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Bjørklund G, Lysiuk R, Semenova Y, Lenchyk L, Dub N, Doşa MD, Hangan T. Herbal Substances with Antiviral Effects: Features and Prospects for the Treatment of Viral Diseases with Emphasis on Pro-Inflammatory Cytokines. Curr Med Chem 2024; 31:393-409. [PMID: 36698239 DOI: 10.2174/0929867330666230125121758] [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: 05/19/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 01/26/2023]
Abstract
Viral diseases have a significant impact on human health, and three novel coronaviruses (CoV) have emerged during the 21st century. In this review, we have emphasized the potential of herbal substances with antiviral effects. Our investigation focused on the features and prospects of viral disease treatment, with a particular emphasis on proinflammatory cytokines. We conducted comprehensive searches of various databases, including Science Direct, CABI Direct, Web of Science, PubMed, and Scopus. Cytokine storm mechanisms play a crucial role in inducing a pro-inflammatory response by triggering the expression of cytokines and chemokines. This response leads to the recruitment of leukocytes and promotes antiviral effects, forming the first line of defense against viruses. Numerous studies have investigated the use of herbal medicine candidates as immunomodulators or antivirals. However, cytokine-storm-targeted therapy is recommended for patients with acute respiratory distress syndrome caused by SARS-CoV to survive severe pulmonary failure. Our reviews have demonstrated that herbal formulations could serve as alternative medicines and significantly reduce complicated viral infections. Furthermore, they hold promising potential as specific antiviral agents in experimental animal models.
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Affiliation(s)
- Geir Bjørklund
- Department of Research, Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| | - Roman Lysiuk
- Department of Pharmacognosy and Botany, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
- CONEM Ukraine Life Science Research Group, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University , Astana, Kazakhstan
| | - Larysa Lenchyk
- Department of Research, National University of Pharmacy, Kharkiv, Ukraine
- CONEM Ukraine Pharmacognosy and Natural Product Chemistry Research Group, National University of Pharmacy, Kharkiv, Ukraine
| | - Natalia Dub
- Andrei Krupynskyi Lviv Medical Academy, Lviv, Ukraine
| | | | - Tony Hangan
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
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2
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Ünal Ç, Tunçer G, Çopur B, Pilanci KN, Okutur KS, Yararbaş K, Alan Ö, Sakin A, Simsek M, Ünal İÖ, Topçu A, Alaca Topçu Z, Duymaz T, Ordu Ç. Clinical and inflammation marker features of cancer patients with COVID-19: data of Istanbul, Turkey multicenter cancer patients (2020-2022). Curr Med Res Opin 2023; 39:987-996. [PMID: 37300513 DOI: 10.1080/03007995.2023.2223917] [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: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We aimed to identify a rapid, accurate, and accessible biomarker in the early stages of COVID-19 that can determine the prognosis of the disease in cancer patients. METHODS A total number of 241 patients with solid cancers who had a COVID-19 diagnosis between March 2020 and February 2022 were included in the study. Factors and ten different markers of inflammation were analyzed by year of diagnosis of COVID-19 and grouped by severity of infection. RESULTS Hospitalization, referral to the intensive care unit (ICU), mechanical ventilation, and death were more frequent in 2020 than in 2021 and 2022 (mortality rates, respectively, were 18.8%, 3.8%, and 2.5%). Bilateral lung involvement and chronic lung disease were independent risk factors for severe disease in 2020. In 2021-2022, only bilateral lung involvement was found as an independent risk factor for severe disease. The neutrophil-to-lymphocyte platelet ratio (NLPR) with the highest area under the curve (AUC) value in 2020 had a sensitivity of 71.4% and specificity of 73.3% in detecting severe disease (cut-off > 0.0241, Area Under the Curve (AUC) = 0.842, p <.001). In 2021-2022, the sensitivity of the C-reactive protein-to-lymphocyte ratio (CRP/L) with the highest AUC value was 70.0%, and the specificity was 73.3% (cut-off > 36.7, AUC = 0.829, p = .001). CONCLUSIONS This is the first study to investigate the distribution and characteristics of cancer patients, with a focus on the years of their COVID-19 diagnosis. Based on the data from our study, bilateral lung involvement is an independent factor for severe disease, and the CRP/L inflammation index appears to be the most reliable prognostic marker.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Gülşah Tunçer
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Betül Çopur
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Kezban Nur Pilanci
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Kerem Sadi Okutur
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul, Turkey
| | - Özkan Alan
- Division of Medical Oncology, Department of Internal Medicine, Koc University Hospital, Istanbul, Turkey
| | - Abdullah Sakin
- Division of Medical Oncology, Department of Internal Medicine, Bahçelievler Medipol Hospital, Istanbul, Turkey
| | - Melih Simsek
- Division of Medical Oncology, Department of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Atakan Topçu
- Division of Medical Oncology, Department of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Alaca Topçu
- Division of Medical Oncology, Department of Internal Medicine, Göztepe Medeniyet University, Istanbul, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
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3
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Clever S, Volz A. Mouse models in COVID-19 research: analyzing the adaptive immune response. Med Microbiol Immunol 2023; 212:165-183. [PMID: 35661253 PMCID: PMC9166226 DOI: 10.1007/s00430-022-00735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
The emergence of SARS-CoV-2, the severe acute respiratory syndrome coronavirus type 2 causing the COVID-19 pandemic, resulted in a major necessity for scientific countermeasures. Investigations revealing the exact mechanisms of the SARS-CoV-2 pathogenesis provide the basis for the development of therapeutic measures and protective vaccines against COVID-19. Animal models are inevitable for infection and pre-clinical vaccination studies as well as therapeutic testing. A well-suited animal model, mimicking the pathology seen in human COVID-19 patients, is an important basis for these investigations. Several animal models were already used during SARS-CoV-2 studies with different clinical outcomes after SARS-CoV-2 infection. Here, we give an overview of different animal models used in SARS-CoV-2 infection studies with a focus on the mouse model. Mice provide a well-established animal model for laboratory use and several different mouse models have been generated and are being used in SARS-CoV-2 studies. Furthermore, the analysis of SARS-CoV-2-specific T cells during infection and in vaccination studies in mice is highlighted.
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Affiliation(s)
- Sabrina Clever
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Asisa Volz
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
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4
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Lutun J, Fauvel C, Gay A, Bauer F. COVID-19 in a patient implanted with a total artificial heart: a case report. Eur Heart J Case Rep 2022; 6:ytac317. [PMID: 36245854 PMCID: PMC9555052 DOI: 10.1093/ehjcr/ytac317] [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: 02/28/2022] [Revised: 04/12/2022] [Accepted: 07/27/2022] [Indexed: 11/05/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) was first identified in December 2019 and is currently still a public health issue affecting millions of people worldwide. Heart failure patients are known to be at higher risk of morbidity and mortality in this case. Yet, few data exist concerning COVID-19 among patients with a left ventricular assistance device, and even less among those with a total artificial heart (TAH). Case summary A 27-year-old man with Marfan syndrome underwent prophylactic ascending aorta replacement. Shortly after surgery completion, he developed refractory cardiogenic shock with biventricular dysfunction leading to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation. In the context of no appropriate eligible donor during the following 10 days while waiting on the heart transplantation list, the patient was scheduled for a TAH as a bridge to transplantation. Meanwhile, he developed an acute respiratory distress syndrome secondary to SARS-CoV-2. The patient was successfully treated with corticosteroids, prone positioning and mechanical ventilation, and heart transplantation occurred 5 weeks after COVID-19 onset. Discussion Here, we report the first case of a patient presenting with COVID-19 infection following TAH implantation in a bridge to transplantation. We highlight that (i) cardiogenic shock patients simultaneously infected by COVID-19 should be treated instantly with all-time available technology to ensure best outcomes, including TAH and prone positioning, (ii) heart transplantation safety 5 weeks after COVID-19 onset.
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Affiliation(s)
- Juliette Lutun
- Service de chirurgie cardiaque, Clinique d’insuffisance cardiaque avancée, centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, F-76000 Rouen, France
| | - Charles Fauvel
- INSERM EnVI U1096, Université de Rouen, F-76000 Rouen, France,Department of Cardiology, Rouen University Hospital, F-76000 Rouen, France,Cardiovascular Medicine Division, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Arnaud Gay
- Service de chirurgie cardiaque, Clinique d’insuffisance cardiaque avancée, centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, F-76000 Rouen, France
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Prameswari HS, Putra ICS, Raffaello WM, Nathaniel M, Suhendro AS, Khalid AF, Pranata R. Managing Covid-19 in patients with heart failure: current status and future prospects. Expert Rev Cardiovasc Ther 2022; 20:807-828. [PMID: 36185009 DOI: 10.1080/14779072.2022.2132230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION COVID-19 may contribute to decompensation of previously stable chronic HF or cause a de-novo heart failure, which may come from the hyperinflammatory response and subsequent increase in metabolic demand. AREAS COVERED Two independent investigators searched MEDLINE (via PubMed), Europe PMC, and ScienceDirect databases with the following search terms: COVID-19, heart failure, COVID-19 drugs, heart failure drugs, and device therapy. All of the included full-text articles were rigorously evaluated by both authors in case there was disagreement about whether research should be included or not. In total, 157 studies were included and underwent extensive reading by the authors. EXPERT OPINION The World Health Organization (WHO) and the National Institute of Health (NIH) have published COVID-19 drug recommendations, although recommendations for HF-specific drug choices in COVID-19 are still lacking. We hope that this review can answer the void of comprehensive research data regarding the management options of HF in the COVID-19 condition so that clinicians can at least choose a more beneficial therapy or avoid combination therapies that have a high burden of side effects on HF; thus, morbidity and mortality in COVID-19 patients with HF may be reduced.
