1
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Polpichai N, Saowapa S, Wattanachayakul P, Danpanichkul P, Tahir H, Abdalla M, Trongtorsak A. Impact of diabetic ketoacidosis on outcomes in hospitalized diabetic patients with Clostridioides difficile infection: a national inpatient analysis. Proc AMIA Symp 2024; 37:742-748. [PMID: 39165815 PMCID: PMC11332632 DOI: 10.1080/08998280.2024.2356782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction Diabetic ketoacidosis (DKA) is a critical diabetic emergency with life-threatening complications. The impact of DKA on hospital outcomes in diabetic patients with Clostridioides difficile infection (CDI) remains unclear. Methods This retrospective analysis used data from the 2016 to 2020 National Inpatient Survey. Adults with diabetes and CDI were categorized into groups with and without DKA. Hospitalization characteristics, comorbidities, and clinical outcomes were compared. Primary outcomes included mortality, length of stay, and total hospital charges. Secondary outcomes included CDI complications. Multivariate logistic regression analysis was conducted, with P values ≤ 0.05 considered statistically significant. Results Among 494,664 diabetic patients with CDI, 6130 had DKA. Patients with DKA had significantly higher total hospital charges ($194,824 vs $103,740, P < 0.001) and longer length of stay (10.14 vs 6.04 days, P < 0.001). After adjusting for confounders, DKA patients had increased odds of mortality (adjusted odds ratio [aOR] 2.07), sepsis (aOR 1.40), septic shock (aOR 1.76), cardiac arrest (aOR 3.24), vasopressor use (aOR 2.01), and mechanical ventilation (aOR 1.96) (all P < 0.001). Conclusion The presence of DKA significantly elevates hospital burden and CDI complications in diabetic patients. These findings underscore the need for close monitoring and aggressive management of DKA in patients with concurrent CDI to improve outcomes.
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Affiliation(s)
- Natchaya Polpichai
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA
| | - Sakditad Saowapa
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | | | - Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Hamza Tahir
- Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA
| | - Monzer Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois, USA
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2
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Silaghi-Dumitrescu R, Patrascu I, Lehene M, Bercea I. Comorbidities of COVID-19 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1393. [PMID: 37629683 PMCID: PMC10456773 DOI: 10.3390/medicina59081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) responsible for the coronavirus disease outbreak initiated in 2019 (COVID-19) has been shown to affect the health of infected patients in a manner at times dependent on pre-existing comorbidities. Reported here is an overview of the correlation between comorbidities and the exacerbation of the disease in patients with COVID-19, which may lead to poor clinical outcomes or mortality. General medical issues are also reviewed, such as the types of symptoms present in people infected with SARS-CoV-2, the long-term effects of COVID-19 disease, and the types of treatment that are currently used.
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Affiliation(s)
- Radu Silaghi-Dumitrescu
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, 11 Arany Janos Str., 400028 Cluj-Napoca, Romania (M.L.)
| | - Iulia Patrascu
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, 11 Arany Janos Str., 400028 Cluj-Napoca, Romania (M.L.)
- Bistrita County Emergency Clinical Hospital, 42 General Grigore Bălan, Bld., 420094 Bistrita, Romania
| | - Maria Lehene
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, 11 Arany Janos Str., 400028 Cluj-Napoca, Romania (M.L.)
| | - Iulia Bercea
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, 11 Arany Janos Str., 400028 Cluj-Napoca, Romania (M.L.)
