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Manolis AA, Manolis TA, Vouliotis A, Manolis AS. Metabolic dysfunction-associated steatotic liver disease and the cardiovascular system. Trends Cardiovasc Med 2025; 35:258-265. [PMID: 39848507 DOI: 10.1016/j.tcm.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/09/2025] [Accepted: 01/09/2025] [Indexed: 01/25/2025]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty-liver disease, is an important and rising health issue with a link with atherosclerotic cardiovascular (CV) disease (CVD), affecting ∼25-30 % of the adults in the general population; in patients with diabetes, its prevalence culminates to ∼70 %; its evolutive form, nonalcoholic steatohepatitis, is estimated to be the main cause of liver transplantation in the future. MASLD is a multisystem disease that affects, besides the liver, extra-hepatic organs and regulatory pathways; it raises the risk of type 2 diabetes mellitus (T2D), CVD, and chronic kidney disease; the disease may also progress to hepatocellular carcinoma. Its diagnosis requires hepatic steatosis and at least one cardiometabolic risk factor and the exclusion of both significant alcohol consumption and other competing causes of chronic liver disease. Beyond CV events, associated metabolic comorbidities comprise obesity (∼50 %), T2D (∼20 %), hyperlipidemia (∼70 %), hypertension (∼40 %), and metabolic syndrome (∼40 %). Among the various clinical events, CV events mostly determine prognosis as they are the leading cause of death in these patients. Regarding management, statins exert beneficial effects in improving liver injury; silybin, derived from Silybum marianum, has some protective effects; lifestyle modification, such as weight loss, dietary changes, physical exercise, and abstention from alcohol use combined with optimal management of comorbidities are most helpful. Bariatric surgery may be an option in persons with MASLD and obesity. Adults with non-cirrhotic MASLD and significant liver fibrosis may be candidates for targeted treatment with resmetirom, which has histological efficacy on steatohepatitis and fibrosis with an acceptable safety and tolerability profile, whereas, no MASLD-targeted pharmacotherapy can be beneficial in the cirrhotic stage, whereby other measures may include metabolic drugs, nutritional counseling, surveillance for portal hypertension and hepatocellular carcinoma, and finally, liver transplantation in decompensated cirrhosis.
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Affiliation(s)
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital. Athens, Greece
| | | | - Antonis S Manolis
- Department of Cardiology, Euroclinic Hospital, Athens, Greece; First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Zurob S, Brown A, Billion T, Aslam MN, Tauseef A, Mirza M, Abdul Jabbar AB. Regional Trends in Inflammatory Bowel Disease-Related Mortality in the US from 1999 to 2022. Clin Exp Gastroenterol 2025; 18:55-66. [PMID: 40297243 PMCID: PMC12036685 DOI: 10.2147/ceg.s513012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 04/12/2025] [Indexed: 04/30/2025] Open
Abstract
Purpose Inflammatory bowel disease (IBD) is a grouping of chronic inflammatory diseases of the gastrointestinal tract that affects upwards of 2.4 million Americans. Despite its prevalence, the exact cause remains unknown. This study aims to identify geographical differences in IBD-related mortality. Patients and Methods We utilized Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. IBD-related death and population size data over the span of 1999 to 2022 was extracted. Data was stratified by United States census regions, place of death, and gender. Crude and age-adjusted mortality rates (AAMR) were calculated and trends in mortality were modeled using the Join-point Regression Program, with statistically significant outcomes (p-value ≤ 0.05) denoted via an asterisk (*). Results During the interval from 1999 to 2022, there were a total of 71,628 deaths due to Inflammatory Bowel Disease (IBD) in the United States. All census regions showed an increase in AAMR over the study period. The Midwest had the highest AAMRs with 1.54 (95% CI 1.42 to 1.65) in 1999 and rising to 1.99 (95% CI 1.87 to 2.11) in 2022 with an AAPC of 1.57 (95% CI 0.75 to 2.14)* and an APC of 9.83 (95% CI 3.43 to 21.10)* from 2018 to 2022. More specifically, Midwestern males displayed the highest AAMR with 1.74 (95% CI 1.54 to 1.94) in 1999 and 2.09 (95% CI 1.9 to 2.27) in 2022, and an APC of 8.50 (95% CI 2.254 to 19.40)* between 2018 and 2022. Conclusion Persistent regional differences were seen in IBD mortality, with the Midwest having the highest AAMR and Southern states exhibiting the greatest regional increase in AAMR over the past two decades. IBD mortality worsened across all regions during the period of the COVID-19 pandemic.
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Affiliation(s)
- Saif Zurob
- School of Medicine, Creighton University, Omaha, NE, 68178, USA
| | - Alexandra Brown
- School of Medicine, Creighton University, Omaha, NE, 68178, USA
| | - Taylor Billion
- School of Medicine, Creighton University, Omaha, NE, 68178, USA
| | | | - Abubakar Tauseef
- Department of Internal Medicine, Creighton University, Omaha, NE, 68178, USA
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University, Omaha, NE, 68178, USA
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Taylor J, George E, Cunliffe A. Hypoglycemia Secondary to Intentional Insulin Poisoning Managed With Intravenous Hydrocortisone. JCEM CASE REPORTS 2025; 3:luaf041. [PMID: 40110567 PMCID: PMC11920697 DOI: 10.1210/jcemcr/luaf041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Indexed: 03/22/2025]
Abstract
Insulin poisoning, defined as the administration of any dose exceeding therapeutic levels, is a medical emergency that can lead to profound hypoglycemia, resulting in acute and long-term neurological sequalae and death. Current Australian therapeutic guidelines recommend oral or IV glucose as the sole treatment modality for hypoglycemia resulting from insulin poisoning. However, the altered pharmacokinetics of insulin glargine at doses exceeding 0.9 IU/kg can result in prolonged hypoglycemia, often necessitating several days of IV glucose to maintain euglycemia. Although IV glucose is generally considered a benign intervention, its prolonged use can be associated with several adverse effects, including thrombophlebitis, extravasation necrosis, fluid overload, hyponatremia, and glycogenic hepatopathy. To reduce these complications, adjunct therapies such as glucocorticoids, octreotide, glucagon, and surgical excision of subcutaneous insulin deposits have been described in the literature. We report a case of refractory hypoglycemia secondary to insulin poisoning managed with IV hydrocortisone as an adjunctive therapy to IV glucose. To the authors knowledge, this is the first case report describing the use of IV hydrocortisone as a single adjunct in this setting.
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Affiliation(s)
- Jeremy Taylor
- Department of Endocrinology and Diabetes, Barwon Health, Geelong, VIC 3220, Australia
| | - Elizabeth George
- Department of Endocrinology and Diabetes, Barwon Health, Geelong, VIC 3220, Australia
| | - Anna Cunliffe
- Department of Endocrinology and Diabetes, Barwon Health, Geelong, VIC 3220, Australia
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Aktemur MR, Songur Kodik M, Capar Aktemur FN, Aksay E, Ersel M. Comparative evaluation of HEART, T-MACS, and HE-MACS scores for risk stratification and management of patients with chest pain in the emergency department. Medicine (Baltimore) 2025; 104:e41432. [PMID: 39928787 PMCID: PMC11813012 DOI: 10.1097/md.0000000000041432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 01/13/2025] [Accepted: 01/16/2025] [Indexed: 02/12/2025] Open
Abstract
This study evaluated the effectiveness of history, electrocardiogram, age, risk factors, and troponin (HEART), troponin-only Manchester acute coronary syndromes (T-MACS), and history and electrocardiogram-only Manchester acute coronary syndromes (HE-MACS) in diagnosing and managing acute coronary syndrome in patients presenting with chest pain in the emergency department. These scoring systems are crucial for risk stratification and the prediction of major adverse cardiac events (MACEs) and mortality within 30 days. A single-center prospective analytical study was conducted following the STROBE guidelines, with 560 patients presenting with chest pain or ischemic equivalent symptoms at the Ege University Faculty of Medicine Hospital from August 2020 to March 2021. The HEART, T-MACS, and HE-MACS scores were calculated for each patient, and their predictive values for MACE and mortality were analyzed using receiver operating characteristic analysis. The HEART score demonstrated an area under the curve (AUC) of 0.929 for predicting mortality, with 100% sensitivity and 81% specificity. It has been identified as the most reliable predictor of mortality. The T-MACS score showed an AUC of 0.875 for mortality prediction with 85.7% sensitivity and 83.9% specificity. It is particularly effective for high-risk patients, predicting 30-day MACE development rates, which is consistent with the literature. The HE-MACS score yielded an AUC of 0.729 for mortality prediction, with 71.4% sensitivity and 80.7% specificity. Although it effectively excludes MACE in very-low-risk patients, it is limited by its application to a highly isolated group. The discussion interprets the results and compares them with existing literature. The study confirms the high effectiveness of the HEART score in mortality risk assessment, the specificity of the T-MACS score for high-risk patients, and the utility of the HE-MACS score for excluding very-low-risk cases. The limitations of each scoring system are discussed and recommendations for their application in clinical practice are provided. The study concluded that selecting the most appropriate scoring system based on individual patient characteristics is essential for optimal patient management in the emergency department. For optimal patient management, it is essential to select the most appropriate scoring system based on the individual patient characteristics.
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Affiliation(s)
- Mehmet Ragip Aktemur
- Department of Emergency Medicine, Ercis Sehit Ridvan Cevik State Hospital, Van, Turkey
| | - Meltem Songur Kodik
- Department of Emergency Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Ersin Aksay
- Department of Emergency Medicine, Medical Point Hospital, Izmir, Turkey
| | - Murat Ersel
- Department of Emergency Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
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Zhang C, Liu J, Zhong Y, Zhang Y, Meng Y, Huang R, Wang H, Liu Y. Deeper affection, more consumptions: consumer decision-making among people with different levels of intimacy-evidence from fNIRS. Cereb Cortex 2025; 35:bhae504. [PMID: 40007050 DOI: 10.1093/cercor/bhae504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 12/20/2024] [Accepted: 12/24/2024] [Indexed: 02/27/2025] Open
Abstract
Consumer decision-making varies according to an individual's relationship with the recipient of the gift. This study used a mock purchase task to investigate consumer decision-making and its underlying neurological mechanisms when purchasing gifts of different prices for recipients with varying levels of intimacy. Functional near-infrared spectroscopy was used to record neural activity during the task. Behavioral results found that the lover group had a much higher purchasing rate than the friend group, particularly when acquiring premium products. Analysis of the functional near-infrared spectroscopy data found that neural activity in the dorsolateral prefrontal cortex and orbitofrontal cortex decreased when items were discounted, with lower activation in the dorsolateral prefrontal cortex in lovers during the purchasing of premium products. Furthermore, we identified significant differences in functional connectivity between the dorsolateral prefrontal cortex and orbitofrontal cortex under different conditions. We compared the support vector machine algorithm and logistic regression, finding that logistic regression better predicts purchasing tendencies based on neuroactivation levels. In our view, a stronger emotional connection leads to a more rewarding experience for consumers when buying premium products. This study reveals the impact of intimate relationships on consumer decision-making and provides guidance for businesses in developing marketing strategies targeted at the lover's market.
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Affiliation(s)
- Chenyu Zhang
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
| | - Jingyue Liu
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
| | - Yifei Zhong
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
| | - Ye Zhang
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
| | - Yujia Meng
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, No. 199 South Chang' an Road, Xi'an, Shaanxi province 710062, China
| | - Rui Huang
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
| | - He Wang
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
- School of Public Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
| | - Yingjie Liu
- School of Psychology and Mental Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
- School of Public Health, North China University of Science and Technology, 21 Bohai avenue, Caofeidian District, Tangshan, Hebei province 063210, China
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Li R, Chen PY, Li HW, Ren L, Cheng Y, Liu LY, Wei LJ, Zeng ZH, Xu WF, Gong ST, Geng LL. The Incidence and Clinical Characteristics of COVID-19 in Children With IBD During the Omicron Wave: A Single-Center Experience in China. Gastroenterol Res Pract 2025; 2025:1868214. [PMID: 39850808 PMCID: PMC11756934 DOI: 10.1155/grp/1868214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 12/31/2024] [Indexed: 01/25/2025] Open
Abstract
Background and Aims: The pandemic of coronavirus disease 2019 (COVID-19) had a major impact on the health of people worldwide, including the pediatric inflammatory bowel disease (PIBD) patients. As no study has investigated the susceptibility and disease course of COVID-19 in PIBD patients after the end of zero-COVID policy in China, we conducted a retrospective cross-sectional study in our center. Methods: A cross-sectional survey enrolling PIBD patients has been completed by online survey, phone, and face-to-face assessment. The demographic data, epidemiological characteristics, clinical manifestations, treatment, and prognosis of the patients were analyzed. Results: PIBD patients represented 55.45% (56/101) of SARS-CoV-2-positive cases between December 1st 2022 and January 31st 2023; 67.86% were male; the mean age was 11.15 ± 3.92 years old. Among the SARS-CoV-2-positive cases, three patients (5.36%) were asymptomatic, and 53 patients (94.64%) had mild symptoms. The main symptoms were fever (92.86%), cough (69.64%), nasal congestion or running nose (35.71%), and sore throat (33.93%). No severe case or deaths were reported. All patients recovered from COVID-19 symptoms within 1 week. We found no significant association between the type of inflammatory bowel disease (IBD) (Crohn's disease, ulcerative colitis, and unclassified) and SARS-CoV-2 infection rates, nor did we observe any correlation between different treatments and the risk of infection. Fifty-one patients were reported to be in close contact with persons confirmed with COVID-19 infection, and out of them, 36 patients test positive for SARS-CoV-2, which is significantly higher than that in patients without exposure to COVID-19 (70.59% vs. 33.33%, p = 0.002). A total of 10 patients were underweight, of which nine patients tested positive for COVID-19 (90% vs. 51.65%, p = 0.048). Meanwhile, unvaccinated patients were also found to be more susceptible to SARS-CoV-2 than vaccinated patients (70.97% vs. 48.48%, p = 0.049). The multivariable analysis showed that patients with moderate/severe activity of IBD were associated with an increased risk of SARS-CoV-2 infection (odds ratio (OR), 1.12; 95% confidence interval (CI), 1.13-8.33, p = 0.028). Conclusions: The incidence of SARS-CoV-2 infection in our center of PIBD patients during the Omicron pandemic was 55.45%. No severity or death case was observed. The incidence was higher in underweight and unvaccinated IBD children. Patients with moderate/severe activity of IBD were at a higher risk of SARS-CoV-2 infection.
