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Attell BK, Plaxco AP, Zhou M, Valle J, Reeves SL, Patel PN, Latta K, Smeltzer MP, Snyder AB. Emergency department utilization before and during the COVID-19 pandemic among individuals with sickle cell disease. BMC Emerg Med 2024; 24:134. [PMID: 39075379 PMCID: PMC11287848 DOI: 10.1186/s12873-024-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The emergency department (ED) is a vital source of healthcare for individuals living with sickle cell disease (SCD). Prior research indicates that during the COVID-19 pandemic some individuals with SCD avoided the ED for fear of acquiring COVID-19 or delayed visiting the ED by self-management of symptoms or pain crisis at home. The purpose of the current study was to understand ED utilization rates before and during the pandemic among individuals living with SCD. METHODS We conducted a retrospective cohort study using population-based SCD surveillance systems in California, Georgia, Michigan, and Tennessee to assess the impact of the pandemic on ED utilization among people with SCD by (1) analyzing trends in monthly ED utilization from January 2019 - December 2020, with specific attention given to immediate changes at the onset of the pandemic; and (2) calculating changes in the volume of utilization by comparing the total ED visits made from March - December 2020 to the same period in 2019, both overall and by demographic characteristics. RESULTS Across all states, a decline in ED utilization during the onset of the pandemic was seen, with the largest decline seen in those under age 10. By December 2020, utilization rates were higher than their lowest observed month of April 2020, but had not fully returned to pre-COVID levels. During the pandemic, ED visits in each state decreased by as much as 25%, and the number of people with any ED utilization decreased by as much as 26%. CONCLUSIONS This study confirms and extends the existing literature related to the impact of the pandemic on healthcare utilization patterns in the US, in a unique population with increased healthcare needs.
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Affiliation(s)
- Brandon K Attell
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Atlanta, GA, 30303, USA.
| | - Allison P Plaxco
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 222 Robison Hall, Memphis, TN, 38152, USA
| | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Atlanta, GA, 30303, USA
| | - Jhaqueline Valle
- Tracking California Program, Public Health Institute, 555 12th Street, Suite 600, Oakland, CA, 94607, USA
| | - Sarah L Reeves
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, Department of Pediatrics, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415, Washington Heights, Ann Arbor, MI, 48109, USA
| | - Pooja N Patel
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, Department of Pediatrics, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Krista Latta
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, Department of Pediatrics, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 222 Robison Hall, Memphis, TN, 38152, USA
| | - Angela B Snyder
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Atlanta, GA, 30303, USA
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Patange AP, Desai JV, Pujari B, Marwah A, Dey A. Dynamic Assessment of Hematological Parameters as Predictive Biomarkers for Disease Severity and Prognosis in COVID-19 Patients: A Longitudinal Study. Cureus 2024; 16:e63593. [PMID: 39087175 PMCID: PMC11290381 DOI: 10.7759/cureus.63593] [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: 06/02/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to substantial morbidity and mortality worldwide. Hematological abnormalities are common in COVID-19 patients and play a significant role in disease pathogenesis and prognosis. OBJECTIVE This study aimed to longitudinally monitor hematological parameters in COVID-19 patients and investigate their predictive value for disease severity and prognosis. METHODS A prospective longitudinal design was employed to enroll 121 adult patients diagnosed with COVID-19 based on positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results. Baseline demographic and clinical data were collected, and hematological parameters, including complete blood count (CBC) indices, inflammatory markers, and coagulation profiles, were measured at predefined time points during hospitalization or outpatient visits. Follow-up assessments were conducted longitudinally to monitor the disease progression and clinical outcomes. RESULTS This study revealed dynamic changes in hematological parameters over the course of COVID-19. Hemoglobin levels showed a decrease from baseline (mean ± SD: 12.5 ± 1.8 g/dL) to the peak of illness (10.2 ± 2.0 g/dL), indicating the development of anemia during the acute phase of infection. White blood cell counts demonstrated an initial increase (8.9 ± 3.2 × 10^9/L) followed by a decline (5.4 ± 1.9 × 10^9/L) as the disease progressed, suggesting an early inflammatory response followed by immune suppression. The platelet counts fluctuated, with a decrease observed during the acute phase (190 ± 50 × 10^9/L) and subsequent recovery during convalescence (240 ± 60 × 10^9/L). Inflammatory markers, such as C-reactive protein and interleukin-6, were elevated, peaking at 120 and 150 pg/mL, respectively, indicating systemic inflammation. Coagulation profiles showed abnormalities suggestive of COVID-19-associated coagulopathy, including elevated D-dimer levels (mean ± SD: 3.5 ± 1.2 µg/mL) and prolonged prothrombin time (15.8 ± 2.5 seconds). Longitudinal analysis of hematological parameters revealed associations between disease severity and clinical outcomes, with certain abnormalities correlating with an increased risk of complications and a poor prognosis. CONCLUSION This study highlights the importance of monitoring hematological parameters in COVID-19 patients for risk stratification, prognostication, and guiding therapeutic interventions.
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Affiliation(s)
- Aparna P Patange
- Department of Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Jabbar V Desai
- Department of Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Bhupal Pujari
- Department of Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Aparna Marwah
- Department of Management Studies, Bharati Vidyapeeth (Deemed to be University) Institute of Management and Research, New Delhi, IND
| | - Animesh Dey
- Department of Allied Health Sciences, Brainware University, Kolkota, IND
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Borrego-Moreno JC, Cárdenas-de Luna MJ, Márquez-Castillo JC, Reyes-Ruiz JM, Osuna-Ramos JF, León-Juárez M, del Ángel RM, Rodríguez-Carlos A, Rivas-Santiago B, Farfan-Morales CN, García-Herrera AC, De Jesús-González LA. Acute Kidney Injury in the Context of COVID-19: An Analysis in Hospitalized Mexican Patients. Infect Dis Rep 2024; 16:458-471. [PMID: 38804444 PMCID: PMC11130795 DOI: 10.3390/idr16030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
During the COVID-19 pandemic, a considerable proportion of patients developed a severe condition that included respiratory failure, shock, or multiple organ dysfunction. Acute Kidney Injury (AKI) has been recognized as a possible cause of severe COVID-19 development. Given this, this study investigates the occurrence and consequences of AKI in Mexican patients to contribute to better knowledge and management of this problem. Methods: Using a retrospective observational cohort methodology, we investigated 313 cases from a cohort of 1019 patients diagnosed with COVID-19 at the IMSS Zacatecas General Hospital of Zone No. 1 in 2020. The prevalence of AKI was determined using the AKIN criteria based on serum creatinine levels and a detailed review of demographic characteristics, medical history, comorbidities, and clinical development. Results: The data showed a 25.30% prevalence of AKI among patients infected with severe COVID-19. Remarkably, these patients with AKI exhibited an advanced age (>65 years), arterial hypertension, a higher number of white blood cells during admission and the hospital stay, and elevated levels of C-reactive protein, serum creatinine, and blood urea nitrogen (BUN). Clinically, patients with AKI had signs of prostration, pneumonia, and the requirement for ventilatory assistance when compared to those without AKI. Finally, those diagnosed with AKI and COVID-19 had a 74% death rate. Relative risk analyses indicated that age (>65 years), arterial hypertension, high creatinine levels, endotracheal intubation, and pneumonia are associated with the development of AKI. On the other hand, among the protective factors against AKI, high hemoglobin levels and the consumption of statins during COVID-19 were found. Conclusions: The findings of this study underscore the significance of promptly identifying and effectively managing AKI to potentially alleviate the negative consequences of this complication within the Mexican population during COVID-19.