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Affiliation(s)
- Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Iwan Cahyo Santosa Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Michael Nathaniel
- School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Adrian Sebastian Suhendro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Achmad Fitrah Khalid
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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John K, Mishra AK, Nayar J, Mehawej J, Lal A. Coronavirus disease 2019 and mechanical circulatory support devices: A comprehensive review. Monaldi Arch Chest Dis 2022; 93. [PMID: 36063088 DOI: 10.4081/monaldi.2022.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
Coronavirus disease (COVID-19) can cause circulatory shock refractory to medical therapy. Such patients can be managed with mechanical circulatory support (MCS) devices like IABP, Impella, VA ECMO, and Left Ventricular Assist Devices (LVADs). Moreover, patients on long-term durable LVADs are a special population having increased susceptibility and mortality to COVID-19 infection. In this narrative review, we searched PubMed and Medline for studies on COVID-19 patients on short-term MCS devices. We found 36 papers with 110 patients who met our review criteria, including 89 LVAD patients and 21 COVID-19 patients who needed MCS device therapy. These studies were used to extract patient demographics, clinical presentation, MCS device details, management, and outcomes. Mean age of patients with COVID-19 infection on LVADs was 60, 73% were male, and HeartMate 3 was the most common device (53%). Most patients (77.5%) needed hospitalization, and mortality was 23.6%. Among the 21 reported cases of critically ill COVID-19 patients who required MCS, the mean age was 49.8 years, 52% were women, and the most common MCS device used was VA ECMO (62%) in conjunction with an Impella for LV venting. Comorbidities were not present in 43%, but 71% had abnormal ventricular function on echocardiography. MCS is a viable option for managing severe COVID-19 infection with shock, with many reported cases of favorable outcomes.
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John KJ, Mishra AK, Ramasamy C, George AA, Selvaraj V, Lal A. Heart failure in COVID-19 patients: Critical care experience. World J Virol 2022; 11:1-19. [PMID: 35117968 PMCID: PMC8788216 DOI: 10.5501/wjv.v11.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/09/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with heart failure (HF) may be at a higher risk of coronavirus disease 2019 (COVID-19) infection and may have a worse outcome due to their comorbid conditions and advanced age. In this narrative review, we aim to study the interaction between COVID-19 and HF from a critical care perspective. We performed a systematic search for studies that reported HF and critical care-related outcomes in COVID-19 patients in the PubMed and Medline databases. From a total of 1050 papers, we identified 26 that satisfied the eligibility criteria for our review. Data such as patient demographics, HF, intensive care unit (ICU) admission, management, and outcome were extracted from these studies and analyzed. We reported outcomes in heart-transplant patients with COVID-19 separately. In hospitalized patients with COVID-19, the prevalence of HF varied between 4% and 21%. The requirement for ICU admission was between 8% and 33%. HF patients with COVID-19 had an overall mortality rate between 20% and 40%. We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients, and patients with HF were more likely to require ventilation, ICU admission and develop complications. Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction, and HF with preserved ejection fraction. COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.
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Affiliation(s)
- Kevin John John
- Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla 689103, India
| | - Ajay K Mishra
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Chidambaram Ramasamy
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anu A George
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Vijairam Selvaraj
- Division of Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Mayo Clinic, Rochester, MN 55902, United States
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8
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Zhang Y, Wang Q, Mackay CR, Ng LG, Kwok I. Neutrophil subsets and their differential roles in viral respiratory diseases. J Leukoc Biol 2022; 111:1159-1173. [PMID: 35040189 PMCID: PMC9015493 DOI: 10.1002/jlb.1mr1221-345r] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/19/2022] Open
Abstract
Neutrophils play significant roles in immune homeostasis and as neutralizers of microbial infections. Recent evidence further suggests heterogeneity of neutrophil developmental and activation states that exert specialized effector functions during inflammatory disease conditions. Neutrophils can play multiple roles during viral infections, secreting inflammatory mediators and cytokines that contribute significantly to host defense and pathogenicity. However, their roles in viral immunity are not well understood. In this review, we present an overview of neutrophil heterogeneity and its impact on the course and severity of viral respiratory infectious diseases. We focus on the evidence demonstrating the crucial roles neutrophils play in the immune response toward respiratory infections, using influenza as a model. We further extend the understanding of neutrophil function with the studies pertaining to COVID‐19 disease and its neutrophil‐associated pathologies. Finally, we discuss the relevance of these results for future therapeutic options through targeting and regulating neutrophil‐specific responses.
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Affiliation(s)
- Yuning Zhang
- Department of Research, National Skin Centre, Singapore, Singapore
| | - Quanbo Wang
- School of Pharmaceutical Sciences, Shandong Analysis and Test Center, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Charles R Mackay
- School of Pharmaceutical Sciences, Shandong Analysis and Test Center, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China.,Department of Microbiology, Infection and Immunity Program, Biomedicine Discovery Institute, Monash University, Melbourne, Australia
| | - Lai Guan Ng
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), Biopolis, Singapore.,State Key Laboratory of Experimental Hematology, Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.,Department of Microbiology and Immunology, Immunology Translational Research Program, Yong Loo Lin School of Medicine, Immunology Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
| | - Immanuel Kwok
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), Biopolis, Singapore
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Management of Patients with Left Ventricular Assist Device during the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010116. [PMID: 35056424 PMCID: PMC8781665 DOI: 10.3390/medicina58010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/17/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) is an infectious disease with multi-organ involvement, including the cardiovascular system. The disease may cause several cardiovascular complications, and may increase morbidity and mortality among patients with background cardiovascular disease. Patients with advanced heart failure are often treated with left ventricular assist device (LVAD), and represent a unique population mandating multi-disciplinary approach. Several aspects of COVID-19 should be taken into account in LVAD implants, including right ventricular involvement, hemodynamic alterations, thromboembolic and haemorrhagic complications, and the psychological effects of social isolation. Patients with VAD and suspected COVID-19 should be transferred to specialized centers for better management of complications. Here, we review the implications of COVID-19 pandemic on LVAD patients with our recommendations for appropriate management.
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COVID-19: Origin, epidemiology, virology, pathogenesis, and treatment. LESSONS FROM COVID-19 2022. [PMCID: PMC9347366 DOI: 10.1016/b978-0-323-99878-9.00012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
COVID-19 (or Coronavirus Disease) originated in China (Hubei provenance, Wuhan city). The first recorded illness occurred in December 2019. It has affected all parts of the world, and the WHO designated the COVID-19 disease, caused by the new Coronavirus SARS-CoV-2, a pandemic on March 11, 2020. Some debatable speculations indicate that it is a man-made virus, intentionally synthesized in the laboratory but was unintentionally emancipated from a laboratory of Wuhan, China. The primitive theory suggested the spread from the Hunan seafood market of China probably from an animal source. However, this theory is not fully supported. COVID-19 infection has a varying range of signs and symptoms from low fever, dry cough to lower respiratory tract infection, breathing difficulties, pulmonary edema, acute respiratory distress syndrome (ARDS), metabolic acidosis, sepsis, coagulation, lymphopenia, hypoxemia, multiorgan failure, and eventually, mortality. In patients with comorbidity such as diabetes, cardiovascular disease, high blood pressure, stroke, and kidney disease, fatality rate is higher. Young and elderly people are more likely to experience unfavorable outcomes due to poor immunity. There have been several treatment methods explored to tackle the COVID-19 pandemic, including medications, interferon, vaccines, oligonucleotides, peptides, and monoclonal and immunomodulatory antibodies, among other things. The World Health Organization has recommended preventive measures like washing hands, using face masks, sanitizers, and maintaining a safe distance to prevent the spread of the pandemic. One of the promising alternatives is the vaccine. One must take all preventive measures in the pandemic until it becomes feeble.
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Rezabakhsh A, Sadat-Ebrahimi SR, Ala A, Nabavi SM, Banach M, Ghaffari S. A close-up view of dynamic biomarkers in the setting of COVID-19: Striking focus on cardiovascular system. J Cell Mol Med 2021; 26:274-286. [PMID: 34894069 PMCID: PMC8743667 DOI: 10.1111/jcmm.17122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 10/15/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Based on the recent reports, cardiovascular events encompass a large portion of the mortality caused by the COVID‐19 pandemic, which drawn cardiologists into the management of the admitted ill patients. Given that common laboratory values may provide key insights into the illness caused by the life‐threatening SARS‐CoV‐2 virus, it would be more helpful for screening, clinical management and on‐time therapeutic strategies. Commensurate with these issues, this review article aimed to discuss the dynamic changes of the common laboratory parameters during COVID‐19 and their association with cardiovascular diseases. Besides, the values that changed in the early stage of the disease were considered and monitored during the recovery process. The time required for returning biomarkers to basal levels was also discussed. Finally, of particular interest, we tended to abridge the latest updates regarding the cardiovascular biomarkers as prognostic and diagnostic criteria to determine the severity of COVID‐19.
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Affiliation(s)
- Aysa Rezabakhsh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Alireza Ala
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Eissa M, Shaarawy S, Abdellateif MS. The Role of Different Inflammatory Indices in the Diagnosis of COVID-19. Int J Gen Med 2021; 14:7843-7853. [PMID: 34795505 PMCID: PMC8593597 DOI: 10.2147/ijgm.s337488] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
AIM To assess the role of different inflammatory indices in the diagnosis of COVID-19 infection. METHODS The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), derived NLR (dNLR), neutrophil to lymphocyte, platelet ratio (NLPR), systemic inflammation index (SII), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI) and C-reactive protein-to-lymphocyte ratio (CRP/L) were assessed in 88 COVID-19 patients compared to 41 healthy control subjects. RESULTS The NLR, PLR, NLPR, SIRI, and CRP/L were significantly increased, while LMR was significantly decreased in COVID-19 patients compared to the control group (P = 0.008, 0.011, <0.001, 0.032, 0.002 and P < 0.001; respectively). The AUC for the assessed indices was LMR (0.738, P = 0.008), NLPR (0.721, P < 0.001), CRP/L (0.692, P = 0.002), NLR (0.649, P < 0.001), PLR (0.643, P = 0.011), SIRI (0.623, P = 0.032), dNLR (0.590, P = 0.111), SII (0.571, P = 0.207), and AISI (0.567, P-0.244). Multivariate analysis showed that NLPR >0.011 (OR: 38.751, P = 0.014), and CRP/L >7.6 (OR: 7.604, P = 0.022) are possible independent diagnostic factors for COVID-19 infection. CONCLUSION NLPR and CRP/L could be potential independent diagnostic factors for COVID-19 infection.