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Affiliation(s)
- Rui Li
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Pei-Yu Chen
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Hui-Wen Li
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Lu Ren
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yang Cheng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Li-Ying Liu
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Li-Juan Wei
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zi-Huan Zeng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Wan-Fu Xu
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Si-Tang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Lan-Lan Geng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
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Bucci T, Nabrdalik K, Baratta F, Pastori D, Pignatelli P, Hydes T, Alam U, Violi F, Lip GYH. Risk of Adverse Events in Anticoagulated Patients With Atrial Fibrillation and Nonalcoholic Fatty Liver Disease. J Clin Endocrinol Metab 2024; 110:208-217. [PMID: 38864452 PMCID: PMC11651694 DOI: 10.1210/clinem/dgae394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/15/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The clinical impact of nonalcoholic fatty liver disease (NAFLD) in patients with atrial fibrillation (AF) is still controversial. AIM To evaluate the 1-year risk of all-cause death, thromboembolic events, and bleeding in patients with AF-NAFLD. METHODS Retrospective study with a health research network (TriNetX). Patients with AF on oral anticoagulation (OAC) were categorized according to the presence of NAFLD into 2 groups. The primary outcomes were the 1-year risks of (1) a composite cardiovascular outcome (all-cause death, myocardial infarction, stroke, cardiac arrest, and pulmonary embolism) and (2) a composite hemorrhagic outcome (intracranial hemorrhage and gastrointestinal bleeding). Cox regression analysis before and after propensity score matching was used to estimate hazard ratio (HR) and 95% 95% CI,. Sensitivity analyses investigated the risk associated with cirrhosis, thrombocytopenia, and type of OAC (warfarin vs non-vitamin K antagonist oral anticoagulants (NOACs). RESULTS We identified 22 636 patients with AF-NAFLD (69 ± 12 years, 46.7% females) and 391 014 patients with AF and without liver disease (72 ± 12 years, 42.7% females). NAFLD was associated with a higher risk of composite cardiovascular (HR, 1.54; 95% CI, 1.47-1.61) and hemorrhagic (HR, 1.56; 95% CI, 1.42-1.72) outcomes. This was consistent also for all the single outcomes. Cirrhotic and thrombocytopenic patients with AF-NAFLD showed the highest risks. Compared to patients with AF-NAFLD on NOACs, those on warfarin were associated with a higher risk of cardiovascular and hemorrhagic outcomes. CONCLUSION In patients with AF, NAFLD is associated with a higher 1-year risk of adverse events, with the risk of adverse events progressively increasing from noncirrhotic to cirrhotic and from nonthrombocytopenic to thrombocytopenic patients. NOACs were associated with a better effectiveness and safety profile compared to warfarin.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool L7 8TX, UK
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Katarzyna Nabrdalik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool L7 8TX, UK
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland
| | - Francesco Baratta
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Theresa Hydes
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool L7 8TX, UK
- Diabetes & Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool L69 7ZX, UK
| | - Uazman Alam
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool L7 8TX, UK
- Diabetes & Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool L69 7ZX, UK
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool L7 8TX, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
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Classen JM, Muzalyova A, Römmele C, Nagl S, Ebigbo A, Schnoy E. Antibody Response to SARS-CoV-2 before and after the Third Vaccination in Patients with Inflammatory Bowel Disease. Dig Dis 2024; 43:19-27. [PMID: 39616993 DOI: 10.1159/000542353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 10/27/2024] [Indexed: 12/25/2024]
Abstract
INTRODUCTION Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy might have an increased risk of developing a severe course of SARS-CoV-2 infection. The aim of this study was to investigate the development of antibodies in immunosuppressed patients with IBD compared to a healthy control group and to determine the effect of immunomodulators on the level of anti-SARS-CoV-2 IgG antibody levels before and after a third vaccination against SARS-CoV-2. METHODS This is a single-center study with a retrospective observational design. Seventy-one IBD patients matched by propensity score to 71 healthy employees (control group) were included. Blood was taken from both groups at predetermined times before and after the third booster vaccination. RESULTS All patients with IBD (n = 71, 100%) received immunomodulatory therapy. The mean antibody level before the third vaccination was 1,352.88 U/mL (SD = 1,011.489) in the IBD group and was not lower compared to the control group (p = 0.088). Gender, age, and disease duration had no significant impact on the development of antibody levels. Patients with TNF-alpha blockers had significantly lower antibody titers (p = 0.011) compared to the control group. Patients with integrin inhibitor therapy had significantly higher antibody titers (p = 0.003) than the controls. After the third vaccination, an increase in antibody titers was recorded in all patients in the IBD group. CONCLUSION We recorded an antibody titer in all patients with IBD that was not significantly lower compared to healthy controls despite immunomodulatory therapy. The booster vaccination led to an increase in antibody levels in all patients with IBD.
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Affiliation(s)
| | - Anna Muzalyova
- Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Nagl
- Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Internal Medicine III, University Hospital Augsburg, Augsburg, Germany,
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Vukovic J, Jukic I, Tonkic A. The Challenges in Treating Inflammatory Bowel Diseases During the COVID-19 Pandemic: An Opinion. J Clin Med 2024; 13:7128. [PMID: 39685586 DOI: 10.3390/jcm13237128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/18/2024] [Accepted: 11/22/2024] [Indexed: 12/18/2024] Open
Abstract
The COVID-19 pandemic posed significant challenges in the treatment of chronic diseases, particularly inflammatory bowel diseases (IBDs) such as Crohn's disease and ulcerative colitis. These challenges are multifaceted, encompassing difficulties in maintaining routine care, concerns about the safety of immunosuppressive therapies, disruptions in healthcare delivery, and the complexities of managing IBD in patients who contract COVID-19. This article explores the various obstacles faced in the treatment of IBD during the pandemic and discusses potential strategies to overcome these challenges.
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Affiliation(s)
- Jonatan Vukovic
- Department of Gastroenterology and Hepatology, Internal Clinic, Clinical Hospital Centre Split, Spinciceva 1, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivana Jukic
- Department of Gastroenterology and Hepatology, Internal Clinic, Clinical Hospital Centre Split, Spinciceva 1, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Ante Tonkic
- Department of Gastroenterology and Hepatology, Internal Clinic, Clinical Hospital Centre Split, Spinciceva 1, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
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ALruwaili BF. Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1822. [PMID: 39597007 PMCID: PMC11596216 DOI: 10.3390/medicina60111822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/31/2024] [Accepted: 11/05/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: Hypertensive patients' knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill-Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill-Bone Medication Adherence Scale scores (Spearman's rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18-3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85-5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36-4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.
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Affiliation(s)
- Bashayer Farhan ALruwaili
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
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11
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Vitus ES, Mann S, Lees CW, Jess T, Elmahdi R. A Systematic Review and Meta-Analysis: Adverse Inflammatory Bowel Disease Outcomes Following Acute COVID-19. GASTRO HEP ADVANCES 2024; 4:100581. [PMID: 39926204 PMCID: PMC11803825 DOI: 10.1016/j.gastha.2024.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 10/18/2024] [Indexed: 02/11/2025]
Abstract
Background and Aims Respiratory viral infections have been implicated in the exacerbation of immune-mediated inflammatory diseases such as inflammatory bowel disease (IBD). To understand the impact of early SARS-CoV-2 variants on the risk of adverse IBD outcomes, we aimed to perform a meta-analysis of high-quality studies. Methods Cohort studies investigating adverse IBD outcomes (IBD flares, change in disease activity, change in medication, IBD-related hospitalization, and surgery) following COVID-19 were retrieved from MEDLINE and Embase. The Risk Of Bias In Nonrandomized Studies-of Exposure tool was used to assess risk of bias. Random effects model meta-analysis was used to calculate the hazard ratio (HR) for risk of adverse outcomes. Subgroup analysis was performed to estimate risk of outcomes for ulcerative colitis and Crohn's disease patients. Metaregression was performed for sex and duration of follow-up. Results Of the 3119 identified studies, 5 were included in the meta-analysis. A total of 34,977 IBD patients with COVID-19 and 53,270 IBD patients without recorded COVID-19 infection were identified. Two of the studies showed a high risk of bias. The random effects model did not show a statistically significant increase in the risk of adverse IBD outcomes following COVID infection (HR:1.05 [0.75-1.46]). There was no significant difference in adverse outcomes between Crohn's disease (HR: 0.91 [0.82-1.02]) and ulcerative colitis patients (HR: 0.83 [0.76-0.90]). Neither the proportion of male participants nor the mean duration of follow-up were found to be significant predictors of effect size. Conclusion In this systematic review and meta-analysis, we find that COVID-19 did not increase the risk of adverse IBD outcomes.
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Affiliation(s)
- Evangelin Shaloom Vitus
- Department of Clinical Medicine, PREDICT Center for Molecular Prediction of Inflammatory Bowel Disease, Aalborg University, Copenhagen, Denmark
| | - Simran Mann
- Department of Anesthetics, St Peter’s Hospital, Ashford and St Peter’s NHS Trust, Chertsey, UK
| | - Charlie W. Lees
- Centre for Genomics and Experimental Medicine, University of Edinburgh, Edinburgh, Scotland
- Department of Gastroenterology and Hepatology, the Western General Hospital, Edinburgh, Scotland
| | - Tine Jess
- Department of Clinical Medicine, PREDICT Center for Molecular Prediction of Inflammatory Bowel Disease, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Rahma Elmahdi
- Department of Clinical Medicine, PREDICT Center for Molecular Prediction of Inflammatory Bowel Disease, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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12
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Wu F, Ibarburu GH, Grimes C. The trends and outcomes of inflammatory bowel disease surgery during the COVID-19 pandemic: A retrospective propensity score-matched analysis from a multi-institutional research network. Health Sci Rep 2024; 7:e70107. [PMID: 39355102 PMCID: PMC11439741 DOI: 10.1002/hsr2.70107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 10/03/2024] Open
Abstract
Background and Aims The coronavirus disease 2019 (COVID-19) pandemic has affected the management of inflammatory bowel disease (IBD) patients. Elective operations and surveillance endoscopies were postponed for IBD patients to preserve healthcare resources and to prevent the spread of COVID-19. This study aimed to describe the trends and outcomes of IBD surgery during the pandemic. Methods This was a retrospective propensity score-matched analysis using data extracted from TriNetX, a multi-institutional research database. IBD patients admitted for surgery were identified between March 2019 to February 2020 (prepandemic) and March 2020 to February 2023 (pandemic). The monthly volume of IBD surgical procedures was compared during the pandemic to the prepandemic period. After matching, the risk of adverse outcomes following IBD surgery was compared between the 3 years of the pandemic compared to the prepandemic cohort. Results There was a reduction in both elective and emergency IBD operations during the pandemic. These trends were not significant. After matching, the risks of returning to theaters and hospital readmission were comparable across the 3 years of the pandemic. In the first and second years of the pandemic, elective patients were at a greater risk of mortality (risk ratio [RR], 2; 95% confidence interval [CI], 1.160-3.448 and RR, 1.778; 95% CI, 1.003-3.150, respectively) and the emergency cohort had a higher risk of critical care admission (RR, 1.759; 95% CI, 1.126-2.747 and RR, 1.742; 95% CI, 1.131-2.682, respectively). Conclusion Our study highlights the impact of the COVID-19 pandemic on the management of IBD patients undergoing surgery. These results provide insights into the management of IBD surgery during times of crisis and can help guide decision-making and resource allocation for IBD patients requiring surgical intervention.
