Coronavirus Disease 2019 and Diabetes: The Epidemic and the Korean Diabetes Association Perspective

A year of experience with COVID-19 in patients with cancer: A nationwide study

BACKGROUND

Cancer is a major public health problem and comorbidity associated with COVID-19 infection. According to previous studies, a higher mortality rate of COVID-19 in cancer patients has been reported.

AIMS

This study was undertaken to determine associated risk factors and epidemiological characteristics of hospitalized COVID-19 patients with cancer using a nationwide COVID-19 hospital data registry in Iran for the first time.

METHODS

In this retrospective study, we used a national data registry of hospitalized patients with Severe Acute Respiratory Syndrome (SARS) symptoms and patients with confirmed positive COVID-19 PCR between 18 February 2020 and 18 November 2020. The patients were classified into two groups patients with/without malignancy. Logistic regression model was utilized to analyze demographic factors, clinical features, comorbidities, and their associations with the disease outcomes.

RESULTS

In this study, 11 068 and 645 186 in-patients with SARS symptoms with and without malignancy were included, respectively. About 1.11% of our RT-PCR-positive patients had cancer. In patients with malignancy and COVID-19, older ages than 60 (OR: 1.88, 95% CI: 1.29-2.74, p-value: .001), male gender (OR: 1.43, 95% CI: 1.16-1.77, p-value: .001), concomitant chronic pulmonary diseases (CPD) (OR: 1.75, 95% CI: 1.14-2.68, p-value: .009), and presence of dyspnea (OR; 2.00, 95% CI: 1.60-2.48, p-value: <.001) were associated with increased mortality rate.

CONCLUSION

Given the immunocompromised state of patients with malignancy and their vulnerability to Covid-19 complications, collecting data on the comorbidities and their effects on the disease outcome can build on a better clinical view and help clinicians make decisions to manage these cases better; for example, determining special clinical care, especially in the shortage of health services.

Medical comorbidities as predictors of COVID-19 short-term mortality: A historical cohort study in Indonesia

Objectives

In this study, we aimed to evaluate the relation of comorbidities to coronavirus disease 2019 (COVID-19) short-term mortality.

Materials and Methods

This was a single-center observational study with a historical cohort method at Bethesda Hospital Yogyakarta, Indonesia. COVID-19 diagnosis was made using reverse transcriptase-polymerase chain reaction on nasopharyngeal swabs. Patient data were obtained from digital medical records and used for Charlson Comorbidity Index assessments. Inhospital mortality was monitored throughout their hospital stay.

Results

This study enrolled 333 patients. According to the total number of comorbidities in Charlson, 11.7% (n = 39) of patients had no comorbidities; 30.9% (n = 103) of patients had one comorbidity; 20.1% (n = 67) of patients had two comorbidities; and 37.2% (n = 124) of patients had more than three comorbidities. In multivariate analysis, these variables were significantly related to short-term mortality in COVID-19 patients: older age (odds ratio [OR] per year: 1.64; 95% confidence interval [CI]: 1.23-2.19; P 0.001), myocardial infarction (OR: 3.57; 95% CI: 1.49-8.56; P: 0.004), diabetes mellitus (OR: 2.41; 95 CI: 1.17-4.97; P: 0.017), renal disease (OR: 5.18; 95% CI: 2.07-12.97; P < 0.001), and longer duration of stay (OR: 1.20; 95% CI: 1.08-1.32; P < 0.001).

Conclusion

This study revealed multiple short-term mortality predictors in COVID-19 patients. The coexistence of cardiovascular disease, diabetes, and renal problem is a significant predictor of short-term mortality in COVID-19 patients.

Impact of COPD on clinical and CT characteristics of COVID-19-associated pneumonia: single tertiary center experience

Background

The severe acute respiratory syndrome-related coronavirus 2 pandemic continues to this day worldwide. Individuals with COPD are at increased risk of contracting SARS-CoV-2. Most of the conducted studies are based on the clinical assessment of COVID-19 infection with different comorbidities. The specific contribution of COPD to the severity of the disease and outcome still remains the point of investigation. The main goals of our study are to assess COPD’s influence on the severity of clinical and CT characteristics of COVID-19 pneumonia and associated in-hospital mortality.

