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Yousaf M, Almughalles S, Rehman S, Jamal W, Abusriwil H, Alhariri B. Mass-like pleural thickening in sarcoidosis. Qatar Med J 2024; 2024:13. [PMID: 38680406 PMCID: PMC11046130 DOI: 10.5339/qmj.2024.qitc.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Muhammad Yousaf
- Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine - Qatar, Cornell University, Doha, Qatar
| | | | - Saad Rehman
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Wasim Jamal
- Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine - Qatar, Cornell University, Doha, Qatar
| | - Hatem Abusriwil
- Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bassem Alhariri
- Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine - Qatar, Cornell University, Doha, Qatar
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A Elrayess M, T Zedan H, A Alattar R, Abusriwil H, Al-Ruweidi MKAA, Almuraikhy S, Parengal J, Alhariri B, Yassine HM, A Hssain A, Nair A, Al Samawi M, Abdelmajid A, Al Suwaidi J, Omar Saad M, Al-Maslamani M, Omrani AS, Yalcin HC. Soluble ACE2 and angiotensin II levels are modulated in hypertensive COVID-19 patients treated with different antihypertension drugs. Blood Press 2022; 31:80-90. [PMID: 35548940 DOI: 10.1080/08037051.2022.2055530] [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] [Indexed: 11/02/2022]
Abstract
PURPOSE This study examines the effect of antihypertensive drugs on ACE2 and Angiotensin II levels in hypertensive COVID-19 patients. INTRODUCTION Hypertension is a common comorbidity among severe COVID-19 patients. ACE2 expression can be modulated by antihypertensive drugs such as ACEis and ARBs, which may affect COVID-19's prognosis. BB and CCB reduce mortality, according to some evidence. Their effect on circulating levels of ACE2 and angiotensin II, as well as the severity of COVID-19, is less well studied. MATERIALS AND METHODS The clinical data were collected from 200 patients in four different antihypertensive medication classes (ACEi, ARB, BB, and CCB). Angiotensin II and ACE2 levels were determined using standard ELISA kits. ACE2, angiotensin II, and other clinical indices were evaluated by linear regression models. RESULTS Patients on ACEi (n = 57), ARB (n = 68), BB (n = 15), or CCB (n = 30) in this study had mild (n = 76), moderate (n = 76), or severe (n = 52) COVID-19. ACE2 levels were higher in COVID-19 patients with severe disease (p = 0.04) than mild (p = 0.07) and moderate (p = 0.007). The length of hospital stay is correlated with ACE2 levels (r = 0.3, p = 0.003). Angiotensin II levels decreased with severity (p = 0.04). Higher ACE2 levels are associated with higher CRP and D-dimer levels. Elevated Angiotensin II was associated with low levels of CRP, D-dimer, and troponin. ACE2 levels increase with disease severity in patients taking an ARB (p = 0.01), patients taking ACEi, the degree of disease severity was associated with a decrease in angiotensin II. BB patients had the lowest disease severity. CONCLUSION We found different levels of soluble ACE2, and angiotensin II are observed among COVID-19 patients taking different antihypertensive medications and exhibiting varying levels of disease severity. COVID-19 severity increases with elevated ACE2 levels and lower angiotensin II levels indicating that BB treatment reduces severity regardless of levels of ACE2 and angiotensin II.
