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Epstein NK, Yelin D, Shitenberg D, Yahav D, Leibovici L, Daitch V, Margalit I. One-year follow-up of COVID-19 recoverees with impaired pulmonary function: A prospective cohort study. Infect Dis Now 2024; 54:104890. [PMID: 38499177 DOI: 10.1016/j.idnow.2024.104890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/02/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
Decreased diffusion capacity for carbon monoxide (DLCO) is the most prevalent pulmonary testing abnormality among COVID-19 recoverees. We prospectively followed 51 individuals with impaired DLCO at an average of ∼3 months following COVID-19 and re-examined them at one year. At follow-up, mean DLCO increased from 68.0 % to 72.6 % (p = 0.002); while 33 % of the cohort experienced a clinically significant rise (>10 points) in DLCO, only 29 % normalized their values. While DLCO change did not correlate with symptoms, lack of improvement was more prevalent among individuals with obesity. Regardless of COVID-19 severity, a substantial proportion continued to exhibit DLCO impairment at 1-year.
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Affiliation(s)
- Nitzan Karny Epstein
- Infectious Diseases Unit, Meir Medical Center, Kfar-Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dana Yelin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Dorit Shitenberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pulmonology Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - Dafna Yahav
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Leonard Leibovici
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - Vered Daitch
- Department of Internal Medicine E, Rabin Medical Center, Petach-Tikva, Israel
| | - Ili Margalit
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
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Yelin D, Daitch V, Kalfon T, Mor M, Buchrits S, Shafir Y, Awwad M, Ghantous N, Shapira-Lichter I, Leibovici L, Yahav D, Margalit I. Long COVID sexual dysfunction among both genders: Evaluation of a cohort of COVID-19 recoverees. Infect Dis Now 2023; 53:104750. [PMID: 37406989 DOI: 10.1016/j.idnow.2023.104750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES We aimed to assess Long COVID sexual dysfunction among both sexes. PATIENTS AND METHODS A cross-sectional study at a multidisciplinary COVID clinic. Consecutive patients answered a symptom-based questionnaire, which included sexual dysfunction. Individuals reporting any degree of sexual dysfunction were compared with those who denied. A multivariable logistic regression was conducted to identify risk factors. A principal component analysis was implemented to explore other symptoms associated with sexual dysfunction. RESULTS All in all, 391 individuals recovering from COVID-19 completed the questionnaire, 211 women and 180 men. Mean age was 45.2 (SD 15.4) years. Most (280, 85.9%) had mild COVID-19, assessed at a median of 3.8 (IQR 2.0) months from diagnosis. Sexual dysfunction was reported by 55 (36%) of the men and 48 (28%) of the women. Increased age [per year; men OR 1.05 (95% CI 1.02-1.08)], long COVID cough [men 2.58 (1.05-6.32)], chest pain [women 3.54 (1.28-9.80)], irritability [women 3.45 (1.28-9.29)], paresthesia [men 4.23 (1.55-10.44); women 3.08 (1.14-8.32)], and emotional distress [men 3.26 (1.36-7.82); women 4.29 (1.65-11.18)] were significantly associated with sexual dysfunction. In women, sexual dysfunction was part of the emotional pattern, while among men, it was part of the emotional and pulmonary patterns. CONCLUSION Sexual dysfunction is a common manifestation of long COVID in both men and women. Presence of other long COVID symptoms, and older age, are associated with this phenomenon. Further studies should explore the mechanisms for long COVID sexual dysfunction in both men and women, as well as strategies for prevention and treatment.
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Affiliation(s)
- D Yelin
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - V Daitch
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - T Kalfon
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - M Mor
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - S Buchrits
- Department of Internal Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Y Shafir
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - M Awwad
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - N Ghantous
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - I Shapira-Lichter
- Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel and Sagol School of Neuroscience, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - L Leibovici
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - D Yahav
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - I Margalit
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
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Manor U, Kfir J, Livneh N, Zilberman T, Yelin D, Meltzer E. Concurrent Visual and Auditory Deficits in a Patient with Rickettsia conorii Infection. Am J Trop Med Hyg 2023; 109:501-502. [PMID: 37400067 PMCID: PMC10484261 DOI: 10.4269/ajtmh.23-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Uri Manor
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Kfir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel HaShomer, Israel
| | - Nir Livneh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Sheba Medical Center, Tel HaShomer, Israel
| | - Tal Zilberman
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Infectious Disease Unit, Sheba Medical Center, Tel HaShomer, Israel
| | - Dana Yelin
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Infectious Disease Unit, Sheba Medical Center, Tel HaShomer, Israel
| | - Eyal Meltzer
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nave L, Margalit I, Tau N, Cohen I, Yelin D, Lienert F, Yahav D. Immunogenicity and Safety of Modified Vaccinia Ankara (MVA) Vaccine-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Vaccines (Basel) 2023; 11:1410. [PMID: 37766090 PMCID: PMC10536351 DOI: 10.3390/vaccines11091410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Prevention of mpox has become an important public health interest. We aimed to evaluate the safety and immunogenicity of the Modified Vaccinia Ankara (MVA) vaccine. We conducted a systematic review and meta-analysis of randomized-controlled trials (RCTs) comparing MVA versus no intervention, placebo, or another vaccine. Outcomes included safety and immunogenicity outcomes. We also performed a systematic review of RCTs evaluating various MVA regimens. Fifteen publications were included in the quantitative meta-analysis. All but one (ACAM2000) compared MVA with placebo. We found that cardiovascular adverse events following two MVA doses were significantly more common compared to placebo (relative risk [RR] 4.07, 95% confidence interval [CI] 1.10-15.10), though serious adverse events (SAEs) were not significantly different. Following a single MVA dose, no difference was demonstrated in any adverse event outcomes. Seroconversion rates were significantly higher compared with placebo after a single or two doses. None of the RCTs evaluated clinical effectiveness in preventing mpox. This meta-analysis provides reassuring results concerning the immunogenicity and safety of MVA. Further studies are needed to confirm the immunogenicity of a single dose and its clinical effectiveness. A single vaccine dose may be considered according to vaccine availability, with preference for two doses.