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Affiliation(s)
- Marwa Eissa
- Internal Medicine and Endocrinology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Endocrinology Department, Faculty of Armed Forces of Medical College (AFMC), Cairo, Egypt
| | - Sabry Shaarawy
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mona S Abdellateif
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Nooh HA, Abdellateif MS, Refaat L, Kandeel EZ, Bayoumi A, Samra M, Khafagy M. The role of inflammatory indices in the outcome of COVID-19 cancer patients. Med Oncol 2021; 39:6. [PMID: 34748094 PMCID: PMC8573297 DOI: 10.1007/s12032-021-01605-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 02/08/2023]
Abstract
To assess the prognostic role of different inflammatory indices on the outcome of cancer patients with COVID-19. Sixty-two adults and 22 pediatric cancer patients with COVID-19 infection were assessed for the prognostic value of certain inflammatory indices including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), derived NLR (dNLR), systemic inflammation index (SII), mean platelet volume to platelet ratio (MPR), C-reactive protein to lymphocyte ratio (CRP/L), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and neutrophil to lymphocyte, platelet ratio (NLPR). Data were correlated to patients' outcome regarding ICU admission, and incidence of mortality. Increased CRP/L ratio in adult COVID-19 cancer patients was significantly associated with inferior survival [152 (19-2253) in non-survivors, compared to 27.4 (0.8-681) in survivors (P = 0.033)]. It achieved a sensitivity (60%) and a specificity (90.2%) at a cut-off 152, while it achieved a sensitivity of 60% and specificity 95.1% at a cut-off 252 (AUC 0.795, P = 0.033). When combining both CRP/L and NLPR for the prediction of poor outcome in adult cancer patients with COVID19, the sensitivity increased to 80% and the specificity was 70.7% (AUC 0.805, P = 0.027). Increased incidence of ICU admission in pediatric cancer patients associated significantly with the severity of covid19 infection, decreased mean corpuscular hemoglobin (MCH) < 28.3, increased red cell distribution width (RDW) > 16, lymphopenia < 1.04, pseudo Pelger-Huet appearance, and PLR < 196.4 (P = 0.004, P = 0.040, P = 0.029, P = 0. 0.039, P = 0.050, and P = 0.040; respectively). The mean corpuscular volume (MCV), MCH, and RDW could be useful prognostic markers for poor outcome in COVID-19 pediatric cancer patients (P < 0.05 for all). Increased both CRP/L and NLPR associated significantly with poor survival in adult COVID-19 cancer patients, while PLR associated significantly with ICU admission in pediatric COVID-19 cancer patients.
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Affiliation(s)
- Hend A Nooh
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mona S Abdellateif
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt. .,Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Lobna Refaat
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman Z Kandeel
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Bayoumi
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Samra
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Medhat Khafagy
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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14
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Zhigalov K, Van den Eynde J, Zubarevich A, Chrosch T, Goerdt L, Arjomandi Rad A, Vardanyan R, Sá MPBO, Luedike P, Pizanis N, Koch A, Schmack B, Kamler M, Ruhparwar A, Weymann A. Initial experience with CytoSorb therapy in patients receiving left ventricular assist devices. Artif Organs 2021; 46:95-105. [PMID: 34694644 DOI: 10.1111/aor.14099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/24/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of left ventricular assist devices (LVAD) in patients with advance heart failure is still associated with an important risk of immune dysregulation and infections. The aim of this study was to determine whether extracorporeal blood purification using the CytoSorb device benefits patients after LVAD implantation in terms of complications and overall survival. MATERIALS AND METHODS Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation, of whom 72 underwent CytoSorb therapy and 135 did not. Overall survival, major adverse events, and laboratory parameters were compared between 112 propensity score-matched patients (CytoSorb: 72 patients; non-CytoSorb: 40 patients). RESULTS WBC (p = .033), CRP (p = .001), and IL-6 (p < .001), significantly increased with LVAD implantation, while CytoSorb did not influence this response. In-hospital mortality and overall survival during follow-up were similar with CytoSorb. However, patients treated with CytoSorb were more likely to develop respiratory failure (54.2% vs. 30.0%, p = .024), need mechanical ventilation for longer than 6 days post-implant (50.0% vs. 27.5%, p = .035), and require tracheostomy during hospitalization (31.9% vs. 12.5%, p = .040). No other significant differences were observed with regard to major adverse events during follow-up. CONCLUSIONS Overall, our results showed that CytoSorb might not convey a significant morbidity or mortality benefit for patients undergoing LVAD implantation.
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Affiliation(s)
- Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
| | - Jef Van den Eynde
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Chrosch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas Goerdt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Michel Pompeu Barros Oliveira Sá
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
| | - Markus Kamler
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
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15
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Sharma HN, Latimore COD, Matthews QL. Biology and Pathogenesis of SARS-CoV-2: Understandings for Therapeutic Developments against COVID-19. Pathogens 2021; 10:pathogens10091218. [PMID: 34578250 PMCID: PMC8470303 DOI: 10.3390/pathogens10091218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 01/18/2023] Open
Abstract
Coronaviruses are positive sense, single-stranded, enveloped, and non-segmented RNA viruses that belong to the Coronaviridae family within the order Nidovirales and suborder Coronavirinae. Two Alphacoronavirus strains: HCoV-229E and HCoV-NL63 and five Betacoronaviruses: HCoV-HKU1, HCoV-OC43, SARS-CoV, MERS-CoV, and SARS-CoV-2 have so far been recognized as Human Coronaviruses (HCoVs). Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is currently the greatest concern for humanity. Despite the overflow of research on SARS-CoV-2 and other HCoVs published every week, existing knowledge in this area is insufficient for the complete understanding of the viruses and the diseases caused by them. This review is based on the analysis of 210 published works, and it attempts to cover the basic biology of coronaviruses, including the genetic characteristics, life cycle, and host-pathogen interaction, pathogenesis, the antiviral drugs, and vaccines against HCoVs, especially focusing on SARS-CoV-2. Furthermore, we will briefly discuss the potential link between extracellular vesicles (EVs) and SARS-CoV-2/COVID-19 pathophysiology.
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Affiliation(s)
- Homa Nath Sharma
- Microbiology Program, Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA;
| | | | - Qiana L. Matthews
- Microbiology Program, Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA;
- Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA;
- Correspondence:
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16
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Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, Kadner A, Schefold JC, Räber L, Potapov EV, Luedi MM. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:321-332. [PMID: 34511222 PMCID: PMC7826053 DOI: 10.1016/j.bpa.2021.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 10/28/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has potentiated the need for implementation of strict safety measures in the medical care of surgical patients - and especially in cardiac surgery patients, who are at a higher risk of COVID-19-associated morbidity and mortality. Such measures not only require minimization of patients' exposure to COVID-19 but also careful balancing of the risks of postponing nonemergent surgical procedures and providing appropriate and timely surgical care. We provide an overview of current evidence for preoperative strategies used in cardiac surgery patients, including risk stratification, telemedicine, logistical challenges during inpatient care, appropriate screening capacity, and decision-making on when to safely operate on COVID-19 patients. Further, we focus on perioperative measures such as safe operating room management and address the dilemma over when to perform cardiovascular surgical procedures in patients at risk.
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Affiliation(s)
- Maks Mihalj
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Selim Mosbahi
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Paul Philipp Heinisch
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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17
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Bhatt AS, Adler ED, Albert NM, Anyanwu A, Bhadelia N, Cooper LT, Correa A, Defilippis EM, Joyce E, Sauer AJ, Solomon SD, Vardeny O, Yancy C, Lala A. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. J Card Fail 2021; 28:93-112. [PMID: 34481067 PMCID: PMC8408888 DOI: 10.1016/j.cardfail.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Ankeet S Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric D Adler
- Department of Cardiology, University of California, San Diego, California
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute; Cleveland Clinic, Cleveland, Ohio
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nahid Bhadelia
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts; Center for Emerging Infectious Diseases Policy and Research (CEID), Boston University, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ersilia M Defilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, and School of Medicine, University College Dublin, Ireland
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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18
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Belfort DDSP, Biselli B, Ávila MS, Lira MTSDS, Galas FRBG, Steffen SP, Gaiotto FA, Jatene FB, Bocchi EA, Ferreira SMA. COVID-19 complicating perioperative management of LVAD implantation: A case report and systematic review. J Card Surg 2021; 36:3405-3409. [PMID: 34091934 PMCID: PMC8242914 DOI: 10.1111/jocs.15690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 01/05/2023]
Abstract
The coronavirus 2019 disease (COVID-19) affected 125 million people worldwide and caused 2.7 million deaths. Some comorbidities are associated with worse prognosis and left ventricular assist device (LVAD) recipients are probably part of this high-risk population. We report a 31-year-old male patient who developed COVID-19 during LVAD implantation. His postoperative period was complicated by severe pneumonia and mechanical ventilation (MV) leading to right ventricular failure (RVF) and inotrope necessity. He experienced multiple complications, but eventually recovered. We present a systematic review of LVAD recipients and COVID-19. Among 14 patients, the mean age was 62.7 years, 78.5% were male. A total of 5 patients (35.7%) required MV and 3 patients (21.4%) died. A total of 2 patients (14.2%) had thromboembolic events. This case and systematic review suggest LVAD recipients are at particular risk of unfavorable outcomes and they may be more susceptible to RVF in the setting of COVID-19, particularly during perioperative period.
