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Lagier JC, Million M, Cortaredona S, Delorme L, Colson P, Fournier PE, Brouqui P, Raoult D, Parola P. Outcomes of 2111 COVID-19 Hospitalized Patients Treated with Hydroxychloroquine/Azithromycin and Other Regimens in Marseille, France, 2020: A Monocentric Retrospective Analysis. Ther Clin Risk Manag 2022; 18:603-617. [PMID: 35669696 PMCID: PMC9167052 DOI: 10.2147/tcrm.s364022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/22/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives We evaluated the 6-week mortality of SARS-CoV-2 hospitalized patients treated using a standardized protocol in 2020 in Marseille, France. Methods A retrospective monocentric cohort study was conducted in the standard hospital wards at the Institut Hospitalo-Universitaire Méditerranée Infection, between March and December 2020 in adults with SARS-CoV-2 PCR-proven infection. Results Of the 2111 hospitalized patients (median age, 67 [IQR 55-79] years; 1154 [54.7%] men), 271 were transferred to the intensive care unit (12.8%) and 239 died (11.3%; the mean age of patients who died was 81.2 (±9.9)). Treatment with hydroxychloroquine plus azithromycin (HCQ-AZ), used in 1270 patients, was an independent protective factor against death (0.68 [0.52 - 0.88]). This effect was consistent for all subgroups of age, comorbidities, severity of the disease and comedications with zinc or corticosteroids. Zinc was independently protective against death (0.39 [0.23 - 0.67]), in a subgroup analysis of patients treated with HCQ-AZ without dexamethasone. The use of high-flow oxygen therapy in elderly patients who were not eligible for intensive care unit transfer saved 19 patients (33.9%). Conclusions In our 2020 cohort, treating COVID-19 with HCQ-AZ was associated with lower mortality. These results need to be analyzed in the context of academic discussions about observational studies versus randomized clinical trials. More data will deserve to be analyzed in the SARS-Cov 2 variants, vaccination and post-vaccination era.
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Affiliation(s)
- Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France,MEPHI, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Marseille, France,Jean-Christophe Lagier, Email
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France,MEPHI, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Sébastien Cortaredona
- IHU-Méditerranée Infection, Marseille, France,VITROME, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Service de Santé des Armées, Marseille, France
| | - Léa Delorme
- IHU-Méditerranée Infection, Marseille, France
| | - Philippe Colson
- IHU-Méditerranée Infection, Marseille, France,MEPHI, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre-Edouard Fournier
- IHU-Méditerranée Infection, Marseille, France,VITROME, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Service de Santé des Armées, Marseille, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, Marseille, France,MEPHI, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France,MEPHI, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France,VITROME, Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Service de Santé des Armées, Marseille, France,Correspondence: Philippe Parola, Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France, Tel + 33 0 4 13 73 24 01, Fax + 33 0 4 13 73 24 02, Email
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Alimoradi N, Sharqi M, Firouzabadi D, Sadeghi MM, Moezzi MI, Firouzabadi N. SNPs of ACE1 (rs4343) and ACE2 (rs2285666) genes are linked to SARS-CoV-2 infection but not with the severity of disease. Virol J 2022; 19:48. [PMID: 35305693 PMCID: PMC8934128 DOI: 10.1186/s12985-022-01782-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/10/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19 and the renin-angiotensin system (RAS) are linked by angiotensin-converting enzyme 2 (ACE2), a key enzyme in RAS that has been validated as a SARS-CoV-2 receptor. Functional ACE1/ACE2 gene polymorphisms may lead to the imbalance between ACE/ACE2 ratio and thus generating RAS imbalance that is associated with higher degrees of lung damage in ARDS that may contribute to the COVID-19 infection outcome. Herein, we investigated the role of RAS gene polymorphisms, ACE1 (A2350G) and ACE2 (G8790A) as risk predictors for susceptibility and severity of COVID-19 infection. A total of 129 included: negative controls without a history of COVID-19 infection (n = 50), positive controls with a history of COVID-19 infection who were not hospitalized (n = 35), and patients with severe COVID-19 infection who were hospitalized in the intensive care unit (n = 44). rs4343 of ACE and rs2285666 of ACE2 were genotyped using PCR–RFLP method. Our results indicated that susceptibility to COVID-19 infection was associated with age, GG genotype of A2350G (Pa = 0.01; OR 4.7; 95% CI 1.4–15.1 and Pc = 0.040; OR 2.5; 95% CI 1.05–6.3) and GG genotype of G8790A (Pa = 0.044; OR 6.17; 95% CI 1.05–35.71 and Pc = 0.0001; OR 5.5; 95% CI 2.4–12.4). The G allele of A2350G (Pa = 0.21; OR 1.74; 95% CI 0.73–4.17 and Pc = 0.007; OR 2.1; 95% CI 1.2–3.5) and G allele of G8790A (Pa = 0.002; OR 4.26; 95% CI 1.7–10.65 and Pc = 0.0001; OR 4.7; 95% CI 2.4–9.2) were more frequent in ICU-admitted patients and positive control group. Also lung involvement due to COVID-19 infection was associated with age and the comorbidities such as diabetes. In conclusion, our findings support the association between the wild genotype (GG) of ACE2 and homozygote genotype (GG) of ACE1 and sensitivity to COVID-19 infection, but not its severity. However, confirmation of this hypothesis requires further studies with more participants.
