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Zhang Q, Pavlinov I, Ye Y, Zheng W. Therapeutic development targeting host heparan sulfate proteoglycan in SARS-CoV-2 infection. Front Med (Lausanne) 2024; 11:1364657. [PMID: 38618194 PMCID: PMC11014733 DOI: 10.3389/fmed.2024.1364657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
The global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an urgent need for effective therapeutic options. SARS-CoV-2 is a novel coronavirus responsible for the COVID-19 pandemic that has resulted in significant morbidity and mortality worldwide. The virus is known to enter host cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor, and emerging evidence suggests that heparan sulfate proteoglycans (HSPGs) play a crucial role in facilitating this process. HSPGs are abundant cell surface proteoglycan present in many tissues, including the lung, and have been shown to interact directly with the spike protein of SARS-CoV-2. This review aims to summarize the current understanding of the role of HSPGs in SARS-CoV-2 infection and the potential of developing new therapies targeting HSPGs.
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Affiliation(s)
- Qi Zhang
- Therapeutic Development Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Ivan Pavlinov
- Therapeutic Development Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Yihong Ye
- Laboratory of Molecular Biology, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Wei Zheng
- Therapeutic Development Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
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2
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Al-Jewair T, Michelogiannakis D, Khoo E, Prevost R. Potential Impact of Long COVID-19 on Orthodontic Treatment. Eur J Dent 2024; 18:387-391. [PMID: 37336480 PMCID: PMC10959594 DOI: 10.1055/s-0043-1768467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Pooled estimates indicate about 226 million individuals are currently experiencing or have experienced persistent symptoms from COVID-19. Long COVID-19 (LC) has been associated with a prolonged inflammatory and stress responses in affected individuals. Due to common pathways, LC could impact the biological mechanisms of orthodontic tooth movement, orthodontically-induced inflammatory root resorption and periodontal tissue response of patients undergoing orthodontic treatment. The authors of the present report discussed potential biological mechanisms through which LC may influence orthodontic treatment highlighting the need for further research in this area.
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Affiliation(s)
- Thikriat Al-Jewair
- Department of Orthodontics, School of Dental Medicine, University at Buffalo, Buffalo, New York, United States
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, New York, United States
| | - Edmund Khoo
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, New York, United States
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, United States
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, New York, United States
| | - Ryan Prevost
- Department of Orthodontics, School of Dental Medicine, University at Buffalo, Buffalo, New York, United States
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3
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Jog K, Nazirudeen R, Eagappan S, Santharam RK, Sridhar S. Epidemiology, Clinical Profile, and Analysis of Risk Factors in COVID Associated Rhino-orbito-cerebral Mucormycosis Patients - An Observational Study. Indian J Endocrinol Metab 2023; 27:519-523. [PMID: 38371190 PMCID: PMC10871010 DOI: 10.4103/ijem.ijem_372_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 02/20/2024] Open
Abstract
Aim of Study To study the clinico-epidemiological profile and identify risk factors for the development of COVID-19-associated mucormycosis (CAM) among the patients treated at our regional mucormycosis center. Materials and Methods This was a cross-sectional single-centre observational study. All CAM patients admitted to Government Rajaji Hospital, Madurai from April 2021- August 2021 were included in the study. Information regarding clinical features, potential risk factors, diagnostic workup, and comorbid illness was collected. Results A total of 164 patients of CAM were admitted to our hospital with a mean age of 51.7 years. Out of 164 patients, 12 patients were not covid positive, based on imaging and RT-PCR, however subclinical infection could not be ruled out. Out of the 164 patients studied, 160 patients had diabetes, out of which 66% (n = 105) patients had a previous history of diabetes, and 34% (n = 55) had newly detected diabetes. Most of the patients admitted with mucormycosis had uncontrolled diabetes (94%) and were not on insulin therapy, but were on oral antidiabetic drugs alone. The majority of the patients (68%) have received steroids (IV/oral) during the COVID-19 illness. 74% of these patients were under hospitalization for COVID-19 disease. Only 30% (n = 50) of CAM patients had a history of oxygen therapy and 7% of these patients were treated in ICU during active COVID-19 illness. 59% of patients used cloth masks without adequate hygiene, rest 41% (n = 67) patients reused disposable masks. We also found that 87% of the patients developing mucormycosis had exposure to organic material in the convalescence period of COVID-19 illness. Conclusions From our study, we found steroid use, poorly controlled diabetes mellitus, reuse of masks, daily steam inhalation, and exposure to organic matter to be more associated with CAM, but oxygen therapy was less associated with CAM. Hence, we could suggest screening for hyperglycemia and daily use of disposable surgical masks to be continued for at least 4 weeks post-COVID-19. It is preferable to continue insulin in titrated doses along with OHA for at least 4 weeks following steroid cessation in the post-COVID-19 period as there is are considerably increased inflammatory cytokine levels in the convalescence phase. Clean environmental hygiene would also help prevent CAM.
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Affiliation(s)
- Komal Jog
- Department of Endocrinology and Diabetology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
| | - Roshan Nazirudeen
- Department of Endocrinology and Diabetology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
| | - Subbiah Eagappan
- Department of Diabetology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
| | - Raghavan K. Santharam
- Department of Diabetology and Endocrinology, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Subbiah Sridhar
- Department of Endocrinology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
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4
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Geyer CE, Chen HJ, Bye AP, Manz XD, Guerra D, Caniels TG, Bijl TP, Griffith GR, Hoepel W, de Taeye SW, Veth J, Vlaar AP, Vidarsson G, Bogaard HJ, Aman J, Gibbins JM, van Gils MJ, de Winther MP, den Dunnen J. Identification of new drugs to counteract anti-spike IgG-induced hyperinflammation in severe COVID-19. Life Sci Alliance 2023; 6:e202302106. [PMID: 37699657 PMCID: PMC10497933 DOI: 10.26508/lsa.202302106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
Previously, we and others have shown that SARS-CoV-2 spike-specific IgG antibodies play a major role in disease severity in COVID-19 by triggering macrophage hyperactivation, disrupting endothelial barrier integrity, and inducing thrombus formation. This hyperinflammation is dependent on high levels of anti-spike IgG with aberrant Fc tail glycosylation, leading to Fcγ receptor hyperactivation. For development of immune-regulatory therapeutics, drug specificity is crucial to counteract excessive inflammation whereas simultaneously minimizing the inhibition of antiviral immunity. We here developed an in vitro activation assay to screen for small molecule drugs that specifically counteract antibody-induced pathology. We identified that anti-spike-induced inflammation is specifically blocked by small molecule inhibitors against SYK and PI3K. We identified SYK inhibitor entospletinib as the most promising candidate drug, which also counteracted anti-spike-induced endothelial dysfunction and thrombus formation. Moreover, entospletinib blocked inflammation by different SARS-CoV-2 variants of concern. Combined, these data identify entospletinib as a promising treatment for severe COVID-19.
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Affiliation(s)
- Chiara E Geyer
- https://ror.org/05grdyy37 Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Hung-Jen Chen
- https://ror.org/05grdyy37 Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Alexander P Bye
- Institute for Cardiovascular and Metabolic Research, and School of Biological Sciences, University of Reading, Reading, UK
- Molecular and Clinical Sciences Research Institute, St George's University, London, UK
- School of Pharmacy, University of Reading, Reading, UK
| | - Xue D Manz
- https://ror.org/05grdyy37 Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Denise Guerra
- https://ror.org/05grdyy37 Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Tom G Caniels
- https://ror.org/05grdyy37 Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Tom Pl Bijl
- https://ror.org/05grdyy37 Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Guillermo R Griffith
- https://ror.org/05grdyy37 Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Willianne Hoepel
- https://ror.org/05grdyy37 Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Steven W de Taeye
- https://ror.org/05grdyy37 Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Jennifer Veth
- https://ror.org/05grdyy37 Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Alexander Pj Vlaar
- https://ror.org/05grdyy37 Department of Intensive Care Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, Netherlands
| | - Harm Jan Bogaard
- https://ror.org/05grdyy37 Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Jurjan Aman
- https://ror.org/05grdyy37 Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Jonathan M Gibbins
- Institute for Cardiovascular and Metabolic Research, and School of Biological Sciences, University of Reading, Reading, UK
| | - Marit J van Gils
- https://ror.org/05grdyy37 Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Menno Pj de Winther
- https://ror.org/05grdyy37 Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Jeroen den Dunnen
- https://ror.org/05grdyy37 Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, Netherlands
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5
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Bostanghadiri N, Ziaeefar P, Mofrad MG, Yousefzadeh P, Hashemi A, Darban-Sarokhalil D. COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1879554. [PMID: 37674935 PMCID: PMC10480030 DOI: 10.1155/2023/1879554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/07/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
The world is presently in crisis facing an outbreak of a health-threatening microorganism known as COVID-19, responsible for causing uncommon viral pneumonia in humans. The virus was first reported in Wuhan, China, in early December 2019, and it quickly became a global concern due to the pandemic. Challenges in this regard have been compounded by the emergence of several variants such as B.1.1.7, B.1.351, P1, and B.1.617, which show an increase in transmission power and resistance to therapies and vaccines. Ongoing researches are focused on developing and manufacturing standard treatment strategies and effective vaccines to control the pandemic. Despite developing several vaccines such as Pfizer/BioNTech and Moderna approved by the U.S. Food and Drug Administration (FDA) and other vaccines in phase 4 clinical trials, preventive measures are mandatory to control the COVID-19 pandemic. In this review, based on the latest findings, we will discuss different types of drugs as therapeutic options and confirmed or developing vaccine candidates against SARS-CoV-2. We also discuss in detail the challenges posed by the variants and their effect on therapeutic and preventive interventions.
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Affiliation(s)
- Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morvarid Golrokh Mofrad
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Parsa Yousefzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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6
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Golla R, Vuyyuru SK, Kante B, Kedia S, Ahuja V. Disorders of gut-brain interaction in post-acute COVID-19 syndrome. Postgrad Med J 2023; 99:834-843. [PMID: 37130814 DOI: 10.1136/pmj-2022-141749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/18/2022] [Indexed: 11/03/2022]
Abstract
The novel coronavirus SARS-CoV-2 is responsible for the devastating pandemic which has caused more than 5 million deaths across the world until today. Apart from causing acute respiratory illness and multiorgan dysfunction, there can be long-term multiorgan sequalae after recovery, which is termed 'long COVID-19' or 'post-acute COVID-19 syndrome'. Little is known about long-term gastrointestinal (GI) consequences, occurrence of post-infection functional gastrointestinal disorders and impact the virus may have on overall intestinal health. In this review, we put forth the various mechanisms which may lead to this entity and possible ways to diagnose and manage this disorder. Hence, making physicians aware of this spectrum of disease is of utmost importance in the present pandemic and this review will help clinicians understand and suspect the occurrence of functional GI disease post recovery from COVID-19 and manage it accordingly, avoiding unnecessary misconceptions and delay in treatment.