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Affiliation(s)
- Deborah de Sá Pereira Belfort
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Bruno Biselli
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Mônica Samuel Ávila
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Maria Tereza Sampaio de Sousa Lira
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Filomena Regina Barbosa Gomes Galas
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Samuel Padovani Steffen
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Fabio Antonio Gaiotto
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Fabio Biscegli Jatene
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Edimar Alcides Bocchi
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Silvia Moreira Ayub Ferreira
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
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19
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In-depth review of cardiopulmonary support in COVID-19 patients with heart failure. World J Cardiol 2021. [DOI: 10.4330/wjc.v13.i8.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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20
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Raffaello WM, Huang I, Budi Siswanto B, Pranata R. In-depth review of cardiopulmonary support in COVID-19 patients with heart failure. World J Cardiol 2021; 13:298-308. [PMID: 34589166 PMCID: PMC8436686 DOI: 10.4330/wjc.v13.i8.298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 infection has spread worldwide and causing massive burden to our healthcare system. Recent studies show multiorgan involvement during infection, with direct insult to the heart. Worsening of the heart function serves as a predictor of an adverse outcome. This finding raises a particular concern in high risk population, such as those with history of preexisting heart failure with or without implantable device. Lower baseline and different clinical characteristic might raise some challenge in managing either exacerbation or new onset heart failure that might occur as a consequence of the infection. A close look of the inflammatory markers gives an invaluable clue in managing this condition. Rapid deterioration might occur anytime in this setting and the need of cardiopulmonary support seems inevitable. However, the use of cardiopulmonary support in this patient is not without risk. Severe inflammatory response triggered by the infection in combination with the preexisting condition of the worsening heart and implantable device might cause a hypercoagulability state that should not be overlooked. Moreover, careful selection and consideration have to be met before selecting cardiopulmonary support as a last resort due to limited resource and personnel. By knowing the nature of the disease, the interaction between the inflammatory response and different baseline profile in heart failure patient might help clinician to salvage and preserve the remaining function of the heart.
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Affiliation(s)
| | - Ian Huang
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta 11420, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang 15810, Indonesia
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21
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COVID-19 ARDS in two patients with left ventricular assist device. J Artif Organs 2021; 25:148-154. [PMID: 34333741 PMCID: PMC8325621 DOI: 10.1007/s10047-021-01288-y] [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: 01/04/2021] [Accepted: 07/14/2021] [Indexed: 12/23/2022]
Abstract
Coronavirus disease 2019 affected millions of people and caused pneumonia, acute respiratory distress syndrome and increased mortality worldwide. Data from multicenter studies showed that concomitant chronic diseases are associated with severe coronavirus disease. Patients with left ventricular assist device (LVAD) support may also be vulnerable to the disease. Some symptoms of COVID-19 infection like dyspnea and fatigue can overlap with heart failure or LVAD dysfunction. Careful evaluation should be made to diagnose and treat these patients. In these two cases with COVID-19, here we presented the first two patients supported with LVAD in Turkey.
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22
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Han Q, Li X, Wang Z. How Should Athletes Coping With COVID-19: Focus on Severity and Psychological Support. Front Psychol 2021; 12:559125. [PMID: 34248725 PMCID: PMC8264358 DOI: 10.3389/fpsyg.2021.559125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Athletes are suffering from many uncertainties and hope to achieve the best possible position under the current circumstances of this global coronavirus disease (COVID-19) pandemic. In this study, we aimed to address the severity and psychological support for athletes with COVID-19. Methods: We extracted public data and news reports of the up-to-date first seven cases of elite athletes with COVID-19 confirmed in China and made psychological recommendations based on scientific evidence. Results: The severity and mortality in athletes who tested positive to COVID-19 are mild and extremely low. The included cases from different sports are two soccer players, two athletes from ice hockey, and three from fencing. In this study, we adapted well-recognized psychological questionnaires, improvised it for athletes to use under the COVID-19 pandemic, and also provided recommended psychological support. Conclusion: The severity and mortality in Chinese athletes contracted with COVID-19 are mild and low with zero death. Psychological support of any kind from nurses, team medical staff, psychologists, family, and friends through social media and telecommunication should be adopted and can be of great help.
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Affiliation(s)
- Qi Han
- Sport Science College, Beijing Sport University, Beijing, China.,Department of Sports Nutrition Research Center, National Research Institute of Sports Medicine, Beijing, China
| | - Xueyang Li
- Sport Science College, Beijing Sport University, Beijing, China.,Department of Academic Affairs, Yanqi Lake Beijing Institute of Mathematical Sciences and Applications, Beijing, China
| | - Zhenghanxiao Wang
- Department of Psychology, University of Limerick, Limerick, Ireland.,School of Psychology, Beijing Sport University, Beijing, China
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23
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Telemonitoring and Care Program for Left Ventricular Assist Device Patients During COVID-19 Outbreak: A European Experience. ASAIO J 2021; 67:973-981. [PMID: 34403376 DOI: 10.1097/mat.0000000000001526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) radically modified the organization of healthcare systems with shutdown of routine activities and outpatient clinics. Herein, we report our institutional experience with a Telemonitoring and Care Program (TC-Program) to monitor and support left ventricular assist device (LVAD) patients during COVID-19 outbreak. This single-arm cohort study analyzed 156 patients who entered the TC-Program at our institution between April and August 2020. The TC-Program was based on routine phone calls to patients and a 24/7 emergency line. In November 2020, patients were asked for feedback on the TC-Program and checked for survival, transplant, or explant. The primary endpoint was the rate of TC-Program-driven interventions. Patients (males: 82.8%) were 61 years old (interquartile range [IQR]: 53.0-67.5) and on LVAD support for 1,266 days (IQR: 475-2,211). Patients were included in the TC-Program for a median time of 99 days (min:15, max:120) and received a median number of six phone calls (min:1, max:14). Twenty-three patients (14.7%) were referred for clinical evaluation after phone contact. Two patients (1.27%) were diagnosed with COVID-19: one of them died after intensive care, and one remained paucisymptomatic and recovered. Three patients asked to exit the program considering it not useful while the others gave high rates in terms of usefulness (median: 9, IQR: 8-10), information (median: 9, IQR: 8-10), good medical care (median: 9, IQR: 8-10), and psychologic support (median: 8, IQR: 7-10). A TC-Program based on the four ICSA principles (Inform, Care, Support, and Adapt) is feasible in LVAD patients and can be rapidly implemented during the COVID-19 pandemic.
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24
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Birati EY, Najjar SS, Tedford RJ, Houston BA, Shore S, Vorovich E, Atluri P, Urgo K, Molina M, Chambers S, Escobar N, Hsich E, Estep JD, Alexander KM, Teuteberg JJ, Chaudhry SP, Ravichandran A, DeVore AD, Margulies KB, Hanff TC, Zimmer R, Kilic A, Wald JW, Vidula H, Martens J, Blumberg EA, Mazurek JA, Owens AT, Goldberg LR, Alvarez-Garcia J, Mancini DM, Moss N, Genuardi MV. Characteristics and Outcomes of COVID-19 in Patients on Left Ventricular Assist Device Support. Circ Heart Fail 2021; 14:e007957. [PMID: 33813838 PMCID: PMC8059761 DOI: 10.1161/circheartfailure.120.007957] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. Methods: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry. Results: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46–68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations. Conclusions: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.
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Affiliation(s)
- Edo Y Birati
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia.,Perelman School of Medicine and Cardiovascular Outcomes, Quality, and Evaluative Research Center (E.Y.B.), University of Pennsylvania, Philadelphia.,Cardiovascular Division, Poriya Medical Center, Bar-Ilan University, Israel. (E.Y.B.)
| | - Samer S Najjar
- MedStar Washington Hospital Center, Washington, DC (S.S.N.)
| | - Ryan J Tedford
- Medical University of South Carolina, Charleston, SC (R.J.T., B.A.H.)
| | - Brian A Houston
- Medical University of South Carolina, Charleston, SC (R.J.T., B.A.H.)
| | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor (S.S.)
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL (E.V.)
| | - Pavan Atluri
- Department of Cardiothoracic Surgery (P.A.), University of Pennsylvania, Philadelphia
| | - Kimberly Urgo
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Maria Molina
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Nicole Escobar
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH (E.H., J.D.E.)
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH (E.H., J.D.E.)
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (K.M.A., J.J.T.)
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (K.M.A., J.J.T.)
| | - Sunit-Preet Chaudhry
- St Vincent Medical Group, St Vincent Heart Center, Indianapolis, IN (S.-P.C., A.R.)
| | - Ashwin Ravichandran
- St Vincent Medical Group, St Vincent Heart Center, Indianapolis, IN (S.-P.C., A.R.)
| | - Adam D DeVore
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC (A.D.D.)
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (A.K.)
| | - Joyce W Wald
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, NY (H.V., J.M.)
| | - John Martens
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, NY (H.V., J.M.)
| | - Emily A Blumberg
- Division of Infectious Diseases (E.A.B.), University of Pennsylvania, Philadelphia
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Jesus Alvarez-Garcia
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Donna M Mancini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Michael V Genuardi
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
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25
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Balan S, Beauchamps L, Gonzales-Zamora JA, Vu C, Amoros A, Quiroz T, Stevenson M, Sharkey M, Andrews DM, Abbo L. Recovery does not always signal the end of the battle: A case of post SARS-CoV-2 multisystem inflammatory syndrome in an adult. IDCases 2021; 24:e01067. [PMID: 33747788 PMCID: PMC7968306 DOI: 10.1016/j.idcr.2021.e01067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
We describe a case of SARS-CoV-2 post-infectious inflammatory syndrome in an adult who presented with multiorgan failure two months following his initial diagnosis of SARS-CoV-2 infection. This case highlights clinician’s early recognition of this devastating sequela and challenges in appropriate management of this patient.
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Affiliation(s)
- Shuba Balan
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laura Beauchamps
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jose Armando Gonzales-Zamora
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Christine Vu
- Jackson Memorial Hospital, Department of Pharmacy, Miami, FL, United States
| | - Annette Amoros
- Division of Infectious Diseases and Critical Care, Jackson Memorial Hospital, Miami, FL, United States
| | - Tanya Quiroz
- Division of Infectious Diseases, Jackson Memorial Hospital, Miami, FL, United States
| | - Mario Stevenson
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mark Sharkey
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - David M Andrews
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lilian Abbo
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States.,Department of Infection Prevention and Antimicrobial Stewardship, Jackson Health System, Miami, FL, United States
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26
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Alonderytė A, Navickas G, Samalavičius RS, Šerpytis P. Review of New Clinical Aspects of Cardiac Pathology in Patients with COVID-19 Infection. Acta Med Litu 2021; 28:31-35. [PMID: 34393626 PMCID: PMC8311833 DOI: 10.15388/amed.2021.28.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/17/2021] [Indexed: 11/27/2022] Open
Abstract
Summary. Background: COVID-19 disease is a huge burden for society and healthcare specialists. As more information is gathered about this new disease, it becomes clear that it affects not only respiratory, but also cardiovascular system. Materials and Methods: The aim of this review is to analyse the information about myocardial injury caused by COVID-19 and overview treatment options for these patients in publications which were published in the last 5 years. The data for this overview were collected in the PubMed database. Full-text articles were used for analysis when their title, summary, or keywords matched the purpose of the review. Only publications published in English that appeared in the last 5 years were analysed. For the analysis 14 publications were selected and analysed. Conclusion: COVID-19 infection could mimic ST-elevation myocardial infarction and it is crucial to differentiate the main cause and choose the appropriate treatment. Cardiovascular complications are related with poorer prognosis and higher mortality. This should be thoroughly considered by the healthcare specialists in order to choose appropriate treatment strategy. Patients with acute coronary syndrome (ACS) due to plaque rupture should receive dual antiplatelet therapy and full-dose anticoagulation if it is not contraindicated. Therefore, priority should be given to the acute coronary syndrome given the low evidence of new antiviral treatment effectiveness. Number of agents which are under investigation for COVID-19 may have interactions with oral antiplatelet drugs. Selected patients could receive immunosuppressive treatment as well as extracorporeal membrane oxygenation as a bridge to recovery.
