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Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, Zhao HL. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metabolism 2020; 113:154378. [PMID: 33002478 PMCID: PMC7521361 DOI: 10.1016/j.metabol.2020.154378] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation. OBJECTIVE This study explores the effects of obesity with the risk of severe disease among patients with COVID-19. METHODS Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity. RESULTS A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID-19 with higher BMI: 1.76 (95%: 1.21, 2.56, P = 0.003) for hospitalization, 1.67 (95%CI: 1.26, 2.21, P<0.001) for ICU admission, 2.19 (95%CI: 1.56, 3.07, P<0.001) for IMV requirement, and 1.37 (95%CI: 1.06, 1.75, P = 0.014) for death, giving an overall OR for severe COVID-19 of 1.67 (95%CI: 1.43, 1.96; P<0.001). Multivariate analyses revealed increased ORs of severe COVID-19 associated with higher BMI: 2.36 (95%CI: 1.37, 4.07, P = 0.002) for hospitalization, 2.32 (95%CI: 1.38, 3.90, P = 0.001) for requiring ICU admission, 2.63 (95%CI: 1.32, 5.25, P = 0.006) for IMV support, and 1.49 (95%CI: 1.20, 1.85, P<0.001) for mortality, giving an overall OR for severe COVID-19 of 2.09 (95%CI: 1.67, 2.62; P<0.001). Compared to non-severe COVID-19 patients, severe COVID-19 cases showed significantly higher VAT accumulation with a SMD of 0.49 for hospitalization (95% CI: 0.11, 0.87; P = 0.011), 0.57 (95% CI: 0.33, 0.81; P<0.001) for requiring ICU admission and 0.37 (95% CI: 0.03, 0.71; P = 0.035) for IMV support. The overall SMD for severe COVID-19 was 0.50 (95% CI: 0.33, 0.68; P<0.001). CONCLUSIONS Obesity increases risk for hospitalization, ICU admission, IMV requirement and death among patients with COVID-19. Further, excessive visceral adiposity appears to be associated with severe COVID-19 outcomes. These findings emphasize the need for effective actions by individuals, the public and governments to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.
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Affiliation(s)
- Yi Huang
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China
| | - Yao Lu
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China
| | - Yan-Mei Huang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Min Wang
- Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China
| | - Wei Ling
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China; Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Sui
- Department of Clinical Nutrition, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hai-Lu Zhao
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541100, China; Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin 541100, China; Institute of Basic Medical Sciences, Guilin Medical University, Guilin 541100, China.
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152
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Pivonello R, Auriemma RS, Pivonello C, Isidori AM, Corona G, Colao A, Millar RP. Sex Disparities in COVID-19 Severity and Outcome: Are Men Weaker or Women Stronger? Neuroendocrinology 2020; 111:1066-1085. [PMID: 33242856 PMCID: PMC7900484 DOI: 10.1159/000513346] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health issue which has profound effects on most aspects of societal well-being, including physical and mental health. A plethora of studies globally have suggested the existence of a sex disparity in the severity and outcome of COVID-19 patients, mainly due to mechanisms of virus infection, immune response to the virus, development of systemic inflammation, and consequent systemic complications, particularly thromboembolism. Epidemiological data report a sex difference in the severity of COVID-19, with a more favorable course of the disease in women compared to men regardless of age, although the rate of SARS-CoV-2 infection seems to be similar in both sexes. Sex hormones, including androgens and estrogens, may not only impact virus entry and load, but also shape the clinical manifestations, complications, and ultimately the outcome of the disease. The current review comprehensively summarizes the current literature on sex disparities in susceptibility and outcome of COVID-19 as well as the literature underpinning the pathophysiological and molecular mechanisms, which may provide a rationale to a sex disparity. These mechanisms include sex hormone influence on factors that facilitate virus entry and priming, immune and inflammatory response, as well as coagulation and thrombosis diathesis. Based on present evidence, women appear to be relatively protected from COVID-19 because of a more effective immune response and a less pronounced systemic inflammation, with consequent moderate clinical manifestations of the disease, together with a lesser predisposition to thromboembolism. Conversely, men appear to be particularly susceptible to COVID-19 because of a less effective immune response with consequent severe clinical manifestations of the disease, together with a greater predisposition to thromboembolism. In the elderly, generally characterized by the phenomenon of inflammaging, sex disparities in overall mortality following SARS-CoV-2 infection are even more palpable as elderly men appear to be more prone to severe COVID-19 because of a greater predisposition to infections, a weaker immune defense, and an enhanced thrombotic state compared to women. The information revealed from the review highlights potential novel therapeutic approaches employing the administration of hormonal or antihormonal therapy in combination with antiviral drugs in COVID-19 patients.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy,
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy,
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Annamaria Colao
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Robert P Millar
- Centre for Neuroendocrinology, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Neurosciences Institute and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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153
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Wang Y, Ao G, Qi X, Ma M. The relationship between severe or dead COVID-19 and asthma: A meta-analysis. Clin Exp Allergy 2020; 51:354-359. [PMID: 33131117 DOI: 10.1111/cea.13773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Xin Qi
- Department of Neurology, Chengdu Third People's Hospital, Chengdu, Sichuan, China
| | - Min Ma
- Department of Cardiology, Chengdu Sixth People's Hospital, Chengdu, Sichuan, China
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154
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Chen R, Yu YL, Li W, Liu Y, Lu JX, Chen F, Zhou Q, Xia ZY, Gao L, Meng QT, Ma D. Gastrointestinal Symptoms Associated With Unfavorable Prognosis of COVID-19 Patients: A Retrospective Study. Front Med (Lausanne) 2020; 7:608259. [PMID: 33262996 PMCID: PMC7686879 DOI: 10.3389/fmed.2020.608259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background and Aim: The global pandemic of COVID-19 has posed an enormous threat to the economy and people's lives across various countries. Patients with COVID-19 most commonly present with respiratory symptoms. However, gastrointestinal (GI) symptoms can also occur. We aimed to study the relationship between GI symptoms and disease prognosis in patients with COVID-19. Methods: In a single-center and retrospective cohort study, the outcomes in COVID-19 patients with or without GI symptoms were compared. The propensity score is a conditional probability of having a particular exposure (COVID-19 patients with GI symptoms vs. without GI symptoms) given a set of baseline measured covariates. Survival was estimated using the Kaplan-Meier method, and any differences in survival were evaluated with a stratified log-rank-test. To explore the GI symptoms associated with ARDS, non-invasive ventilator treatment, tracheal intubation, tracheotomy, and CRRT, univariable and multivariable COX regression models were used. Results: Among 1,113 eligible patients, 359 patients with GI symptoms and 718 without GI symptoms had similar propensity scores and were included in the analyses. Patients with GI symptoms, as compared with those without GI symptoms, were associated with a similar risk of death, but with higher risks of ARDS, non-invasive mechanical ventilation in COVID-19 patients, respectively. Conclusions: The presence of GI symptoms was associated with a high risk of ARDS, non-invasive mechanical ventilation and tracheal intubation in patients with COVID-19 but not mortality.
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Affiliation(s)
- Rong Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan-li Yu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ya Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing-xiao Lu
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fangyue Chen
- Department of General Medicine, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
| | - Qin Zhou
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhong-yuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Gao
- Department of Endocrinology and Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing-tao Meng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Daqing Ma
- Division Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
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155
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Akin H, Kurt R, Tufan F, Swi A, Ozaras R, Tahan V, Hammoud G. Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis. Diseases 2020; 8:E41. [PMID: 33182651 PMCID: PMC7709133 DOI: 10.3390/diseases8040041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIM Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. METHODS We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman-Tukey's transforming random effect model. RESULTS A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16-0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10-0.27) followed by diarrhea at 15% (95%CI, 0.12-0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the "inpatient-only" studies when compared with studies that included outpatients only and those including both inpatients and outpatients. CONCLUSIONS In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.
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Affiliation(s)
- Hakan Akin
- Birinci International Hospital, Istanbul 34525, Turkey;
| | - Ramazan Kurt
- Sondurak Medical Center, Istanbul 34764, Turkey;
| | - Fatih Tufan
- Independent Investigator, Istanbul 34107, Turkey;
| | - Ahmed Swi
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Resat Ozaras
- Medilife International Hospital, Istanbul 34523, Turkey;
| | - Veysel Tahan
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Ghassan Hammoud
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
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156
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Jiménez E, Fontán-Vela M, Valencia J, Fernandez-Jimenez I, Álvaro-Alonso EA, Izquierdo-García E, Lazaro Cebas A, Gallego Ruiz-Elvira E, Troya J, Tebar-Martinez AJ, Garcia-Marina B, Peña-Lillo G, Abad-Motos A, Macaya L, Ryan P, Pérez-Butragueño M. Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study. BMJ Open 2020; 10:e042398. [PMID: 33172949 PMCID: PMC7656887 DOI: 10.1136/bmjopen-2020-042398] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital. DESIGN AND SETTING Retrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain. PARTICIPANTS All patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020. RESULTS A total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0-81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51-71); 74.1% men; median length of stay 9 days (IQR 5-19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6-14). CONCLUSIONS This study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity.