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Affiliation(s)
- Juan Carlos Borrego-Moreno
- Instituto Mexicano del Seguro Social, Hospital General de Zona # 1, Servicio de Epidemiologia, Zacatecas 98000, Mexico;
| | - María Julieta Cárdenas-de Luna
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar # 1, Servicio de Medicina Familiar, Guadalupe, Zacatecas 98608, Mexico;
| | - José Carlos Márquez-Castillo
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar # 57, Servicio de Medicina Familiar, Zacatecas 98085, Mexico;
| | - José Manuel Reyes-Ruiz
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico;
- Facultad de Medicina, Región Veracruz, Universidad Veracruzana (UV), Veracruz 91700, Mexico
| | | | - Moisés León-Juárez
- Laboratorio de Virología Perinatal y Diseño Molecular de Antígenos y Biomarcadores, Departamento de Inmunobioquímica, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Rosa María del Ángel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City 07360, Mexico;
| | - Adrián Rodríguez-Carlos
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
| | - Bruno Rivas-Santiago
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
| | - Carlos Noe Farfan-Morales
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana (UAM), Unidad Cuaji-malpa, Mexico City 05348, Mexico;
| | - Ana Cristina García-Herrera
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
| | - Luis Adrián De Jesús-González
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
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Taslem Mourosi J, Anwar S, Hosen MJ. The sex and gender dimensions of COVID-19: A narrative review of the potential underlying factors. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 103:105338. [PMID: 35863677 PMCID: PMC9288935 DOI: 10.1016/j.meegid.2022.105338] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 12/17/2022]
Abstract
Multiple lines of evidence indicate that the male sex is a significant risk factor for severe disease and mortality due to coronavirus disease 2019 (COVID-19). However, the precise explanation for the discrepancy is currently unclear. Immunologically, the female-biased protection against COVID-19 could presumably be due to a more rapid and robust immune response to viruses exhibited by males. The female hormones, e.g., estrogens and progesterone, may have protective roles against viral infections. In contrast, male hormones, e.g., testosterone, can act oppositely. Besides, the expression of the ACE-2 receptor in the lung and airway lining, which the SARS-CoV-2 uses to enter cells, is more pronounced in males. Estrogen potentially plays a role in downregulating the expression of ACE-2, which could be a plausible biological explanation for the reduced severity of COVID-19 in females. Comorbidities, e.g., cardiovascular diseases, diabetes, and kidney disorders, are considered significant risk factors for severe outcomes in COVID-19. Age-adjusted data shows that males are statistically more predisposed to these morbidities-amplifying risks for males with COVID-19. In addition, many sociocultural factors and gender-constructed behavior of men and women impact exposure to infections and outcomes. In many parts of the world, women are more likely to abide by health regulations, e.g., mask-wearing and handwashing, than men. In contrast, men, in general, are more involved with high-risk behaviors, e.g., smoking and alcohol consumption, and high-risk jobs that require admixing with people, which increases their risk of exposure to the infection. Overall, males and females suffer differently from COVID-19 due to a complex interplay between many biological and sociocultural factors.
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Affiliation(s)
- Jarin Taslem Mourosi
- Department of Biology, The Catholic University of America, Washington, DC, USA; Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh; Bacteriophage Medical Research Center, The Catholic University of America, Washington, DC, USA.
| | - Saeed Anwar
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh.
| | - Mohammad Jakir Hosen
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh.
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Zhang W, Li D, Xu B, Xu L, Lyu Q, Liu X, Li Z, Zhang J, Sun W, Ma Q, Qiao L, Liao P. Serum peptidome profiles immune response of COVID-19 Vaccine administration. Front Immunol 2022; 13:956369. [PMID: 36091008 PMCID: PMC9450691 DOI: 10.3389/fimmu.2022.956369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused significant loss of life and property. In response to the serious pandemic, recently developed vaccines against SARS-CoV-2 have been administrated to the public. Nevertheless, the research on human immunization response against COVID-19 vaccines is insufficient. Although much information associated with vaccine efficacy, safety and immunogenicity has been reported by pharmaceutical companies based on laboratory studies and clinical trials, vaccine evaluation needs to be extended further to better understand the effect of COVID-19 vaccines on human beings.MethodsWe performed a comparative peptidome analysis on serum samples from 95 participants collected at four time points before and after receiving CoronaVac. The collected serum samples were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to profile the serum peptides, and also subjected to humoral and cellular immune response analyses to obtain typical immunogenicity information.ResultsSignificant difference in serum peptidome profiles by MALDI-TOF MS was observed after vaccination. By supervised statistical analysis, a total of 13 serum MALDI-TOF MS feature peaks were obtained on day 28 and day 42 of vaccination. The feature peaks were identified as component C1q receptor, CD59 glycoprotein, mannose-binding protein C, platelet basic protein, CD99 antigen, Leucine-rich alpha-2-glycoprotein, integral membrane protein 2B, platelet factor 4 and hemoglobin subunits. Combining with immunogenicity analysis, the study provided evidence for the humoral and cellular immune responses activated by CoronaVac. Furthermore, we found that it is possible to distinguish neutralizing antibody (NAbs)-positive from NAbs-negative individuals after complete vaccination using the serum peptidome profiles by MALDI-TOF MS together with machine learning methods, including random forest (RF), partial least squares-discriminant analysis (PLS-DA), linear support vector machine (SVM) and logistic regression (LR).ConclusionsThe study shows the promise of MALDI-TOF MS-based serum peptidome analysis for the assessment of immune responses activated by COVID-19 vaccination, and discovered a panel of serum peptides biomarkers for COVID-19 vaccination and for NAbs generation. The method developed in this study can help not only in the development of new vaccines, but also in the post-marketing evaluation of developed vaccines.