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Affiliation(s)
| | - Giedrius Navickas
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Robertas Stasys Samalavičius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, LithuaniaEmergency Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Pranas Šerpytis
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaInstitute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, LithuaniaEmergency Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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27
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Fernández-Pérez GC, Oñate Miranda M, Fernández-Rodríguez P, Velasco Casares M, Corral de la Calle M, Franco López Á, Díez Blanco M, Cuchat JMO. SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies. RADIOLOGIA 2021; 63:115-126. [PMID: 33309398 PMCID: PMC7671642 DOI: 10.1016/j.rx.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022]
Abstract
COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets.
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Affiliation(s)
- G C Fernández-Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España.
| | - M Oñate Miranda
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | | | - M Velasco Casares
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | - M Corral de la Calle
- Servicio de Radiodiagnóstico, Hospital Nuestra Señora de Sonsoles, Ávila, España
| | - Á Franco López
- Servicio Radiodiagnóstico, Hospital Universitario Vinalopó, Alicante, España
| | - M Díez Blanco
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | - J M Oñate Cuchat
- Servicio de Anatomía Patológica, Hospital Universitario Río Hortega, Valladolid, España
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28
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Fernández-Pérez G, Oñate Miranda M, Fernández-Rodríguez P, Velasco Casares M, Corral de la Calle M, Franco López Á, Díez Blanco M, Oñate Cuchat J. SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies. RADIOLOGIA 2021. [PMCID: PMC7862877 DOI: 10.1016/j.rxeng.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets.
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29
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Woodby B, Arnold MM, Valacchi G. SARS-CoV-2 infection, COVID-19 pathogenesis, and exposure to air pollution: What is the connection? Ann N Y Acad Sci 2021; 1486:15-38. [PMID: 33022781 PMCID: PMC7675684 DOI: 10.1111/nyas.14512] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022]
Abstract
Exposure to air pollutants has been previously associated with respiratory viral infections, including influenza, measles, mumps, rhinovirus, and respiratory syncytial virus. Epidemiological studies have also suggested that air pollution exposure is associated with increased cases of SARS-CoV-2 infection and COVID-19-associated mortality, although the molecular mechanisms by which pollutant exposure affects viral infection and pathogenesis of COVID-19 remain unknown. In this review, we suggest potential molecular mechanisms that could account for this association. We have focused on the potential effect of exposure to nitrogen dioxide (NO2 ), ozone (O3 ), and particulate matter (PM) since there are studies investigating how exposure to these pollutants affects the life cycle of other viruses. We have concluded that pollutant exposure may affect different stages of the viral life cycle, including inhibition of mucociliary clearance, alteration of viral receptors and proteases required for entry, changes to antiviral interferon production and viral replication, changes in viral assembly mediated by autophagy, prevention of uptake by macrophages, and promotion of viral spread by increasing epithelial permeability. We believe that exposure to pollutants skews adaptive immune responses toward bacterial/allergic immune responses, as opposed to antiviral responses. Exposure to air pollutants could also predispose exposed populations toward developing COIVD-19-associated immunopathology, enhancing virus-induced tissue inflammation and damage.
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Affiliation(s)
- Brittany Woodby
- Animal Science DepartmentPlants for Human Health Institute, N.C. Research Campus, North Carolina State UniversityKannapolisNorth Carolina
| | - Michelle M. Arnold
- Department of Microbiology and ImmunologyCenter for Molecular and Tumor VirologyLouisiana State University Health Sciences CenterShreveportLouisiana
| | - Giuseppe Valacchi
- Animal Science DepartmentPlants for Human Health Institute, N.C. Research Campus, North Carolina State UniversityKannapolisNorth Carolina
- Department of Life Sciences and BiotechnologyUniversity of FerraraFerraraItaly
- Department of Food and NutritionKyung Hee UniversitySeoulSouth Korea
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30
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Abstract
Heart failure is a common disease state that can be encountered at different stages in the course of a COVID-19 patient presentation. New or existing heart failure in the setting of COVID-19 can present a set of unique challenges that can complicate presentation, management, and prognosis. A careful understanding of the hemodynamic and diagnostic implications is essential for appropriate triage and management of these patients. Abnormal cardiac biomarkers are common in COVID-19 and can stem from a variety of mechanisms that involve the viral entry itself through the ACE2 receptors, direct cardiac injury, increased thrombotic activity, stress cardiomyopathy, and among others. The cytokine storm observed in this pandemic can be a culprit in many of the observed mechanisms and presentations. A correct understanding of the two-way interaction between heart failure medications and the infection as well as the proposed COVID-19 medications and heart failure can result in optimal management. Guideline-directed medical therapy for heart failure should not be interrupted for theoretical concerns but rather based on tolerance and clinical presentation. Initiating specific cardiac or heart failure medications to prevent the infection or mitigate the disease is also not an evidence-based practice at this time. Heart failure patients on advanced therapies including those with heart transplantation will particularly benefit from involving the advanced heart failure team members in the overall management if they contract the virus.
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Affiliation(s)
- Feras Bader
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Yosef Manla
- Department of Research and Education, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates
| | - Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH, USA
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31
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Khan N, Kumar N, Geiger JD. Possible therapeutic targets for SARS-CoV-2 infection and COVID-19. JOURNAL OF ALLERGY AND INFECTIOUS DISEASES 2021; 2:75-83. [PMID: 37564275 PMCID: PMC10414779 DOI: 10.46439/allergy.2.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
SARS-CoV-2 infection causes COVID-19, which has emerged as a health emergency worldwide. SARS-CoV-2 infects cells by binding to ACE2 receptors and enters into the cytoplasm following its escape from endolysosomes. Once in the cytoplasm, the virus replicates and eventually causes various pathological conditions including acute respiratory distress syndrome (ARDS) that is caused by pro-inflammatory cytokine storms. Thus, endolysosomes and cytokine storms are important therapeutic targets to suppress SARS-CoV-2 infection and COVID-19. Here, we discuss therapeutic targets of SARS-CoV-2 infection and available drugs that could be helpful in the suppression of the SARS-CoV-2 infection and pathological condition COVID-19. The urgency of the COVID-19 pandemic precludes the development of new drugs and increased focus on drug repurposing might provide the quickest way to finding effective medicines.
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Affiliation(s)
- Nabab Khan
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota 58203, USA
| | - Nirmal Kumar
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota 58203, USA
| | - Jonathan D. Geiger
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota 58203, USA
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32
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Khan N, Chen X, Geiger JD. Possible Therapeutic Use of Natural Compounds Against COVID-19. JOURNAL OF CELLULAR SIGNALING 2021; 2:63-79. [PMID: 33768214 PMCID: PMC7990267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The outbreak of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has led to coronavirus disease-19 (COVID-19); a pandemic disease that has resulted in devastating social, economic, morbidity and mortality burdens. SARS-CoV-2 infects cells following receptor-mediated endocytosis and priming by cellular proteases. Following uptake, SARS-CoV-2 replicates in autophagosome-like structures in the cytosol following its escape from endolysosomes. Accordingly, the greater endolysosome pathway including autophagosomes and the mTOR sensor may be targets for therapeutic interventions against SARS-CoV-2 infection and COVID-19 pathogenesis. Naturally existing compounds (phytochemicals) through their actions on endolysosomes and mTOR signaling pathways might provide therapeutic relief against COVID-19. Here, we discuss evidence that some natural compounds through actions on the greater endolysosome system can inhibit SARS-CoV-2 infectivity and thereby might be repurposed for use against COVID-19.
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33
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Callaghan PJ, Rybakovsky E, Ferrick B, Thomas S, Mullin JM. Retinoic acid improves baseline barrier function and attenuates TNF-α-induced barrier leak in human bronchial epithelial cell culture model, 16HBE 14o. PLoS One 2020; 15:e0242536. [PMID: 33301441 PMCID: PMC7728186 DOI: 10.1371/journal.pone.0242536] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023] Open
Abstract
Retinoic acid (RA) has been shown to improve epithelial and endothelial barrier function and development and even suppress damage inflicted by inflammation on these barriers through regulating immune cell activity. This paper thus sought to determine whether RA could improve baseline barrier function and attenuate TNF-α-induced barrier leak in the human bronchial epithelial cell culture model, 16HBE14o- (16HBE). We show for the first time that RA increases baseline barrier function of these cell layers indicated by an 89% increase in transepithelial electrical resistance (TER) and 22% decrease in 14C-mannitol flux. A simultaneous, RA-induced 70% increase in claudin-4 attests to RA affecting the tight junctional (TJ) complex itself. RA was also effective in alleviating TNF-α-induced 16HBE barrier leak, attenuating 60% of the TNF-α-induced leak to 14C-mannitol and 80% of the leak to 14C-inulin. Interleukin-6-induced barrier leak was also reduced by RA. Treatment of 16HBE cell layers with TNF-α resulted in dramatic decrease in immunostaining for occludin and claudin-4, as well as a downward “band-shift” in occludin Western immunoblots. The presence of RA partially reversed TNF-α’s effects on these select TJ proteins. Lastly, RA completely abrogated the TNF-α-induced increase in ERK-1,2 phosphorylation without significantly decreasing the TNF-driven increase in total ERK-1,2. This study suggests RA could be effective as a prophylactic agent in minimizing airway barrier leak and as a therapeutic in preventing leak triggered by inflammatory cascades. Given the growing literature suggesting a “cytokine storm” may be related to COVID-19 morbidity, RA may be a useful adjuvant for use with anti-viral therapies.