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Affiliation(s)
- Rithvik Golla
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sudheer Kumar Vuyyuru
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Bhaskar Kante
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Saurabh Kedia
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vineet Ahuja
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
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7
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Gladstone DE, D'Alessio F, Howard C, Lyu MA, Mock JR, Gibbs KW, Abrams D, Huang M, Zeng K, Herlihy JP, Castillo ST, Bassett R, Sadeghi T, Parmar S, Flowers CR, Mukherjee S, Schoenfeld D, Thall PF, Slutsky AS. Randomized, double-blinded, placebo-controlled trial of allogeneic cord blood T-regulatory cells for treatment of COVID-19 ARDS. Blood Adv 2023; 7:3075-3079. [PMID: 36961352 PMCID: PMC10043947 DOI: 10.1182/bloodadvances.2022009619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Douglas E Gladstone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY
| | - Franco D'Alessio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Mi-Ae Lyu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason R. Mock
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin W. Gibbs
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY
| | - Meixian Huang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ke Zeng
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Roland Bassett
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | | | - Simrit Parmar
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R. Flowers
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Siddhartha Mukherjee
- Division of Hematology/ Oncology, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | | | - Peter F. Thall
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Arthur S. Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto and University of Toronto, Toronto, Canada
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8
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Grinevich VB, Lazebnik LB, Kravchuk YA, Radchenko VG, Tkachenko EI, Pershko AM, Seliverstov PV, Salikova CP, Zhdanov KV, Kozlov KV, Makienko VV, Potapova IV, Ivanyuk ES, Egorov DV, Sas EI, Korzheva MD, Kozlova NM, Ratnikova AK, Ratnikov VA, Sitkin SI, Bolieva LZ, Turkina CV, Abdulganieva DI, Ermolova TV, Kozhevnikova SA, Tarasova LV, Myazin RG, Khomeriki NM, Pilat TL, Kuzmina LP, Khanferyan RA, Novikova VP, Polunina AV, Khavkin AI. Gastrointestinal disorders in post-COVID syndrome. Clinical guidelines. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:4-68. [DOI: 10.31146/1682-8658-ecg-208-12-4-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Summary Post- COVID syndrome refers to the long-term consequences of a new coronavirus infection COVID-19, which includes a set of symptoms that develop or persist after COVID-19. Symptoms of gastrointestinal disorders in post- COVID syndrome, due to chronic infl ammation, the consequences of organ damage, prolonged hospitalization, social isolation, and other causes, can be persistent and require a multidisciplinary approach. The presented clinical practice guidelines consider the main preventive and therapeutic and diagnostic approaches to the management of patients with gastroenterological manifestations of postCOVID syndrome. The Guidelines were approved by the 17th National Congress of Internal Medicine and the 25th Congress of Gastroenterological Scientifi c Society of Russia.
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Affiliation(s)
| | - L. B. Lazebnik
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | | | | | | | | | | | | - K. V. Kozlov
- Military Medical Academy named after S. M. Kirov
| | | | | | | | - D. V. Egorov
- Military Medical Academy named after S. M. Kirov
| | - E. I. Sas
- Military Medical Academy named after S. M. Kirov
| | | | | | - A. K. Ratnikova
- North-West District Scientifi c and Clinical Center named after L. G. Sokolov Federal Medical and Biological Agency
| | - V. A. Ratnikov
- North-West District Scientifi c and Clinical Center named after L. G. Sokolov Federal Medical and Biological Agency
| | - S. I. Sitkin
- North-Western state medical University named after I. I. Mechnikov;
Almazov National Medical Research Centre
| | | | | | | | - T. V. Ermolova
- North-Western state medical University named after I. I. Mechnikov
| | | | | | | | - N. M. Khomeriki
- Moscow Regional Research Clinical Institute n. a. M. F. Vladimirsky”
| | - T. L. Pilat
- Scientifi c Research Institute of labour medicine named after academician N. F. Izmerov
| | - L. P. Kuzmina
- Scientifi c Research Institute of labour medicine named after academician N. F. Izmerov;
I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | - A. I. Khavkin
- Russian National Research Medical University named after N. I. Pirogov
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9
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Myska V, Genzor S, Mezina A, Burget R, Mizera J, Stybnar M, Kolarik M, Sova M, Dutta MK. Artificial-Intelligence-Driven Algorithms for Predicting Response to Corticosteroid Treatment in Patients with Post-Acute COVID-19. Diagnostics (Basel) 2023; 13:diagnostics13101755. [PMID: 37238239 DOI: 10.3390/diagnostics13101755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Pulmonary fibrosis is one of the most severe long-term consequences of COVID-19. Corticosteroid treatment increases the chances of recovery; unfortunately, it can also have side effects. Therefore, we aimed to develop prediction models for a personalized selection of patients benefiting from corticotherapy. The experiment utilized various algorithms, including Logistic Regression, k-NN, Decision Tree, XGBoost, Random Forest, SVM, MLP, AdaBoost, and LGBM. In addition easily human-interpretable model is presented. All algorithms were trained on a dataset consisting of a total of 281 patients. Every patient conducted an examination at the start and three months after the post-COVID treatment. The examination comprised a physical examination, blood tests, functional lung tests, and an assessment of health state based on X-ray and HRCT. The Decision tree algorithm achieved balanced accuracy (BA) of 73.52%, ROC-AUC of 74.69%, and 71.70% F1 score. Other algorithms achieving high accuracy included Random Forest (BA 70.00%, ROC-AUC 70.62%, 67.92% F1 score) and AdaBoost (BA 70.37%, ROC-AUC 63.58%, 70.18% F1 score). The experiments prove that information obtained during the initiation of the post-COVID-19 treatment can be used to predict whether the patient will benefit from corticotherapy. The presented predictive models can be used by clinicians to make personalized treatment decisions.
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Affiliation(s)
- Vojtech Myska
- Department of Telecommunications, Faculty of Electrical Engineering and Communications, Brno University of Technology, Technicka 12, 616 00 Brno, Czech Republic
| | - Samuel Genzor
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Anzhelika Mezina
- Department of Telecommunications, Faculty of Electrical Engineering and Communications, Brno University of Technology, Technicka 12, 616 00 Brno, Czech Republic
| | - Radim Burget
- Department of Telecommunications, Faculty of Electrical Engineering and Communications, Brno University of Technology, Technicka 12, 616 00 Brno, Czech Republic
| | - Jan Mizera
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Michal Stybnar
- Czech National e-Health Center, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Martin Kolarik
- Department of Telecommunications, Faculty of Electrical Engineering and Communications, Brno University of Technology, Technicka 12, 616 00 Brno, Czech Republic
| | - Milan Sova
- Department of Respiratory Diseases and Tuberculosis, University Hospital Brno and Faculty of Medicine and Dentistry, Masaryk University Brno, Jihlavska 340/20, 625 00 Brno, Czech Republic
| | - Malay Kishore Dutta
- Centre for Advanced Studies, Dr. A. P. J. Abdul Kalam Technical University, Jankipuram Vistar, Lucknow 226021, India
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10
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Sahraei Z, Panahi P, Solhjoukhah K, Mesbah M, Afaghi S, Amirdosara M, Salamzadeh J, Esmaeili Tarki F, Alavi Darazam I. The Efficacy of High-Dose Pulse Therapy vs. Low-Dose Intravenous Methylprednisolone on Severe to Critical COVID-19 Clinical Outcomes: A Randomized Clinical Trial. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2023; 22:e137838. [PMID: 38116548 PMCID: PMC10728836 DOI: 10.5812/ijpr-137838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 12/21/2023]
Abstract
Background It remains unclear which formulation of the corticosteroid regimen has the optimum efficacies on COVID-19 pneumonia. Objectives The aim of this study was to compare the clinical outcomes of 2 different regimens in the treatment of acute respiratory distress syndrome (ARDS) caused by COVID-19: Methylprednisolone at a dose of 1 mg/kg every 12 hours (low-dose group) and 1000 mg/day pulse therapy for 3 days following 1 mg/kg methylprednisolone every 12 hours (high-dose group). Methods In this randomized clinical trial, patients with mild to moderate ARDS due to COVID-19 were randomly assigned to receive either low-dose (n = 47) or high-dose (n = 48) intravenous methylprednisolone regimens. Two groups were matched for age, gender, body mass index (BMI), comorbidities, leukocytes, lymphocytes, neutrophil/lymphocyte, platelet, hemoglobin, and inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and ferritin). Both regimens were initiated upon admission and continued for 10 days. The clinical outcome and secondary complications were evaluated. Results Evaluating in-hospital outcomes, no difference was revealed in the duration of intensive care unit (ICU) stays (5.4 ± 4.6 vs. 4.5 ± 4.9; P = 0.35), total hospital stays (8 ± 3.1 vs. 6.9 ± 3.4; P = 0.1), requirement rate for invasive ventilation (29.2% vs. 36.2%; P = 0.4) or non-invasive ventilation (16.6% vs 23.4%; P = 0.4), and hemoperfusion (16.6% vs 11.3%; P = 0.3) between the low- and high-dose groups. There was no significant difference in fatality due to ARDS (29.2% vs. 38.3%; P = 0.3) and septic shock (4.2% vs. 6.4%; P = 0.3) between the low- and high-dose groups. Patients in the high-dose group had significantly higher bacterial pneumonia co-infection events compared with those in the low-dose group (18.7% vs 10.6%; P = 0.01). Conclusions The use of adjuvant pulse therapy with intravenous methylprednisolone did not result in improved in-hospital clinical outcomes among patients with mild to moderate ARDS due to COVID-19. A higher risk of bacterial pneumonia should be considered in such cases as receiving a higher dose of steroids.
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Affiliation(s)
- Zahra Sahraei
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parnaz Panahi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kouroush Solhjoukhah
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mesbah
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Afaghi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,Iran
| | - Mahdi Amirdosara
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Esmaeili Tarki
- Research Institute of Internal Medicine, Shahid Modarres Hospital, Shahid Behehsti University of Medical Sciences,Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Jou E, Zhou AK, Ho JSY, Thahir A. Perioperative use of intra-articular steroids during the COVID-19 pandemic. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022; 32:1225-1235. [PMID: 34468841 PMCID: PMC8408365 DOI: 10.1007/s00590-021-03105-x] [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] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE There are growing concerns with the widely used glucocorticoids during the Coronavirus disease-19 (COVID-19) pandemic due to the associated immunosuppressive effects, which may increase the risk of COVID-19 infection and worsen COVID-19 patient outcome. Heavily affecting orthopaedics, the pandemic led to delay and cancellation of almost all surgical cases, and procedures including perioperative intra-articular corticosteroid injections (ICIs) saw similar decreases. However, the benefits of ICI treatments during the pandemic may outweigh these potential risks, and their continued use may be warranted. METHODS A literature search was conducted, and all relevant articles including original articles and reviews were identified and considered in full for inclusion, and analysed with expert opinion. Epidemiological statistics and medical guidelines were consulted from relevant authorities. RESULTS ICIs allow a targeted approach on the affected joint and are effective in reducing pain while improving functional outcome and patient quality-of-life. ICIs delay the requirement for surgery, accommodating for the increased healthcare burden during the pandemic, while reducing postoperative hospital stay, bringing significant financial benefits. However, ICIs can exert systemic effects and suppress the immune system. ICIs may increase the risk of COVID-19 infection and reduce the efficacy of COVID-19 vaccinations, leading to important public health implications. CONCLUSION Perioperative ICI treatments may bring significant, multifaceted benefits during the pandemic. However, ICIs increase the risk of infection, and perioperative COVID-19 is associated with mortality. The use of ICIs during the COVID-19 pandemic should therefore be considered carefully on an individual patient basis, weighing the associated risks and benefits.