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MESH Headings
- Acute Kidney Injury/physiopathology
- Acute Kidney Injury/therapy
- Adrenal Cortex Hormones/therapeutic use
- Age Factors
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antiviral Agents/therapeutic use
- Betacoronavirus
- COVID-19
- Cardiovascular Diseases/epidemiology
- Comorbidity
- Coronavirus Infections/complications
- Coronavirus Infections/mortality
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Cough/physiopathology
- Dyspnea/physiopathology
- Female
- Fever/physiopathology
- Hospitalization
- Humans
- Hypertension/epidemiology
- Intensive Care Units
- Length of Stay
- Male
- Middle Aged
- Neoplasms
- Nervous System Diseases/epidemiology
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/mortality
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pulmonary Disease, Chronic Obstructive/epidemiology
- Renal Insufficiency, Chronic/epidemiology
- Respiration, Artificial
- Respiratory Distress Syndrome/physiopathology
- Respiratory Distress Syndrome/therapy
- Retrospective Studies
- SARS-CoV-2
- Sex Factors
- Spain/epidemiology
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Affiliation(s)
- Eva Jiménez
- Preventive Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Mario Fontán-Vela
- Preventive Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jorge Valencia
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | | | | | - Jesús Troya
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | - Ane Abad-Motos
- Anesthesiology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Laura Macaya
- Intensive Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
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157
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Hüls A, Costa ACS, Dierssen M, Baksh RA, Bargagna S, Baumer NT, Brandão AC, Carfi A, Carmona-Iragui M, Chicoine BA, Ghosh S, Lakhanpaul M, Manso C, Mayer MA, Del Carmen Ortega M, de Asua DR, Rebillat AS, Russell LA, Sgandurra G, Valentini D, Sherman SL, Strydom A. An international survey on the impact of COVID-19 in individuals with Down syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.03.20225359. [PMID: 33173907 PMCID: PMC7654903 DOI: 10.1101/2020.11.03.20225359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health conditions and immune dysfunction associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19 once infected by SARS-CoV-2. METHODS The T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers/family members on patients with COVID-19 and DS (N=1046). De-identified survey data collected between April and October 2020 were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS. COVID-19 patients with DS from the ISARIC4C survey (ISARIC4C DS cases=100) were matched to a random set of patients without DS (ISARIC4C controls=400) and hospitalized DS cases in the T21RS survey (T21RS DS cases=100) based on age, gender, and ethnicity. FINDING The mean age in the T21RS survey was 29 years (SD=18), 73% lived with their family. Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Pain and nausea were reported less frequently (p<0.01), whereas altered consciousness/confusion were reported more frequently (p<0.01). Risk factors for hospitalization and mortality were similar to the general population (age, male gender, diabetes, obesity, dementia) with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher than for controls (T21RS DS versus controls: risk ratio (RR)=3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus controls: RR=2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality. INTERPRETATION Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of mortality, especially from age 40. FUNDING Down Syndrome Affiliates in Action, Down Syndrome Medical Interest Group-USA, GiGi's Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, Matthews Foundation, National Down Syndrome Society, National Task Group on Intellectual Disabilities and Dementia Practices.
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158
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Maldonado M, Ossorio M, Del Peso G, Santos C, Álvarez L, Sánchez-Villanueva R, Rivas B, Vega C, Selgas R, Bajo MA. [COVID-19 incidence and outcomes in a home dialysis unit in Madrid (Spain) at the height of the pandemic]. Nefrologia 2020; 41:329-336. [PMID: 33248799 PMCID: PMC7643625 DOI: 10.1016/j.nefro.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Introducción La enfermedad por coronavirus 2019 (COVID-19) es una infección viral causada por un nuevo coronavirus que está afectando a todo el mundo. Hay estudios previos de pacientes en hemodiálisis en centro, pero hay pocos datos sobre población en diálisis domiciliaria. Nuestro objetivo es estudiar la incidencia y evolución de la COVID-19 en una unidad de diálisis domiciliaria (UDD) durante el pico de la pandemia. Métodos Estudio observacional y retrospectivo que incluye todos los pacientes diagnosticados de COVID-19 de la UDD del Hospital Universitario La Paz (Madrid, España) entre el 10 de marzo y el 15 de mayo de 2020. Se recogieron los datos clínicos de la UDD (57 pacientes en diálisis peritoneal y 22 pacientes en hemodiálisis domiciliaria) y comparamos las características clínicas y la evolución de los pacientes con o sin infección por COVID-19. Resultados Doce pacientes fueron diagnosticados de COVID-19 (9 diálisis peritoneal, 3 hemodiálisis domiciliaria). No hubo diferencias estadísticamente significativas entre las características clínicas de los pacientes con COVID-19 y el resto de la unidad. La edad media fue 62 ± 18,5 años; la mayoría eran varones (75%). Todos los pacientes menos uno necesitaron hospitalización. Diez pacientes (83%) fueron dados de alta tras una media de 16,4 ± 9,7 días de hospitalización. Dos pacientes fueron diagnosticados durante su hospitalización por otro motivo y fueron los únicos que fallecieron. Los fallecidos eran de mayor edad que los supervivientes. Conclusión La incidencia de COVID-19 en nuestra UDD en Madrid durante el pico de la pandemia fue alto, especialmente en los pacientes en diálisis peritoneal, sin observarse un potencial beneficio para prevenir la infección en los pacientes en diálisis domiciliaria. La edad avanzada y la transmisión nosocomial fueron los principales factores relacionados con peor pronóstico.
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Affiliation(s)
- María Maldonado
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España.
| | - Marta Ossorio
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España
| | - Gloria Del Peso
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, España
| | - Carlos Santos
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España
| | - Laura Álvarez
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España
| | - Rafael Sánchez-Villanueva
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España
| | - Begoña Rivas
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
| | - Cristina Vega
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
| | - Rafael Selgas
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
| | - María A Bajo
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
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159
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Picchio CA, Valencia J, Doran J, Swan T, Pastor M, Martró E, Colom J, Lazarus JV. The impact of the COVID-19 pandemic on harm reduction services in Spain. Harm Reduct J 2020; 17:87. [PMID: 33143699 PMCID: PMC7609370 DOI: 10.1186/s12954-020-00432-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. METHODS This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March-June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. RESULTS All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March-21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. CONCLUSION Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.
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Affiliation(s)
- Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Jason Doran
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Marta Pastor
- Comisión Ciudadana Antisida de Bizkaia, Bilbao, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias I Pujol, Institut D'Investigació en Ciències de La Salut Germans Trias I Pujol (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Colom
- Programme for Substance Abuse and for Prevention, Control and Treatment of HIV, STIs and Viral Hepatitis, Agency of Public Health of Catalonia, Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
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160
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Mesas AE, Cavero-Redondo I, Álvarez-Bueno C, Sarriá Cabrera MA, Maffei de Andrade S, Sequí-Dominguez I, Martínez-Vizcaíno V. Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions. PLoS One 2020; 15:e0241742. [PMID: 33141836 PMCID: PMC7608886 DOI: 10.1371/journal.pone.0241742] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors. Methods A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed. Results The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8). Conclusion The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients. PROSPERO registration number CRD42020176595.
