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Younes S. The role of nutrition on the treatment of Covid 19. HUMAN NUTRITION & METABOLISM 2024; 36:200255. [DOI: 10.1016/j.hnm.2024.200255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
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Mao S, Wu L, Shi W. Calcium, phosphorus, magnesium levels in frequent respiratory tract infections. Ann Med 2024; 55:2304661. [PMID: 38233369 PMCID: PMC10798295 DOI: 10.1080/07853890.2024.2304661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND It was well documented that calcium (Ca), phosphorus (P), and magnesium (Mg) participate in many physiological processes. We aimed to study the changing trend of serum levels of Ca, P, and Mg in frequent respiratory tract infections (FRTI) in children. METHODS A retrospective study was performed in our centre. A total of 213 FRTI cases and 33 controls were enrolled in our study. We analyzed the correlation between serum Ca/P/Mg levels and inflammatory indexes by using Spearman correlation analysis. Standard mean difference (SMD) was applied to test the differences of serum Ca/P/Mg levels between FRTI subgroups and controls. In terms of the findings of SMD between Ca/P/Mg status between FRTI subgroups and controls, receiver operating characteristics (ROC) curve analysis was further applied to test the association between serum Ca level and bronchitis, parainfluenza virus infection, influenza B virus infection and cytomegalovirus infection. RESULTS Serum Ca level was significantly associated with white blood cell (WBC), platelet (PLT) and procalcitonin (PCT) (p = 0.006; p < 10-4; p = 0.004). Serum P level was markedly associated with eryhtrocyte sedimentation rate (ESR) and PCT (p = 0.018; p < 10-4). Controls showed significantly lower serum Ca level than that among bronchitis (p = 0.001), parainfluenza virus infection (p = 0.027), influenza B virus infection (p = 0.017), cytomegalovirus infection (p = 0.029), and two pathogens infected (p = 0.020). ROC curve analysis showed that serum Ca level was significantly associated with bronchitis (p = 0.047) and influenza B virus infection (p = 0.049). CONCLUSIONS Serum levels of Ca and P may reflect the inflammatory status in children with FRTI. Alteration of serum Ca level may predict the risk of bronchitis and influenza B virus infection. Keeping the homeostasis of Ca, P, and Mg may be important for the prevention and treatment of FRTI.
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Affiliation(s)
- Song Mao
- Department of Pediatrics, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangxia Wu
- Department of Pediatrics, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Shi
- Department of Pediatrics, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kotepui KU, Mahittikorn A, Wilairatana P, Masangkay FR, Kotepui M. Regional and Age-Related Variations in Blood Calcium Levels among Patients with Plasmodium falciparum and P. vivax malaria: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:4522. [PMID: 37960176 PMCID: PMC10650696 DOI: 10.3390/nu15214522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Despite several studies examining the relationship between calcium levels and malaria, inconsistencies and varied results remain in the literature. This study aimed to synthesize the evidence on the association between blood calcium levels and malaria severity. A systematic literature search was conducted in the Embase, Scopus, PubMed, Ovid, and Google Scholar databases. The studies that investigated calcium levels in participants with malaria were reviewed and included for synthesis. The quality of included studies was assessed based on a standardized checklist by the Joanna Briggs Institute (JBI) critical appraisal checklists. The thematic synthesis had been used for qualitative synthesis. For the quantitative synthesis, the meta-analysis was performed to estimate the pooled effect sizes for differences in calcium levels between groups of participants using a random effect model using Hedge's g as a measure of effect size. Out of the 4574 identified records, 14 studies were reviewed. The thematic synthesis across these studies noted a consistent theme: reduced calcium levels in malaria patients compared to uninfected controls. However, the meta-analysis encompassing three specific analyses-comparing calcium levels between malaria patients and controls, severe and non-severe malaria cases, and fatal cases versus survivors-showed no significant difference in calcium levels. The statistics were as follows: (1) p = 0.15, Hedge's g: -1.00, 95% CI: -2.37-0.38, I2: 98.97, 9 studies; (2) p = 0.35, Hedge's g: -0.33, 95% CI: -1.02-0.36, I2: 81.61, 3 studies; and (3) p = 0.71, Hedge's g: -0.14, 95% CI: -0.91-0.62, I2: 87.05, 3 studies. Subgroup analyses indicated that regional disparities, especially between Africa and Asia, and participant age groups may influence these outcomes. While a trend of decreased calcium levels in malaria patients was observed, the meta-analytical results suggest regional and age-related variations. Further investigations should emphasize these differences to better guide clinical management, prognostic applications, and the crafting of policies concerning malaria's metabolic effects.
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Affiliation(s)
- Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat 80160, Thailand
| | - Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | | | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat 80160, Thailand
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Wei X, Pan C, Zhang X, Zhang W. Total network controllability analysis discovers explainable drugs for Covid-19 treatment. Biol Direct 2023; 18:55. [PMID: 37670359 PMCID: PMC10478273 DOI: 10.1186/s13062-023-00410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The active pursuit of network medicine for drug repurposing, particularly for combating Covid-19, has stimulated interest in the concept of structural controllability in cellular networks. We sought to extend this theory, focusing on the defense rather than control of the cell against viral infections. Accordingly, we extended structural controllability to total structural controllability and introduced the concept of control hubs. Perturbing any control hub may render the cell uncontrollable by exogenous stimuli like viral infections, so control hubs are ideal drug targets. RESULTS We developed an efficient algorithm to identify all control hubs, applying it to a largest homogeneous network of human protein interactions, including interactions between human and SARS-CoV-2 proteins. Our method recognized 65 druggable control hubs with enriched antiviral functions. Utilizing these hubs, we categorized potential drugs into four groups: antiviral and anti-inflammatory agents, drugs acting on the central nervous system, dietary supplements, and compounds enhancing immunity. An exemplification of our approach's effectiveness, Fostamatinib, a drug initially developed for chronic immune thrombocytopenia, is now in clinical trials for treating Covid-19. Preclinical trial data demonstrated that Fostamatinib could reduce mortality rates, ICU stay length, and disease severity in Covid-19 patients. CONCLUSIONS Our findings confirm the efficacy of our novel strategy that leverages control hubs as drug targets. This approach provides insights into the molecular mechanisms of potential therapeutics for Covid-19, making it a valuable tool for interpretable drug discovery. Our new approach is general and applicable to repurposing drugs for other diseases.
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Affiliation(s)
- Xinru Wei
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, 210001, China
| | - Chunyu Pan
- School of Computer Science and Engineering, Northeastern University, Shenyang, Liaoning, 110167, China
| | - Xizhe Zhang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, 210001, China.
| | - Weixiong Zhang
- Department of Health Technology and Informatics, Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China.