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Affiliation(s)
- Eric Jou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, UK.
| | | | | | - Azeem Thahir
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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12
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Efficacy of Dexamethasone and Methylprednisolone in Hospitalization Outcomes of COVID-19 Patients: A Comparative Retrospective Study. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-129727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Control of the COVID-19 pandemic, its treatment, and prevention of mortality and morbidity have been the main focus of researchers over the past two years. Due to disagreement on the usefulness of different corticosteroids in the treatment of COVID-19, this work compared the efficacy of dexamethasone and methylprednisolone in the treatment outcomes of intensive critical care (ICU) patients. Methods: The present retrospective cohort study examined clinical records of 105 COVID-19 patients hospitalized in the ICUs of Firoozabadi Hospital in 2021. Clinical outcomes, including the length of hospital stay, the need for a ventilator, and mortality, were compared between patients who received either dexamethasone (DXM) or methylprednisolone (MP). Data were analyzed by SPSS V.20 software at P < 0.05 as statistical significance. Results: The mean ± SD ages of the patients in the DXM and MP groups were 58.82 ± 19.29 and 60.66 ± 14.17 years, respectively, without a statistically significant difference (P > 0.05). The mean duration of hospitalization was 8.14 ± 4.36 days in the DXM group and 6.80 ± 3.34 days in the MP group (P = 0.295). Also, 19 (33.3%) cases in the DXM group an, 19 (39.6%) in the MP group needed mechanical ventilation during hospitalization (P = 0.546). Finally, 30 (52.6%) patients in the DXM group and 27 (56.2%) in the MP group died. Conclusions: The findings indicated no significant difference in the mean duration of hospitalization, the need for a ventilator, and mortality in COVID-19 ICU patients treated with methylprednisolone or dexamethasone. There is a need to perform meta-analyses owing to conflicting results regarding the effects of different corticosteroids on the COVID-19 course.
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13
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Reese JT, Blau H, Bergquist T, Loomba JJ, Callahan T, Laraway B, Antonescu C, Casiraghi E, Coleman B, Gargano M, Wilkins KJ, Cappelletti L, Fontana T, Ammar N, Antony B, Murali TM, Karlebach G, McMurry JA, Williams A, Moffitt R, Banerjee J, Solomonides AE, Davis H, Kostka K, Valentini G, Sahner D, Chute CG, Madlock-Brown C, Haendel MA, Robinson PN. Generalizable Long COVID Subtypes: Findings from the NIH N3C and RECOVER Programs. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.05.24.22275398. [PMID: 35665012 PMCID: PMC9164456 DOI: 10.1101/2022.05.24.22275398] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Accurate stratification of patients with post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID) would allow precision clinical management strategies. However, the natural history of long COVID is incompletely understood and characterized by an extremely wide range of manifestations that are difficult to analyze computationally. In addition, the generalizability of machine learning classification of COVID-19 clinical outcomes has rarely been tested. We present a method for computationally modeling PASC phenotype data based on electronic healthcare records (EHRs) and for assessing pairwise phenotypic similarity between patients using semantic similarity. Our approach defines a nonlinear similarity function that maps from a feature space of phenotypic abnormalities to a matrix of pairwise patient similarity that can be clustered using unsupervised machine learning procedures. Using k-means clustering of this similarity matrix, we found six distinct clusters of PASC patients, each with distinct profiles of phenotypic abnormalities. There was a significant association of cluster membership with a range of pre-existing conditions and with measures of severity during acute COVID-19. Two of the clusters were associated with severe manifestations and displayed increased mortality. We assigned new patients from other healthcare centers to one of the six clusters on the basis of maximum semantic similarity to the original patients. We show that the identified clusters were generalizable across different hospital systems and that the increased mortality rate was consistently observed in two of the clusters. Semantic phenotypic clustering can provide a foundation for assigning patients to stratified subgroups for natural history or therapy studies on PASC.
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14
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Guliani A, Tandon A, Chakroborty A, Gupta PP. Predictors of post COVID complications in patients admitted with moderate to severe COVID symptoms: A single center, prospective, observational study. Monaldi Arch Chest Dis 2022; 93. [PMID: 35872628 DOI: 10.4081/monaldi.2022.2307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/07/2022] [Indexed: 12/30/2022] Open
Abstract
While the world was still busy battling active COVID-19 infections, a large subset of patients started showing prolonged symptoms or developing complications following an initial recovery from COVID-19. Post covid complications range from mild symptoms such as fatigue, headache, shortness of breath to serious, life threatening conditions like opportunistic infections, deep venous thrombosis, pulmonary embolism, pneumothorax and lung fibrosis. A single center, prospective, observational study was carried out in a tertiary respiratory care institute in North India from June 2021 to August 2021 where 224 cases of previously treated COVID-19/ongoing symptomatic COVID-19 (those patients who were manifesting symptoms beyond 4 weeks), were enrolled and followed up for a period of 3 months to estimate the prevalence of persistent symptoms, complications and any risk factors associated with it. Data analysis was done using SPSS software version 21. Univariate and multivariate analysis done among risk factors and outcome variables. ROC was done on predictor variables and area under curve (AUC) calculated. p value less than 0.05 was considered significant. Among the 24.6% symptomatic patients at follow up, the most common symptom was fatigue (51.8%) followed by dyspnea (43.8%) and anxiety (43.3%). Among the complications of COVID-19, the most common according to our study was fibrosis (15.2%), followed by pulmonary thromboembolism (PTE) (12.1%), echocardiographic abnormalities (11.2%) and pulmonary mucormycosis (5.4%). Female gender, presence of comorbidities, requirement of non-invasive or invasive ventilation during hospital stay emerged as independent risk factors for complications following COVID-19. This study brings forth the huge morbidity burden that COVID-19 brought upon seemingly cured individuals and lists the risk factors associated with persistence of symptoms and complications. This would help to better streamline health resources and standardize follow up guidance of COVID-19 patients.
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Affiliation(s)
- Astha Guliani
- Department of Respiratory Medicine, Pt. BD. Postgraduate Institute of Medical Sciences, Rohtak.
| | - Abhishek Tandon
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Amartya Chakroborty
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Prem Parkash Gupta
- Department of Respiratory Medicine, Pt. BD. Postgraduate Institute of Medical Sciences, Rohtak.
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15
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Sarker H, Panigrahi R, Hardy E, Glover JNM, Elahi S, Fernandez-Patron C. Glucocorticoids Bind to SARS-CoV-2 S1 at Multiple Sites Causing Cooperative Inhibition of SARS-CoV-2 S1 Interaction With ACE2. Front Immunol 2022; 13:906687. [PMID: 35784352 PMCID: PMC9242398 DOI: 10.3389/fimmu.2022.906687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022] Open
Abstract
Dexamethasone may reduce mortality in COVID-19 patients. Whether dexamethasone or endogenous glucocorticoids, such as cortisol, biochemically interact with SARS-CoV-2 spike 1 protein (S1), or its cellular receptor ACE2, is unknown. Using molecular dynamics (MD) simulations and binding energy calculations, we identified 162 druggable pockets in various conformational states of S1 and all possible binding pockets for cortisol and dexamethasone. Through biochemical binding studies, we confirmed that cortisol and dexamethasone bind to S1. Limited proteolysis and mass spectrometry analyses validated several MD identified binding pockets for cortisol and dexamethasone on S1. Interaction assays indicated that cortisol and dexamethasone separately and cooperatively disrupt S1 interaction with ACE2, through direct binding to S1, without affecting ACE2 catalytic activity. Cortisol disrupted the binding of the mutant S1 Beta variant (E484K, K417N, N501Y) to ACE2. Delta and Omicron variants are mutated in or near identified cortisol-binding pockets in S1, which may affect cortisol binding to them. In the presence of cortisol, we find increased inhibition of S1 binding to ACE2 by an anti-SARS-CoV-2 S1 human chimeric monoclonal antibody against the receptor binding domain. Whether glucocorticoid/S1 direct interaction is an innate defence mechanism that may have contributed to mild or asymptomatic SARS-CoV-2 infection deserves further investigation.
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Affiliation(s)
- Hassan Sarker
- Department of Biochemistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Panigrahi
- Department of Biochemistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - J. N. Mark Glover
- Department of Biochemistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shokrollah Elahi
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carlos Fernandez-Patron
- Department of Biochemistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Carlos Fernandez-Patron,
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16
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Wang Y, Wu M, Li Y, Yuen HH, He ML. The effects of SARS-CoV-2 infection on modulating innate immunity and strategies of combating inflammatory response for COVID-19 therapy. J Biomed Sci 2022; 29:27. [PMID: 35505345 PMCID: PMC9063252 DOI: 10.1186/s12929-022-00811-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
The global pandemic of COVID-19 has caused huge causality and unquantifiable loss of social wealth. The innate immune response is the first line of defense against SARS-CoV-2 infection. However, strong inflammatory response associated with dysregulation of innate immunity causes severe acute respiratory syndrome (SARS) and death. In this review, we update the current knowledge on how SARS-CoV-2 modulates the host innate immune response for its evasion from host defense and its corresponding pathogenesis caused by cytokine storm. We emphasize Type I interferon response and the strategies of evading innate immune defense used by SARS-CoV-2. We also extensively discuss the cells and their function involved in the innate immune response and inflammatory response, as well as the promises and challenges of drugs targeting excessive inflammation for antiviral treatment. This review would help us to figure out the current challenge questions of SARS-CoV-2 infection on innate immunity and directions for future studies.
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Affiliation(s)
- Yiran Wang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Mandi Wu
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Yichen Li
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Ho Him Yuen
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Ming-Liang He
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China. .,CityU Shenzhen Research Institute, Nanshan, Shenzhen, China.
