bone marrow biopsy (2012-2017) or by flow cytometry (2018-2022), according to the hospital information system and registry data. RESULTS Of the total 210 leukemic patients (61.4% males and 38.6% females), 104 cases (2012-2017) were diagnosed based on peripheral blood smear and bone marrow biopsy, and 106 cases (2018-2022) based on flow cytometry. Fifteen subtypes of leukemia were identified, with chronic myeloid leukemia being the most common (34.2%), followed by acute myeloid leukemia (17.6%), chronic lymphoblastic leukemia (11.9%), and B-cell acute lymphoid leukemia (9.5%). Other rare cases were also found. CONCLUSION Of the 210 leukemia cases diagnosed in the Aseer region between 2012-2022, the most common subtype was chronic myeloid leukemia, followed by acute myeloid leukemia. In all leukemia subtypes, distinctive significant changes were observed in hematological parameters, biochemical parameters, and coagulation profiles.
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Affiliation(s)
- Adil M. Alshahrani
- From the Department of Laboratory and Blood Bank (Adil, Omayma), Aseer Central Hospital; and from the Department of Clinical Laboratory Sciences (Mohammed, Sultan), Faculty of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Omayma S Bakheet
- From the Department of Laboratory and Blood Bank (Adil, Omayma), Aseer Central Hospital; and from the Department of Clinical Laboratory Sciences (Mohammed, Sultan), Faculty of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mohammed H. Makkawi
- From the Department of Laboratory and Blood Bank (Adil, Omayma), Aseer Central Hospital; and from the Department of Clinical Laboratory Sciences (Mohammed, Sultan), Faculty of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sultan Z. Alasmari
- From the Department of Laboratory and Blood Bank (Adil, Omayma), Aseer Central Hospital; and from the Department of Clinical Laboratory Sciences (Mohammed, Sultan), Faculty of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
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Almegren MO, Alharbi SH, Alshuaibi TA, Almansour MM, Alharbi KA, Al Rawahi B, Al Balushi AK, Alraizah AA, Alqahtani FH. Outcomes and complications of patients with cerebral venous thrombosis: a retrospective study. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2024; 29:32-36. [PMID: 38195128 PMCID: PMC10827010 DOI: 10.17712/nsj.2024.1.20230050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/17/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To assess outcomes and complications of patients with cerebral venous thrombosis (CVT). METHODS This multicenter retrospective study was conducted at 2 health care centers in Saudi Arabia and Oman. Adult patients diagnosed with CVT in radiological imaging between 2006 and 2020 were included. Data were collected from medical records and analyzed using the software IBM® SPSS version 22. Neurological disability occurring after CVT was graded according to the modified Rankin scale (mRS). RESULTS The study included 103 patients, of which the majority (68%) were female. The mean age was 39.12±12.96 years. Two-thirds of patients received low-molecular-weight heparin (LMWH) in acute treatment, while 76% of discharged patients used warfarin. The majority of patients had no or mild neurological disability during follow-up, and 6 patients had an mRS score ≥3, implying significant neurological disability. There were 55 patients (52.3%) who had complications from CVT, including seizures in 17 (16.5%) patients and one mortality. Follow-up imaging of 55 patients showed complete thrombus resolution in 20 patients (36%). CONCLUSION Anticoagulation is the mainstay treatment for CVT patients. Approximately half of patients experience complications. Prospective studies are needed to assess the long-term neurological outcomes in such patients.
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Affiliation(s)
- Mosaad O. Almegren
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Saleh H. Alharbi
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Turki A. Alshuaibi
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Mohammed M. Almansour
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Khalid A. Alharbi
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Bader Al Rawahi
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Abdulmajeed K. Al Balushi
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Abdulrahman A. Alraizah
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
| | - Farjah H. Alqahtani
- From the Department of Medicine (Almegren, Alharbi S), College of Medicine, Imam Mohammad Ibn Saud Islamic University, from the Department of Oncology (Alraizah), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Department of Medicine (Alshuaibi, Alharbi K, Almansour), King Fahad Hospital, Jeddah, and from the Division of Hematology (Alqahtani), Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, and from the Department of Hematology (Al Rawahi), College of Medicine and Health Sciences (Al Balushi), Sultan Qaboos University Hospital, Muscat, Oman.
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Naik R, Avula S, Palleti SK, Gummadi J, Ramachandran R, Chandramohan D, Dhillon G, Gill AS, Paiwal K, Shaik B, Balachandran M, Patel B, Gurugubelli S, Mariswamy Arun Kumar AK, Nanjundappa A, Bellamkonda M, Rathi K, Sakhamuri PL, Nassar M, Bali A. From Emergence to Endemicity: A Comprehensive Review of COVID-19. Cureus 2023; 15:e48046. [PMID: 37916248 PMCID: PMC10617653 DOI: 10.7759/cureus.48046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/03/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later renamed coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in early December 2019. Initially, the China office of the World Health Organization was informed of numerous cases of pneumonia of unidentified etiology in Wuhan, Hubei Province at the end of 2019. This would subsequently result in a global pandemic with millions of confirmed cases of COVID-19 and millions of deaths reported to the WHO. We have analyzed most of the data published since the beginning of the pandemic to compile this comprehensive review of SARS-CoV-2. We looked at the core ideas, such as the etiology, epidemiology, pathogenesis, clinical symptoms, diagnostics, histopathologic findings, consequences, therapies, and vaccines. We have also included the long-term effects and myths associated with some therapeutics of COVID-19. This study presents a comprehensive assessment of the SARS-CoV-2 virology, vaccines, medicines, and significant variants identified during the course of the pandemic. Our review article is intended to provide medical practitioners with a better understanding of the fundamental sciences, clinical treatment, and prevention of COVID-19. As of May 2023, this paper contains the most recent data made accessible.