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3
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Injinari N, Ghoshouni H, Mehrabbeik A, Namiranian N, Ghadiri-Anari A, Azizi R. Comparison of Diabetic Ketoacidosis Characteristics During- and Before the COVID-19 Pandemic. Int J Endocrinol Metab 2023; 21:e134882. [PMID: 38028247 PMCID: PMC10676655 DOI: 10.5812/ijem-134882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Despite evidence about the relationship between diabetic ketoacidosis (DKA) and infectious diseases, our knowledge of DKA during the coronavirus disease 2019 (COVID-19) pandemic remains unclear. Objectives This study aimed to compare the DKA situation among individuals with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic compared to pre-pandemic. Methods This retrospective-longitudinal study included individuals with T1DM and T2DM hospitalized with newly diagnosed DKA before (March to August 2018 and 2019) and during (March to August 2020 and 2021) the COVID-19 pandemic. Demographics, the frequency of new-onset diabetes mellitus (DM) and new-onset DKA, days of hospitalization, DKA severity, laboratory tests, and mortality were assessed. Results Of 162 patients with DKA, 139 patients were newly diagnosed. The frequency of individuals with new-onset DM had increased during the pandemic compared to pre-pandemic (P = 0.047). Moreover, new-onset DKA was higher in 2020 and 2021 versus 2019 and 2018 (P = 0.002). Significantly, there were no T2DM patients with DKA in pre-pandemic, but DKA admissions in people with T2DM increased in 2021 (P < 0.001). The severity of new-onset DKA had increased during the pandemic compared to pre-pandemic (P = 0.000). However, there was no significant difference between pre-and the pandemic regarding mortality (P = 0.981). Additionally, hospitalization length (P = 0.043) and mortality (P = 0.038) were higher in patients with T2DM compared to T1DM. Conclusions During the COVID-19 pandemic, the frequency of DKA and its severity was higher than in pre-pandemic, and COVID-19 can be more life-threatening in patients with T2DM. Therefore, healthcare providers should be alert to DKA, especially in patients with T2DM.
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Affiliation(s)
- Nastaran Injinari
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamed Ghoshouni
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Akram Mehrabbeik
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Akram Ghadiri-Anari
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reyhaneh Azizi
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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4
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Devi SM, Pamreddy A, Narendra VR. Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review. J Diabetes Metab Disord 2023; 22:135-146. [PMID: 37250369 PMCID: PMC10083065 DOI: 10.1007/s40200-023-01207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/28/2023] [Indexed: 05/31/2023]
Abstract
Background SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) has become a global pandemic, and medical experts are scrambling to understand the wide range of symptoms and consequences of the virus. Although acute pancreatitis (AP) and pancreatic damage have been associated with SARS-CoV-2, the mechanism behind this is still unclear. The current article explores whether COVID-19 is an additional cause of AP and diabetic ketoacidosis (DKA). The article illustrates the conditions associated with AP and DKA among COVID-19 patients and diabetes mellitus (DM). Another critical condition is acute kidney injury (AKI), often associated with DKA. Methods A search strategy for the article was assigned and retrieved from PubMed, Web of Science, and Scopus databases from 2020 to June 2022. The articles which discussed case studies on AP, DKA, and AKI were included in the study. Results The present review of 24 reported case studies represented conditions of AP (12), DKA (5), AP and DKA (5), AP and AKI (1), and DKA and AKI (1) among COVID-19 participants, and showed a potential relationship between the complications. Conclusion Healthcare during the COVID-19 pandemic plays a major role among AP, DKA, and AKI-associated COVID-19 patients. A compilation of case studies suggests effective management of COVID-19 infection-related complications such as AP, DKA, and AKI.
