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Horváth RA, Sütő Z, Cséke B, Schranz D, Darnai G, Kovács N, Janszky I, Janszky J. Epilepsy is overrepresented among young people who died from COVID-19: Analysis of nationwide mortality data in Hungary. Seizure 2022; 94:136-141. [PMID: 34906799 PMCID: PMC8634695 DOI: 10.1016/j.seizure.2021.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Studies examining epilepsy as a COVID-related death risk have come to conflicting conclusions. Our aim was to assess the prevalence of epilepsy among COVID-related deaths in Hungary. METHODS Each COVID-19 infection case is required to be reported on a daily basis to the National Public Health Center of Hungary. This online report includes the beginning and end of the infection, as well as information on comorbidities. Death during infection is regarded as COVID-related. The anonymized data of each deceased patient are published on an information website (www.koronavirus.gov.hu) and provides up-to-date information on each patient with the date of death, the patient's sex, age, and chronic illness. RESULTS There were 11,968 patients who died of COVID-19 in Hungary between 13 March 2020 and 23 January 2021. Among 11,686 patients with no missing values for comorbidities, 255 patients had epilepsy (2.2%). Epilepsy was much more common among those who died at a young age: 9.3% of those who died under the age of 50 had epilepsy, compared with only 1.3% in those over the age of 80. The younger an age group was, the higher was the prevalence of epilepsy. CONCLUSION Patients who died of COVID-19 under the age of 50 were 10 to 20 times more likely to have epilepsy than what would have been expected from epidemiological data. Our results highlight the need for increased protection of young people with epilepsy from COVID-19 infection and the development of a vaccination strategy accordingly.
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Affiliation(s)
- Réka A. Horváth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary
| | - Zsófia Sütő
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary
| | - Balázs Cséke
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary
| | - Dániel Schranz
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary
| | - Gergely Darnai
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary,MTA-PTE Clinical Neuroscience MRI Research Group. Hungary, Ifjúság u. 20., H-7624 Pécs, Hungary,Department of Behavioral Sciences, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary,MTA-PTE Clinical Neuroscience MRI Research Group. Hungary, Ifjúság u. 20., H-7624 Pécs, Hungary
| | - Imre Janszky
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11 and Mauritz Hanssens gate, 7491 Trondheim, Norway,Regional Center for Health Care Improvement, St Olav's Hospital, Trondheim, Norway
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary,MTA-PTE Clinical Neuroscience MRI Research Group. Hungary, Ifjúság u. 20., H-7624 Pécs, Hungary,Corresponding author at: Department of Neurology, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary
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302
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Dowell AC, Butler MS, Jinks E, Tut G, Lancaster T, Sylla P, Begum J, Bruton R, Pearce H, Verma K, Logan N, Tyson G, Spalkova E, Margielewska-Davies S, Taylor GS, Syrimi E, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Ireland G, Aiano F, Amin-Chowdhury Z, Jones S, Borrow R, Linley E, Wright J, Azad R, Waiblinger D, Davis C, Thomson EC, Palmarini M, Willett BJ, Barclay WS, Poh J, Amirthalingam G, Brown KE, Ramsay ME, Zuo J, Moss P, Ladhani S. Children develop robust and sustained cross-reactive spike-specific immune responses to SARS-CoV-2 infection. Nat Immunol 2022; 23:40-49. [PMID: 34937928 PMCID: PMC8709786 DOI: 10.1038/s41590-021-01089-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2 infection is generally mild or asymptomatic in children but a biological basis for this outcome is unclear. Here we compare antibody and cellular immunity in children (aged 3-11 years) and adults. Antibody responses against spike protein were high in children and seroconversion boosted responses against seasonal Beta-coronaviruses through cross-recognition of the S2 domain. Neutralization of viral variants was comparable between children and adults. Spike-specific T cell responses were more than twice as high in children and were also detected in many seronegative children, indicating pre-existing cross-reactive responses to seasonal coronaviruses. Importantly, children retained antibody and cellular responses 6 months after infection, whereas relative waning occurred in adults. Spike-specific responses were also broadly stable beyond 12 months. Therefore, children generate robust, cross-reactive and sustained immune responses to SARS-CoV-2 with focused specificity for the spike protein. These findings provide insight into the relative clinical protection that occurs in most children and might help to guide the design of pediatric vaccination regimens.
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Affiliation(s)
- Alexander C Dowell
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elizabeth Jinks
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gokhan Tut
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Panagiota Sylla
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jusnara Begum
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hayden Pearce
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kriti Verma
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Grace Tyson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Eliska Spalkova
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sandra Margielewska-Davies
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Graham S Taylor
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleni Syrimi
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Ifeanyichukwu O Okike
- Public Health England, 61 Colindale Avenue, London, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Aston, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Wellington Square, Oxford, UK
| | | | | | | | | | - Samuel Jones
- Public Health England, 61 Colindale Avenue, London, UK
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - Brian J Willett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College, London, UK
| | - John Poh
- Public Health England, 61 Colindale Avenue, London, UK
| | | | - Kevin E Brown
- Public Health England, 61 Colindale Avenue, London, UK
| | - Mary E Ramsay
- Public Health England, 61 Colindale Avenue, London, UK
| | - Jianmin Zuo
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Shamez Ladhani
- Public Health England, 61 Colindale Avenue, London, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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303
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Naghavi S, Kavosh A, Adibi I, Shaygannejad V, Arabi S, Rahimi M, Mazaheri S, Ashtari F. COVID-19 infection and hospitalization rate in Iranian multiple sclerosis patients: What we know by May 2021. Mult Scler Relat Disord 2022; 57:103335. [PMID: 35158427 PMCID: PMC8519664 DOI: 10.1016/j.msard.2021.103335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/12/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite investigations on the effect of disease modifying therapies (DMTs) used in multiple sclerosis (MS) on coronavirus disease 2019 (COVID-19); there are still controversies. OBJECTIVE We designed this study to evaluate the epidemiological features of covid-19 in a large sample of people with MS (pwMS) in Isfahan, Iran, as well as the association between DMTs, risk of COVID-19 infection and hospitalization. METHODS In an observational pwMS, we interviewed subjects on their MS and COVID-19 history. RESULTS 3050 subjects were included (74% female) with a mean age of 41.36. 423 (13.8%) had confirmed COVID-19 which shows that pwMS are at a higher risk of infection compared to the general population, No significant relationship was observed in COVID-19 infection when individual drugs. Dimethyl fumarate and rituximab had the lowest and the highest relative risks for hospitalization rate compared to other drugs, respectively. CONCLUSION We found no evidence supporting a higher prevalence of COVID-19 in pwMS compared to the general population. However, our results show pwMS to be more prone to hospitalization compared to the general population, Therefore, it is advised to use safer treatment if possible until complete vaccination, and to postpone the use of rituximab.
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Affiliation(s)
- Saba Naghavi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan
| | | | - Iman Adibi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, b. Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan
| | - Sina Arabi
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan.
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304
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Golovatyuk K, Karonova T, Mikhailova A, Lagutina D, Chernikova A, Vasilieva E, Shlyakhto E. Cholecalciferol as part of complex therapy for acute COVID-19. PROFILAKTICHESKAYA MEDITSINA 2022; 25:106. [DOI: 10.17116/profmed202225121106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
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305
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Rahmah L, Abarikwu SO, Arero AG, Essouma M, Jibril AT, Fal A, Flisiak R, Makuku R, Marquez L, Mohamed K, Ndow L, Zarębska-Michaluk D, Rezaei N, Rzymski P. Oral antiviral treatments for COVID-19: opportunities and challenges. Pharmacol Rep 2022; 74:1255-1278. [PMID: 35871712 PMCID: PMC9309032 DOI: 10.1007/s43440-022-00388-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
The use of antiviral COVID-19 medications can successfully inhibit SARS-CoV-2 replication and prevent disease progression to a more severe form. However, the timing of antiviral treatment plays a crucial role in this regard. Oral antiviral drugs provide an opportunity to manage SARS-CoV-2 infection without a need for hospital admission, easing the general burden that COVID-19 can have on the healthcare system. This review paper (i) presents the potential pharmaceutical antiviral targets, including various host-based targets and viral-based targets, (ii) characterizes the first-generation anti-SARS-CoV-2 oral drugs (nirmatrelvir/ritonavir and molnupiravir), (iii) summarizes the clinical progress of other oral antivirals for use in COVID-19, (iv) discusses ethical issues in such clinical trials and (v) presents challenges associated with the use of oral antivirals in clinical practice. Oral COVID-19 antivirals represent a part of the strategy to adapt to long-term co-existence with SARS-CoV-2 in a manner that prevents healthcare from being overwhelmed. It is pivotal to ensure equal and fair global access to the currently available oral antivirals and those authorized in the future.
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Affiliation(s)
- Laila Rahmah
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Jakarta, Indonesia
| | - Sunny O. Abarikwu
- Department of Biochemistry, University of Port Harcourt, Choba, Nigeria ,Universal Scientific Education and Research Network (USERN), Choba, Nigeria
| | - Amanuel Godana Arero
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Addis Ababa, Ethiopia
| | - Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ,Universal Scientific Education and Research Network, Yaoundé, Cameroon
| | - Aliyu Tijani Jibril
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran ,Nutritional and Health Team (NHT), Universal Scientific Education and Research Network (USERN), Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Accra, Ghana
| | - Andrzej Fal
- Department of Population Health, Division of Public Health, Wroclaw Medical University, Wroclaw, Poland ,Collegium Medicum, Warsaw Faculty of Medicine, Cardinal Stefan Wyszyński University, Warsaw, Poland ,Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), Poznań, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Rangarirai Makuku
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Harare, Zimbabwe
| | - Leander Marquez
- College of Social Sciences and Philosophy, University of the Philippines Diliman, Quezon City, Philippines ,Education and Research Network (USERN), Universal Scientific, Quezon City, Philippines
| | - Kawthar Mohamed
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Manama, Bahrain
| | - Lamin Ndow
- National Health Laboratory Service, Kotu, Gambia ,Universal Scientific Education and Research Network (USERN), Banjul, Gambia
| | | | - Nima Rezaei
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran ,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Piotr Rzymski
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), Poznań, Poland ,Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
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306
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Zavala S, Stout JE. Understanding and Communicating Risk: Assessing both Relative and Absolute Risk Is Absolutely Necessary. JID INNOVATIONS 2022; 2:100097. [PMID: 35199093 PMCID: PMC8844685 DOI: 10.1016/j.xjidi.2022.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sofia Zavala
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jason E. Stout
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Corresponding author
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307
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Bhatti SI, Mindikoglu AL. The impact of dawn to sunset fasting on immune system and its clinical significance in Covid-19 pandemic. Metabol Open 2021; 13:100162. [PMID: 34977523 PMCID: PMC8713419 DOI: 10.1016/j.metop.2021.100162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
Dawn to sunset fasting, a type of intermittent fasting commonly practiced in the month of Ramadan, requires fasting from dawn to sunset without food or liquid intake. Dawn and dusk are two transition time zones of the day that play a critical role in the human circadian rhythm. Practicing dawn to sunset fasting requires the alignment of mealtimes and wake-sleep times with the human biological dawn and dusk. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impairs immune cell responses at multiple levels and leads to severe Coronavirus Disease 2019 (COVID-19). It generates high levels of pro-inflammatory cytokines and chemokines, also known as a cytokine storm, leads to mitochondrial dysfunction and generation of excessive amounts of mitochondrial reactive oxygen species, downregulates autophagy to escape detection for unchecked replication, and alters gut microbiome composition. Severe cases of COVID-19 have been associated with several comorbidities that impair immune responses (e.g., obesity, diabetes, malignancy) and blood laboratory abnormalities (e.g., elevated procalcitonin, C-reactive protein, interleukin-6 (IL-6), leukocytosis, lymphopenia). Several studies of dawn to sunset fasting showed anti-inflammatory effect by suppressing several pro-inflammatory cytokines, reducing oxidative stress, inducing a proteome response associated with increased autophagy, remodeling the gut microbiome, and improving the components of metabolic syndrome (e.g., obesity, blood glucose levels, blood pressure, lipids). In conclusion, dawn to sunset fasting has the potential to optimize the immune system function against SARS-CoV-2 during the COVID-19 pandemic as it suppresses chronic inflammation and oxidative stress, improves metabolic profile, and remodels the gut microbiome. This review presents scientific literature related to the effects of dawn to sunset fasting on the immune system. Studies are needed to assess and confirm the potential benefits of dawn to sunset fasting against SARS-CoV-2.