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Affiliation(s)
- Roopa Naik
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
- Internal Medicine/Hospital Medicine, Geisinger Health System, Wilkes Barre, USA
| | - Sreekant Avula
- Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jyotsna Gummadi
- Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
| | | | | | - Gagandeep Dhillon
- Physician Executive MBA, University of Tennessee, Knoxville, USA
- Internal Medicine, University of Maryland Baltimore Washington Medical Center, Glen Burnie, USA
| | | | - Kapil Paiwal
- Oral & Maxillofacial Pathology, Daswani Dental College & Research Center, Kota, IND
| | - Bushra Shaik
- Internal Medicine, Onslow Memorial Hospital, Jacksonville, USA
| | | | - Bhumika Patel
- Oral Medicine and Radiology, Howard University, Washington, D.C., USA
| | | | | | | | - Mahita Bellamkonda
- Hospital Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Kanika Rathi
- Internal Medicine, University of Florida, Gainesville, USA
| | | | - Mahmoud Nassar
- Endocrinology, Diabetes, and Metabolism, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Atul Bali
- Internal Medicine/Nephrology, Geisinger Medical Center, Danville, USA
- Internal Medicine/Nephrology, Geisinger Health System, Wilkes-Barre, USA
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
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Potere N, Abbate A, Kanthi Y, Carrier M, Toldo S, Porreca E, Di Nisio M. Inflammasome Signaling, Thromboinflammation, and Venous Thromboembolism. JACC Basic Transl Sci 2023; 8:1245-1261. [PMID: 37791298 PMCID: PMC10544095 DOI: 10.1016/j.jacbts.2023.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 10/05/2023]
Abstract
Venous thromboembolism (VTE) remains a major health burden despite anticoagulation advances, suggesting incomplete management of pathogenic mechanisms. The NLRP3 (NACHT-, LRR- and pyrin domain-containing protein 3) inflammasome, interleukin (IL)-1, and pyroptosis are emerging contributors to the inflammatory pathogenesis of VTE. Inflammasome pathway activation occurs in patients with VTE. In preclinical models, inflammasome signaling blockade reduces venous thrombogenesis and vascular injury, suggesting that this therapeutic approach may potentially maximize anticoagulation benefits, protecting from VTE occurrence, recurrence, and ensuing post-thrombotic syndrome. The nonselective NLRP3 inhibitor colchicine and the anti-IL-1β agent canakinumab reduce atherothrombosis without increasing bleeding. Rosuvastatin reduces primary venous thrombotic events at least in part through lipid-lowering independent mechanisms, paving the way to targeted anti-inflammatory strategies in VTE. This review outlines recent preclinical and clinical evidence supporting a role for inflammasome pathway activation in venous thrombosis, and discusses the, yet unexplored, therapeutic potential of modulating inflammasome signaling to prevent and manage VTE.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Yogendra Kanthi
- Vascular Thrombosis & Inflammation Section, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Stefano Toldo
- Robert M. Berne Cardiovascular Research Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Ettore Porreca
- Department of Innovative Technologies in Medicine and Dentistry, School of Medicine and Health Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, “G. d'Annunzio” University, Chieti, Italy
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Rieder M, Baldus N, Stallmann D, Jeserich M, Goller I, Wirth L, Pollmeier L, Hofmann M, Bode C, Busch HJ, Schmid B, Gauchel N, Scharf RE, Duerschmied D, Lother A, Krauel K. Early SARS-CoV-2 infection: Platelet-neutrophil complexes and platelet function. Res Pract Thromb Haemost 2023; 7:100025. [PMID: 36575689 PMCID: PMC9783187 DOI: 10.1016/j.rpth.2022.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Conflicting results have been reported on platelet activity ex vivo and responsiveness in vitro among patients with COVID-19 with or without thromboembolic complications. Objectives To assess platelet reactivity in patients with moderate disease at early stages of COVID-19. Methods We performed a prospective, descriptive analysis of 100 consecutive patients presenting with suspected SARS-CoV-2 infection at University Medical Center Freiburg during the first or second wave of the pandemic. Following polymerase chain reaction testing and compliance with study inclusion criteria, 20 SARS-CoV-2-positive and 55 SARS-CoV-2-negative patients (serving as patient controls) were enrolled. In addition, 15 healthy subjects were included. Platelet reactivity was assessed using whole-blood impedance aggregometry and flow cytometry in response to various agonists. Results Platelet aggregation was significantly impaired in the patients with COVID-19 compared with that in the patient controls or healthy subjects. The reduced platelet responsiveness in the patients with COVID-19 was associated with impaired activation of GPIIb/IIIa (αIIbβ3). In contrast, low expression of P-selectin at baseline and intact secretion upon stimulation in vitro suggest that no preactivation in vivo, leading to "exhausted" platelets, had occurred. The proportion of circulating platelet-neutrophil complexes was significantly higher in the patients with COVID-19 (mean ± SD, 41% ± 13%) than in the patient controls (18% ± 7%; 95% CI, 11.1-34.1; P = .0002) or healthy subjects (17% ± 4%; 95% CI, 13.8-33.8; P < .0001). An analysis of neutrophil adhesion receptors revealed upregulation of CD11b (α-subunit of αMβ2) and CD66b (CEACAM8) but not of CD162 (PSGL-1) in the patients with COVID-19. Conclusion Despite reduced platelet responsiveness, platelet-neutrophil complexes are increased at early stages of moderate disease. Thus, this cellular interaction may occur during COVID-19 without preceding platelet activation.