Results

This is a retrospective study on 281 patients with RT-PCR-confirmed COVID-19 infection and CT spectrum of COVID-19 pneumonia. Fifty patients have COPD based on CT criteria. No significant difference was observed in the mean hospital length of stay, arterial oxygen saturation on admission or in-hospital mortality between COPD and non-COPD groups. Patients with COPD were two times less likely to have fever less than 37.9 °C (RR = 2.037; 95% CI 1.114–3.724, p = 0.016), but higher absolute neutrophil count (p = 0.033) and median level of neutrophil/lymphocyte ratio (p = 0.029). The COPD group was presented with milder CT severity score (especially CT1, less than 25% of lung involvement) (p = 0.022), less likely to have bilateral (RR = 2.601; 95% CI: 1.341–5.044, p = 0.023) or central (RR = 1.754; 95% CI 1.024–3.003, p = 0.046) distribution of ground-glass opacities, right lower lobe (RR = 2.887; 95% CI 1.574–5.293, p = 0.008) or left lung (RR = 2.627; 95% CI 1.448–4.765, p = 0.009) involvement, and “crazy-paving” pattern (RR = 2.208; 95% CI 1.292–3.774, p = 0.003). Both moderate positive and negative relationship was observed between CT1, CT4, hypoxia and in-hospital mortality in the COPD group (r = − 0.383, p = 0.033; r = 0.486, p = 0.007; r = − 0,354, p = 0,022, respectively).

Conclusion

The presence of COPD by imaging criteria in the settings of COVID-19-associated pneumonia did not significantly influence the clinical or imaging performance of the patients, nor was it linked to the increased in-hospital mortality.

Dissection of non-pharmaceutical interventions implemented by Iran, South Korea, and Turkey in the fight against COVID-19 pandemic

Purpose

The novel coronavirus disease 2019 (COVID-19) has imposed a great global burden on public health. As one of the most affected countries, Iran has tackled emerging challenges in the path to overcoming the epidemic, with three peaks of the disease propagation as of February 19, 2020. To flatten the curve of the COVID-19 pandemic, most countries have implemented bundles of intrusive, sometimes extremely stringent non-pharmaceutical interventions (NPIs). In this communication, we have dissected the effectiveness of NPIs and compared the strategies implemented by Iran, Turkey, and South Korea to mitigate the disease’s spread.

Methods

We searched online databases via PubMed, Web of Knowledge, and Scopus. Titles/abstracts and full-texts were screened by two reviewers and discrepancies were resolved upon discussion.

Results

Our results provide insights into five domains: prevention, screening, in-patient and out-patient facilities, governance, and management of diabetes mellitus. Analysis of previous efforts put in place illustrates that by fostering efficient social distancing measures, increasing the capability to perform prompt polymerase chain reaction tests, applying smart contact tracing, and supplying adequate personal protective equipment, Turkey and South Korea have brought the epidemic sub-optimally under control.

Conclusion

From the perspective of policymakers, these achievements are of utmost importance given that attaining the aspirational goals in the management of the COVID-19 necessities a suitable adjustment of previous successful strategies. Hence, policymakers should be noticed that a suitable combination of NPIs is necessary to stem the disease’s propagation.

Towards Telemedicine Adoption in Korea: 10 Practical Recommendations for Physicians

Due to the coronavirus disease 2019 (COVID-19) outbreak, consultation and prescription via telemedicine were temporarily allowed in the Korean population. However, at this point, it is difficult to determine whether telemedicine fulfills its role as a health care strategy. Arguably, if we had enough previous experience with telemedicine or sufficient preparation for its application, telemedicine could be more smoothly and flexibly adopted in the medical field. As it is still not possible to predict when the COVID-19 pandemic will end, phone consultation and prescription are likely to continue for some time. Hence, it is expected that telemedicine will naturally settle in the medical field in the near future. However, as we have noticed during this outbreak, improvised telemedicine without adequate guidance can be confusing to both patients and health professionals, thus reducing the benefit to patients. Medical staff requires preparation on how to appropriately use telemedicine. Thus, here we present some suggestions on implementing and preparing for telemedicine in the medical community.

Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19

BACKGROUND

Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM).

METHODS

As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset.

RESULTS

Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682).

CONCLUSION

This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.