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Affiliation(s)
- Wenjia Zhang
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
| | - Dandan Li
- Department of Chemistry, Fudan University, Shanghai, China
| | - Bin Xu
- Bioyong Technologics, Inc., Beijing, China
| | - Lanlan Xu
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
| | - Qian Lyu
- Bioyong Technologics, Inc., Beijing, China
| | - Xiangyi Liu
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhijie Li
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
| | - Jian Zhang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China
| | - Wei Sun
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China
| | - Qingwei Ma
- Bioyong Technologics, Inc., Beijing, China
| | - Liang Qiao
- Department of Chemistry, Fudan University, Shanghai, China
- *Correspondence: Pu Liao, ; Liang Qiao,
| | - Pu Liao
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
- *Correspondence: Pu Liao, ; Liang Qiao,
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Parakh N, Pahuja S, Singh V, Kumar N, Chandra J. COVID-19 pandemic and care of transfusion-dependent patients of thalassaemia: Experience from a paediatric centre in North India. J Paediatr Child Health 2022; 58:1760-1765. [PMID: 35789061 PMCID: PMC9350329 DOI: 10.1111/jpc.16082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 01/28/2023]
Abstract
AIM COVID-19 has presented an unprecedented challenge to health services and has significantly affected the management of non-Covid illnesses, like thalassemia. The present study documents the impact of Covid-associated restrictions and disruptions on working of the pediatric thalassemia day care centre (TDCC), and measures taken by TDCC and blood transfusion services to adapt to and mitigate the negative impact of Covid pandemic and associated lockdown on patient care. METHODS Pre-transfusion haemoglobin and packed cell transfusion requirement were compared across three time periods, namely pre-lockdown, lockdown and post-lockdown in paediatric transfusion-dependent thalassaemia (TDT) patients. Caregivers were interviewed to document any problems faced by them. RESULTS The study involved 181 TDT patients. There was a significant reduction in mean pre-transfusion haemoglobin and red cells transfused during lockdown phase as compared to pre-lockdown phase. Regular care was interrupted in 45% of patients and 76% of patients getting blood from outside could not get leukoreduced red cells. Investigations, monitoring and continuity of iron chelation were also affected. Blood centre faced 30.5% reduction in blood supply during lockdown. TDCC and blood centre took several steps, including prolongation of service hours and staggering of transfusions to ensure maximum transfusions while ensuring social distancing. CONCLUSION The COVID-19 pandemic imposed many unprecedented challenges to the routine care of thalassaemic patients; however, some of them could be dealt with by a proactive approach and micro-planning at the institution level. Other similar resource-limited settings could learn from experiences for continued quality care for chronic medical conditions during pandemic like situations.
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Affiliation(s)
- Nupur Parakh
- Division of Pediatric Hematology, Department of PediatricsLHMC and Associated KSCHNew DelhiIndia
| | - Sangeeta Pahuja
- Department of Immuno‐Haematology and Blood TransfusionLHMC and Associated KSCHNew DelhiIndia
| | - Varinder Singh
- Division of Pediatric Hematology, Department of PediatricsLHMC and Associated KSCHNew DelhiIndia
| | - Narender Kumar
- Division of Pediatric Hematology, Department of PediatricsLHMC and Associated KSCHNew DelhiIndia
| | - Jagdish Chandra
- Division of Pediatric Hematology, Department of PediatricsLHMC and Associated KSCHNew DelhiIndia
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The Effect of COVID-19 on Hemoglobinopathy Patients’ Daily Lives While Quarantined: Four Greek Hospitals’ Experiences. THALASSEMIA REPORTS 2022. [DOI: 10.3390/thalassrep12020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During a pandemic, people are fearful of becoming infected with the virus, which causes anxiety, loss of purpose, and depression. This study aimed to evaluate the social and psychological impact, as well as the impact on homecare, of patients with hemoglobinopathies during the pandemic. Material and Methods: In total, 130 patients from four Thalassemia and Sickle Cell Disease Units of the National Health System of Greece Hospitals were examined via an anonymous questionnaire developed and distributed through stratified sampling. Results: Transfusion-dependent thalassemia, transfused sickle cell disease, and other hemoglobinopathies were represented by 130 patients. During the pandemic, the main concern of patients was the affordability of blood for transfusion. During the lockdown, patients’ moods varied, and their daily lives were disrupted by a lack of access to basic goods and communication with friends and family. Their eating habits, access to exercise, and, to a lesser extent, their financial situation have all been affected in their daily lives. It is crucial to highlight that while access to health services did not suffer in terms of medication and regular visits for their actual disease, it did suffer in terms of the systematic monitoring of complications.
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de Jesus JR, Galazzi RM, Lopes Júnior CA, Arruda MAZ. Trace element homeostasis in the neurological system after SARS-CoV-2 infection: Insight into potential biochemical mechanisms. J Trace Elem Med Biol 2022; 71:126964. [PMID: 35240553 PMCID: PMC8881805 DOI: 10.1016/j.jtemb.2022.126964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/10/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several studies have suggested that COVID-19 is a systemic disease that can affect several organs, including the brain. In the brain, specifically, viral infection can cause dyshomeostasis of some trace elements that promote complex biochemical reactions in specialized neurological functions. OBJECTIVE Understand the neurovirulence of SARS-CoV-2 and the relationship between trace elements and neurological disorders after infection, and provide new insights on the drug development for the treatment of SARS-CoV-2 infections. METHODS The main databases were used to search studies published up September 2021, focusing on the role of trace elements during viral infection and on the correct functioning of the brain. RESULTS The imbalance of important trace elements can accelerate SARS-CoV-2 neurovirulence and increase the neurotoxicity since many neurological processes can be associated with the homeostasis of metal and metalloproteins. Some studies involving animals and humans have suggested the synapse as a vulnerable region of the brain to neurological disorders after viral infection. Considering the combined evidence, some mechanisms have been suggested to understand the relationship between neurological disorders and imbalance of trace elements in the brain after viral infection. CONCLUSION Trace elements play important roles in viral infections, such as helping to activate immune cells, produce antibodies, and inhibit virus replication. However, the relationship between trace elements and virus infections is complex since the specific functions of several elements remain largely undefined. Therefore, there is still a lot to be explored to understand the biochemical mechanisms involved between trace elements and viral infections, especially in the brain.