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Affiliation(s)
- Fiona Wu
- Department of General Surgery, East Sussex Healthcare NHS TrustConquest Hospital, The RidgeHastingsUK
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13
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Gogtay M, Yadukumar L, Singh Y, Suresh MG, Soni A, Yekula A, Bullappa A, Abraham GM. Retrospective study evaluating association of colorectal tumors and hepatitis C virus. World J Virol 2024; 13:92647. [PMID: 39323450 PMCID: PMC11401003 DOI: 10.5501/wjv.v13.i3.92647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/04/2024] [Accepted: 06/28/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) has been associated with hepatic and extrahepatic malignancies. Limited studies have shown an association between colorectal adenomas and HCV populations. AIM To study the prevalence of colorectal adenomas in patients with HCV compared to the general population and to evaluate if it is an independent risk factor for colorectal adenomas. METHODS Patients were divided into HCV and non-HCV based on their HCV RNA titers. Patients with alcoholic liver disease, hepatitis B infection, and inflammatory bowel disease were excluded. Continuous variables were analyzed using the Mann-Whitney U test, and categorical variables using χ 2 with P < 0.05 were considered statistically significant. The significant covariates (independent variables) were matched in both groups by propensity score matching, followed by multivariate regression analysis. RESULTS Of the 415 patients screened, 109 HCV patients and 97 non-HCV patients with colonoscopy results were included in the study. HCV patients were older, had a smoking history, had less frequent aspirin use, and had a lower body mass index (BMI) (P < 0.05). The HCV cohort had a significantly increased number of patients with adenomas (adenoma detection rate of 53.2% vs 34%. P = 0.006). We performed a propensity-matched multivariate analysis where HCV infection was significantly associated with colorectal adenoma (OR: 2.070, P = 0.019). CONCLUSION Our study shows a significantly higher rate of adenomas in HCV patients compared to the general population. Prospective studies would help determine if the increase in adenoma detection lowers the risk for colorectal cancer.
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Affiliation(s)
- Maya Gogtay
- Department of Hematology and Oncology, Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Lekha Yadukumar
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
| | - Yuvaraj Singh
- Department of Gastroenterology and Hepatology, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Mithil Gowda Suresh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anuroop Yekula
- Department of Internal Medicine, St. Vincent Hospital, Worcester, MA 01608, United States
| | - Asha Bullappa
- Department of Community Medicine, SS Institute of Medical Sciences and Research Centre, Davangere 577003, Karnataka, India
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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14
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Zeb U, Khan NA, Ullah N, Khan MH. Prevalence of Non-ST-Segment Elevation Myocardial Infarction in Acute Coronary Syndrome With Unremarkable Electrocardiogram: A Cross-Sectional Study From Lady Reading Hospital, Medical Teaching Institute, Peshawar. Cureus 2024; 16:e70575. [PMID: 39483937 PMCID: PMC11527507 DOI: 10.7759/cureus.70575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 11/03/2024] Open
Abstract
Introduction Patients admitted to the cardiac care unit with non-ST-segment elevation myocardial infarction frequently have inconclusive electrocardiogram results. In individuals presenting with sudden central chest discomfort, non-ST-segment elevation myocardial infarction should be suspected until confirmed or ruled out by a cardiac biomarker analysis. This study aims to determine the prevalence of non-ST-elevation myocardial infarction among acute coronary syndrome patients who present with normal electrocardiogram findings. Materials and methods This study was conducted from October 24, 2022, to April 24, 2023, and involved 120 patients who came to the cardiac emergency department at Lady Reading Hospital, Peshawar. These patients experienced chest pain and symptoms of acute coronary syndrome, all within 24 hours of the onset of their symptoms. Demographic data and clinical histories were recorded for each patient. Electrocardiograms were performed, and non-ST-segment elevation was observed. The diagnosis of non-ST-segment elevation myocardial infarction was confirmed by measuring cardiac troponin T levels. A threshold value greater than 0.5 ng/mL was considered diagnostic. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics for Windows, Version 23, Armonk, NY), and grammar was checked using the Grammarly software (Grammarly, Inc., San Francisco, CA). Results The study participants had an average age of 53.96 years, with a standard deviation of 8.57. Most participants were male, comprising 65.83% of the total population, while 34.17% were female. Among the participants, 26.66% were diagnosed with non-ST-segment elevation myocardial infarction, affecting 32 individuals. The results showed a significant correlation between the occurrence of non-ST-segment elevation myocardial infarction and male gender, as well as with individuals who had pre-existing comorbidities. The p-values for these associations were 0.032 and 0.043, respectively, indicating statistically significant relationships. Conclusion In conclusion, a significant proportion of patients who presented to the emergency department with acute coronary syndrome symptoms and a normal electrocardiogram were diagnosed with non-ST-segment elevation myocardial infarction. This highlights the need for special attention to male patients and those with comorbidities.
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Affiliation(s)
- Usman Zeb
- Internal Medicine, Lady Reading Hospital, Medical Teaching Institute, Peshawar, PAK
| | - Nisar Ahmad Khan
- Internal Medicine, Lady Reading Hospital, Medical Teaching Institute, Peshawar, PAK
| | - Najeeb Ullah
- Internal Medicine, Lady Reading Hospital, Medical Teaching Institute, Peshawar, PAK
| | - Muhammad Hamza Khan
- General Surgery, Lady Reading Hospital, Medical Teaching Institute, Peshawar, PAK
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15
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Khokhlov L, Siraw B, Ali M, Hussain F, Brown A, Shemisa K. Patients with atrial fibrillation and diabetes mellitus affected by nonalcoholic fatty liver disease have a greater risk of mortality and worse clinical outcomes. Cardiovasc Endocrinol Metab 2024; 13:e0307. [PMID: 38846627 PMCID: PMC11152824 DOI: 10.1097/xce.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/13/2024] [Indexed: 06/09/2024]
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is associated with several adverse clinical outcomes. In this study, we assessed the association between NAFLD and several clinical outcome measures in patients with diabetes mellitus (DM) and atrial fibrillation (AF). Methods We queried the National Inpatient Sample (NIS) between 2016 and 2019 for adult patients who were hospitalized with DM and AF. NAFLD was the independent variable. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay, and total hospital charges. A multivariable logistic regression model was used to estimate odds ratios with a 95% confidence interval (CI) and a P value of less than 0.05 was considered significant. Results There were 6 723 293 hospitalizations with AF and DM and 253 639 (3.7%) had NAFLD. NAFLD and non-NAFLD cohorts had a mean age of 70.4 vs. 73.8 years, respectively. Overall, 55.6% were male and 73.8% were White. NAFLD was found to be significantly associated with in-hospital mortality [adjusted odds ratio (AOR), 4.2; 95% CI, 4.08-4.32], cardiogenic shock (AOR, 4.78; 95% CI, 4.59-4.98), cardiac arrest (AOR, 3.43; 95% CI, 3.27-3.59), GIB (AOR, 1.92; 95% CI, 1.86-1.98), length of stay, and total hospital charges. Conclusion In patients with AF and DM patients, the presence of NAFLD was associated with significantly worse clinical outcomes and higher resource utilization. Adverse cardiovascular events were common as well as GIB. Screening and prevention strategies modifying the risk and disease severity of NAFLD are needed.
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Affiliation(s)
- Leonid Khokhlov
- Department of Internal Medicine, Good Samaritan Hospital, TriHealth, Cincinnati, Ohio
| | - Bekure Siraw
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, Illinois
| | - Mehnaaz Ali
- Department of Internal Medicine, Good Samaritan Hospital, TriHealth, Cincinnati, Ohio
| | - Fatima Hussain
- Department of Internal Medicine, Good Samaritan Hospital, TriHealth, Cincinnati, Ohio
| | - Amanda Brown
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kamal Shemisa
- Department of Internal Medicine, Good Samaritan Hospital, TriHealth, Cincinnati, Ohio
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16
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Bianchi FP, Contaldo A, Polignano MG, Pisani A. Incidence of Severe COVID-19 Outcomes and Immunization Rates in Apulian Individuals with Inflammatory Bowel Disease: A Retrospective Cohort Study. Vaccines (Basel) 2024; 12:881. [PMID: 39204007 PMCID: PMC11359773 DOI: 10.3390/vaccines12080881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 09/03/2024] Open
Abstract
The etiology of Inflammatory Bowel Disease (IBD) is not fully understood but is believed to involve a dysregulated immune response to intestinal microbiota in genetically susceptible individuals. Individuals with IBD are at increased risk of infections due to immunosuppressive treatments, comorbidities, and advanced age. Current evidence indicates that IBD patients are not at higher risk of SARS-CoV-2 infection compared to the general population, though the risk of severe outcomes remains debated. A retrospective observational study was conducted using Apulian regional health data from 2020 to 2022. This study included 1029 IBD patients and 3075 controls, matched by age and sex. COVID-19 incidence, hospitalization, and case fatality rates were analyzed alongside vaccination coverage. No significant differences in COVID-19 incidence (IRR = 0.97), hospitalization (p = 0.218), or lethality (p = 0.271) were evidenced between IBD patients and the general population. Vaccination rates were high in both groups, with slightly higher uptake in IBD patients. Multivariate analysis identified age and male sex as risk factors for severe COVID-19 outcomes, while vaccination significantly reduced hospitalization and lethality risks. IBD patients in Apulia do not have an increased risk of COVID-19 infection or severe outcomes compared to the general population. Vaccination is crucial in protecting IBD patients, and ongoing efforts to promote vaccination within this population are essential. Future research should focus on the impact of specific IBD treatments on COVID-19 outcomes and the long-term effectiveness of vaccines.
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Affiliation(s)
| | - Antonella Contaldo
- National Institute of Gastroenterology, IRCCS S. De Bellis, Research Hospital, 70013 Castellana Grotte, Italy (M.G.P.); (A.P.)
| | - Maurizio Gaetano Polignano
- National Institute of Gastroenterology, IRCCS S. De Bellis, Research Hospital, 70013 Castellana Grotte, Italy (M.G.P.); (A.P.)
| | - Antonio Pisani
- National Institute of Gastroenterology, IRCCS S. De Bellis, Research Hospital, 70013 Castellana Grotte, Italy (M.G.P.); (A.P.)
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17
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Tsai TY, Wu JF, Weng MT, Chuang CH, Huang TY, Tai WC, Tai CM, Chung CS, Chen CC, Lin CP, Tsai YY, Wei SC. Exacerbated gastrointestinal symptoms and long COVID in IBD patients with SARS-CoV-2 infection: A multi-center study from taiwan. J Formos Med Assoc 2024; 123:866-874. [PMID: 38553294 DOI: 10.1016/j.jfma.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND/PURPOSE Limited studies have addressed the exacerbation of symptoms and long COVID in inflammatory bowel disease (IBD) patients following non-severe COVID-19 infection, particularly with post-COVID-19 vaccination. We aim to investigate factors associated with exacerbated gastrointestinal symptoms (EGS) and long COVID in IBD patients with non-severe COVID-19, which is most common situation in daily practice. METHODS This is an observational study by multiple centers in Taiwan from May 2020 to March 2023. We collected clinical manifestation, data, and medication information from IBD patients with non-severe COVID-19. EGS was defined as increased frequency of diarrhea, bloody stool, and abdomen pain within 14 days after SARS-COV-2 infection. Long COVID was defined following the guidelines of the World Health Organization. RESULTS Out of 90 patients, most of them (88.9%) received at least standard two doses of COVID-19 vaccination and the majority (87.8%) were mild diseases of COVID-19.30% of patients experienced EGS during COVID-19 with higher ESR levels serving as a predictive factor (Odds ratio: 3.6, 95% confidence interval: 1.2-10.5, P = 0.02). 38.1% of those patients developed long COVID. The patients who experienced EGS during COVID-19 and with a history of longer IBD duration showed a significant association with long COVID (p = 0.03 and p = 0.02). CONCLUSION Our study revealed that EGS and long COVID occurred in one third of IBD patients with non-severe COVID-19, even though most of them had received the standard plus booster vaccination. We identified associated factors for EGS and long COVID, emphasizing the importance of post-COVID-19 follow-up in IBD patients.
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Affiliation(s)
- Tsung-Yu Tsai
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Center for Translational Genomics & Regenerative Medicine Research, China Medical University Hospital, Taichung, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Tzu Weng
- Department of Medical Research, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan; Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiao-Hsiung Chuang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chen Tai
- Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi-Ming Tai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chen-Shuan Chung
- Division for Gastroenterology and Hepatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Cheng Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Pin Lin
- Division of Gastroenterology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shu-Chen Wei
- Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan.
