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Pontiroli AE, Ambrosio G, Leoni O, Forlani M, Antonelli B, Gronda E, Palazzuoli A, Bandera F, Galati G, Tagliabue E. Heart failure and co-morbidities confer a negative prognosis in COVID-19 infection. Int J Cardiol 2025:133492. [PMID: 40490033 DOI: 10.1016/j.ijcard.2025.133492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2025] [Revised: 06/01/2025] [Accepted: 06/06/2025] [Indexed: 06/11/2025]
Abstract
BACKGROUND Since early reports, it has been shown that cardiovascular (CV) diseases, including heart failure (HF), represent a risk factor for infection, hospital admissions and mortality from COVID-19. The COVID-19 pandemics has been of major importance in Italy and in the Lombardy Region. Aims of this study were to compare COVID-19 infection in HF and No-HF subjects, and to quantify among HF patients the risk for COVID-19 infection and all-cause mortality. METHODS All consecutive patients (98,549) with at least one hospital discharge of HF (primary diagnosis) during January 1st, 2015, to December 31st, 2019, were identified in the Lombardy Region Database (>10 million inhabitants), and compared with No-HF subjects (394,104 with a lower age limit 40 years), randomly chosen in a 4:1 proportion among hospitalized patients. The whole cohort of cases of COVID-19 infection, laboratory-confirmed by RT-PCR, aged >40 years, diagnosed from the beginning of the epidemic on 21 February 2020 to 1 October 2020 was studied. The study outcomes were: occurrence, hospitalization, and death in COVID-19 cases. RESULTS Incidence of COVID-19 increased with age in both HF (p < 0.001) and No-HF patients (p < 0.001); cases (and incidence rates, IR) were 8648 (IR = 29.653 × 100.000) in HF and 14,256 (IR = 10.195) and in No-HF (p < 0.001); hospital admissions were 4974 (IR = 14.970) and 4943 (IR = 3.484), respectively (p 〈0001); deaths were 7650 (IR = 5.368) and 18,368 (IR = 56.921), respectively (p < 0.001); the incidence rate ratio (IRR) was 2.909 (95 % C.I. 2.908-2.909) for infection (p < 0.001), 4.297 (95 % C.I. 4.296-4.297) for hospital admission (p < 0.001), and 10.603 (95 % C.I.10.602-10.604) for mortality (p < 0.001). The excess IRR for mortality varied from 25.001 (95 % C.I. 24.971-25.032) for the age decade 40-49 to 1.925 (95 % C.I. 1.923-1.926) for the age decade 100-109. Among HF patients, age (OR = 1.087, 95 % C.I.1.05-1.088), male sex (OR = 1.27, 95 % C.I. 1.23-1.31), number of hospital admissions for HF during the period 2015-2019 (OR = 2.22, 95 % C.I. 2.11-2.33), co-morbidities (OR = 1.33, 95 % C.I. 1.32-1.35), or Charlson Index (OR = 1.21, 95 % C.I. 1.20-1.22), were risk factors for both infection and all-cause mortality at univariable and at multivariable analysis. CONCLUSION Infections, hospital admissions, and mortality for COVID-19 increased with age and male sex were more frequent in HF than in No-HF patients. Among HF patients, age and sex, number of hospital admissions for HF, co-morbidities, were risk factors for both infection and mortality. These data are of relevance for prioritizing interventions for prevention of infection, and for assistance to patients with COVID-19, and to inform management of future pandemics.
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Affiliation(s)
- Antonio E Pontiroli
- Università degli Studi di Milano, Dipartimento di Scienze della Salute, Milan, Italy.
| | - Giuseppe Ambrosio
- Università di Perugia, Dipartimento di Medicina - CERICLET, Istituto Nazionale Ricerche Cardiovascolari - INRC, Perugia, Italy; IRCCS MultiMedica, Milan, Italy
| | - Olivia Leoni
- Dipartimento della Salute, Regione Lombardia, Osservatorio Epidemiologico, Milan, Italy.
| | | | | | - Edoardo Gronda
- IRCCS Policlinico, U.O.C. Nefrologia, Dialisi e Trapianti di Rene, Milan, Italy
| | - Alberto Palazzuoli
- Unità Autonoma Malattie Cardiovascolari, Dipartimento Cardio-Toracico e Vascolare, Ospedale le Scotte, Universita di Siena, Siena, Italy.
| | - Francesco Bandera
- IRCCS MultiMedica, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, Italy.