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17
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Gupta S, Dutta A, Chakraborty U, Kumar R, Das D, Ray BK. Post-COVID-19 HSV encephalitis: a review. QJM 2022; 115:222-227. [PMID: 35199176 PMCID: PMC9383498 DOI: 10.1093/qjmed/hcac060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/17/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Herpes simplex virus encephalitis (HSVE) is one of the most common infectious causes of sporadic encephalitis. Coronavirus disease (COVID-19) has been associated with immune dysregulation of the host that might increase the risk of infections like HSVE following SARS-CoV-2 infection. There is paucity of literature on post COVID-19 HSVE. This study was conducted with the aim of analyzing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within 6 weeks of COVID-19 and providing a comprehensive review on the possible mechanisms of post-COVID-19 HSVE. METHODS This observational study included patients who had laboratory-confirmed HSVE (type 1 or type 2) and a history of COVID-19 within the previous 6 weeks. Patients were followed up for 3 months. RESULTS Eight patients were included and all of them had type 1 HSVE. The mean latency of onset of neurological symptoms from being diagnosed with COVID-19 is 23.87 days and a majority of the patients have received injectable steroids with a mean duration of 6.5 days. Behavioral abnormality was the commonest neurological presentation and typical brain imaging involved T2 FLAIR hyperintensities of the medial temporal lobes. All patients received intravenous acyclovir 10 mg/kg every eight hourly for atleast 14 days. One patient with concomitant rhinocerebral mucormycosis succumbed while the majority had a complete recovery. CONCLUSION Possible immune dysregulation in COVID-19 may increase the susceptibility of HSVE in patients with a history of recent SARS-CoV-2 infection. The clinical manifestations and laboratory findings of HSVE in such patients are similar to typical HSVE.
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Affiliation(s)
- S Gupta
- From the Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, India
| | - A Dutta
- From the Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, India
| | - U Chakraborty
- Address correspondence to Dr Uddalak Chakraborty, Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, West Bengal, India.
| | - R Kumar
- Department of Neurology, G.S Neuroscience Clinic and Research Center, 3/214, Boring Rd, New Patliputra Colony, Patliputra Colony, Patna, Bihar 800013, India
| | - D Das
- From the Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, India
- Woodlands Multi-Speciality Hospital and C K Birla Hospitals,8/5, Alipur Rd, Alipore, Kolkata, West Bengal 700027, India
| | - B K Ray
- From the Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, India
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Hensley MK, Prescott HC. Caring for the Critically Ill Patient with COVID-19. Clin Chest Med 2022; 43:441-456. [PMID: 36116813 PMCID: PMC9020480 DOI: 10.1016/j.ccm.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Matthew K Hensley
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh Medical Center, 5200 Centre Avenue, Suite 610, Pittsburgh, PA 15232, USA.
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, NCRC Building 16, Room 341E / 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA; VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI, USA. https://twitter.com/HalliePrescott
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19
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Sarzani R, Spannella F, Giulietti F, Di Pentima C, Giordano P, Giacometti A. Possible harm from glucocorticoid drugs misuse in the early phase of SARS-CoV-2 infection: a narrative review of the evidence. Intern Emerg Med 2022; 17:329-338. [PMID: 34718937 PMCID: PMC8557262 DOI: 10.1007/s11739-021-02860-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
Since the publication of the RECOVERY trial, the use of glucocorticoid drugs (GC) has spread for the treatment of severe COVID-19 worldwide. However, the benefit of dexamethasone was largest in patients who received mechanical ventilation or supplemental oxygen therapy, while no benefit was found among patients without hypoxemia. In addition, a positive outcome was found in patients who received dexamethasone after several days of symptoms, while possible harm could exist if administered early. The right time interval for GC administration is still a matter of debate. Previous studies showed that an early GC use during the first phase of the disease, when viral replication peaks, may negatively affect the innate immune response through several mechanisms, such as the inhibition of pro-inflammatory and antiviral cytokine production and signaling pathway, including type I interferon, that is fundamental to counteract the virus and that was found to be impaired in several patients with life-threatening COVID-19. The GC misuse can lead to a more severe disease even in patients who do not have the established risk factors, such as obesity and cardiovascular diseases. In our focused review, we describe the role of immune response in viral infections, especially SARS-CoV-2, and discuss the potential harms of GC misuse in COVID-19.
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Affiliation(s)
- Riccardo Sarzani
- Internal Medicine and Geriatrics, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", Via Tronto 10/a, Ancona, Italy.
| | - Francesco Spannella
- Internal Medicine and Geriatrics, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Chiara Di Pentima
- Internal Medicine and Geriatrics, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy
| | - Andrea Giacometti
- Department of Biological Sciences and Public Health, Infectious Diseases Clinic, University "Politecnica Delle Marche", Via Tronto 10/a, Ancona, Italy
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(Takefumi Tsunemitsu) 恒健, (Takao Suzuki) 鈴崇, (Masaru Matsumoto) 松優. 重症COVID–19患者における侵襲的人工呼吸管理中のステロイドの投与終了と28日死亡率の関連の検討,後方視的コホート研究(Association between corticosteroid treatment termination during invasive mechanical ventilation and 28–day mortality in severe COVID–19 patients, a retrospective cohort study). NIHON KYUKYU IGAKUKAI ZASSHI: JOURNAL OF JAPANESE ASSOCIATION FOR ACUTE MEDICINE 2022. [PMCID: PMC9088569 DOI: 10.1002/jja2.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: To investigate the association between corticosteroid treatment termination during invasive mechanical ventilation and 28–day mortality in severe COVID–19 patients. Methods: The study was a single–center, retrospective cohort study of COVID–19 patients undergoing invasive mechanical ventilation on their scheduled corticosteroid termination day between March 1, 2020, and June 30, 2021. The scheduled corticosteroid termination day was scheduled 10 days after initiation of dexamethasone 6mg orally or 6.6mg intravenously. Patients who terminated corticosteroids during the ventilatory period and did not receive corticosteroids thereafter were defined as the termination group, whereas patients who continued to receive corticosteroids in some form after the scheduled corticosteroid termination day were defined as the continuation group. The primary endpoint was 28–day mortality, and the difference was evaluated using the log–rank test. Results: The 28–day mortality was found to be 61% (14 of 23 patients) in the termination group, which was significantly higher than the 28–day mortality of 22% (5 of 23 patients) in the continuation group (Hazard Ratio: 3.82, 95% CI: 1.37–10.68; p=0.005). Conclusions: In severe COVID–19 patients, corticosteroid termination during invasive ventilation is associated with an increased 28–day mortality.
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Affiliation(s)
- 恒光 健史 (Takefumi Tsunemitsu)
- 兵庫県立尼崎総合医療センター救急集中治療科(Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center)
| | - 鈴木 崇生 (Takao Suzuki)
- 兵庫県立尼崎総合医療センター救急集中治療科(Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center)
| | - 松本 優 (Masaru Matsumoto)
- 兵庫県立尼崎総合医療センター救急集中治療科(Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center)
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Molecular Insights of SARS-CoV-2 Antivirals Administration: A Balance between Safety Profiles and Impact on Cardiovascular Phenotypes. Biomedicines 2022; 10:biomedicines10020437. [PMID: 35203646 PMCID: PMC8962379 DOI: 10.3390/biomedicines10020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has resulted in a complex clinical challenge, caused by a novel coronavirus, partially similar to previously known coronaviruses but with a different pattern of contagiousness, complications, and mortality. Since its global spread, several therapeutic agents have been developed to address the heterogeneous disease treatment, in terms of severity, hospital or outpatient management, and pre-existing clinical conditions. To better understand the rationale of new or old repurposed medications, the structure and host–virus interaction molecular bases are presented. The recommended agents by EDSA guidelines comprise of corticosteroids, JAK-targeting monoclonal antibodies, IL-6 inhibitors, and antivirals, some of them showing narrow indications due to the lack of large population trials and statistical power. The aim of this review is to present FDA-approved or authorized for emergency use antivirals, namely remdesivir, molnupinavir, and the combination nirmatrelvir-ritonavir and their impact on the cardiovascular system. We reviewed the literature for metanalyses, randomized clinical trials, and case reports and found positive associations between remdesivir and ritonavir administration at therapeutic doses and changes in cardiac conduction, relatable to their previously known pro-arrhythmogenic effects and important ritonavir interactions with cardioactive medications including antiplatelets, anti-arrhythmic agents, and lipid-lowering drugs, possibly interfering with pre-existing therapeutic regimens. Nonetheless, safety profiles of antivirals are largely questioned and addressed by health agencies, in consideration of COVID-19 cardiac and pro-thrombotic complications generally experienced by predisposed subjects. Our advice is to continuously adhere to the strict indications of FDA documents, monitor the possible side effects of antivirals, and increase physicians’ awareness on the co-administration of antivirals and cardiovascular-relevant medications. This review dissects the global and local tendency to structure patient-based treatment plans, for a glance towards practical application of precision medicine.
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Shi C, Wu T, Hu J, Guo R, Liu Z. Effect of combining anticoagulant and glucocorticoid therapy on mortality in patients with severe COVID-19. EUR J INFLAMM 2022. [PMCID: PMC9361025 DOI: 10.1177/1721727x221100942] [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: 12/15/2022] Open
Abstract
Introduction Coronavirus disease (COVID-19) has spread rapidly to more than 200 countries and regions worldwide. Although several options have been implemented in attempts to control the rate of COVID-19 infection, the mortality rates remain high. The aim of this study is to evaluate whether patients with severe COVID-19 will benefit from the combination of anticoagulant and glucocorticoid therapy. Methods A single-center retrospective cohort study of patients with COVID-19 was performed. Several factors influencing patients with COVID-19 have been analyzed retrospectively, including basic conditions, inflammatory factors, coagulation parameters, medications, and outcomes. Continuous and categorical variables have been evaluated via binary logistic regression analysis to predict mortality. The association between anticoagulant treatment and outcomes has also been evaluated, stratifying patients according to glucocorticoid treatment. Results 61 patients with severe COVID-19, including 23 critically ill patients have been enrolled in the study. In those with severe and critical illness COVID-19, mortality rate was lower in those who received combined anticoagulant and glucocorticoid with odds ratio of 0.003 ( p = 0.042) and 0.031 ( p = 0.046), respectively. In cases of severe COVID-19, those who were treated with both anticoagulant and glucocorticoid had lower mortality (17.6%) than those treated with glucocorticoid alone (31.8%), although this did not reach statistical significance ( p = 0.321). In the critically ill COVID-19 patients who received both anticoagulant and glucocorticoid, there was significantly lower mortality (30%) than those who received glucocorticoid alone (77.8%) ( p = 0.047). Seventy-five percent of non-survivors of COVID-19 met the International Society on Thrombosis and Haemostasis criteria of disseminated intravascular coagulation (total points ≥5). Conclusion Patients with severe COVID-19 or critically ill patients with COVID-19 may benefit from the combination therapy of anticoagulant and glucocorticoid. As the disease getting severe, more benefits may be obtained from the combination therapy.