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Affiliation(s)
- Patrick J. Callaghan
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - Elizabeth Rybakovsky
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - Bryan Ferrick
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, United States of America
| | - Sunil Thomas
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - James M. Mullin
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
- * E-mail:
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34
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Thakkar S, Arora S, Kumar A, Jaswaney R, Faisaluddin M, Ammad Ud Din M, Shariff M, Barssoum K, Patel HP, Nirav A, Jani C, Patel K, Savani S, DeSimone C, Mulpuru S, Deshmukh A. A Systematic Review of the Cardiovascular Manifestations and Outcomes in the Setting of Coronavirus-19 Disease. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820977196. [PMID: 33312009 PMCID: PMC7716078 DOI: 10.1177/1179546820977196] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/01/2020] [Indexed: 01/08/2023]
Abstract
The impact of coronavirus disease, 2019 (COVID-19), has been profound. Though COVID-19 primarily affects the respiratory system, it has also been associated with a wide range of cardiovascular (CV) manifestations portending extremely poor prognosis. The principal hypothesis for CV involvement is through direct myocardial infection and systemic inflammation. We conducted a systematic review of the current literature to provide a foundation for understanding the CV manifestations and outcomes of COVID-19. PubMed and EMBASE databases were electronically searched from the inception of the databases through 27 April 2020. A second literature review was conducted to include major trials and guidelines that were published after the initial search but before submission. The inclusion criteria for studies to be eligible were case reports, case series, and observation studies reporting CV outcomes among patients with COVID-19 infection. This review of the current COVID-19 disease and CV outcomes literature revealed a myriad of CV manifestations with potential avenues for treatment and prevention. Future studies are required to understand on a more mechanistic level the effect of COVID-19 on the myocardium and thus provide avenues to improve mortality and morbidity.
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Affiliation(s)
| | - Shilpkumar Arora
- Department of Cardiology, Case Western Reserve University, Cleveland, OH, USA
| | - Ashish Kumar
- Department of Critical Care Medicine, St. John’s Medical College Hospital, Bangalore, India
| | - Rahul Jaswaney
- Department of Internal Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mohammed Faisaluddin
- Department of Medicine, Deccan College of Medical Science, Hyderabad, Telangana, India
| | | | - Mariam Shariff
- Department of Critical Care Medicine, St. John’s Medical College Hospital, Bangalore, India
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Arora Nirav
- MS in Computer Science, Lamar University, TX, USA
| | - Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Kripa Patel
- Department of Medicine, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Sejal Savani
- Department of Public Health, NYU College of Dentistry, NY, USA
| | | | - Siva Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Rassaf T, Totzeck M, Mahabadi AA, Hendgen-Cotta U, Korste S, Settelmeier S, Luedike P, Dittmer U, Herbstreit F, Brenner T, Klingel K, Hasenberg M, Walkenfort B, Gunzer M, Schlosser T, Weymann A, Kamler M, Schmack B, Ruhparwar A. Ventricular assist device for a coronavirus disease 2019-affected heart. ESC Heart Fail 2020; 8:162-166. [PMID: 33219613 PMCID: PMC7753611 DOI: 10.1002/ehf2.13120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is challenging the care for cardiovascular patients, resulting in serious consequences with increasing mortality in pre-diseased heart failure patients. In the current state of the pandemic, the physiopathology of COVID-19 affecting pre-diseased hearts and the management of terminal heart failure in COVID-19 patients remain unclear. We outline the findings of a young COVID-19 patient suffering from idiopathic cardiomyopathy who was treated for acute multi-organ failure and required cardiac surgery with implantation of a temporary right ventricular and durable left ventricular assist device (LVAD). For deeper translational insights, we used in-depth tissue analysis by electron and light sheet fluorescence microscopy revealing evidence for spatial distribution of severe acute respiratory syndrome coronavirus 2 in the heart. This indicates that in-depth analysis may represent a valuable tool in understanding indistinct clinical cases. We conclude that COVID-19 directly affects pre-diseased hearts, but the consequences can be treated successfully with LVAD implantation.
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Affiliation(s)
- Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulrike Hendgen-Cotta
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Sebastian Korste
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Karin Klingel
- Department of Cardiopathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Mike Hasenberg
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Bernd Walkenfort
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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George I, Salna M, Kobsa S, Deroo S, Kriegel J, Blitzer D, Shea NJ, D’Angelo A, Raza T, Kurlansky P, Takeda K, Takayama H, Bapat V, Naka Y, Smith CR, Bacha E, Argenziano M. The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: insights and clinical strategies from a centre at the epicentre. Eur J Cardiothorac Surg 2020; 58:667-675. [PMID: 32573737 PMCID: PMC7337744 DOI: 10.1093/ejcts/ezaa228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery programme and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care and enable support for the hospital in terms of physical resources, providers and resident training. METHODS In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our programme, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS We recognize that individual programmes around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programmes to plan for the future.
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Affiliation(s)
- Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Salna
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Serge Kobsa
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Scott Deroo
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jacob Kriegel
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - David Blitzer
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Nicholas J Shea
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alex D’Angelo
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Tasnim Raza
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Vinayak Bapat
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Craig R Smith
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Emile Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Argenziano
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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37
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Muñoz-Fontela C, Dowling WE, Funnell SGP, Gsell PS, Riveros-Balta AX, Albrecht RA, Andersen H, Baric RS, Carroll MW, Cavaleri M, Qin C, Crozier I, Dallmeier K, de Waal L, de Wit E, Delang L, Dohm E, Duprex WP, Falzarano D, Finch CL, Frieman MB, Graham BS, Gralinski LE, Guilfoyle K, Haagmans BL, Hamilton GA, Hartman AL, Herfst S, Kaptein SJF, Klimstra WB, Knezevic I, Krause PR, Kuhn JH, Le Grand R, Lewis MG, Liu WC, Maisonnasse P, McElroy AK, Munster V, Oreshkova N, Rasmussen AL, Rocha-Pereira J, Rockx B, Rodríguez E, Rogers TF, Salguero FJ, Schotsaert M, Stittelaar KJ, Thibaut HJ, Tseng CT, Vergara-Alert J, Beer M, Brasel T, Chan JFW, García-Sastre A, Neyts J, Perlman S, Reed DS, Richt JA, Roy CJ, Segalés J, Vasan SS, Henao-Restrepo AM, Barouch DH. Animal models for COVID-19. Nature 2020; 586:509-515. [PMID: 32967005 PMCID: PMC8136862 DOI: 10.1038/s41586-020-2787-6] [Citation(s) in RCA: 572] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the aetiological agent of coronavirus disease 2019 (COVID-19), an emerging respiratory infection caused by the introduction of a novel coronavirus into humans late in 2019 (first detected in Hubei province, China). As of 18 September 2020, SARS-CoV-2 has spread to 215 countries, has infected more than 30 million people and has caused more than 950,000 deaths. As humans do not have pre-existing immunity to SARS-CoV-2, there is an urgent need to develop therapeutic agents and vaccines to mitigate the current pandemic and to prevent the re-emergence of COVID-19. In February 2020, the World Health Organization (WHO) assembled an international panel to develop animal models for COVID-19 to accelerate the testing of vaccines and therapeutic agents. Here we summarize the findings to date and provides relevant information for preclinical testing of vaccine candidates and therapeutic agents for COVID-19.
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Affiliation(s)
- César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - William E Dowling
- Centre for Epidemic Preparedness Innovations (CEPI), Washington, DC, USA
| | | | | | | | - Randy A Albrecht
- Department of Microbiology, Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ralph S Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Miles W Carroll
- National Infection Service, Public Health England, Salisbury, UK
| | | | - Chuan Qin
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking, China
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kai Dallmeier
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | | | - Emmie de Wit
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Leen Delang
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Erik Dohm
- Animal Resources Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Paul Duprex
- Department of Microbiology and Molecular Genetics, Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darryl Falzarano
- VIDO-Intervac, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Courtney L Finch
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Matthew B Frieman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lisa E Gralinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Bart L Haagmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Amy L Hartman
- Department of Microbiology and Molecular Genetics, Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sander Herfst
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzanne J F Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - William B Klimstra
- Department of Immunology, Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Philip R Krause
- Center for Biologics Evaluation and Research, FDA, Silver Spring, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Roger Le Grand
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Inserm, CEA, Université Paris-Saclay, Paris, France
| | | | - Wen-Chun Liu
- Department of Microbiology, Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pauline Maisonnasse
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Inserm, CEA, Université Paris-Saclay, Paris, France
| | - Anita K McElroy
- Division of Pediatric Infectious Diseases, Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vincent Munster
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Nadia Oreshkova
- Wageningen Bioveterinary Research (WBVR), Wageningen University and Research, Lelystad, The Netherlands
| | - Angela L Rasmussen
- Center for Infection and Immunity, Columbia Mailman |School of Public Health, New York, NY, USA
| | - Joana Rocha-Pereira
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Barry Rockx
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Estefanía Rodríguez
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Thomas F Rogers
- Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA
| | | | - Michael Schotsaert
- Department of Microbiology, Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Hendrik Jan Thibaut
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Chien-Te Tseng
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Júlia Vergara-Alert
- Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Martin Beer
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Trevor Brasel
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jasper F W Chan
- Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Adolfo García-Sastre
- Department of Microbiology, Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Stanley Perlman
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - Douglas S Reed
- Department of Immunology, Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juergen A Richt
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - Chad J Roy
- Tulane National Primate Research Center, Covington, LA, USA
| | - Joaquim Segalés
- Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Sanitat i Anatomia Animals, Facultat de Veterinària, UAB, Bellaterra, Spain
| | - Seshadri S Vasan
- Australian Centre for Disease Preparedness, CSIRO, Geelong, Victoria, Australia
- Department of Health Sciences, University of York, York, UK
| | | | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Wijeratne T, Sales C, Karimi L, Crewther SG. Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review. Front Neurol 2020; 11:1031. [PMID: 33101164 PMCID: PMC7546832 DOI: 10.3389/fneur.2020.01031] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020 with 5,934 936 infections, 367,166 deaths and affecting over 200 countries as of 30th May 2020. Acute Ischemic Stroke (AIS) in brain is also emerging as an important neurovascular/neurological complication of COVID-19, associated with extreme immune responses leading to dysregulated coagulation system and generalized thrombo-embolic status and increased risk of AIS especially among usually less vulnerable younger adults in this cohort. Thus, in early June 2020, we aimed to review the clinical data on all published cases of COVID-19 and concomitant AIS, with a view to understanding the pertinent clinical, laboratory and imaging features. The neutrophil-lymphocyte ratio (NLR) at time of hospital admission for COVID infection correlates positively with the duration of time before onset of clinical features of AIS. Higher NLR, C-Reactive protein, serum ferritin, D-dimer and fibrinogen levels are associated with poor prognosis of AIS in COVID-19 with 75% of patients dying or being severely disabled at present. Currently it is too early to comment on the long-term outcomes for survivors.