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Affiliation(s)
- Arthur Eumann Mesas
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brasil
| | - Iván Cavero-Redondo
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
- * E-mail:
| | - Celia Álvarez-Bueno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Selma Maffei de Andrade
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brasil
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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161
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Ayerdi O, Puerta T, Clavo P, Vera M, Ballesteros J, Fuentes ME, Estrada V, Rodríguez C, Del Romero J. Preventive Efficacy of Tenofovir/Emtricitabine Against Severe Acute Respiratory Syndrome Coronavirus 2 Among Pre-Exposure Prophylaxis Users. Open Forum Infect Dis 2020; 7:ofaa455. [PMID: 33200081 PMCID: PMC7543639 DOI: 10.1093/ofid/ofaa455] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The preventive effect that tenofovir/emtricitabine (FTC) could have against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human immunodeficiency virus-negative people is unknown. The objective of this study was to analyze the seroprevalence and clinical manifestations of COVID-19 among users of pre-exposure prophylaxis (PrEP), disoproxil fumarate/FTC (TDF/FTC), or tenofovir alafenamide (TAF)/FTC and to compare it to that of a control group. METHODS An observational descriptive study of the seroprevalence of antibodies for SARS-CoV-2 among men who have sex with men and transgender women without use of PrEP (Group 1; n = 250) and PrEP users with TDF/FTC (n = 409) or TAF/FTC (n = 91) (Group 2; n = 500) was conducted from May11, 2020 to June 27, 2020. All participants were provided with a structured questionnaire that collected information on the variables to be analyzed, and testing for immunoglobulin G antibodies to SARS-CoV-2 (chemiluminescent microparticle immunoassay) was then carried out. RESULTS The seroprevalence of SARS-CoV-2 was 9.2% (95% confidence interval [CI], 5.9-13.5) in the group without PrEP and 15.0% (95% CI, 12.0-18.4) in the group with PrEP (P = .026). Among users of TDF/FTC it was 14.7% (95% CI, 11.4-18.5), and in users of TAF/FTC it was 16.5% (95% CI, 9.5-25.7) (P = .661). In those who tested positive for SARS-CoV-2 and receiving PrEP, 57.4% manifested symptoms, compared with 78.3% in the control group (P = .070). In users of TDF/FTC the figure was 53.3% and in users of TAF/FTC the figure was 73.3% (P = .100). The duration of symptoms was 11.5 days in the control group, 9.0 days in PrEP users (P = .116), 7.0 days in users of TDF/FTC, and 13.0 days in users of TAF/FTC (P = .100). CONCLUSIONS Users of PrEP, TDF/FTC, or TAF/FTC presented a higher seroprevalence to SARS-CoV-2 than the control group. No statistically significant differences were found in relation to clinical manifestations. The PrEP users should use the same prevention measures as those indicated for the general population.
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Affiliation(s)
- Oskar Ayerdi
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Teresa Puerta
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Petunia Clavo
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Mar Vera
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Juan Ballesteros
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Manuel Enrique Fuentes
- Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Alfonso X el Sabio, Madrid, Spain
| | - Vicente Estrada
- Servicio de Infecciosas, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Carmen Rodríguez
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Jorge Del Romero
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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162
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Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, Alsukait RF, Alluhidan M, Alazemi N, Shekar M. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev 2020; 21:e13128. [PMID: 32845580 PMCID: PMC7461480 DOI: 10.1111/obr.13128] [Citation(s) in RCA: 670] [Impact Index Per Article: 167.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
The linkage of individuals with obesity and COVID-19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID-19, 75 studies were used to conduct a series of meta-analyses on the relationship of individuals with obesity-COVID-19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID-19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID-19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30-1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74-2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46-2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22-1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID-19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID-19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.
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Affiliation(s)
- Barry M. Popkin
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Shufa Du
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - William D. Green
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Melinda A. Beck
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Reem F. Alsukait
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Community Health SciencesKing Saud UniversityRiyadhKingdom of Saudi Arabia
| | | | | | - Meera Shekar
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
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163
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Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res 2020; 161:105107. [PMID: 32739424 PMCID: PMC7393179 DOI: 10.1016/j.phrs.2020.105107] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Currently, coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. This study aimed to investigate whether the presence of acute kidney injury (AKI) might increase the risk of severe infection and fatality in COVID-19 patients. We searched the PubMed, Web of Science, ScienceDirect, MedRxiv and COVID-19 academic research communication platforms for studies reporting severe infection rates and case-fatality rates in COVID-19 patients with and without AKI up to June 20, 2020. The main outcomes were the comparisons of the severe infection rates and fatality rates in COVID-19 patients with and without AKI and the estimation of the odds ratio (OR) and its 95 % confidence interval (CI) for severe infection and mortality. Statistical analyses were performed with R statistical software. A total of 40 studies involving 24,527 patients with COVID-19 were included in our meta-analysis. The incidence of AKI was 10 % (95 % CI 8%-13 %) in COVID-19 patients. The patients had higher severe infection and fatality rates (55.6 % vs. 17.7 % and 63.1 % vs. 12.9 %, respectively, all P < 0.01) with COVID-19. AKI was a predictor of fatality (OR = 14.63, 95 % CI: 9.94-21.51, P < 0.00001) and severe infection (OR = 8.11, 95 % CI: 5.01-13.13, P < 0.00001) in patients with COVID-19. Higher levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were associated with a significant increase in fatality [Scr: mean difference (MD): 20.19 μmol/L, 95 % CI: 14.96-25.42, P < 0.001; BUN: MD: 4.07 mmol/L, 95 % CI: 3.33-4.81, P < 0.001] and severe infection (Scr: MD: 7.78 μmol/L, 95 % CI: 4.43-11.14, P < 0.00001, BUN: MD: 2.12 mmol/L, 95 % CI: 1.74-2.50, P < 0.00001) in COVID-19 patients. In conclusion, AKI is associated with severe infection and higher fatality rates in patients with COVID-19. Clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with AKI.
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Affiliation(s)
- Mengjiao Shao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - XiaoMei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junyi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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164
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García-Tardón N, Abbes AP, Gerrits A, Slingerland RJ, den Besten G. Laboratory parameters as predictors of mortality in COVID-19 patients on hospital admission. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - André P. Abbes
- Isala , Klinisch Chemisch Laboratorium , Zwolle , Netherlands
| | - Alice Gerrits
- Isala , Klinisch Chemisch Laboratorium , Zwolle , Netherlands
| | | | - Gijs den Besten
- Isala , Zwolle , Netherlands
- Isala , Klinisch Chemisch Laboratorium , Zwolle , Netherlands
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165
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Laosa O, Pedraza L, Álvarez-Bustos A, Carnicero JA, Rodriguez-Artalejo F, Rodriguez-Mañas L. Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status. J Am Med Dir Assoc 2020; 21:1798-1802.e2. [PMID: 33160872 PMCID: PMC7543696 DOI: 10.1016/j.jamda.2020.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the role of functional status along with other used clinical factors on the occurrence of death in patients hospitalized with COVID-19. Design Prospective cohort study. Setting Public university hospital (Madrid). Participants and Methods A total of 375 consecutive patients with COVID-19 infection, admitted to a Public University Hospital (Madrid) between March 1 and March 31, 2020, were included in the Prospective Cohort study. Death was the main outcome. The main variable was disability in activities of daily living (ADL) assessed with the Barthel Index. Covariates included sex, age, severity index (Quick Sequential Organ Failure Assessment, qSOFA), polypharmacy (≥5 drugs in the month before admission), and comorbidity (≥3 diseases). Multivariable logistic regression was used to identify risk factors for adverse outcomes. Estimated model coefficients served to calculate the expected probability of death for a selected combination of 5 variables: Barthel Index, sex, age, comorbidities, and severity index (qSOFA). Results Mean age was 66 years (standard deviation 15.33), and there were 207 (55%) men. Seventy-four patients died (19.8%). Mortality was associated with low Barthel Index (odds ratio per 5-point decrease 1.11, 95% confidence interval 1.03-1.20), male sex (0.23, 0.11-0.47), age (1.07, 1.03-1.10), and comorbidity (2.15, 1.08-4.30) but not with qSOFA (1.29, 0.87-1.93) or polypharmacy (1.54, 0.77-3.08). Calculated mortality risk ranged from 0 to 0.78. Conclusions and Implications Functional status predicts death in hospitalized patients with COVID-19. Combination of 5 variables allows to predict individual probability of death. These findings provide useful information for the decision-making process and management of patients.
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Affiliation(s)
- Olga Laosa
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain; Institute of Biomedical Research, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Laura Pedraza
- Institute of Biomedical Research, University Hospital of Getafe, Getafe, Madrid, Spain
| | | | - Jose A Carnicero
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain; Institute of Biomedical Research, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain; Geriatrics Department, University Hospital of Getafe, Getafe, Madrid, Spain.