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Affiliation(s)
- Jemmyson Romário de Jesus
- Research Laboratory in Bionanomaterials, LPbio, Brazil; Chemistry Department, Federal University of Viçosa, UFV, Viçosa, Minas Gerais, Brazil.
| | - Rodrigo Moretto Galazzi
- Analytical Instrumentation Division, Analytik Jena GmbH, an Endress & Hauser Company, São Paulo, SP 04029-901, Brazil.
| | - Cícero Alves Lopes Júnior
- Grupo de Estudos em Bioanalítica - GEBIO, Department of Chemistry, Federal University of Piauí, 64049-550 Teresina, PI, Brazil.
| | - Marco Aurélio Zezzi Arruda
- Spectrometry, Sample Preparation and Mechanization Group, GEPAM, Institute of Chemistry, University of Campinas, UNICAMP, Campinas, Brazil; National Institute of Science and Technology for Bioanalytics, Brazil.
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Yuan Y, Mao J, Ou X, Huang L, Tu Q, Wang N. Geriatric Nutritional Risk Index assessment in elderly patients during the COVID‐19 outbreak. Health Sci Rep 2022; 5:e560. [PMID: 35509397 PMCID: PMC9059217 DOI: 10.1002/hsr2.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/08/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Globally, coronavirus disease‐2019 (COVID‐19) is persistent in many countries and presents a major threat to public health. Critically, elderly individuals, especially those with underlying disease, poor nutritional and immune functions, are highly susceptible. Therefore, we analyzed the epidemiological features in elderly COVID‐19 patients. Methods In total, 126 patients were recruited in the Fifth Affiliated Hospital of Sun Yat‐sen University, China from January 2020 to March 2020 (including 103 confirmed COVID‐19 patients and 23 elderly suspected cases). Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. We assessed nutritional risks in elderly patients by calculating the Geriatric Nutritional Risk Index (GNRI). Results When compared with young patients, elderly patients were more likely to have underlying comorbidities and received nutritional support and intensive care unit treatment. Elderly patients had significantly lower levels of the following: lymphocyte percentages, red blood cell counts, hemoglobin levels, and serum albumin values. When compared with suspected COVID‐19 elderly cases, elderly patients had significantly lower red blood cell counts and hemoglobin levels. The average GNRI of suspected cases and confirmed patients indicated no nutritional risk. There were no marked differences in GNRI values between groups. Conclusion Nutritional risk assessments may provide valuable information for predicting a COVID‐19 prognosis, especially in elderly patients. Anemia prevention and management should be actively and timely provided. GNRI is a potentially prognostic factor for hospitalized elderly patients. Moreover, it is also important to follow up discharged patients for continuous nutritional observations.
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Affiliation(s)
- Yajun Yuan
- Department of Interventional Medicine, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
| | - Junjie Mao
- Department of Interventional Medicine, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
| | - Xueqing Ou
- Department of Interventional Medicine, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
| | - Lili Huang
- Department of Interventional Medicine, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
| | - Qiuyun Tu
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
- Department of Gerontology and Geriatrics, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
| | - Nan Wang
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
- Department of Gerontology and Geriatrics, The Fifth Affiliated Hospital Sun Yat‐sen University Zhuhai China
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10
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Atmakusuma TD. COVID-19 in Patients with Transfusion Dependent Thalassemia (TDT) in Indonesia: Characteristics of the Disease and Patients, and Comparison between Epidemiological Data for COVID-19 and Thalassemia in Indonesia and Southeast Asia. Hematol Rep 2022; 14:2-12. [PMID: 35323173 PMCID: PMC8953260 DOI: 10.3390/hematolrep14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
Background: People living with transfusion dependent thalassemia have a high risk of becoming infected with COVID-19. This can be caused by both internal factors, namely the formation of alloantibodies and autoimmune disorder, and external factors such as routine visits for blood transfusions. Chronic complications of thalassemia also render them more vulnerable to infectious diseases, including COVID-19. However, anecdotal data shows that thalassemia patients experience less incidence of COVID-19 compared to the general population. Purpose: This study aims to find the correlation between COVID-19 in thalassemia-dependent transfusion patients in Indonesia and Southeast Asia. Patients and Methods: This study used a cross-sectional design. The study was conducted at the Division of Hematology and Medical Oncology of the Cipto Mangunkusumo Hospital in Jakarta from May 2020–August 2021. The total sampling method was used involving all thalassemia major patients who had been infected with COVID-19 (obtained directly from medical record and through the thalassemia patients-parents foundation). Results: From 10,397 patients with thalassemia, 67 (0.64%) people were infected by COVID-19 and 2 (2.9%) were deceased. Meanwhile, the incidence of COVID-19 in the general population of Indonesia was 0.87% (more than in the thalassemia population). This means that thalassemia might provide additional protection against COVID-19 due to several mechanisms. This phenomenon has also been seen in other countries with a high prevalence of thalassemia, wherein there are less COVID-19 cases despite the pandemic. On the contrary, countries with low rates of thalassemia had experienced deadly surges of the pandemic. Conclusion: Indonesia and other countries with a high prevalence of thalassemia have lower COVID-19 incidence than countries with low prevalence of thalassemia. Thalassemia might provide additional protection against COVID-19. Well-designed studies are needed to provide better evidence on the protective effect of thalassemia on COVID-19.
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Affiliation(s)
- Tubagus Djumhana Atmakusuma
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
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11
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The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19. Life (Basel) 2021; 11:life11121341. [PMID: 34947872 PMCID: PMC8708699 DOI: 10.3390/life11121341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 12/22/2022] Open
Abstract
Currently available anti-viral drugs may be useful in reducing the viral load but are not providing the necessary physiological effects to reduce the SARS-CoV-2 complications efficiently. Treatments that provide better clinical outcomes are urgently needed. Vitamin C (ascorbic acid, AA) is an essential nutrient with many biological roles that have been proven to play an important part in immune function; it serves as an antioxidant, an anti-viral, and exerts anti-thrombotic effects among many other physiological benefits. Research has proven that AA at pharmacological doses can be beneficial to patients with acute respiratory distress syndrome (ARDS) and other respiratory illnesses, including sepsis. In addition, High-Dose Intravenous Vitamin C (HDIVC) has proven to be effective in patients with different viral diseases, such as influenza, chikungunya, Zika, and dengue. Moreover, HDIVC has been demonstrated to be very safe. Regarding COVID-19, vitamin C can suppress the cytokine storm, reduce thrombotic complications, and diminish alveolar and vascular damage, among other benefits. Due to these reasons, the use of HDIVC should be seriously considered in complicated COVID-19 patients. In this article, we will emphasize vitamin C’s multiple roles in the most prominent pathophysiological processes presented by the COVID-19 disease.