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Affiliation(s)
- Lior Nave
- Internal Medicine E, Sheba Medical Center, Ramat-Gan 52621, Israel; (L.N.)
| | - Ili Margalit
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel; (I.M.)
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Noam Tau
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel; (I.M.)
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Ido Cohen
- Internal Medicine E, Sheba Medical Center, Ramat-Gan 52621, Israel; (L.N.)
| | - Dana Yelin
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel; (I.M.)
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan 52621, Israel
| | | | - Dafna Yahav
- Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel; (I.M.)
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan 52621, Israel
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Turjeman A, von Dach E, Molina J, Franceschini E, Koppel F, Yelin D, Dishon-Benattar Y, Mussini C, Rodríguez-Baño J, Cisneros JM, Huttner A, Paul M, Leibovici L, Yahav D. Duration of antibiotic treatment for Gram-negative bacteremia - Systematic review and individual participant data (IPD) meta-analysis. EClinicalMedicine 2023; 55:101750. [PMID: 36483269 PMCID: PMC9722443 DOI: 10.1016/j.eclinm.2022.101750] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We aim to compare the effect of short versus long treatment duration in Gram-negative bacteremia on all-cause mortality in pre-specified sub-groups. METHODS Individual participant data meta-analysis of randomized controlled trials (RCTs) comparing short (≤7) versus longer (>7 days) antibiotic treatment for Gram-negative bacteremia. Participants were adults (≥18 years), with Gram-negative bacteremia during hospital stay. We searched PubMed, Cochrane Central Register of Controlled Trials, and Web of Science to identify trials conducted up to May 2022. Primary outcome was 90-day all-cause mortality. Secondary outcomes were 30-day mortality, relapse of bacteremia, length of hospital stay, readmission, local or distant infection complications, adverse events, and resistance emergence.Outcomes were assessed in pre-specified subgroups: women vs men; non-urinary vs urinary source; presence vs absence of hypotension on initial presentation; immunocompromised patients versus non-immunocompromised patients, and age (above/below 65). Fixed-effect meta-analysis model was used to estimate pooled odds ratio (OR) and 95% confidence interval (CI). All three trials had low risk of bias for allocation generation and concealment. FINDINGS Three RCTs (1186 patients) were included; 1121 with enterobacterales bacteremia. No significant difference in mortality was demonstrated between 7- and 14-days treatment (90-day mortality: OR 1.08, 95% CI 0.73-1.58; 30-day mortality: 1.08, 0.62-1.91). Relapse (1.00, 0.50-1.97); length of hospital stay (P = 0.78); readmission (0.96, 0.80-1.22); and infection complications (local: 1.62 0.76-3.47; distant: 2.00, 0.18-22.08), were without significant difference, and so were adverse events or resistance emergence.No significant difference in clinical outcomes between 7 and 14 days of antibiotics was demonstrated in the subgroups of gender, age, hemodynamic status, immune status, and source of infection. INTERPRETATION For patients hemodynamically stable and afebrile at 48 h prior to discontinuation, seven days of antibiotic therapy for enterobacterales bacteremia result in similar outcomes as 14 days, in terms of mortality, relapse, length of hospital stay, complications of infection, resistance emergence, and adverse events. These results apply for any adult age group, gender, source of infection, immune status, and hemodynamic status on presentation. FUNDING There was no funding source for this study.