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166
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von Bartheld CS, Hagen MM, Butowt R. Prevalence of Chemosensory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis Reveals Significant Ethnic Differences. ACS Chem Neurosci 2020; 11:2944-2961. [PMID: 32870641 PMCID: PMC7571048 DOI: 10.1021/acschemneuro.0c00460] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A significant proportion of people who test positive for COVID-19 have chemosensory deficits. However, the reported prevalence of these deficits in smell and taste varies widely, and the reason for the differences between studies is unclear. We determined the pooled prevalence of such chemosensory deficits in a systematic review and meta-analysis. We searched the COVID-19 portfolio of the National Institutes of Health for studies that reported the prevalence of smell or taste deficits or both in patients diagnosed with COVID-19. One-hundred-four studies reporting on 38 198 patients qualified and were subjected to a systematic review and meta-analysis. Estimated random prevalence of olfactory dysfunction was 43.0%, that of taste dysfunction was 44.6%, and that of overall chemosensory dysfunction was 47.4%. We examined the effects of age, gender, disease severity, and ethnicity on chemosensory dysfunction. Prevalence of smell or taste dysfunction or both decreased with older age, male gender, and disease severity. Ethnicity was highly significant: Caucasians had a three times higher prevalence of chemosensory dysfunctions (54.8%) than Asians (17.7%). The finding of geographic differences points to two causes that are not mutually exclusive. A virus mutation (D614G) may cause differing infectivity, while at the host level genetic, ethnicity-specific variants of the virus-binding entry proteins may facilitate virus entry in the olfactory epithelium and taste buds. Both explanations have major implications for infectivity, diagnosis, and management of the COVID-19 pandemic.
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Affiliation(s)
- Christopher S. von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Molly M. Hagen
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Rafal Butowt
- Department of Molecular Cell Genetics and Department of Anatomy, L. Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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167
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Del Amo J, Polo R, Moreno S, Díaz A, Martínez E, Arribas JR, Jarrín I, Hernán MA. Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy : A Cohort Study. Ann Intern Med 2020; 173:536-541. [PMID: 32589451 PMCID: PMC7394316 DOI: 10.7326/m20-3689] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations. OBJECTIVE To describe the incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART. DESIGN Cohort study. SETTING HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020. PARTICIPANTS 77 590 HIV-positive persons receiving ART. MEASUREMENTS Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction-confirmed COVID-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for COVID-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models. RESULTS Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for COVID-19 diagnosis and hospitalization were greater in men and persons older than 70 years. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for COVID-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died. LIMITATION Residual confounding by comorbid conditions cannot be completely excluded. CONCLUSION HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV. PRIMARY FUNDING SOURCE Instituto de Salud Carlos III and National Institutes of Health.
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Affiliation(s)
| | - Rosa Polo
- Ministry of Health, Madrid, Spain (J.D., R.P.)
| | - Santiago Moreno
- University Hospital Ramón y Cajal and HIV Network of Excellence, Madrid, Spain (S.M.)
| | - Asunción Díaz
- Ministry of Health, HIV Network of Excellence, and Institute of Health Carlos III, Madrid, Spain (A.D.)
| | - Esteban Martínez
- HIV Network of Excellence, Madrid, and University Hospital Clinic, Barcelona, Spain (E.M.)
| | - José Ramón Arribas
- HIV Network of Excellence and University Hospital La Paz, IdiPAZ, Madrid, Spain (J.R.A.)
| | - Inma Jarrín
- HIV Network of Excellence and Institute of Health Carlos III, Madrid, Spain (I.J.)
| | - Miguel A Hernán
- Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts (M.A.H.)
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Shang L, Shao M, Guo Q, Shi J, Zhao Y, Xiaokereti J, Tang B. Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis. Arch Med Res 2020; 51:700-709. [PMID: 32811670 PMCID: PMC7413048 DOI: 10.1016/j.arcmed.2020.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Currently, the number of patients with coronavirus disease 2019 (COVID-19) infection is increasing rapidly worldwide. In this study, we aimed to assess whether diabetes mellitus (DM) would increase the risk of severe infection and death in patients with COVID-19. METHODS We systematically searched the PubMed, Web of Science, MedRxiv and COVID-19 academic research communication platform for studies reporting clinical severity and/or overall mortality data on DM in patients with COVID-19 published up to July 10, 2020. The primary outcome was to compare the severe infection rate and mortality rate in COVID-19 patients with and without DM, and to calculate the odds ratio (OR) and 95% confidence interval (CI). RESULTS A total of 76 studies involving 31,067 patients with COVID-19 were included in our meta-analysis. COVID-19 patients with DM had higher severe infection and case-mortality rates compared with those without DM (21.4 vs. 10.6% and 28.5 vs. 13.3%, respectively, all p <0.01). COVID-19 patients with DM were at significantly elevated risk of severe infection (OR = 2.38, 95% CI: 2.05-2.78, p <0.001) and mortality (OR = 2.21, 95% CI: 1.83-2.66, p <0.001). CONCLUSION DM is associated with increased risk of severe infection and higher mortality in patients with COVID-19. Our study suggests that clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with DM.
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Affiliation(s)
- Luxiang Shang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mengjiao Shao
- Department of Cardiology, Xinjiang Key Laboratory of Cardiovascular Disease Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qilong Guo
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jia Shi
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Zhao
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Hospital of Shenzhen General Station of Exit and Entry Frontier Inspection, Shenzhen, China
| | - Jiasuoer Xiaokereti
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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169
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Clinical characteristics, risk factors, and incidence of symptomatic coronavirus disease 2019 in a large cohort of adults living with HIV: a single-center, prospective observational study. AIDS 2020; 34:1775-1780. [PMID: 32773471 PMCID: PMC7493771 DOI: 10.1097/qad.0000000000002643] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text Background: It is unclear how characteristics, risk factors, and incidence of coronavirus disease 2019 (COVID-19) in people living with HIV (PLWH) differ from the general population. Methods: Prospective observational single-center cohort study of adult PLWH reporting symptoms of COVID-19. We assessed clinical characteristics, risk factors for COVID-19 diagnosis and severity, and standardized incidence rate ratio for COVID-19 cases in PLWH cohort and in Barcelona. Results: From 1 March 2020 to 10 May 2020, 53 out of 5683 (0.9% confidence interval 0.7–1.2%) PLWH were diagnosed with COVID-19. Median age was 44 years, CD4+ T cells were 618/μl and CD4+/CD8+ was 0.90. All but two individuals were virologically suppressed. Cough (87%) and fever (82%) were the most common symptoms. Twenty-six (49%) were admitted, six (14%) had severe disease, four (8%) required ICU admission, and two (4%) died. Several laboratory markers (lower O2 saturation and platelets, and higher leukocytes, creatinine, lactate dehydrogenase, C reactive protein, procalcitonin, and ferritin) were associated with COVID-19 severity. No HIV or antiretroviral-related factors were associated with COVID-19 diagnosis or severity. Standardized incidence rate ratios of confirmed or confirmed/probable COVID-19 in PLWH were 38% (95% confidence interval 27–52%, P < 0.0001) and 33% (95% confidence interval 21–50%, P < 0.0001), respectively relative to the general population. Conclusion: PLWH with COVID-19 did not differ from the rest of the HIV cohort. Clinical presentation, severity rate, and mortality were not dependent on any HIV-related or antiretroviral-related factor. COVID-19 standardized incidence rate was lower in PLWH than in the general population. These findings should be confirmed in larger multicenter cohort studies.
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170
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Wang Y, Ao G, Qi X, Xie B. The association between COVID-19 and asthma: A systematic review and meta-analysis. Clin Exp Allergy 2020; 50:1274-1277. [PMID: 32930476 DOI: 10.1111/cea.13733] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, China
| | - Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, China
| | - Xin Qi
- Department of Neurology, Chengdu Third People's Hospital, Chengdu, China
| | - Bo Xie
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, China
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171
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Zuazua-Gonzalez A, Collazo-Lorduy T, Coello-Casariego G, Collazo-Lorduy A, Leon-Soriano E, Torralba-Moron A, Onrubia-Parra T, Gomez-Martin-Zarco JM, Echarri-SanMartin R, Ripolles-Melchor J, Martinez-De-la-Gandara A, Domingo-Carrasco C. Surgical Tracheostomies in COVID-19 Patients: Indications, Technique, and Results in a Second-Level Spanish Hospital. OTO Open 2020; 4:2473974X20957636. [PMID: 32974425 PMCID: PMC7495941 DOI: 10.1177/2473974x20957636] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
Objective The main purpose of this work is to describe the sociodemographic and clinical characteristics of intensive care unit (ICU) patients in a second-level hospital in Madrid, Spain, focusing in those who underwent surgical tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic. The surgical technique and associated complications are also detailed. Study Design Observational and historical cohort. Setting Single center. Methods Eighty-three intubated COVID-19 patients were analyzed. Thirty bedside surgical tracheostomies had been performed following our safety protocol. Results Data from 83 patients admitted to the ICU in Infanta Leonor University Hospital were collected; 74.7% were male. The average age was 59.7 years. The main comorbidities found were hypertension in 51.8%, diabetes mellitus in 25.3%, asthma in 7.2%, and chronic obstructive pulmonary disease in 3.6%. A surgical tracheostomy was carried out in 36.1% of patients who needed a prolonged intubation. The most frequent complication of the surgical procedure, bleeding, occurred in 30%, but the majority were mild and ceased with compression only. The most relevant complication was local infection, which occurred in 26.7% of patients. There were statistically significant differences in the time from the beginning of mechanical ventilation until weaning between tracheostomized and nontracheostomized patients. The mortality rate of patients who underwent tracheostomy was 56.7%. Despite severe acute respiratory syndrome coronavirus 2 being highly contagious and tracheostomy being considered a high-risk procedure, our rate of infected ear, nose, and throat specialists was only 11.8%. Conclusion In our experience, bedside surgical tracheostomy is a safe procedure in COVID-19 patients when safety protocols are followed.