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Murugan AK, Alzahrani AS. Potential impacts of SARS-CoV-2 on parathyroid: current advances and trends. Endocrine 2023; 81:391-408. [PMID: 37328666 DOI: 10.1007/s12020-023-03415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection affects several important organs including endocrine glands. Experimental studies demonstrated that the virus exploits the ACE2, a transmembrane glycoprotein on the cell surface as a receptor for cellular entry. This entry process is exclusively facilitated by other intracellular protein molecules such as TMPRSS2, furin, NRP1, and NRP2. Recent findings documented the involvement of the SARS-CoV-2 in inducing various parathyroid disorders including hypoparathyroidism and hypocalcemia, which received significant attention. This review extensively describes rapidly evolving knowledge on the potential part of SARS-CoV-2 in emerging various parathyroid disorders due to SARS-CoV-2 infection particularly parathyroid malfunction in COVID-19 cases, and post-COVID-19 conditions. Further, it presents the expression level of various molecules such as ACE2, TMPRSS2, furin, NRP1, and NRP2 in the parathyroid cells that facilitate the SARS-CoV-2 entry into the cell, and discusses the possible mechanism of parathyroid gland infection. Besides, it explores parathyroid malfunction in COVID-19 vaccine-administered cases. It also explains the possible long-COVID-19 effect on parathyroid and post-COVID-19 management of parathyroid. A complete understanding of the mechanisms of SARS-CoV-2-triggered pathogenesis in parathyroid dysfunctions may curtail treatment options and aid in the management of SARS-CoV-2-infected cases.
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Affiliation(s)
- Avaniyapuram Kannan Murugan
- Division of Molecular Endocrinology, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.
| | - Ali S Alzahrani
- Division of Molecular Endocrinology, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
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Anghel L, Manole C, Nechita A, Tatu AL, Ștefănescu BI, Nechita L, Bușilă C, Zainea P, Baroiu L, Mușat CL. Calcium, Phosphorus and Magnesium Abnormalities Associated with COVID-19 Infection, and Beyond. Biomedicines 2023; 11:2362. [PMID: 37760804 PMCID: PMC10525362 DOI: 10.3390/biomedicines11092362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic caused by the novel coronavirus SARS-CoV-2 has had a profound impact on global health, leading to a surge in research to better understand the pathophysiology of the disease. Among the various aspects under investigation, disruptions in mineral homeostasis have emerged as a critical area of interest. This review aims to provide an overview of the current evidence linking calcium, phosphorus and magnesium abnormalities with COVID-19 infection and explores the potential implications beyond the acute phase of the disease. Beyond the acute phase of COVID-19, evidence suggests a potential impact of these mineral abnormalities on long-term health outcomes. Persistent alterations in calcium, phosphorus and magnesium levels have been linked to increased cardiovascular risk, skeletal complications and metabolic disorders, warranting continuous monitoring and management in post-COVID-19 patients.
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Affiliation(s)
- Lucreția Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
| | - Corina Manole
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
| | - Aurel Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Alin Laurențiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 800010 Galati, Romania
| | - Bogdan Ioan Ștefănescu
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
- Clinical Surgery Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
| | - Camelia Bușilă
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Pușica Zainea
- Clinical Emergency County Hospital Braila, 810318 Braila, Romania;
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.A.); (A.N.); (A.L.T.); (L.N.); (C.B.); (L.B.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Carmina Liana Mușat
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (B.I.Ș.); (C.L.M.)
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
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Drácz B, Müller V, Takács I, Hagymási K, Dinya E, Miheller P, Szijártó A, Werling K. Hypocalcemia on Admission Is a Predictor of Disease Progression in COVID-19 Patients with Cirrhosis: A Multicenter Study in Hungary. Biomedicines 2023; 11:1541. [PMID: 37371636 PMCID: PMC10295302 DOI: 10.3390/biomedicines11061541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 (p < 0.05; 95% CI 1.566-15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683-0.953, p < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child-Turcette-Pugh score (r = -0.400, p < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.
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Affiliation(s)
- Bálint Drácz
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary; (K.H.); (P.M.); (A.S.); (K.W.)
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary;
| | - István Takács
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary;
| | - Krisztina Hagymási
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary; (K.H.); (P.M.); (A.S.); (K.W.)
| | - Elek Dinya
- Digital Health Department, Semmelweis University, 1083 Budapest, Hungary;
| | - Pál Miheller
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary; (K.H.); (P.M.); (A.S.); (K.W.)
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary; (K.H.); (P.M.); (A.S.); (K.W.)
| | - Klára Werling
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary; (K.H.); (P.M.); (A.S.); (K.W.)
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Zhang J, Ali A, Liu Y, Peng L, Pu J, Yi Q, Zhou H. Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism. Thromb J 2023; 21:20. [PMID: 36793097 PMCID: PMC9930215 DOI: 10.1186/s12959-023-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management. METHODS This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm. RESULTS Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. The addition of serum calcium to ESC risk stratification enhanced net reclassification improvement. Low-risk group with serum calcium level > 2.12 mmol/L had a 0% mortality rate, improving the negative predictive value up to 100%, while high-risk group with serum calcium level ≤ 2.12 mmol/L indicated a higher mortality of 25%. CONCLUSION Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.
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Affiliation(s)
- Jiarui Zhang
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Adila Ali
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Yu Liu
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Lige Peng
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Jiaqi Pu
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China. .,Cancer Hospital Affiliate to School of Medicine, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, UESTC, Sichuan Province, Chengdu, China.
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Song HJJMD, Chia AZQ, Tan BKJ, Teo CB, Lim V, Chua HR, Samuel M, Kee A. Electrolyte imbalances as poor prognostic markers in COVID-19: a systemic review and meta-analysis. J Endocrinol Invest 2023; 46:235-259. [PMID: 36070177 PMCID: PMC9449297 DOI: 10.1007/s40618-022-01877-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. We aim to systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome. METHODS PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR + , LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed. RESULTS We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR = 2.08, 95% CI = 1.48-2.94, I2 = 93%, N = 8), hypernatremia (OR = 4.32, 95% CI = 3.17-5.88, I2 = 45%, N = 7) and hypocalcemia (OR = 3.31, 95% CI = 2.24-4.88, I2 = 25%, N = 6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR + 4.0, PPV = 55%, AUC = 0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV = 87%, AUC = 0.71). Overall quality of evidence ranged from very low to moderate. CONCLUSION Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome, and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.
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Affiliation(s)
- H J J M D Song
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - A Z Q Chia
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - B K J Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - C B Teo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - V Lim
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - H R Chua
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - M Samuel
- Systematic Review Unit, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - A Kee
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore.
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Mohammadi AH, Behjati M, Karami M, Abari AH, Sobhani-Nasab A, Rourani HA, Hazrati E, Mirghazanfari SM, Hadi V, Hadi S, Milajerdi A. An overview on role of nutrition on COVID-19 immunity: Accumulative review from available studies. CLINICAL NUTRITION OPEN SCIENCE 2023; 47:6-43. [PMID: 36540357 PMCID: PMC9754583 DOI: 10.1016/j.nutos.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
The novel coronavirus infection (COVID-19) conveys a serious global threat to health and economy. A common predisposing factor for development to serious progressive disease is presence of a low-grade inflammation, e.g., as seen in diabetes, metabolic syndrome, and heart failure. Micronutrient deficiencies may also contribute to the development of this state. Therefore, the aim of the present study is to explore the role of the nutrition to relieve progression of COVID-19. According PRISMA protocol, we conducted an online databases search including Scopus, PubMed, Google Scholar and web of science for published literatures in the era of COVID-19 Outbreak regarding to the status of nutrition and COVID-19 until December 2021. There were available studies (80 studies) providing direct evidence regarding the associations between the status of nutrition and COVID-19 infection. Adequate nutritional supply is essential for resistance against other viral infections and also for improvement of immune function and reduction of inflammation. Hence, it is suggested that nutritional intervention which secures an adequate status might protect against the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - coronavirus-2) and mitigate its course. We also recommend initiation of adequate nutritional supplementation in high-risk areas and/or soon after the time of suspected infection with SARS-CoV-2. Subjects in high-risk groups should have high priority for applying this nutritive adjuvant therapy that should be started prior to administration of specific and supportive medical measures.