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Affiliation(s)
- Adi Turjeman
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elodie von Dach
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Geneva, Switzerland
| | - José Molina
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
- Center for Biomedical Research Network (CIBER) on Infectious Diseases, Madrid, Spain
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Fidi Koppel
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Dana Yelin
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Yael Dishon-Benattar
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Jesús Rodríguez-Baño
- Center for Biomedical Research Network (CIBER) on Infectious Diseases, Madrid, Spain
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital; Department of Medicine, School of Medicine, University of Seville; and Biomedicine Institute of Seville/CSIC, Seville, Spain
| | - José Miguel Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
- Center for Biomedical Research Network (CIBER) on Infectious Diseases, Madrid, Spain
| | - Angela Huttner
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leonard Leibovici
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
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Shechter A, Yelin D, Margalit I, Abitbol M, Morelli O, Hamdan A, Vaturi M, Eisen A, Sagie A, Kornowski R, Shapira Y. Assessment of Adult Patients with Long COVID Manifestations Suspected as Cardiovascular: A Single-Center Experience. J Clin Med 2022; 11:jcm11206123. [PMID: 36294444 PMCID: PMC9605399 DOI: 10.3390/jcm11206123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Persistent symptoms affect a subset of coronavirus disease 2019 (COVID-19) survivors. Some of these may be cardiovascular (CV)-related. Objective: To assess the burden of objective CV morbidity among, and to explore the short-term course experienced by, COVID-19 patients with post-infectious symptomatology suspected as CV. Methods: This was a single-center, retrospective analysis of consecutive adult patients with new-onset symptoms believed to be CV following recovery from COVID-19, who had been assessed at a dedicated ‘Cardio’-COVID clinic between June 2020 and June 2021. All participants were followed for 1 year for symptomatic course and the occurrence of new CV diagnoses and major adverse cardiovascular events (MACE). Results: A total of 96 patients (median age 54 (IQR, 44–64) years, 52 (54%) females) were included in the final analysis. Initial visits occurred within a median of 142 days after the diagnosis of acute COVID. Nearly all (99%) patients experienced a symptomatic acute illness, which was graded as severe in 26 (27%) cases according to the National Institutes of Health (NIH) criteria. Long-COVID symptoms included mainly dyspnea and fatigue. While the initial work-up was mostly normal, 45% of the 11 cardiac magnetic resonance studies performed revealed pathologies. New CV diagnoses were made in nine (9%) patients and mainly included myocarditis that later resolved. An abnormal spirometry was the only variable associated with these. No MACE were recorded. Fifty-two (54%) participants felt that their symptoms improved. No association was found between CV morbidity and symptomatic course. Conclusions: In our experience, long-COVID symptoms of presumed CV origin signified actual CV disease in a minority of patients who, irrespective of the final diagnosis, faced a fair 1-year prognosis.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
- Correspondence: ; Tel.: +972-3-9377107; Fax: +972-3-9249850
| | - Dana Yelin
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
- Long-COVID Clinic, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Ili Margalit
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
- Long-COVID Clinic, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Merry Abitbol
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Olga Morelli
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Mordehay Vaturi
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Alex Sagie
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6910203, Israel
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Daitch V, Yelin D, Awwad M, Guaraldi G, Milić J, Mussini C, Falcone M, Tiseo G, Carrozzi L, Pistelli F, Nehme M, Guessous I, Kaiser L, Vetter P, Bordas-Martínez J, Durà-Miralles X, Peleato-Catalan D, Gudiol C, Shapira-Lichter I, Abecasis D, Leibovici L, Yahav D, Margalit I. Characteristics of long-COVID among older adults: a cross-sectional study. Int J Infect Dis 2022; 125:287-293. [PMID: 36191820 DOI: 10.1016/j.ijid.2022.09.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To describe long-COVID symptoms among older adults and to assess the risk factors for two common long-COVID symptoms: fatigue and dyspnea. METHODS This is a multicenter, prospective cohort study conducted in Israel, Switzerland, Spain, and Italy. Individuals were included at least 30 days after their COVID-19 diagnosis. We compared long-COVID symptoms between elderly (aged >65 years) and younger individuals (aged 18-65 years) and conducted univariate and multivariable analyses for the predictors of long-COVID fatigue and dyspnea. RESULTS A total of 2333 individuals were evaluated at an average of 5 months (146 days [95% confidence interval 142-150]) after COVID-19 onset. The mean age was 51 years, and 20.5% were aged >65 years. Older adults were more likely to be symptomatic, with the most common symptoms being fatigue (38%) and dyspnea (30%); they were more likely to complain of cough and arthralgia and have abnormal chest imaging and pulmonary function tests. Independent risk factors for long-COVID fatigue and dyspnea included female gender, obesity, and closer proximity to COVID-19 diagnosis; older age was not an independent predictor. CONCLUSION Older individuals with long-COVID have different persisting symptoms, with more pronounced pulmonary impairment. Women and individuals with obesity are at risk. Further research is warranted to investigate the natural history of long-COVID among the elderly population and to assess possible interventions aimed at promoting rehabilitation and well-being.