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Affiliation(s)
- Alejandro Zuazua-Gonzalez
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Teresa Collazo-Lorduy
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Guadalupe Coello-Casariego
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ana Collazo-Lorduy
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda (Madrid), Spain
| | - Elena Leon-Soriano
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Tomas Onrubia-Parra
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jose-M Gomez-Martin-Zarco
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Rosa Echarri-SanMartin
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier Ripolles-Melchor
- Department of Anesthesia and Intensive Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Carlos Domingo-Carrasco
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
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172
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Collado S, Arenas MD, Barbosa F, Cao H, Montero MM, Villar-García J, Barrios C, Rodríguez E, Sans L, Sierra A, Pérez-Sáez MJ, Redondo-Pachón D, Coca A, Maiques JM, Güerri-Fernández R, Horcajada JP, Crespo M, Pascual J. COVID-19 in Grade 4-5 Chronic Kidney Disease Patients. Kidney Blood Press Res 2020; 45:768-774. [PMID: 32898845 PMCID: PMC7573888 DOI: 10.1159/000511082] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) increases the risk of mortality during coronavirus disease 2019 (COVID-19) episodes, and some reports have underlined the high incidence and severity of this infection in dialysis patients. Information on COVID-19 in nondialysis CKD patients is not available yet. Case Reports Here we present 7 patients with grade 4–5 CKD who developed symptomatic COVID-19; they comprise 2.6% of our 267 advanced CKD patients. The estimated GFR was between 12 and 20 mL/min during the month prior to COVID-19. The 3 major symptoms were fever, cough, and dyspnea, and 5 patients showed bilateral pneumonia. Hydroxychloroquine, azithromycin, ceftriaxone, and steroids were the most frequently prescribed drugs. Two patients needed noninvasive mechanical ventilation. All patients showed minimal to moderate kidney function deterioration during admission, with an eGFR decline below 5 mL/min in 6 cases. No patient required acute dialysis. Six patients were discharged alive and remained dialysis free athe t the time of reporting, and one 76-year-old patient died. Conclusions COVID-19 affects grade 4–5 CKD patients, but prognosis may be acceptable if prompt supportive measures are applied. These findings should be confirmed in larger cohorts, and further observations will be needed to understand the full spectrum of clinical features and the optimal approach to COVID-19 in patients with advanced CKD.
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Affiliation(s)
- Silvia Collado
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - Higini Cao
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - Clara Barrios
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Laia Sans
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Adriana Sierra
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - Armando Coca
- Department of Nephrology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain,
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173
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Domínguez-Ortega J, López-Carrasco V, Barranco P, Ifim M, Luna JA, Romero D, Quirce S. Early experiences of SARS-CoV-2 infection in severe asthmatics receiving biologic therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2784-2786. [PMID: 32592790 PMCID: PMC7313481 DOI: 10.1016/j.jaip.2020.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain; CIBER of Respiratory Diseases, CIBERES, Madrid, Spain.
| | | | - Pilar Barranco
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain; CIBER of Respiratory Diseases, CIBERES, Madrid, Spain
| | - Mihaela Ifim
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Juan Alberto Luna
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain; CIBER of Respiratory Diseases, CIBERES, Madrid, Spain
| | - David Romero
- CIBER of Respiratory Diseases, CIBERES, Madrid, Spain; Department of Pulmonology, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain; CIBER of Respiratory Diseases, CIBERES, Madrid, Spain
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174
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García-Moguel I, Díaz Campos R, Alonso Charterina S, Fernández Rodríguez C, Fernández Crespo J. COVID-19, severe asthma, and biologics. Ann Allergy Asthma Immunol 2020; 125:357-359.e1. [PMID: 32553608 PMCID: PMC7293849 DOI: 10.1016/j.anai.2020.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Ismael García-Moguel
- Severe Asthma Unit, Allergy Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Rocío Díaz Campos
- Severe Asthma Unit, Pneumology Department Hospital Universitario 12 de Octubre Madrid, Spain
| | | | | | - Jesús Fernández Crespo
- Severe Asthma Unit, Allergy Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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175
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Kelada M, Anto A, Dave K, Saleh SN. The Role of Sex in the Risk of Mortality From COVID-19 Amongst Adult Patients: A Systematic Review. Cureus 2020; 12:e10114. [PMID: 33005531 PMCID: PMC7523740 DOI: 10.7759/cureus.10114] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A worldwide outbreak of coronavirus disease 2019 (COVID-19), identified as being caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), was classified as a Public Health Emergency of International Concern by the World Health Organisation (WHO) on January 30, 2020. Initial sex-disaggregated mortality data emerging from the Wuhan province of China identified male sex as a risk factor for increased COVID-19 mortality. In this systematic review, we aimed to assess the role of sex in the risk of mortality from COVID-19 in adult patients through comparison of clinical markers and inflammatory indexes. A systematic search was conducted on the following databases: PubMed, WHO COVID-19 database, Ovid MEDLINE, and Web of Science between the dates of June 15, 2020, and June 30, 2020. Key search terms used included: "sex", "gender", "SARS-COV-2", "COVID" and "mortality". We accepted the following types of studies concerning adult COVID-19 patients: retrospective cohort, observational cohort, case series, and applied research. Further studies were extracted from reference searching. The risk of bias was determined using the National Institutes of Health Quality Assessment Tool for Observational Cohort, Cross-Sectional Studies, and Case Series. We identified a total of 16 studies published between January 2020 and June 2020 for analysis in this systematic review. Our study population consisted of 11 cohort studies, four case series, and one genetic study, including a total of 76,555 participants. Ten of the studies included in this review observed a higher risk of mortality among males compared to females, and eight of these studies found this risk to be statistically significant. Sex-disaggregated COVID-19 mortality data identifies male patients with comorbidities as being at an increased risk of mortality worldwide. Further investigation revealed differences in immune response regulated by sex hormones, angiotensin-converting enzyme 2 (ACE2) expression, and health behaviours as contributing factors to increased risk of mortality from COVID-19 among males. Nine out of the 16 studies included were conducted in China. In order to comprehensively assess sex-differences in the risk of mortality from COVID-19, more studies will need to be conducted worldwide. Sex-disaggregated COVID-19 data published in the medical literature is limited, however it has become evident that male sex is an important risk factor for mortality. Further exploration into the impact of sex on this pandemic is required in order to develop targeted therapies, as well as public health policies, and to prevent sex bias in treatment.
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Affiliation(s)
- Monica Kelada
- Infectious Diseases, Imperial College London, London, GBR
| | - Ailin Anto
- Infectious Diseases, Imperial College London, London, GBR
| | - Karishma Dave
- Infectious Diseases, Imperial College London, London, GBR
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176
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Sisó-Almirall A, Kostov B, Mas-Heredia M, Vilanova-Rotllan S, Sequeira-Aymar E, Sans-Corrales M, Sant-Arderiu E, Cayuelas-Redondo L, Martínez-Pérez A, García-Plana N, Anguita-Guimet A, Benavent-Àreu J. Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona. PLoS One 2020; 15:e0237960. [PMID: 32822413 PMCID: PMC7444503 DOI: 10.1371/journal.pone.0237960] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. Aim To determine clinical factors of a poor prognosis in patients with COVID-19 infection. Design and setting Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. Method Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. Results We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. Conclusion Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts.