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Affiliation(s)
- Amir Hossein Mohammadi
- Department of Biochemistry, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Behjati
- Cellular, Molecular and Genetics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Karami
- Department of Biochemistry, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Afrouzossadat Hosseini Abari
- Department of Cell and Molecular Biology & Microbiology, Faculty of Biological Sciences and Technology, University of Isfahan, Isfahan, Iran
| | - Ali Sobhani-Nasab
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Core Research Lab, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamed Amini Rourani
- Department of Cell and Molecular Biology & Microbiology, Faculty of Biological Sciences and Technology, University of Isfahan, Isfahan, Iran
| | - Ebrahim Hazrati
- Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Sayid Mahdi Mirghazanfari
- Department of Physiology and Iranian Medicine, School of Medicine, AJA University of Medical Sciences, Iran
| | - Vahid Hadi
- Department of Health, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Saeid Hadi
- Department of Health, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Milajerdi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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11
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Díez JJ, Iglesias P, García A, Martín-Casasempere I, Bernabéu-Andréu FA. Serum Calcium, Magnesium, and Phosphorus Levels in Patients with COVID-19: Relationships with Poor Outcome and Mortality. Horm Metab Res 2023; 55:31-39. [PMID: 35998676 DOI: 10.1055/a-1899-8862] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this retrospective study to assess the impact of serum corrected calcium (CorrCa), magnesium (Mg) and phosphorus (P) levels, all adult patients with laboratory-confirmed COVID-19 hospitalized during 2020 were included. Poor outcome was considered in patients who presented need for mechanical ventilation, intensive care unit (ICU) admission, or in-hospital mortality. We analyzed 2473 patients (956 females) aged (mean±SD) 63.4±15.9 years. During admission, 169 patients (6.8%) required mechanical ventilation, 205 (8.3%) were admitted to the ICU, and 270 (10.9%) died. Composite variable of poor outcome, defined as need for mechanical ventilation, ICU admission or death, was present in 434 (17.5%) patients. In univariate analysis, the need for mechanical ventilation was positively related to Mg levels (OR 8.37, 95% CI 3.62-19.33; p<0.001); ICU admission was related to CorrCa (OR 0.49, 95% CI 0.25-0.99; p=0.049) and Mg levels (OR 5.81, 95% CI 2.74-12.35; p<0.001); and in-hospital mortality was related to CorrCa (OR 1.73, 95% CI 1.14-2.64; p=0.011). The composite variable of poor outcome was only related to Mg (OR 2.68, 95% CI 1.54-4.68; p=0.001). However, in multivariate analysis only CorrCa was significantly related to the need for mechanical ventilation (OR 0.19, 95% CI 0.05-0.72; p=0.014) and ICU admission (OR 0.25; 95% CI 0.09-0.66; p=0.005), but not with in-hospital mortality or the composite variable. In conclusion, CorrCa can be used as a simple and reliable marker of poor outcome in patients with COVID-19, although not to predict the risk of in-hospital mortality.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Agustín García
- Department of Admission and Clinical Documentation, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Ignacio Martín-Casasempere
- Subdirección General de Farmacia y Productos Sanitarios, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
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12
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Shedeed I, Abdel-Aaty H, El-Habashy M, Mahrous A. Laboratory markers and radiological signs of mild versus severe COVID-19 patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_84_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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13
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Iamartino L, Brandi ML. The calcium-sensing receptor in inflammation: Recent updates. Front Physiol 2022; 13:1059369. [PMID: 36467702 PMCID: PMC9716066 DOI: 10.3389/fphys.2022.1059369] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/07/2022] [Indexed: 07/30/2023] Open
Abstract
The Calcium-Sensing Receptor (CaSR) is a member of the class C of G-proteins coupled receptors (GPCRs), it plays a pivotal role in calcium homeostasis by directly controlling calcium excretion in the kidneys and indirectly by regulating parathyroid hormone (PTH) release from the parathyroid glands. The CaSR is found to be ubiquitously expressed in the body, playing a plethora of additional functions spanning from fluid secretion, insulin release, neuronal development, vessel tone to cell proliferation and apoptosis, to name but a few. The present review aims to elucidate and clarify the emerging regulatory effects that the CaSR plays in inflammation in several tissues, where it mostly promotes pro-inflammatory responses, with the exception of the large intestine, where contradictory roles have been recently reported. The CaSR has been found to be expressed even in immune cells, where it stimulates immune response and chemokinesis. On the other hand, CaSR expression seems to be boosted under inflammatory stimulus, in particular, by pro-inflammatory cytokines. Because of this, the CaSR has been addressed as a key factor responsible for hypocalcemia and low levels of PTH that are commonly found in critically ill patients under sepsis or after burn injury. Moreover, the CaSR has been found to be implicated in autoimmune-hypoparathyroidism, recently found also in patients treated with immune-checkpoint inhibitors. Given the tight bound between the CaSR, calcium and vitamin D metabolism, we also speculate about their roles in the pathogenesis of severe acute respiratory syndrome coronavirus-19 (SARS-COVID-19) infection and their impact on patients' prognosis. We will further explore the therapeutic potential of pharmacological targeting of the CaSR for the treatment and management of aberrant inflammatory responses.
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Affiliation(s)
- Luca Iamartino
- Department of Experimental Clinical and Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- F.I.R.M.O. (Italian Foundation for the Research on Bone Diseases), Florence, Italy
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14
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HOŞGÜN D, AYDEMİR S. Evaluation of the correlation of serum calcium, phosphorus levels and calcium phosphorus product with disease severity and ICU mortality in SARS-COV-2 pneumonia patients followed up in ICU. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1120563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Calcium and phosphorus are important elements in the body that have been shown to decrease in critical inflammatory diseases. The aim of this study was to evaluate serum levels of calcium and phosphorus and the calcium phosphate product (CPP) in patients followed up in intensive care unit (ICU) due to hypoxemic respiratory failure caused by coronavirus disease 2019 (COVID-19) pneumonia. The secondary endpoint of the study were respiratory support therapies used in the evaluation of independent mortality and disease severity in ICU that were divided into four groups depending on the time of administration: (i) first 24 hours, (ii) 48-72 hours, (iii) 72 hours, and (iv) 72 hours-28 days.
Material and Method: The retrospective study included patients with critical and severe COVID-19 pneumonia followed up in ICU.
Results: The study included 369 patients with a mean age of 64.3±14.8 years. ICU mortality was observed in 142 (38.5%) patients, among whom 17 (4.6%) patients died within 24 hours, 28 (7.6%) died between 48-72 hours, 50 (12.7%) died within 72 hours, and 47 (12.7%) died between 72 hours and 28 days. Serum calcium level established a significant relationship with ICU mortality at 28 days and 72 hours (p0.05).
Conclusion: Serial assessment of serum calcium may be a new criterion in the prediction of independent mortality in critical and severe COVID-19 pneumonia, which has been recently identified and has numerous unknown features.