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Affiliation(s)
- Vered Daitch
- COVID recovery clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Dana Yelin
- COVID recovery clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Muhammad Awwad
- Internal medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Giovanni Guaraldi
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Jovana Milić
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Francesco Pistelli
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Mayssam Nehme
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Xavier Durà-Miralles
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital. Institut Català d'Oncologia (ICO), Hospital Duran I Reynals. IDIBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Irit Shapira-Lichter
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Donna Abecasis
- Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Leonard Leibovici
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Ili Margalit
- COVID recovery clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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8
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Margalit I, Yelin D, Sagi M, Rahat MM, Sheena L, Mizrahi N, Gordin Y, Agmon H, Epstein NK, Atamna A, Tishler O, Daitch V, Babich T, Abecasis D, Yarom Y, Kazum S, Shitenberg D, Baltaxe E, Elkana O, Shapira-Lichter I, Leibovici L, Yahav D. Risk factors and multidimensional assessment of long COVID fatigue: a nested case-control study. Clin Infect Dis 2022; 75:1688-1697. [PMID: 35403679 PMCID: PMC9383780 DOI: 10.1093/cid/ciac283] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fatigue is the most prevalent and debilitating long COVID symptom, however risk factors and pathophysiology of this condition remain unknown.We assessed risk factors for long COVID fatigue and explored its possible pathophysiology. METHODS Nested case-control study in a COVID recovery clinic. Individuals with (cases) and without (controls) significant fatigue were included. We performed a multidimensional assessment evaluating various parameters, including pulmonary function tests and cardiopulmonary exercise testing, and implemented multivariable logistic regression to assess risk factors for significant long COVID fatigue. RESULTS Total of 141 individuals were included. Mean age was 47 (SD 13) years; 115 (82%) were recovering from mild COVID-19. Mean time for evaluation was 8 months following COVID-19. Sixty-six (47%) individuals were classified with significant long COVID fatigue. They had significantly higher number of children, lower proportion of hypothyroidism, higher proportion of sore throat during acute illness and long COVID symptoms, and of physical limitation in daily activities.Individuals with fatigue had poorer sleep quality and higher degree of depression. They had significantly lower heart rate [153.52 (22.64) vs 163.52 (18.53), p=0.038] and oxygen consumption per Kg [27.69 (7.52) vs 30.71 (7.52), p=0.036] at peak exercise.The two independent risk factors for fatigue identified in multivariable analysis were peak exercise heart rate (odds ratio [OR] 0.79 per 10 beats/minute, 95% confidence interval [CI] 0.65-0.96, p=0.019); and long COVID memory impairment (OR 3.76, 95% CI 1.57-9.01, p=0.003). CONCLUSIONS Long COVID fatigue may be related to autonomic dysfunction, impaired cognition and decreased mood. This may suggest a limbic-vagal pathophysiology. Clinical Trial registration: NCT04851561.
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Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dana Yelin
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Moshe Sagi
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Maya Merav Rahat
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Liron Sheena
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Nadav Mizrahi
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yael Gordin
- The Hebrew University-Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Hadar Agmon
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Nitzan Karny Epstein
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alaa Atamna
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ori Tishler
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Vered Daitch
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tanya Babich
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Donna Abecasis
- Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yoni Yarom
- Medix Sport Medicine Center, Tel Aviv, Israel
| | - Shirit Kazum
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Erik Baltaxe
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yafo, Tel Aviv-Jaffa, Israel
| | - Irit Shapira-Lichter
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sagol School of Neuroscience, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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9
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Yelin D, Moschopoulos CD, Margalit I, Gkrania-Klotsas E, Landi F, Stahl JP, Yahav D. ESCMID rapid guidelines for assessment and management of long COVID. Clin Microbiol Infect 2022; 28:955-972. [PMID: 35182760 PMCID: PMC8849856 DOI: 10.1016/j.cmi.2022.02.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/06/2023]
Abstract
Scope The aim of these guidelines is to provide evidence-based recommendations for the assessment and management of individuals with persistent symptoms after acute COVID-19 infection and to provide a definition for this entity, termed ‘long COVID’. Methods We performed a search of the literature on studies addressing epidemiology, symptoms, assessment, and treatment of long COVID. The recommendations were grouped by these headings and by organ systems for assessment and treatment. An expert opinion definition of long COVID is provided. Symptoms were reviewed by a search of the available literature. For assessment recommendations, we aimed to perform a diagnostic meta-analysis, but no studies provided relevant results. For treatment recommendations we performed a systematic review of the literature in accordance with the PRISMA statement. We aimed to evaluate patient-related outcomes, including quality of life, return to baseline physical activity, and return to work. Quality assessment of studies included in the systematic review is provided according to study design. Recommendations Evidence was insufficient to provide any recommendation other than conditional guidance. The panel recommends considering routine blood tests, chest imaging, and pulmonary functions tests for patients with persistent respiratory symptoms at 3 months. Other tests should be performed mainly to exclude other conditions according to symptoms. For management, no evidence-based recommendations could be provided. Physical and respiratory rehabilitation should be considered. On the basis of limited evidence, the panel suggests designing high-quality prospective clinical studies/trials, including a control group, to further evaluate the assessment and management of individuals with persistent symptoms of COVID-19.
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Affiliation(s)
- Dana Yelin
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Charalampos D Moschopoulos
- Fourth Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ili Margalit
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | - Francesco Landi
- Geriatric Internal Medicine Department, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Jean-Paul Stahl
- Infectious Diseases Department, University and Hospital Grenoble Alpes, Grenoble Cedex, France
| | - Dafna Yahav
- Fourth Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
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10
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Yelin D, Margalit I. Challenges and Management of Long COVID in Individuals with Hematological Illnesses. Acta Haematol 2022; 145:275-281. [PMID: 35134812 PMCID: PMC9059010 DOI: 10.1159/000522437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
COVID-19 has impacted hundreds of millions of people globally, a relatively large proportion of whom continue to suffer from ongoing, sometime debilitating symptoms. This phenomenon, termed “long COVID,” is difficult to diagnose and manage because of a paucity of objective findings and despite the abundance of descriptive data published so far. In this review, we aimed to describe the common manifestations of long COVID, diagnostic and management challenges, and address specific aspects in hematologic patients.