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Affiliation(s)
- Marina Rieder
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Niklas Baldus
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Daniela Stallmann
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Maren Jeserich
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Isabella Goller
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Luisa Wirth
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luisa Pollmeier
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Hans-Joerg Busch
- Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bonaventura Schmid
- Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadine Gauchel
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - Rüdiger E Scharf
- Division of Experimental and Clinical Hemostasis, Hemotherapy, and Transfusion Medicine, Institute of Transplantation Diagnostics and Cell Therapy, Heinrich Heine University Medical Center, Düsseldorf, Germany.,Hemophilia Comprehensive Care Center, Institute of Transplantation Diagnostics and Cell Therapy, Heinrich Heine University Medical Center, Düsseldorf, Germany.,Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Duerschmied
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.,Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience and German Center for Cardiovascular Research partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Achim Lother
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Krystin Krauel
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.,Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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7
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Zhang Q, Ye Z, McGowan P, Jurief C, Ly A, Bignotti A, Yada N, Zheng XL. Effects of convalescent plasma infusion on the ADAMTS13-von Willebrand factor axis and endothelial integrity in patients with severe and critical COVID-19. Res Pract Thromb Haemost 2023; 7:100010. [PMID: 36531671 PMCID: PMC9744678 DOI: 10.1016/j.rpth.2022.100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 01/13/2023] Open
Abstract
Background Convalescent plasma infusion (CPI) was given to patients with COVID-19 during the early pandemic with mixed therapeutic efficacy. However, the impacts of CPI on the ADAMTS13-von Willebrand factor (VWF) axis and vascular endothelial functions are not known. Objectives To determine the impacts of CPI on the ADAMTS13-VWF axis and vascular endothelial functions. Methods Sixty hospitalized patients with COVID-19 were enrolled in the study; 46 received CPI and 14 received no CPI. Plasma ADAMTS13 activity, VWF antigen, endothelial syndecan-1, and soluble thrombomodulin (sTM) were assessed before and 24 hours after treatment. Results Patients with severe and critical COVID-19 exhibited significantly lower plasma ADAMTS13 activity than the healthy controls. Conversely, these patients showed a significantly increased VWF antigen. This resulted in markedly reduced ratios of ADAMTS13 to VWF in these patients. The levels of plasma ADAMTS13 activity in each patient remained relatively constant throughout hospitalization. Twenty-four hours following CPI, plasma ADAMTS13 activity increased by ∼12% from the baseline in all patients and ∼21% in those who survived. In contrast, plasma levels of VWF antigen varied significantly over time. Patients who died exhibited a significant reduction of plasma VWF antigen from the baseline 24 hours following CPI, whereas those who survived did not. Furthermore, patients with severe and critical COVID-19 showed significantly elevated plasma levels of syndecan-1 and sTM, similar to those found in patients with immune thrombotic thrombocytopenic purpura. Both syndecan-1 and sTM levels were significantly reduced 24 hours following CPI. Conclusion Our results demonstrate the relative deficiency of plasma ADAMTS13 activity and endothelial damage in patients with severe and critical COVID-19, which could be modestly improved following CPI therapy.
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Affiliation(s)
- Quan Zhang
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Zhan Ye
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul McGowan
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Jurief
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew Ly
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Antonia Bignotti
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Noritaka Yada
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - X. Long Zheng
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Institute of Reproductive and Developmental Sciences, The University of Kansas Medical Center, Kansas City, Kansas, USA
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8
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Kobusiak-Prokopowicz M, Fułek K, Fułek M, Kaaz K, Mysiak A, Kurpas D, Beszłej JA, Brzecka A, Leszek J. Cardiovascular, Pulmonary, and Neuropsychiatric Short- and Long-Term Complications of COVID-19. Cells 2022; 11:cells11233882. [PMID: 36497138 PMCID: PMC9735460 DOI: 10.3390/cells11233882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Beginning with the various strategies of the SARS-CoV-2 virus to invade our bodies and manifest infection, and ending with the recent long COVID, we are witnessing the evolving course of the disease in addition to the pandemic. Given the partially controlled course of the COVID-19 pandemic, the greatest challenge currently lies in managing the short- and long-term complications of COVID-19. We have assembled current knowledge of the broad spectrum of cardiovascular, pulmonary, and neuropsychiatric sequelae following SARS-CoV-2 infection to understand how these clinical manifestations collectively lead to a severe form of the disease. The ultimate goal would be to better understand these complications and find ways to prevent clinical deterioration.