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Affiliation(s)
- Can Shi
- The Third Xiangya Hospital, Central South University, China
| | - Tian Wu
- The Third Xiangya Hospital, Central South University, China
- Xiangya School of Pharmaceutical Sciences, Central South University, China
| | - Jing Hu
- The Third Xiangya Hospital, Central South University, China
| | - Ren Guo
- The Third Xiangya Hospital, Central South University, China
| | - Zuoliang Liu
- The Third Xiangya Hospital, Central South University, China
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De Marco I. The supercritical antisolvent precipitation from a sustainable perspective: A Life Cycle Assessment. J CO2 UTIL 2022. [DOI: 10.1016/j.jcou.2021.101808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Briones-Claudett KH, Briones-Claudett MH, Cordova Loor FJ, Murillo Vasconez RA, Rivera Salas CDR, Bajaña Huilcapi CK, Estupinan Vargas DF, Rodriguez Garcia SE, Benitez Sólis J, Briones Zamora KH, Briones Marquez DC, Grunauer M. A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa. J Investig Med High Impact Case Rep 2022; 10:23247096221140250. [DOI: 10.1177/23247096221140250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Unvaccinated patients with comorbidities that impair the immune function, such as type 2 diabetes mellitus, are more likely to develop severe COVID-19. The COVID-19-associated acute respiratory distress syndrome has raised new concerns in intensive care units globally owing to the presence of secondary fungal infections. We report the case of a 71-year-old man from Ecuador with a history of type 2 diabetes mellitus, severe COVID-19 pneumonia, and lung cavitation associated with triple infections with Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient with a history of high blood pressure and type 2 diabetes was admitted to our hospital from a private care center with a diagnosis of COVID-19-associated acute respiratory distress syndrome. On arrival, the patient presented with signs of hypoxemic respiratory failure. During his stay at another hospital, he had received tocilizumab and corticosteroid therapy. Therefore, intubation was performed and mechanical ventilation was initiated. The patient developed a septic shock and renal failure with a glomerular filtration rate of 27.5 mL/min/1.73 m2; therefore, two hemodiafiltration sessions were started. The bronchoalveolar lavage revealed erythematous lesions in the bronchial tree and abundant purulent secretions and erosions in the bronchial mucosa, with a cavitary lesion in the right bronchial tree. The bronchoalveolar lavage samples were used to isolate Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa carbapenemase class A. Matrix-assisted laser desorption/ionization–time of flight (MALDI-TOF) Biotyper mass spectrometry and polymerase chain reaction (PCR) molecular identification were performed. This case report suggested that patients with severe COVID-19 pneumonia, with or without comorbidities, are more susceptible to opportunistic infections.
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25
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Sabetian G, Abdolrahimzadeh Fard H, Ostovan M, Azadikhah S, Zand F, Masjedi M, Asmarian N. Trauma and COVID-19: Clinical and Paraclinical similarities between Trauma Patients with Positive and Negative PCR Tests. Bull Emerg Trauma 2022; 10:172-180. [PMID: 36568719 PMCID: PMC9758711 DOI: 10.30476/beat.2022.96357.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/12/2022] [Accepted: 09/25/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To compare clinical and paraclinical similarities between trauma patients with positive RT-PCR tests (PCR+ve) and the RT-PCR negative ones (PCR -ve). Methods This a case-control study, where cases had a PCR+ve and controls had a negative result. Two groups were compared regarding (para) clinical values. Multivariable binary logistic regression analysis investigated the variables predicting COVID-19 and the mortality rate. Results Both groups were similar regarding the clinical findings and comorbidities (p>0.05). PCR+ve group had lower lymphocyte count (1.41 [1.45] vs. 1.66 [1.61], p=0.030), CPK level (411 [928.75] vs. 778 [1946.5]. p=0.006) and CRP level (17 [42.5] vs. 24 [50.75], p=0.004). However, none of these findings were significant in the multivariable analysis. Finally, PCR+ve group had increased odds of death (OR=2.88; 95% CI=1.22-7.41). Conclusion Unlike our primary hypothesis, the study failed to mark any significant (para) clinical features guiding us to detect COVID-19 earlier in trauma patients. Moreover, the PCR+ve group is at increased mortality risk. A larger, multicentric prospective study should be designed to address this issue.
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Affiliation(s)
- Golnar Sabetian
- Department of Intensive Care Medicine, Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mina Ostovan
- Department of Intensive Care Medicine, Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Mina Ostovan Address: Trauma Research Center, Rajaee (Emtyaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. e-mail:
| | - Sina Azadikhah
- Department of Intensive Care Medicine, Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farid Zand
- Department of Anesthesia and Critical Care Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoor Masjedi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Chatterjee S, Ghosh R, Vardhan B, Ojha UK, Kalra S. An epidemic of iatrogenic Cushing's syndrome in anticipation in post-COVID era. J Family Med Prim Care 2022; 11:412-413. [PMID: 35309640 PMCID: PMC8930165 DOI: 10.4103/jfmpc.jfmpc_1523_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Subhankar Chatterjee
- Department of General Medicine, Patliputra Medical College and Hospital, Dhanbad, Jharkhand, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Bhagya Vardhan
- Department of General Medicine, Patliputra Medical College and Hospital, Dhanbad, Jharkhand, India
| | - Umesh Kumar Ojha
- Department of General Medicine, Patliputra Medical College and Hospital, Dhanbad, Jharkhand, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Albarrán-Sánchez A, Ramírez-Rentería C, Mercado M, Sánchez-García M, de Jesús Barrientos-Flores C, Ferreira-Hermosillo A. Real-world evidence of the use of glucocorticoids for severe COVID-19. Ther Adv Endocrinol Metab 2022; 13:20420188211072704. [PMID: 35070258 PMCID: PMC8777321 DOI: 10.1177/20420188211072704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Currently, only glucocorticoids have proved to impact adverse outcomes in COVID-19. However, their risk/benefit balance remains inconclusive and populations' characteristics should be considered. OBJECTIVE The objective was to evaluate the real-life use of glucocorticoids in patients with severe COVID-19 hospitalized in a third-level referral center and to determine the type, accumulated doses, and the in-hospital outcomes related with their use. METHODS We evaluated a retrospective cohort of 737 patients with criteria for severe COVID-19 and a positive polymerase chain reaction (PCR) test for SARS-CoV-2. We extracted data for epidemiological analysis, medical history, and medications, as well as baseline laboratory tests. Data were analyzed using SPSS 21.0 and nonparametric tests, medians, and interquartile ranges (IQR). A p < 0.05 was considered significant. RESULTS A total of 65.3% were men, with a median age of 59 years (IQR 46-70) and a median of 10 days of hospital stay (IQR 6-16), more than 40% had diabetes, hypertension, and/or obesity, and 0.8% used steroids chronically. At the time of the study, 54.0% had been discharged due to improvement and 40.8% died. The most common treatment used was dexamethasone 6 mg/day/10 days (46.6%). Patients with a complete dexamethasone scheme [as proposed by the Randomized Evaluation of COVID-19 Therapy (RECOVERY) study] had a lower mortality risk [hazard ratio (HR) 0.441, 95% confidence interval (CI) 0.232-0.840] in comparison with patients with lower doses (HR 1.803, 95% CI 1.080-3.012). Patients with methylprednisolone or several steroids tended to have higher cumulative doses (equivalent to >675 mg of prednisolone). CONCLUSION The use of steroids in severe COVID-19 reduces mortality only at the dose proposed in the RECOVERY study in the younger population. No benefit of the use of steroids was observed in patients with older age or higher number of comorbidities.
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Affiliation(s)
- Alejandra Albarrán-Sánchez
- Internal Medicine Department, Hospital de
Especialidades Centro Medico Nacional Siglo XXI, Instituto Mexicano del
Seguro Social, Ciudad de México, México
| | - Claudia Ramírez-Rentería
- Unidad de Investigación Médica en Enfermedades
Endócrinas, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro
Social, Ciudad de México, México
| | - Moisés Mercado
- Unidad de Investigación Médica en Enfermedades
Endócrinas, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro
Social, Ciudad de México, México
| | - Miriam Sánchez-García
- Endocrinology Department, Hospital General de
Zona #8, Instituto Mexicano del Seguro Social, Ciudad de México,
México
| | - Corazón de Jesús Barrientos-Flores
- Internal Medicine Department, Hospital de
Especialidades Centro Medico Nacional Siglo XXI, Instituto Mexicano del
Seguro Social, Ciudad de México, México
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Gautam P, Paul G, Sharma S, Kumar J, Gupta A, Sharma M, Khehra A, Paul B, Mohan B. Analysis of trimodal pattern of mortality among hospitalized COVID-19 patients- Lessons from tertiary care hospital. J Anaesthesiol Clin Pharmacol 2022; 38:S107-S114. [PMID: 36060178 PMCID: PMC9438816 DOI: 10.4103/joacp.joacp_58_22] [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] [Received: 02/12/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Many patients with COVID-19 become critically ill and requireICU admission. Risk factors associated with mortality have been studied, but this study provides insight regarding disease progression and hence help to plan rescue strategies to improve patient outcome. Material and Methods: This retrospective, observational study included all patients with diagnosis of COVID-19 from March1 to June30,2021 who died in hospital. Results: During the study period, 1600 patients were admitted, with 1138 (71%) needing ICU care. There were 346 (21.6%) deaths, distributed as 15.8%(n = 55) within 48h of admission, 46.2%(n = 160) in next 10 days, and 37.8%(n = 131) thereafter. This trimodal mortality pattern of distribution was similar to polytrauma patients. Patients were divided into categories according to time duration from admission to death. In our cohort, 235 (14.7%) patients required mechanical ventilation, with a mortality of 85.4%(n = 201). Tachypnea was significantly (P < 0.001) associated with death at all times; however, hypotension was associated with early death and low oxygen saturation with poor outcome upto 10 days (P < 0.001). Refractory hypoxia was cause of death in all three groups, while other causes in group II were AKI (28%), sepsis (18%), and MODS (10%). Group III patients had different causes of mortality, including barotrauma (9%), pulmonary thromboembolism (8%), refractory hypercarbia (12%), MODS (13%), AKI (10%), sepsis (7%), and cardiac events (6%). Conclusion: While physiological dearrangements are associated with rapid progression and early death, complications related to hyper-coagulable state, lung injury, and organ failure lead to death later. Providing quality care to a high volume of patients is a challenge for all, but posthoc analysis such as air crash investigation can help find out potential areas of improvement and contribute to better outcomes and mortality reduction.
