Low levels of vitamin D were associated with coagulopathy among hospitalized coronavirus disease-19 (COVID-19) patients: A single-centered study in Indonesia

The Impact of Aromatherapy Gelatin Cold Compresses on the Concentration Level of Students in the Covid-19 Pandemic Online Class

Introduction

Stressful circumstances presented by the Covid-19 pandemic led to reduced levels of study concentration among students, and these conditions had been linked with dopamine levels.

Objectives

This study aimed to evaluate the impact of aromatherapy gelatin cold compress in increasing the study concentration of students by decreasing stress levels and elevating dopamine levels during the Covid-19 pandemic online class.

Methods

The study participants consisted of 42 students, who were selected using the simple random sampling method. Subsequently, the participants were comparably divided into control and treatment groups. Compress intervention was given to the treatment group on the forehead for 10 min before studying online. The Visual Analog Scale (VAS) and Stroop test were then used to determine stress and concentration levels of the students, respectively. The catecholamine fractionated urine was used to measure dopamine levels. Analysis was carried out using Paired T-test and Independent T-test with α = 0.05 and CI = 95%.

Results

The mean value of the VAS before and after treatment was 5.81 ± 2.48 and 5.28 ± 2.61 in the control (p = 0.205), as well as 6.28 ± 1.62 and 4.38 ± 1.89 in the treatment group (p = 0.000). The mean interference score of the Stroop test before and after treatment was 13.16 ± 1.05 and 13.22 ± 1.31 among the controls (p = 0.947), while 13.35 ± 6.94 and 8.92 ± 5.91 were recorded in the treatment group (p = 0.000). The average dopamine levels before and after the intervention were 145.50 ± 7.94 mg/mL and 146.65 ± 8.23 mg/mL creatinine among the controls (p = 0.542), while 145.35 ± 1.03 mg/mL and 265.18 ± 1.27 mg/mL creatinine were obtained in the treatment group (p = 0.01). Furthermore, the results showed that the creatinine levels were within the normal ranges. The Independent T-test of stress, concentration, and dopamine levels obtained p = 0.024, p = 0.010, and p = 0.090, respectively.

Conclusion

Aromatherapy gelatin cold compress was effective in increasing study concentration by decreasing stress levels and increasing dopamine levels during the Covid-19 pandemic online class.

Modeling risk factors of degree of severity of Coronavirus disease 2019 (COVID-19) infection in inpatient patients at Dr. M. Djamil Padang

Background

RSUP Dr. M. Djamil was one of the COVID referral hospitals that treats patients with degrees of severity ranging from mild to critical. The high prevalence of COVID-19 differs from the severity of which it is necessary to know the risk factors as a preventive measure to minimize the higher risk. This study aims to determine the factors associated with the severity of COVID-19 in inpatients at Dr. M. Djamil Hospital, Padang, Indonesia.

Design and methods

A quantitative study with a cross-sectional design was conducted by reviewing the medical record data of COVID-19 inpatients from March 2020 to February 2021. Sampling using a simple random sampling technique with a total of 95 patients. The Prevalence Odds Ratio (POR) is a statistical measure used in epidemiology and medical research to assess the association between an exposure or risk factor and a particular outcome in a cross-sectional study.

Results

Based on research, there are 41 (43.2%) severe patients. There is a relationship between age with p-value 0.004 (POR 4.5; 95% CI; 1.48-12.1), cardiovascular disease with p-value 0.003 (POR 5.9; 95% CI 1.7-21.4), and respiratory disease with p-value 0.001 (POR 6.6; 95% CI; 2.1-20.8) against COVID-19 infection. Diabetes Mellitus is the confounding variable. Respiratory disease is the dominant factor associated with the severity of COVID-19. Respiratory disease has 6.6 POR or Prevalence Odds Ratio values which means that COVID-19 patients with respiratory disease 6.6 more severe than those who has not respiratory disease history.

Conclusions

Age, cardiovascular, and respiratory diseases are associated with the severity of COVID-19 infection in patients at Dr. M. Djamil Hospital, Padang, Indonesia. It is highly recommended to increase health promotion regarding risk factors for the severity of COVID-19 to the community to avoid a more severe outcome.

Is Circulating Vitamin D Status Associated with the Risk of Venous Thromboembolism? A Meta-Analysis of Observational Studies

BACKGROUND

Although vitamin D is antithrombotic, associations between serum vitamin D status and the risk of venous thromboembolism (VTE) remain inconsistent.

METHODS

We searched the EMBASE, MEDLINE, Cochrane Library, and Google Scholar databases from inception to June 2022 to identify observational studies examining associations between vitamin D status and VTE risk in adults. The primary outcome presented as odds ratio (OR) or hazard ratio (HR) was the association of vitamin D levels with the risk of VTE. Secondary outcomes included the impacts of vitamin D status (i.e., deficiency or insufficiency), study design, and the presence of neurological diseases on the associations.

RESULTS

Pooled evidence from a meta-analysis of sixteen observational studies, including 47648 individuals published from 2013 to 2021, revealed a negative relationship between vitamin D levels and the risk of VTE either based on OR (1.74, 95% confidence interval (CI): 1.37 to 2.20, p < 0.00001; I² = 31%, 14 studies, 16074 individuals) or HR (1.25, 95% CI: 1.07 to 1.46, p = 0.006; I² = 0%, 3 studies, 37,564 individuals). This association remained significant in subgroup analyses of the study design and in the presence of neurological diseases. Compared to individuals with normal vitamin D status, an increased risk of VTE was noted in those with vitamin D deficiency (OR = 2.03, 95% CI: 1.33 to 3.11) but not with vitamin D insufficiency.

CONCLUSIONS

This meta-analysis demonstrated a negative association between serum vitamin D status and the risk of VTE. Further studies are required to investigate the potential beneficial effect of vitamin D supplementation on the long-term risk of VTE.