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Affiliation(s)
- Sundus I Bhatti
- Margaret M. and Albert B. Alkek Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA
| | - Ayse L Mindikoglu
- Margaret M. and Albert B. Alkek Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA
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308
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Arbel R, Hammerman A, Sergienko R, Friger M, Peretz A, Netzer D, Yaron S. BNT162b2 Vaccine Booster and Mortality Due to Covid-19. N Engl J Med 2021; 385:2413-2420. [PMID: 34879190 PMCID: PMC8728797 DOI: 10.1056/nejmoa2115624] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND The emergence of the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 and the reduced effectiveness over time of the BNT162b2 vaccine (Pfizer-BioNTech) led to a resurgence of coronavirus disease 2019 (Covid-19) cases in populations that had been vaccinated early. On July 30, 2021, the Israeli Ministry of Health approved the use of a third dose of BNT162b2 (booster) to cope with this resurgence. Evidence regarding the effectiveness of the booster in lowering mortality due to Covid-19 is still needed. METHODS We obtained data for all members of Clalit Health Services who were 50 years of age or older at the start of the study and had received two doses of BNT162b2 at least 5 months earlier. The mortality due to Covid-19 among participants who received the booster during the study period (booster group) was compared with that among participants who did not receive the booster (nonbooster group). A Cox proportional-hazards regression model with time-dependent covariates was used to estimate the association of booster status with death due to Covid-19, with adjustment for sociodemographic factors and coexisting conditions. RESULTS A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (95% confidence interval, 0.07 to 0.14; P<0.001). CONCLUSIONS Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.
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Affiliation(s)
- Ronen Arbel
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
| | - Ariel Hammerman
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
| | - Ruslan Sergienko
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
| | - Michael Friger
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
| | - Alon Peretz
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
| | - Doron Netzer
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
| | - Shlomit Yaron
- From the Community Medical Services Division, Clalit Health Services, Tel Aviv (R.A., A.H., A.P., D.N., S.Y.), the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.), and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba (R.S., M.F.) - all in Israel
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309
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Mortality Predictors in Severe COVID-19 Patients from an East European Tertiary Center: A Never-Ending Challenge for a No Happy Ending Pandemic. J Clin Med 2021; 11:jcm11010058. [PMID: 35011795 PMCID: PMC8745635 DOI: 10.3390/jcm11010058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
(1) Background: There are limited clinical data in patients from the Eastern European regions hospitalized for a severe form of Coronavirus disease 2019 (COVID-19). This study aims to identify risk factors associated with intra-hospital mortality in patients with COVID-19 severe pneumonia admitted to a tertiary center in Iasi, Romania. (2) Methods: The study is of a unicentric retrospective observational type and includes 150 patients with severe COVID-19 pneumonia divided into two subgroups, survivors and non-survivors. Demographic and clinical parameters, as well as comorbidities, laboratory and imaging investigations upon admission, treatments, and evolution during hospitalization were recorded. First, we sought to identify the risk factors associated with intra-hospital mortality using logistic regression. Secondly, we assessed the correlations between D-Dimer and C-reactive protein and predictors of poor prognosis. (3) Results: The predictors of in-hospital mortality identified in the study are D-dimers >0.5 mg/L (p = 0.002), C-reactive protein >5 mg/L (p = 0.001), and heart rate above 100 beats per minute (p = 0.001). The biomarkers were also significantly correlated the need for mechanical ventilation, admission to intensive care unit, or multiple organ dysfunction syndrome. By area under the curve (AUC) analysis, we noticed that both D-Dimer (AUC 0.741) and C-reactive protein (AUC 0.707) exhibit adequate performance in predicting a poor prognosis in patients with severe viral infection. (4) Conclusions: COVID-19's outcome is significantly influenced by several laboratory and clinical factors. As mortality induced by severe COVID-19 pneumonia is considerable, the identification of risk factors associated with negative outcome coupled with an early therapeutic approach are of paramount importance, as they may significantly improve the outcome and survival rates.
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310
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Morales JS, Valenzuela PL, Castillo-García A, Butragueño J, Jiménez-Pavón D, Carrera-Bastos P, Lucia A. The Exposome and Immune Health in Times of the COVID-19 Pandemic. Nutrients 2021; 14:24. [PMID: 35010900 PMCID: PMC8746533 DOI: 10.3390/nu14010024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/07/2023] Open
Abstract
Growing evidence supports the importance of lifestyle and environmental exposures-collectively referred to as the 'exposome'-for ensuring immune health. In this narrative review, we summarize and discuss the effects of the different exposome components (physical activity, body weight management, diet, sun exposure, stress, sleep and circadian rhythms, pollution, smoking, and gut microbiome) on immune function and inflammation, particularly in the context of the current coronavirus disease 2019 (COVID-19) pandemic. We highlight the potential role of 'exposome improvements' in the prevention-or amelioration, once established-of this disease as well as their effect on the response to vaccination. In light of the existing evidence, the promotion of a healthy exposome should be a cornerstone in the prevention and management of the COVID-19 pandemic and other eventual pandemics.
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Affiliation(s)
- Javier S. Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain;
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
| | - Pedro L. Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (P.L.V.); (A.L.)
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12′), 28041 Madrid, Spain
| | | | - Javier Butragueño
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences, Polytechnic University of Madrid (UPM), 28040 Madrid, Spain;
| | - David Jiménez-Pavón
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain;
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Pedro Carrera-Bastos
- Centre for Primary Health Care Research, Lund University, Skane University Hospital, 205 02 Malmö, Sweden;
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (P.L.V.); (A.L.)
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12′), 28041 Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
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311
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Weinberger B. Vaccines and Vaccination against SARS-CoV-2: Considerations for the Older Population. Vaccines (Basel) 2021; 9:1435. [PMID: 34960181 PMCID: PMC8704374 DOI: 10.3390/vaccines9121435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 12/23/2022] Open
Abstract
Age is among the most prominent risk factors for developing severe COVID-19 disease, and therefore older adults are a major target group for vaccination against SARS-CoV-2. This review focusses on age-associated aspects of COVID-19 vaccines and vaccination strategies, and summarizes data on immunogenicity, efficacy and effectiveness of the four COVID-19 vaccines, which are licensed in the US and/or Europe; namely, the two mRNA vaccines by BioNTech/Pfizer (BNT162b2) and Moderna (mRNA-1273), and the adenovector vaccines developed by AstraZeneca/University Oxford (ChAdOx1-nCoV-19, AZD1222) and Janssen/Johnson&Johnson (Ad26.COV2-S), respectively. After very high protection rates in the first months after vaccination even in the older population, effectiveness of the vaccines, particularly against asymptomatic infection and mild disease, declined at later time points and with the emergence of virus variants. Many high-income countries have recently started administration of additional doses to older adults and other high-risk groups, whereas other parts of the world are still struggling to acquire and distribute vaccines for primary vaccination. Other vaccines are available in other countries and clinical development for more vaccine candidates is ongoing, but a complete overview of COVID-19 vaccine development is beyond the scope of this article.
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Affiliation(s)
- Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, 6020 Innsbruck, Austria
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312
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Clouston SAP, Luft BJ, Sun E. Clinical risk factors for mortality in an analysis of 1375 patients admitted for COVID treatment. Sci Rep 2021; 11:23414. [PMID: 34862487 PMCID: PMC8642440 DOI: 10.1038/s41598-021-02920-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/15/2021] [Indexed: 12/13/2022] Open
Abstract
The goal of the present work was to examine clinical risk factors for mortality in 1375 COVID + patients admitted to a hospital in Suffolk County, NY. Data were collated by the hospital epidemiological service for patients admitted from 3/7/2020 to 9/1/2020. Time until final discharge or death was the outcome. Cox proportional hazards models were used to estimate time until death among admitted patients. In total, all cases had resolved leading to 207 deaths. Length of stay was significantly longer in those who died as compared to those who did not (p = 0.007). Of patients who had been discharged, 54 were readmitted and nine subsequently died. Multivariable-adjusted Cox proportional hazards regression revealed that in addition to older age, male sex, and a history of chronic heart failure, chronic obstructive pulmonary disease, and diabetes, that a history of premorbid depression was a risk factors for COVID-19 mortality (aHR = 2.42 [1.38-4.23] P = 0.002), and that this association remained after adjusting for age and for neuropsychiatric conditions as well as medical comorbidities including cardiovascular disease and pulmonary conditions. Sex-stratified analyses revealed that associations between mortality and depression was strongest in males (aHR = 4.45 [2.04-9.72], P < 0.001), and that the association between heart failure and mortality was strongest in participants aged < 65 years old (aHR = 30.50 [9.17-101.48], P < 0.001). While an increasing number of studies have identified several comorbid medical conditions including chronic heart failure and age of patient as risk factors for mortality in COVID + patients, this study confirmed several prior reports and also noted that a history of depression is an independent risk factor for COVID-19 mortality.
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Affiliation(s)
- Sean A P Clouston
- Stony Brook Medicine, Stony Brook, NY, USA.
- Program in Public Health, Stony Brook Health Sciences Center, Stony Brook University, 101 Nichols Rd., Stony Brook, NY, 11794-8338, USA.
| | | | - Edward Sun
- Stony Brook Medicine, Stony Brook, NY, USA
- Stony Brook University Hospital, Stony Brook, NY, USA
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313
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Dakroub F, Fakhredine S, Yassine M, Dayekh A, Jaber R, Fadel A, Akl H, Maatouk A. A retrospective analysis of 902 hospitalized COVID‐19 patients in Lebanon: clinical epidemiology and risk factors. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100048. [PMID: 35262028 PMCID: PMC8532499 DOI: 10.1016/j.jcvp.2021.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The clinical epidemiology of hospitalized COVID-19 patients has never been described before in Lebanon. Moreover, the hospital admission and PCR positivity rates have not been assessed and compared yet. Objectives: To describe the characteristics and outcomes of hospitalized patients with coronavirus induced disease 2019 (COVID-19) in Lebanon and identify risk factors for severe disease or death. Study design: This is a retrospective mono-center cohort study in which we used patients’ files to extract and analyse data on demographic and clinical characteristics, as well as mortality. Moreover, we tracked the pandemic by recording the daily total and ICU inpatient census and the PCR positivity rate for admitted and outpatients. Results: Although the total admission rate increased from September to April, the ICU census switched this trend in December to stabilize at an average of around 10 patients/day until April. The case fatality rate was 19% for the 902 hospitalized patients, of which the majority (80%) had severe COVID-19. The severity odds ratio is significantly decreased in immunosuppressed cases (OR, 0.18; CI, 0.05-0.67; p=0.011). Additionally, the odds of COVID-19 related death are significantly greater if consolidations are found in the chest computed tomography (CT) scan (OR, 12; CI, 2.63-55.08; p=0.0013). Conclusion: Consolidations in the lungs significantly increase the COVID-19 death risk. Risk factors identification is important to improve patients’ management and vaccination strategies. In addition, hospital statistics are good indicators of a pandemic's track.