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Affiliation(s)
| | - Katarzyna Fułek
- Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland
| | - Michał Fułek
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: (M.F.); (J.L.)
| | - Konrad Kaaz
- Department of Cardiology, Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Andrzej Mysiak
- Department of Cardiology, Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Donata Kurpas
- Department and Clinic of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
| | | | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence: (M.F.); (J.L.)
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9
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Zebardast A, Latifi T, Shabani M, Hasanzadeh A, Danesh M, Babazadeh S, Sadeghi F. Thrombotic storm in coronavirus disease 2019: from underlying mechanisms to its management. J Med Microbiol 2022; 71. [DOI: 10.1099/jmm.0.001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction. Coronavirus disease 2019 (COVID-19) identified in December 2019 in Wuhan, China, is associated with high mortality rates worldwide.
Hypothesis/Gap Statement. Thrombotic problems, such as coagulopathy, are common in COVID-19 patients. Despite anticoagulation, thrombosis is more common in patients in the intensive care unit and patients with more severe disease. Although the exact mechanisms of coagulopathy in COVID-19 patients are still unclear, studies showed that overactivation of the renin-angiotensin system (RAS), cytokine storm, endothelial damage, formation of neutrophil extracellular traps (NETs), and also extracellular vesicles (EVs) in response to COVID-19 induced inflammation can lead to systemic coagulation and thrombosis.
Aim. The management of COVID-19 patients requires the use of basic and readily available laboratory markers, both on admission and during hospitalization. Because it is critical to understand the pathophysiology of COVID-19 induced coagulopathy and treatment strategies, in this review we attempt to explain the underlying mechanism of COVID-19 coagulopathy, its diagnosis, and the associated successful treatment strategies.
Conclusion. The exact mechanisms behind COVID-19-related coagulopathy are still unclear, but several studies revealed some mechanisms. More research is needed to determine the best anticoagulant regimen and to study other therapeutic options.
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Affiliation(s)
- Arghavan Zebardast
- Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Latifi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shabani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hasanzadeh
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Golestan, Iran
| | - Manizheh Danesh
- Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Babazadeh
- Department of Pathology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Farzin Sadeghi
- Cellular & Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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10
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Does COVID-19 pose a threat for patients after univentricular palliation? Thrombosis of the Fontan tunnel. Cardiol Young 2022; 32:1698-1700. [PMID: 35086604 PMCID: PMC8861546 DOI: 10.1017/s1047951122000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 6-year-old boy, born with hypoplastic left heart syndrome, underwent total cavopulmonary connection and later presented in a significantly deteriorated condition. A CT scan revealed multiple thrombi in the extracardiac conduit, although the patient was maintained on an effective anticoagulant therapy. Further examination revealed anamnestic antibodies suggesting that the patient had gone through a clinically inapparent COVID-19 infection, which we conclude most likely contributed to his hypercoagulable state and led to the formation of significant thrombi impairing the patient's haemodynamics. The patient underwent a surgical thrombectomy; there were no post-operative thrombotic complications.
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11
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Wifi MN, Morad MA, El Sheemy R, Abdeen N, Afify S, Abdalgaber M, Abdellatef A, Zaghloul M, Alboraie M, El-Kassas M. Hemostatic system and COVID-19 crosstalk: A review of the available evidence. World J Methodol 2022; 12:331-349. [PMID: 36186748 PMCID: PMC9516549 DOI: 10.5662/wjm.v12.i5.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19) pandemic, respiratory manifestations have been the mainstay of clinical diagnosis, laboratory evaluations, and radiological investigations. As time passed, other pathological aspects of SARS-CoV-2 have been revealed. Various hemostatic abnormalities have been reported since the rise of the pandemic, which was sometimes superficial, transient, or fatal. Mild thrombocytopenia, thrombocytosis, venous, arterial thromboembolism, and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19. Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19, especially in patients admitted to intensive care units. Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation. Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood, professional societies recommend prophylactic antithrombotic therapy in severe cases, especially in the presence of abnormal coagulation indices. The review article discusses the various available evidence on coagulation disorders, management strategies, outcomes, and prognosis associated with COVID-19 coagulopathy, which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.