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Affiliation(s)
- Dana Yelin
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Dana Yelin,
| | - Ili Margalit
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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11
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Yelin D, Rozen-Zvi B, Yahav D, Ben-Dor N, Steinmetz T, Agur T, Zingerman B, Schneider S, Lichtenberg S, Ben-Zvi H, Mashraki T, Rahamimov R. OUP accepted manuscript. Clin Kidney J 2022; 15:992-998. [PMID: 35498878 PMCID: PMC8903319 DOI: 10.1093/ckj/sfac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 11/29/2022] Open
Abstract
Data regarding immunogenicity of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines among kidney transplant recipients in the months following vaccination are lacking. We aimed to investigate humoral immune response at 3–4 months post-vaccination among a cohort of kidney transplant recipients, compared with a control group of dialysis patients. Anti-spike antibodies were tested at 1 and 3–4 months after vaccination. Of 259 kidney transplant recipients tested at a median time of 110 days from second vaccine dose, 99 (38%) were seropositive, compared with 83% (101/122) of control patients. Younger age, better renal function and lower immunosuppression levels were associated with seropositivity. A total of 14% (13/94) of participants seropositive at 1 month became seronegative at follow-up and 11% (18/165) became seropositive. The latter were mainly individuals with higher antibody levels at 1 month. Antibody levels at 3–4 months were significantly reduced in both study groups, although the decline was more pronounced in the control group. Kidney transplant recipients present poor antibody response to mRNA SARS-CoV-2 vaccination, with only 38% seropositive at 3–4 months. Nevertheless, the decay in antibody response over time is modest, and some patients may present delayed response, reaching adequate antibody levels at 3–4 months. Low seropositivity rates in this group call for investigating other immunization strategies.
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Affiliation(s)
| | | | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
| | - Naomi Ben-Dor
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Steinmetz
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Timna Agur
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Zingerman
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Schneider
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Lichtenberg
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Tiki Mashraki
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
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12
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Shechter A, Yelin D, Hamdan A, Vaturi M, Eisen A, Sagie A, Kornowski R, Shapira Y. Cardio-COVID clinic – a one-center experience. Eur Heart J 2021. [PMCID: PMC8767590 DOI: 10.1093/eurheartj/ehab724.2738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Persistent symptoms affect a relatively large portion of coronavirus disease (COVID) survivors. Hence, specific clinics had been established in order to better characterize and manage this emerging entity of Post-COVID, among them our Cardio-COVID Clinic, which is dedicated to the cardiovascular (CV) aspects of the phenomenon. Aim To present the experience of our Cardio-COVID Clinic. Methods Included in this report are 76 adult patients seen at the clinic between June 2020 and March 2021, who have recovered from a polymerase chain reaction (PCR)-confirmed COVID, and who were suspected by their referring physicians to experience ongoing cardiac sequelae. All participants underwent a structured assessment by a single cardiologist, which consisted of history taking, physical examination (PE), electrocardiogram (ECG), trans-thoracic echocardiogram (TTE), and further tests as deemed appropriate, including any combination of Holter, ischemic provocation test, cardiopulmonary exercise test (CPET), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT). Results Initial visits occurred within a median of 131 days after diagnosis. Most participants (83%) were referred from our general Long-COVID Clinic. About half were males, and the mean age was 53 years. 18% of participants had prior CV conditions, and the majority (72%) had at least one CV risk factor, mostly dyslipidemia. Nearly all participants experienced a symptomatic acute illness, which was graded according to the National Institutes of Health (NIH) criteria as severe in 23% of the study cohort. As for Post-COVID, late symptoms were present in 97% of patients, the most common being dyspnea (57%). While PE was unremarkable in all but 3 patients who exhibited murmurs, ECG findings were revealed in 45% – mostly non-specific ST-T changes (31%) and conduction abnormalities (14%) – and TTE aberrations were discovered in 28% – including pericardial effusion (24%), reduced left ventricular ejection fraction (LVEF) (5%), grade 2 diastolic dysfunction (3%), moderate and up valvular dysfunction (1%), and systolic pulmonary hypertension (1%); right ventricular function was universally normal. Upon conclusion of the work-up, CV diagnoses were made in 8 (11%) patients – including myocarditis (4), myopericarditis (1), inappropriate sinus tachycardia (1), chronotropic incompetence (1), and an aberrant coronary (1). Of note, CPET and CMR had the highest diagnostic yield, in light of 57% positive results on each – followed by CCT, Holter, and provocation test. Interesting as well, among those with abnormal CMR findings, 40% had normal ECG's and TTE's. Also, none of the CV restraints on CPET translated to provocation test anomalies. Conclusion CV symptoms of Post-COVID are highly prevalent, but signify actual CV disease only in a minority of patients. Further research is needed that will help identify predictors for CV morbidity and define optimal clinical pathways. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- A Shechter
- Rabin Medical Center, Petah Tikva, Israel
| | - D Yelin
- Rabin Medical Center, Petah Tikva, Israel
| | - A Hamdan
- Rabin Medical Center, Petah Tikva, Israel
| | - M Vaturi