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Affiliation(s)
- Fatima Dakroub
- Research unit, Saint George Hospital, Lebanon
- Biology Department, Faculty of Sciences-I, Lebanese University, Lebanon
| | - Suha Fakhredine
- Research unit, Saint George Hospital, Lebanon
- Infectious diseases division, Saint George Hospital, Lebanon
| | - Mohammad Yassine
- Research unit, Saint George Hospital, Lebanon
- Pharmacy Department, Saint George Hospital, Lebanon
| | - Alaa Dayekh
- Research unit, Saint George Hospital, Lebanon
- Quality Improvement Department, Saint George Hospital, Lebanon
| | - Rachid Jaber
- Faculty of Medicine, Lebanese University, Lebanon
| | - Abbass Fadel
- Infectious diseases division, Saint George Hospital, Lebanon
| | - Haidar Akl
- Biology Department, Faculty of Sciences-I, Lebanese University, Lebanon
| | - Ali Maatouk
- The pulmonary department, Saint George Hospital, Lebanon
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314
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Storz MA. Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets. Curr Nutr Rep 2021; 10:352-363. [PMID: 34506003 PMCID: PMC8429479 DOI: 10.1007/s13668-021-00369-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The SARS-CoV-2-pandemic has caused mortality and morbidity at an unprecedented global scale. Many patients infected with SARS-CoV-2 continue to experience symptoms after the acute phase of infection and report fatigue, sleep difficulties, anxiety, and depression as well as arthralgia and muscle weakness. Summarized under the umbrella term "long-COVID," these symptoms may last weeks to months and impose a substantial burden on affected individuals. Dietary approaches to tackle these complications have received comparably little attention. Although plant-based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID-19 outcomes, their role with regard to COVID-19 sequelae is yet largely unknown. Thus, this review sought to investigate whether a plant-based diet could reduce the burden of long-COVID. RECENT FINDINGS The number of clinical trials investigating the role of plant-based nutrition in COVID-19 prevention and management is currently limited. Yet, there is evidence from pre-pandemic observational and clinical studies that a plant-based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID-19. These include anxiety, depression, sleep disorders, and musculoskeletal pain. Adoption of a plant-based diet leads to a reduced intake in pro-inflammatory mediators and could be one accessible strategy to tackle long-COVID associated prolonged systemic inflammation. Plant-based diets may be of general benefit with regard to some of the most commonly found COVID-19 sequelae. Additional trials investigating which plant-based eating patterns confer the greatest benefit in the battle against long-COVID are urgently warranted.
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Affiliation(s)
- Maximilian Andreas Storz
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
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315
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The Effect of COVID-19 Infection During Pregnancy; Evaluating Neonatal Outcomes and the Impact of the B.1.1.7. Variant. Pediatr Infect Dis J 2021; 40:e475-e481. [PMID: 34620797 PMCID: PMC8575080 DOI: 10.1097/inf.0000000000003352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with adverse perinatal outcomes. We aim to evaluate the neonatal outcomes including the incidence of preterm birth, admission to the neonatal unit and incidence of congenital anomalies in this cohort. We will also describe these outcomes in the context of the B.1.1.7. variant outbreak, the dominant variant in Ireland since January 2021, which has had a greater impact on pregnant patients. METHODS This was a retrospective study of liveborn infants, delivered between 1st March 2020 and 1st March 2021, to women with a severe acute respiratory syndrome coronavirus 2 diagnosis during pregnancy, in a tertiary maternity hospital (8,500 deliveries/year). Clinical data were collected, and analyses were performed to evaluate the impact of maternal symptom status, time from diagnosis to delivery and the B.1.1.7. variant on neonatal outcome. RESULTS In total 133 infants (1.6%) were born to women with severe acute respiratory syndrome coronavirus 2 identified during pregnancy. The median birth weight was 3.45 kg and gestational age at birth was 39.3 weeks. 14 infants (10.5%) were preterm. 22 infants (16.5%) required admission to the neonatal unit and 7 (5.3%) were small for gestational age. There was no difference in growth, preterm birth or neonatal unit admission based on maternal symptom status or infection after the outbreak of B.1.1.7. as the dominant strain. CONCLUSIONS Following a COVID-19 infection in pregnancy, there was no increase in the incidence of preterm birth or neonatal intensive care unit admission compared with 5-year hospital data. Maternal symptom status did not influence neonatal outcomes. Further studies to evaluate the impact of COVID-19 in early pregnancy, the variants of concern, particularly the emerging Delta variant and COVID-19 placentitis are required.
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316
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Seong GM, Baek AR, Baek MS, Kim WY, Kim JH, Lee BY, Na YS, Lee SI. Comparison of Clinical Characteristics and Outcomes of Younger and Elderly Patients with Severe COVID-19 in Korea: A Retrospective Multicenter Study. J Pers Med 2021; 11:jpm11121258. [PMID: 34945730 PMCID: PMC8708855 DOI: 10.3390/jpm11121258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary care centers in South Korea. This retrospective multicenter study included patients with severe COVID-19 who were admitted at seven hospitals in South Korea from 2 February 2020 to 28 February 2021. The Cox regression analyses were performed to assess factors associated with the in-hospital mortality. Of 488 patients with severe COVID-19, 318 (65.2%) were elderly (≥65 years). The older patient group had more underlying diseases and a higher severity score than the younger patient group. The older patient group had a higher in-hospital mortality rate than the younger patient group (25.5% versus 4.7%, p-value < 0.001). The in-hospital mortality risk factors among patients with severe COVID-19 included age, acute physiology and chronic health evaluation II score, presence of diabetes and chronic obstructive lung disease, high white blood cell count, low neutrophil-lymphocyte ratio and platelet count, do-not-resuscitate order, and treatment with invasive mechanical ventilation. In addition to old age, disease severity and examination results must be considered in treatment decision-making.
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Affiliation(s)
- Gil Myeong Seong
- Department of Internal Medicine, Jeju National University, Jeju 63243, Korea;
| | - Ae-Rin Baek
- Department of Internal Medicine, Division of Allergy and Pulmonology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Moon Seong Baek
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (M.S.B.); (W.-Y.K.)
| | - Won-Young Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (M.S.B.); (W.-Y.K.)
| | - Jin Hyoung Kim
- Department of Internal Medicine, Division of Respiratory and Critical Care Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea;
| | - Bo Young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju 61453, Korea;
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Correspondence: ; Tel.: +82-42-280-6816
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317
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Cossio Y, Aller MB, Abadias MJ, Domínguez JM, Romea MS, Barba MÀ, Rodríguez MI, Roman A, Salazar A. Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona. F1000Res 2021; 10:1197. [PMID: 35966962 PMCID: PMC9350435 DOI: 10.12688/f1000research.73988.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d'Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. METHODS A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. RESULTS The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. CONCLUSIONS Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.
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Affiliation(s)
- Yolima Cossio
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | - Marta-Beatriz Aller
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | - Maria José Abadias
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | | | - Maria-Soledad Romea
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | - Maria-Àngels Barba
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | | | - Antonio Roman
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | - Albert Salazar
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Health Services Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
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318
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Zirpe K, Pote P, Deshmukh A, Gurav SK, Tiwari AM, Suryawanshi P. A Retrospective Analysis of Risk Factors of COVID-19 Associated Mucormycosis and Mortality Predictors: A Single-Center Study. Cureus 2021; 13:e18718. [PMID: 34790473 PMCID: PMC8584128 DOI: 10.7759/cureus.18718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background Mucormycosis has been identified with increasing frequency in patients with coronavirus disease 2019 (COVID-19). Aims We aimed to determine the in-hospital outcome of patients with COVID-19 associated mucormycosis (CAM). Materials and methods This was a single-center, retrospective, observational study. We included patients diagnosed with CAM from a tertiary care hospital in Pune, India. Clinical, laboratory, and in-hospital outcomes were noted. We analyzed factors associated with in-hospital mortality. Results Between February 2021 and June 2021, we identified 84 patients of CAM. The mean age was 49.3 ± 12.1 years. Of the included patients, 64.3% had diabetes mellitus, and 83.3% had received steroids. Mucormycosis was diagnosed after a median of 11 days from the COVID-19 diagnosis. Orbital and central nervous system (CNS) involvement was seen in 29.8% and 23.8% of patients, respectively. During a mean hospital stay of 12.5 ± 8.5 days, 15.5% of patients died. Compared to survivors, the presence of chronic kidney disease (CKD) (p<0.0001), orbital involvement (p=0.039), use of tocilizumab (p<0.0001), and development of renal dysfunction during hospitalization (p<0.0001) were seen in a significantly higher proportion of nonsurvivors. The proportion of patients with diabetes, those receiving steroids, and mean glycosylated hemoglobin (HbA1c) levels did not differ significantly in survivors and nonsurvivors. Conclusion In-hospital mortality in CAM is relatively lower in our institution. CKD, orbital involvement, use of tocilizumab, and renal dysfunction during hospital stay were found to be strong predictors of mortality.
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Affiliation(s)
- Kapil Zirpe
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
| | - Prajakta Pote
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
| | | | - Sushma K Gurav
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
| | - Anand M Tiwari
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
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319
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Pineda-Santoyo C, Campos-Romero A, Luna-Ruiz Esparza MA, López-Luna LE, Sánchez-Zarate ME, Zepeda-González A, Fernández-Rojas MA, Alcántar-Fernández J. Control and Prevention of SARS-CoV-2 Outbreaks among Healthcare Workers from 129 Healthcare Facilities in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211772. [PMID: 34831527 PMCID: PMC8625209 DOI: 10.3390/ijerph182211772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
Few reports have shared the workflows to reduce SARS-CoV-2 infections among risk groups, including healthcare workers (HCWs). This study describes an occupational health program implemented to reduce the incidence of COVID-19 and establishes a back-to-work algorithm in HCWs of 129 Salud Digna outpatient care clinics in Mexico. This program was composed of training plans, screening SARS-CoV-2 infections, the containment of infections, follow-up COVID-19 cases, and continuing supervision in addition to the steady supply and training for the correct use of PPE. From 16 April 2020 to 15 April 2021, 7376 individuals were enrolled, of which 423 were excluded because they did not meet the inclusion criteria or refused the follow-up. In the cohort studied, we found a COVID-19 incidence of 35.4% (2610 individuals), lower hospitalization (0.11%), ICU (0.04%) and lethality rate (0.04%). Additionally, 85.9% of COVID-19 cases tested negative for SARS-CoV-2 after 14 days of the first positive test with an average isolation time of 26–33 days. Finally, 99% of people received personal protective equipment and adequate training to use it. Our results show that the program implemented reduced the hospitalization ICU admission and lethality in HCWs; we consider this workflow to help other workplaces offer safe conditions for HCWs and patients.
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Affiliation(s)
- César Pineda-Santoyo
- Hygiene and Occupational Safety Department, Salud Digna, Culiacan 80000, Mexico;
- Human Resources Department, Salud Digna, Culiacan 80000, Mexico
| | - Abraham Campos-Romero
- Innovation and Research Department, Salud Digna, Culiacan 80000, Mexico; (A.C.-R.); (M.A.L.-R.E.); (M.A.F.-R.)
| | - Marco A. Luna-Ruiz Esparza
- Innovation and Research Department, Salud Digna, Culiacan 80000, Mexico; (A.C.-R.); (M.A.L.-R.E.); (M.A.F.-R.)
| | | | | | | | - Miguel A. Fernández-Rojas
- Innovation and Research Department, Salud Digna, Culiacan 80000, Mexico; (A.C.-R.); (M.A.L.-R.E.); (M.A.F.-R.)
| | - Jonathan Alcántar-Fernández
- Innovation and Research Department, Salud Digna, Culiacan 80000, Mexico; (A.C.-R.); (M.A.L.-R.E.); (M.A.F.-R.)
- Correspondence: ; Tel.: +52-667-713-7521
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320
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Mandala WL, Liu MKP. SARS-CoV-2 and HIV-1: Should HIV-1-Infected Individuals in Sub-Saharan Africa Be Considered a Priority Group for the COVID-19 Vaccines? Front Immunol 2021; 12:797117. [PMID: 34858440 PMCID: PMC8630634 DOI: 10.3389/fimmu.2021.797117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022] Open
Abstract
Since its emergence in 2019 SARS-CoV-2 has proven to have a higher level of morbidity and mortality compared to the other prevailing coronaviruses. Although initially most African countries were spared from the devastating effect of SARS-CoV-2, at present almost every country has been affected. Although no association has been established between being HIV-1-infected and being more vulnerable to contracting COVID-19, HIV-1-infected individuals have a greater risk of developing severe COVID-19 and of COVID-19 related mortality. The rapid development of the various types of COVID-19 vaccines has gone a long way in mitigating the devastating effects of the virus and has controlled its spread. However, global vaccine deployment has been uneven particularly in Africa. The emergence of SARS-CoV-2 variants, such as Beta and Delta, which seem to show some subtle resistance to the existing vaccines, suggests COVID-19 will still be a high-risk infection for years. In this review we report on the current impact of COVID-19 on HIV-1-infected individuals from an immunological perspective and attempt to make a case for prioritising COVID-19 vaccination for those living with HIV-1 in Sub-Saharan Africa (SSA) countries like Malawi as one way of minimising the impact of COVID-19 in these countries.