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18
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Long MD, Parlett L, Lewis JD, Haynes K, Adimadhyam S, Hou L, Wolfe A, Toh S, Burris J, Dorand J, Kappelman MD. Corticosteroids but not Anti-TNF Are Associated With Increased COVID-19 Complications in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2024; 30:1345-1352. [PMID: 37611117 DOI: 10.1093/ibd/izad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS Immunosuppressed individuals are at higher risk for COVID-19 complications, yet data in patients with inflammatory bowel disease (IBD) are limited. We evaluated the risk of COVID-19- severe sequelae by medication utilization in a large cohort of patients with IBD. METHODS We conducted a retrospective cohort study utilizing insurance claims data between August 31, 2019, and August 31, 2021.We included IBD patients identified by diagnosis and treatment codes. Use of IBD medications was defined in the 90 days prior to cohort entry. Study outcomes included COVID-19 hospitalization, mechanical ventilation, and inpatient death. Patients were followed until the outcome of interest, outpatient death, disenrollment, or end of study period. Due to the aggregate nature of available data, we were unable to perform multivariate analyses. RESULTS We included 102 986 patients (48 728 CD, 47 592 UC) with a mean age of 53 years; 55% were female. Overall, 412 (0.4%) patients were hospitalized with COVID-19. The incidence of hospitalization was higher in those on corticosteroids (0.6% vs 0.3%; P < .0001; 13.6 per 1000 person-years; 95% confidence interval [CI], 10.8-16.9) and lower in those receiving anti-tumor necrosis factor α therapy (0.2% vs 0.5%; P < .0001; 3.9 per 1000 person-years; 95% CI, 2.7-5.4). Older age was associated with increased hospitalization with COVID-19. Overall, 71 (0.07%) patients required mechanical ventilation and 52 (0.05%) died at the hospital with COVID-19. The proportion requiring mechanical ventilation (1.9% vs 0.05%; P < .0001; 3.9 per 1000 person-years; 95% CI, 2.5-5.9) was higher among users of corticosteroids. CONCLUSIONS Among patients with IBD, those on corticosteroids had more hospitalizations and mechanical ventilation with COVID-19. Anti-tumor necrosis factor α therapy was associated with a decreased risk of hospitalization. These findings reinforce previous guidance to taper and/or discontinue corticosteroids in IBD.
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Affiliation(s)
- Millie D Long
- Department of Medicine and Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - James D Lewis
- Department of Medicine, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sruthi Adimadhyam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Laura Hou
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Audrey Wolfe
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | - Michael D Kappelman
- Department of Medicine and Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Naseem K, Sohail A, Quang Nguyen V, Khan A, Cooper G, Lashner B, Katz J, Cominelli F, Regueiro M, Mansoor E. Predictors of Hospital-related Outcomes of COVID-19 Infection in Patients With Inflammatory Bowel Disease in the Early Pandemic Phase: A Nationwide Inpatient Database Survey. Inflamm Bowel Dis 2024; 30:1334-1344. [PMID: 37725039 PMCID: PMC11519050 DOI: 10.1093/ibd/izad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at higher risk for severe COVID-19 infection. However, most studies are single-center, and nationwide data in the United States are lacking. This study aimed to investigate hospital-related outcomes and predictors of these outcomes in patients with IBD and COVID-19 infection. METHODS The National Inpatient Sample and National Readmission database were queried for all the patient hospitalizations with IBD with concurrent COVID-19 in the study group and non-COVID-19 related hospitalizations in the control group. For patients under 18 years, elective and trauma-related hospitalizations were excluded. Primary outcomes included mortality, septic shock, mechanical ventilation, and intensive care utilization. Secondary outcomes included length of stay and total hospitalization costs. RESULTS From this query, 8865 adult patients with IBD and COVID-19 were identified. These patients were relatively older (62.8 vs 57.7 years, P < .01), and the majority were females (52.1% with COVID-19 vs 55.2% without COVID-19). Patients with IBD and COVID-19 had higher mortality (12.24% vs 2.55%; P < .01), increased incidence of septic shock (7.9% vs 4.4%; P < .01), mechanical ventilation (11.5% vs 3.7%; P < .01), and intensive care utilization (12% vs 4.6%; P < .01). These patients also had higher mean length of stay (8.28 days vs 5.47 days; P < .01) and total hospitalization costs ($21 390 vs $16 468; P < .01) than those without COVID-19 infection. CONCLUSIONS Patients with IBD and COVID-19 have worse outcomes, with a higher incidence of severe COVID-19 disease, leading to higher mortality rates, longer lengths of stay, and increased total hospitalization costs. Encouraging preventive health measures and treating promptly with advanced COVID-19 therapies may improve outcomes and decrease the healthcare burden.
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Affiliation(s)
| | - Abdullah Sohail
- The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Ahmad Khan
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Jeffry Katz
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Emad Mansoor
- Case Western Reserve University, Cleveland, OH, USA
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20
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Wu J, Fang Y, Bai B, Wu Y, Liu Q, Hu J, Hu N, Mei Q, Han W. Clinical characteristics and the risk factors for the exacerbation of symptoms in patients with inflammatory bowel disease during the COVID-19 pandemic. Front Med (Lausanne) 2024; 11:1404880. [PMID: 38903816 PMCID: PMC11188298 DOI: 10.3389/fmed.2024.1404880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 06/22/2024] Open
Abstract
Background In 2023, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant caused a large-scale outbreak of coronavirus disease 2019 (COVID-19) in China. It is not clear the risk factors that lead to the exacerbation of symptoms in patients with inflammatory bowel disease (IBD) after COVID-19 infection. Our study aims to find out the risk factors for the exacerbation of IBD-related symptoms in IBD patients with COVID-19 infection and to provide guidance for the clinical management of IBD. Methods This is a retrospective, observational study. The online questionnaire was distributed to conduct a survey to collect demographic, clinical, and IBD related characteristics in IBD patients. Univariate and multivariate regression analyses were conducted to assess the independent effects. Results In total, 534 cases of IBD patients were analyzed in our study. Among them, 466 (87.3%) cases diagnosed with COVID-19, 160 (34.3%) cases experienced exacerbation of IBD symptoms, and 84 (18.0%) patients opted for medication discontinuation. Male sex (OR 2.04, 95% CI 1.34-3.49, p = 0.001), and the decrease in body mass index (BMI) (OR 0.93, 95% CI 0.87-1.00, p = 0.035) were positively correlated with the exacerbation of IBD symptoms. Furthermore, the medication discontinuation (OR 2.60, 95% CI 1.58-4.30, p < 0.001) was strongly positively correlated with the exacerbation of IBD symptoms. No significant association was seen between age, comorbidities, smoking, disease activity, vaccination, therapy for COVID-19 and the worsening of IBD symptoms. Conclusion This study confirms that the infection rate of COVID-19 in China IBD patients was comparable to the general population. Male sex, the decrease in BMI and medication discontinuation are significant risk factors for the exacerbation of IBD-related symptoms in IBD patients with COVID-19 infection.
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Affiliation(s)
| | | | | | | | | | | | | | - Qiao Mei
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Han
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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21
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Wang A, Wu J, Yuan X, Liu J, Lu C. A case study of a liver transplant-treated patient with glycogen storage disease type Ia presenting with multiple inflammatory hepatic adenomas: an analysis of clinicopathologic and genetic data. BMC Med Genomics 2024; 17:124. [PMID: 38711024 PMCID: PMC11075316 DOI: 10.1186/s12920-024-01888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Glycogen storage disease (GSD) is a disease caused by excessive deposition of glycogen in tissues due to genetic disorders in glycogen metabolism. Glycogen storage disease type I (GSD-I) is also known as VonGeirk disease and glucose-6-phosphatase deficiency. This disease is inherited in an autosomal recessive manner, and both sexes can be affected. The main symptoms include hypoglycaemia, hepatomegaly, acidosis, hyperlipidaemia, hyperuricaemia, hyperlactataemia, coagulopathy and developmental delay. CASE PRESENTATION Here, we present the case of a 13-year-old female patient with GSD Ia complicated with multiple inflammatory hepatic adenomas. She presented to the hospital with hepatomegaly, hypoglycaemia, and epistaxis. By clinical manifestations and imaging and laboratory examinations, we suspected that the patient suffered from GSD I. Finally, the diagnosis was confirmed by liver pathology and whole-exome sequencing (WES). WES revealed a synonymous mutation, c.648 G > T (p.L216 = , NM_000151.4), in exon 5 and a frameshift mutation, c.262delG (p.Val88Phefs*14, NM_000151.4), in exon 2 of the G6PC gene. According to the pedigree analysis results of first-generation sequencing, heterozygous mutations of c.648 G > T and c.262delG were obtained from the patient's father and mother. Liver pathology revealed that the solid nodules were hepatocellular hyperplastic lesions, and immunohistochemical (IHC) results revealed positive expression of CD34 (incomplete vascularization), liver fatty acid binding protein (L-FABP) and C-reactive protein (CRP) in nodule hepatocytes and negative expression of β-catenin and glutamine synthetase (GS). These findings suggest multiple inflammatory hepatocellular adenomas. PAS-stained peripheral hepatocytes that were mostly digested by PAS-D were strongly positive. This patient was finally diagnosed with GSD-Ia complicated with multiple inflammatory hepatic adenomas, briefly treated with nutritional therapy after diagnosis and then underwent living-donor liver allotransplantation. After 14 months of follow-up, the patient recovered well, liver function and blood glucose levels remained normal, and no complications occurred. CONCLUSION The patient was diagnosed with GSD-Ia combined with multiple inflammatory hepatic adenomas and received liver transplant treatment. For childhood patients who present with hepatomegaly, growth retardation, and laboratory test abnormalities, including hypoglycaemia, hyperuricaemia, and hyperlipidaemia, a diagnosis of GSD should be considered. Gene sequencing and liver pathology play important roles in the diagnosis and typing of GSD.
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Affiliation(s)
- Ao Wang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610000, China
- Department of Pathology, Affiliated Hospital of Panzhihua University, Panzhihua, 617000, China
| | - Jiamei Wu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Xiaohui Yuan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Jianping Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Changli Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610000, China.
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22
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Sahyoun LC, Fetene J, McMillan C, Protiva P, Al Bawardy B, Gaidos JKJ, Proctor D. Impact of COVID-19 Treatment on Real-World Outcomes in Inflammatory Bowel Disease. Dig Dis Sci 2024; 69:1654-1660. [PMID: 38466459 DOI: 10.1007/s10620-024-08355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND While there are multiple safe and effective agents for COVID-19 treatment, their impact in inflammatory bowel disease (IBD) remains uncertain. AIMS Our objective was to assess the effects of these therapies on both IBD and COVID outcomes. METHODS A single-center retrospective study of adult patients with IBD who contracted COVID-19 between 12/2020 and 11/2022 was performed. Patients were stratified by COVID-19 treatment (antivirals and/or intravenous antibodies) vs no therapy. The primary outcome was the development of severe COVID-19 infection, defined by need for supplemental oxygen, corticosteroids and/or antibiotics, or hospitalization. Secondary outcomes included rates of withholding advanced IBD therapy (defined as biologic agents or small molecules) and of post-COVID-19 IBD flare. RESULTS Of 127 patients with COVID-19 infection, 70% were on advanced therapies, 35% received COVID-19 treatment, and 15% developed severe COVID-19. Those treated for COVID-19 were more likely to be on corticosteroids [odds ratio (OR) 4.61, 95% confidence interval (CI) 1.72-12.39, p = 0.002] or advanced IBD therapies (OR 2.78, 95% CI 1.04-7.43, p = 0.041). After adjusting for age, race, sex, corticosteroid use, obesity, COVID-19 vaccination status, and severe COVID-19 infection, those treated for COVID-19 were more likely to have IBD therapy held (OR 6.95, 95% CI 1.72-28.15, p = 0.007). There was no significant difference in rates of post-COVID-19 IBD flares or severe COVID-19 infection. There were no COVID-related deaths. CONCLUSIONS Patients with IBD on advanced therapies were frequently treated for acute COVID-19. Although COVID-19 treatment was associated with temporary withholding of IBD therapy, it did not result in increased IBD flares.
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Affiliation(s)
- Laura C Sahyoun
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Fetene
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Chandler McMillan
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Petr Protiva
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
- VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Badr Al Bawardy
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jill K J Gaidos
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Deborah Proctor
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
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23
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Ruiz MA, Kaiser Junior RL, Piron-Ruiz L, Pinho TS, Castiglioni L, de Quadros LG. COVID-19 impact in Crohn’s disease patients submitted to autologous hematopoietic stem cell transplantation. World J Hematol 2024; 11:89084. [DOI: 10.5315/wjh.v11.i1.89084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/11/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 is the virus responsible for coronavirus disease 2019 (COVID-19), a disease that has been blamed for inducing or exacerbating symptoms in patients with autoimmune diseases. Crohn's disease (CD) is an inflammatory bowel disease that affects genetically susceptible patients who develop an abnormal mucosal immune response to the intestinal microbiota. Patients who underwent hematopoietic stem cell transplantation (HSCT) are considered at risk for COVID-19.
AIM To describe for the first time the impact of COVID-19 in CD patients who had undergone autologous, non-myeloablative HSCT.
METHODS In this descriptive study a series of 19 patients were diagnosed with positive COVID-19. For two patients there were reports of the occurrence of two infectious episodes. Parameters related to HSCT, such as time elapsed since the procedure, vaccination status, CD status before and after infection, and clinical manifestations resulting from COVID-19, were evaluated.
RESULTS Among the patients with COVID-19, three, who underwent Auto HSCT less than six months ago, relapsed and one, in addition to the CD symptoms, started to present thyroid impairment with positive anti-TPO. Only one of the patients required hospitalization for five days to treat COVID-19 and remained in CD clinical remission. Nine patients reported late symptoms that may be related to COVID-19. There were no deaths, and a statistical evaluation of the series of COVID-19 patients compared to those who did not present any infectious episode did not identify significant differences regarding the analyzed parameters.