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The Role of Ionizing Radiation for Diagnosis and Treatment against COVID-19: Evidence and Considerations. Cells 2022; 11:cells11030467. [PMID: 35159277 PMCID: PMC8834503 DOI: 10.3390/cells11030467] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, the supportive evidence for low dose radiation therapy (LDRT), and the risks of radiation-induced cancer and cardiac disease associated with LDRT. In this paper, we address concerns regarding the effective management of COVID-19 patients and potential avenues that could provide empirical evidence for the fight against the disease.
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Brouqui P, Drancourt M, Raoult D. COVID-19 Management at IHU Méditerranée Infection: A One-Year Experience. J Clin Med 2021; 10:2881. [PMID: 34209634 PMCID: PMC8268723 DOI: 10.3390/jcm10132881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Hospital-University Institute (IHU) Méditerranée Infection features a 27,000 square meter building hosting 700 employees and 75 hospitalized patients in the center of Marseille, France. METHOD Previous preparedness in contagious disease management allowed the IHU to manage the COVID-19 outbreak by continuing adaptation for optimal diagnosis, care and outcome. We report here the output of this management. RESULTS From 5 March 2020, and 26 April 2021, 608,313 PCR tests were provided for 424,919 patients and 44,089 returned positive. A total of 23,390 patients with COVID-19 were followed at IHU with an overall case fatality ratio of 1.7%. Of them 20,270 were followed as outpatients with an overall CFR of 0.17%. We performed 24,807 EKG, 5759 low dose CT Scanner, and 18,344 serology. Of the 7643 nasopharyngeal samples inoculated in cell cultures 3317 (43.3%) yielded SARS-Cov-2 isolates. Finally, 7370 SARS-Cov-2 genomes were analyzed, allowing description of the first genetic variants and their implication in the epidemiologic curves. Continuous clinical care quality evaluation provided the opportunity for 155 publications allowing a better understanding of the disease and improvement of care and 132 videos posted on the IHU Facebook network, totaling 60 million views and 390,000 followers, and dealing with COVID-19, outbreaks, epistemology, and ethics in medicine. CONCLUSIONS During this epidemic, IHU Méditerranée Infection played the role for which it has been created; useful clinical research to guarantee a high-quality diagnostic and care for patient and a recognized expertise.
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Affiliation(s)
| | | | - Didier Raoult
- Aix-Marseille University, IRD, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (P.B.); (M.D.)
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Finance J, Zieleskewicz L, Habert P, Jacquier A, Parola P, Boussuges A, Bregeon F, Eldin C. Low Dose Chest CT and Lung Ultrasound for the Diagnosis and Management of COVID-19. J Clin Med 2021; 10:jcm10102196. [PMID: 34069557 PMCID: PMC8160936 DOI: 10.3390/jcm10102196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has provided an opportunity to use low- and non-radiating chest imaging techniques on a large scale in the context of an infectious disease, which has never been done before. Previously, low-dose techniques were rarely used for infectious diseases, despite the recognised danger of ionising radiation. METHOD To evaluate the role of low-dose computed tomography (LDCT) and lung ultrasound (LUS) in managing COVID-19 pneumonia, we performed a review of the literature including our cases. RESULTS Chest LDCT is now performed routinely when diagnosing and assessing the severity of COVID-19, allowing patients to be rapidly triaged. The extent of lung involvement assessed by LDCT is accurate in terms of predicting poor clinical outcomes in COVID-19-infected patients. Infectious disease specialists are less familiar with LUS, but this technique is also of great interest for a rapid diagnosis of patients with COVID-19 and is effective at assessing patient prognosis. CONCLUSIONS COVID-19 is currently accelerating the transition to low-dose and "no-dose" imaging techniques to explore infectious pneumonia and their long-term consequences.
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Affiliation(s)
- Julie Finance
- IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix Marseille University, 13005 Marseille, France; (J.F.); (F.B.)
- Service des Explorations Fonctionnelles Respiratoires, APHM, 13005 Marseille, France
| | - Laurent Zieleskewicz
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, APHM, Aix Marseille Université, 13005 Marseille, France;
- INRA, INSERM, Centre for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, 13005 Marseille, France;
| | - Paul Habert
- Service de Radiologie Cardio-Thoracique, Hôpital La Timone, APHM, 13005 Marseille, France; (P.H.); (A.J.)
- LIIE, Aix Marseille University, 13005 Marseille, France
| | - Alexis Jacquier
- Service de Radiologie Cardio-Thoracique, Hôpital La Timone, APHM, 13005 Marseille, France; (P.H.); (A.J.)
- CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale—Centre d’Exploration Métaboliques par Résonance Magnétique), APHM, Aix-Marseille University, UMR 7339, 13005 Marseille, France
| | - Philippe Parola
- IRD, APHM, SSA, VITROME, Aix Marseille University, 13005 Marseille, France;
- IHU-Méditerranée Infection, Aix Marseille University, 13005 Marseille, France
| | - Alain Boussuges
- INRA, INSERM, Centre for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, 13005 Marseille, France;
| | - Fabienne Bregeon
- IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix Marseille University, 13005 Marseille, France; (J.F.); (F.B.)
- Service des Explorations Fonctionnelles Respiratoires, APHM, 13005 Marseille, France
| | - Carole Eldin
- IRD, APHM, SSA, VITROME, Aix Marseille University, 13005 Marseille, France;
- IHU-Méditerranée Infection, Aix Marseille University, 13005 Marseille, France
- Correspondence:
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