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Anderson W, Gould R, Patil N, Mohr N, Dodd K, Boyce D, Dasher P, Guerin PJ, Khan R, Cheruku S, Kumar VK, Mathé E, Mehta AK, Michelson AP, Williams A, Heavner SF, Podichetty JT. Unveiling sub-populations in critical care settings: a real-world data approach in COVID-19. Front Public Health 2025; 13:1544904. [PMID: 40443932 PMCID: PMC12119499 DOI: 10.3389/fpubh.2025.1544904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/31/2025] [Indexed: 06/02/2025] Open
Abstract
Background Disease presentation and progression can vary greatly in heterogeneous diseases, such as COVID-19, with variability in patient outcomes, even within the hospital setting. This variability underscores the need for tailored treatment approaches based on distinct clinical subgroups. Objectives This study aimed to identify COVID-19 patient subgroups with unique clinical characteristics using real-world data (RWD) from electronic health records (EHRs) to inform individualized treatment plans. Materials and methods A Factor Analysis of Mixed Data (FAMD)-based agglomerative hierarchical clustering approach was employed to analyze the real-world data, enabling the identification of distinct patient subgroups. Statistical tests evaluated cluster differences, and machine learning models classified the identified subgroups. Results Three clusters of COVID-19 in patients with unique clinical characteristics were identified. The analysis revealed significant differences in hospital stay durations and survival rates among the clusters, with more severe clinical features correlating with worse prognoses and machine learning classifiers achieving high accuracy in subgroup identification. Conclusion By leveraging RWD and advanced clustering techniques, the study provides insights into the heterogeneity of COVID-19 presentations. The findings support the development of classification models that can inform more individualized and effective treatment plans, improving patient outcomes in the future.
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Affiliation(s)
| | - Ruth Gould
- Centers of Disease Control and Prevention, Atlanta, GA, United States
| | - Namrata Patil
- Brigham and Women’s Hospital, Boston, MA, United States
| | - Nicholas Mohr
- University of Iowa Healthcare, Iowa City, IA, United States
| | - Kenneth Dodd
- Advocate Aurora Health, Downers Grove, IL, United States
| | - Danielle Boyce
- Tufts University School of Medicine, Boston, MA, United States
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pam Dasher
- Critical Path Institute, Tucson, AZ, United States
| | | | - Reham Khan
- Society of Critical Care Medicine, Mount Prospect, IL, United States
| | - Sreekanth Cheruku
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, United States
| | - Vishakha K. Kumar
- Society of Critical Care Medicine, Mount Prospect, IL, United States
| | - Ewy Mathé
- National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), Rockville, MD, United States
| | - Aneesh K. Mehta
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Andrew P. Michelson
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Andrew Williams
- Tufts University School of Medicine, Boston, MA, United States
| | - Smith F. Heavner
- Critical Path Institute, Tucson, AZ, United States
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, United States
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3
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Dei Cas A, Aldigeri R, Eletto E, Ticinesi A, Nouvenne A, Prati B, Vazzana A, Antonini M, Moretti V, Balestreri E, Spigoni V, Fantuzzi F, Schirò S, Ruffini L, Sverzellati N, Meschi T, Bonadonna R. Hyperglycemia in the diabetic range, but not previous diagnosis of diabetes mellitus, is an independent indicator of poor outcome in patients hospitalized for severe COVID-19. Acta Diabetol 2025:10.1007/s00592-025-02507-1. [PMID: 40314776 DOI: 10.1007/s00592-025-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 03/29/2025] [Indexed: 05/03/2025]
Abstract
AIMS Diabetes mellitus (DM) and hyperglycemia are associated with poor outcome(s) in COVID-19 hospitalized patients, but their independent impact on prognosis remains unclear. We aimed to assess the impact of DM and hyperglycemia on COVID-19 outcomes. METHODS Clinical data/records from COVID-19 patients admitted to the Parma University-Hospital (February 23rd to March 31st, 2020) were retrieved and analysed (NCT04550403). Fasting plasma glucose (FPG), inflammatory markers and the main biochemical variables were collected at admission. Patients underwent chest high-resolution CT and arterial blood gas analysis to determine the PaO2/FiO2 ratio (P/F ratio). The primary outcome was a composite of intensive care unit admission and/or death. RESULTS Among 756 subjects, 143 (19%) had DM. These patients were older with higher comorbidity rates. The primary outcome occurred in 61.5% DM patients versus 43.4% without DM (p < 0.001). In multivariable analysis (accuracy UC = 0.93), older age, cardiovascular and kidney diseases, FPG ≥ 126 mg/dl, C-reactive protein, and P/F ratio, but not previous DM, were independent risk indicators. CONCLUSIONS DM indicated poor COVID-19 outcomes, but not when adjusted for other clinical variables/comorbities, suggesting that its impact was mostly driven by concomitant factors. The independent role of fasting hyperglycemia points to the need for further research on its contribution to COVID-19.