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Affiliation(s)
- Wilson Lewis Mandala
- Academy of Medical Sciences, Malawi University of Science and Technology (MUST), Thyolo, Malawi
| | - Michael K. P. Liu
- Centre for Immunology and Vaccinology, Department of Infectious Disease, Imperial College London, London, United Kingdom
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321
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Association between physical activity status and severity of COVID-19 in older adults. Epidemiol Infect 2021; 150:e189. [PMID: 36325838 PMCID: PMC9744453 DOI: 10.1017/s0950268822001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The risk factors specific to the elderly population for severe coronavirus disease 2019 (COVID-19) caused by the Omicron variant of concern (VOC) are not yet clear. We performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive severe acute respiratory coronavirus 2 (SARS-CoV-2) test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors - dementia, admission from a long-term care facility and poor physical activity status - and used Fisher's exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. Of the 4,868 cases analysed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility and poor physical activity status was -0.04 (95% confidence interval -0.07 to -0.01), 0.09 (0.06 to 0.12) and 0.17 (0.14 to 0.19), respectively. Our results suggest that poor physical activity status and living in a long-term care facility have a substantial association with the risk of severe COVID-19 caused by the Omicron VOC, while dementia may be associated with non-severe illness.
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Velásquez García HA, Wilton J, Smolina K, Chong M, Rasali D, Otterstatter M, Rose C, Prystajecky N, David S, Galanis E, McKee G, Krajden M, Janjua NZ. Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study. Viruses 2021; 13:v13112196. [PMID: 34835002 PMCID: PMC8624346 DOI: 10.3390/v13112196] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
This study identified factors associated with hospital admission among people with laboratory-diagnosed COVID-19 cases in British Columbia. The study used data from the BC COVID-19 Cohort, which integrates data on all COVID-19 cases with data on hospitalizations, medical visits, emergency room visits, prescription drugs, chronic conditions and deaths. The analysis included all laboratory-diagnosed COVID-19 cases in British Columbia to 15 January 2021. We evaluated factors associated with hospital admission using multivariable Poisson regression analysis with robust error variance. Of the 56,874 COVID-19 cases included in the analysis, 2298 were hospitalized. Factors associated with increased hospitalization risk were as follows: male sex (adjusted risk ratio (aRR) = 1.27; 95% CI = 1.17–1.37), older age (p-trend < 0.0001 across age groups increasing hospitalization risk with increasing age [aRR 30–39 years = 3.06; 95% CI = 2.32–4.03, to aRR 80+ years = 43.68; 95% CI = 33.41–57.10 compared to 20–29 years-old]), asthma (aRR = 1.15; 95% CI = 1.04–1.26), cancer (aRR = 1.19; 95% CI = 1.09–1.29), chronic kidney disease (aRR = 1.32; 95% CI = 1.19–1.47), diabetes (treated without insulin aRR = 1.13; 95% CI = 1.03–1.25, requiring insulin aRR = 5.05; 95% CI = 4.43–5.76), hypertension (aRR = 1.19; 95% CI = 1.08–1.31), injection drug use (aRR = 2.51; 95% CI = 2.14–2.95), intellectual and developmental disabilities (aRR = 1.67; 95% CI = 1.05–2.66), problematic alcohol use (aRR = 1.63; 95% CI = 1.43–1.85), immunosuppression (aRR = 1.29; 95% CI = 1.09–1.53), and schizophrenia and psychotic disorders (aRR = 1.49; 95% CI = 1.23–1.82). In an analysis restricted to women of reproductive age, pregnancy (aRR = 2.69; 95% CI = 1.42–5.07) was associated with increased risk of hospital admission. Older age, male sex, substance use, intellectual and developmental disability, chronic comorbidities, and pregnancy increase the risk of COVID-19-related hospitalization.
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Affiliation(s)
- Héctor Alexander Velásquez García
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
| | - Kate Smolina
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
| | - Drona Rasali
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
| | - Samara David
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
| | - Eleni Galanis
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Geoffrey McKee
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (H.A.V.G.); (J.W.); (K.S.); (M.C.); (D.R.); (M.O.); (C.R.); (N.P.); (S.D.); (E.G.); (G.M.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
- Correspondence: ; Tel.: +1-604-707-2514
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Hernandez-Garcia E, Chrysikou E, Kalea AZ. The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10891. [PMID: 34682637 PMCID: PMC8536084 DOI: 10.3390/ijerph182010891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 12/11/2022]
Abstract
Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.
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Affiliation(s)
- Eva Hernandez-Garcia
- The Bartlett Real Estate Institute, The Bartlett School of Sustainable Construction, University College London, London WC1E 6BT, UK;
| | - Evangelia Chrysikou
- The Bartlett Real Estate Institute, The Bartlett School of Sustainable Construction, University College London, London WC1E 6BT, UK;
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, 700 13 Heraklion, Greece
| | - Anastasia Z. Kalea
- Division of Medicine, University College London, London WC1E 6JF, UK;
- Institute of Cardiovascular Science, University College London, London WC1E 6HX, UK
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Weinberger B. Vaccination of older adults: Influenza, pneumococcal disease, herpes zoster, COVID-19 and beyond. Immun Ageing 2021; 18:38. [PMID: 34627326 PMCID: PMC8501352 DOI: 10.1186/s12979-021-00249-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
Preserving good health in old age is of utmost importance to alleviate societal, economic and health care-related challenges caused by an aging society. The prevalence and severity of many infectious diseases is higher in older adults, and in addition to the acute disease, long-term sequelae, such as exacerbation of underlying chronic disease, onset of frailty or increased long-term care dependency, are frequent. Prevention of infections e.g. by vaccination is therefore an important measure to ensure healthy aging and preserve quality of life. Several vaccines are specifically recommended for older adults in many countries, and in the current SARS-CoV-2 pandemic older adults were among the first target groups for vaccination due to their high risk for severe disease. This review highlights clinical data on the influenza, Streptococcus pneumoniae and herpes zoster vaccines, summarizes recent developments to improve vaccine efficacy, such as the use of adjuvants or higher antigen dose for influenza, and gives an overview of SARS-CoV-2 vaccine development for older adults. Substantial research is ongoing to further improve vaccines, e.g. by developing universal influenza and pneumococcal vaccines to overcome the limitations of the current strain-specific vaccines, and to develop novel vaccines against pathogens, which cause considerable morbidity and mortality in older adults, but for which no vaccines are currently available. In addition, we need to improve uptake of the existing vaccines and increase awareness for life-long vaccination in order to provide optimal protection for the vulnerable older age group.
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Affiliation(s)
- Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Rennweg 10, 6020, Innsbruck, Austria.
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Assessing Predictive Factors of COVID-19 Outcomes: A Retrospective Cohort Study in the Metropolitan Region of São Paulo (Brazil). MEDICINA-LITHUANIA 2021; 57:medicina57101068. [PMID: 34684105 PMCID: PMC8540449 DOI: 10.3390/medicina57101068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: The aim of this retrospective cohort study was to search individual, sociodemographic and environmental predictors of COVID-19 outcomes. Materials and Methods: A convenience sample of 1036 COVID-19 confirmed patients (3-99 years, mean 59 years; 482 females) who sought treatment at the emergency units of the public health system of Diadema (Brazil; March-October 2020) was included. Primary data were collected from medical records: sex, age, occupation/education, onset of symptoms, presence of chronic diseases/treatment and outcome (death and non-death). Secondary socioeconomic and environmental data were provided by the Department of Health. Results: The mean time spent between COVID-19 symptom onset and admission to the health system was 7.4 days. Principal component analysis summarized secondary sociodemographic data, and a Poisson regression model showed that the time between symptom onset and health system admission was higher for younger people and those from the least advantaged regions (availability of electricity, a sewage network, a water supply and garbage collection). A multiple logistic regression model showed an association of age (OR = 1.08; 1.05-1.1), diabetes (OR = 1.9; 1.1-3.4) and obesity (OR = 2.9; 1.1-7.6) with death outcome, while hypertension and sex showed no significant association. Conclusion: The identification of vulnerable groups may help the development of health strategies for the prevention and treatment of COVID-19.
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326
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Jung A, Orenti A, Dunlevy F, Aleksejeva E, Bakkeheim E, Bobrovnichy V, Carr SB, Colombo C, Corvol H, Cosgriff R, Daneau G, Dogru D, Drevinek P, Vukic AD, Fajac I, Fox A, Fustik S, Gulmans V, Harutyunyan S, Hatziagorou E, Kasmi I, Kayserová H, Kondratyeva E, Krivec U, Makukh H, Malakauskas K, McKone EF, Mei-Zahav M, de Monestrol I, Olesen HV, Padoan R, Parulava T, Pastor-Vivero MD, Pereira L, Petrova G, Pfleger A, Pop L, van Rens JG, Rodic´ M, Schlesser M, Storms V, Turcu O, Woz´niacki L, Yiallouros P, Zolin A, Downey DG, Naehrlich L. Factors for severe outcomes following SARS-CoV-2 infection in people with cystic fibrosis in Europe. ERJ Open Res 2021; 7:00411-2021. [PMID: 34984210 PMCID: PMC8557394 DOI: 10.1183/23120541.00411-2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in people with cystic fibrosis (pwCF) can lead to severe outcomes. METHODS In this observational study, the European Cystic Fibrosis Society Patient Registry collected data on pwCF and SARS-CoV-2 infection to estimate incidence, describe clinical presentation and investigate factors associated with severe outcomes using multivariable analysis. RESULTS Up to December 31, 2020, 26 countries reported information on 828 pwCF and SARS-CoV-2 infection. Incidence was 17.2 per 1000 pwCF (95% CI: 16.0-18.4). Median age was 24 years, 48.4% were male and 9.4% had lung transplants. SARS-CoV-2 incidence was higher in lung-transplanted (28.6; 95% CI: 22.7-35.5) versus non-lung-transplanted pwCF (16.6; 95% CI: 15.4-17.8) (p≤0.001).SARS-CoV-2 infection caused symptomatic illness in 75.7%. Factors associated with symptomatic SARS-CoV-2 infection were age >40 years, at least one F508del mutation and pancreatic insufficiency.Overall, 23.7% of pwCF were admitted to hospital, 2.5% of those to intensive care, and regretfully 11 (1.4%) died. Hospitalisation, oxygen therapy, intensive care, respiratory support and death were 2- to 6-fold more frequent in lung-transplanted versus non-lung-transplanted pwCF.Factors associated with hospitalisation and oxygen therapy were lung transplantation, cystic fibrosis-related diabetes (CFRD), moderate or severe lung disease and azithromycin use (often considered a surrogate marker for Pseudomonas aeruginosa infection and poorer lung function). CONCLUSION SARS-CoV-2 infection yielded high morbidity and hospitalisation in pwCF. PwCF with forced expiratory volume in 1 s <70% predicted, CFRD and those with lung transplants are at particular risk of more severe outcomes.