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Affiliation(s)
- Derya HOŞGÜN
- Atatürk Sanatoryum Education and Research Hospital
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15
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Costa BTD, Araújo GRL, da Silva Júnior RT, Santos LKDS, Lima de Souza Gonçalves V, Lima DBA, Cuzzuol BR, Santos Apolonio J, de Carvalho LS, Marques HS, Silva CS, Barcelos IDS, Oliveira MV, Freire de Melo F. Effects of nutrients on immunomodulation in patients with severe COVID-19: Current knowledge. World J Crit Care Med 2022; 11:201-218. [PMID: 36051942 PMCID: PMC9305681 DOI: 10.5492/wjccm.v11.i4.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
Recent research has demonstrated that critically ill patients with coronavirus disease 2019 (COVID-19) show significant immune system dysregulation. Due to that, some nutrients that influence immunomodulation have been suggested as a form of treatment against the infection. This review collected the information on the impact of vitamins on the prognosis of COVID-19, with the intention of facilitating treatment and prevention of the disease risk status in patients. The collected information was obtained using the PubMed electronic database by searching for articles that relate COVID-19 and the mechanisms/effects of the nutrients: Proteins, glucose, lipids, vitamin B12, vitamin D, calcium, iron, copper, zinc, and magnesium, including prospective, retrospective, and support articles. The findings reveal an optimal response related mainly to omega-3, eicosapentaenoic acid, docosahexaenoic acid, calcium, and iron that might represent benefits in the treatment of critically ill patients. However, nutrient supplementation should be done with caution due to the limited availability of randomized controlled studies.
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Affiliation(s)
- Bruna Teixeira da Costa
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Luana Kauany de Sá Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Daniel Bastos Alves Lima
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Beatriz Rocha Cuzzuol
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lorena Sousa de Carvalho
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | - Camilo Santana Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Isadora de Souza Barcelos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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16
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Liu Q, Ruan H, Sheng Z, Sun X, Li S, Cui W, Li C. Nanoantidote for repression of acidosis pH promoting COVID-19 infection. VIEW 2022; 3:20220004. [PMID: 35937939 PMCID: PMC9347551 DOI: 10.1002/viw.20220004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/08/2023] Open
Abstract
Acidosis, such as respiratory acidosis and metabolic acidosis, can be induced by coronavirus disease 2019 (COVID-19) infection and is associated with increased mortality in critically ill COVID-19 patients. It remains unclear whether acidosis further promotes SARS-CoV-2 infection in patients, making virus removal difficult. For antacid therapy, sodium bicarbonate poses great risks caused by sodium overload, bicarbonate side effects, and hypocalcemia. Therefore, new antacid antidote is urgently needed. Our study showed that an acidosis-related pH of 6.8 increases SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) expression on the cell membrane by regulating intracellular microfilament polymerization, promoting SARS-CoV-2 pseudovirus infection. Based on this, we synthesized polyglutamic acid-PEG materials, used complexation of calcium ions and carboxyl groups to form the core, and adopted biomineralization methods to form a calcium carbonate nanoparticles (CaCO3-NPs) nanoantidote to neutralize excess hydrogen ions (H+), and restored the pH from 6.8 to approximately 7.4 (normal blood pH). CaCO3-NPs effectively prevented the heightened SARS-CoV-2 infection efficiency due to pH 6.8. Our study reveals that acidosis-related pH promotes SARS-CoV-2 infection, which suggests the existence of a positive feedback loop in which SARS-CoV-2 infection-induced acidosis enhances SARS-CoV-2 infection. Therefore, antacid therapy for acidosis COVID-19 patients is necessary. CaCO3-NPs may become an effective antacid nanoantidote superior to sodium bicarbonate.
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Affiliation(s)
- Qidong Liu
- Department of Anesthesiology and Perioperative MedicineShanghai Fourth People's Hospital, School of Medicine, Tongji UniversityShanghaiP. R. China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopedic Department, Tongji Hospital, School of Medicine, Tongji UniversityShanghaiP. R. China
| | - Huitong Ruan
- Department of OrthopaedicsShanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Zhihao Sheng
- Department of AnesthesiologyShanghai First Maternity and Infant Hospital, School of Medicine, Tongji UniversityShanghaiP. R. China
| | - Xiaoru Sun
- Department of Anesthesiology and Perioperative MedicineShanghai Fourth People's Hospital, School of Medicine, Tongji UniversityShanghaiP. R. China
| | - Siguang Li
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopedic Department, Tongji Hospital, School of Medicine, Tongji UniversityShanghaiP. R. China
| | - Wenguo Cui
- Department of OrthopaedicsShanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Cheng Li
- Department of Anesthesiology and Perioperative MedicineShanghai Fourth People's Hospital, School of Medicine, Tongji UniversityShanghaiP. R. China
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17
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Mazik M. Promising Therapeutic Approach for SARS-CoV-2 Infections by Using a Rutin-Based Combination Therapy. ChemMedChem 2022; 17:e202200157. [PMID: 35489042 PMCID: PMC9321678 DOI: 10.1002/cmdc.202200157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Indexed: 11/23/2022]
Abstract
The development of new therapeutic approaches for SARS-CoV-2 infections is of particular current importance. The combination therapy proposed here is based on already proven, safe and inexpensive compounds. The natural compound rutin, one of the six therapy components, has the potential to inhibit both viral and host cell targets. In addition, this therapy involves the use of acetylsalicylic acid, vitamin C and vitamin D3 , which should be administered together with calcium and magnesium. The importance of each component is briefly described in this article. Due to multiple anti-infective properties of rutin, it provides a basis for combating a SARS-CoV-2 infection as well as various viral and bacterial co-infections. There are strong indications for a good effect of this simple combination therapy, especially in the early stages of infection. It has the potential to be of interest both prophylactically and therapeutically, and offers the possibility of protection against severe disease progression.
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Affiliation(s)
- Monika Mazik
- Institut für Organische ChemieTechnische Universität Bergakademie FreibergLeipziger Straße 2909599FreibergGermany
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18
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di Filippo L, Doga M, Frara S, Giustina A. Hypocalcemia in COVID-19: Prevalence, clinical significance and therapeutic implications. Rev Endocr Metab Disord 2022; 23:299-308. [PMID: 33846867 PMCID: PMC8041474 DOI: 10.1007/s11154-021-09655-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 extra-pulmonary features include several endocrine manifestations and these are becoming strongly clinically relevant in patients affected influencing disease severity and outcomes.At the beginning of COVID-19 pandemic no population data on calcium levels in patients affected were available and in April 2020 a first case of severe acute hypocalcemia in an Italian patient with SARS-CoV-2 infection was reported. Subsequently, several studies reported hypocalcemia as a highly prevalent biochemical abnormality in COVID-19 patients with a marked negative influence on disease severity, biochemical inflammation and thrombotic markers, and mortality. Also a high prevalence of vertebral fractures with worse respiratory impairment in patients affected and a widespread vitamin D deficiency have been frequently observed, suggesting an emerging "Osteo-Metabolic Phenotype" in COVID-19.To date, several potential pathophysiological factors have been hypothesized to play a role in determining hypocalcemia in COVID-19 including calcium dependent viral mechanisms of action, high prevalence of hypovitaminosis D in general population, chronic and acute malnutrition during critical illness and high levels of unbound and unsaturated fatty acids in inflammatory responses.Since hypocalcemia is a frequent biochemical finding in hospitalized COVID-19 patients possibly predicting worse outcomes and leading to acute cardiovascular and neurological complications if severe, it is reasonable to assess, monitor and, if indicated, replace calcium at first patient hospital evaluation and during hospitalization.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mauro Doga
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
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19
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Pechlivanidou E, Vlachakis D, Tsarouhas K, Panidis D, Tsitsimpikou C, Darviri C, Kouretas D, Bacopoulou F. The prognostic role of micronutrient status and supplements in COVID-19 outcomes: A systematic review. Food Chem Toxicol 2022; 162:112901. [PMID: 35227861 PMCID: PMC8873042 DOI: 10.1016/j.fct.2022.112901] [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] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/23/2022]
Abstract
Micronutrients constitute an adjuvant treatment for respiratory viral infections. Since there is no effective antiviral therapy for COVID-19 yet, adjuvant intervention for the survival of critically ill patients may be significant. Search of the PubMed, CINAHL and Cochrane databases was carried out to find human studies investigating the prognostic role of micronutrient status and the effects of micronutrient supplementation intervention in COVID-19 outcomes of adult patients. Patients with certain comorbidities (diabetes mellitus type 2, obesity, renal failure, liver dysfunction etc.) or pregnant women were excluded. 31 studies (27 observational studies and 4 clinical trials) spanning the years 2020-2021, pertaining to 8624 COVID-19 patients (mean age±SD, 61 ± 9 years) were included in this systematic review. Few studies provided direct evidence on the association of serum levels of vitamin D, calcium, zinc, magnesium, phosphorus and selenium to patients' survival or death. Vitamin D and calcium were the most studied micronutrients and those with a probable promising favorable impact on patients. This review highlights the importance of a balanced nutritional status for a favorable outcome in COVID-19. Micronutrients' deficiency on admission to hospital seems to be related to a high risk for ICU admission, intubation and even death. Nevertheless, evidence for intervention remains unclear.