The Role of Vitamin D for Modulating the T Helper 1 Immune Response After the Coronavac Vaccination

The purpose of this study was to observe the role of vitamin D levels with T helper 1 (Th1)-type cytokines, such as interferon γ (IFN-γ) and interleukin-12 (IL-12) efficacy, in those who had already received 2 injections of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines (CoronaVac). We also observed if these cytokines played any significance in the CoronaVac effectiveness for preventing coronavirus disease 2019 (Covid-19) infection. One hundred ninety-four volunteers were monitored for 8 months upon receiving 2 inactivated SARS-CoV2 vaccination injections (CoronaVac, Sinovac Life Sciences). The rate of confirmed Covid-19 infections was the primary outcome. Six to 7 weeks after the second vaccine injection, and blood samples were obtained to measure the serum vitamin D, IFN-γ, and IL-12 levels. Low vitamin D level was defined if vitamin D level <30 ng/mL. Subjects with low vitamin D had lower IFN-γ and IL-12 levels (P = 0.04 and P = 0.04, respectively). The receiver operating characteristics curve analysis revealed that the area under curve for IFN-γ was 0.59, whereas IL-12 was 0.59 for predicting the low vitamin D levels. During follow-up, a higher incidence of Covid-19 infections was observed in subjects with low IFN-γ levels (P = 0.03). Kaplan-Meier survival analysis revealed that the cumulative hazard of confirmed Covid-19 cases was increased in subjects with low IFN-γ levels (log-rank test, P = 0.03). We concluded that lower vitamin D level was correlated with a lower Th1 immune response, whereas the adequate IFN-γ level was required to obtain better CoronaVac effectiveness.

Prognostic and Therapeutic Role of Vitamin D in COVID-19: Systematic Review and Meta-analysis

PURPOSE

Vitamin D deficiency/insufficiency may increase the susceptibility to coronavirus disease 2019 (COVID-19). We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality, and role of vitamin D in its treatment.

METHODS

We searched CINAHL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Science up to May 30, 2021, for observational studies on association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, severe disease, and death among adults, and, randomized controlled trials (RCTs) comparing vitamin D treatment against standard care or placebo, in improving severity or mortality among adults with COVID-19. Risk of bias was assessed using Newcastle-Ottawa scale for observational studies and AUB-KQ1 Cochrane tool for RCTs. Study-level data were analyzed using RevMan 5.3 and R (v4.1.0). Heterogeneity was determined by I2 and sources were explored through prespecified sensitivity analyses, subgroup analyses, and meta-regressions.

RESULTS

Of 1877 search results, 76 studies satisfying eligibility criteria were included. Seventy-two observational studies were included in the meta-analysis (n = 1 976 099). Vitamin D deficiency/insufficiency increased the odds of developing COVID-19 (odds ratio [OR] 1.46; 95% CI, 1.28-1.65; P < 0.0001; I2 = 92%), severe disease (OR 1.90; 95% CI, 1.52-2.38; P < 0.0001; I2 = 81%), and death (OR 2.07; 95% CI, 1.28-3.35; P = 0.003; I2 = 73%). The 25-hydroxy vitamin D concentrations were lower in individuals with COVID-19 compared with controls (mean difference [MD] -3.85 ng/mL; 95% CI, -5.44 to -2.26; P ≤ 0.0001), in patients with severe COVID-19 compared with controls with nonsevere COVID-19 (MD -4.84 ng/mL; 95% CI, -7.32 to -2.35; P = 0.0001) and in nonsurvivors compared with survivors (MD -4.80 ng/mL; 95% CI, -7.89 to -1.71; P = 0.002). The association between vitamin D deficiency/insufficiency and death was insignificant when studies with high risk of bias or studies reporting unadjusted effect estimates were excluded. Risk of bias and heterogeneity were high across all analyses. Discrepancies in timing of vitamin D testing, definitions of severe COVID-19, and vitamin D deficiency/insufficiency partly explained the heterogeneity. Four RCTs were widely heterogeneous precluding meta-analysis.

CONCLUSION

Multiple observational studies involving nearly 2 million adults suggest vitamin D deficiency/insufficiency increases susceptibility to COVID-19 and severe COVID-19, although with a high risk of bias and heterogeneity. Association with mortality was less robust. Heterogeneity in RCTs precluded their meta-analysis.

Vitamin D Immune-Mediated Responses and SARS-CoV-2 Infection: Clinical Implications in COVID-19

Active vitamin D is a true steroid hormone with pleiotropic biological effects that go beyond the classical concept of bone metabolism regulation. In fact, adequate serum levels of 25-hydroxyvitamin D (>40 ng/mL) are required to support several biological functions, including the control of innate and adaptive immunity in course of infectious, inflammatory and autoimmune diseases. SARS-CoV-2 is responsible for the COVID-19 pandemic and deficient/insufficient serum levels of 25-hydroxyvitamin D are reported in very large cohorts of patients. Of note, vitamin D is involved in different pathophysiological processes, such as expression of SARS-CoV-2 receptor (ACE2), activation of innate (neutrophils with their extracellular traps, monocytes/macrophages, dendritic cells, natural killer cells) and adaptive (T and B lymphocytes) immune cells and clinical manifestations, such as coagulation/thrombotic disorders and acute respiratory distress syndrome. Randomized clinical trials regarding vitamin D supplementation in COVID-19 patients have shown favorable effects on the control of inflammation markers, arterial oxygen saturation/inspired fraction of oxygen ratio, admission to hospital intensive care units and mortality. A target of serum 25-hydroxyvitamin D > 50 ng/mL has been identified as protective for the course of COVID-19, potentially playing an ancillary role in the treatment of the disease.