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Affiliation(s)
- Andreas Jung
- Paediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland
- Co-first authors
| | - Annalisa Orenti
- Dept of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G.A. Maccacaro, University of Milan, Milan, Italy
- Co-first authors
| | - Fiona Dunlevy
- European Cystic Fibrosis Society, Karup, Denmark
- Co-first authors
| | - Elina Aleksejeva
- Dept of Pneumology, Children's Clinical University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Egil Bakkeheim
- Dept of Paediatrics, Norwegian Cystic Fibrosis Registry, Oslo University Hospital, Oslo, Norway
| | - Vladimir Bobrovnichy
- Belarusian Republic Children's Center of Pulmonology and Cystic Fibrosis, Pulmonary Department, 3rd City Children's Clinical Hospital, Minsk, Belarus
| | - Siobhán B. Carr
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
- NHLI, Imperial College, London, UK
| | - Carla Colombo
- Dept of Pathophysiology and Transplantation, Cystic Fibrosis Reference Center of Lombardia Region, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Harriet Corvol
- Pediatric Pulmonology Dept and Cystic Fibrosis Center, Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm UMR_S938, Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Paris, France
| | | | - Géraldine Daneau
- Sciensano, Epidemiology and Public Health, Health Services Research, Brussels, Belgium
| | - Deniz Dogru
- Cystic Fibrosis Registry of Turkey, Ankara, Turkey
| | - Pavel Drevinek
- Dept of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Andrea Dugac Vukic
- University Hospital Centre Zagreb, Cystic Fibrosis Centre – Paediatrics and Adults, Zagreb, Croatia
| | - Isabelle Fajac
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- AP-HP, Hôpital Cochin, Service de Physiologie et Explorations Fonctionnelles, Paris, France
| | - Alice Fox
- European Cystic Fibrosis Society, Karup, Denmark
| | - Stojka Fustik
- Centre for Cystic Fibrosis, University Children's Hospital, Skopje, North Macedonia
| | - Vincent Gulmans
- Dutch Cystic Fibrosis Foundation (NCFS), Baarn, The Netherlands
| | | | - Elpis Hatziagorou
- Cystic Fibrosis Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irena Kasmi
- Dept of Paediatrics, “Mother Thereza” Hospital Center, Tirana, Albania
| | - Hana Kayserová
- Cystic Fibrosis Centre, University Hospital of Bratislava, Bratislava, Slovakia
| | - Elena Kondratyeva
- Clinical Research Dept of Cystic Fibrosis “Research Centre for Medical Genetics”, Moscow, Russian Federation
| | - Uroš Krivec
- Dept of Paediatric Pulmonology, University Children's Hospital, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Halyna Makukh
- Institute of Hereditary Pathology, Ukrainian National Academy of Medical Sciences, Lviv, Ukraine
| | - Kestutis Malakauskas
- Adult Cystic Fibrosis Center, Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edward F. McKone
- St Vincent's University Hospital & University College Dublin School of Medicine, Dublin, Ireland
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isabelle de Monestrol
- Stockholm CF Centre, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Hanne Vebert Olesen
- Dept of Pediatrics and Adolescent Medicine, Cystic Fibrosis Center, Aarhus University Hospital, Aarhus, Denmark
| | - Rita Padoan
- Dept of Paediatrics, Cystic Fibrosis Regional Support Centre, University of Brescia, Brescia
- Scientific Board of Italian CF Registry, Rome, Italy
| | | | | | - Luísa Pereira
- Centre for Cystic Fibrosis, Hospital de Santa Maria, Lisbon, Portugal
| | - Guergana Petrova
- Pediatric Clinic, Alexandrovska University Hospital, Medical University, Sofia, Bulgaria
| | - Andreas Pfleger
- Dept of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - Liviu Pop
- Victor Babes University of Medicine and Pharmacy Timisoara, National Cystic Fibrosis Centre, Timisoara, Romania
| | | | - Milan Rodic´
- National Centre for Cystic Fibrosis, Mother and Child Health Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia
| | - Marc Schlesser
- Dept of Pulmonology, Hôpital Robert Schuman, Luxembourg, Luxembourg
| | | | - Oxana Turcu
- Dept of Pediatrics, Ambulatory Cystic Fibrosis and Other Rare Diseases Center, Institute for Maternal and Child Healthcare, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova
| | - Lukasz Woz´niacki
- Dziekanow Paediatric Hospital, Cystic Fibrosis Centre, Institute of Mother and Child, Warsaw, Poland
| | | | - Anna Zolin
- Dept of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G.A. Maccacaro, University of Milan, Milan, Italy
| | - Damian G. Downey
- Wellcome–Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Regional Respiratory Centre, Belfast City Hospital, Belfast, UK
- Co-senior authors
| | - Lutz Naehrlich
- Dept of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G.A. Maccacaro, University of Milan, Milan, Italy
- Universities of Giessen and Marburg Lung Center, German Center of Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
- Co-senior authors
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Les facteurs pronostiques dans la Covid-19. NPG NEUROLOGIE - PSYCHIATRIE - GÉRIATRIE 2021. [PMCID: PMC8206591 DOI: 10.1016/j.npg.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Depuis la fin de l’année 2019, la France, de même que l’ensemble des pays du monde, est confrontée à une situation épidémiologique inédite : la Covid-19. Les personnes les plus vulnérables, et notamment les personnes âgées sont particulièrement touchées par cette épidémie. Bien que de nombreux patients se rétablissent complètement, plusieurs facteurs conduisent à un mauvais pronostic. Diverses études ont proposé comme objectif d’identifier les facteurs pronostiques de mortalité et d’évolution vers une maladie grave pour les patients diagnostiqués avec la Covid-19. Certains de ces facteurs pronostiques peuvent être utilisés dans la prise de décision relative à la prise en charge des patients infectés par la Covid-19.
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Garcia-Pelagio KP, Hew-Butler T, Fahlman MM, Roche JA. Women's Lives Matter-The Critical Need for Women to Prioritize Optimal Physical Activity to Reduce COVID-19 Illness Risk and Severity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10271. [PMID: 34639569 PMCID: PMC8507774 DOI: 10.3390/ijerph181910271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023]
Abstract
Physical activity (PA) is beneficial for the health and wellness of individuals and societies. During an infectious disease pandemic, such as the one caused by COVID-19, social distancing, quarantines, and lockdowns are used to reduce community spread of the disease. Unfortunately, such nonpharmacological interventions or physical risk mitigation measures also make it challenging to engage in PA. Reduced PA could then trigger physiological changes that affect both mental and physical health. In this regard, women are more likely to experience physical and psychological distress. PA is a safe and effective nonpharmacological modality that can help prevent and manage several mental and physical health problems when performed correctly. PA might even confer benefits that are directly related to decreasing COVID-19 morbidity and mortality in women. In this review, we summarize why optimal PA must be a priority for women during the COVID-19 pandemic. We then discuss chronic COVID-19 illness and its impact on women, which further underscores the need for worldwide preventive health strategies that include PA. Finally, we discuss the importance of vaccination against COVID-19 for women, as part of prioritizing preventive healthcare and an active lifestyle.
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Affiliation(s)
- Karla P. Garcia-Pelagio
- Departamento de Física, Facultad de Ciencias, Universidad Nacional Autónoma de México, Ciudad de México 4510, Mexico
| | - Tamara Hew-Butler
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48201, USA; (T.H.-B.); (M.M.F.)
| | - Mariane M. Fahlman
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48201, USA; (T.H.-B.); (M.M.F.)
| | - Joseph A. Roche
- Physical Therapy Program, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
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Atkinson L, Kite C, McGregor G, James T, Clark CCT, Randeva HS, Kyrou I. Uncertainty, Anxiety and Isolation: Experiencing the COVID-19 Pandemic and Lockdown as a Woman with Polycystic Ovary Syndrome (PCOS). J Pers Med 2021; 11:952. [PMID: 34683093 PMCID: PMC8539750 DOI: 10.3390/jpm11100952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The COVID-19 pandemic and the related lockdown measures presented a significant risk to physical and mental wellbeing in affected populations. Women with polycystic ovary syndrome (PCOS) are predisposed to several cardio-metabolic risk factors which increase the susceptibility to severe COVID-19 and also exhibit increased likelihood of impaired mental health wellbeing. Therefore, these women who usually receive care from multiple primary and specialist healthcare services may be disproportionately impacted by this pandemic and the related restrictions. This study aimed to explore the lived experience of the first UK national lockdown as a woman with PCOS. Methods: As part of a larger cross-sectional study, 12 women with PCOS living in the UK during the first national COVID-19 lockdown were recruited to a qualitative study. Telephone interviews were conducted in June/July of 2020, and data collected were subjected to thematic analysis. Results: Five themes were identified. "My PCOS Journey" describes participants' experiences of diagnosis, treatment and ongoing management of their PCOS. "Living Through Lockdown" describes the overall experience and impact of the lockdown on all aspects of participants' lives. "Self-care and Managing Symptoms" describe multiple challenges to living well with PCOS during the lockdown, including lack of access to supplies and services, and disruption to weight management. "Healthcare on Hold" describes the uncertainty and anxiety associated with delays in accessing specialised healthcare for a range of PCOS aspects, including fertility treatment. "Exacerbating Existing Issues" captures the worsening of pre-existing mental health issues, and an increase in health anxiety and feelings of isolation. Conclusion: For the women with PCOS in this study, the COVID-19 pandemic and the first national lockdown was mostly experienced as adding to the pre-existing challenges of living with their condition. The mental health impact experienced by the study participants was increased due to lack of access to their normal support strategies, limitations on healthcare services and uncertainty about their risk of COVID-19.
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Affiliation(s)
- Lou Atkinson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK;
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; (C.K.); (C.C.T.C.)
| | - Chris Kite
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; (C.K.); (C.C.T.C.)
- Centre for Active Living, University Centre Shrewsbury, University of Chester, Shrewsbury SY3 8HQ, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK;
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK;
- Centre for Exercise & Health, Department of Cardiopulmonary Rehabilitation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Tamsin James
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK;
| | - Cain C. T. Clark
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; (C.K.); (C.C.T.C.)
- Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, UK
| | - Harpal S. Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; (C.K.); (C.C.T.C.)
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Ioannis Kyrou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; (C.K.); (C.C.T.C.)
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK;
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
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330
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Jones A, Pitre T, Junek M, Kapralik J, Patel R, Feng E, Dawson L, Tsang JLY, Duong M, Ho T, Beauchamp MK, Costa AP, Kruisselbrink R. External validation of the 4C mortality score among COVID-19 patients admitted to hospital in Ontario, Canada: a retrospective study. Sci Rep 2021; 11:18638. [PMID: 34545103 PMCID: PMC8452633 DOI: 10.1038/s41598-021-97332-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023] Open
Abstract
Risk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality score, originally developed in the United Kingdom, for a Canadian population, and to examine its performance over time. We conducted an external validation study within a registry of COVID-19 positive hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4, 2020 and June 13, 2021. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. The study included 959 individuals, of whom 224 (23.4%) died in-hospital. Median age was 72 years and 524 individuals (55%) were male. The AUC of the 4C score was 0.77, 95% confidence interval 0.79-0.87. Overall mortality rates across the pre-defined risk groups were 0% (Low), 8.0% (Intermediate), 27.2% (High), and 54.2% (Very High). Wave 1, 2 and 3 values of the AUC were 0.81 (0.76, 0.86), 0.74 (0.69, 0.80), and 0.76 (0.69, 0.83) respectively. The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian hospitals and can be used to prioritize care and resources for patients at greatest risk of death.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. .,Waterloo Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.
| | - Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Mats Junek
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Rina Patel
- Waterloo Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Edward Feng
- Waterloo Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Laura Dawson
- Waterloo Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Canada.,Niagara Health, St. Catharines, Canada
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Terence Ho
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Marla K Beauchamp
- Department of Medicine, McMaster University, Hamilton, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Medicine, McMaster University, Hamilton, Canada.,Centre for Integrated Care, St. Joseph's Health System, Hamilton, Canada
| | - Rebecca Kruisselbrink
- Waterloo Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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331
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Cui Y, Hu C, Cheng Y, Han X, Wang W. Plasmapheresis: a feasible choice for bullous pemphigoid patients infected with SARS-CoV-2. Int J Dermatol 2021; 61:252-256. [PMID: 34520570 PMCID: PMC8653043 DOI: 10.1111/ijd.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
Bullous pemphigoid (BP) patients were vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection because they have similar risk factors, so we should pay attention to patients with BP during the epidemic of coronavirus disease-19 (COVID-19). As far as treatment is concerned, many strategies for BP were changed during the epidemic. Plasmapheresis not only has been included in the guidelines for BP but also has been used successfully to rescue COVID-19 patients, especially in severe cases. Therefore, it is a feasible choice for BP patients, especially for refractory BP patients, infected with SARS-CoV-2. Apart from these, we have reviewed some points for attention during the plasmapheresis session.