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Affiliation(s)
- Evmorfia Pechlivanidou
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, 11527, Greece
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, 11855, Greece
| | - Konstantinos Tsarouhas
- Department of Cardiology, University Hospital of Larissa, Mezourlo, Larissa, 41110, Greece
| | | | | | - Christina Darviri
- Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527, Athens, Greece
| | - Dimitrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, 11527, Greece; Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527, Athens, Greece.
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20
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SAYGILI ES, KARAKILIÇ E. Vitamin D levels and in-hospital mortality of COVID-19. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1056650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Deodatus JA, Kooistra SA, Kurstjens S, Mossink JCL, van Dijk JD, Groeneveld PHP, van der Kolk B(BYM. Lower plasma calcium associated with COVID-19, but not with disease severity: a two-centre retrospective cohort study. Infect Dis (Lond) 2022; 54:90-98. [PMID: 34586002 PMCID: PMC8500306 DOI: 10.1080/23744235.2021.1981549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Previous studies indicate hypocalcaemia as a potential diagnostic and prognostic marker of corona-virus disease 2019 (COVID-19). Our aim was to investigate these relations in more detail in a large test cohort and an independent validation cohort. METHODS We retrospectively included 2792 COVID-19 suspected patients that presented to the emergency department (ED) of two hospitals. Plasma calcium and ionized plasma calcium levels were compared between COVID-19 positive and negative patients, and between severe and non-severe COVID-19 patients using univariate and multivariate analyses in the first hospital (N = 1363). Severe COVID-19 was defined as intensive care unit (ICU) admission or death within 28 d after admission. The results were validated by repeating the same analyses in the second hospital (N = 1429). RESULTS A total of 693 (24.8%) of the enrolled patients were COVID-19 positive, of whom 238 (34.3%) had severe COVID-19. In both hospitals, COVID-19 positive patients had lower plasma calcium levels than COVID-19 negative patients, regardless of correction for albumin, in univariate and multivariate analysis (Δ0.06-0.13 mmol/L, p < .001). Ionized plasma calcium concentrations, with and without correction for pH, were also lower in COVID-19 positive patients in multivariate analyses (Δ0.02-0.05 mmol/L, N = 567, p < .001). However, we did not find a significant association between COVID-19 disease severity and plasma calcium in multivariate analyses. CONCLUSIONS Plasma calcium concentrations were lower in COVID-19 positive than COVID-19 negative patients but we found no association with disease severity in multivariate analyses. Further understanding of plasma calcium perturbation may facilitate the development of new preventive and therapeutic modalities for the current pandemic.
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22
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Perez-Araluce R, Martínez-González MÁ, Gea A, Carlos S. Components of the Mediterranean Diet and Risk of COVID-19. Front Nutr 2022; 8:805533. [PMID: 35141266 PMCID: PMC8819171 DOI: 10.3389/fnut.2021.805533] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 12/17/2022] Open
Abstract
Adherence to the traditional Mediterranean diet has been customarily assessed with the Mediterranean diet score (MDS or Trichopolou Index), with values of 0 or 1 assigned to each of the nine elements, and with the use of the sex-specific median as the cutoff. The value of persons whose consumption of the six beneficial items (ratio of monounsaturated to saturated fatty acids, vegetables, legumes, fruits and nuts, cereal, and fish) is at or above the median and is assigned a value of 1. Otherwise they receive 0 points. For detrimental elements (meats and dairy products) persons whose consumption is below the median are assigned a value of 1. An additional ninth point is assigned to moderate ethanol intake. We assessed the effect of each of the nine components of the MDS (replacing the fats ratio with olive oil, the main source of monounsaturated fats in the Mediterranean diet) on the risk of COVID-19 infection, symptomatic and severe COVID-19. From March to December 2020, 9,699 participants of the "Seguimiento Universidad de Navarra" (SUN) cohort answered a COVID-19 questionnaire. After excluding doctors and nurses, 5,194 participants were included in the main statistical analyses. Among them, we observed 382 cases of COVID-19 based on symptoms and clinical diagnosis; 167 of them with test confirmation. For the two COVID-19 definitions used, we found a significant decrease in risk for a higher adherence to the Mediterranean diet (OR = 0.64, 95% CI: 0.42-0.98, p for trend = 0.040; and OR = 0.44, 95% CI: 0.22-0.88, p for trend = 0.020, for test-diagnosed cases). A protective effect was also found for symptomatic COVID-19 (OR = 0.64, 95% CI: 0.41-1.00, p for trend = 0.050). Among the different individual food groups, only the consumption of whole dairy products showed a harmful direct association. The Mediterranean diet as a whole seems more important than each of its components in preventing the infection and symptoms of COVID-19.