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12
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Oymak Y, Karapinar TH. COVID-19 Pandemic and Thalassemia Major Patients: Transfusion Practice and Treatment Assessment. J Pediatr Hematol Oncol 2021; 43:e1073-e1076. [PMID: 33273415 DOI: 10.1097/mph.0000000000002016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/22/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND When the COVID-19 epidemic occurred for the first time in December 2019, the governments worldwide took some restriction measures for slowing the spread of novel coronavirus. Eventually, there was a considerable decrease in volunteer blood donations. Regular transfusions and follow-up of patients with thalassemia major (TM) should be maintained during this period. It is possible that the treatment of the patients with TM may hinder due to the difficulty of reaching the treatment center and the difficulty of blood supply. Thus, in this study, we aimed to investigate whether there were any differences in the follow-up and treatment of the patients with TM during the outbreak. MATERIALS AND METHODS Sixty-one patients with TM who were followed up in our center without COVID-19 contact history and symptoms were included in this study. The demographic features and red blood cell volume per kilogram they received, pretransfusion hemoglobin, serum ferritin (SF) level, biochemical parameters, and transfusion interval were recorded. The difference between the arithmetic mean of the data before and during the pandemic was evaluated. RESULTS In this study, 61 patients with TM (32 males/29 females, mean age 13.9±6.8 y) were evaluated. The mean pretransfusion hemoglobin value was 9.14±0.77 g/dL and 8.87± 0.80 g/dL before and during the pandemic, respectively (P=0.023). There was no difference between before and during the pandemic concerning transfusion interval and transfusion volume. However, SF levels increased above 1000 ng/mL in 16.6% of patients. CONCLUSION Although blood donation decreased significantly during the pandemic, it was observed in this study that the blood needs of patients with TM could be provided. The results of the SF level showed that the management of chelation therapy should be more meticulous. However, we should be ready for the challenges in the transfusion practice of patients with TM due to fluctuations in the COVID-19 pandemic.
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Affiliation(s)
- Yesim Oymak
- Department of Pediatric Hematology and Oncology, SBU. Izmir Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
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13
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Moon CY, Schilder BM, Raj T, Huang KL. Phenome-wide and expression quantitative trait locus associations of coronavirus disease 2019 genetic risk loci. iScience 2021; 24:102550. [PMID: 34027315 PMCID: PMC8129787 DOI: 10.1016/j.isci.2021.102550] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
While several genes and clinical traits have been associated with higher risk of severe coronavirus disease 2019 (COVID-19), how host genetic variants may interact with these parameters and contribute to severe disease is still unclear. Herein, we performed phenome-wide association study, tissue and immune-cell-specific expression quantitative trait locus (eQTL)/splicing quantitative trait locus, and colocalization analyses for genetic risk loci suggestively associated with severe COVID-19 with respiratory failure. Thirteen phenotypes/traits were associated with the severe COVID-19-associated loci at the genome-wide significance threshold, including monocyte counts, fat metabolism traits, and fibrotic idiopathic interstitial pneumonia. In addition, we identified tissue and immune subtype-specific eQTL associations affecting 48 genes, including several ones that may directly impact host immune responses, colocalized with the severe COVID-19 genome-wide association study associations, and showed altered expression in single-cell transcriptomes. Collectively, our work demonstrates that host genetic variations associated with multiple genes and traits show genetic pleiotropy with severe COVID-19 and may inform disease etiology.
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Affiliation(s)
- Chang Yoon Moon
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Brian M. Schilder
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Nash Family Department of Neuroscience & Friedman Brain Institute, New York, NY, USA
- Ronald M. Loeb Center for Alzheimer's disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Estelle and Daniel Maggin Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Towfique Raj
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Nash Family Department of Neuroscience & Friedman Brain Institute, New York, NY, USA
- Ronald M. Loeb Center for Alzheimer's disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Estelle and Daniel Maggin Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kuan-lin Huang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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14
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Haghpanah S, Hosseini-Bensenjan M, Sayadi M, Karimi M. Incidence Rate of COVID-19 Infection in Hemoglobinopathies: A Systematic Review and Meta-analysis. Hemoglobin 2021; 45:371-379. [PMID: 34027786 DOI: 10.1080/03630269.2021.1927751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
During the coronavirus-19 disease (COVID-19) pandemic, several studies were performed to determine the mortality and incidence rates of coronavirus infection among patients with hemoglobinopathies. However, there has been no systematic approach or meta-analysis to evaluate the results worldwide. This meta-analysis summarized the existing evidence of incidence and mortality rates of COVID-19 and related risk factors among patients with hemoglobinopathies with a focus on β-thalassemia (β-thal) and sickle cell disease. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Two authors independently screened the articles, extracted eligible ones, and assessed the quality of studies using the Joanna Briggs Institute (JBI) checklist. The collected data were analyzed by the Stata software. The amount of heterogeneity was demonstrated by the I2 test. The incidence of COVID-19 among patients with a hemoglobinopathy, β-thal and sickle cell disease was 4.44, 1.34, and 17.22 per 100,000 person-day, respectively, to June 15 2020. The mortality rate of COVID-19 in patients with hemoglobin (Hb) disorders was calculated as 1.07 per 1000 person-day in the same period. Our findings showed a higher incidence rate of COVID-19 in sickle cell disease patients compared to the general population. A slightly higher mortality rate was also observed in patients with hemoglobinopathies compared to the general population, possibly due to the associated risk factors and comorbidities in this vulnerable group, which underscore special care, timely diagnosis and management along with current immunization, were crucial in decreasing the frequency, disease severity and mortality of these patients.