- Rabin Medical Center, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Petah Tikva, Israel
| | - A Sagie
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Y Shapira
- Rabin Medical Center, Petah Tikva, Israel
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13
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Yahav D, Yelin D, Eckerle I, Eberhardt CS, Wang J, Cao B, Kaiser L. Definitions for coronavirus disease 2019 reinfection, relapse and PCR re-positivity. Clin Microbiol Infect 2021; 27:315-318. [PMID: 33285276 PMCID: PMC7718119 DOI: 10.1016/j.cmi.2020.11.028] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Dana Yelin
- Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Isabella Eckerle
- Geneva Centre for Emerging Viral Disease, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine of Geneva, University of Geneva, Geneva, Switzerland; Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Division of Infectious Disease. Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland
| | - Christiane S Eberhardt
- Centre for Vaccinology and Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland; Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Disease, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine of Geneva, University of Geneva, Geneva, Switzerland; Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Division of Infectious Disease. Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland
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14
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Yelin D, Margalit I, Yahav D, Runold M, Bruchfeld J. Long COVID-19-it's not over until? Clin Microbiol Infect 2020; 27:506-508. [PMID: 33316400 PMCID: PMC7832095 DOI: 10.1016/j.cmi.2020.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 10/31/2022]
Affiliation(s)
- Dana Yelin
- Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Ili Margalit
- Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Michael Runold
- Department of Respiratory Medicine and Allergy Karolinska University Hospital, Stockholm, Sweden
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm Sweden; Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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15
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Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, Guaraldi G, Mussini C, Gudiol C, Pujol M, Bandera A, Scudeller L, Paul M, Kaiser L, Leibovici L. Long-term consequences of COVID-19: research needs. The Lancet Infectious Diseases 2020; 20:1115-1117. [PMID: 32888409 PMCID: PMC7462626 DOI: 10.1016/s1473-3099(20)30701-5] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Dana Yelin
- Unit of infectious Diseases, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva 49100, Israel
| | - Eytan Wirtheim
- Management, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva 49100, Israel
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Division of Infectious Diseases, Division of Laboratory Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andre C Kalil
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden; Divison of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael Runold
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Alessandra Bandera
- Clinic of Infectious Diseases, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Foundation, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luigia Scudeller
- Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Foundation, Milan, Italy
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Division of Infectious Diseases, Division of Laboratory Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Leonard Leibovici
- Research Authority, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva 49100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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16
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Diker-Cohen T, Rozen-Zvi B, Yelin D, Akirov A, Robenshtok E, Gafter-Gvili A, Shepshelovich D. Endocrinopathy-induced euvolemic hyponatremia. Intern Emerg Med 2018; 13:679-688. [PMID: 29790126 DOI: 10.1007/s11739-018-1872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/06/2018] [Indexed: 10/16/2022]
Abstract
Euvolemic hyponatremia results from either the syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothyroidism, or adrenal insufficiency. Furthermore, the criteria for diagnosis of SIADH entail the exclusion of hypothyroidism and hypoadrenalism. We aim to assess the yield of euvolemic hyponatremia workup focusing on underlying endocrinopathies in a real-world setting. A single-center retrospective study includes all patients diagnosed with euvolemic hyponatremia in a tertiary hospital between 1.1.2007 and 1.1.2013. Demographic, clinical, and laboratory data were collected from medical charts. Euvolemic hyponatremia was detected in 564 patients. Thyroid function was tested in 69% (391/564) and adrenal function was assessed in 29% (164/564) of cases. Endocrinopathy-induced euvolemic hyponatremia was diagnosed in nine (1.6%) patients: three patients were diagnosed with hypothyroidism-induced hyponatremia, three with adrenal insufficiency as an underlying cause, and three with central hypothyroidism and central hypoadrenalism. All nine had medical history and symptoms suggestive of endocrine deficiencies other than the hyponatremia, which resolved within 1-3 days after administration of hormone replacement therapy. Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low. However, in this real-world study, only a limited number of patients underwent a full ascertainment of hypoadrenalism and hypothyroidism, which was diagnosed only in patients with additional findings supportive of these endocrinopathies; a higher rate of undiagnosed endocrinopathies cannot be ruled out. As both hypoadrenalism and hypothyroidism are easily treatable, potentially life-threatening conditions, there are insufficient data to change current recommendation for their universal evaluation in patients with euvolemic hyponatremia.
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Affiliation(s)
- Talia Diker-Cohen
- Medicine A, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St, 49100, Petah-Tikva, Israel.