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Karakoc H, Aksoy A, Aydin M, Ozcan S, Zengin G, Yasar H. Outcome of patients with severe COVID-19 pneumonia treated with high-dose corticosteroid pulse therapy: A retrospective study. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.343881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ghosh A, Sarkar A, Paul P, Patel P. The rise in cases of mucormycosis, candidiasis and aspergillosis amidst COVID19. FUNGAL BIOL REV 2021; 38:67-91. [PMID: 34548877 PMCID: PMC8445778 DOI: 10.1016/j.fbr.2021.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022]
Abstract
The Coronavirus outbreak globally has changed the medical system and also led to a shortage of medical facilities in both developing and underdeveloped countries. The COVID19 disease, being novel in nature along with high infectivity and frequent mutational rate, has been termed to be fatal across the globe. The advent of infection by SARS-CoV-2 has brought a myriad of secondary complications and comorbidities resulting in additional challenges to the health care system induced by novel therapeutic procedures. The emerging variant with respect to the Indian subcontinent and the associated genetic mutations have worsened the situation at hand. Proper clinical management along with epidemiological studies and clinical presentations in scientific studies and trials is necessary in order to combat the simultaneous waves of emerging strains. This article summarizes three of the major fungal outbreaks in India namely mucormycosis, candidiasis and aspergillosis, and elaborates their subtypes, pathogenesis, symptoms and treatment and detection techniques. A detail of future therapeutics under consideration are also elaborated along with a general hypothesis on how COVID19 is related to immunological advances leading to major widespread fungal infection in the country. The factors that contribute in promoting virus proliferation and invasive fungal infections include cell-mediated immunity, associated immunocompromised conditions and treatment protocols that slows down immune mechanisms. To better comprehend a fungal or bacterial outbreak, it is very important to conduct audits mediated through multicenter national and state research teams for recognizing patterns and studying current cases of fungal infection in both healthy and comorbid groups of COVID19 patients.
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Affiliation(s)
- Asmita Ghosh
- Department of Biotechnology, Heritage Institute of Technology, Kolkata 700107, West Bengal, India
| | - Anusua Sarkar
- Department of Biotechnology, Heritage Institute of Technology, Kolkata 700107, West Bengal, India
| | - Pubali Paul
- Department of Biotechnology, Heritage Institute of Technology, Kolkata 700107, West Bengal, India
| | - Parth Patel
- H. K. College of Pharmacy, Jogeshwari West, Mumbai 400102, Maharashtra, India
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Settanni CR, Ianiro G, Ponziani FR, Bibbò S, Segal JP, Cammarota G, Gasbarrini A. COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms. World J Gastroenterol 2021; 27:7433-7445. [PMID: 34887641 PMCID: PMC8613742 DOI: 10.3748/wjg.v27.i43.7433] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/10/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
In December 2019 a novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic. Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease. Typical symptoms of the initial phase include fever and cough, with possible progression to acute respiratory distress syndrome. Gastrointestinal manifestations such as diarrhoea, vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2. The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses. Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations, such as fatigue and psychological impairment. To date, there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection. Since COVID-19 can directly or indirectly affect the gut physiology in different ways, it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations (dysbiosis, disruption of the intestinal barrier, mucosal microinflammation, post-infectious states, immune dysregulation and psychological stress). In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.
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Affiliation(s)
- Carlo Romano Settanni
- Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gianluca Ianiro
- Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesca Romana Ponziani
- Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Bibbò
- Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jonathan Philip Segal
- Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge HA1 3UJ, United Kingdom
| | - Giovanni Cammarota
- Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Antonio Gasbarrini
- Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Joseph SM, Iyer DS, Pillai RV. Ayurvedic Response to COVID-19 Pandemic in Kerala, India and Its Impact on Quarantined Individuals - A Community Case Study. Front Public Health 2021; 9:732523. [PMID: 34722442 PMCID: PMC8554199 DOI: 10.3389/fpubh.2021.732523] [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: 06/29/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The SARS-CoV-2 infection has resulted in massive loss of valuable human lives, extensive destruction of livelihoods and financial crisis of unprecedented levels across the globe. Kerala, a province in India, like the rest of the country, launched preventive and control measures to mitigate the impact of COVID-19 early in 2020. The Government of Kerala started 1206 Ayur Raksha Clinics and associated Task Forces across the state in April 2020 to improve the reach and penetration of Ayurvedic preventive, therapeutic and convalescent care strategies for the COVID-19 pandemic. The implementation framework of the strategy was properly designed, and had a decentralized, people-centered, and participatory approach. Kerala has robust public health machinery with adequate human resource and infrastructure in the conventional medicine sector. This community case study examines how the decentralized organizational framework was effectively utilized for facilitating the delivery of Ayurvedic services in the COVID-19 situation. Key observations from the study are: Ayurvedic programs implemented systematically, under an organized framework with social participation enables wider utilization of the services. Such a framework is easily replicable even in resource-poor settings. Rather than a pluralistic approach, an integrative health system approach may be more viable in the Kerala scenario in public health emergencies.
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Affiliation(s)
| | - Divya S Iyer
- Department of Ayush, Government of Kerala, Thiruvananthapuram, India
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Early Effects of Low Molecular Weight Heparin Therapy with Soft-Mist Inhaler for COVID-19-Induced Hypoxemia: A Phase IIb Trial. Pharmaceutics 2021; 13:pharmaceutics13111768. [PMID: 34834183 PMCID: PMC8618458 DOI: 10.3390/pharmaceutics13111768] [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: 09/08/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
In COVID-19-induced acute respiratory distress syndrome, the lungs are incapable of filling with sufficient air, leading to hypoxemia that results in high mortality among hospitalized patients. In clinical trials, low-molecular-weight heparin was administered via a specially designed soft-mist inhaler device in an investigator initiated, single-center, open-label, phase-IIb clinical trial. Patients with evidently worse clinical presentations were classed as the “Device Group”; 40 patients were given low-molecular-weight heparin via a soft mist inhaler at a dose of 4000 IU per administration, twice a day. The Control Group, also made up of 40 patients, received the standard therapy. The predetermined severity of hypoxemia and the peripheral oxygen saturation of patients were measured on the 1st and 10th days of treatment. The improvement was particularly striking in cases of severe hypoxemia. In the 10-day treatment, low-molecular-weight heparin was shown to significantly improve breathing capability when delivered via a soft-mist inhaler.
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Efficacy of Ceftazidime and Cefepime in the Management of COVID-19 Patients: Single Center Report from Egypt. Antibiotics (Basel) 2021; 10:antibiotics10111278. [PMID: 34827216 PMCID: PMC8614536 DOI: 10.3390/antibiotics10111278] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to explore the value of using cefepime and ceftazidime in treating patients with COVID-19. A total of 370 (162 males) patients, with RT-PCR-confirmed cases of COVID-19, were included in the study. Out of them, 260 patients were treated with cefepime or ceftazidime, with the addition of steroids to the treatment. Patients were divided into three groups: Group 1: patients treated with cefepime (124 patients); Group 2: patients treated with ceftazidime (136 patients); Group 3 (control group): patients treated according to the WHO guidelines and the Egyptian COVID-19 management protocol (110 patients)/ Each group was classified into three age groups: 18–30, 31–60, and >60 years. The dose of either cefepime or ceftazidime was 1000 mg twice daily for five days. Eight milligrams of dexamethasone were used as the steroidal drug. Careful follow-ups for the patients were carried out. In vitro and in silico Mpro enzyme assays were performed to investigate the antiviral potential of both antibiotics. The mean recovery time for Group 1 was 12 days, for Group 2 was 13 days, and for Group 3 (control) was 19 days. No deaths were recorded, and all patients were recovered without any complications. For Group 1, the recovery time was 10, 12, and 16 days for the age groups 18–30, 30–60, and >60 years, respectively. For Group 2, the recovery time was 11, 13, and 15 days for the age groups 18–30, 30–60, and >60 years, respectively. For Group 3 (control), the recovery time was 15, 16, and 17 days for the age groups 18–30, 30–60, and >60 years, respectively. Both ceftazidime and cefepime showed very good inhibitory activity towards SARS CoV-2′s Mpro, with IC50 values of 1.81 µM and 8.53 µM, respectively. In conclusion, ceftazidime and cefepime are efficient for the management of moderate and severe cases of COVID-19 due to their potential anti-SARS CoV-2 activity and low side effects, and, hence, the currently used complex multidrug treatment protocol can be replaced by the simpler one proposed in this study.
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Bobamuratova DT, Boymuradov SA, Dar-Odeh NS, Kurbanov YK, Umarov RZ. Impact of COVID-19 disease and its treatment on the development of maxillofacial complications. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [PMCID: PMC8434691 DOI: 10.1016/j.adoms.2021.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The novel coronavirus spread worldwide in 2020, causing millions of deaths and disabilities. Even though the virus was considered a respiratory virus, its adverse effects can be detected in several body systems. The article describes COVID-19 disease and its complications in the maxillofacial area. Several complications develop either in response to therapeutic modalities used to treat the underlying disease, or due to overuse of particular medications namely glucocorticoids, antirheumatic agents, interleukin 6-inhibitors, and antibiotics. This article will describe a number of complications ranging from mild complications to severe ones such as osteonecrosis of the upper jaw and facial bones, ophthalmologic and neurological complications. It will also summarize recommendations that will help prevent or minimize these complications.
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Shionoya Y, Taniguchi T, Kasai H, Sakuma N, Imai S, Shikano K, Takayanagi S, Yahaba M, Nakada TA, Igari H, Sakao S, Suzuki T. Possibility of deterioration of respiratory status when steroids precede antiviral drugs in patients with COVID-19 pneumonia: A retrospective study. PLoS One 2021; 16:e0256977. [PMID: 34473766 PMCID: PMC8412353 DOI: 10.1371/journal.pone.0256977] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Although most patients with COVID-19 develop asymptomatic or mild disease, some patients develop severe disease. The effectiveness of various therapeutic agents, including antiviral drugs, steroids, and anti-inflammatories for COVID-19, have been being confirmed. The effect of administering steroids in early disease is unclear. This study therefore aimed to evaluate the effectiveness and risk of exacerbation of steroids administered preceding antiviral drugs in patients with COVID-19 pneumonia. Methods This retrospective, single-center, observational study included consecutive patients with COVID-19 between March 2020 and March 2021. Patients were divided into a steroids-first group and antiviral-drugs-first group. Mortality, duration of hospitalization, incidence rate and duration of intensive care unit (ICU) admission, intubation, and extracorporeal membrane oxygenation (ECMO) induction of the two groups were compared. Results A total of 258 patients were admitted during the study period. After excluding patients who received symptomatic treatment only, who were taking immunosuppressive drugs, or who were administered antiviral drugs only, 68 patients were included in the analysis, 16 in the steroids-first group and 52 in the antiviral-drugs-first group. The rate of intubation, ICU admission and ECMO induction were significantly higher in the steroids-first group than in the antiviral-drugs-first group (81.3% vs. 33.3, p<0.001, 75.0% vs. 29.4%, p = 0.001, and 31.3% vs. 7.8%, p = 0.017, respectively). Furthermore, patients who received steroids within ten days after starting antiviral drugs had significantly lower rates of ICU admission, intubation, and ECMO induction. (81.3% vs. 42.9% p = 0.011, 75.0% vs. 37.1% p = 0.012, and 31.3% vs. 8.6% p = 0.039, respectively). Conclusions Administering steroids prior to antiviral drugs soon after symptom onset can aggravate disease severity. When administration of steroids is considered soon after symptom onset, it may be safer to initiate antiviral drugs first.