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Affiliation(s)
- Rafael Perez-Araluce
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research, Pamplona, Spain
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Muhammad A, Forcados GE, Sani H, Ndidi US, Adamu A, Katsayal BS, Sadiq IZ, Abubakar YS, Sulaiman I, Abubakar IB, Yusuf AP, Malami I, Ibrahim S, Abubakar MB. Epigenetic modifications associated with genes implicated in cytokine storm: The potential biotherapeutic effects of vitamins and minerals in COVID‐19. J Food Biochem 2022; 46:e14079. [DOI: 10.1111/jfbc.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Aliyu Muhammad
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Hadiza Sani
- Department of Medicine Kaduna State University Kaduna Nigeria
| | - Uche Samuel Ndidi
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | - Auwal Adamu
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Idris Zubairu Sadiq
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Ibrahim Sulaiman
- Department of Human Physiology Federal University Dutse Dutse Nigeria
| | | | | | - Ibrahim Malami
- Department of Pharmacognosy and Ethnopharmacy, Faculty of Pharmaceutical Sciences Usmanu Danfodiyo University Sokoto Nigeria
| | - Sani Ibrahim
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
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Qin X, Cen J, Hu H, Chen X, Wei Z, Wan Q, Cao R. Non-linear relationship between albumin-corrected calcium and 30-day in-hospital mortality in ICU patients: A multicenter retrospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1059201. [PMID: 36619536 PMCID: PMC9810799 DOI: 10.3389/fendo.2022.1059201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Albumin-corrected calcium is usually calculated to reflect the real serum calcium level of the whole body by physicians. However, studies on the association between albumin-corrected calcium and 30-day in-hospital mortality in Intensive Care Unit (ICU) patients are rare. The purpose of our study was to explore the association between baseline albumin-corrected calcium and 30-day in-hospital mortality in the American ICU population. METHODS A multicenter retrospective cohort study of 102,245 ICU patients in the eICU-CRD v2.0 from the USA during 2014-2015 was performed. The average age was 63.7 ± 16.9 years, of which 55,313 (53.7%) were men and 47,758 (46.3%) were women. The association between albumin-corrected calcium and 30-day in-hospital mortality was analyzed by Cox proportional-hazards regression, smooth curve fitting, piecewise linear regression, subgroup analyses, and a series of sensitivity analyses. RESULTS We found that among ICU patients with calcium abnormalities, more than 95% were mild hypocalcemia or mild hypercalcemia. The risk of 30-day in-hospital mortality will increase by 10% in the ≥7.5-< 8.5 mg/dl subgroup (OR=1.1, 95% CI 1.0-1.3) or 20% in the ≥10.3-<12 mg/dl subgroup (OR=1.2, 95% CI 1.1-1.3) when the albumin-corrected calcium level increases by 1 mg/dl. Additionally, the relationship between albumin-corrected calcium and 30-day in-hospital mortality was U shaped; the inflection point was 8.9 mg/dl (log likelihood ratio test P = 0.005). Finally, after a series of sensitivity analyses, we found that the relationship between albumin-corrected calcium and 30-day in-hospital mortality remained significant. CONCLUSION In a large nationally representative cohort of ICU patients, abnormalities in albumin-corrected calcium, particularly slight hypocalcemia or slight hypercalcemia, were associated with an increased 30-day in-hospital mortality risk, and yet the findings in this study need to be further confirmed by prospective studies.
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Affiliation(s)
- Xun Qin
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
| | - Ji Cen
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xinglin Chen
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Epidemiology and Biostatistics, Empower U, X&Y Solutions Inc., Boston, MA, United States
| | - Zhe Wei
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
- *Correspondence: Rong Cao, ; Qijun Wan, ; Zhe Wei,
| | - Qijun Wan
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Rong Cao, ; Qijun Wan, ; Zhe Wei,
| | - Rong Cao
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Rong Cao, ; Qijun Wan, ; Zhe Wei,
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25
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Mehta M, Ghani H, Chua F, Draper A, Calmonson S, Prabhakar M, Shah R, Navarra A, Vaghela T, Barlow A, Vancheeswaran R. Retrospective case-control study to evaluate hypocalcaemia as a distinguishing feature of COVID-19 compared with other infective pneumonias and its association with disease severity. BMJ Open 2021; 11:e053810. [PMID: 34876435 PMCID: PMC8655344 DOI: 10.1136/bmjopen-2021-053810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate whether calcium derangement was a specific feature of COVID-19 that distinguishes it from other infective pneumonias, and its association with disease severity. DESIGN A retrospective observational case-control study looking at serum calcium on adult patients with COVID-19, and community-acquired pneumonia (CAP) or viral pneumonia (VP). SETTING A district general hospital on the outskirts of London, UK. PARTICIPANTS 506 patients with COVID-19, 95 patients with CAP and 152 patients with VP. OUTCOME MEASURES Baseline characteristics including hypocalcaemia in patients with COVID-19, CAP and VP were detailed. For patients with COVID-19, the impact of an abnormally low calcium level on the maximum level of hospital care, as a surrogate of COVID-19 severity, was evaluated. The primary outcome of maximal level of care was based on the WHO Clinical Progression Scale for COVID-19. RESULTS Hypocalcaemia was a specific and common clinical finding in patients with COVID-19 that distinguished it from other respiratory infections. Calcium levels were significantly lower in those with severe disease. Ordinal regression of risk estimates for categorised care levels showed that baseline hypocalcaemia was incrementally associated with OR of 2.33 (95% CI 1.5 to 3.61) for higher level of care, superior to other variables that have previously been shown to predict worse COVID-19 outcome. Serial calcium levels showed improvement by days 7-9 of admission, only in survivors of COVID-19. CONCLUSION Hypocalcaemia is specific to COVID-19 and may help distinguish it from other infective pneumonias. Hypocalcaemia may independently predict severe disease and warrants detailed prognostic investigation. The fact that decreased serum calcium is observed at the time of clinical presentation in COVID-19, but not other infective pneumonias, suggests that its early derangement is pathophysiological and may influence the deleterious evolution of this disease. TRIAL REGISTRATION NUMBER 20/HRA/2344.
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Affiliation(s)
- Meera Mehta
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Hakim Ghani
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adrian Draper
- Respiratory Medicine, St George's Hospital, London, UK
| | - Sam Calmonson
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Meghna Prabhakar
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rijul Shah
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Alessio Navarra
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Tejal Vaghela
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Andrew Barlow
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rama Vancheeswaran
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
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Alemzadeh E, Alemzadeh E, Ziaee M, Abedi A, Salehiniya H. The effect of low serum calcium level on the severity and mortality of Covid patients: A systematic review and meta-analysis. Immun Inflamm Dis 2021; 9:1219-1228. [PMID: 34534417 PMCID: PMC8589360 DOI: 10.1002/iid3.528] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Imbalances of various electrolytes, including calcium, are associated with the prognosis of Covid disease. This study investigated the relationship between serum calcium and clinical outcomes in patients with COVID-19. METHOD This study is a systematic review and meta-analysis by searching PubMed, Scopus, web of sciences until August 2021 using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID, coronavirus disease, SARS-COV-infection. 2, SARS-COV-2, COVID19, calcium, calcium isotopes, calcium radioisotopes, hypercalcemia, and hypocalcemia were performed. Heterogeneity of studies was investigated using I2 index, data were analyzed using meta-analysis (random effects model) with Comprehensive Meta-Analysis Software software. RESULTS Finally, 25 articles were included in the study. Clinical data from 12 articles showed that 59% (95% confidence interval [CI]: 0.49-0.68) of people with COVID-19 have hypocalcemia. The results of meta-analysis showed that hypocalcemia was significantly associated with severity of the disease (p = .002), mortality in patients with COVID-19 (odds ratio [OR] = 6.99, 95% CI: 2.71-17.99), number of hospitalization days (p < .001) and admission to the intensive care unit (OR = 5.09, 95% CI: 2.14-12.10). The results also showed that there is a direct relationship between low serum calcium levels with increasing D-dimer levels (p = .02) and decreasing lymphocyte counts (p = .007). CONCLUSION Based on the results of meta-analysis in people with lower calcium, mortality and complications are higher, therefore, serum calcium is a prognostic factor in determining the severity of the disease. Consequently, it is suggested that serum calcium levels should be considered in initial assessments.