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Affiliation(s)
- Sezaneh Haghpanah
- Hematology Research Center, Shiraz, University of Medical Sciences, Shiraz, Iran
| | | | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz, University of Medical Sciences, Shiraz, Iran
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15
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Gille T, Sesé L, Aubourg E, Fabre EE, Cymbalista F, Ratnam KC, Valeyre D, Nunes H, Richalet JP, Planès C. The Affinity of Hemoglobin for Oxygen Is Not Altered During COVID-19. Front Physiol 2021; 12:578708. [PMID: 33912067 PMCID: PMC8072381 DOI: 10.3389/fphys.2021.578708] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background: A computational proteomic analysis suggested that SARS-CoV-2 might bind to hemoglobin (Hb). The authors hypothesized that this phenomenon could result in a decreased oxygen (O2) binding and lead to hemolytic anemia as well. The aim of this work was to investigate whether the affinity of Hb for O2 was altered during COVID-19. Methods: In this retrospective, observational, single-center study, the blood gas analyses of 100 COVID-19 patients were compared to those of 100 non-COVID-19 patients. Fifty-five patients with carboxyhemoglobin (HbCO) ≥8% and 30 with sickle cell disease (SCD) were also included ("positive controls" with abnormal Hb affinity). P50 was corrected for body temperature, pH, and PCO2. Results: Patients did not differ statistically for age or sex ratio in COVID-19 and non-COVID-19 groups. Median P50 at baseline was 26 mmHg [25.2-26.8] vs. 25.9 mmHg [24-27.3], respectively (p = 0.42). As expected, P50 was 22.5 mmHg [21.6-23.8] in the high HbCO group and 29.3 mmHg [27-31.5] in the SCD group (p < 0.0001). Whatever the disease severity, samples from COVID-19 to non-COVID-19 groups were distributed on the standard O2-Hb dissociation curve. When considering the time-course of P50 between days 1 and 18 in both groups, no significant difference was observed. Median Hb concentration at baseline was 14 g.dl-1 [12.6-15.2] in the COVID-19 group vs. 13.2 g.dl-1 [11.4-14.7] in the non-COVID-19 group (p = 0.006). Among the 24 COVID-19 patients displaying anemia, none of them exhibited obvious biological hemolysis. Conclusion: There was no biological argument to support the hypothesis that SARS-CoV-2 could alter O2 binding to Hb.
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Affiliation(s)
- Thomas Gille
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Lucile Sesé
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Eric Aubourg
- CNRS, CEA, Astroparticule et Cosmologie, Université de Paris, Paris, France
| | - Emmanuelle E Fabre
- Laboratoire de Biochimie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 978 ASIH, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Florence Cymbalista
- Inserm UMR 978 ASIH, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Laboratoire d'Hématologie-Biologie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Kayaththiry Caroline Ratnam
- Laboratoire d'Hématologie-Biologie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Dominique Valeyre
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Hilario Nunes
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Jean-Paul Richalet
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Carole Planès
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
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16
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Kasai ET, Opara JPAA, Agasa SB, Gulbis B, Uvoya NA, Nguma JDB, Maloba PK, Hubert P, Etienne AM, Djang Eing A RM. [Acceptability of neonatal screening of the sickle cell disease during the pandemic of COVID-19 in Kisangani, Democratic Republic of the Congo]. Pan Afr Med J 2021; 37:299. [PMID: 33654518 PMCID: PMC7881920 DOI: 10.11604/pamj.2020.37.299.26654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction l´implémentation du dépistage néonatal de la drépanocytose pendant la pandémie de coronavirus (COVID-19) représente un défi majeur en République Démocratique du Congo (RDC). La présente étude vise à déterminer si des facteurs socio-économiques sont associés à l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 à Kisangani, en RDC. Méthodes étude observationnelle conduite dans les maternités de Kisangani du 21 mars au 30 juin 2020 chez les mères sensibilisées au dépistage néonatal de la drépanocytose de leurs nouveau-nés à l´hemotypeSCTM (HT401RUO-USA). Les données recueillies étaient la parité, le niveau d´étude, l´âge, le niveau socio-économique, la profession, la notion de sensibilisation et le motif du refus du dépistage. Résultats sur 55,5% (273/492) des mères sensibilisées, 107 (39,19 %) ont accepté et 166 (60,80 %) ont refusé le dépistage néonatal de la drépanocytose chez leur nouveau-né. Les motifs du refus étaient l´absence d´information (67,5%; IC 95% [59,8-74,5]), le manque d´argent dû au confinement (66,3%; IC 95% [58,5-73,4]), la prise de sang pour tentative du vaccin anti-COVID-19 (63,2%; IC 95% = [55,4-70,6]). Les facteurs associés à l´acceptabilité du dépistage étaient l´âge > 35 ans (p = 0,0009; ORa = 3,04; IC 95% = 1,57-5,87) et le bas niveau socio-économique (p = 0,0016; ORa = 2,29; IC à 95% = 1,37-3,85). Conclusion l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 reste faible à Kisangani. Le gouvernement devrait identifier les canaux de communication efficaces afin de promouvoir les initiatives dans le secteur de la Santé.
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Affiliation(s)
- Emmanuel Tebandite Kasai
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
| | - Jean Pierre Alworong A Opara
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
| | - Salomon Batina Agasa
- Département de Médecine Interne, Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
| | - Béatrice Gulbis
- Département de Chimie Clinique, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Naura Apio Uvoya
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo.,Département de Pédiatrie, Faculté de Médecine, Université de Bunia, Bunia, République Démocratique du Congo
| | - Jean Didier Bosenge Nguma
- Département de Gynécologie-Obstétrique, Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
| | - Philippe Kasongo Maloba
- Département de Psychologie, Faculté de Psychologie et des Sciences de l´Education, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Philippe Hubert
- Laboratoire de Chimie Analytique Pharmaceutique, Center for Interdisciplinary Research on Medicines (CIRM), Faculté de Médecine, Université de Liège, Liège, Belgique
| | - Anne-Marie Etienne
- Unité de Psychologie de la Santé, Faculté de Psychologie, Logopédie et Sciences de l´Education, Université de Liège, Liège, Belgique
| | - Roland Marini Djang Eing A
- Laboratoire de Chimie Analytique Pharmaceutique, Center for Interdisciplinary Research on Medicines (CIRM), Faculté de Médecine, Université de Liège, Liège, Belgique.,Département de Pharmacie, Faculté de Médicine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
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17
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Rahman A, Niloofa R, Jayarajah U, De Mel S, Abeysuriya V, Seneviratne SL. Hematological Abnormalities in COVID-19: A Narrative Review. Am J Trop Med Hyg 2021; 104:1188-1201. [PMID: 33606667 PMCID: PMC8045618 DOI: 10.4269/ajtmh.20-1536] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is caused by SARS-CoV-2. Although pulmonary manifestations have been identified as the major symptoms, several hematological abnormalities have also been identified. This review summarizes the reported hematological abnormalities (changes in platelet, white blood cell, and hemoglobin, and coagulation/fibrinolytic alterations), explores their patho-mechanisms, and discusses its management. Common hematological abnormalities in COVID-19 are lymphopenia, thrombocytopenia, and elevated D-dimer levels. These alterations are significantly more common/prominent in patients with severe COVID-19 disease, and thus may serve as a possible biomarker for those needing hospitalization and intensive care unit care. Close attention needs to be paid to coagulation abnormalities, and steps should be taken to prevent these occurring or to mitigate their harmful effects. The effect of COVID-19 in patients with hematological abnormalities and recognized hematological drug toxicities of therapies for COVID-19 are also outlined.