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Affiliation(s)
- Sundru Manjulata Devi
- Bioinformatics section, SVR BioScience Research Services, 570003 Mysuru, Karnataka India
| | - Annapurna Pamreddy
- Division of Nephrology, Department of Medicine, Long School of Medicine, University of Texas Health, San Antonio, TX USA
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5
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Anindya R, Rutter GA, Meur G. New-onset type 1 diabetes and severe acute respiratory syndrome coronavirus 2 infection. Immunol Cell Biol 2023; 101:191-203. [PMID: 36529987 PMCID: PMC9877852 DOI: 10.1111/imcb.12615] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Type 1 diabetes (T1D) is a condition characterized by an absolute deficiency of insulin. Loss of insulin-producing pancreatic islet β cells is one of the many causes of T1D. Viral infections have long been associated with new-onset T1D and the balance between virulence and host immunity determines whether the viral infection would lead to T1D. Herein, we detail the dynamic interaction of pancreatic β cells with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the host immune system with respect to new-onset T1D. Importantly, β cells express the crucial entry receptors and multiple studies confirmed that β cells are infected by SARS-CoV-2. Innate immune system effectors, such as natural killer cells, can eliminate such infected β cells. Although CD4+ CD25+ FoxP3+ regulatory T (TREG ) cells provide immune tolerance to prevent the destruction of the islet β-cell population by autoantigen-specific CD8+ T cells, it can be speculated that SARS-CoV-2 infection may compromise self-tolerance by depleting TREG -cell numbers or diminishing TREG -cell functions by repressing Forkhead box P3 (FoxP3) expression. However, the expansion of β cells by self-duplication, and regeneration from progenitor cells, could effectively replace lost β cells. Appearance of islet autoantibodies following SARS-CoV-2 infection was reported in a few cases, which could imply a breakdown of immune tolerance in the pancreatic islets. However, many of the cases with newly diagnosed autoimmune response following SARS-CoV-2 infection also presented with significantly high HbA1c (glycated hemoglobin) levels that indicated progression of an already set diabetes, rather than new-onset T1D. Here we review the potential underlying mechanisms behind loss of functional β-cell mass as a result of SARS-CoV-2 infection that can trigger new-onset T1D.
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Affiliation(s)
- Roy Anindya
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Guy A Rutter
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.,Centre of Research of Centre Hospitalier de l'Université de Montréal (CRCHUM), Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - Gargi Meur
- ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
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6
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Nassar M, Misra A, Bloomgarden Z. COVID-19 Vaccination in Persons with Diabetes: How they Work. CONTEMPORARY ENDOCRINOLOGY 2023:195-206. [DOI: 10.1007/978-3-031-28536-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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7
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Capra ME, Stanyevic B, Giudice A, Monopoli D, Decarolis NM, Esposito S, Biasucci G. The Effects of COVID-19 Pandemic and Lockdown on Pediatric Nutritional and Metabolic Diseases: A Narrative Review. Nutrients 2022; 15:nu15010088. [PMID: 36615746 PMCID: PMC9823544 DOI: 10.3390/nu15010088] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
SARS-CoV-2 was the first pathogen implied in a worldwide health emergency in the last decade. Containment measures have been adopted by various countries to try to stop infection spread. Children and adolescents have been less clinically involved by COVID-19, but the pandemic and consequent containment measures have had an important influence on the developmental ages. The COVID-19 pandemic and the subsequent lockdown periods have influenced the nutrition and lifestyles of children and adolescents, playing an epigenetic role in the development of nutrition and metabolic diseases in this delicate age group. The aim of our review is to investigate the effects of the COVID-19 pandemic on nutrition and metabolic diseases in the developmental ages. Moreover, we have analyzed the effect of different containment measures in children and adolescents. An increase in being overweight, obesity and type 2 diabetes mellitus has been detected. Concerning type 1 diabetes mellitus, although a validated mechanism possibly linking COVID-19 with new onset type 1 diabetes mellitus has not been yet demonstrated, barriers to the accessibility to healthcare services led to delayed diagnosis and more severe presentation of this disease. Further studies are needed to better investigate these relationships and to establish strategies to contain the nutritional and metabolic impact of new pandemics in the developmental ages.
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Affiliation(s)
- Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Brigida Stanyevic
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Antonella Giudice
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Delia Monopoli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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8
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Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death that could be prevented in patients with diabetes mellitus. DKA occurs more commonly among patients with type-1 diabetes with a thirty percent of the cases take place in patients with type 2 diabetes. DKA is characterized by sever hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive replacement and monitoring of fluids, electrolytes and insulin therapy. Management of DKA has been updated with guidelines, to help standardize care, and reduce mortality and morbidity. The major precipitating factors for DKA include new diagnosis of diabetes, non-adherence to insulin therapy as well as infection in patients with diabetes. Discharge plans should include appropriate selection of insulin dosing and regimens as well as patient education to prevent recurrence of DKA. Further, definition and management of euglycemic DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors are discussed. Special consideration is reviewed for specific patient population including pregnancy, renal replacement, acute pancreatitis, and insulin pump users as well as patients with COVID-19.