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Affiliation(s)
- Yu Cui
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Caixia Hu
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Yi Cheng
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Xiaomei Han
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Wenqing Wang
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
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332
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Rodriguez M, López-Cepero A, Ortiz-Martínez AP, Fernández-Repollet E, Pérez CM. Influence of Health Beliefs on COVID-19 Vaccination among Individuals with Cancer and Other Comorbidities in Puerto Rico. Vaccines (Basel) 2021; 9:994. [PMID: 34579231 PMCID: PMC8473277 DOI: 10.3390/vaccines9090994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 12/23/2022] Open
Abstract
Ethnic minority populations are more likely to suffer from chronic comorbidities, making them more susceptible to the poor health outcomes associated with COVID-19 infection. Therefore, ensuring COVID-19 vaccination among vulnerable populations is of utmost importance. We aimed to investigate health behaviors and perceptions of COVID-19 vaccination among adults self-reporting diagnosis of cancer and of other chronic comorbidities in Puerto Rico (PR). This secondary analysis used data from 1911 participants who completed an online survey from December 2020 to February 2021. The Health Belief Model was used to measure perceptions surrounding COVID-19 vaccination among individuals self-reporting diagnosis of cancer and of other chronic comorbidities, and healthy adults. Among study participants, 76% were female, 34% were 50 years or older, 5% self-reported cancer diagnosis, and 70% had other chronic comorbidities. Participants self-reporting a cancer diagnosis had two times higher odds of getting vaccinated than healthy individuals (95% CI: 1.00-4.30). Compared to healthy participants, those self-reporting being diagnosed with cancer and those with chronic conditions other than cancer had significantly higher perceived COVID-19 susceptibility and severity. Our findings elucidate the effect of disease status on health-related decision-making and highlights information needed to be included in education campaigns to increase vaccine uptake among ethnic minority populations.
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Affiliation(s)
- McClaren Rodriguez
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Andrea López-Cepero
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Ana P. Ortiz-Martínez
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, San Juan, PR 00936, USA;
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA;
| | - Emma Fernández-Repollet
- Department of Pharmacology, Center for Collaborative Research in Health Disparities, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA;
| | - Cynthia M. Pérez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA;
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333
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Schmidt J, Berghaus S, Blessing F, Wenzel F, Herbeck H, Blessing J, Schierack P, Rödiger S, Roggenbuck D. Serological and viral genetic features of patients with COVID-19 in a selected German patient cohort-correlation with disease characteristics. GeroScience 2021; 43:2249-2264. [PMID: 34468954 PMCID: PMC8408040 DOI: 10.1007/s11357-021-00443-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/12/2021] [Indexed: 12/16/2022] Open
Abstract
To study host-virus interactions after SARS coronavirus-2 (SARS-CoV-2) infection, genetic virus characteristics and the ensued humoral immune response were investigated for the first time. Fifty-five SARS-CoV-2-infected patients from the early pandemic phase were followed up including serological testing and whole genome sequencing. Anti-spike and nucleocapsid protein (S/N) IgG and IgM levels were determined by screening ELISA and IgG was further characterized by reactivity to S-subunit 1 (anti-S1), S-subunit 2 (anti-S2) and anti-N. In 55 patients, 90 genetic SARS-CoV-2 changes including 48 non-synonymous single nucleotide variants were identified. Phylogenetic analysis of the sequencing data showed a cluster representing a local outbreak and various family clusters. Anti-S/N and anti-N IgG were detected in 49 patients at an average of 83 days after blood collection. Anti-S/N IgM occurred significantly less frequently than IgG whereas anti-S2 was the least prevalent IgG reactivity (P < 0.05, respectively). Age and overweight were significantly associated with higher anti-S/N and anti-S1 IgG levels while age only with anti-N IgG (multiple regression, P < 0.05, respectively). Anti-S/N IgG/IgM levels, blood group A + , cardiovascular and tumour disease, NSP12 Q444H and ORF3a S177I were independent predictors of clinical characteristics with anti-S/N IgM being associated with the need for hospitalization (multivariate regression, P < 0.05, respectively). Anti-SARS-CoV-2 antibody generation was mainly affected by higher age and overweight in the present cohort. COVID-19 traits were associated with genetic SARS-CoV-2 variants, anti-S/N IgG/IgM levels, blood group A + and concomitant disease. Anti-S/N IgM was the only antibody associated with the need for hospitalization.
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Affiliation(s)
- Jonas Schmidt
- Institute for Laboratory Medicine, Singen, Germany
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Großenhainer Str. 57, 01968, Senftenberg, Germany
| | | | - Frithjof Blessing
- Institute for Laboratory Medicine, Singen, Germany
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
| | - Folker Wenzel
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
| | | | | | - Peter Schierack
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Großenhainer Str. 57, 01968, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus - Senftenberg, Senftenberg, Germany
| | - Stefan Rödiger
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Großenhainer Str. 57, 01968, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus - Senftenberg, Senftenberg, Germany
| | - Dirk Roggenbuck
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Großenhainer Str. 57, 01968, Senftenberg, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus - Senftenberg, Senftenberg, Germany.
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334
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Volpatto VL, Borgonhi EM, Ornell F, Bavaresco DV, Moura HF, Rabelo-da-Ponte FD, Kessler FHP. High COVID-19 morbidity and mortality risk among smoked drug users in Brazil. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 45:e20210290. [PMID: 34847315 PMCID: PMC10226771 DOI: 10.47626/2237-6089-2021-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
Abstract
ABSTRACT In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic.
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Affiliation(s)
- Vanessa Loss Volpatto
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazil Programa de Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Ellen Mello Borgonhi
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazil Programa de Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Felipe Ornell
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazil Programa de Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Daniela Vicente Bavaresco
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Helena Ferreira Moura
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazil Programa de Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de BrasíliaBrasíliaDFBrazil Departamento de Clínica Médica, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brazil.
| | - Francisco Diego Rabelo-da-Ponte
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazil Programa de Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
- Laboratório de Psiquiatria MolecularHospital de Clínicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.
| | - Felix Henrique Paim Kessler
- Centro de Pesquisa em Álcool e DrogasHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazil Programa de Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
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335
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Abstract
Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.
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336
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Cadegiani F, Goren A, Wambier C, McCoy J. Early COVID-19 therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in outpatient settings significantly improved COVID-19 outcomes compared to known outcomes in untreated patients. New Microbes New Infect 2021; 43:100915. [PMID: 34249367 PMCID: PMC8262389 DOI: 10.1016/j.nmni.2021.100915] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In a prospective observational study (pre-AndroCoV Trial), the use of nitazoxanide, ivermectin and hydroxychloroquine demonstrated unexpected improvements in COVID-19 outcomes when compared to untreated patients. The apparent yet likely positive results raised ethical concerns on the employment of further full placebo controlled studies in early-stage COVID-19. The present analysis aimed to elucidate, through a comparative analysis with two control groups, whether full placebo-control randomized clinical trials (RCTs) on early-stage COVID-19 are still ethically acceptable. The Active group (AG) consisted of patients enrolled in the Pre-AndroCoV-Trial (n = 585). Control Group 1 (CG1) consisted of a retrospectively obtained group of untreated patients of the same population (n = 137), and Control Group 2 (CG2) resulted from a precise prediction of clinical outcomes based on a thorough and structured review of indexed articles and official statements. Patients were matched for sex, age, comorbidities and disease severity at baseline. Compared to CG1 and CG2, AG showed reduction of 31.5-36.5% in viral shedding (p < 0.0001), 70-85% in disease duration (p < 0.0001), and 100% in respiratory complications, hospitalization, mechanical ventilation, deaths and post-COVID manifestations (p < 0.0001 for all). For every 1000 confirmed cases for COVID-19, at least 70 hospitalizations, 50 mechanical ventilations and five deaths were prevented. Benefits from the combination of early COVID-19 detection and early pharmacological approaches were consistent and overwhelming when compared to untreated groups, which, together with the well-established safety profile of the drug combinations tested in the Pre-AndroCoV Trial, precluded our study from continuing employing full placebo in early COVID-19.
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Affiliation(s)
- F.A. Cadegiani
- Corpometria Institute, Brasília, DF, Brazil
- Applied Biology, Inc., Irvine, CA, USA
| | - A. Goren
- Applied Biology, Inc., Irvine, CA, USA
| | - C.G. Wambier
- Department of Dermatology, The Alpert Medical School of Brown University, RI, USA
| | - J. McCoy
- Applied Biology, Inc., Irvine, CA, USA
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337
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Peterson DR, Baran AM, Bhattacharya S, Branche AR, Croft DP, Corbett AM, Walsh EE, Falsey AR, Mariani TJ. Gene Expression Risk Scores for COVID-19 Illness Severity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.08.24.457521. [PMID: 34462743 PMCID: PMC8404885 DOI: 10.1101/2021.08.24.457521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The correlates of COVID-19 illness severity following infection with SARS-Coronavirus 2 (SARS-CoV-2) are incompletely understood. METHODS We assessed peripheral blood gene expression in 53 adults with confirmed SARS-CoV-2-infection clinically adjudicated as having mild, moderate or severe disease. Supervised principal components analysis was used to build a weighted gene expression risk score (WGERS) to discriminate between severe and non-severe COVID. RESULTS Gene expression patterns in participants with mild and moderate illness were similar, but significantly different from severe illness. When comparing severe versus non-severe illness, we identified >4000 genes differentially expressed (FDR<0.05). Biological pathways increased in severe COVID-19 were associated with platelet activation and coagulation, and those significantly decreased with T cell signaling and differentiation. A WGERS based on 18 genes distinguished severe illness in our training cohort (cross-validated ROC-AUC=0.98), and need for intensive care in an independent cohort (ROC-AUC=0.85). Dichotomizing the WGERS yielded 100% sensitivity and 85% specificity for classifying severe illness in our training cohort, and 84% sensitivity and 74% specificity for defining the need for intensive care in the validation cohort. CONCLUSION These data suggest that gene expression classifiers may provide clinical utility as predictors of COVID-19 illness severity.
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Affiliation(s)
- Derick R Peterson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Andrea M Baran
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Soumyaroop Bhattacharya
- Division of Neonatology and Pediatric Molecular and Personalized Medicine Program, Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Angela R Branche
- Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Daniel P Croft
- Division of Pulmonary and Critical Care, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Anthony M Corbett
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Edward E Walsh
- Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, NY, USA
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ann R Falsey
- Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, NY, USA
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Thomas J Mariani
- Division of Neonatology and Pediatric Molecular and Personalized Medicine Program, Department of Pediatrics, University of Rochester, Rochester, NY, USA
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338
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[Complaints and clinical findings six months after COVID-19: outpatient follow-up at the University Medical Center Freiburg]. Dtsch Med Wochenschr 2021; 146:e65-e73. [PMID: 34425627 DOI: 10.1055/a-1546-4291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing evidence suggests that some patients suffer from persistent symptoms for months after recovery from acute COVID-19. However, the clinical phenotype and its pathogenesis remain unclear. We here present data on complaints and results of a diagnostic workup of patients presenting to the post-COVID clinic at the University Medical Center Freiburg. METHODS Retrospective data analysis of persistently symptomatic patients presenting to our clinic at least 6 months after onset of acute COVID-19. All patients were assessed by a doctor and routine laboratory analysis was carried out. Quality of life was assessed using SF-36 questionnaire. In case of specific persisting symptoms, further organ-specific diagnostic evaluation was performed, and patients were referred to respective departments/specialists. FINDINGS 132 Patients (58 male, 74 female; mean age 53.8 years) presented to our clinic at least 6 months after COVID-19. 79 (60 %) had been treated as outpatients and 53 (40 %) as inpatients. Most common complaints were persistent fatigue (82 %) and dyspnea on exertion (61 %). Further common complaints were impairments of concentration (54 %), insomnia (43 %), and impairments of smell or taste (35 %). Quality of life was reduced in all sections of the SF-36 questionnaire, yielding a reduced working capacity. Significant pathological findings in laboratory, echocardiographic and radiological work-up were rare. Impairments in lung function tests were more common in previously hospitalized patients. CONCLUSION Patients presenting 6 months after onset of acute COVID-19 suffer from a diverse spectrum of symptoms with impaired quality of life, also referred to as Long COVID or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Further research is needed to determine the frequency of these post-COVID syndromes and their pathogenesis, natural course and treatment options. Evaluation and management should be multi-disciplinary.