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Affiliation(s)
- Tissa Wijeratne
- Neurology & Stroke, Australian Institute for Musculoskeletal Science, Melbourne Medical School, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia.,School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Parkville, VIC, Australia.,Department of Medicine and Dean's Office, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Carmela Sales
- Department of Neurology, Australian Institute for Musculoskeletal Science, Level Three, Western Centre for Health Research and Education, Sunshine Hospital, Western Health & University Melbourne, St Albans, VIC, Australia
| | - Leila Karimi
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Parkville, VIC, Australia.,Faculty of Social and Political Sciences, Tbilisi State University, Tbilisi, Georgia
| | - Sheila Gillard Crewther
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Parkville, VIC, Australia.,Department of Neurology, Australian Institute for Musculoskeletal Science, Level Three, Western Centre for Health Research and Education, Sunshine Hospital, Western Health & University Melbourne, St Albans, VIC, Australia
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Cytokine Storm in COVID-19 Patients, Its Impact on Organs and Potential Treatment by QTY Code-Designed Detergent-Free Chemokine Receptors. Mediators Inflamm 2020; 2020:8198963. [PMID: 33029105 PMCID: PMC7512100 DOI: 10.1155/2020/8198963] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus is not only causing respiratory problems, but it may also damage the heart, kidneys, liver, and other organs; in Wuhan, 14 to 30% of COVID-19 patients have lost their kidney function and now require either dialysis or kidney transplants. The novel coronavirus gains entry into humans by targeting the ACE2 receptor that found on lung cells, which destroy human lungs through cytokine storms, and this leads to hyperinflammation, forcing the immune cells to destroy healthy cells. This is why some COVID-19 patients need intensive care. The inflammatory chemicals released during COVID-19 infection cause the liver to produce proteins that defend the body from infections. However, these proteins can cause blood clotting, which can clog blood vessels in the heart and other organs; as a result, the organs are deprived of oxygen and nutrients which could ultimately lead to multiorgan failure and consequent progression to acute lung injury, acute respiratory distress syndrome, and often death. However, there are novel protein modification tools called the QTY code, which are similar in their structure to antibodies, which could provide a solution to excess cytokines. These synthetic proteins can be injected into the body to bind the excess cytokines created by the cytokine storm; this will eventually remove the excessive cytokines and inhibit the severe symptoms caused by the COVID-19 infection. In this review, we will focus on cytokine storm in COVID-19 patients, their impact on the body organs, and the potential treatment by QTY code-designed detergent-free chemokine receptors.
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Characteristics and Outcomes of Patients With a Left Ventricular Assist Device With Coronavirus Disease-19. J Card Fail 2020; 26:895-897. [PMID: 32956813 PMCID: PMC7501531 DOI: 10.1016/j.cardfail.2020.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 12/15/2022]
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Yang M, Chen X, Xu Y. A Retrospective Study of the C-Reactive Protein to Lymphocyte Ratio and Disease Severity in 108 Patients with Early COVID-19 Pneumonia from January to March 2020 in Wuhan, China. Med Sci Monit 2020; 26:e926393. [PMID: 32914767 PMCID: PMC7507794 DOI: 10.12659/msm.926393] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to determine the effect of C-reactive protein (CRP), lymphocytes (LYM), and the ratio of CRP to LYM (CRP/LYM) on assessing the prognosis of COVID-19 severity at early stages of disease. Material/Methods A total of 108 hospitalized patients diagnosed with COVID-19 in Zhongnan Hospital of Wuhan University from January 17, 2020 to March 12, 2020 were enrolled. Data of demographic parameters, clinical characteristics, laboratory indicators, clinical manifestation, and outcome of disease were collected. The patients were divided into a severe group and a non-severe group according to diagnosis and classification, which followed the guidelines and management of the Chinese National Health Council COVID-19. The receiver-operating characteristic (ROC) analysis and comparison of ROC curves were used for the laboratory findings for assessment of COVID-19 severity. Results Of the 108 patients, 42 patients (38.9%) were male and 24 patients (22.2%) were considered severe cases, with the mean age of 51.0 years old. Males and patients with comorbidities were more likely to become severe cases. CRP increased and LYM decreased in the severe group.The results for the areas under the curve (AUC) of CRP/LYM and CRP used to assess severe COVID-19 were 0.787 (95% CI 0.698–0.860, P<0.0001) and 0.781 (95% CI 0.693–0.856, P<0.0001), respectively; both results were better than that of LYM. The associated criterion value of CRP/LYM was calculated, with an excellent sensitivity of 95.83%. Conclusions The effect of CRP/LYM and CRP on the assessment for severe COVID-19 may be superior to LYM alone. CRP/LYM is a highly sensitive indicator to assess the severity of COVID-19 in the early stage of disease.
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Affiliation(s)
- Miao Yang
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Xiaoping Chen
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Yancheng Xu
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
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Ita K. Coronavirus Disease (COVID-19): Current Status and Prospects for Drug and Vaccine Development. Arch Med Res 2020; 52:15-24. [PMID: 32950264 PMCID: PMC7832760 DOI: 10.1016/j.arcmed.2020.09.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has spread to almost all nooks and corners of the world. There are numerous potential approaches to pharmacologically fight COVID-19: small-molecule drugs, interferon therapies, vaccines, oligonucleotides, peptides, and monoclonal antibodies. Medications are being developed to target the spike, membrane, nucleocapsid or envelope proteins. The spike protein is also a critical target for vaccine development. Immunoinformatic approaches are being used for the identification of B cell and cytotoxic T lymphocyte (CTL) epitopes in the SARS-CoV-2 spike protein. Different vaccine vectors are also being developed. Chemical and physical methods such as formaldehyde, UV light or β-propiolactone are being deployed for the preparation of inactivated virus vaccine. Currently, there are many vaccines undergoing clinical trials. Even though mRNA and DNA vaccines are being designed and moved into clinical trials, these types of vaccines are yet to be approved by regulatory bodies for human use. This review focuses on the drugs and vaccines being developed against the COVID-19.
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Affiliation(s)
- Kevin Ita
- College of Pharmacy, Touro University, California, USA.
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43
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Management of COVID-19 in a durable left ventricular assist device recipient: A continuity of care perspective. Heart Lung 2020; 49:688-691. [PMID: 32861886 PMCID: PMC7440278 DOI: 10.1016/j.hrtlng.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 is impacting the cardiovascular community both here in the United States and globally. The rapidly emerging cardiac complications have heightened implications for those with underlying cardiovascular disease. We describe an early case of COVID-19 in a left ventricular assist device recipient in the United States. We discuss our clinical management during the initial admission, outpatient management, and a unique complication of this disease over a 40-day disease course.
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44
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Chatterjee S, Sengupta T, Majumder S, Majumder R. COVID-19: a probable role of the anticoagulant Protein S in managing COVID-19-associated coagulopathy. Aging (Albany NY) 2020; 12:15954-15961. [PMID: 32826388 PMCID: PMC7485709 DOI: 10.18632/aging.103869] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic has caused monumental mortality, and there are still no adequate therapies. Most severely ill COVID-19 patients manifest a hyperactivated immune response, instigated by interleukin 6 (IL6) that triggers a so called "cytokine storm" and coagulopathy. Hypoxia is also associated with COVID-19. So far overlooked is the fact that both IL6 and hypoxia depress the abundance of a key anticoagulant, Protein S. We speculate that the IL6-driven cytokine explosion plus hypoxemia causes a severe drop in Protein S level that exacerbates the thrombotic risk in COVID-19 patients. Here we highlight a mechanism by which the IL6-hypoxia curse causes a deadly hypercoagulable state in COVID-19 patients, and we suggest a path to therapy.
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Affiliation(s)
- Sabyasachi Chatterjee
- Department of Biochemistry and Molecular Biology, LSU Health Science Center, New Orleans, LA 70112, USA
| | - Tanusree Sengupta
- Department of Chemistry, Sri Sivasubramaniya Nadar College of Engineering, Tamilnadu, India
| | - Samarpan Majumder
- Department of Genetics, LSU Health Science Center, New Orleans, LA 70112, USA
| | - Rinku Majumder
- Department of Biochemistry and Molecular Biology, LSU Health Science Center, New Orleans, LA 70112, USA
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45
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Khan N. Possible protective role of 17β-estradiol against COVID-19. JOURNAL OF ALLERGY AND INFECTIOUS DISEASES 2020; 1:38-48. [PMID: 33196058 PMCID: PMC7665224 DOI: 10.46439/allergy.1.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19); a worldwide pandemic as declared by the World Health Organization (WHO). SARS-CoV-2 appears to infect cells by first binding and priming its viral-spike proteins with membrane-associated angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2). Through the coordinated actions of ACE2 and TMPRSS2, SARS-CoV-2 spike proteins fuse with plasma membranes and ultimately the virus enters cells. ACE2 is integral to the renin-angiotensin-aldosterone system (RAAS), and SARS-CoV-2 down-regulates protein expression levels of ACE2. Once infected, patients typically develop acute respiratory distress syndrome (ARDS) and a number of other severe complications that result in a high rate of fatality, especially in older (>60 years) adults and in people with pre-existing medical conditions. Data now indicate clearly that among people of all age groups, COVID-19 fatalities are higher in men than women. Here, attention is focused on these sex differences and posit a role of estrogen in these differences as well as possible therapeutic and protective actions of 17β-estradiol against COVID-19.