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Affiliation(s)
- Mohamed-Naguib Wifi
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Abdelkader Morad
- Clinical Hematology Unit, Department of Internal Medicine, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Reem El Sheemy
- Department of Tropical Medicine, Minia Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria 21523, Egypt
| | - Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo 11451, Egypt
| | - Mohammad Abdalgaber
- Department of Gastroenterology and Hepatology, Police Authority Hospital, Agoza, Giza 12511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan 11731, Egypt
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12
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Khanna NN, Maindarkar M, Puvvula A, Paul S, Bhagawati M, Ahluwalia P, Ruzsa Z, Sharma A, Munjral S, Kolluri R, Krishnan PR, Singh IM, Laird JR, Fatemi M, Alizad A, Dhanjil SK, Saba L, Balestrieri A, Faa G, Paraskevas KI, Misra DP, Agarwal V, Sharma A, Teji J, Al-Maini M, Nicolaides A, Rathore V, Naidu S, Liblik K, Johri AM, Turk M, Sobel DW, Pareek G, Miner M, Viskovic K, Tsoulfas G, Protogerou AD, Mavrogeni S, Kitas GD, Fouda MM, Kalra MK, Suri JS. Vascular Implications of COVID-19: Role of Radiological Imaging, Artificial Intelligence, and Tissue Characterization: A Special Report. J Cardiovasc Dev Dis 2022; 9:jcdd9080268. [PMID: 36005433 PMCID: PMC9409845 DOI: 10.3390/jcdd9080268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS-CoV-2 virus has caused a pandemic, infecting nearly 80 million people worldwide, with mortality exceeding six million. The average survival span is just 14 days from the time the symptoms become aggressive. The present study delineates the deep-driven vascular damage in the pulmonary, renal, coronary, and carotid vessels due to SARS-CoV-2. This special report addresses an important gap in the literature in understanding (i) the pathophysiology of vascular damage and the role of medical imaging in the visualization of the damage caused by SARS-CoV-2, and (ii) further understanding the severity of COVID-19 using artificial intelligence (AI)-based tissue characterization (TC). PRISMA was used to select 296 studies for AI-based TC. Radiological imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were selected for imaging of the vasculature infected by COVID-19. Four kinds of hypotheses are presented for showing the vascular damage in radiological images due to COVID-19. Three kinds of AI models, namely, machine learning, deep learning, and transfer learning, are used for TC. Further, the study presents recommendations for improving AI-based architectures for vascular studies. We conclude that the process of vascular damage due to COVID-19 has similarities across vessel types, even though it results in multi-organ dysfunction. Although the mortality rate is ~2% of those infected, the long-term effect of COVID-19 needs monitoring to avoid deaths. AI seems to be penetrating the health care industry at warp speed, and we expect to see an emerging role in patient care, reduce the mortality and morbidity rate.
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Affiliation(s)
- Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Annu’s Hospitals for Skin and Diabetes, Nellore 524101, India
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Mrinalini Bhagawati
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Super Specialty Hospital, New Delhi 110017, India
| | - Zoltan Ruzsa
- Invasive Cardiology Division, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22904, USA
| | - Smiksha Munjral
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Raghu Kolluri
- Ohio Health Heart and Vascular, Columbus, OH 43214, USA
| | | | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA 94574, USA
| | - Mostafa Fatemi
- Department of Physiology & Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Surinder K. Dhanjil
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy
| | - Antonella Balestrieri
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124 Cagliari, Italy
| | | | - Durga Prasanna Misra
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aman Sharma
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Jagjit Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON L4Z 4C4, Canada
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA 95119, USA
| | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN 55812, USA
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753 Delmenhorst, Germany
| | - David W. Sobel
- Rheumatology Unit, National Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI 02912, USA
| | - Martin Miner
- Men’s Health Centre, Miriam Hospital Providence, Providence, RI 02906, USA
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Athanasios D. Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, 17674 Athens, Greece
| | - George D. Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Manudeep K. Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Correspondence: ; Tel.: +1-916-749-5628
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13
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Lawal IO, Kgatle MM, Mokoala K, Farate A, Sathekge MM. Cardiovascular disturbances in COVID-19: an updated review of the pathophysiology and clinical evidence of cardiovascular damage induced by SARS-CoV-2. BMC Cardiovasc Disord 2022; 22:93. [PMID: 35264107 PMCID: PMC8905284 DOI: 10.1186/s12872-022-02534-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory coronavirus-2 (SARS-Co-2) is the causative agent of coronavirus disease-2019 (COVID-19). COVID-19 is a disease with highly variable phenotypes, being asymptomatic in most patients. In symptomatic patients, disease manifestation is variable, ranging from mild disease to severe and critical illness requiring treatment in the intensive care unit. The presence of underlying cardiovascular morbidities was identified early in the evolution of the disease to be a critical determinant of the severe disease phenotype. SARS-CoV-2, though a primarily respiratory virus, also causes severe damage to the cardiovascular system, contributing significantly to morbidity and mortality seen in COVID-19. Evidence on the impact of cardiovascular disorders in disease manifestation and outcome of treatment is rapidly emerging. The cardiovascular system expresses the angiotensin-converting enzyme-2, the receptor used by SARS-CoV-2 for binding, making it vulnerable to infection by the virus. Systemic perturbations including the so-called cytokine storm also impact on the normal functioning of the cardiovascular system. Imaging plays a prominent role not only in the detection of cardiovascular damage induced by SARS-CoV-2 infection but in the follow-up of patients' clinical progress while on treatment and in identifying long-term sequelae of the disease.
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Affiliation(s)
- Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa. .,Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa.
| | - Mankgopo M Kgatle
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa.,Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Kgomotso Mokoala
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa.,Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Abubakar Farate
- Department of Radiology, University of Maiduguri, Maiduguri, Nigeria
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa.,Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
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14
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Sinaga BYM, Ananda FR. Pregnant Women Infected with Coronavirus Disease 2019 Pneumonia: A Case Series in Medan, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Pregnancy state affects the immune regulation including physical barrier, innate, and adaptive immunity-related to susceptibility of infections and increasing risk for severe to critical case of COVID-19. Further, high risk of thrombosis becomes a challenge in the management of COVID19 in pregnancy due to the strong association with worse outcome.
CASE REPORT: Here, we present three cases of pregnant women infected with COVID-19 pneumonia with different outcomes in maternal and fetal condition related to high-risk thrombosis. Serial inflammatory markers were needed to the early detect the disease progressivity in pregnant women with COVID-19. Further, complete assessment of fetus including reverse transcriptase-polymerase chain reaction and chest X-ray must be performed to the early diagnosis of COVID-19 in neonatal whose mother was infected by SARS-CoV-2.