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339
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Dabbah MA, Reed AB, Booth ATC, Yassaee A, Despotovic A, Klasmer B, Binning E, Aral M, Plans D, Morelli D, Labrique AB, Mohan D. Machine learning approach to dynamic risk modeling of mortality in COVID-19: a UK Biobank study. Sci Rep 2021; 11:16936. [PMID: 34413324 PMCID: PMC8376891 DOI: 10.1038/s41598-021-95136-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic has created an urgent need for robust, scalable monitoring tools supporting stratification of high-risk patients. This research aims to develop and validate prediction models, using the UK Biobank, to estimate COVID-19 mortality risk in confirmed cases. From the 11,245 participants testing positive for COVID-19, we develop a data-driven random forest classification model with excellent performance (AUC: 0.91), using baseline characteristics, pre-existing conditions, symptoms, and vital signs, such that the score could dynamically assess mortality risk with disease deterioration. We also identify several significant novel predictors of COVID-19 mortality with equivalent or greater predictive value than established high-risk comorbidities, such as detailed anthropometrics and prior acute kidney failure, urinary tract infection, and pneumonias. The model design and feature selection enables utility in outpatient settings. Possible applications include supporting individual-level risk profiling and monitoring disease progression across patients with COVID-19 at-scale, especially in hospital-at-home settings.
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Affiliation(s)
| | | | | | - Arrash Yassaee
- Huma Therapeutics Limited, London, UK
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Aleksa Despotovic
- Huma Therapeutics Limited, London, UK
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Mert Aral
- Huma Therapeutics Limited, London, UK
| | - David Plans
- Huma Therapeutics Limited, London, UK.
- University of Exeter, SITE, Exeter, UK.
| | - Davide Morelli
- Huma Therapeutics Limited, London, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Alain B Labrique
- Johns Hopkins Bloomberg School Public Health, Baltimore, MD, USA
| | - Diwakar Mohan
- Johns Hopkins Bloomberg School Public Health, Baltimore, MD, USA
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340
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Using mobile phone data for epidemic response in low resource settings—A case study of COVID-19 in Malawi. DATA & POLICY 2021. [DOI: 10.1017/dap.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
The COVID-19 global pandemic has had considerable health impact, including sub-Saharan Africa. In Malawi, a resource-limited setting in Africa, gaining access to data to inform the COVID-19 response is challenging. Information on adherence to physical distancing guidelines and reducing contacts are nonexistent, but critical to understanding and communicating risk, as well as allocating scarce resources. We present a case study which leverages aggregated call detail records into a daily data pipeline which summarize population density and mobility in an easy-to-use dashboard for public health officials and emergency operations. From March to April 2021, we have aggregated 6-billion calls and text messages and continue to process 12 million more daily. These data are summarized into reports which describe, quantify, and locate mass gatherings and travel between subdistricts. These reports are accessible via web dashboards for policymakers within the Ministry of Health and Emergency Operations Center to inform COVID-19 response efforts and resource allocation.
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341
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Hawk C, Amorin-Woods L, Evans MW, Whedon JM, Daniels CJ, Williams RD, Parkin-Smith G, Taylor DN, Anderson D, Farabaugh R, Walters SA, Schielke A, Minkalis AL, Crivelli LS, Alpers C, Hinkeldey N, Hoang J, Caraway D, Whalen W, Cook J, Redwood D. The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med 2021; 27:850-867. [PMID: 34314609 DOI: 10.1089/acm.2021.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January-February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.
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Affiliation(s)
- Cheryl Hawk
- Texas Chiropractic College, Pasadena, Texas, USA
| | | | - Marion W Evans
- University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - James M Whedon
- Southern California University of Health Sciences, Whittier, California, USA
| | | | | | | | | | - Derek Anderson
- VA Puget Sound Health Care System American Lake Division, Tacoma, Washington, USA
| | | | | | | | | | | | | | | | | | | | | | - Jason Cook
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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342
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So ACP, McGrath H, Ting J, Srikandarajah K, Germanou S, Moss C, Russell B, Monroy-Iglesias M, Dolly S, Irshad S, Van Hemelrijck M, Enting D. COVID-19 Vaccine Safety in Cancer Patients: A Single Centre Experience. Cancers (Basel) 2021; 13:3573. [PMID: 34298785 PMCID: PMC8304256 DOI: 10.3390/cancers13143573] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 12/23/2022] Open
Abstract
Emergency approval of vaccines against COVID-19 provides an opportunity for us to return to pre-pandemic oncology care. However, safety data in cancer patients is lacking due to their exclusion from most phase III trials. We included all patients aged less than 65 years who received a COVID-19 vaccine from 8 December 2020 to 28 February 2021 at our London tertiary oncology centre. Solicited and unsolicited vaccine-related adverse events (VRAEs) were collected using telephone or face-to-face consultation. Within the study period, 373 patients received their first dose of vaccine: Pfizer/BioNTech (75.1%), Oxford/AstraZeneca (23.6%), Moderna (0.3%), and unknown (1.1%). Median follow-up was 25 days (5-85). Median age was 56 years (19-65). Of the patients, 94.9% had a solid malignancy and 76.7% were stage 3-4. The most common cancers were breast (34.0%), lung (13.4%), colorectal (10.2%), and gynaecological (10.2%). Of the patients, 88.5% were receiving anti-cancer treatment (36.2% parenteral chemotherapy and 15.3% immunotherapy), 76.1% developed any grade VRAE of which 2.1% were grade 3. No grade 4/5 or anaphylaxis were observed. The most common VRAEs within 7 days post-vaccination were sore arm (61.7%), fatigue (18.2%), and headaches (12.1%). Most common grade 3 VRAE was fatigue (1.1%). Our results demonstrate that COVID-19 vaccines in oncology patients have mild reactogenicity.
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Affiliation(s)
- Alfred Chung Pui So
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Harriet McGrath
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Jonathan Ting
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Krishnie Srikandarajah
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Styliani Germanou
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Charlotte Moss
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Beth Russell
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Maria Monroy-Iglesias
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Saoirse Dolly
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Sheeba Irshad
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Deborah Enting
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
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343
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Peng B, Zhou W, Pettit RW, Yu P, Matos PG, Greninger AL, McCashin J, Amos CI. Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study. BMJ Open 2021; 11:e050473. [PMID: 34272225 PMCID: PMC8290949 DOI: 10.1136/bmjopen-2021-050473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of SARS-CoV-2 testing on shortening the duration of quarantines for COVID-19 and to identify the most effective choices of testing schedules. DESIGN We performed extensive simulations to evaluate the performance of quarantine strategies when one or more SARS-CoV-2 tests were administered during the quarantine. Simulations were based on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available testing methods. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the outcomes of optimal strategies. RESULTS We found that SARS-CoV-2 testing can effectively reduce the length of a quarantine without compromising safety. A single reverse transcription-PCR (RT-PCR) test performed before the end of quarantine can reduce quarantine duration to 10 days. Two tests can reduce the duration to 8 days, and three highly sensitive RT-PCR tests can justify a 6-day quarantine. More strategic testing schedules and longer quarantines are needed if tests are administered with less-sensitive RT-PCR tests or antigen tests. Shorter quarantines can be used for applications that tolerate a residual postquarantine transmission risk comparable to a 10-day quarantine. CONCLUSIONS Testing could substantially reduce the length of isolation, reducing the physical and mental stress caused by lengthy quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, test-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.
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Affiliation(s)
- Bo Peng
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Wen Zhou
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Rowland W Pettit
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Patrick Yu
- Corporate Medical Advisors, Houston, Texas, USA
| | | | - Alexander L Greninger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher I Amos
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
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344
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Rzymski P, Pazgan-Simon M, Simon K, Łapiński T, Zarębska-Michaluk D, Szczepańska B, Chojnicki M, Mozer-Lisewska I, Flisiak R. Clinical Characteristics of Hospitalized COVID-19 Patients Who Received at Least One Dose of COVID-19 Vaccine. Vaccines (Basel) 2021; 9:781. [PMID: 34358197 PMCID: PMC8310296 DOI: 10.3390/vaccines9070781] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022] Open
Abstract
The clinical trials of the COVID-19 vaccines that are authorized in the European Union have revealed high efficacy in preventing symptomatic infections. However, during vaccination campaigns, some vaccine recipients, including those partially and fully vaccinated, will experience severe COVID-19, requiring hospitalization. This may particularly concern patients with a diminished immune response to the vaccine, as well as non-responders. This work has retrospectively analyzed the 92 cases of patients who were hospitalized between 27 December 2020 and 31 May 2021 in four Polish healthcare units due to COVID-19, and who have previously received the COVID-19 vaccine (54.3% ≤ 14 days after the first dose, 26.1% > 14 days after the first dose, 7.6% ≤ 14 days after the second dose, and 12% > 14 days after the second dose). These patients represented a minute fraction (1.2%) of all the COVID-19 patients who were hospitalized during the same period in the same healthcare institutions. No significant differences in white blood count, absolute lymphocyte count nadir, C-reactive protein, interleukin-6, procalcitonin, oxygen saturation, lung involvement, and fever frequency were found between the recipients of the first and second vaccine dose. A total of 15 deaths were noted (1.1% of all fatal COVID-19 cases in the considered period and healthcare units), including six in patients who received the second dose (five > 14 days after the second dose)-three of these subjects were using immunosuppressive medicines, and two were confirmed to be vaccine non-responders. The study reassures that severe COVID-19 and deaths are not common in vaccinated individuals, highlights that the clinical course in such patients may not reveal any distinctive features, and advocates for close monitoring of those at a higher risk of vaccine failure.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
| | - Monika Pazgan-Simon
- 1st Infectious Diseases Ward, Gromkowski Regional Specialist Hospital, 50-149 Wroclaw, Poland;
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, 51-149 Wrocław, Poland;
| | - Krzysztof Simon
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, 51-149 Wrocław, Poland;
| | - Tadeusz Łapiński
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Białystok, Poland;
| | | | - Barbara Szczepańska
- Department of the Children’s Diseases, The Infectious-Neurological Subdivision, Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Michał Chojnicki
- Department of Immunobiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Department of Infectious Diseases, Jozef Strus Hospital, 61-285 Poznań, Poland;
| | | | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Białystok, Poland;
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345
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Koehler J, Ritzer B, Weidlich S, Gebhardt F, Kirchhoff C, Gempt J, Querbach C, Hoffmann D, Haller B, Schmid RM, Schneider J, Spinner CD, Iakoubov R. Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany. Infection 2021; 49:1313-1318. [PMID: 34244967 PMCID: PMC8269399 DOI: 10.1007/s15010-021-01657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
Additional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.
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Affiliation(s)
- Johanna Koehler
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Barbara Ritzer
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Simon Weidlich
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Friedemann Gebhardt
- School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Traumatology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christiane Querbach
- School of Medicine, Hospital Pharmacy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dieter Hoffmann
- School of Medicine, Institute of Virology, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roman Iakoubov
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.
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346
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Bil J, Możeńska O. The vicious cycle: a history of obesity and COVID-19. BMC Cardiovasc Disord 2021; 21:332. [PMID: 34229605 PMCID: PMC8258476 DOI: 10.1186/s12872-021-02134-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/23/2021] [Indexed: 12/11/2022] Open
Abstract
Recently, we face a surge in the fast-forward Coronavirus Disease 2019 (COVID-19) pandemic with nearly 170 million confirmed cases and almost 3.5 million confirmed deaths at the end of May 2021. Obesity, also known as the pandemic of the 21st century, has been evolving as an adverse prognostic marker. Obesity is associated with a higher risk of being SARS-CoV-2-positive (46%), as well as hospitalization (113%) and death (48%) due to COVID-19. It is especially true for subjects with morbid obesity. Also, observational studies suggest that in the case of COVID-19, no favorable “obesity paradox” is observed. Therefore, it is postulated to introduce a new entity, i.e., coronavirus disease-related cardiometabolic syndrome (CIRCS). In theory, it applies to all stages of COVID-19, i.e., prevention, acute proceedings (from COVID-19 diagnosis to resolution or three months), and long-term outcomes. Consequently, lifestyle changes, glycemic control, and regulation of the renin-angiotensin-aldosterone pathway have crucial implications for preventing and managing subjects with COVID-19. Finally, it is crucial to use cardioprotective drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and statins. Nevertheless, there is the need to conduct prospective studies and registries better to evaluate the issue of obesity in COVID-19 patients.