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Affiliation(s)
- Asma Rahman
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Roshan Niloofa
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sanjay De Mel
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore, Singapore
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
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18
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Orlando V, Rea F, Savaré L, Guarino I, Mucherino S, Perrella A, Trama U, Coscioni E, Menditto E, Corrao G. Development and validation of a clinical risk score to predict the risk of SARS-CoV-2 infection from administrative data: A population-based cohort study from Italy. PLoS One 2021; 16:e0237202. [PMID: 33471809 PMCID: PMC7816996 DOI: 10.1371/journal.pone.0237202] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The novel coronavirus (SARS-CoV-2) pandemic spread rapidly worldwide increasing exponentially in Italy. To date, there is lack of studies describing clinical characteristics of the people at high risk of infection. Hence, we aimed (i) to identify clinical predictors of SARS-CoV-2 infection risk, (ii) to develop and validate a score predicting SARS-CoV-2 infection risk, and (iii) to compare it with unspecific scores. METHODS Retrospective case-control study using administrative health-related database was carried out in Southern Italy (Campania region) among beneficiaries of Regional Health Service aged over than 30 years. For each person with SARS-CoV-2 confirmed infection (case), up to five controls were randomly matched for gender, age and municipality of residence. Odds ratios and 90% confidence intervals for associations between candidate predictors and risk of infection were estimated by means of conditional logistic regression. SARS-CoV-2 Infection Score (SIS) was developed by generating a total aggregate score obtained from assignment of a weight at each selected covariate using coefficients estimated from the model. Finally, the score was categorized by assigning increasing values from 1 to 4. Discriminant power was used to compare SIS performance with that of other comorbidity scores. RESULTS Subjects suffering from diabetes, anaemias, Parkinson's disease, mental disorders, cardiovascular and inflammatory bowel and kidney diseases showed increased risk of SARS-CoV-2 infection. Similar estimates were recorded for men and women and younger and older than 65 years. Fifteen conditions significantly contributed to the SIS. As SIS value increases, risk progressively increases, being odds of SARS-CoV-2 infection among people with the highest SIS value (SIS = 4) 1.74 times higher than those unaffected by any SIS contributing conditions (SIS = 1). CONCLUSION Conditions and diseases making people more vulnerable to SARS-CoV-2 infection were identified by the current study. Our results support decision-makers in identifying high-risk people and adopting of preventive measures to minimize the spread of further epidemic waves.
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Affiliation(s)
- Valentina Orlando
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Laura Savaré
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Ilaria Guarino
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Alessandro Perrella
- Infectious Disease of Healthcare Direction, AORN Antonio Cardarelli, Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, Naples, Italy
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Enrica Menditto
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
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19
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Alyammahi SK, Abdin SM, Alhamad DW, Elgendy SM, Altell AT, Omar HA. The dynamic association between COVID-19 and chronic disorders: An updated insight into prevalence, mechanisms and therapeutic modalities. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2021; 87:104647. [PMID: 33264669 PMCID: PMC7700729 DOI: 10.1016/j.meegid.2020.104647] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/27/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023]
Abstract
The devastating pandemic of coronavirus disease 2019 (COVID-19) has caused thousands of deaths and left millions of restless patients suffering from its complications. Increasing data indicate that the disease presents in a severe form in patients with pre-existing chronic conditions like cardiovascular diseases, diabetes, respiratory system diseases, and renal diseases. This denotes that these patients are more susceptible to COVID-19 and have higher mortality rates compared to patients with no comorbid conditions. Several factors can explain the heightened susceptibility and fatal presentation of COVID-19 in these patients, for example, the enhanced expression of the angiotensin-converting enzyme-2 (ACE2) in specific organs, cytokine storm, and drug interactions contribute to the increased morbidity and mortality. Adding to the findings that individuals with pre-existing conditions may be more susceptible to COVID-19, it has also been shown that COVID-19 can induce chronic diseases in previously healthy patients. Therefore, understanding the interlinked relationship between COVID-19 and chronic diseases helps in optimizing the management of susceptible patients. This review comprehensively described the molecular mechanisms that contribute to worse COVID-19 prognosis in patients with pre-existing comorbidities such as diabetes, cardiovascular diseases, respiratory diseases, gastrointestinal and renal diseases, blood disorders, autoimmune diseases, and finally, obesity. It also focused on how COVID-19 could, in some cases, lead to chronic conditions as a result of long-term multi-organ damage. Lastly, this work carefully discussed the tailored management plans for each specific patient population, aiming to achieve the best therapeutic outcome with minimum complications.
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Affiliation(s)
- Shatha K Alyammahi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates; College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Shifaa M Abdin
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates; College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Dima W Alhamad
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates; College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sara M Elgendy
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates; College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Amani T Altell
- School of Public Health and Health Sciences, University of Massachusetts, Amherst 01002, United States of America
| | - Hany A Omar
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates; College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates.
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20
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Nlemadim A, Okoi-Obuli J, Odey F, Meremikwu M. Telemedicine for children with sickle cell anemia in a resource-poor setting during COVID-19 pandemic: An observational study. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_183_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Vilela TDS, Braga JAP, Loggetto SR. Hemoglobinopathy and pediatrics in the time of COVID-19. Hematol Transfus Cell Ther 2021; 43:87-100. [PMID: 33289008 PMCID: PMC7709722 DOI: 10.1016/j.htct.2020.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION It is important to know if patients with hemoglobinopathy could be more susceptible to COVID-19. OBJECTIVE Analyze SARS-CoV-2 infection in pediatric patients with hemoglobinopathy. METHODS Using the online platforms LILACS, PUBMED and EMBASE, on 17- JUL-2020 a search was made for the terms COVID-19 and SARS-CoV-2 associated with "sickle cell", "thalassemia" and "hemoglobinopathy". RESULTS There were 623 pediatric and adult patients with sickle cell disease (SCD) or beta thalassemia (BT) and COVID-19. Total mortality rate was 6.42%. No pediatric patient with BT has been described. So, our analysis focused on children and adolescents with SCD: there were 121 pediatric patients, one adolescent died, prophylactic anticoagulation was prescribed to six patients, 11.76% needed intensive care unit, blood transfusion was prescribed in 29.70%. Vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) were the main clinical manifestations in SCD. DISCUSSION Pediatric patients with SCD and COVID-19 have a low mortality rate when compared to adults, although is higher than the global pediatric population with COVID-19 (0-0.67%). The comorbidities associated with age and the long-term complications inherent to hemoglobinopathies may contribute to the increased mortality outside the pediatric age group. In SCD the clinical manifestations, both in children and adults, are VOC and ACS, and there was increase in blood requirement. Pediatric SCD patients with COVID-19 need more intensive care unit than the global pediatric population (3.30%). CONCLUSION Despite pediatric population with SCD needs more intensive care, the outcome after infection by COVID-19 is favorable.