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Affiliation(s)
- Effat Alemzadeh
- Infectious Diseases Research CenterBirjand University of Medical SciencesBirjandIran
| | - Esmat Alemzadeh
- Department of Medical Biotechnology, Faculty of MedicineBirjand University of Medical ScienceBirjandIran
- Cellular and Molecular Research CenterBirjand University of Medical SciencesBirjandIran
| | - Masood Ziaee
- Infectious Diseases Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ali Abedi
- Zahedan University of Medical SciencesZahedanIran
| | - Hamid Salehiniya
- Social Determinants of Health Research CenterBirjand University of Medical SciencesBirjandIran
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Su W, Zhu JG, Zhao XQ, Chen H, Li WP, Li HW. Altered serum calcium homeostasis independently predicts mortality in patients with acute coronary syndrome: a retrospective observational cohort study. BMJ Open 2021; 11:e049957. [PMID: 34848511 PMCID: PMC8634212 DOI: 10.1136/bmjopen-2021-049957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Serum calcium levels (sCa) were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyse the association between sCa and long-term mortality in patients with acute coronary syndrome (ACS). DESIGN A retrospective observational cohort study. SETTING Single-centre study with participants recruited from the local area. PARTICIPANTS A total of consecutive 13 772 patients with ACS were included in this analysis. Patients were divided based on their sCa profile (≤2.1 mmol/L, 2.1-2.2 mmol/L, 2.2-2.3 mmol/L, 2.3-2.4 mmol/L, 2.4-2.5 mmol/L,>2.5 mmol/L) and followed up for a median of 2.96 years (IQR 1.01-4.07). PRIMARY OUTCOME Long-term all-cause mortality. RESULTS During a median follow-up period of 2.96 years, patients with sCa ≤2.1 mmol/L had the highest cumulative incidences of all-cause mortality (16.7%), whereas those with sCa 2.4-2.5 mmol/L had the lowest cumulative incidences of all-cause mortality (3.5%). After adjusting for potentially confounding variables, the Cox analysis revealed that compared with the reference group (sCa 2.4-2.5 mmol/L), all the other groups had higher mortality except for the sCa 2.3-2.4 mmol/L group (HR, 1.32, 95% CI 0.93 to 1.87). Restricted cubic splines showed that the relationship between sCa and all-cause mortality seemed to be U shaped. The optimal sCa cut-off point, 2.35 mmol/L, was determined based on the shape of restricted cubic splines. CONCLUSIONS Altered serum calcium homeostasis at admission independently predicts all-cause mortality in patients with ACS. In addition, a U-shaped relationship between sCa and all-cause mortality exists, and maintaining sCa at approximately 2.35 mmol/L may minimise the risk of mortality.
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Affiliation(s)
- Wen Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei-Ping Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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di Filippo L, Allora A, Locatelli M, Rovere Querini P, Frara S, Banfi G, Giustina A. Hypocalcemia in COVID-19 is associated with low vitamin D levels and impaired compensatory PTH response. Endocrine 2021; 74:219-225. [PMID: 34586582 PMCID: PMC8480127 DOI: 10.1007/s12020-021-02882-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypocalcemia has been identified as a major distinctive feature of COVID-19, predicting poor clinical outcomes. Among the mechanisms underlying this biochemical finding, high prevalence of vitamin D (VD) deficiency in COVID-19 patients reported so far in several studies was advocated. However, robust data in favor of this hypothesis are still lacking. Therefore, aim of our study was to investigate the role of hypovitaminosis D and parathyroid hormone (PTH) levels in the development of hypocalcemia in COVID-19 patients. METHODS Patients admitted to IRCCS Ospedale San Raffaele for COVID-19 were enrolled in this study, excluding those with comorbidities and therapies influencing calcium and VD metabolism. Serum levels of total calcium (tCa), ionized calcium (Ca2+), 25-OH-VD, and PTH were evaluated at admission. We defined VD deficiency as VD below 20 ng/mL, hypocalcemia as tCa below 2.2 mmol/L or as Ca2+ below 1.18 mmol/L, and hyperparathyroidism as PTH above 65 pg/mL. RESULTS A total of 78 patients were included in the study. Median tCa and Ca2+ levels were 2.15 and 1.15 mmol/L, respectively. Total and ionized hypocalcemia were observed in 53 (67.9%) and 55 (70.5%) patients, respectively. VD deficiency was found in 67.9% of patients, but secondary hyperparathyroidism was detected in 20.5% of them, only. tCa levels were significantly lower in patients with VD deficiency and regression analyses showed a positive correlation between VD and tCa. CONCLUSIONS In conclusion, we confirmed a high prevalence of hypocalcemia in COVID-19 patients and we showed for the first time that it occurred largely in the context of marked hypovitaminosis D not adequately compensated by secondary hyperparathyroidism.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere Querini
- Division of Immunology, Transplantation and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Experimental Biochemistry & Molecular Biology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
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29
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García de Guadiana-Romualdo L, Ramos-Arenas V, Rodríguez Mulero MD, Hernández Olivo M, Campos-Rodríguez V, Galindo Martínez M, Ros Braquehais MS, Consuegra-Sánchez L, González Morales M, Albaladejo-Otón MD. Value of hypocalcemia and thromboinflammatory biomarkers for prediction of COVID-19 severity during the second wave: were all the waves the same? Clin Chem Lab Med 2021; 60:e38-e41. [PMID: 34674416 DOI: 10.1515/cclm-2021-0996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Verónica Ramos-Arenas
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
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30
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Maganeva IS, Gorbacheva AM, Bibik EE, Aboisheva EA, Eremkina AK, Mokrysheva NG. Mineral metabolism and COVID-19: is there a connection? TERAPEVT ARKH 2021; 93:1227-1233. [DOI: 10.26442/00403660.2021.10.201114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022]
Abstract
Due to global spread of COVID-19, the search for new factors that could influence its clinical course becomes highly important. This review summarize the relevant publications on the association between immune system and the main regulators of mineral homeostasis including. In addition, we have highlighted the various aspects of phosphorus-calcium metabolism related to the acute respiratory diseases and in particular to COVID-19. The data about the calcium-phosphorus metabolism in SARS-CoV-2 infection is required to understand the possible clinical implications and to develop new therapeutic and preventive interventions.
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31
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Mamishi S, Esslami GG, Mohammadi M, Abdolsalehi MR, Sadeghi RH, Mahmoudi S, Pourakbari B. Detection of SARS-CoV-2 antibodies in pediatric patients: An Iranian referral hospital-based study. Hum Antibodies 2021; 29:217-223. [PMID: 34151783 DOI: 10.3233/hab-210448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND As the extent of the pandemic and its seroprevalence pattern has been less clarified in pediatrics to date, we aimed to conduct this study to investigate the clinical and laboratory characteristics of COVID-19 in Iranian children, with a focus on evaluating the antibody prevalence and its relation with the laboratory tests. METHODS All children with highly suspected COVID-19 were included. Anti-nucleoprotein SARS-CoV-2 were measured using SARS-CoV-2 immunoglobulin M (IgM) and SARS-CoV-2 IgG ELISA kits. Hypothesis testing was carried out through SPSS to unravel any association between the measurement tools and important clinical and laboratory characteristics. RESULTS In this study, 254 patients were evaluated and 117 cases (46%) were male. The nucleic acid detection results for patient 55 were negative, but the IgM and IgG results were positive. Totally, 190 patients were tested for IgM in which only 14 (7.3%) had positive tests. Positive IgG was detected in 51 (20%) out of 254 patients; among them, 30 patients had negative SARS-CoV-2 RT-PCR (59%). Lower level of platelets in IgG positive group in comparison with the IgG negative group was observed (P value: 0.015). Moreover, higher alanine aminotransferase (ALT) was observed in the in IgG positive group (P value: 0.02). In patients with positive IgM, relative hypocalcemia (median of 8.25; IQR: 8.02-8.62) was found which appeared to be significant (P value: 0.02). CONCLUSION This is the first largest study describing the SARS-CoV-2 seropositivity among children in Iran and provides important insight about the COVID-19 infection in children.