CONCLUSION: Pregnancy state affects the immune regulation including physical barrier, innate, and adaptive immunity-related to susceptibility of infections and increasing risk for severe to critical case of COVID-19. Further, high risk of thrombosis becomes a challenge in the management of COVID19 in pregnancy due to the strong association with worse outcome. Although fetal transmission of COVID-19 to fetus remains unclear, complete assessment of fetus including RT-PCR, and chest X-ray must be performed to the early diagnosis of COVID-19 in neonatal whose mother was infected by SARS-CoV-2.
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15
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Batah SS, Benatti MN, Siyuan L, Telini WM, Barboza JO, Menezes MB, Nadai TR, Sá KSG, Vaswani CM, Gupta S, Zamboni DS, Wada DT, Calado RT, Oliveira RDR, Louzada‐Junior P, Auxiliadora‐Martins M, Veras FP, Cunha LD, Cunha TM, Luppino‐Assad R, Balancin ML, Morais SS, Martins RB, Arruda E, Chahud F, Santos MK, Cetlin AA, Cunha FQ, dos Santos C, Capelozzi VL, Fukuoka J, Achcar RD, Fabro AT. COVID‐19 bimodal clinical and pathological phenotypes. Clin Transl Med 2022; 12:e648. [PMID: 35075808 PMCID: PMC8787021 DOI: 10.1002/ctm2.648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 02/06/2023] Open
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16
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Mouzarou A, Ioannou M, Leonidou E, Chaziri I. Pulmonary Embolism in Post-CoviD-19 Patients, a Literature Review: Red Flag for Increased Awareness? SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:190. [PMID: 35999860 PMCID: PMC9389494 DOI: 10.1007/s42399-022-01273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Although COVID-19 was primarily considered a respiratory illness, rapidly accumulating data suggest that COVID-19 is associated with a high incidence of venous thromboembolic complications. The primary objective of this review article was to reveal whether we need to increase awareness of pulmonary embolism in the period following the COVID-19 infection given that the epidemiologic facts are still poor. A literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EMBASE) from June 2020 until June 2022. The long-term health consequences of COVID-19 remain largely unclear. This review highlights the importance of awareness of the potentially increased incidence of venous thromboembolism in post-COVID-19 patients, even those with mild or asymptomatic disease. Further research is required to establish appropriate clinical management guidelines for the prevention of thromboembolic complications in the post-COVID-19 period.
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Affiliation(s)
- Angeliki Mouzarou
- Critical Care Unit COVID-19, General Hospital Limassol, State Health Organization Services, 4131 Limassol, Cyprus
| | - Maria Ioannou
- Department of Cardiology, General Hospital Limassol, State Health Organization Services, Limassol, Cyprus
| | - Elena Leonidou
- Department of Cardiology, General Hospital Limassol, State Health Organization Services, Limassol, Cyprus
| | - Ioanna Chaziri
- Department of Pneumonology, Northern Älvborg County Hospital, Trollhättan, Sweden
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17
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Aung HM, Thida AM, Fils-Aime M, Thwin M. Incidental Finding of Bilateral Acute Pulmonary Emboli in a Patient With Asymptomatic COVID-19 Infection. Cureus 2021; 13:e18496. [PMID: 34754657 PMCID: PMC8569651 DOI: 10.7759/cureus.18496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
A 58-year-old male with a history of hypertension, dyslipidemia, osteoarthritis of both knees, and morbid obesity presented to the emergency department for opioid detoxification. He complained of generalized soreness, anxiety, and difficulty sleeping but denied signs and symptoms suggestive of coronavirus disease 2019 (COVID-19) infection. His COVID-19 polymerase chain reaction (PCR) result came back positive, and his D-dimer level was 5373 ng/mL. A computed tomography pulmonary angiogram showed a moderate burden of bilateral acute pulmonary emboli. He was managed with enoxaparin sodium subcutaneous therapeutic dose for three days, followed by oral apixaban 10 mg twice a day for seven days and then 5 mg twice a day for six months. To date, the rate of venous thromboembolism (VTE) in nonhospitalized patients with COVID-19 has not been reported, and current guidelines do not recommend thromboprophylaxis for these patients.
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Affiliation(s)
- Htun M Aung
- Department of Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Aye M Thida
- Department of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, USA
| | | | - Malar Thwin
- Department of Medicine, Interfaith Medical Center, Brooklyn, USA
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18
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Caesario J, Hertanto DM, Hernugrahanto KD, Utomo DN, Budhiparama NC, Santoso D, Hogendoorn PC. Case Report: Asymptomatic COVID-19 patient with a subtle hypercoagulable state and fluctuating D-dimer level. F1000Res 2021; 10:1112. [PMID: 35251595 PMCID: PMC8861469 DOI: 10.12688/f1000research.74009.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: COVID-19 can infect an asymptomatic person silently without any overt symptoms despite diffuse blood clots throughout the body. Clot formation is induced by COVID-19 associated coagulopathy that can cause a high mortality rate. D-dimer, a fairly decisive marker for the coagulopathy event, is physiologically a marker of the fibrinolysis process. The increase of D-dimers in COVID-19 cases must be followed up because it relates to the initiation of a cytokine storm. Case presentation: We report an asymptomatic patient with sudden D-dimer elevation who received anticoagulant therapy. After three days of heparin administration, D-dimer results became normal and anticoagulant therapy was stopped. However, on the 12th day, the D-dimer level rebounded back and was followed by an increase of hs-C-reactive protein, erythrocyte sedimentation rate, IL-6, although SARS-CoV-2 PCR result became negative. A hyperglycaemic reaction and a sudden increase of HbA1C was observed in the patient. After three weeks D-dimer had returned to normal levels, and so did the other markers. The patient recovered fully and still no symptoms were obvious. Conclusion: COVID-19 patients without symptoms may be at risk of an asymptomatic coagulopathy process. The decreasing level of D-dimer erroneously cannot ensure that the coagulopathy process stops.