| | - Benaya Rozen-Zvi
- Department of Nephrology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Yelin
- Medicine A, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St, 49100, Petah-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Akirov
- Institute of Endocrinology, Diabetes and Metabolism, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Robenshtok
- Institute of Endocrinology, Diabetes and Metabolism, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Medicine A, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St, 49100, Petah-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Medicine A, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St, 49100, Petah-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shepshelovich D, Yelin D, Gafter-Gvili A, Goldman S, Avni T, Yahav D. Comparison of reporting phase III randomized controlled trials of antibiotic treatment for common bacterial infections in ClinicalTrials.gov and matched publications. Clin Microbiol Infect 2018; 24:1211.e9-1211.e14. [PMID: 29454846 DOI: 10.1016/j.cmi.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/06/2018] [Accepted: 02/10/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Discrepancies between ClinicalTrials.gov entries and matching publications were previously described in general medicine. We aimed to evaluate the consistency of reporting in trials addressing systemic antibiotic therapy. METHODS We searched ClinicalTrials.gov for completed phase III trials comparing antibiotic regimens until May 2017. Matched publications were identified in PubMed. Two independent reviewers extracted data and identified inconsistencies. Reporting was assessed among studies started before and after 1 July 2005, when the International Committee of Medical Journal Editors (ICMJE) required mandatory registration as a prerequisite for considering a trial for publication. RESULTS Matching publications were identified for 75 (70%) of 107 ClinicalTrials.gov entries. Median time from study completion to publication was 26 months (interquartile range 19-42). Primary outcome definition was inconsistent between ClinicalTrials.gov and publications in seven trials (7/72, 10%) and reporting of the primary outcome timeframe was inconsistent in 14 (14/71, 20%). Secondary outcomes definitions were inconsistent in 36 trials (36/66, 55%). Reporting of inclusion criteria and study timeline were inconsistent in 17% (13/65) and 3% (2/65), respectively. Trials started after July 2005 were significantly less likely to have reporting inconsistencies and were published in higher impact factor journals. CONCLUSIONS We found a lower inconsistency rate of outcome reporting compared with other medical disciplines. Reporting completeness and consistency were significantly better after July 2005. The ICMJE requirement for mandatory registration was associated with significant improvement in reporting quality in infectious diseases trials. Prolonged time lag to publication and missing data from unpublished trials should raise a discussion on current reporting and publishing procedures.
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Affiliation(s)
- D Shepshelovich
- Medicine A, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - D Yelin
- Medicine A, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - A Gafter-Gvili
- Medicine A, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - S Goldman
- Department of Nephrology and Hypertension, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - T Avni
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - D Yahav
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel.
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Shepshelovich D, Yelin D, Bach LO, Halevy N, Ziv Y, Green H, Rozen-Zvi B, Ben-Zvi H, Bishara J, Gafter-Gvili A, Yahav D. Chills During Hemodialysis: Prediction and Prevalence of Bacterial Infections - A Retrospective Cohort Study. Am J Med 2017; 130:477-481. [PMID: 27993572 DOI: 10.1016/j.amjmed.2016.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule. METHODS We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection. RESULTS Overall, 269 hemodialysis patients with a first episode of chills were included. Ninety patients (33.5%) had bacteremia and 162 (60.2%) had an infection. Risk factors for bacteremia in multivariate analysis included fever (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009) and vascular catheter as dialysis access (OR 6.2; 95% CI, 3.2-12.0, P <.001). Leukocytosis was an additional risk factor in multivariate analysis for any type of infection (OR 1.265; 95% CI, 1.113-1.438; P <.001). Using a prediction model to evaluate patients without obvious source of infection, we found that patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, had a low rate (1/17, 6%) of bacteremia. CONCLUSIONS Hemodialysis patients presenting with chills during dialysis, with or without fever, have high rates (∼60%) of infection. Patients with no obvious source of infection, with fistula or graft as access, presenting without fever, leukocytosis, or hypoalbuminemia have low risk for bacteremia and may be investigated without prompt antibiotic treatment. All other patients should receive antibiotic coverage immediately following a chills episode.
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Affiliation(s)
- Daniel Shepshelovich
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dana Yelin
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Lior Or Bach
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Noy Halevy
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yonatan Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Hefziba Green
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Benaya Rozen-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Haim Ben-Zvi
- Laboratory of Clinical Microbiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Anat Gafter-Gvili
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
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Viny AD, Ott CJ, Spitzer B, Rivas M, Meydan C, Papalexi E, Yelin D, Shank K, Reyes J, Chiu A, Romin Y, Boyko V, Thota S, Maciejewski JP, Melnick A, Bradner JE, Levine RL. Dose-dependent role of the cohesin complex in normal and malignant hematopoiesis. J Exp Med 2015; 212:1819-32. [PMID: 26438361 PMCID: PMC4612085 DOI: 10.1084/jem.20151317] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/04/2015] [Indexed: 01/18/2023] Open
Abstract
Cohesin complex members have recently been identified as putative tumor suppressors in hematologic and epithelial malignancies. The cohesin complex guides chromosome segregation; however, cohesin mutant leukemias do not show genomic instability. We hypothesized that reduced cohesin function alters chromatin structure and disrupts cis-regulatory architecture of hematopoietic progenitors. We investigated the consequences of Smc3 deletion in normal and malignant hematopoiesis. Biallelic Smc3 loss induced bone marrow aplasia with premature sister chromatid separation and revealed an absolute requirement for cohesin in hematopoietic stem cell (HSC) function. In contrast, Smc3 haploinsufficiency increased self-renewal in vitro and in vivo, including competitive transplantation. Smc3 haploinsufficiency reduced coordinated transcriptional output, including reduced expression of transcription factors and other genes associated with lineage commitment. Smc3 haploinsufficiency cooperated with Flt3-ITD to induce acute leukemia in vivo, with potentiated Stat5 signaling and altered nucleolar topology. These data establish a dose dependency for cohesin in regulating chromatin structure and HSC function.