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Affiliation(s)
- Antoni Sisó-Almirall
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
- * E-mail:
| | - Belchin Kostov
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Minerva Mas-Heredia
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
| | - Sergi Vilanova-Rotllan
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
| | - Ethel Sequeira-Aymar
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Mireia Sans-Corrales
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Primary Care Centre Comte Borrell, Barcelona, Spain
| | - Elisenda Sant-Arderiu
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Laia Cayuelas-Redondo
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Angela Martínez-Pérez
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Noemí García-Plana
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Comte Borrell, Barcelona, Spain
| | - August Anguita-Guimet
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
| | - Jaume Benavent-Àreu
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Crespo M, Mazuecos A, Rodrigo E, Gavela E, Villanego F, Sánchez-Alvarez E, González-Monte E, Jiménez-Martín C, Melilli E, Diekman F, Zárraga S, Hernández D, Pascual J. Respiratory and Gastrointestinal COVID-19 Phenotypes in Kidney Transplant Recipients. Transplantation 2020; 104:2225-2233. [DOI: 10.1097/tp.0000000000003413] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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178
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Valencia I, Peiró C, Lorenzo Ó, Sánchez-Ferrer CF, Eckel J, Romacho T. DPP4 and ACE2 in Diabetes and COVID-19: Therapeutic Targets for Cardiovascular Complications? Front Pharmacol 2020; 11:1161. [PMID: 32848769 PMCID: PMC7426477 DOI: 10.3389/fphar.2020.01161] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/17/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 outbreak, caused by severe acute respiratory syndrome (SARS)-CoV-2 coronavirus has become an urgent health and economic challenge. Diabetes is a risk factor for severity and mortality of COVID-19. Recent studies support that COVID-19 has effects beyond the respiratory tract, with vascular complications arising as relevant factors worsening its prognosis, then making patients with previous vascular disease more prone to severity or fatal outcome. Angiotensin-II converting enzime-2 (ACE2) has been proposed as preferred receptor for SARS-CoV-2 host infection, yet specific proteins participating in the virus entry are not fully known. SARS-CoV-2 might use other co-receptor or auxiliary proteins allowing virus infection. In silico experiments proposed that SARS-CoV-2 might bind dipeptidyl peptidase 4 (DPP4/CD26), which was established previously as receptor for MERS-CoV. The renin-angiotensin-aldosterone system (RAAS) component ACE2 and DPP4 are proteins dysregulated in diabetes. Imbalance of the RAAS and direct effect of soluble DPP4 exert deleterious vascular effects. We hypothesize that diabetic patients might be more affected by COVID-19 due to increased presence ACE2 and DPP4 mediating infection and contributing to a compromised vasculature. Here, we discuss the role of ACE2 and DPP4 as relevant factors linking the risk of SARS-CoV-2 infection and severity of COVID-19 in diabetic patients and present an outlook on therapeutic potential of current drugs targeted against RAAS and DPP4 to treat or prevent COVID-19-derived vascular complications. Diabetes affects more than 400 million people worldwide, thus better understanding of how they are affected by COVID-19 holds an important benefit to fight against this disease with pandemic proportions.
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Affiliation(s)
- Inés Valencia
- Vascular Pharmacology and Metabolism Group (FARMAVASM), Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigaciones Sanitarias del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Concepción Peiró
- Vascular Pharmacology and Metabolism Group (FARMAVASM), Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigaciones Sanitarias del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Óscar Lorenzo
- Laboratory of Vascular Pathology and Diabetes, FIIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain
| | - Carlos F Sánchez-Ferrer
- Vascular Pharmacology and Metabolism Group (FARMAVASM), Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigaciones Sanitarias del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Jürgen Eckel
- German Diabetes Center, Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tania Romacho
- German Diabetes Center, Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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179
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Agyeman AA, Chin KL, Landersdorfer CB, Liew D, Ofori-Asenso R. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. Mayo Clin Proc 2020; 95:1621-1631. [PMID: 32753137 PMCID: PMC7275152 DOI: 10.1016/j.mayocp.2020.05.030] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the prevalence of olfactory and gustatory dysfunctions (OGDs) among patients infected with novel coronavirus disease 2019 (COVID-19). METHODS A systematic review was conducted by searching MEDLINE, EMBASE, and the preprint server MedRxiv from their inception until May 11, 2020, using the terms anosmia or hyposmia or dysosmia or olfactory dysfunction or olfaction disorder or smell dysfunction or ageusia or hypogeusia or dysgeusia or taste dysfunction or gustatory dysfunction or neurological and COVID-19 or 2019 novel coronavirus or 2019-nCoV or SARS-CoV-2. The references of included studies were also manually screened. Only studies involving patients with diagnostic-confirmed COVID-19 infection were included. Random-effects meta-analysis was performed. RESULTS Twenty-four studies with data from 8438 patients with test-confirmed COVID-19 infection from 13 countries were included. The pooled proportions of patients presenting with olfactory dysfunction and gustatory dysfunction were 41.0% (95% CI, 28.5% to 53.9%) and 38.2% (95% CI, 24.0% to 53.6%), respectively. Increasing mean age correlated with lower prevalence of olfactory (coefficient = -0.076; P=.02) and gustatory (coefficient = -0.073; P=.03) dysfunctions. There was a higher prevalence of olfactory dysfunctions with the use of objective measurements compared with self-reports (coefficient = 2.33; P=.01). No significant moderation of the prevalence of OGDs by sex was observed. CONCLUSION There is a high prevalence of OGDs among patients infected with COVID-19. Routine screening for these conditions could contribute to improved case detection in the ongoing COVID-19 pandemic. However, to better inform population screening measures, further studies are needed to establish causality.
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Affiliation(s)
- Akosua Adom Agyeman
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Melbourne, Victoria, Australia
| | - Ken L Chin
- Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia; Monash University, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Cornelia B Landersdorfer
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia; Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
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180
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Mostaza JM, García-Iglesias F, González-Alegre T, Blanco F, Varas M, Hernández-Blanco C, Hontañón V, Jaras-Hernández MJ, Martínez-Prieto M, Menéndez-Saldaña A, Cachán ML, Estirado E, Lahoz C. Clinical course and prognostic factors of COVID-19 infection in an elderly hospitalized population. Arch Gerontol Geriatr 2020; 91:104204. [PMID: 32771883 PMCID: PMC7383171 DOI: 10.1016/j.archger.2020.104204] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Older subjects have a higher risk of COVID-19 infection and a greater mortality. However, there is a lack of studies evaluating the characteristics of this infection at advanced age. PATIENTS AND METHODS We studied 404 patients ≥ 75 years (mean age 85.2 ± 5.3 years, 55 % males), with PCR-confirmed COVID-19 infection, attended in two hospitals in Madrid (Spain). Patients were followed-up until they were discharged from the hospital or until death. RESULTS Symptoms started 2-7 days before admission, and consisted of fever (64 %), cough (59 %), and dyspnea (57 %). A total of 145 patients (35.9 %) died a median of 9 days after hospitalization. In logistic regression analysis, predictive factors of death were age (OR 1.086; 1.015-1.161 per year, p = 0.016), heart rate (1.040; 1.018-1.061 per beat, p < 0.0001), a decline in renal function during hospitalization (OR 7.270; 2.586-20.441, p < 0.0001) and worsening dyspnea during hospitalization (OR 73.616; 30.642-176.857, p < 0.0001). Factors predicting survival were a female sex (OR 0.271; 0.128-0.575, p = 0.001), previous treatment with RAAS inhibitors (OR 0.459; 0.222-0.949, p = 0.036), a higher oxygen saturation at admission (OR 0.901; 0.842-0.963 per percentage point increase, p = 0.002), and a greater platelet count (OR 0.995; 0.991-0.999 per 106/L, p = 0.025). CONCLUSION Elderly patients with COVID-19 infection have a similar clinical course to younger individuals. Previous treatment with RAAS inhibitors, and demographic, clinical and laboratory data influence prognosis.
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Affiliation(s)
- Jose M Mostaza
- Departments of Internal Medicine, Hospital Carlos III, Madrid, Spain.
| | | | | | - Francisco Blanco
- Departments of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - Marta Varas
- Departments of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | | | | | | | | | | | - María L Cachán
- Departments of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - Eva Estirado
- Departments of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - Carlos Lahoz
- Departments of Internal Medicine, Hospital Carlos III, Madrid, Spain
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181
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Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo E, Artero-Mora A, Arnalich-Fernández F, García-Bruñén JM, Vargas-Núñez JA, Freire-Castro SJ, Manzano-Espinosa L, Perales-Fraile I, Crestelo-Viéitez A, Puchades-Gimeno F, Rodilla-Sala E, Solís-Marquínez MN, Bonet-Tur D, Fidalgo-Moreno MP, Fonseca-Aizpuru EM, Carrasco-Sánchez FJ, Rabadán-Pejenaute E, Rubio-Rivas M, Torres-Peña JD, Gómez-Huelgas R. Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. Rev Clin Esp 2020; 220:480-494. [PMID: 33994573 PMCID: PMC7368900 DOI: 10.1016/j.rce.2020.07.003] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/13/2023]
Abstract
Antecedentes España ha sido uno de los países más afectados por la pandemia de COVID-19. Objetivo Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. Métodos Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. Resultados Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥ 80 años: 46%). Conclusiones El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad.