CONCLUSION Despite the change in CD status in three patients and the presence of nine patients with late symptoms, we can conclude that there was no significant adverse impact concerning COVID-19 in the evaluated patients who underwent HSCT to treat CD.
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Affiliation(s)
- Milton Artur Ruiz
- Department of Bone Marrow Transplantation, Associação Portuguesa de Beneficência, São José do Rio Preto SP 15090 470, Brazil
| | | | - Lilian Piron-Ruiz
- Department of Bone Marrow Transplantation, Beneficência Portuguesa Hospital, São José do Rio Preto 15090 470, São Paulo, Brazil
| | - Tainara Souza Pinho
- Department of Bone Marrow Transplantation, Beneficência Portuguesa Hospital, São José do Rio Preto 15090 470, São Paulo, Brazil
| | - Lilian Castiglioni
- FAMERP, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090 000, São Paulo, Brazil
| | - Luiz Gustavo de Quadros
- Beneficência Portuguesa Hospital, ABC Medical School, São Bernardo 15015 110, São Paulo, Brazil
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24
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Schmidt C, Stallmach A, Sturm A, Bachmann O, Helwig U, Koletzko S, Lynen P, Schnoy E, Dignass A, Kucharzik T, Blumenstein I. [Update: Addendum to S3-Guidelines Crohn disease and ulcerative colitis: Management of Patients with Inflammatory Bowel Disease with regard to COVID-19 (version 2.0)]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:517-534. [PMID: 38599579 DOI: 10.1055/a-2255-7184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Carsten Schmidt
- Medizinischen Klinik II (Gastroenterologie, Hepatologie, Endokrinologie, Diabetologie und Infektiologie), Klinikum Fulda, Universitätsmedizin Marburg-Campus Fulda, Fulda
- Medizinische Fakultät der Friedrich-Schiller-Universität, Jena
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Infektiologie und Hepatologie), Universitätsklinikum Jena, Jena
| | - Andreas Sturm
- Klinik für Innere Medizin, Schwerpunkt Gastroenterologie, DRK Kliniken Berlin | Westend, Berlin
| | - Oliver Bachmann
- Klinik für Innere Medizin 1, Siloah St. Trudpert Klinikum, Pforzheim
| | - Ulf Helwig
- Internistische Praxengemeinschaft Oldenburg, Oldenburg
| | - Sibylle Koletzko
- Ehem. Kinderklinik und Kinderpoliklinik im Dr. von Hauner Kinderspital, LMU Klinikum der Universität München, München
| | - Petra Lynen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
| | - Elisabeth Schnoy
- III. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg
| | - Axel Dignass
- Medizinischen Klinik I, Agaplesion Markus Krankenhaus, Frankfurt
| | - Torsten Kucharzik
- Klinik für Innere Medizin & Gastroenterologie, Klinikum Lüneburg, Lüneburg
| | - Irina Blumenstein
- Goethe-Universität Frankfurt, Universitätsklinikum, Medizinische Klinik 1, Frankfurt am Main
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25
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Li S, Zhang F, Lin R, Sun Q, Qu L, Zhong L. Shared Immune Associations Between COVID-19 and Inflammatory Bowel Disease: A Cross-Sectional Observational Study in Shanghai, China. J Inflamm Res 2024; 17:1929-1940. [PMID: 38558943 PMCID: PMC10981870 DOI: 10.2147/jir.s449746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose The rapid global spread of the SARS-CoV-2 Omicron variant introduces a novel complication: the emergence of IBD (inflammatory bowel disease)-like ulcers in certain patients. This research delves into this new challenge by juxtaposing the clinical manifestations and genetic expression patterns of individuals affected by the Omicron variant of COVID-19 with those diagnosed with IBD. It aims to decode the link between these conditions, potentially shedding light on previously unexplored facets of COVID-19 pathophysiology. This investigation emphasizes gene expression analysis as a key tool to identify wider disease correlations and innovative therapeutic avenues. Patients and Methods From March to December 2022, patients with SARS-CoV-2 Omicron infection and inflammatory bowel disease and healthy controls were recruited in Shanghai East Hospital, Shanghai, China. The epidemiological and clinical characteristics of the patients were compared. Four RNA sequencing datasets (GSE205244, GSE201530, GSE174159, and GSE186507) were extracted from the Gene Expression Omnibus database to detect mutually differentially expressed genes and common pathways in patients with SARS-CoV-2 infection and inflammatory bowel disease. Results Compared to patients with active inflammatory bowel disease, patients with SARS-CoV-2 infection were more likely to have elevated interferon-α levels and an increased lymphocyte count and less likely to have high interleukin-6, tumor necrosis factor-α, and C-reactive protein levels and an elevated neutrophil count. A total of 51 common differentially expressed genes were identified in the four RNA-sequencing datasets. Enrichment analysis suggested that these genes were related to inflammation and the immune response, especially the innate immune response and nucleotide oligomerization domain-like receptor signaling pathway. Conclusion The inflammation and immune-response pathways in COVID-19 and inflammatory bowel disease have several similarities and some differences. The study identifies the NLR signaling pathway's key role in both COVID-19 and IBD, suggesting its potential as a target for therapeutic intervention and vaccine development.
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Affiliation(s)
- Shan Li
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Fengdi Zhang
- Department of Infectious Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Ritian Lin
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Qinjuan Sun
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Lihong Qu
- Department of Infectious Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Lan Zhong
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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26
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Yukselen Z, Majmundar V, Dasari M, Arun Kumar P, Singh Y. Chest Pain Risk Stratification in the Emergency Department: Current Perspectives. Open Access Emerg Med 2024; 16:29-43. [PMID: 38343728 PMCID: PMC10853047 DOI: 10.2147/oaem.s419657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/24/2024] [Indexed: 01/11/2025] Open
Abstract
Chest pain is the second leading cause of all emergency department (ED) visits in adults in the United States, with nearly 11 million encounters yearly. While identifying low-risk patients is crucial for early discharge, identifying high-risk patients in ED is vital in timely and appropriate acute coronary syndrome (ACS) management. Traditional methods such as physical examination, cardiac markers, or imaging tests cannot reliably confirm or rule out ACS; they cannot be singularly incorporated to risk stratify patients. Various clinical risk scores have been proposed to address this challenge for risk stratification in patients being evaluated for suspected ACS. The ideal risk score should demonstrate high sensitivity and specificity to accurately differentiate between patients with varying levels of risk, particularly in identifying those at high risk for major adverse cardiovascular events. Simultaneously, an ideal scoring system should also be able to compute information for other non-coronary etiologies of chest pain that require time-sensitive interventions and workups (eg, aortic dissection and pulmonary embolism). In this review, we have assembled major risk scores used for risk stratification in patients with acute chest pain in ED. We have abbreviated their salient features to assist readers in their clinical decision-making.
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Affiliation(s)
- Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Yuvaraj Singh
- Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, MA, 01605, USA
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27
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Aishwarya S, Gunasekaran K. Differential Gene Expression Profiles Involved in the Inflammations Due to COVID-19 and Inflammatory Bowel Diseases and the Investigation of Predictive Biomarkers. Biochem Genet 2024; 62:311-332. [PMID: 37335372 DOI: 10.1007/s10528-023-10414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Gastrointestinal manifestations in COVID-19 were attributed to 74-86% of the hospitalised patients due to severe or prolonged pathogenesis. Though it is a respiratory disease, the impact it elicits on the gastrointestinal tract and brain are intense. Inflammatory bowel disease including Crohn's disease and ulcerative colitis are idiopathic inflammatory disorders of the gastrointestinal tract. The intrinsic mechanisms involved in gut inflammations due to a respiratory viral disease can be deciphered when the gene expression profiles of COVID-19 and IBD are compared. The current study utilises an integrated bioinformatics approach to unravel them. The publicly available gene expression profiles of colon transcriptomes infected with COVID-19, Crohn's disease and Ulcerative colitis were retrieved, integrated and analysed for the identification of differentially expressed genes. The inter-relational analysis along with gene annotation and pathway enrichment detailed the functional and metabolic pathways of the genes during normal and diseased conditions. The protein-protein interactions deduced from the STRING database and the identified hub genes predicted potential biomarker candidates for COVID-19, Crohn's disease and ulcerative colitis. The inflammatory response pathways were upregulated and enrichment of chemokine signalling, altered lipid metabolism, coagulation and complement cascades were seen in all three conditions along with impaired transport mechanisms. CXCL11, MMP10, and CFB are predicted to be overexpressed biomarkers, whilst GUCA2A, SLC13A2, CEACAM, and IGSF9 as downregulated novel biomarker candidates for colon inflammations. The three miRNAs hsa-miR-16-5p, hsa-miR-21-5p, and hsa-miR-27b-5p exhibited significant interactions with the upregulated hub genes and four long non-coding RNAs NEAT1, KCNQ1OT1, and LINC00852 capable of regulating miRNA were also predicted. This study offers significant information on the underlying molecular mechanisms of inflammatory bowel disease with identification of potential biomarkers.
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Affiliation(s)
- S Aishwarya
- Department of Bioinformatics, Stella Maris College (Autonomous), Chennai, India.
- CAS in Crystallography and Biophysics, University of Madras, Chennai, India.
| | - K Gunasekaran
- CAS in Crystallography and Biophysics, University of Madras, Chennai, India
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28
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Straume Z, Krūmiņa N, Elbere I, Rozenberga M, Rudzīte D, Proskurina A, Ozoliņa J, Kloviņš J, Skuja V, Krūmiņa A. Exploring the Impact of COVID-19 on Ulcerative Colitis Patients: A Lifestyle Perspective. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:182. [PMID: 38276061 PMCID: PMC10819492 DOI: 10.3390/medicina60010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 is the new coronavirus that caused the coronavirus disease 2019 (COVID-19) outbreak. Studies have increasingly reported the involvement of organs outside the respiratory system, including the gastrointestinal tract. Data on the association between COVID-19 and ulcerative colitis (UC) are lacking. Materials and Methods: In this one-centre cross-sectional study, 49 patients with UC from the Riga East Clinical University Hospital outpatient clinic were included from June 2021 to December 2021. The patients were divided into two groups according to their history of a confirmed positive or negative COVID-19 status. Data on their lifestyle, diet, and medications and the food supplements used by the patients were collected during interviews and analysed using the R 4.2.1 software. Results: Out of 49 patients, 33 (63.3%) were male and 13 (36.7%) were female, with a mean age of 32.33 ± 8.6 years. Fourteen patients (28.6%) had a confirmed COVID-19 infection in the last year. The most common COVID-19-related symptoms were a fever and rhinorrhoea. A third of patients followed the inflammatory bowel disease diet (16; 32.7%); out of these patients, 12 (34.3%) did not contract COVID-19 (OR: 0.78 (0.18; 2.98), p > 0.05). In the COVID-19-positive group, the majority of patients did not use vitamin D (11; 79% vs. 3; 21%, (OR: 0.38 (0.07; 1.51), p = 0.28) or probiotics (11; 78.6% vs. 3; 21.4%, OR: 1.33 (0.23; 6.28), p = 0.7). In the COVID-19-positive group, most patients did not smoke (12; 85.7% vs. 2; 14.3%, p = 0.475) and did not use alcohol (9; 64.3% vs. 5; 35.7%, OR: 0.63 (0.16; 2.57), p = 0.5). Most of the patients who participated in sports activities were COVID-negative (18; 51.4% vs. 6; 42.9%, p = 0.82). Conclusions: There were no statistically significant differences in the use of food supplements, probiotics, or vitamins; the lifestyle habits; or the COVID-19 status in patients with UC.
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Affiliation(s)
- Zane Straume
- Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Hipokrata Street 2, LV-1038 Riga, Latvia; (J.O.); (V.S.)
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Nikola Krūmiņa
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Ilze Elbere
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, LV-1067 Riga, Latvia; (I.E.); (J.K.)
| | - Maija Rozenberga
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, LV-1067 Riga, Latvia; (I.E.); (J.K.)
| | - Dace Rudzīte
- Laboratory “Gailezers”Riga East Clinical University Hospital, Hipokrata Street 2, LV-1038 Riga, Latvia;
| | - Anna Proskurina
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
- Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Juliana Ozoliņa
- Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Hipokrata Street 2, LV-1038 Riga, Latvia; (J.O.); (V.S.)
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Jānis Kloviņš
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, LV-1067 Riga, Latvia; (I.E.); (J.K.)
| | - Vita Skuja
- Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Hipokrata Street 2, LV-1038 Riga, Latvia; (J.O.); (V.S.)