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Affiliation(s)
| | - Decsa M. Hertanto
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia
| | - Kukuh D. Hernugrahanto
- Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia
| | - Dwikora N. Utomo
- Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia
| | - Nicolaas C. Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakaarta, 12950, Indonesia
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, 2333, The Netherlands
- Faculty of Vocational Studies, Airlangga University, Surabaya, 60286, Indonesia
| | - Djoko Santoso
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia
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19
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Clavijo MM, Vicente Reparaz MDLA, Ruiz JI, Acuña MA, Casali CE, Aizpurua MF, Mahuad CV, Eciolaza S, Ventura A, Garate GM. Mild COVID-19 Illness as a Risk Factor for Venous Thromboembolism. Cureus 2021; 13:e18236. [PMID: 34722035 PMCID: PMC8544806 DOI: 10.7759/cureus.18236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction From the beginning of the current coronavirus disease 2019 (COVID-19) pandemic, there is cumulative evidence suggesting that patients hospitalized due to this disease are at a high risk for venous thromboembolism (VTE). The association between mild non-hospitalized illness and VTE is unclear. The purpose of this research is to assess the association between VTE and mild COVID-19 infection. Methods A case-control study was conducted. The cases were adult patients diagnosed with VTE from March 1, 2020 to March 31, 2021. The controls were randomly chosen adult patients who required healthcare services that were equivalent to those of the cases, for any cause, during the same time period, without a VTE diagnosis. To assess the association between mild COVID and VTE, a multivariate logistic regression analysis was conducted, considering other thromboembolic risk variables, such as age, gender and active cancer, among others. A p-value <0.05 was considered statistically significant. Results A total of 186 cases and 475 controls were analyzed. There were 21 (11.3%) and 31 (6.5%) patients infected with mild COVID-19 in the previous three months in the groups of cases and controls, respectively. Mild COVID-19 infection was statistically significant as a risk factor for VTE both in the univariate analysis and in the multivariate analysis, OR=1.82 (95% CI 1.02-3.26) and OR=2.62 (95% CI 1.34-5.13), respectively. Conclusion Mild COVID-19 infection might be an independent risk factor for VTE. We conclude that the results suggest some thromboprophylaxis strategy should be considered in certain patients with COVID-19 infection in an outpatient fashion.
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Affiliation(s)
| | | | - Juan I Ruiz
- Internal Medicine, Hospital Aleman, Buenos Aires, ARG
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20
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Keane G, Dorman T. Fatal pulmonary thromboembolism in asymptomatic COVID-19. Ir J Med Sci 2021; 191:1777-1783. [PMID: 34482482 PMCID: PMC8418686 DOI: 10.1007/s11845-021-02735-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/29/2021] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has claimed the lives of millions of people globally. Aims This study aims to identify the pathological findings at autopsy of asymptomatic COVID-19 death, to compare the incidence of acute bilateral pulmonary thromboembolism (ABPTE) in asymptomatic COVID-19 deaths versus non-COVID-19 deaths and to explore the possible pathogenesis of thrombosis in COVID-19. We also consider the place of COVID-19 in the death certification of 4 cases who died from ABPTE. Methods This study primarily reviewed post-mortem reports of 6 asymptomatic COVID-19 deaths. Post-mortem reports for the years 2019 and 2020 were also reviewed to establish the incidence of ABPTE. Each post-mortem report was reviewed for gross examination, histology and toxicology findings. A literature review on COVID-19 autopsy findings, COVID-19 pathogenesis, thrombosis in COVID-19 and asymptomatic SARS-CoV-2 infection was also conducted using PubMed. Results Of the 6 asymptomatic COVID-19 deaths, 4 died as a result of ABPTE, 1 died of ischaemic and hypertensive cardiac disease caused by coronary artery disease and ventricular hypertrophy and the remaining case died of heart failure due to dilated cardiomyopathy caused by subendocardial fibrosis. There were 2 cases of bilateral pulmonary thromboembolism (BPTE) in 2019 out of 140 post-mortems. Excluding the 4 cases of ABPTE described already, there was 1 case of ABPTE in 2020 out of 156 post-mortems. A literature review on the pathogenesis of thrombosis in COVID-19 highlighted the significant role that the endothelium plays. Conclusions Massive pulmonary thromboembolism may be a significant cause of death in asymptomatic COVID-19 infection.