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Affiliation(s)
- Alessandra Dei Cas
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elisa Eletto
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Beatrice Prati
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Angela Vazzana
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Monica Antonini
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Valentina Moretti
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Emanuela Balestreri
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Valentina Spigoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federica Fantuzzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Schirò
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Radiological Sciences, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Riccardo Bonadonna
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy.
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Endocrinology, Diabetology and Metabolic Diseases, University of Verona and University Hospital of Verona, Verona, Italy.
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Kumar A, Yendamuri S, Ahmad F, Mukherjee PB, Kumar R, Manrai M, Muthukrishnan J, Dawra S. Inflammatory biomarkers and adverse outcome in COVID-19: Prelude for future viral pandemics. J Family Med Prim Care 2025; 14:720-728. [PMID: 40115551 PMCID: PMC11922368 DOI: 10.4103/jfmpc.jfmpc_1326_24] [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: 08/01/2024] [Revised: 10/05/2024] [Accepted: 10/15/2024] [Indexed: 03/23/2025] Open
Abstract
Background Dysregulated inflammatory response plays a key role in the pathogenesis of COVID-19. The role of inflammatory markers to predict adverse clinical outcome is still controversial. The aim of this study was to analyze the association of inflammatory markers with disease outcomes independent of the effect of age and co-morbidities. Materials and Methods This is a retrospective analysis of COVID-19 patients admitted at a dedicated COVID center from July 2020 to Mar 2022. Clinical characteristics and inflammatory markers namely serum Ferritin levels, CRP, D-Dimer levels, serum LDH and IL-6 Levels were studied. The following outcome parameters were collected: disease severity at onset and outcome (discharge/death). Results 48.4% of the of 244 COVID-19 cases included had severe disease while 51.6% had moderate disease. Mean age was 61.3 ± 14.17 years and 71.7% were males. Primary Hypertension (48.4%) and Diabetes Mellitus (39.3%) were the most common co-morbidities. Increasing age, smoking, and alcohol consumption were associated with severe disease. CRP, D-dimer, and IL-6 were independent risk factors for disease severity while CRP, D dimer, LDH, Ferritin, and NLR (Neutrophil Lymphocyte ratio) were independent predictors of disease mortality. D-dimer was the most sensitive (95.8%) and specific (92.2%) marker to predict disease severity and serum LDH was the most sensitive (74.7%) to predict disease mortality at baseline. Conclusion Measurement of inflammatory markers might assist clinicians in predicting disease severity and prognosis of COVID-19. This may serve as a benchmark to understand the role of inflammatory markers in other diseases associated with dysregulated inflammatory response.