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Angelika Krūmiņa
- Department of Infectology, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia;
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29
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Yang J, Ke J, Jiang X, Wang L. The association between ulcerative colitis and COVID-19 severity: a systematic review and meta-analysis systematic review. Int J Colorectal Dis 2023; 39:5. [PMID: 38108846 DOI: 10.1007/s00384-023-04568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE After the COVID-19 pandemic, many challenges arose regarding the impact of this disease on people with ulcerative colitis. The aims of this study were to estimate the prevalence, severity, and death consequences of COVID-19 in patients with ulcerative colitis using a systematic review and meta-analysis. METHODS This study was conducted using a systematic review and meta-analysis method in the field of prevalence, severity, and clinical consequences of COVID-19 in people with ulcerative colitis worldwide. The search was conducted in international scientific databases, such as Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar, from the beginning of 2020 to October 2023. The quality of the eligible studies was assessed using the Strobe and Newcastle Ottawa checklists. The data were analyzed using a fixed-effects model in the meta-analysis. Subgroup analysis and meta-regression were performed using STATA version 17. RESULTS Nineteen studies with a sample size of 224,520 patients were included in this meta-analysis. The results showed that, in COVID-19 patients with ulcerative colitis, the prevalence of hospitalization, death, COVID-19 severity, and mortality rate in severe patients was 54% (95% CI, 27-80%), 10% (95% CI, 4-16%), 20% (95% CI, 8-34%), 63% (95% CI, 46-80%), respectively. In comparison with the general population, the odds ratio (OR) of hospitalization in patients due to COVID-19 was OR = 1.28 (95% CI, 1.19-1.38, P < 0.001), and the chance of severe COVID-19 was OR = 1.30 (95% CI, 1.22-1.53, P < 0.001). CONCLUSION The probability of contracting the severe type of COVID-19 and hospitalization in patients with ulcerative colitis was higher than in the general population.
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Affiliation(s)
- Jingjing Yang
- Department of Occupational Disease, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, NO.1, Jingba Road, Jinan, 250000, China
| | - Jianlin Ke
- Department of Special Inspection, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, NO.1, Jingba Road, Jinan, 250000, China
| | - Xueliang Jiang
- Department of Digestive Center, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, NO.1, Jingba Road, Jinan, 250000, China.
| | - Lei Wang
- Department of Special Inspection, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, NO.1, Jingba Road, Jinan, 250000, China
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Sarb OF, Vacaras V, Filip VP, Sarb AD, Zaharie RD, Draghici N, Muresanu DF, Tantau AI. The impact of the COVID-19 pandemic on the mental health of patients diagnosed with inflammatory bowel diseases. J Med Life 2023; 16:1864-1868. [PMID: 38585531 PMCID: PMC10994603 DOI: 10.25122/jml-2023-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/26/2023] [Indexed: 04/09/2024] Open
Abstract
Understanding the profound impact of a viral pandemic on the mental health of patients with autoimmune diseases undergoing biological treatment is crucial for future insights. This cross-sectional case-control study aimed to assess the mental health implications of the COVID-19 pandemic on individuals with inflammatory bowel disease (IBD) in Romania, spanning from November 2022 to March 2023. A specialized self-report questionnaire in the Romanian language was developed to measure the multifaceted effects of COVID-19 on the mental well-being of these patients. The findings revealed a significant decline in the mental health of patients with IBD during the pandemic compared to the control group. Patients with IBD exhibited elevated levels of anxiety and concern regarding the virus. Intriguingly, despite the challenges, the vaccination rate was notably higher among patients with IBD, indicating a proactive approach to safeguarding their health. The study also shed light on various coping mechanisms employed by patients with IBD to navigate the pandemic-related restrictions. Engaging in activities such as social media and computer games emerged as effective strategies for managing heightened stress and limitations. In conclusion, the emergence of a novel viral pathogen represents a significant distress factor for patients with autoimmune diseases. Recognizing and comprehending these consequences enhances our understanding of the intricate interplay between physical and mental health and equips authorities with valuable insights to better manage future epidemics or viral outbreaks. This study underscores the importance of tailored support systems and strategies for patients with autoimmune diseases during global health crises.
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Affiliation(s)
- Oliviu-Florentiu Sarb
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 4 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vitalie Vacaras
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vladimir-Petru Filip
- Department of Infectious Disease, Clinical Hospital of Infectious Disease, Cluj-Napoca, Romania
| | - Adriana-Daniela Sarb
- Heart Institute, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana-Delia Zaharie
- Department of Gastroenterology, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Cluj, Romania
- Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicu Draghici
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dafin-Fior Muresanu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina-Ioana Tantau
- 4 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Soni A, Yekula A, Dahiya DS, Sundararajan R, Dutta P, Singh Y, Cheng CI, Abraham G. Influence of nonalcoholic fatty liver disease on inflammatory bowel disease hospitalizations in the United States. Ann Gastroenterol 2023; 36:646-653. [PMID: 38023970 PMCID: PMC10662065 DOI: 10.20524/aog.2023.0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The reported prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD) is 32%. We assessed the influence of NAFLD on IBD hospitalizations in the United States (US). METHODS We utilized the National Inpatient Sample database, from 2016-2019, to identify the total IBD hospitalizations in the US and we further subdivided them according to the presence or absence of NAFLD. Hospitalization characteristics, comorbidities and outcomes were compared. Statistical significance was set at P<0.05. RESULTS There were 1,272,260 IBD hospitalizations in the US, of which 5.04% involved NAFLD. For IBD hospitalizations with NAFLD, the mean age was 50-64 years, and the proportion of males was 46.97%. IBD hospitalizations with NAFLD had a lower proportion of African Americans (8.7% vs. 11.38%, P<0.001). Comorbidities such as hypertension (50.34% vs. 44.04%, P<0.001) and obesity (18.77% vs. 11.81%, P<0.001) were significantly higher in the NAFLD cohort. Overall, based on the Charlson Comorbidity Index, patients with NAFLD had a higher number of comorbidities (52.77% vs. 20.66%, P<0.001). Mortality was higher in the NAFLD compared to the non-NAFLD cohort (3.14% vs. 1.44%, P<0.001). Patients with NAFLD also incurred significantly higher hospital charges ($69,536 vs. $55,467, p<0.001) and had a longer mean length of stay (6.10 vs. 5.27 days, P<0.001) compared to the cohort without NAFLD. Complications and inpatient procedure requirements were also higher in the NAFLD cohort. CONCLUSION Our study revealed greater mortality, morbidity, and healthcare resource utilization in patients with IBD who were hospitalized with a concomitant diagnosis of NAFLD.
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Affiliation(s)
- Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
| | - Anuroop Yekula
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI (Dushyant Singh Dahiya)
| | - Ramaswamy Sundararajan
- Department of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (Ramaswamy Sundararajan)
| | - Priyata Dutta
- Department of Internal Medicine, Trinity Health, Ann Arbor, MI (Priyata Dutta)
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
| | - Chin-I Cheng
- Department of Statistics, Actuarial, and Data Science, Central Michigan University, Mt. Pleasant, MI (Chin-I Cheng)
| | - George Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
- Department of Infectious Diseases, Saint Vincent Hospital, Worcester, MA (George Abraham), USA
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Hashim A, Maraey A, Elzanaty A, Zordok M, Elsharnoby H, Khalil M, Al Wahadneh O, Siragy H. Nonalcoholic Fatty Liver Disease Predicts Acute Kidney Injury Readmission in Heart Failure Hospitalizations: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101816. [PMID: 37211306 DOI: 10.1016/j.cpcardiol.2023.101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has been associated with the progression of chronic kidney disease. However, limited data is available on its impact on acute kidney injury (AKI) in heart failure(HF) patients. All primary adult HF admissions from the national readmission database of 2016-2019 were identified. Admissions from July to December of each year were excluded to allow 6 months of follow-up. Patients were stratified according to the presence of NAFLD. Complex multivariate cox regression was used to adjust for confounders and calculate the adjusted hazard ratio. A total of 420,893 weighted patients admitted with HF were included in our cohort, of whom 780 had a secondary diagnosis of NAFLD. Patients with NAFLD were younger, more likely to be female, and had higher rates of obesity and diabetes mellitus. Both groups had similar rates of chronic kidney disease irrespective of the stage. NAFLD was associated with an increased risk of 6-month readmission with AKI (26.8% vs 16.6%, adjusted hazard ratio:1.44, 95% CI [1.14-1.82], P = 0.003). The mean time to AKI readmission was 150 ± 44 days. NAFLD was associated with a shorter mean time to readmission (145 ± 45 vs 155 ± 42 days, β = -10 days, P = 0.044). Our study from a national database suggests that NAFLD is an independent predictor of 6-months readmission with AKI in patients admitted with HF. Further research is warranted to validate these findings.
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Affiliation(s)
- Ahmed Hashim
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Ahmed Maraey
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL.
| | - Ahmed Elzanaty
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH
| | - Magdi Zordok
- Department of Internal Medicine, Catholic Medical Center, Manchester, NH
| | - Hadeer Elsharnoby
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL
| | - Mahmoud Khalil
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY
| | - Omar Al Wahadneh
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL
| | - Helmy Siragy
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA
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Joseph JM, Akhlaq A, Awan RU, Aziz S, Ryu M, Farooq A, Gangu K, Edigin E, Sheikh AB. COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample. Gastroenterology Res 2023; 16:262-269. [PMID: 37937227 PMCID: PMC10627357 DOI: 10.14740/gr1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/29/2023] [Indexed: 11/09/2023] Open
Abstract
Background There is no uniformity in the available literature concerning the effects of coronavirus disease 2019 (COVID-19) viral illness on people with inflammatory bowel disease (IBD). Methods We conducted an analysis using the 2020 National Inpatient Sample (NIS) database to compare the outcomes of COVID-19 hospitalized patients with and without IBD. Results Of 1,050,040 patients admitted with COVID-19, 5,750 (0.5%) also had IBD. The group with COVID-19 and IBD had higher percentages of females and White individuals and a greater prevalence of chronic lung disease, peripheral vascular disease, and liver disease. However, after accounting for confounding variables, there was no significant difference in mortality rates, length of hospital stays, or hospitalization costs between the two groups. Conclusion According to our findings, the presence of IBD does not appear to elevate the risk of COVID-19 complications.
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Affiliation(s)
- Justin M. Joseph
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Anum Akhlaq
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rehmat Ullah Awan
- Department of Internal Medicine, Ochsner Rush Medical Center, Meridian, MS, USA
| | - Saleha Aziz
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Moon Ryu
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Ehizogie Edigin
- Department of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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Abstract
Crohn disease and ulcerative colitis, the predominant forms of inflammatory bowel disease (IBD), occur in approximately 1% of the population and are typically characterized by chronic diarrhea (with or without bleeding), abdominal pain, and weight loss. The diagnosis is based on history, physical examination, laboratory studies, and endoscopic evaluation. Extraintestinal manifestations may coincide with or precede IBD diagnosis. Treatments have markedly advanced in the past decade, resulting in improved outcomes. IBD, itself, as well as immunosuppressive therapy can increase rates of certain conditions, making collaboration between primary care and gastroenterology imperative for ensuring comprehensive patient care.
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Affiliation(s)
- Lia Pierson Bruner
- Augusta University/University of Georgia Medical Partnership, UGA Health Sciences Campus, Russell Hall, Room 235K, 1425 Prince Avenue, Athens, GA 30602, USA.
| | - Anna Marie White
- University of Pittsburgh School of Medicine, UPMC Shadyside Hospital, North Tower, Room 307, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Siobhan Proksell
- Division of Digestive Health and Liver Disease, University of Miami, Miller School of Medicine, 1120 Northwest 14th Street, CRB, Room 1184, Miami, FL 33136, USA
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Lelong M, Josien R, Coste-Burel M, Rimbert M, Bressollette-Bodin C, Nancey S, Bouguen G, Allez M, Serrero M, Caillo L, Rouillon C, Blanc P, Laharie D, Olivier R, Peyrin-Biroulet L, Dib N, De Maissin A, Montuclard C, Trang-Poisson C, Vavasseur F, Gallot G, Berthome M, Braudeau C, Chevreuil J, Bourreille A, Le Berre C. The risk of COVID-19 in IBD patients is increased by urban living and is not influenced by disease activity or intravenous biologics. Front Immunol 2023; 14:1243898. [PMID: 37701431 PMCID: PMC10494533 DOI: 10.3389/fimmu.2023.1243898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) may have a modified immune response to SARS-CoV-2. The objectives were to evaluate the prevalence of COVID-19 in patients treated with infliximab or vedolizumab, to analyze the factors associated with the infection, the impact of treatments and trough levels. Methods Patients with IBD treated with intravenous biologics in 14 French centers were included between March and June 2020 and followed-up for 6 months. Blood samples were collected for serologies and trough levels. The analysis of factors associated with COVID-19 was conducted in a matched 1:1 case-control sub-study with positive patients. Results In total, 1026 patients were included (74.9% infliximab). Over the follow-up period, 420 patients reported the occurrence of COVID-19 symptoms; 342 had been tested of whom 18 were positive. At the end of follow-up, 38 patients had a positive serology. Considering both nasal tests and serologies together, 46 patients (4.5%) had been infected. The risk of COVID-19 was related neither to the use of treatments (whatever the trough levels) nor to disease activity. Infections were more frequent when using public transport or living in flats in urban areas. Conclusions The prevalence rate of COVID-19 in this IBD population treated with intravenous infliximab or vedolizumab was the same as the one in the French population before the start of the vaccination campaign. The risk was increased by urban living and was not influenced by disease activity or biologics. Sanitary barrier measures remain the best way to protect against SARS-CoV-2 in patients with IBD in biological therapy.