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Affiliation(s)
- Yu Shionoya
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- * E-mail:
| | - Noriko Sakuma
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shun Imai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohei Shikano
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shin Takayanagi
- Matsudo City General Hospital Department of Infectious Diseases, Matsudo, Japan
| | - Misuzu Yahaba
- Department of Infectious Diseases, Chiba University Hospital, Chiba, Japan
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidetoshi Igari
- Department of Infectious Diseases, Chiba University Hospital, Chiba, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Katti V, Ramamurthy LB, Kanakpur S, Shet S, Dhoot M. Response to comments on: Neuro-ophthalmic presentation of COVID-19 disease: A case report. Indian J Ophthalmol 2021; 69:2555. [PMID: 34427276 PMCID: PMC8544065 DOI: 10.4103/ijo.ijo_813_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Venkatram Katti
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Lakshmi B Ramamurthy
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Savitha Kanakpur
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Sathish Shet
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Manisha Dhoot
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
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Agrafiotis AC, Rummens P, Lardinois I. Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review. J Thorac Dis 2021; 13:4519-4529. [PMID: 34422378 PMCID: PMC8339789 DOI: 10.21037/jtd-21-208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023]
Abstract
Background Cases of spontaneous pneumothorax have been described in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in healthy patients with no underlying lung disease and who did not receive invasive mechanical ventilation. Methods A PubMed research was conducted. The following data were collected: age, sex, side of the pneumothorax, smoking habit, time form onset of symptoms to the diagnosis of pneumothorax, the development of new bullous lesions on computed tomography and the type of treatment. In order to analyze the most homogeneous population possible, intubated patients were deliberately excluded. In total, 44 cases of spontaneous pneumothorax in otherwise healthy patients were taken into account. Since the available data were extracted from small observational studies, no particular bias risk assessment was performed. Descriptive statistics were used to synthesize results. Results There were 37 male (84.1%) and 6 female (13.6%) patients. The majority of patients (66%) were treated only by chest tube thoracostomy, which most of the times resulted in a complete resolution of the pneumothorax. Simple surveillance was applied in 10 cases. Three patients underwent minimally invasive surgery. In 14 cases (31.8%) air-filled lesions were detected on imaging. Eleven patients received corticosteroids during their hospital stay. In the majority of cases (86.3%) the pneumothorax was resolved. Discussion Even if the level of evidence, derived from case reports and small case series is low, the existence of a true secondary spontaneous pneumothorax due to SARS-CoV-2 should be recognized. Imaging techniques should be repeated throughout the clinical course of the patients in order to detect newly developed pulmonary complications. Surgical treatment is feasible and patients whose general condition permits, should be offered surgery according to the existing guidelines regarding spontaneous pneumothorax. National registries and databases are necessary in order to better understand the pathogenesis and complications of this novel entity.
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Affiliation(s)
- Apostolos C Agrafiotis
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Peter Rummens
- Department of Respiratory Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ines Lardinois
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Abstract
CoVID-19 is a multi-symptomatic disease which has made a global impact due to its ability to spread rapidly, and its relatively high mortality rate. Beyond the heroic efforts to develop vaccines, which we do not discuss herein, the response of scientists and clinicians to this complex problem has reflected the need to detect CoVID-19 rapidly, to diagnose patients likely to show adverse symptoms, and to treat severe and critical CoVID-19. Here we aim to encapsulate these varied and sometimes conflicting approaches and the resulting data in terms of chemistry and biology. In the process we highlight emerging concepts, and potential future applications that may arise out of this immense effort.
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Affiliation(s)
| | - Yimon Aye
- Swiss Federal Institute of Technology in Lausanne (EPFL)1015LausanneSwitzerland
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Sepehrinezhad A, Gorji A, Sahab Negah S. SARS-CoV-2 may trigger inflammasome and pyroptosis in the central nervous system: a mechanistic view of neurotropism. Inflammopharmacology 2021; 29:1049-1059. [PMID: 34241783 PMCID: PMC8266993 DOI: 10.1007/s10787-021-00845-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can enter the central nervous system and cause several neurological manifestations. Data from cerebrospinal fluid analyses and postmortem samples have been shown that SARS-CoV-2 has neuroinvasive properties. Therefore, ongoing studies have focused on mechanisms involved in neurotropism and neural injuries of SARS-CoV-2. The inflammasome is a part of the innate immune system that is responsible for the secretion and activation of several pro-inflammatory cytokines, such as interleukin-1β, interleukin-6, and interleukin-18. Since cytokine storm has been known as a major mechanism followed by SARS-CoV-2, inflammasome may trigger an inflammatory form of lytic programmed cell death (pyroptosis) following SARS-CoV-2 infection and contribute to associated neurological complications. We reviewed and discussed the possible role of inflammasome and its consequence pyroptosis following coronavirus infections as potential mechanisms of neurotropism by SARS-CoV-2. Further studies, particularly postmortem analysis of brain samples obtained from COVID-19 patients, can shed light on the possible role of the inflammasome in neurotropism of SARS-CoV-2.
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Affiliation(s)
- Ali Sepehrinezhad
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Gorji
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
- Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Epilepsy Research Center, Westfälische Wilhelms-Universität, Münster, Germany
- Department of Neurosurgery, Westfälische Wilhelms-Universität, Münster, Germany
- Department of Neurology, Westfälische Wilhelms-Universität, Münster, Germany
| | - Sajad Sahab Negah
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran.
- Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Society for Brain Mapping and Therapeutics, Iranian Chapter, SBMT, Los Angeles, USA.
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Che Mohd Nassir CMN, Hashim S, Wong KK, Abdul Halim S, Idris NS, Jayabalan N, Guo D, Mustapha M. COVID-19 Infection and Circulating Microparticles-Reviewing Evidence as Microthrombogenic Risk Factor for Cerebral Small Vessel Disease. Mol Neurobiol 2021; 58:4188-4215. [PMID: 34176095 PMCID: PMC8235918 DOI: 10.1007/s12035-021-02457-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/16/2021] [Indexed: 02/08/2023]
Abstract
Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) due to novel coronavirus disease 2019 (COVID-19) has affected the global society in numerous unprecedented ways, with considerable morbidity and mortality. Both direct and indirect consequences from COVID-19 infection are recognized to give rise to cardio- and cerebrovascular complications. Despite current limited knowledge on COVID-19 pathogenesis, inflammation, endothelial dysfunction, and coagulopathy appear to play critical roles in COVID-19-associated cerebrovascular disease (CVD). One of the major subtypes of CVD is cerebral small vessel disease (CSVD) which represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger subsequent neuroinflammation and neurodegeneration. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, and Alzheimer's disease. In the background of COVID-19 infection, the heightened cellular activations from inflammations and oxidative stress may result in elevated levels of microthrombogenic extracellular-derived circulating microparticles (MPs). Consequently, MPs could act as pro-coagulant risk factor that may serve as microthrombi for the vulnerable microcirculation in the brain leading to CSVD manifestations. This review aims to appraise the accumulating body of evidence on the plausible impact of COVID-19 infection on the formation of microthrombogenic MPs that could lead to microthrombosis in CSVD manifestations, including occult CSVD which may last well beyond the pandemic era.
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Affiliation(s)
- Che Mohd Nasril Che Mohd Nassir
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Sabarisah Hashim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Kah Keng Wong
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Sanihah Abdul Halim
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nur Suhaila Idris
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nanthini Jayabalan
- Translational Neuroscience Lab, UQ Centre for Clinical Research, the University of Queensland, Herston, Brisbane, 4029, Australia
| | - Dazhi Guo
- Department of Hyperbaric Oxygen, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Rd, Beijing, 100048, China
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Chen F, Hao L, Zhu S, Yang X, Shi W, Zheng K, Wang T, Chen H. Potential Adverse Effects of Dexamethasone Therapy on COVID-19 Patients: Review and Recommendations. Infect Dis Ther 2021; 10:1907-1931. [PMID: 34296386 PMCID: PMC8298044 DOI: 10.1007/s40121-021-00500-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
In the context of the coronavirus disease 2019 (COVID-19) pandemic, the global healthcare community has raced to find effective therapeutic agents against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, dexamethasone is the first and an important therapeutic to significantly reduce the risk of death in COVID-19 patients with severe disease. Due to powerful anti-inflammatory and immunosuppressive effects, dexamethasone could attenuate SARS-CoV-2-induced uncontrolled cytokine storm, severe acute respiratory distress syndrome and lung injury. Nevertheless, dexamethasone treatment is a double-edged sword, as numerous studies have revealed that it has significant adverse impacts later in life. In this article, we reviewed the literature regarding the adverse effects of dexamethasone administration on different organ systems as well as related disease pathogenesis in an attempt to clarify the potential harms that may arise in COVID-19 patients receiving dexamethasone treatment. Overall, taking the threat of COVID19 pandemic into account, we think it is necessary to apply dexamethasone as a pharmaceutical therapy in critical patients. However, its adverse side effects cannot be ignored. Our review will help medical professionals in the prognosis and follow-up of patients treated with dexamethasone. In addition, given that a considerable amount of uncertainty, confusion and even controversy still exist, further studies and more clinical trials are urgently needed to improve our understanding of the parameters and the effects of dexamethasone on patients with SARS-CoV-2 infection.
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Affiliation(s)
- Fei Chen
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China.
| | - Lanting Hao
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Shiheng Zhu
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Xinyuan Yang
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Wenhao Shi
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Kai Zheng
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Tenger Wang
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Huiran Chen
- Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
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Karn M, Yonghang S, Ghimire S. Corticosteroids in COVID-19: We Should Be Mindful of Their Acute Toxicities. J Clin Pharmacol 2021; 61:1301-1302. [PMID: 34196415 PMCID: PMC8426745 DOI: 10.1002/jcph.1936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Mitesh Karn
- School of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Sapana Yonghang
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Sadikshya Ghimire
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
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Yuen KCJ, Mortensen MJ, Azadi A, Fonkem E, Findling JW. Rethinking the management of immune checkpoint inhibitor-related adrenal insufficiency in cancer patients during the COVID-19 pandemic. Endocrinol Diabetes Metab 2021; 4:e00246. [PMID: 34268454 PMCID: PMC8250331 DOI: 10.1002/edm2.246] [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: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) is currently a major pandemic challenge, and cancer patients are at a heightened risk of severity and mortality from this infection. In recent years, immune checkpoint inhibitor (ICI) use to treat multiple cancers has increased in oncology, but equally has raised the question of whether ICI therapy and its side-effects is harmful or beneficial during this pandemic. Methods A combination of published literature in PubMed between January 2010 and December 2020, recommended guidelines in non-cancer patients, and clinical experience was utilized to outline recommendations on glucocorticoid timing and dosing regimens in ICI-treated patients presenting with AI during this COVID-19 pandemic. Results The potential immune interaction between ICIs and COVID-19 require major consideration because these agents act at the intersection between effective cancer immunotherapy and increasing patient susceptibility, severity and complications from the SARS-CoV-2 sepsis. Furthermore, ICI use can induce autoimmune adrenal insufficiency (AI) that further increases infection susceptibility. Thus, ICI-treated cancer patients with AI may be at greater risk of COVID-19 infection. Glucocorticoids are the cornerstone for replacement therapy, and for treatment and mitigation of adrenal crisis and relief of mass effects in ICI-related hypophysitis. High-dose glucocorticoids have also been used with cytotoxic chemotherapy as part of cancer treatment, and iatrogenic AI may arise after glucocorticoid discontinuation that increases the risk of adrenal crisis. Furthermore, in patients who develop the "long COVID-19" syndrome, when to discontinue glucocorticoid therapy becomes crucial to avoid unnecessary prolongation of therapy and the development of iatrogenic hypercortisolemia. Conclusion During the COVID-19 pandemic, much of cancer care have been impacted and an important clinical question is how to optimally manage ICI-related AI during these unprecedented times. Herein, we suggest practical recommendations on the timing and dosing regimens of glucocorticoids in different clinical scenarios of ICI-treated cancer patients presenting with AI during this COVID-19 pandemic.