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22
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Wanigasinghe J, Jayawickrama A, Hewawitharana G, Munasinghe J, Weeraratne CT, Ratnayake P, Wijesekara DS, Fernando S, Rupasinghe P. Experience during COVID-19 lockdown and self-managing strategies among caregivers of children with epilepsy: A study from low middle income country. Seizure 2020; 84:112-115. [PMID: 33321430 DOI: 10.1016/j.seizure.2020.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Abrupt halt of service provision due to pandemic state of COVID-19, significantly affected care of patients with chronic diseases like epilepsy; its impact being greater on caregivers of vulnerable groups such as children with epilepsy. We performed this study to describe difficulties posed by the lockdown to caregivers of children with epilepsy in a low-middle income country and describe their responses and self-management strategies to overcome difficulties and prepare for a recurrence. METHOD A cross-sectional all-island survey was carried out at paediatric neurology centers in Sri Lanka. Data was gathered via a face-to-face interview after the lockdown period. Parental stress level was evaluated using a self-rating Stress Assessment Questionnaire. RESULTS Caregivers of 140 children with epilepsy from seven centers served by paediatric neurologists were interviewed. Mean duration of epilepsy was 7.9 years(SD 4). Majority were on one (52.1 %) or two (20 %) anti-seizure medications regularly. The pandemic did not affect epilepsy control in majority (87.3 %), however, signficant proportion faced difficulties over regular reviews and presecription refills. Despite difficluties, 87.1 % of parents maintained dispensing anti-seizure medications to their child regularly. Caregivers demonstrated healthy self-management strategies such as awareness on medications and access methods to healthcare during lockdown and remained confident of accessability to services. Stress was experienced in < 5%. CONCLUSION Lockdown status for COVID-19 did not significantly affect the control of epilepsy in children though it posed difficulties for regular reviews and obtaining medications. Self-management strategies will help caregivers to adopt to new-normal status and potential future outbreaks.
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Affiliation(s)
| | - Ashan Jayawickrama
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Jagath Munasinghe
- Sirimavo Bandaranayaike Specialized Children's Hospital, Peradeniya, Sri Lanka
| | | | | | - Dimuthu S Wijesekara
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
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23
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Noun P, Ibrahim A, Hodroj MH, Bou-Fakhredin R, Taher AT. COVID-19 in benign hematology: emerging challenges and special considerations for healthcare professionals. Expert Rev Hematol 2020; 13:1081-1092. [DOI: 10.1080/17474086.2020.1819785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Peter Noun
- Division of Pediatric Hematology-Oncology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Ahmad Ibrahim
- Division of Hematology and Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
- Middle East Institute of Health, Lebanese University, Beirut, Lebanon
| | - Mohammad Hassan Hodroj
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou-Fakhredin
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T. Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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24
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De Sanctis V, Canatan D, Corrons JLV, Karimi M, Daar S, Kattamis C, Soliman AT, Wali Y, Alkindi S, Huseynov V, Nasibova A, Tiryaki TO, Sezgin Evim M, Gunes AM, Karakas Z, Christou S, Yassin MA, Galati MC, Campisi S, Zarei T, Khater D, Oymak Y, Kaleva V, Stoyanova D, Banchev A, Skafida M, Kilinc Y. A comprehensive update of ICET-A Network on COVID-19 in thalassemias: what we know and where we stand. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020026. [PMID: 32921722 PMCID: PMC7716954 DOI: 10.23750/abm.v91i3.10063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/10/2023]
Abstract
A review of the literature on COVID-19 pandemic in patients with thalassemias is presented. Globally, the prevalence of COVID-19 among β-thalassemia patients seems to be lower than in general population; associated co-morbidities aggravated the severity of COVID- 19, leading to a poorer prognosis, irrespective of age. A multicenter registry will enhance the understanding of COVID-19 in these patients and will lead to more evidence-based management recommendations.
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Affiliation(s)
| | - Duran Canatan
- Antalya Genetic Diseases Diagnostic Center, Antalya,Turkey.
| | - Joan Lluis Vives Corrons
- Red Blood Cell and Haematopoietic Disorders Unit, Institute for Leukaemia Research Josep Carreras (IJC) and University of Barcelona, Catalonia, Spain. ENERCA Coordinator.
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman.
| | - Christos Kattamis
- First Department of Paediatrics, National Kapodistrian University of Athens, Athens, Greece.
| | - Ashraf T Soliman
- Pediatrics and Endocrinology Department of Pediatrics, Hamad Medical Center, Doha, Qatar and Department of Pediatrics, University of Alexandria, Alexandria, Egypt.
| | - Yasser Wali
- Paediatric Hematology Unit, Child Health Department, College of Medicine, Sultan Qaboos University Oman and Department of Paediatrics, Faculty of Medicine, Alexandria University, Egypt.
| | - Salam Alkindi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman.
| | | | | | - Tarık Onur Tiryaki
- 10 İstanbul University, Faculty of Medicine, Department of Hematology, İstanbul,Turkey.
| | - Melike Sezgin Evim
- Uludag University, Medical Faculty, Dept. of Pediatric Hematology, Bursa, Turkey.
| | - Adalet Meral Gunes
- Uludag University, Medical Faculty, Dept. of Pediatric Hematology, Bursa, Turkey.
| | - Zeynep Karakas
- Istanbul University, Istanbul Faculty of Medicine, Pediatric Hematology / Oncology, Istanbul, Turkey.
| | - Soteroula Christou
- Archibishop Makarios III Hospital, Thalassaemia Clinic, Nicosia, Cyprus.
| | - Mohamed A Yassin
- Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, (HMC), Doha, Qatar.
| | | | | | - Tahereh Zarei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Doaa Khater
- Department of Pediatric Endocrinology Alexandria University, Egypt and Department of Pediatrics, Sultan Qaboos University, Oman, Qatar.
| | - Yesim Oymak
- Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
| | - Valeriya Kaleva
- Expert Center for Coagulopathies and Rare Anemias, Varna, Bulgaria.
| | - Denka Stoyanova
- Pediatric Hematoncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria.
| | - Atanas Banchev
- Pediatric Hematoncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria.
| | - Myrto Skafida
- First Department of Paediatrics, National Kapodistrian University of Athens, Athens, Greece.
| | - Yurdanur Kilinc
- Pediatric Hematology Department, Çukurova University, Adana, Turkey.
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