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Affiliation(s)
- J M Casas-Rojo
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España
| | - J M Antón-Santos
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España.
| | | | | | - J M Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - E Roy-Vallejo
- Servicio de Medicina Interna, H. U. La Princesa, Madrid, España
| | - A Artero-Mora
- Servicio de Medicina Interna, H. U. Dr. Peset, Valencia, España
| | | | | | - J A Vargas-Núñez
- Servicio de Medicina Interna, H. U. Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - I Perales-Fraile
- Servicio de Medicina Interna, H. U. Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | | | - F Puchades-Gimeno
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - E Rodilla-Sala
- Servicio de Medicina Interna, H. de Sagunto, Sagunto, Valencia, España
| | | | - D Bonet-Tur
- Servicio de Medicina Interna, H. U. San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | | | | | | | | | - M Rubio-Rivas
- Servicio de Medicina Interna, H. U. de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J D Torres-Peña
- Servicio de Medicina Interna, H. U. Reina Sofía, Córdoba, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, H. Regional Universitario de Málaga, Málaga, España.
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182
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Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo E, Artero-Mora A, Arnalich-Fernández F, García-Bruñén JM, Vargas-Núñez JA, Freire-Castro SJ, Manzano-Espinosa L, Perales-Fraile I, Crestelo-Viéitez A, Puchades-Gimeno F, Rodilla-Sala E, Solís-Marquínez MN, Bonet-Tur D, Fidalgo-Moreno MP, Fonseca-Aizpuru EM, Carrasco-Sánchez FJ, Rabadán-Pejenaute E, Rubio-Rivas M, Torres-Peña JD, Gómez-Huelgas R. Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. Rev Clin Esp 2020. [PMID: 32762922 PMCID: PMC7480740 DOI: 10.1016/j.rceng.2020.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.
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Affiliation(s)
- J M Casas-Rojo
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España
| | - J M Antón-Santos
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España.
| | | | | | - J M Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - E Roy-Vallejo
- Servicio de Medicina Interna, H. U. La Princesa, Madrid, España
| | - A Artero-Mora
- Servicio de Medicina Interna, H. U. Dr. Peset, Valencia, España
| | | | | | - J A Vargas-Núñez
- Servicio de Medicina Interna, H. U. Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - I Perales-Fraile
- Servicio de Medicina Interna, H. U. Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | | | - F Puchades-Gimeno
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - E Rodilla-Sala
- Servicio de Medicina Interna, H. de Sagunto, Sagunto, Valencia, España
| | | | - D Bonet-Tur
- Servicio de Medicina Interna, H. U. San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | | | | | | | | | - M Rubio-Rivas
- Servicio de Medicina Interna, H. U. de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J D Torres-Peña
- Servicio de Medicina Interna, H. U. Reina Sofía, Córdoba, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, H. Regional Universitario de Málaga, Málaga, España.
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183
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López-Collazo E, Avendaño-Ortiz J, Martín-Quirós A, Aguirre LA. Immune Response and COVID-19: A mirror image of Sepsis. Int J Biol Sci 2020; 16:2479-2489. [PMID: 32792851 PMCID: PMC7415424 DOI: 10.7150/ijbs.48400] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
The emergence of SARS-CoV-2 virus and its associated disease COVID-19 have triggered significant threats to public health, in addition to political and social changes. An important number of studies have reported the onset of symptoms compatible with pneumonia accompanied by coagulopathy and lymphocytopenia during COVID-19. Increased cytokine levels, the emergence of acute phase reactants, platelet activation and immune checkpoint expression are some of the biomarkers postulated in this context. As previously observed in prolonged sepsis, T-cell exhaustion due to SARS-CoV-2 and even their reduction in numbers due to apoptosis hinder the response to the infection. In this review, we synthesized the immune changes observed during COVID-19, the role of immune molecules as severity markers for patient stratification and their associated therapeutic options.
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Affiliation(s)
- Eduardo López-Collazo
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - José Avendaño-Ortiz
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Alejandro Martín-Quirós
- Emergency Department and Emergent Pathology Research Group, IdiPAZ La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Luis A. Aguirre
- The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
- Tumor Immunology Laboratory, IdiPAZ, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
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184
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Wu T, Zuo Z, Kang S, Jiang L, Luo X, Xia Z, Liu J, Xiao X, Ye M, Deng M. Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis. Aging Dis 2020; 11:874-894. [PMID: 32765952 PMCID: PMC7390520 DOI: 10.14336/ad.2020.0520] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023] Open
Abstract
This study aimed to provide systematic evidence for the association between multiorgan dysfunction and COVID-19 development. Several online databases were searched for articles published until May 13, 2020. Two investigators independently selected trials, extracted data, and evaluated the quality of individual trials. Single-arm meta-analysis was performed to summarize the clinical features of confirmed COVID-19 patients. Fixed effects meta-analysis was performed for clinically relevant parameters that were closely related to the patients' various organ functions. A total of 73 studies, including 171,108 patients, were included in this analysis. The overall incidence of severe COVID-19 and mortality were 24% (95% confidence interval [CI], 20%-28%) and 2% (95% CI, 1%-3%), respectively. Patients with hypertension (odds ratio [OR] = 2.40; 95% CI, 2.08-2.78), cardiovascular disease (CVD) (OR = 3.54; 95% CI, 2.68-4.68), chronic obstructive pulmonary disease (COPD) (OR=3.70; 95% CI, 2.93-4.68), chronic liver disease (CLD) (OR=1.48; 95% CI, 1.09-2.01), chronic kidney disease (CKD) (OR = 1.84; 95% CI, 1.47-2.30), chronic cerebrovascular diseases (OR = 2.53; 95% CI, 1.84-3.49) and chronic gastrointestinal (GI) disease (OR = 2.13; 95% CI, 1.12-4.05) were more likely to develop severe COVID-19. Increased levels of lactate dehydrogenase (LDH), creatine kinase (CK), high-sensitivity cardiac troponin I (hs-cTnI), myoglobin, creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were highly associated with severe COVID-19. The incidence of acute organ injuries, including acute cardiac injury (ACI); (OR = 11.87; 95% CI, 7.64-18.46), acute kidney injury (AKI); (OR=10.25; 95% CI, 7.60-13.84), acute respiratory distress syndrome (ARDS); (OR=27.66; 95% CI, 18.58-41.18), and acute cerebrovascular diseases (OR=9.22; 95% CI, 1.61-52.72) was more common in patients with severe COVID-19 than in patients with non-severe COVID-19. Patients with a history of organ dysfunction are more susceptible to severe conditions. COVID-19 can aggravate an acute multiorgan injury.
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Affiliation(s)
- Ting Wu
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
| | - Zhihong Zuo
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
| | - Shuntong Kang
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
| | - Liping Jiang
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
| | - Xuan Luo
- Hunan Yuanpin Cell Biotechnology Co., Ltd, Hunan 410129, China.
| | - Zanxian Xia
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China.
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha 410013, China.
| | - Jing Liu
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
| | - Xiaojuan Xiao
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
| | - Mao Ye
- Molecular Science and Biomedicine Laboratory, State Key Laboratory for Chemo/Biosensing and Chemometrics, College of Biology, College of Chemistry and Chemical Engineering, Collaborative Innovation Center for Molecular Engineering for Theranostics, Hunan University, Changsha, China
| | - Meichun Deng
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha 410013, China.
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185
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Nuño L, Novella Navarro M, Bonilla G, Franco-Gómez K, Aguado P, Peiteado D, Monjo I, Tornero C, Villalba A, Miranda-Carus ME, De Miguel E, Bogas P, Castilla-Plaza A, Bernad-Pineda M, García-Lorenzo E, Rodríguez-Araya T, Balsa A. Clinical course, severity and mortality in a cohort of patients with COVID-19 with rheumatic diseases. Ann Rheum Dis 2020; 79:1659-1661. [PMID: 32606046 PMCID: PMC7677491 DOI: 10.1136/annrheumdis-2020-218054] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Laura Nuño
- Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | - Gema Bonilla
- Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | - Pilar Aguado
- Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | - Irene Monjo
- Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Alejandro Balsa
- Rheumatology, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
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186
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von Bartheld CS, Hagen MM, Butowt R. Prevalence of Chemosensory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis Reveals Significant Ethnic Differences. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.15.20132134. [PMID: 32587993 PMCID: PMC7310651 DOI: 10.1101/2020.06.15.20132134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A significant fraction of people who test positive for COVID-19 have chemosensory deficits. However, the reported prevalence of these deficits in smell and/or taste varies widely, and the reason for the differences between studies is unclear. We determined the pooled prevalence of such chemosensory deficits in a systematic review. We searched the COVID-19 portfolio of the National Institutes of Health for all studies that reported the prevalence of smell and/or taste deficits in patients diagnosed with COVID-19. Forty-two studies reporting on 23,353 patients qualified and were subjected to a systematic review and meta-analysis. Estimated random prevalence of olfactory dysfunction was 38.5%, of taste dysfunction was 30.4% and of overall chemosensory dysfunction was 50.2%. We examined the effects of age, disease severity, and ethnicity on chemosensory dysfunction. The effect of age did not reach significance, but anosmia/hypogeusia decreased with disease severity, and ethnicity was highly significant: Caucasians had a 3-6 times higher prevalence of chemosensory deficits than East Asians. The finding of ethnic differences points to genetic, ethnicity-specific differences of the virus-binding entry proteins in the olfactory epithelium and taste buds as the most likely explanation, with major implications for infectivity, diagnosis and management of the COVID-19 pandemic.