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Affiliation(s)
- Ankit Kumar
- Department of Medicine, Military Hospital, Shimla, Himachal Pradesh, India
| | - Sushma Yendamuri
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Faiz Ahmad
- Commandant, Military Hospital, Jammu, Jammu and Kashmir, India
| | - Partha B Mukherjee
- Department of Medicine, Command Hospital, Southern Command, Pune, Maharashtra, India
| | - Ravi Kumar
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Manish Manrai
- Department of Gastroenterology, Command Hospital, Central Command, Lucknow, Uttar Pradesh, India
| | - J Muthukrishnan
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Dawra
- Department of Gastroenterology, Command Hospital, Southern Command, Pune, Maharashtra, India
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5
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Alqahtani L, Kano S, Bokhary H, Bahamdan S, Ghazi R, Abdu S, Almutiri S, Alhejaili F. Association Between Severities of Obstructive Sleep Apnea and COVID-19 Outcomes. Cureus 2025; 17:e77626. [PMID: 39834670 PMCID: PMC11743573 DOI: 10.7759/cureus.77626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2025] [Indexed: 01/22/2025] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse resulting in episodes of apnea and hypopnea. Studies have shown worsened coronavirus disease 2019 (COVID-19) severity due to coexisting respiratory conditions and suggest increased severity of COVID-19 in patients with or at high risk of OSA. However, the extent of this correlation is unclear. This retrospective study aimed to evaluate the association between OSA severity and COVID-19 severity and assess the impact of continuous positive airway pressure (CPAP) compliance. Methods This single-center retrospective study was conducted at King Abdulaziz University Hospital (KAUH), a tertiary care center in Jeddah, Saudi Arabia. Data were collected from 62 adult patients with OSA who were diagnosed via polysomnography (PSG) and had a positive documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test result. COVID-19 severity was categorized into mild, moderate, and severe. Results There was no significant correlation between OSA severity as measured by the apnea-hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), arousal index (AI), respiratory disturbance index (RDI), or the type of treatment used, including adherence to CPAP, and the outcomes of COVID-19. However, higher arousal with respiratory index (ARI) and a lower percentage of time with SpO2 < 90% (T90) values were linked to moderate COVID-19 severity with significant p-values of 0.046 and 0.007, respectively. Conclusion There was no significant correlation between the severity or types of OSA treatment and the severity of COVID-19. Further research including multicenter studies with bigger populations and extensive sleep study data is warranted. Understanding the OSA-COVID-19 link may improve risk stratification and patient management.
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Affiliation(s)
- Lamis Alqahtani
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Suzana Kano
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Hanaa Bokhary
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Sulafah Bahamdan
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Rafah Ghazi
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Shahad Abdu
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Sarah Almutiri
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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Cruces-Salguero S, Larrañaga I, Mar J, Matheu A. Electronic health records reveal that COVID-19 impacted health resources and survival of Basque population. Aging Clin Exp Res 2024; 36:228. [PMID: 39612148 DOI: 10.1007/s40520-024-02884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 11/06/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND The COVID-19 pandemic impacted worldwide. The Basque Country was one of the regions in Spain most affected by the virus. METHODS In this retrospective study, we took advantage of the Basque Health Service electronic health records data lake of over 20,000 deceased individuals, including 5000 positives for COVID-19, between 2020 and 2022 in Gipuzkoa (Basque Country, Spain). RESULTS Comparison between COVID-19-positive and negative individuals' showed that the prevalence of infections was higher inside nursing homes and COVID-19 promoted a significant rise in hospitalizations, emergency entrances, and ICU admissions. No differences were observed between genders in terms of infections or survival but were detected in health resources and vaccination showed a strong protective effect against the disease. CONCLUSIONS Our results provided a complete characterization of the impact of COVID-19 on the Basque population, which expands the knowledge of the pandemic on older individuals and the health system. Our study also highlights the benefit of the use of Electronic Health Records in studying human diseases.
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Affiliation(s)
- Sara Cruces-Salguero
- Cellular Oncology group, Biodonostia Health Research Institute, Paseo Dr. Beguiristain s/n, 20014, San Sebastian, Spain
| | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Healthcare Organisation, Research Unit, Mondragón, Gipuzkoa, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Healthcare Organisation, Research Unit, Mondragón, Gipuzkoa, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Ander Matheu
- Cellular Oncology group, Biodonostia Health Research Institute, Paseo Dr. Beguiristain s/n, 20014, San Sebastian, Spain.
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento (CIBERfes), Carlos III Institute, Madrid, Spain.
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Galiatsatos P, Brems H, Myers CN, Montemayor K. Race, Ethnicity, and Gender Disparities in Management and Outcomes of Critically Ill Adults with Sepsis. Crit Care Clin 2024; 40:741-752. [PMID: 39218483 DOI: 10.1016/j.ccc.2024.06.001] [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] [Indexed: 09/04/2024]
Abstract
Critical care pathologies are not immune to potential social challenges in both health equity and health disparities. Over the last century, as sepsis physiology and interventions have continued to improve clinical outcomes, recognition that such improvements are not seen in all diverse populations warrants an understanding of this disproportionate success. In this review, the authors evaluate sepsis incidence and outcomes across ethnicity, race, and sex and gender, taking into account social and biological categorization and the association of sepsis-related mortality and morbidity. Further, the authors review how such issues transcend across age groups, with vulnerability to sepsis.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Health System, Baltimore, MD, USA.