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Affiliation(s)
- Nabab Khan
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota 58203, USA
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46
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Oliveros E, Brailovsky Y, Scully P, Nikolou E, Rajani R, Grapsa J. Coronavirus Disease 2019 and Heart Failure: A Multiparametric Approach. Card Fail Rev 2020; 6:e22. [PMID: 32944292 PMCID: PMC7479531 DOI: 10.15420/cfr.2020.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a debilitating viral infection and, to date, 628,903 people have died from it, numbers that cannot yet be compared to the 50 million who died in the 1918 flu pandemic. As COVID-19 became better understood, cardiovascular manifestations associated with it were identified. This led to a complete healthcare restructuring with virtual clinics and changes to the triaging of critically ill patients. There are a lot of questions over how COVID-19 affects patients with heart failure (HF) as this condition is a leading cause of cardiovascular death. This review describes the cardiovascular implications of COVID-19 and new practices surrounding the use of telehealth to follow up and triage patients with HF. Current practices supported by medical societies, the role of angiotensin-converting enzyme inhibitors and, finally, a brief note regarding the management of advanced HF patients will also be discussed.
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Affiliation(s)
- Estefania Oliveros
- Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York, NY, US
| | - Yevgeniy Brailovsky
- Center for Advanced Cardiac Care, Columbia University Irving Medical Center New York, NY, US
| | - Paul Scully
- Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust London, UK.,4. Institute of Cardiovascular Sciences, University College London London, UK
| | - Evgenia Nikolou
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, UK
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King's College London London, UK
| | - Julia Grapsa
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, UK
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47
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Bartoszewski R, Dabrowski M, Jakiela B, Matalon S, Harrod KS, Sanak M, Collawn JF. SARS-CoV-2 may regulate cellular responses through depletion of specific host miRNAs. Am J Physiol Lung Cell Mol Physiol 2020; 319:L444-L455. [PMID: 32755307 DOI: 10.1152/ajplung.00252.2020] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cold viruses have generally been considered fairly innocuous until the appearance of the severe acute respiratory coronavirus 2 (SARS-CoV-2) in 2019, which caused the coronavirus disease 2019 (COVID-19) global pandemic. Two previous viruses foreshadowed that a coronavirus could potentially have devastating consequences in 2002 [severe acute respiratory coronavirus (SARS-CoV)] and in 2012 [Middle East respiratory syndrome coronavirus (MERS-CoV)]. The question that arises is why these viruses are so different from the relatively harmless cold viruses. On the basis of an analysis of the current literature and using bioinformatic approaches, we examined the potential human miRNA interactions with the SARS-CoV-2's genome and compared the miRNA target sites in seven coronavirus genomes that include SARS-CoV-2, MERS-CoV, SARS-CoV, and four nonpathogenic coronaviruses. Here, we discuss the possibility that pathogenic human coronaviruses, including SARS-CoV-2, could modulate host miRNA levels by acting as miRNA sponges to facilitate viral replication and/or to avoid immune responses.
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Affiliation(s)
- Rafal Bartoszewski
- Department of Biology and Pharmaceutical Botany, Medical University of Gdansk, Gdansk, Poland
| | - Michal Dabrowski
- Laboratory of Bioinformatics, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, Warsaw, Poland
| | - Bogdan Jakiela
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sadis Matalon
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin S Harrod
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marek Sanak
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - James F Collawn
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
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48
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Sattar Y, Ullah W, Rauf H, Virk HUH, Yadav S, Chowdhury M, Connerney M, Mamtani S, Pahuja M, Patel RD, Mir T, Almas T, Moussa Pacha H, Chadi Alraies M. COVID-19 cardiovascular epidemiology, cellular pathogenesis, clinical manifestations and management. IJC HEART & VASCULATURE 2020; 29:100589. [PMID: 32724831 PMCID: PMC7359794 DOI: 10.1016/j.ijcha.2020.100589] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is a rapidly progressing global pandemic that may present with a variety of cardiac manifestations including, but not limited to, myocardial injury, myocardial infarction, arrhythmias, heart failure, cardiomyopathy, shock, thromboembolism, and cardiac arrest. These cardiovascular effects are worse in patients who have pre-existing cardiac conditions such as coronary artery disease, hypertension, diabetes mellitus, and coagulation abnormalities. Other predisposing risk factors include advanced age, immunocompromised state, and underlying systemic inflammatory conditions. Here we review the cellular pathophysiology, clinical manifestations and treatment modalities of the cardiac manifestations seen in patients with COVID-19.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, PA, USA
| | - Hiba Rauf
- Internal Medicine, American Society of Clinical Oncology, VA, USA
| | - Hafeez ul Hassan Virk
- Interventional Cardiology, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Sunita Yadav
- Internal Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA
| | - Medhat Chowdhury
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Michael Connerney
- Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital, NY, USA
| | - Sahil Mamtani
- Internal Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA
| | - Mohit Pahuja
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Raj D. Patel
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
- University of Illinois College of Medicine Peoria, Chicago, IL, USA
| | - Tanveer Mir
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Talal Almas
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Homam Moussa Pacha
- Cardiology Department, University of Texas, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - M. Chadi Alraies
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
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49
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DeFilippis EM, Reza N, Donald E, Givertz MM, Lindenfeld J, Jessup M. Considerations for Heart Failure Care During the COVID-19 Pandemic. JACC. HEART FAILURE 2020; 8:681-691. [PMID: 32493638 PMCID: PMC7266777 DOI: 10.1016/j.jchf.2020.05.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus-2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF) who have contracted COVID-19 as well as those without COVID-19 who have been impacted by the restructuring of health care delivery. Patients with HF and other cardiovascular comorbidities are at risk for severe disease and complications of infection. Similarly, COVID-19 has been demonstrated to cause myocarditis and may be implicated in new-onset cardiomyopathy. During this pandemic, special considerations are needed for patients with advanced HF, including those supported by durable left ventricular assist devices (LVADs) and heart transplant recipients. The purpose of this review is to summarize emerging data regarding the development of HF secondary to COVID-19 infection in patients with advanced HF and the implications of the pandemic for care of uninfected patients with HF.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - Nosheen Reza
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elena Donald
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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50
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de la Rica R, Borges M, Aranda M, del Castillo A, Socias A, Payeras A, Rialp G, Socias L, Masmiquel L, Gonzalez-Freire M. Low Albumin Levels Are Associated with Poorer Outcomes in a Case Series of COVID-19 Patients in Spain: A Retrospective Cohort Study. Microorganisms 2020; 8:microorganisms8081106. [PMID: 32722020 PMCID: PMC7463882 DOI: 10.3390/microorganisms8081106] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
There is limited information available describing the clinical and epidemiological features of Spanish patients requiring hospitalization for coronavirus disease 2019 (COVID-19). In this observational study, we aimed to describe the clinical characteristics and epidemiological features of severe (non-ICU) and critically patients (ICU) with COVID-19 at triage, prior to hospitalization. Forty-eight patients (27 non-ICU and 21 ICU) with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed (mean age, 66 years, [range, 33–88 years]; 67% males). There were no differences in age or sex among groups. Initial symptoms included fever (100%), coughing (85%), dyspnea (76%), diarrhea (42%) and asthenia (21%). ICU patients had a higher prevalence of dyspnea compared to non-ICU patients (95% vs. 61%, p = 0.022). ICU-patients had lymphopenia as well as hypoalbuminemia. Lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin were significantly higher in ICU patients compared to non-ICU (p < 0.001). Lower albumin levels were associated with poor prognosis measured as longer hospital length (r = −0.472, p < 0.001) and mortality (r = −0.424, p = 0.003). As of 28 April 2020, 10 patients (8 ICU and 2 non-ICU) have died (21% mortality), and while 100% of the non-ICU patients have been discharged, 33% of the ICU patients still remained hospitalized (5 in ICU and 2 had been transferred to ward). Critically ill patients with COVID-19 present lymphopenia, hypoalbuminemia and high levels of inflammation.
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Affiliation(s)
- Roberto de la Rica
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.B.); (M.A.); (A.d.C.); (A.S.)
- Correspondence: (R.d.l.R.); (M.G.-F.)
| | - Marcio Borges
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.B.); (M.A.); (A.d.C.); (A.S.)
- Intensive Care Unit, Son Llatzer University Hospital, Balearic Islands, 07198 Palma de Mallorca, Spain; (G.R.); (L.S.)
| | - Maria Aranda
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.B.); (M.A.); (A.d.C.); (A.S.)
- Intensive Care Unit, Son Llatzer University Hospital, Balearic Islands, 07198 Palma de Mallorca, Spain; (G.R.); (L.S.)
| | - Alberto del Castillo
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.B.); (M.A.); (A.d.C.); (A.S.)
- Intensive Care Unit, Son Llatzer University Hospital, Balearic Islands, 07198 Palma de Mallorca, Spain; (G.R.); (L.S.)
| | - Antonia Socias
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.B.); (M.A.); (A.d.C.); (A.S.)
- Intensive Care Unit, Son Llatzer University Hospital, Balearic Islands, 07198 Palma de Mallorca, Spain; (G.R.); (L.S.)
| | - Antoni Payeras
- Internal Medicine Unit, Son Llatzer University Hospital, Balearic Islands, 07120 Palma de Mallorca, Spain;
| | - Gemma Rialp
- Intensive Care Unit, Son Llatzer University Hospital, Balearic Islands, 07198 Palma de Mallorca, Spain; (G.R.); (L.S.)
- Cardiopulmonary Pathology of the Critically Ill Patient Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Lorenzo Socias
- Intensive Care Unit, Son Llatzer University Hospital, Balearic Islands, 07198 Palma de Mallorca, Spain; (G.R.); (L.S.)
| | - Lluis Masmiquel
- Vascular and Metabolic Pathologies Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain;
| | - Marta Gonzalez-Freire
- Vascular and Metabolic Pathologies Group, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: (R.d.l.R.); (M.G.-F.)
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