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Affiliation(s)
- Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Woloska Street 137, 02-507, Warsaw, Poland.
| | - Olga Możeńska
- Department of Internal Medicine, Hypertension and Angiology, Independent Public Central Clinical Hospital, Medical University of Warsaw, Warsaw, Poland
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347
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Wernli D, Clausin M, Antulov-Fantulin N, Berezowski J, Biller-Andorno N, Blanchet K, Böttcher L, Burton-Jeangros C, Escher G, Flahault A, Fukuda K, Helbing D, Jaffé PD, Søgaard Jørgensen P, Kaspiarovich Y, Krishnakumar J, Lawrence RJ, Lee K, Léger A, Levrat N, Martischang R, Morel CM, Pittet D, Stauffer M, Tediosi F, Vanackere F, Vassalli JD, Wolff G, Young O. Building a multisystemic understanding of societal resilience to the COVID-19 pandemic. BMJ Glob Health 2021; 6:e006794. [PMID: 34301677 PMCID: PMC8300552 DOI: 10.1136/bmjgh-2021-006794] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022] Open
Abstract
The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.
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Affiliation(s)
- Didier Wernli
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Mia Clausin
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
| | | | - John Berezowski
- Vetsuisse Faculty, Veterinary Public Health Institute, University of Bern, Bern, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva and Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Lucas Böttcher
- Computational Medicine, UCLA, Los Angeles, California, USA
| | | | - Gérard Escher
- Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Keiji Fukuda
- School of Public Health, Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Dirk Helbing
- Computational Social Science, ETH Zurich, Zurich, Switzerland
| | - Philip D Jaffé
- Interfaculty Center for Children's Rights Studies, Faculty of Psychology and Education, University of Geneva, Geneva, Switzerland
| | - Peter Søgaard Jørgensen
- Stockholm Resilience Centre, Stockholm, Sweden
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Yuliya Kaspiarovich
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Jaya Krishnakumar
- Institute of Economics and Econometrics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Roderick John Lawrence
- Institute for Environmental Sciences, Geneva School of Social Sciences, University of Geneva, Geneva, Switzerland
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Anaïs Léger
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Nicolas Levrat
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
- Faculty of Law, University of Geneva, Geneva, Switzerland
| | - Romain Martischang
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Chantal M Morel
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maxime Stauffer
- Geneva Science Policy Interface, University of Geneva, Geneva, Switzerland
- Simon Institute for Longterm Governance, Geneva, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Flore Vanackere
- Geneva Transformative Governance Lab, Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Jean-Dominique Vassalli
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- International Institute for the Rights of the Child, Sion, Switzerland
| | - Gaélane Wolff
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Oran Young
- Bren School of Environmental Science and Management, University of California Santa Barbara, Santa Barbara, California, USA
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348
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Lawton R, Zheng K, Zheng D, Huang E. A longitudinal study of convergence between Black and White COVID-19 mortality: A county fixed effects approach. LANCET REGIONAL HEALTH. AMERICAS 2021; 1:100011. [PMID: 34528022 PMCID: PMC8426155 DOI: 10.1016/j.lana.2021.100011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Non-Hispanic Black populations have suffered much greater per capita COVID-19 mortality than White populations. Previous work has shown that rates of Black and White mortality have converged over time. Understanding of COVID-19 disparities over time is complicated by geographic changes in prevalence, and some prior research has claimed that regional shifts in COVID-19 prevalence may explain the convergence. METHODS Using county-level COVID-19 mortality data stratified by race, we investigate the trajectory of Black and White per capita mortality from June 2020-January 2021. We use a county fixed-effects model to estimate changes within counties, then extend our models to leverage county-level variation in prevalence to study the effects of prevalence versus time trajectories in mortality disparities. FINDINGS Over this period, cumulative mortality rose by 61% and 90% for Black and White populations respectively, decreasing the mortality ratio by 0.4 (25.8%). These trends persisted when a county-level fixed-effects model was applied. Results revealed that county-level changes in prevalence nearly fully explain changes in mortality disparities over time. INTERPRETATION Results suggest mechanisms underpinning convergence in Black/White mortality are not driven by fixed county-level characteristics or changes in the regional dispersion of COVID-19, but instead by changes within counties. Further, declines in the Black/White mortality ratio over time appear primarily linked to county-level changes in COVID-19 prevalence rather than other county-level factors that may vary with time. Research into COVID-19 disparities should focus on mechanisms that operate within-counties and are consistent with a prevalence-disparity relationship. FUNDING This work was supported by the National Center for Advancing Translational Sciences [E.H.: UL1TR002553].
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Affiliation(s)
- Ralph Lawton
- Department of Economics, Duke University, 213 Social Sciences, 419 Chapel Drive, Durham, North Carolina, US,Corresponding author: Ralph Lawton, Telephone: 302-256-1539.
| | - Kevin Zheng
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, North Carolina, US
| | - Daniel Zheng
- University of Maryland, Baltimore County, 1000 Hilltop Cir, Baltimore, Maryland, US
| | - Erich Huang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, North Carolina, US,Onduo, 55 Chapel Street, Suite 300, Newton, MA, US
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349
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Stojanovic J, Boucher VG, Gagne M, Gupta S, Joyal-Desmarais K, Paduano S, Aburub AS, Sheinfeld Gorin SN, Kassianos AP, Ribeiro PAB, Bacon SL, Lavoie KL. Global Trends and Correlates of COVID-19 Vaccination Hesitancy: Findings from the iCARE Study. Vaccines (Basel) 2021; 9:661. [PMID: 34204379 PMCID: PMC8235754 DOI: 10.3390/vaccines9060661] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Abstract
The success of large-scale COVID-19 vaccination campaigns is contingent upon people being willing to receive the vaccine. Our study explored COVID-19 vaccine hesitancy and its correlates in eight different countries around the globe. We analyzed convenience sample data collected between March 2020 and January 2021 as part of the iCARE cross-sectional study. Univariate and multivariate statistical analyses were conducted to explore the correlates of vaccine hesitancy. We included 32,028 participants from eight countries, and observed that 27% of the participants exhibited vaccine hesitancy, with increases over time. France reported the highest level of hesitancy (47.3%) and Brazil reported the lowest (9.6%). Women, younger individuals (≤29 years), people living in rural areas, and those with a lower perceived income were more likely to be hesitant. People who previously received an influenza vaccine were 70% less likely to report COVID-19 vaccine hesitancy. We observed that people reporting greater COVID-19 health concerns were less likely to be hesitant, whereas people with higher personal financial concerns were more likely to be hesitant. Our findings indicate that there is substantial vaccine hesitancy in several countries, with cross-national differences in the magnitude and direction of the trend. Vaccination communication initiatives should target hesitant individuals (women, younger adults, people with lower incomes and those living in rural areas), and should highlight the immediate health, social and economic benefits of vaccination across these settings. Country-level analyses are warranted to understand the complex psychological, socio-environmental, and cultural factors associated with vaccine hesitancy.
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Affiliation(s)
- Jovana Stojanovic
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montréal, QC H4B 1R6, Canada; (J.S.); (K.J.-D.); (S.L.B.)
- Montreal Behavioural Medicine Centre, Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l’Ile de Montréal (CIUSSS-NIM), Montréal, QC H4J 1C5, Canada; (V.G.B.); (P.A.B.R.)
| | - Vincent G. Boucher
- Montreal Behavioural Medicine Centre, Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l’Ile de Montréal (CIUSSS-NIM), Montréal, QC H4J 1C5, Canada; (V.G.B.); (P.A.B.R.)
- Department of Psychology, University of Québec at Montreal (UQAM), Montréal, QC C3H 3P8, Canada
| | - Myriam Gagne
- Unity Health Toronto, Department of Medicine, Division of Respirology, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (M.G.); (S.G.)
| | - Samir Gupta
- Unity Health Toronto, Department of Medicine, Division of Respirology, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (M.G.); (S.G.)
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON M52 3M2, Canada
| | - Keven Joyal-Desmarais
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montréal, QC H4B 1R6, Canada; (J.S.); (K.J.-D.); (S.L.B.)
- Montreal Behavioural Medicine Centre, Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l’Ile de Montréal (CIUSSS-NIM), Montréal, QC H4J 1C5, Canada; (V.G.B.); (P.A.B.R.)
| | - Stefania Paduano
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Ala’ S. Aburub
- Physical Therapy Department, Faculty of Allied Medical Sciences, Isra University, Queen Alia International Airport South of the Capital Amman, Amman 11622, Jordan;
| | | | - Angelos P. Kassianos
- Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus;
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Paula A. B. Ribeiro
- Montreal Behavioural Medicine Centre, Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l’Ile de Montréal (CIUSSS-NIM), Montréal, QC H4J 1C5, Canada; (V.G.B.); (P.A.B.R.)
| | - Simon L. Bacon
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montréal, QC H4B 1R6, Canada; (J.S.); (K.J.-D.); (S.L.B.)
- Montreal Behavioural Medicine Centre, Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l’Ile de Montréal (CIUSSS-NIM), Montréal, QC H4J 1C5, Canada; (V.G.B.); (P.A.B.R.)
| | - Kim L. Lavoie
- Montreal Behavioural Medicine Centre, Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l’Ile de Montréal (CIUSSS-NIM), Montréal, QC H4J 1C5, Canada; (V.G.B.); (P.A.B.R.)
- Department of Psychology, University of Québec at Montreal (UQAM), Montréal, QC C3H 3P8, Canada
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Inshasi J, Alroughani R, Al-Asmi A, Alkhaboury J, Alsalti A, Boshra A, Canibano B, Deleu D, Ahmed SF, Shatila A, Thakre M. Expert Consensus and Narrative Review on the Management of Multiple Sclerosis in the Arabian Gulf in the COVID-19 Era: Focus on Disease-Modifying Therapies and Vaccination Against COVID-19. Neurol Ther 2021; 10:1-17. [PMID: 34155473 PMCID: PMC8209665 DOI: 10.1007/s40120-021-00260-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
This article describes consensus recommendations from an expert group of neurologists from the Arabian Gulf region on the management of relapsing multiple sclerosis (RMS) in the COVID-19 era. MS appears not to be a risk factor for severe adverse COVID-19 outcomes (though patients with advanced disability or a progressive phenotype are at higher risk). Disease-modifying therapy (DMT)-based care appears generally safe for patients with MS who develop COVID-19 (although there may be an increased risk of adverse outcomes with anti-CD20 therapy). Interferon-β, teriflunomide, dimethyl fumarate, glatiramer acetate, natalizumab and cladribine tablets are unlikely to increase the risk of infection; fingolimod, anti-CD20 agents and alemtuzumab may confer an intermediate risk. Existing DMT therapy should be continued at this time. For patients requiring initiation of a DMT, all currently available DMTs except alemtuzumab can be started safely at this time; initiate alemtuzumab subject to careful individual risk-benefit considerations. Patients should receive vaccination against COVID-19 where possible, with no interruption of existing DMT-based care. There is no need to alter the administration of interferon-β, teriflunomide, dimethyl fumarate, glatiramer acetate, natalizumab, fingolimod or cladribine tablets for vaccination; new starts on other DMTs should be delayed for up to 6 weeks after completion of vaccination to allow the immune response to develop. Doses of the Oxford University/AstraZeneca vaccine may be scheduled around doses of anti-CD20 or alemtuzumab. Where white cell counts are suppressed by treatment, these should be allowed to recover before vaccination.
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Affiliation(s)
- Jihad Inshasi
- Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority (DHA), Dubai, UAE
| | - Raed Alroughani
- Department of Medicine, Amiri Hospital, Sharq, Kuwait
- Division of Neurological, Department of Medicine, Amiri Hospital, Arabian Gulf Street, 13001 Sharq, Kuwait
| | - Abdullah Al-Asmi
- College of Medicine and Health Sciences, Neurology Unit, Sultan Qaboos University, Muscat, Oman
- Sultan Qaboos University Hospital, Muscat, Oman
| | - Jaber Alkhaboury
- Neurology Department, Khoula Hospital, Ministry of Health, Muscat, Oman
| | - Abdullah Alsalti
- Neurology Department, Khoula Hospital, Ministry of Health, Muscat, Oman
| | - Amir Boshra
- Merck Serono Middle East FZ Ltd, Dubai, UAE
- An Affiliate of Merck KgaA, Darmstadt, Germany
| | - Beatriz Canibano
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Department of Neurology, Ibn Sina Hospital, Kuwait city, Kuwait
| | - Samar Farouk Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait city, Kuwait
- Minia University, Minya, Egypt
| | - Ahmed Shatila
- Neurology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Mona Thakre
- Neurology Department, Al Zahra Hospital, Dubai, United Arab Emirates
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