| | - Henry Brems
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Kristina Montemayor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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8
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Sum Z, Sofija E, Sebar B. Exploring COVID-19 vaccine hesitancy among young adults in Australia. A qualitative study. Vaccine X 2024; 19:100515. [PMID: 39040885 PMCID: PMC11260859 DOI: 10.1016/j.jvacx.2024.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background COVID-19 vaccine hesitancy among young adults in Australia is still poorly understood. Young adults aged 25-34 years have been identified as a population subgroup where COVID-19 vaccine-hesitant views are highly prevalent. Objective Exploring the attitudes, thoughts, feelings and social environments affecting the decision to have or not have the vaccine can provide vital transferrable lessons in future health campaigns. Methods A qualitative phenomenological study was conducted using semi-structured phone interviews between June 2021 and July 2021. Interview questions were adopted from the World Health Organization's guidance document 'Data for Action: Achieving High Uptake of COVID-19 Vaccines'. Participants aged 25-34 years (n = 26) were recruited via purposive and snowball sampling methods. Data were analysed thematically. Results Overall, participants presented themselves as highly vaccine literate, understanding their social contract with society. Many participants also did not display traditional vaccine-hesitant views. Six themes specifically regarding COVID-19 vaccine hesitancy were identified, namely (1) decision-making complexities, (2) perceived risk of COVID-19 infection, (3) media's misrepresentation of COVID-19, (4) vaccine-related issues, (5) inconsistent government messaging and program execution, and (6) social benefits assessment. In addition, motivators to COVID-19 vaccine uptake were classified into three categories: (1) tangible benefits, (2) protecting others, and (3) mandates and incentives. Findings suggest the motivators for COVID-19 vaccine uptake in young adults depend on individual benefits, highlighting the importance of recognising and addressing personal concerns. Conclusion There is a need to re-examine and redefine the meaning of vaccine hesitancy in young Australian adults. We offer an understanding of prospective challenges with vaccine hesitancy and potential solutions to address them. These include carefully tailored approaches regarding ongoing vaccine safety concerns and the expected personal benefits following vaccination. Combining these factors can aid in developing new methods of public engagement in the next public health crisis.
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Affiliation(s)
- Zachary Sum
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
| | - Bernadette Sebar
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
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9
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Embaby A, Maged LA, Abdel-Hamid HM, El Hadidi KT. Factors associated with severe infection in rheumatoid arthritis patients: lessons learned from the COVID-19 pandemic. Infection 2024; 52:1337-1345. [PMID: 38381306 PMCID: PMC11289044 DOI: 10.1007/s15010-024-02187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE This aimed to identify the factors associated with severe/critical coronavirus disease 2019 (COVID-19) infection in rheumatoid arthritis (RA) patients. METHODS Two-hundred RA patients diagnosed according to the American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria with proven COVID-19 infection were recruited and categorized according to the world health organization (WHO) COVID-19 severity grading into 2 groups: patients with mild/moderate COVID-19 (n = 164) and patients with severe/critical COVID-19 (n = 36). Comparison between both groups was done to identify the risk factors associated with severe/critical infection. Incidence of RA disease activity flare defined as increase in clinical disease activity index (CDAI) more than 10 points following infection was calculated. RESULTS Multivariate analysis identified history of previous serious infection, age > 60 years, and diabetes as factors positively associated, whereas COVID-19 vaccination was negatively associated with severe/critical infection. Following COVID-19 infection, the number of patients with severe/critical COVID-19 who had high RA disease activity and the incidence of flares was significantly higher in comparison to patients with mild/moderate COVID-19 (P < 0.001 and 0.003; respectively). CONCLUSION Age > 60 years, diabetes, and history of previous serious infections are risk factors for severe/critical COVID-19, while vaccination has a protective role in RA patients. Infection particularly when severe is associated with risk of disease flare.