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Affiliation(s)
- Aaron D Viny
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065 Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Christopher J Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215 Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Barbara Spitzer
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Martin Rivas
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Cem Meydan
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Efthymia Papalexi
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Dana Yelin
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065 Department of Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikvah 49100, Israel
| | - Kaitlyn Shank
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Jaime Reyes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
| | - April Chiu
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Yevgeniy Romin
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Vitaly Boyko
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Swapna Thota
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Ari Melnick
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065
| | - James E Bradner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215 Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Ross L Levine
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065 Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065 Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Department of Pathology, Molecular Cytology Core Facility, and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065
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Viny AD, Ott CJ, Spitzer B, Rivas M, Meydan C, Papalexi E, Yelin D, Shank K, Reyes J, Chiu A, Romin Y, Boyko V, Thota S, Maciejewski JP, Melnick A, Bradner JE, Levine RL. Dose-dependent role of the cohesin complex in normal and malignant hematopoiesis. J Biophys Biochem Cytol 2015. [DOI: 10.1083/jcb.2111oia226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Endoscopic imaging below tissue surfaces and through turbid media may provide improved diagnostic capabilities and visibility in surgical settings. Spectrally encoded endoscopy (SEE) is a recently developed method that utilizes a single optical fiber, miniature optics and a diffractive grating for high-speed imaging through small diameter, flexible endoscopic probes. SEE has also been shown to provide three-dimensional topological imaging capabilities. In this paper, we have configured SEE to additionally image beneath tissue surfaces, by increasing the system's sensitivity and acquiring the complex spectral density for each spectrally resolved point on the sample. In order to demonstrate the capability of SEE to obtain subsurface information, we have utilized the system to image a resolution target through intralipid solution, and conduct volumetric imaging of a mouse embryo and excised human middle-ear ossicles. Our results demonstrate that real-time subsurface imaging is possible with this miniature endoscopy technique.
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Affiliation(s)
- D Yelin
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel.
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Abstract
Imaging large tissue areas with microscopic resolution in vivo may offer an alternative to random excisional biopsy. We present an approach for performing confocal imaging of large tissue surface areas using spectrally encoded confocal microscopy (SECM). We demonstrate a single-optical-fiber SECM apparatus, designed for imaging luminal organs, that is capable of imaging with a transverse resolution of 2.1 microm over a subsurface area of 16 cm2 in less than 1 min. Due to the unique probe configuration and scanning geometry, the speed and resolution of this new imaging technology are sufficient for comprehensively imaging large tissues areas at a microscopic scale in times that are appropriate for clinical use.
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Affiliation(s)
- D Yelin
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA 02114, USA
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Yelin D, Rizvi I, White WM, Motz JT, Hasan T, Bouma BE, Tearney GJ. Three-dimensional miniature endoscopy. Nature 2006; 443:765. [PMID: 17051200 DOI: 10.1038/443765a] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 09/14/2006] [Indexed: 02/03/2023]
Affiliation(s)
- D Yelin
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Abstract
We present a novel heterodyne approach for performing fast, three-dimensional spectrally encoded imaging. Volumetric data of a volunteer's finger and of coin surfaces were acquired at a rate of 5 volume sets per second with a depth resolution of 145 microm.
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Affiliation(s)
- D Yelin
- Harvard Medical School, Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, BAR 703, Boston, Massachusetts 02114, USA.
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25
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Abstract
Endoscopes employing a single optical fiber may have advantages over conventional fiber-bundle or CCD array imaging techniques, including the potential for greater flexibility and miniaturization. Although single-mode fibers can provide superior resolution compared with multimode fibers, they are prone to increased speckle noise and suffer from limited optical throughput and reduced depth of field. We demonstrate the use of a double-clad fiber for single-mode illumination and multimode detection to achieve high-resolution, reduced-speckle imaging with high optical throughput and a large depth of field.
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Affiliation(s)
- D Yelin
- Harvard Medical School, Wellman Center for Photomedicine, Pathology Department, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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26
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Abstract
A method for three-dimensional surface measurements with phase-sensitive spectrally encoded imaging is demonstrated. Both transverse and depth information is transmitted through a single-mode optical fiber, allowing this scheme to be incorporated into a miniature probe. This approach is demonstrated by measurement of the profile of a lens surface and by three-dimensional imaging of the face of a small doll.
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Affiliation(s)
- D Yelin
- Harvard Medical School, Wellman Laboratories of Photomedicine, Massachusetts General Hospital, 55 Fruit Street, BAR 703, Boston, Massachusetts 02114, USA.
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Abstract
A laser scanning microscope using third-harmonic generation as a probe is shown to produce high-resolution images of transparent biological specimens. Third harmonic light is generated by a tightly focused short-pulse laser beam and collected point-by-point to form a digital image. Demonstrations with two biological samples are presented. Live neurons in a cell culture are imaged with clear and detailed images, including organelles at the threshold of optical resolution. Internal organelles of yeast cells are also imaged, demonstrating the ability of the technique for cellular and intracellular imaging.
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Abstract
A practical adaptive method for femtosecond optical pulse compression is demonstrated experimentally for the first time to our knowledge. The method is robust and capable of handling the general case of pulse compression, in which the input pulses are completely uncharacterized or partially characterized.
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