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Affiliation(s)
- Gerard Keane
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Tony Dorman
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
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21
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Bandapaati S, Bobba H, Navinan MR. Coeliac artery and splenic artery thrombosis complicated with splenic infarction 7 days following the first dose of Oxford vaccination, causal relationship or coincidence? BMJ Case Rep 2021; 14:14/7/e243799. [PMID: 34261633 PMCID: PMC8280896 DOI: 10.1136/bcr-2021-243799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 became a global pandemic in late 2019, and is still ongoing in 2021 causing significant morbidity and mortality. The advent of vaccinations heralded the turning of the tide. The Oxford jab, a vector-based vaccine was favoured due to its low cost and ease of storage. However, its potential association with thromboembolic adverse events resulted in controversy and disrupted its roll-out and use. The aetiopathogenesis of these thromboembolic events and its association with the Oxford vaccine are still speculative and uncertain, more so in the background of SARS-CoV-2 infection being highly thrombogenic in its own right. This paper presents a case of an otherwise healthy 50-year-old Caucasian man who developed acute abdominal pain 7 days following the first dose of Oxford vaccine and was found to have coeliac and splenic artery thrombosis complicated with splenic infarction.
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Affiliation(s)
- Sareesh Bandapaati
- Emergency Department, Kettering General Hospital, Kettering, Northamptonshire, UK
| | - Hemababu Bobba
- Emergency Department, Kettering General Hospital, Kettering, Northamptonshire, UK
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22
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Abstract
The current coronavirus disease 2019 pandemic has been particularly challenging for the clinician because of the unclear nature of the underlying disease mechanisms. One of the hallmarks of the disease involves an increased risk of thrombosis and hypercoagulable state. Here, we describe 2 cases of patients admitted with submassive pulmonary embolism in the setting of positive tests for severe acute respiratory syndrome coronavirus 2.
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23
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Fan BE, Cheung C. Post COVID-19 Arterial Thromboembolism: A Clear and Present Danger. Semin Thromb Hemost 2021; 48:112-114. [PMID: 33860515 DOI: 10.1055/s-0041-1728717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Molecular and Cell Biology, Singapore
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24
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Sessa F, Salerno M, Pomara C. Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:309. [PMID: 33806100 PMCID: PMC8064502 DOI: 10.3390/medicina57040309] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome-Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, Institute of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
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25
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Nardacci R, Colavita F, Castilletti C, Lapa D, Matusali G, Meschi S, Del Nonno F, Colombo D, Capobianchi MR, Zumla A, Ippolito G, Piacentini M, Falasca L. Evidences for lipid involvement in SARS-CoV-2 cytopathogenesis. Cell Death Dis 2021; 12:263. [PMID: 33712574 PMCID: PMC7952828 DOI: 10.1038/s41419-021-03527-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
The pathogenesis of SARS-CoV-2 remains to be completely understood, and detailed SARS-CoV-2 cellular cytopathic effects requires definition. We performed a comparative ultrastructural study of SARS-CoV-1 and SARS-CoV-2 infection in Vero E6 cells and in lungs from deceased COVID-19 patients. SARS-CoV-2 induces rapid death associated with profound ultrastructural changes in Vero cells. Type II pneumocytes in lung tissue showed prominent altered features with numerous vacuoles and swollen mitochondria with presence of abundant lipid droplets. The accumulation of lipids was the most striking finding we observed in SARS-CoV-2 infected cells, both in vitro and in the lungs of patients, suggesting that lipids can be involved in SARS-CoV-2 pathogenesis. Considering that in most cases, COVID-19 patients show alteration of blood cholesterol and lipoprotein homeostasis, our findings highlight a peculiar important topic that can suggest new approaches for pharmacological treatment to contrast the pathogenicity of SARS-CoV-2.
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Affiliation(s)
- Roberta Nardacci
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Franca Del Nonno
- Pathology Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Daniele Colombo
- Pathology Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Giuseppe Ippolito
- Scientific Direction; National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Mauro Piacentini
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Laura Falasca
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy.
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Laouan Brem F, Rasras H, El Ouafi N, Bazid Z. Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection. Cureus 2021; 13:e13848. [PMID: 33854858 PMCID: PMC8038649 DOI: 10.7759/cureus.13848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hypercoagulability state is common in patients with coronavirus disease 2019 (COVID-19), especially those requiring intensive care. Indeed, anticoagulation therapy is recommended for all hospitalized COVID-19-patients. Despite well-conducted thromboprophylaxis, so many patients have developed these life-threatening complications. However, these thrombotic events are not known to occur in asymptomatic COVID-19 patients or in those recovered from active severe acute respiratory syndrome coronavirus 2 infection. This case series of a bilateral pulmonary embolism that occurred in patients recovered from asymptomatic COVID-19 highlights the questions about extending thromboprophylaxis in ambulatory patients with COVID-19.
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Affiliation(s)
- Falmata Laouan Brem
- Cardiology, Mohammed VI University Hospital, Mohammed I University, Oujda, MAR
| | - Hammam Rasras
- Cardiology, Mohammed VI University Hospital, Mohammed I University, Oujda, MAR
| | - Noha El Ouafi
- Cardiology, Mohammed VI University Hospital, Mohammed I University, Oujda, MAR
| | - Zakaria Bazid
- Cardiology, Mohammed VI University Hospital, Mohammed I University, Oujda, MAR
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