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Affiliation(s)
- Christopher S. von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Molly M. Hagen
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Rafal Butowt
- Department of Molecular Cell Genetics, L. Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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187
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Morais-Almeida M, Pité H, Aguiar R, Ansotegui I, Bousquet J. Asthma and the Coronavirus Disease 2019 Pandemic: A Literature Review. Int Arch Allergy Immunol 2020; 181:680-688. [PMID: 32516795 PMCID: PMC7316650 DOI: 10.1159/000509057] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. There is no strong evidence supporting that patients with asthma have a higher risk of becoming seriously ill from coronavirus disease 2019 (CO-VID-19), although recent reports from the USA and the UK suggest that asthma is much more common in children and adults with mild to severe COVID-19 than has previously been reported in Asia and in Europe. As in previous severe acute respiratory syndrome (SARS) outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus with a low rate of asthma exacerbations. A different expression of viral receptors and T2 inflammation can be responsible for different outcomes. Future studies focused on asthma and on other allergic disorders are needed to provide a greater understanding of the impact of underlying asthma and allergic inflammation on COVID-19 susceptibility and disease severity. However, for the moment, it is crucial that asthmatic patients maintain their controller medication, from inhaled corticosteroids to biologics, without making any dose adjustments on their own or stopping the medication. New data are emerging daily, rapidly updating our understanding of this novel coronavirus.
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Affiliation(s)
- Mário Morais-Almeida
- Allergy Center, CUF Descobertas and CUF Infante Santo Hospitals, Lisbon, Portugal
- Portuguese Association of Asthmatics (APA), Porto, Portugal
| | - Helena Pité
- Allergy Center, CUF Descobertas and CUF Infante Santo Hospitals, Lisbon, Portugal
- Portuguese Association of Asthmatics (APA), Porto, Portugal
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rita Aguiar
- Allergy Center, CUF Descobertas and CUF Infante Santo Hospitals, Lisbon, Portugal,
| | | | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- MACVIA-France, Montpellier, France
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188
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Vizcarra P, Pérez-Elías MJ, Quereda C, Moreno A, Vivancos MJ, Dronda F, Casado JL. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort. Lancet HIV 2020; 7:e554-e564. [PMID: 32473657 PMCID: PMC7255735 DOI: 10.1016/s2352-3018(20)30164-8] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
Background Information about incidence, clinical characteristics, and outcomes of HIV-infected individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is scarce. We characterised individuals with COVID-19 among a cohort of HIV-infected adults in Madrid. Methods In this observational prospective study, we included all consecutive HIV-infected individuals (aged ≥18 years) who had suspected or confirmed COVID-19 as of April 30, 2020, at the Hospital Universitario Ramón y Cajal (Madrid, Spain). We compared the characteristics of HIV-infected individuals with COVID-19 with a sample of HIV-infected individuals assessed before the COVID-19 pandemic, and described the outcomes of individuals with COVID-19. Findings 51 HIV-infected individuals were diagnosed with COVID-19 (incidence 1·8%, 95% CI 1·3–2·3). Mean age of patients was 53·3 years (SD 9·5); eight (16%) were women, and 43 (84%) men. 35 (69%) cases of co-infection had laboratory confirmed COVID-19, and 28 (55%) required hospital admission. Age and CD4 cell counts in 51 patients diagnosed with COVID-19 were similar to those in 1288 HIV-infected individuals without; however, 32 (63%) with COVID-19 had at least one comorbidity (mostly hypertension and diabetes) compared with 495 (38%) without COVID-19 (p=0·00059). 37 (73%) patients had received tenofovir before COVID-19 diagnosis compared with 487 (38%) of those without COVID-19 (p=0·0036); 11 (22%) in the COVID-19 group had previous protease inhibitor use (mostly darunavir) compared with 175 (14%; p=0·578). Clinical, analytical, and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population. Six (12%) individuals were critically ill, two of whom had CD4 counts of less than 200 cells per μL, and two (4%) died. SARS-CoV-2 RT-PCR remained positive after a median of 40 days from symptoms onset in six (32%) individuals, four of whom had severe disease or low nadir CD4 cell counts. Interpretation HIV-infected individuals should not be considered to be protected from SARS-CoV-2 infection or to have lower risk of severe disease. Generally, they should receive the same treatment approach applied to the general population. Funding None.
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Affiliation(s)
- Pilar Vizcarra
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - María J Pérez-Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carmen Quereda
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María J Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Fernando Dronda
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
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189
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Rodriguez-Vega B, Palao Á, Muñoz-Sanjose A, Torrijos M, Aguirre P, Fernández A, Amador B, Rocamora C, Blanco L, Marti-Esquitino J, Ortiz-Villalobos A, Alonso-Sañudo M, Cebolla S, Curto J, Villanueva R, de-la-Iglesia MJ, Carracedo D, Casado C, Vidal E, Trigo D, Iglesias N, Cabañas D, Mellado L, García D, Fernández-Encinas C, Navarro R, Mediavilla R, Vidal-Villegas MP, Bravo-Ortiz MF, Bayón C. Implementation of a Mindfulness-Based Crisis Intervention for Frontline Healthcare Workers During the COVID-19 Outbreak in a Public General Hospital in Madrid, Spain. Front Psychiatry 2020; 11:562578. [PMID: 33329103 PMCID: PMC7673433 DOI: 10.3389/fpsyt.2020.562578] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: The COVID-19 outbreak is having an impact on the well-being of healthcare workers. Mindfulness-based interventions have shown effectiveness in reducing stress and fostering resilience and recovery in healthcare workers. There are no studies examining the feasibility of brief mindfulness-based interventions during the COVID-19 outbreak. Materials and Methods: This is an exploratory study with a post intervention assessment. We describe an on-site brief mindfulness intervention and evaluate its helpfulness, safety, and feasibility. Results: One thousand out of 7,000 (14%) healthcare workers from La Paz University Hospital in Madrid (Spain) participated in at least one session. One hundred and fifty out of 1,000 (15%) participants filled out a self-report questionnaire evaluating the helpfulness of the intervention for on-site stress reduction. Ninety two subjects (61%) participated in more than one session. Most of the participants were women (80%) with a mean age of 38.6 years. Almost half of the sample were nurses (46%). Sessions were perceived as being helpful with a mean rating of 8.4 on a scale from 0 to 10. Only 3 people (2%) reported a minor adverse effect (increased anxiety or dizziness). Discussion: Our data supports the utility, safety and feasibility of an on-site, brief mindfulness-based intervention designed to reduce stress for frontline health workers during a crisis. There is a need to continue testing this type of interventions, and to integrate emotion regulation strategies as an essential part of health workers' general training. Clinical Trial Registration number: NCT04555005.
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Affiliation(s)
- Beatriz Rodriguez-Vega
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Autonomous University of Madrid (UAM), Madrid, Spain
| | - Ángela Palao
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Autonomous University of Madrid (UAM), Madrid, Spain
| | - Ainoa Muñoz-Sanjose
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Marta Torrijos
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Pablo Aguirre
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Arancha Fernández
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Blanca Amador
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Cristina Rocamora
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Laura Blanco
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Jesús Marti-Esquitino
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Aránzazu Ortiz-Villalobos
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Mónica Alonso-Sañudo
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Susana Cebolla
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Javier Curto
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Rosa Villanueva
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - María-Jesús de-la-Iglesia
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Diego Carracedo
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Carlos Casado
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Emma Vidal
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Daniel Trigo
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Noelia Iglesias
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Diana Cabañas
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Loreto Mellado
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | - Daniel García
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | | | - Rubén Navarro
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
| | | | - María-Paz Vidal-Villegas
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Autonomous University of Madrid (UAM), Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Autonomous University of Madrid (UAM), Madrid, Spain
| | - Carmen Bayón
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Autonomous University of Madrid (UAM), Madrid, Spain
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