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Affiliation(s)
- Setareh Mamishi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnaz Ghazizadeh Esslami
- Department of Emergency, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Newborn Nursery, Neonates, and Pediatrics, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Family Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Mohammadi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Reza Abdolsalehi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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32
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Skalny AV, Timashev PS, Aschner M, Aaseth J, Chernova LN, Belyaev VE, Grabeklis AR, Notova SV, Lobinski R, Tsatsakis A, Svistunov AA, Fomin VV, Tinkov AA, Glybochko PV. Serum Zinc, Copper, and Other Biometals Are Associated with COVID-19 Severity Markers. Metabolites 2021; 11:metabo11040244. [PMID: 33920813 PMCID: PMC8071197 DOI: 10.3390/metabo11040244] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
The objective of the present study was to evaluate of serum metal levels in COVID-19 patients with different disease severity, and to investigate the independent association between serum metal profile and markers of lung damage. The cohort of COVID-19 patients consisted of groups of subjects with mild, moderate, and severe illness, 50 examinees each. Forty-four healthy subjects of the respective age were involved in the current study as the control group. Serum metal levels were evaluated using inductively-coupled plasma mass-spectrometry. Examination of COVID-19 patients demonstrated that heart rate, respiratory rate, body temperature, C-reactive protein levels, as well as lung damage increased significantly with COVID-19 severity, whereas SpO2 decreased gradually. Increasing COVID-19 severity was also associated with a significant gradual decrease in serum Ca, Fe, Se, Zn levels as compared to controls, whereas serum Cu and especially Cu/Zn ratio were elevated. No significant group differences in serum Mg and Mn levels were observed. Serum Ca, Fe, Se, Zn correlated positively with SpO2, being inversely associated with fever, lung damage, and C-reactive protein concentrations. Opposite correlations were observed for Cu and Cu/Zn ratio. In regression models, serum Se levels were inversely associated with lung damage independently of other markers of disease severity, anthropometric, biochemical, and hemostatic parameters. Cu/Zn ratio was also considered as a significant predictor of lower SpO2 in adjusted regression models. Taken together, these findings demonstrated that metal metabolism significantly interferes with COVID-19 pathogenesis, although the causal relations as well as precise mechanisms are yet to be characterized.
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Affiliation(s)
- Anatoly V. Skalny
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Laboratory of Medical Elementology, KG Razumovsky Moscow State University of Technologies and Management, 109004 Moscow, Russia
| | - Peter S. Timashev
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Chemistry Department, Lomonosov Moscow State University, 119991 Moscow, Russia
- Department of Polymers and Composites, N.N. Semenov Institute of Chemical Physics, 119991 Moscow, Russia
| | - Michael Aschner
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jan Aaseth
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Research Department, Innlandet Hospital Trust, 2380 Brumunddal, Norway
| | - Lyubov N. Chernova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
| | - Vladimir E. Belyaev
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
| | - Andrey R. Grabeklis
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
| | - Svetlana V. Notova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Institute of Bioelementology, Orenburg State University, 460018 Orenburg, Russia
| | - Ryszard Lobinski
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- l’Institut des Sciences Analytiques et de Physico-chimie pour l’Environnement et les Matériaux, Universite de Pau et des Pays de l’Adour, E2S, CNRS, 64000 Pau, France
| | - Aristides Tsatsakis
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Laboratory of Toxicology, Medical School, University of Crete, Voutes, 70013 Heraklion, Crete, Greece
| | - Andrey A. Svistunov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
| | - Victor V. Fomin
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
| | - Alexey A. Tinkov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, 150003 Yaroslavl, Russia
- Correspondence: ; Tel.: +7-961-937-8198
| | - Peter V. Glybochko
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (A.V.S.); (P.S.T.); (M.A.); (J.A.); (L.N.C.); (V.E.B.); (A.R.G.); (S.V.N.); (R.L.); (A.T.); (A.A.S.); (V.V.F.); (P.V.G.)
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Abstract
Although data on the incidence and severity of new coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed more significant disease among adults and the elderly, a clinical manifestation characterized by a multisystem inflammatory syndrome was described in children (MIS-C). It was initially thought to be specific to children, but recent reports have shown that it can also occur in adults. MIS-C is characterized by a number of multisystemic manifestations resembling other known previously described illnesses, mainly Kawasaki disease, especially in cases with shock, toxic shock syndrome, and macrophage activation syndrome. Available literature shows that our knowledge of MIS-C is largely incomplete. Its development in strict relation with SARS-CoV-2 infection seems documented and, in most cases, can be considered a post-infectious manifestation secondary to an abnormal immune response for some aspects, similar to that seen in adults several days after SARS-CoV-2 infection. However, in a minority of cases, a clinical picture with symptoms fulfilling criteria for MIS-C diagnosis develops during the acute phase of SARS-CoV-2 infection. It is highly likely that the criteria currently used to diagnose MIS-C are too broad, meaning that children with different diseases are included. As clarity on the pathogenesis of MIS-C is lacking, different therapeutic approaches have been used, but no specific therapy is currently available. Further studies are urgently needed to improve our definition of MIS-C, to define the real impact on child health, and to elucidate the best clinical and therapeutic approach and true prognosis.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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34
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Martha JW, Wibowo A, Pranata R. Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:337-342. [PMID: 33493853 PMCID: PMC7832827 DOI: 10.1016/j.dsx.2021.01.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Hypocalcemia is commonly in critically ill patients and studies have shown that hypocalcemia is prevalent in patients with COVID-19. This meta-analysis aimed to evaluate the prognostic performance of hypocalcemia in patients with coronavirus disease 2019 (COVID-19). METHODS We performed a systematic literature search on PubMed, Scopus, and Embase with keywords "SARS-CoV-2″ OR″COVID-19″ OR ″2019-nCoV" AND "hypocalcemia" up until 10 December 2020. The key exposure was hypocalcemia, defined as serum calcium below study-defined cut-off points. The main outcome was poor outcome, which was a composite of mortality and severity. The effect estimate of the main outcome was reported as odds ratio (OR) and its 95% confidence interval (95% CI). We also generate sensitivity, specificity, positive and negative likelihood ratio (PLR & NLR), diagnostic odds ratio (DOR), and area under curve (AUC). RESULTS There are 2032 patients from 7 studies included in this systematic review and meta-analysis. The incidence of poor outcome in this study was 26%. Serum calcium was lower in patients with poor outcome (mean difference -0.173 mmol/L [-0.259, -0.087], p < 0.001; I2: 31.3%). Hypocalcemia was associated with poor outcome (OR 3.19 [2.02, 5.06], p < 0.001; I2: 32.86%); with sensitivity of 0.74 [0.53, 0.88], specificity of 0.54 [0.29, 0.77], PLR of 1.6 [1.1, 2.3], NLR of 0.49 [0.35, 0.66], DOR of 3 [2, 5], and AUC of 0.70 [0.66, 0.74]. In this pooled analysis, the post-test probability was 36% in patients with hypocalcemia and 15% in patients without hypocalcemia. CONCLUSION Hypocalcemia was associated with poor outcome in COVID-19 patients. PROSPERO ID CRD42020225506.
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Affiliation(s)
- Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
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