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Affiliation(s)
- Kevin C. J. Yuen
- Departments of Neuroendocrinology and NeurosurgeryBarrow Neurological InstituteUniversity of Arizona College of Medicine and Creighton School of MedicinePhoenixArizonaUSA
| | | | - Amir Azadi
- Departments of Neurology and Neuro‐OncologyBarrow Neurological Institute/Ivy Brain Center at PhoenixSt. Joseph’s Hospital and Medical CenterPhoenixArizonaUSA
| | - Ekokobe Fonkem
- Departments of Neurology and Neuro‐OncologyBarrow Neurological Institute/Ivy Brain Center at PhoenixSt. Joseph’s Hospital and Medical CenterPhoenixArizonaUSA
| | - James W. Findling
- Division of Endocrinology and Molecular MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
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The antiviral activity of iota-, kappa-, and lambda-carrageenan against COVID-19: A critical review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 12:100826. [PMID: 34222718 PMCID: PMC8240443 DOI: 10.1016/j.cegh.2021.100826] [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: 04/18/2021] [Revised: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective There is no specific antiviral treatment available for coronavirus disease 2019 (COVID-19). Among the possible natural constituents is carrageenan, a polymer derived from marine algae that possesses a variety of antiviral properties. The purpose of this review was to summarize the evidence supporting carrageenan subtypes' antiviral activity against the emerging severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19. Methods PubMed/MEDLINE and Google Scholar searches were conducted for publications using the terms 'carrageenan', 'iota carrageenan', 'kappa carrageenan', lambda-carrageenan', 'coronavirus', 'common cold', 'rhinovirus', and 'SARS-CoV-2' search was also done in grey literature to increase our understanding. A search for the word "carrageenan" was also carried out. Most of the publications were discussed in narrative. Results Carrageenan has been shown to have potent antiviral activity against both coronaviruses (coronavirus NL63, SARS-CoV-2) and non-coronaviruses such as dengue virus, herpes simplex virus, cytomegalovirus, vaccinia virus, vesicular stomatitis virus, sindbis virus, human immunodeficiency virus, influenza virus, human papillomavirus, rabies virus, junin virus, tacaribe virus, African swine fever, bovine herpes virus, suid herpes virus, and rhinovirus. No in vivo study has been conducted using carrageenan as an anti-SARS-CoV-2 agent. The majority of the in vivo research was done on influenza, a respiratory virus that causes common cold together with coronavirus. Thus, various clinical trials were conducted to determine the transferability of these in vitro data to clinical effectiveness against SARS-CoV-2. When combined with oral ivermectin, nasally administered iota-carrageenan improved outcome in COVID-19 patients. It is still being tested in clinics for single-dose administration. Conclusion Though the carrageenan exhibited potent antiviral activity against SARS-CoV-2 and was used to treat COVID-19 under emergency protocol in conjunction with oral medications such as ivermectin, there is no solid evidence from clinical trials to support its efficacy. Thus, clinical trials are required to assess its efficacy for COVID-19 treatment prior to broad application.
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Nobrega de Almeida J, Moreno L, Francisco EC, Noronha Marques G, Mendes AV, Barberino MG, Colombo AL. Trichosporon asahii superinfections in critically ill COVID-19 patients overexposed to antimicrobials and corticosteroids. Mycoses 2021; 64:817-822. [PMID: 34091966 PMCID: PMC8242571 DOI: 10.1111/myc.13333] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 01/02/2023]
Abstract
Objectives To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID‐19 patients. Methods From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID‐19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. Results Five critically ill COVID‐19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad‐spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30‐day mortality was 80%. The five T asahii strains from the COVID‐19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross‐transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. Conclusions Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID‐19 patients to prevent infections by hard‐to‐treat fungi like T asahii.
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Octaviana F, Yugo HP, Safri AY, Indrawati LA, Wiratman W, Ayuningtyas T, Hakim M. Case series: COVID-19 in patients with mild to moderate myasthenia gravis in a National Referral Hospital in Indonesia. eNeurologicalSci 2021; 23:100332. [PMID: 33644426 PMCID: PMC7898972 DOI: 10.1016/j.ensci.2021.100332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, patients with myasthenia gravis (MG) are most likely to be affected by this situation. Corticosteroids and immunosuppressant agents increase the risk of severe infection. Furthermore, viral infection and some medications in COVID-19 may exacerbate MG symptoms. CASE DESCRIPTION We presented three patients with MG who contracted COVID-19. All of the patients had a favourable outcome. Only one patient who was not treated with corticosteroids or immunosuppressant therapy experienced deterioration of MG symptoms, while the other patients who received immunosuppressant therapy did not develop MG exacerbation. Surprisingly, azithromycin did not provoke myasthenic crisis (MC) in patients with normal MGFA classification. CONCLUSION Using immunosuppressant agents may not lead to MG deterioration and may not be related to unfavourable outcomes.
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Affiliation(s)
- Fitri Octaviana
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
| | - Hardito Puspo Yugo
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
| | - Ahmad Yanuar Safri
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
| | - Luh Ari Indrawati
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
| | - Winnugroho Wiratman
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
| | - Triana Ayuningtyas
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
| | - Manfaluthy Hakim
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia
- Cipto Mangunkusomo National General Hospital, Jakarta, Indonesia
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Dettorre GM, Patel M, Gennari A, Pentheroudakis G, Romano E, Cortellini A, Pinato DJ. The systemic pro-inflammatory response: targeting the dangerous liaison between COVID-19 and cancer. ESMO Open 2021; 6:100123. [PMID: 33932622 PMCID: PMC8026271 DOI: 10.1016/j.esmoop.2021.100123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammation is an established driver of severe SARS-CoV-2 infection and a mechanism linked to the increased susceptibility to fatal COVID-19 demonstrated by patients with cancer. As patients with cancer exhibit a higher level of inflammation compared with the general patient population, patients with cancer and COVID-19 may uniquely benefit from strategies targeted at overcoming the unrestrained pro-inflammatory response. Targeted and non-targeted anti-inflammatory therapies may prevent end-organ damage in SARS-CoV-2-infected patients with cancer and decrease mortality. Here, we review the clinical role of selective inhibition of pro-inflammatory interleukins, tyrosine kinase modulation, anti-tumor necrosis factor agents, and other non-targeted approaches including corticosteroids in their roles as disease-modulating agents in patients with COVID-19 and cancer. Investigation of these therapeutics in this highly vulnerable patient group is posited to facilitate the development of tailored therapeutics for this patient population, aiding the transition of systemic inflammation from a prognostic domain to a source of therapeutic targets.
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Affiliation(s)
- G M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - M Patel
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - A Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece; Chief Medical Officer, European Society for Medical Oncology, Lugano, Switzerland
| | - E Romano
- Department of Medical Oncology, Center for Cancer Immunotherapy, Institut Curie, Paris, France
| | - A Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - D J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy.
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Organizing Pneumonia and Microvascular Fibrosis as Late Sequelae after a COVID-19 Infection. A Case Report. SURGERIES 2021. [DOI: 10.3390/surgeries2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a patient with COVID-19 requiring hospitalization for two weeks, complicated by multiple segmental pulmonary embolisms for which dabigatran was initiated. After clearing the infection, the patient remained asymptomatic for 5 months. He was then readmitted with a spontaneous haemothorax, most likely related to the use of dabigatran, which progressed to a pleural empyema with a trapped lung. The patient underwent a video assisted thoracoscopy (VATS) with decortication. Because of focal abnormalities, biopsies for histopathology were taken from the lung parenchyma. These showed an organizing pneumonia with progression towards fibrosis and arteries with intimal fibrosis. So far, no histopathological reports exist on late pulmonary changes after a COVID-19 infection. The unusual combined presence of microvascular damage and interstitial fibrosis may reflect a pathophysiological concept in which early endothelial damage by SARS-CoV-2 can lead to a chronic state of microvascular damage, low grade inflammation, and early progression towards pulmonary fibrosis.
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Pagnesi M, Inciardi RM, Lombardi CM, Agostoni P, Ameri P, Barbieri L, Bellasi A, Camporotondo R, Canale C, Carubelli V, Carugo S, Catagnano F, Dalla Vecchia LA, Danzi GB, Di Pasquale M, Gaudenzi M, Giovinazzo S, Gnecchi M, Guazzi M, Iorio A, La Rovere MT, Leonardi S, Maccagni G, Mapelli M, Margonato D, Merlo M, Monzo L, Mortara A, Nuzzi V, Piepoli M, Porto I, Pozzi A, Sarullo F, Sinagra G, Tedino C, Tomasoni D, Volterrani M, Zaccone G, Senni M, Metra M. Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study. Int J Infect Dis 2021; 108:270-273. [PMID: 34052406 PMCID: PMC8159705 DOI: 10.1016/j.ijid.2021.05.056] [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: 02/20/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. Methods A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality. Results A total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26–0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO2/FiO2 ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO2/FiO2 ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L). Conclusions The protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Lucia Barbieri
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rita Camporotondo
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Valentina Carubelli
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Carugo
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Francesco Catagnano
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Laura A Dalla Vecchia
- Cardiology Department, IRCCS Istituti Clinici Scientifici Maugeri, Istituto Scientifico di Milano, Milan, Italy
| | | | - Mattia Di Pasquale
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Margherita Gaudenzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Massimiliano Gnecchi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, Milan, Italy; IRCCS San Donato Hospital, Milan, Italy
| | - Annamaria Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Teresa La Rovere
- Cardiology Department, IRCCS Istituti Clinici Scientifici Maugeri, Istituto Scientifico di Pavia, Pavia, Italy
| | - Sergio Leonardi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Gloria Maccagni
- Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Margonato
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Luca Monzo
- Istituto Clinico Casalpalocco and Policlinico Casilino, Rome, Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy; Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Chiara Tedino
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Gregorio Zaccone
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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