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Affiliation(s)
- Aya Embaby
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lobna A Maged
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hoda M Abdel-Hamid
- Chest Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled T El Hadidi
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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10
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Chidambaram V, Kumar A, Sadaf MI, Lu E, Al’Aref SJ, Tarun T, Galiatsatos P, Gulati M, Blumenthal RS, Leucker TM, Karakousis PC, Mehta JL. COVID-19 in the Initiation and Progression of Atherosclerosis: Pathophysiology During and Beyond the Acute Phase. JACC. ADVANCES 2024; 3:101107. [PMID: 39113913 PMCID: PMC11304887 DOI: 10.1016/j.jacadv.2024.101107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/24/2024] [Accepted: 06/01/2024] [Indexed: 08/10/2024]
Abstract
The incidence of atherosclerotic cardiovascular disease is increasing globally, especially in low- and middle-income countries, despite significant efforts to reduce traditional risk factors. Premature subclinical atherosclerosis has been documented in association with several viral infections. The magnitude of the recent COVID-19 pandemic has highlighted the need to understand the association between SARS-CoV-2 and atherosclerosis. This review examines various pathophysiological mechanisms, including endothelial dysfunction, platelet activation, and inflammatory and immune hyperactivation triggered by SARS-CoV-2 infection, with specific attention on their roles in initiating and promoting the progression of atherosclerotic lesions. Additionally, it addresses the various pathogenic mechanisms by which COVID-19 in the post-acute phase may contribute to the development of vascular disease. Understanding the overlap of these syndromes may enable novel therapeutic strategies. We further explore the need for guidelines for closer follow-up for the often-overlooked evidence of atherosclerotic cardiovascular disease among patients with recent COVID-19, particularly those with cardiometabolic risk factors.
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Affiliation(s)
- Vignesh Chidambaram
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amudha Kumar
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Murrium I. Sadaf
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emily Lu
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Subhi J. Al’Aref
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Tushar Tarun
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thorsten M. Leucker
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Petros C. Karakousis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jawahar L. Mehta
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Division of Cardiovascular Medicine, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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11
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Vass WB, Shankar SN, Lednicky JA, Alipanah M, Stump B, Keady P, Fan ZH, Wu CY. Concentrating viable airborne pathogens using a virtual impactor with a compact water-based condensation air sampler. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2024; 58:1114-1128. [PMID: 39492847 PMCID: PMC11530212 DOI: 10.1080/02786826.2024.2380096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 06/28/2024] [Indexed: 11/05/2024]
Abstract
Pathogens can be collected from air and detected in samples by many methods. However, merely detecting pathogens does not answer whether they can spread disease. To fully assess health risks from exposure to airborne pathogens, the infectivity of those agents must be assessed. Air samplers which operate by growing particles through water vapor condensation and subsequently collecting them into a liquid medium have proven effective at conserving the viability of microorganisms. We present a study that assessed performance improvement of one such sampler, BioSpot-GEM™, gained by augmenting it with an upstream virtual impactor (VI) designed to concentrate particles in aerosols. We demonstrate that such an integrated unit improved the collection of live Escherichia coli by a median Concentration Factor (C F ) of 1.59 and increased the recovery of viable human coronavirus OC43 (OC43) by a median C F of 12.7 as compared to the sampler without the VI. Our results also show that OC43 can be concentrated in this way without significant loss of infectivity. We further present that the small BioSpot-GEM™ bioaerosol sampler can collect live E. coli at an efficiency comparable to the larger BioSpot-VIVAS™ bioaerosol sampler. Our analyses show potential benefits toward improving the collection of viable pathogens from the air using a more portable water-based condensation air sampler while also highlighting challenges associated with using a VI with concentrated bioaerosols. This work can aid further investigation of VI usage to improve the collection of pathogens from air ultimately to better characterize health risks associated with airborne pathogen exposures.