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Affiliation(s)
- Margaux Lelong
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Régis Josien
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
| | - Marianne Coste-Burel
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire de Virologie, Nantes, France
| | - Marie Rimbert
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
| | - Céline Bressollette-Bodin
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire de Virologie, Nantes, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and INSERM U1111-CIRI, Lyon, France
| | - Guillaume Bouguen
- Centre Hospitalier Universitaire (CHU) and University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Matthieu Allez
- Gastroenterology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1160, Université de Paris, Paris, France
| | - Mélanie Serrero
- Department of Gastroenterology, Centre Hospitalier Universitaire (CHU) Marseille, Marseille, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nîmes, France
| | - Cléa Rouillon
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Pierre Blanc
- Service d’hépatogastroentérologie B, Centre Hospitalier Universitaire (CHU) Montpellier et Université Montpellier, Montpellier, France
| | - David Laharie
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Raphaël Olivier
- Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Astrid De Maissin
- Centre Hospitalier Départemental (CHD) La Roche Sur Yon, Department of Gastroenterology, La-Roche-sur-Yon, France
| | - Céline Montuclard
- Department of Endoscopy and Gastroenterology, Valence Public Hospital, Valence, France
| | - Caroline Trang-Poisson
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Fabienne Vavasseur
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Géraldine Gallot
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Centre de ressources biologiques (CRB), Nantes, France
| | - Mathilde Berthome
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Centre de ressources biologiques (CRB), Nantes, France
| | - Cécile Braudeau
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
| | - Justine Chevreuil
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
| | - Arnaud Bourreille
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Catherine Le Berre
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
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Papa A, Covino M, De Lucia SS, Del Gaudio A, Fiorani M, Polito G, Settanni CR, Piccioni A, Franceschi F, Gasbarrini A. Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients. World J Gastroenterol 2023; 29:4099-4119. [PMID: 37475841 PMCID: PMC10354572 DOI: 10.3748/wjg.v29.i26.4099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 07/10/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has several extrapulmonary symptoms. Gastrointestinal (GI) symptoms are among the most frequent clinical manifestations of COVID-19, with severe consequences reported in elderly patients. Furthermore, the impact of COVID-19 on patients with pre-existing digestive diseases still needs to be fully elucidated, particularly in the older population. This review aimed to investigate the impact of COVID-19 on the GI tract, liver, and pancreas in individuals with and without previous digestive diseases, with a particular focus on the elderly, highlighting the distinctive characteristics observed in this population. Finally, the effectiveness and adverse events of the anti-COVID-19 vaccination in patients with digestive disorders and the peculiarities found in the elderly are discussed.
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Affiliation(s)
- Alfredo Papa
- CEMAD, Center for Diagnosis and Treatment of Digestive Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
- CEMAD, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Marcello Covino
- Department of Emergency, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome 00168, Italy
- Emergency Medicine, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Sara Sofia De Lucia
- CEMAD, Center for Diagnosis and Treatment of Digestive Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
| | - Angelo Del Gaudio
- CEMAD, Center for Diagnosis and Treatment of Digestive Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
| | - Marcello Fiorani
- CEMAD, Center for Diagnosis and Treatment of Digestive Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
| | - Giorgia Polito
- CEMAD, Center for Diagnosis and Treatment of Digestive Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
| | - Carlo Romano Settanni
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Andrea Piccioni
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
| | - Francesco Franceschi
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
- Department of Emergency, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Antonio Gasbarrini
- CEMAD, Center for Diagnosis and Treatment of Digestive Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
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Zhang J, Zhang Y, Xia Y, Sun J. Microbiome and intestinal pathophysiology in post-acute sequelae of COVID-19. Genes Dis 2023; 11:S2352-3042(23)00223-4. [PMID: 37362775 PMCID: PMC10278891 DOI: 10.1016/j.gendis.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 06/28/2023] Open
Abstract
Long COVID, also known for post-acute sequelae of COVID-19, describes the people who have the signs and symptoms that continue or develop after the acute COVID-19 phase. Long COVID patients suffer from an inflammation or host responses towards the virus approximately 4 weeks after initial infection with the SARS CoV-2 virus and continue for an uncharacterized duration. Anyone infected with COVID-19 before could experience long-COVID conditions, including the patients who were infected with SARS CoV-2 virus confirmed by tests and those who never knew they had an infection early. People with long COVID may experience health problems from different types and combinations of symptoms over time, such as fatigue, dyspnea, cognitive impairments, and gastrointestinal (GI) symptoms (e.g., nausea, vomiting, diarrhea, decreased or loss of appetite, abdominal pain, and dysgeusia). The critical role of the microbiome in these GI symptoms and long COVID were reported in clinical patients and experimental models. Here, we provide an overall view of the critical role of the GI tract and microbiome in the development of long COVID, including the clinical GI symptoms in patients, dysbiosis, viral-microbiome interactions, barrier function, and inflammatory bowel disease patients with long COVID. We highlight the potential mechanisms and possible treatment based on GI health and microbiome. Finally, we discuss challenges and future direction in the long COVID clinic and research.
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Affiliation(s)
- Jilei Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
| | - Yongguo Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
| | - Yinglin Xia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
| | - Jun Sun
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
- UIC Cancer Center, Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA
- Jesse Brown VA Medical Center, Chicago, IL 60612, USA
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Song H, Lei N, Zeng L, Li X, Jiang C, Feng Q, Su Y, Liu J, Mu J. Mendelian randomization analysis identified tumor necrosis factor as being associated with severe COVID-19. Front Pharmacol 2023; 14:1171404. [PMID: 37397483 PMCID: PMC10311560 DOI: 10.3389/fphar.2023.1171404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background: Observational studies have shown that anti-tumor necrosis factor (TNF) therapy may be beneficial for patients with coronavirus disease 2019 (COVID-19). Nevertheless, because of the methodological restrictions of traditional observational studies, it is a challenge to make causal inferences. This study involved a two-sample Mendelian randomization analysis to investigate the causal link between nine TNFs and COVID-19 severity using publicly released genome-wide association study summary statistics. Methods: Summary statistics for nine TNFs (21,758 cases) were obtained from a large-scale genome-wide association study. Correlation data between single-nucleotide polymorphisms and severe COVID-19 (18,152 cases vs. 1,145,546 controls) were collected from the COVID-19 host genetics initiative. The causal estimate was calculated by inverse variance-weighted (IVW), MR-Egger, and weighted median methods. Sensitivity tests were conducted to assess the validity of the causal relationship. Results: Genetically predicted TNF receptor superfamily member 6 (FAS) positively correlated with the severity of COVID-19 (IVW, odds ratio = 1.10, 95% confidence interval = 1.01-1.19, p = 0.026), whereas TNF receptor superfamily member 5 (CD40) was protective against severe COVID-19 (IVW, odds ratio = 0.92, 95% confidence interval = 0.87-0.97, p = 0.002). Conclusion: Genetic evidence from this study supports that the increased expression of FAS is associated with the risk of severe COVID-19 and that CD40 may have a potential protective effect against COVID-19.
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Affiliation(s)
| | | | | | | | | | | | - Yue Su
- Traditional Chinese Medicine and Inflammation Regulation Research Group, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jibin Liu
- Traditional Chinese Medicine and Inflammation Regulation Research Group, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Mu
- Traditional Chinese Medicine and Inflammation Regulation Research Group, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Scalzo N, Ungaro RC. Managing IBD in the COVID-19 era. Therap Adv Gastroenterol 2023; 16:17562848231176450. [PMID: 37337593 PMCID: PMC10273097 DOI: 10.1177/17562848231176450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/01/2023] [Indexed: 06/21/2023] Open
Abstract
Over the last 2 years the lives of millions have changed because of the emergence of Coronavirus disease 2019 (COVID-19). Patients living with inflammatory bowel disease (IBD) represent a sizable population with their own sets of challenges to providers in the wake of so much uncertainty. The Centers for Disease Control considers immunocompromised individuals at higher risk of infection and complications from COVID-19. Early in the pandemic, the specific risks for IBD patients were unclear as guidance was based on expert opinion regarding the management of IBD during a COVID-19 era. Fortunately, after considerable work in the field, the overwhelming evidence suggests that IBD patients as a whole do not appear to be at increased risk for more severe disease from COVID-19. Certain risk factors such as age, steroids, comorbidities, combination immunomodulatory therapy, and IBD disease activity have been associated with worse outcomes. Most IBD medications are low risk, with the exception of immunomodulator monotherapy and combination therapy with thiopurine and anti-TNF. Vaccination remains safe and effective for all IBD patients, although additional booster doses may be necessary, particularly in patients taking anti-TNF agents.
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Affiliation(s)
- Nicholas Scalzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Department of Medicine Box 1118, New York, NY 10029-6574, USA
| | - Ryan C. Ungaro
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Khalaf A, Ibrahim G, Goble S, Kuijpers M, Nasr R. COVID-19 Hospitalization Outcomes Among Patients With Autoimmune Rheumatic Diseases in the United States. ACR Open Rheumatol 2023. [PMID: 37312632 DOI: 10.1002/acr2.11572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES To investigate the outcomes of COVID-19-related hospitalizations among patients with autoimmune rheumatic diseases (ARDs) in the United States in 2020. The primary outcome was in-hospital mortality, and secondary outcomes included intubation rate, length of hospital stay (LOS), and total hospital charges (THCs). METHODS Data for the study were obtained from the National Inpatient Sample database and included patients who were hospitalized with a principal diagnosis of COVID-19. Univariable and multivariable logistic regression analyses were conducted to calculate odds ratios for the outcomes, adjusting for age, sex, and comorbidities. RESULTS Out of the 1,050,720 COVID-19 admissions, 30,775 had an ARD diagnosis. The unadjusted analysis showed higher mortality (12.21%) and intubation (9.2%) rates in the ARD group compared with the non-ARD group (mortality rate: 11.14%, P = 0.013; intubation rate: 8.5%, P = 0.048). However, this difference was not significant after adjusting for confounding factors. The mean LOS and THCs did not differ significantly between the two groups. Among all ARD subgroups, the vasculitis group had significantly higher intubation rate, LOS, and THC. CONCLUSION The study suggests that ARD is not associated with an increased risk of mortality or worse outcomes among patients hospitalized with COVID-19 after adjusting for confounding factors. However, the vasculitis group had poorer outcomes during COVID-19 hospitalizations. Further studies are needed to evaluate the effect of ARD activity and immunosuppressants on outcomes. Additionally, more research is required to investigate the relationship between COVID-19 and vasculitis.
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Affiliation(s)
- Ahmad Khalaf
- Hennepin County Medical Center, Minneapolis, Minnesota
| | - Garad Ibrahim
- Hennepin County Medical Center, Minneapolis, Minnesota
| | - Spencer Goble
- Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Rawad Nasr
- Hennepin County Medical Center, Minneapolis, Minnesota
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Wang Y, Li P, Lavrijsen M, Rottier RJ, den Hoed CM, Bruno MJ, Kamar N, Peppelenbosch MP, de Vries AC, Pan Q. Immunosuppressants exert differential effects on pan-coronavirus infection and distinct combinatory antiviral activity with molnupiravir and nirmatrelvir. United European Gastroenterol J 2023; 11:431-447. [PMID: 37226653 PMCID: PMC10256998 DOI: 10.1002/ueg2.12417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Immunocompromised populations, such as organ transplant recipients and patients with inflammatory bowel disease (IBD) receiving immunosuppressive/immunomodulatory medications, may be more susceptible to coronavirus infections. However, little is known about how immunosuppressants affect coronavirus replication and their combinational effects with antiviral drugs. OBJECTIVE This study aims to profile the effects of immunosuppressants and the combination of immunosuppressants with oral antiviral drugs molnupiravir and nirmatrelvir on pan-coronavirus infection in cell and human airway organoids (hAOs) culture models. METHODS Different coronaviruses (including wild type, delta and omicron variants of SARS-CoV-2, and NL63, 229E and OC43 seasonal coronaviruses) were used in lung cell lines and hAOs models. The effects of immunosuppressants were tested. RESULTS Dexamethasone and 5-aminosalicylic acid moderately stimulated the replication of different coronaviruses. Mycophenolic acid (MPA), 6-thioguanine (6-TG), tofacitinib and filgotinib treatment dose-dependently inhibited viral replication of all tested coronaviruses in both cell lines and hAOs. The half maximum effective concentration (EC50) of tofacitinib against SARS-CoV-2 was 0.62 μM and the half maximum cytotoxic concentration (CC50) was above 30 μM, which resulted in a selective index (SI) of about 50. The anti-coronavirus effect of the JAK inhibitors tofacitinib and filgotinib is dependent on the inhibition of STAT3 phosphorylation. Combinations of MPA, 6-TG, tofacitinib, and filgotinib with the oral antiviral drugs molnupiravir or nirmatrelvir exerted an additive or synergistic antiviral activity. CONCLUSIONS Different immunosuppressants have distinct effects on coronavirus replication, with 6-TG, MPA, tofacitinib and filgotinib possessing pan-coronavirus antiviral activity. The combinations of MPA, 6-TG, tofacitinib and filgotinib with antiviral drugs exerted an additive or synergistic antiviral activity. Thus, these findings provide an important reference for optimal management of immunocompromised patients infected with coronaviruses.