Impact of COPD on COVID-19 prognosis: A nationwide population-based study in South Korea

Underlying chronic respiratory disease may be associated with the severity of coronavirus disease 2019 (COVID-19). This study investigated the impact of chronic obstructive pulmonary disease (COPD) on the risk for respiratory failure and mortality in COVID-19 patients. A nationwide retrospective cohort study was conducted in 4610 patients (≥ 40 years old) infected with COVID-19 between January 20 and May 27, 2020, using data from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The clinical course and various clinical features were compared between COPD and non-COPD patients, and the risks of respiratory failure and all-cause mortality in COPD patients were analyzed using a multivariate logistic regression model. Among 4610 COVID-19 patients, 4469 (96.9%) and 141 (3.1%) were categorized into the non-COPD and COPD groups, respectively. The COPD group had greater proportions of older (≥ 60 years old) (78.0% vs. 45.2%, P < 0.001) and male (52.5% vs. 36.6%, P < 0.001) patients than the non-COPD group. Relatively greater proportions of patients with COPD received intensive critical care (7.1% vs. 3.7%, P = 0.041) and mechanical ventilation (5.7% vs. 2.4%, P = 0.015). Multivariate analyses showed that COPD was not a risk factor for respiratory failure but was a significant independent risk factor for all-cause mortality (OR = 1.80, 95% CI 1.11–2.93) after adjustment for age, sex, and Charlson Comorbidity Index score. Among COVID-19 patients, relatively greater proportions of patients with COPD received mechanical ventilation and intensive critical care. COPD is an independent risk factor for all-cause mortality in COVID-19 patients in Korea.

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

COVID-19 has gravely threatened high-risk populations, such as people with diabetes and other noncommunicable diseases, leading to disproportionate hospitalizations and deaths worldwide. It is well documented from previous outbreaks that diabetes increases the risk for poor outcomes due to SARS infection. In the present review, we bring evidence that the country and global level health crisis caused by COVID-19 could have been avoided or extremely minimized if measures to protect high-risk populations were implemented timely. In addition to general lockdowns, testing, tracing, isolation and hygiene measures, other specific interventions for diabetes and comorbidities management were shown crucial to allow the continuation of care services during the pandemic. These interventions included: teleconsultation, digital remote education andmonitoring, e-prescriptions, medicine delivery options, mobile clinics, and home point-of-care tests. In conclusion, we recommend prompt actions to protect the most vulnerable groups, valuing knowledge and experiences from previous outbreaks and lessons learned during the COVID-19 pandemic, in order to shield communities, health systems and the global economy.

Clinical Characteristics and Mortality Predictors of COVID-19 Patients Hospitalized at Nationally-Designated Treatment Hospitals

BACKGROUND

Coronavirus disease 2019 (COVID-19) was first reported in December 2019 in China, and then it has disseminated worldwide. In Korea, a religious group-related super-spreading event triggered a sudden outbreak in Daegu city and Gyeongsangbuk-do in southeast Korea. This study was undertaken to document the clinical characteristics of patients hospitalized in Gyeongsangbuk-do.

METHODS

Three hundred and fifty-two patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalized at Dongguk University Gyeongju Hospital or at the Andong Medical Center between February 18th and June 30th were enrolled in this study. Medical records were reviewed and demographic and clinical features, including comorbidities, symptoms, radiological and laboratory findings on admission were analyzed. In addition, we sought to identify risk factors of mortality.

RESULTS

Mean age of the 352 study subjects was 56 years (range, 14-95). The mortality rate was 6.8% and mean age at death was 81 years (range, 57-91). The most common symptom was cough (31.8%) followed by a febrile sensation (28.4%), sputum (17.0%), sore throat (15.6%), and myalgia (13.1%). Eighty-one (23.0%) patients were asymptomatic, but a half of these patients exhibited pneumonic infiltration at presentation. Chest radiology showed no active lesion in 41.8% of the study subjects, bilateral pneumonia in 46.9%, and unilateral pneumonic infiltration in 11.4%. Among 24 patients that died, 18 subjects were transferred from a care facility. An age of ≥ 70 years, previous history of malignancy or diabetes, and fever (≥ 37.5°C) on admission were found to be significant risk factors of mortality.

CONCLUSION

Patients aged ≥ 70 years, those with fever on admission, and patients with an underlying malignancy or diabetes were found to be more likely to succumb to COVID-19. Elderly in care facilities or hospitalized patients with an underlying disease should receive more attention and be considered for preventive quarantine.