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Affiliation(s)
| | - Hadeel T Zedan
- Biomedical Research Center, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Rand A Alattar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Hatem Abusriwil
- Department of Internal Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Jabeed Parengal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.,Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bassem Alhariri
- Department of Internal Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Ali A Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| | - Arun Nair
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.,Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Musaed Al Samawi
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.,Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Alaaeldin Abdelmajid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.,Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Muna Al-Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.,Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali S Omrani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.,Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Omrani AS, Zaqout A, Baiou A, Daghfal J, Elkum N, Alattar RA, Bakdach D, Abusriwil H, Mostafa AM, Alhariri B, Ambra N, Khatib M, Eldeeb AM, Merenkov Z, Fawzi Z, Hmissi SM, Hssain AA, Coyle PV, Alsoub H, Almaslamani MA, Alkhal A. Convalescent plasma for the treatment of patients with severe coronavirus disease 2019: A preliminary report. J Med Virol 2020; 93:1678-1686. [PMID: 32965715 PMCID: PMC7537323 DOI: 10.1002/jmv.26537] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 07/08/2020] [Revised: 08/10/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role of convalescent plasma therapy for patients with coronavirus disease 2019 (COVID-19) is unclear. METHODS We retrospectively compared outcomes in a cohort of critical COVID-19 patients who received standard care (SC Group) and those who, in addition, received convalescent plasma (CP Group). RESULTS In total, 40 patients were included in each group. The median patient age was 53.5 years (interquartile range [IQR] 42-60.5), and the majority of patients required invasive ventilation (69, 86.2%). Plasma was harvested from donors after a median of 37 days (IQR 31-46) from the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result and 26 days (IQR 21-32) after documented viral clearance; it was administered after a median of 10 days (IQR 9-10) from the onset of symptoms and 2.5 days (IQR 2-4) from admission to intensive care unit. The primary endpoint of improvement in respiratory support status within 28 days was achieved in 26 patients (65%) in the SC Group and 31 patients (77.5%) in the CP Group (p = .32). The 28-day all-cause mortality (12.5% vs. 2.5%; p = .22) and viral clearance (65% vs. 55%; p = .49) were not significantly different between the two groups. Convalescent plasma was not significantly associated with the primary endpoint (adjusted hazard ratio 0.87; 95% confidence interval 0.51-1.49; p = .62). Adverse events were balanced between the two study groups. CONCLUSION In severe COVID-19, convalescent plasma therapy was not associated with clinical benefits. Randomized trials are required to confirm our findings.
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Affiliation(s)
- Ali S Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Zaqout
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Anas Baiou
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Joanne Daghfal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Naser Elkum
- Research Department, Sidra Medical, Doha, Qatar
| | - Rand A Alattar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Dana Bakdach
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| | - Hatem Abusriwil
- Department of Internal Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdalrahman M Mostafa
- Department of Internal Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bassem Alhariri
- Department of Internal Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Naseem Ambra
- Department of Internal Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Khatib
- Critical Care and Pulmonary Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ali M Eldeeb
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Zeyd Merenkov
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zeinab Fawzi
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Saloua M Hmissi
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali A Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| | - Peter V Coyle
- Division of Virology, Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Alsoub
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Muna A Almaslamani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Abdullatif Alkhal
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
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Abstract
PURPOSE OF REVIEW Alpha-1-antitrypsin deficiency is a relatively common genetic disease that predisposes to the development of early-onset emphysema and, in some instances, liver disease. The use of alpha-1-antitrypsin replacement therapy in the treatment of alpha-1-antitrypsin deficiency related emphysema is much debated and the purpose of this review is to examine the results of recent studies. We will comment briefly on the pathogenesis and epidemiology of the disease together with new therapeutic approaches currently under intense research. RECENT FINDINGS Several nonrandomized observational studies and one meta-analysis on the clinical effectiveness of alpha-1-antitrypsin replacement treatment showed a favourable result towards reducing forced expiratory volume in 1 s (FEV1) deterioration in alpha-1-antitrypsin-deficient individuals with moderate lung disease or accelerated FEV1 decline. Improved ways of monitoring disease progression, including computed tomography scanning and exacerbations, are being proposed as primary endpoints. Apart from one small randomized, placebo-controlled trial using computed tomography scanning, which showed a trend toward preservation of lung density on scanning with treatment, the literature lacks proof of effectiveness from large randomized trials. SUMMARY There might be a possible, but so far unproven, role of alpha-1-antitrypsin augmentation therapy in reducing the progression of emphysema in subsets of patients with alpha-1-antitrypsin deficiency. Placebo-controlled, randomized clinical trials are required to draw firm conclusions. Recent advances in the understanding of the molecular pathology provide opportunities for development of new therapeutic targets for this genetic disorder.
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Affiliation(s)
- Hatem Abusriwil
- Lung Investigation Unit, Nuffield House, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham, UK
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