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Affiliation(s)
- Yining Wang
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Pengfei Li
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Marla Lavrijsen
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Robbert J. Rottier
- Department of Pediatric SurgeryErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
- Department of Cell BiologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Caroline M. den Hoed
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
- Erasmus MC Transplant InstituteErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Nassim Kamar
- Department of NephrologyDialysis and Organ TransplantationCHU RangueilINSERM UMR 1291Toulouse Institute for Infectious and Inflammatory Disease (Infinity)University Paul SabatierToulouseFrance
| | - Maikel P. Peppelenbosch
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Annemarie C. de Vries
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Qiuwei Pan
- Department of Gastroenterology and HepatologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
- Erasmus MC Transplant InstituteErasmus MC‐University Medical CenterRotterdamThe Netherlands
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Lutz M, Lazarus S, Caldera F. COVID-19 vaccination in adults with inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231173130. [PMID: 37234702 PMCID: PMC10203854 DOI: 10.1177/17562848231173130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/16/2023] [Indexed: 05/28/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are not at increased risk of SARS-CoV-2 infection compared to the general population, and most are not at increased risk for severe disease. COVID-19 is nonetheless common, and vaccination is critical. Four safe and efficacious vaccines are now available for the prevention of COVID-19, with most data available for mRNA vaccines. Patients with IBD have a robust humoral response to vaccination with rates of seroconversion exceeding 95% following a two-dose mRNA vaccine series and 99% following a three-dose mRNA series, although those on certain therapies including anti-tumor necrosis factor α agents may have lower antibody concentrations and waning of antibodies over time. Additionally, rates of cell-mediated immune response, even in those patients with IBD who did not have evidence of humoral immunity, are high. Vaccines are safe and have not been associated with flares in disease activity. Gastroenterology providers should take an active role in ensuring patients with IBD are appropriately vaccinated against COVID-19.
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Affiliation(s)
| | - Sarah Lazarus
- School of Medicine & Public Health, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Freddy Caldera
- School of Medicine & Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, Madison, WI, USA
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Bordalo Ferreira F, Rafael MA, Coimbra L, Boavida N, Arrobas F, Pereira Correia F, Martins Figueiredo L, Carvalho E Branco J, Carvalho Lourenço L, Santos L, Oliveira AM. Anti-tumor necrosis factor therapy is associated with attenuated humoral response to SARS-COV-2 vaccines in patients with inflammatory bowel disease. Vaccine 2023:S0264-410X(23)00530-3. [PMID: 37202269 DOI: 10.1016/j.vaccine.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Immunosuppressive therapy used in the treatment of inflammatory bowel disease (IBD) is known to reduce vaccine immunogenicity. AIMS This study aimed to 1) predict the humoral response elicited by SARS-CoV-2 vaccination in IBD patients based on their ongoing treatment and other relevant patient and vaccine characteristics and 2) assess the humoral response to a booster dose of mRNA vaccine. METHODS We conducted a prospective study in adult IBD patients. Anti-spike (S) IgG antibodies were measured after initial vaccination and again after one booster dose. A multiple linear regression model was created to predict anti-S antibody titer following initial complete vaccination in different therapeutic groups (no immunosuppression, anti-TNF, immunomodulators and combination therapy). A two-tailed Wilcoxon test for two dependent groups was performed to compare anti-S values before and after the booster dose. RESULTS Our study included 198 IBD patients. The multiple linear regression identified anti-TNF and combination therapy (versus no immunosuppression), current smoking, viral vector (versus mRNA) vaccine and interval between vaccination and anti-S measurement as statistically significant predictors of the log anti-S antibody levels (p < 0.001). No statistically significant differences were found between no immunosuppression and immunomodulators (p = 0.349) and between anti-TNF and combination therapy (p = 0.997). Statistically significant differences for anti-S antibody titer before and after the booster dose of mRNA SARS-CoV-2 vaccine were found, both for non-anti-TNF and anti-TNF groups. CONCLUSIONS Anti-TNF treatment (either alone or in combination therapy) is associated with lower anti-S antibody levels. Booster mRNA doses seem to increase anti-S both in non-anti-TNF and anti-TNF treated patients. Special attention should be paid to this group of patients when planning vaccination schemes.
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Affiliation(s)
- Filipa Bordalo Ferreira
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal.
| | - Maria Ana Rafael
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Lúcia Coimbra
- Clinical Pathology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Nazaré Boavida
- Clinical Pathology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | | | - Fábio Pereira Correia
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Luísa Martins Figueiredo
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Joana Carvalho E Branco
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Luís Carvalho Lourenço
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Liliana Santos
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Ana Maria Oliveira
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
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Olajide M, Abdul-Hammed M, Bello IA, Adedotun IO, Afolabi TI. Identification of potential inhibitors of thymidylate synthase (TS) (PDB ID: 6QXH) and nuclear factor kappa-B (NF–κB) (PDB ID: 1A3Q) from Capsicum annuum (bell pepper) towards the development of new therapeutic drugs against colorectal cancer (CRC). PHYSICAL SCIENCES REVIEWS 2023. [DOI: 10.1515/psr-2022-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Abstract
Colorectal cancer is the third most deadly cancer globally. Drug resistance and attendant side effects make the available standard anti-colorectal cancer drugs against target receptors inefficient. Phytochemicals from medicinal plants are safer, cheaper, effective, and heal diseases from the cellular level. This study is aimed at identifying potential inhibitors of thymidylate synthase (TS) and nuclear factor kappa-B (NF–κB) target receptors from Capsicum annuum towards the development of new therapeutic drugs against colorectal cancer via in silico approach. One hundred and fifty (150) ligands previously reported from Capsicum annuum were downloaded from the PubChem database and were subjected to chemo-informatics analyses such as ADMET, drug-likeness, oral bioavailability, bioactivity, and PASS prediction to ascertain their therapeutic and safety profile before docking. The ligands that passed the analyses were docked against TS and NF–κB in duplicate using a creditable docking tool (PyRx). Raltitrexed and emetine were used as the standard drug inhibitors for TS and NF–κB, respectively. The results obtained from this study showed that feruloyl-beta-D-glucose (8.45 kcal/mol), 5-O-caffeoylquinic acid (−8.40 kcal/mol), 5-O-caffeoylquinic acid methyl ester (−7.89 kcal/mol), feruloyl hexoside (−7.40 kcal/mol), O-glucopyranoside (−7.55 kcal/mol), and quercetin (−7.00 kcal/mol) shared the same binding pocket with TS while feruloyl-beta-D-glucose (−7.00 kcal/mol), chlorogenic acid (−6.90 kcal/mol), 5-O-caffeoylquinic acid (−6.90 kcal/mol) and feruloyl hexoside (−6.50 kcal/mol) shared the same pocket with NF–κB. These compounds were selected as best hits due to their excellent inhibitory efficiency and chemoinformatic profiles. Thus, the compounds may function as prospective lead compounds for developing a new anti-colorectal cancer drug.
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Affiliation(s)
- Monsurat Olajide
- Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Along Ogbomoso Ilorin Expressway, Ladoke Akintola University Of Technology , Ogbomoso , Oyo , 210214 , Nigeria
- Computational Biophysical Chemistry Laboratory, Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Ogbomoso , Oyo State , Nigeria
- Department of Chemical Sciences , Crescent University Abeokuta , Abeokuta , Ogun State , Nigeria
| | - Misbaudeen Abdul-Hammed
- Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Along Ogbomoso Ilorin Expressway, Ladoke Akintola University Of Technology , Ogbomoso , Oyo , 210214 , Nigeria
- Computational Biophysical Chemistry Laboratory, Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Ogbomoso , Oyo State , Nigeria
| | - Isah Adewale Bello
- Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Along Ogbomoso Ilorin Expressway, Ladoke Akintola University Of Technology , Ogbomoso , Oyo , 210214 , Nigeria
| | - Ibrahim Olaide Adedotun
- Computational Biophysical Chemistry Laboratory, Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Ogbomoso , Oyo State , Nigeria
| | - Tolulope Irapada Afolabi
- Computational Biophysical Chemistry Laboratory, Department of Pure and Applied Chemistry , Ladoke Akintola University of Technology, Faculty of Pure and Applied Science , Ogbomoso , Oyo State , Nigeria
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Rotheca serrata Flower Bud Extract Mediated Bio-Friendly Preparation of Silver Nanoparticles: Their Characterizations, Anticancer, and Apoptosis Inducing Ability against Pancreatic Ductal Adenocarcinoma Cell Line. Processes (Basel) 2023. [DOI: 10.3390/pr11030893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Over past decades, the green method of synthesizing metal nanoparticles has acquired more attentiveness by scientific consensus because of its industrial and biomedical applications. This study focuses on the anti-proliferative effectiveness of AgNPs synthesized from Rotheca serrata (L.) Steane & Mabb. flower bud extract against the PANC-1 cell line in vitro. Various analytical instruments were utilized to visualize the formation of RsFb-AgNPs, such as UV-Vis spectroscopy, FT-IR, SEM, EDS, TEM, XRD, Zeta potential, and DLS analysis. The biosynthesis of RsFb-AgNPs was observed by a change in color and UV-Vis spectroscopy (415 nm). The FT-IR spectra exhibited the existence of many functional groups. XRD confirmed the crystallinity of the AgNPs. Morphology and elemental mapping were assessed by SEM and EDS analysis. The TEM micrograph revealed spherical-shaped particles with sizes ranging from 12 to 40 nm. Zeta potential and DLS analysis were used to measure surface charge and particle size. Biological properties, including the antioxidant, antimicrobial, and anticancer properties of synthesized RsFb-AgNPs, exhibited dose-dependent activities. In DPPH assay, synthesized RsFb-AgNPs inhibited the scavenging of free radicals in a dose-dependent manner. In addition, the resultant RsFb-AgNPs displayed moderate antimicrobial activity against tested pathogens. Further, the anti-proliferative efficacy of biosynthesized RsFb-AgNPs was determined against the PANC-1 cell line using the MTT assay. The results revealed a dose-dependent decrease in viability of cancer cells with an IC50 value of 36.01 µg/mL. Flow cytometry was then used to confirm the apoptotic effects by double staining with annexin V/PI. In response to the pancreatic ductal adenocarinoma cell line, the results showed notable early and late apoptosis cell population percentages. In conclusion, the synthesized RsFb-AgNPs revealed a potential anticancer agent that can induce apoptosis in the PANC-1 cells.
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Mejía-Chuquispuma NJ, Flores-Jiménez KV, Castro-Auqui AC, Mattos-Vela MA. Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello. BIONATURA 2023. [DOI: 10.21931/rb/2023.08.01.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
La radioterapia es una de las primeras opciones de tratamiento para el cáncer de cabeza y cuello; sin embargo, puede ocasionar diversas manifestaciones secundarias en la cavidad oral tales como mucositis oral, xerostomía, infecciones orales oportunistas, osteorradionecrosis y trismo. El presente artículo tiene como objetivo describir el manejo preventivo y terapéutico de las complicaciones orales inducidas por radioterapia de cabeza y cuello en la práctica odontológica propuestos hasta la actualidad. Se encontraron diversas medidas que han logrado reducir la incidencia y gravedad de dichas manifestaciones orales; sin embargo, aún existen algunas que requieren de más estudios para confirmar su efectividad.
Palabras clave: cáncer de cabeza y cuello; manifestaciones bucales; radioterapia; terapéutica.
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Liver CT Image Recognition Method Based on Capsule Network. INFORMATION 2023. [DOI: 10.3390/info14030183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
The automatic recognition of CT (Computed Tomography) images of liver cancer is important for the diagnosis and treatment of early liver cancer. However, there are problems such as single model structure and loss of pooling layer information when using a traditional convolutional neural network to recognize CT images of liver cancer. Therefore, this paper proposes an efficient method for liver CT image recognition based on the capsule network (CapsNet). Firstly, the liver CT images are preprocessed, and in the process of image denoising, the traditional non-local mean (NLM) denoising algorithm is optimized with a superpixel segmentation algorithm to better protect the information of image edges. After that, CapsNet was used for image recognition for liver CT images. The experimental results show that the average recognition rate of liver CT images reaches 92.9% when CapsNet is used, which is 5.3% higher than the traditional CNN model, indicating that CapsNet has better recognition accuracy for liver CT images.
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Development of a Core Set of Self-Management Support Needs of Esophageal Cancer Patients: Results from a Delphi Study among Healthcare Professionals. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/3164450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Objective. We aimed to gain consensus on HCPs’ perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from “not essential” to “absolutely essential,” using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients’ self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager.
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Li L, Xu Y, Xu Z, Qi F, Li X. Misclassification of Gleason grade and tumor stage in Asian‐American patients with low‐risk prostate cancer. PRECISION MEDICAL SCIENCES 2023. [DOI: 10.1002/prm2.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
- Lu Li
- Student of Nanjing Medical University Nanjing China
| | - Yihang Xu
- Student of The First Clinical Medical College of Nanjing Medical University Nanjing China
| | - Zicheng Xu
- Department of Urologic Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Feng Qi
- Department of Urologic Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xiao Li
- Department of Urologic Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Yang ZH, Wang SX. Exploring the Prognostic Features of Hepatocellular Carcinoma via Text Mining and Data Analysis. Mol Biol 2023. [DOI: 10.1134/s0026893323030160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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