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9
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Da Porto A, Tascini C, Colussi G, Peghin M, Graziano E, De Carlo C, Bulfone L, Antonello M, Sozio E, Fabris M, Curcio F, Pucillo C, Catena C, Sechi LA. Relationship between cytokine release and stress hyperglycemia in patients hospitalized with COVID-19 infection. Front Med (Lausanne) 2022; 9:988686. [PMID: 36059840 PMCID: PMC9437426 DOI: 10.3389/fmed.2022.988686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Stress hyperglycemia is a frequent finding in patients with COVID-19 infection and could affect the outcome of disease. Cytokines released in response to infection could have adverse effects on insulin sensitivity and pancreatic beta-cell function. The aim of the study was to examine the relationships of stress hyperglycemia with cytokines and clinical outcomes in hospitalized patients with COVID-19. Methods In a cross-sectional analysis of 150 patients hospitalized for COVID-19 infection who were included in the GIRA-COVID database, we identified patients with stress hyperglycemia by calculation of the Stress Hyperglycemia Ratio (SHR) and use of a cut-off of 1.14. Plasma levels of cytokines principally involved in COVID-19 infection-related cytokine storm were measured. Outcome variables were use of mechanical ventilation and death within 60 days from hospital admission. Results Patients with SHR > 1.14 had significantly higher plasma insulin, HOMA-index, and levels of interleukin-10 (IL-10), interleukin-10/tumor necrosis factor-a ratio (IL-10/TNF-α), and CXC motif chemokine ligand 10 (CXCL10) than patients with SHR ≤ 1.14. IL-10, IL-10/TNF-α ratio, CXCL10, and IFN-γ were significantly and directly related with SHR in univariate analysis and multivariate logistic regression models showed that IL-10, IL-10/TNF-α ratio, and CXCL10 were independently associated with SHR>1.14. In a multivariate logistic model, stress hyperglycemia predicted use of mechanical ventilation (OR 2.453; CI 1.078–6.012) and death (OR 2.281; CI 1.049–7.369) independently of diabetes and other major confounders. Conclusions In patients hospitalized for COVID-19 infection, stress hyperglycemia is associated with worse clinical outcomes and is independently related to levels of cytokines that might impair glucose homeostasis.
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Affiliation(s)
- Andrea Da Porto
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
- *Correspondence: Andrea Da Porto
| | - Carlo Tascini
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gianluca Colussi
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Elena Graziano
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Chiara De Carlo
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Luca Bulfone
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Martina Antonello
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Emanuela Sozio
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Martina Fabris
- Division of Laboratory Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Francesco Curcio
- Division of Laboratory Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Carlo Pucillo
- Laboratory of Immunology, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiana Catena
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Leonardo A. Sechi
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
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Ehrmann D. Akutkomplikationen des Diabetes mellitus – Schulungsinhalte richtig vermitteln. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1723-5181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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11
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Tzeravini E, Stratigakos E, Siafarikas C, Tentolouris A, Tentolouris N. The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course-A Narrative Review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:812134. [PMID: 36992740 PMCID: PMC10012165 DOI: 10.3389/fcdhc.2022.812134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | | | - Chris Siafarikas
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Saied AA, Metwally AA, Dhama K. Our children are at risk of COVID-19- associated rhino-orbito-cerebral mucormycosis (ROCM). Ann Med Surg (Lond) 2021; 72:103058. [PMID: 34804523 PMCID: PMC8592640 DOI: 10.1016/j.amsu.2021.103058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- AbdulRahman A Saied
- Department of Food Establishments Licensing (Aswan Branch), National Food Safety Authority (NFSA), Aswan, 81511, Egypt.,Touristic Activities and Interior Offices Sector (Aswan Office), Ministry of Tourism and Antiquities, Aswan, 81511, Egypt
| | - Asmaa A Metwally
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Aswan University, Aswan, 81511, Egypt
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
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