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Affiliation(s)
- William B. Vass
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Sripriya Nannu Shankar
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati, Ohio, USA
| | - John A. Lednicky
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Morteza Alipanah
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida, USA
| | - Braden Stump
- Aerosol Devices Inc., Fort Collins, Colorado, USA
| | | | - Z. Hugh Fan
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida, USA
- Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Chang-Yu Wu
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, Florida USA
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12
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Horne BD, Anderson JL, Haddad F, May HT, Le VT, Knight S, Bair TL, Knowlton KU. Periodic Fasting and Acute Cardiac Events in Patients Evaluated for COVID-19: An Observational Prospective Cohort Study. Nutrients 2024; 16:2075. [PMID: 38999823 PMCID: PMC11243697 DOI: 10.3390/nu16132075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Periodic fasting was previously associated with greater longevity and a lower incidence of heart failure (HF) in a pre-pandemic population. In patients with coronavirus disease 2019 (COVID-19), periodic fasting was associated with a lower risk of death or hospitalization. This study evaluated the association between periodic fasting and HF hospitalization and major adverse cardiovascular events (MACEs). METHODS Patients enrolled in the INSPIRE registry from February 2013 to March 2020 provided periodic fasting information and were followed into the pandemic (n = 5227). Between March 2020 and February 2023, N = 2373 patients were studied, with n = 601 COVID-positive patients being the primary study population (2836 had no COVID-19 test; 18 were excluded due to fasting <5 years). A Cox regression was used to evaluate HF admissions, MACEs, and other endpoints through March 2023, adjusting for covariables, including time-varying COVID-19 vaccination. RESULTS In patients positive for COVID-19, periodic fasting was reported by 180 (30.0% of 601), who periodically fasted over 43.1 ± 19.2 years (min: 7, max: 83). HF hospitalization (n = 117, 19.5%) occurred in 13.3% of fasters and 22.1% of non-fasters [adjusted hazard ratio (aHR) = 0.63, CI = 0.40, 0.99; p = 0.044]. Most HF admissions were exacerbations, with a prior HF diagnosis in 111 (94.9%) patients hospitalized for HF. Fasting was also associated with a lower MACE risk (aHR = 0.64, CI = 0.43, 0.96; p = 0.030). In n = 1772 COVID-negative patients (29.7% fasters), fasting was not associated with HF hospitalization (aHR = 0.82, CI = 0.64, 1.05; p = 0.12). In COVID-positive and negative patients combined, periodic fasting was associated with lower mortality (aHR = 0.60, CI = 0.39, 0.93; p = 0.021). CONCLUSIONS Routine periodic fasting was associated with less HF hospitalization in patients positive for COVID-19.
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Affiliation(s)
- Benjamin D. Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA;
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeffrey L. Anderson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA;
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Heidi T. May
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
| | - Viet T. Le
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
- Department of Physician Assistant Studies, Rocky Mountain University of Health Professions, Provo 84606, UT, USA
| | - Stacey Knight
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
- Genetic Epidemiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Tami L. Bair
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
| | - Kirk U. Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (J.L.A.); (H.T.M.); (V.T.L.); (S.K.); (T.L.B.); (K.U.K.)
- Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA
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13
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Manasrah N, Duhan S, Ali S, Atti L, Keisham B, Micho T, Titus A, Pandya KK, Patel NN, Uppal D, Sattar Y, AlJaroudi WA, Alraies MC. Impact of heart failure on COVID-19 patients: An insight from nationwide inpatient sample. Am J Med Sci 2024; 367:363-374. [PMID: 38417573 DOI: 10.1016/j.amjms.2024.02.011] [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: 11/05/2023] [Revised: 01/15/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Patients with COVID-19 have been reported to experience adverse cardiovascular outcomes, such as myocarditis, acute myocardial infarction, and heart failure. Among these complications, heart failure (HF) has emerged as the most common critical complication during exacerbations of COVID-19, potentially leading to increased mortality rates and poorer clinical outcomes. We aimed to investigate the in-hospital outcomes of COVID-19 patients with HF. METHODS We analyzed the Nationwide Inpatient Sample (NIS) dataset to select COVID-19 patients aged over 18 years who were hospitalized between January 1, 2020, and December 31, 2020, using ICD-10. Based on the presence of acute HF, the patients were divided into two cohorts. The clinical outcomes and complications were assessed at index admissions using STATA v.17." RESULTS 1,666,960 COVID-19 patients were hospitalized in 2020, of which 156,755 (9.4%) had associated HF. COVID-19 patients with HF had a mean age of (72.38 ± 13.50) years compared to (62.3 ± 17.67) years for patients without HF. The HF patients had a higher prevalence of hypertension, hyperlipidemia, type 2 diabetes, smoking, and preexisting cardiovascular disease. Additionally, after adjusting for baseline demographics and comorbidities, COVID-19 patients with HF had higher rates of in-hospital mortality (23.86% vs. 17.63%, p<0.001), acute MI (18.83% vs. 10.91%, p<0.001), acute stroke (0.78% vs. 0.58%, p=0.004), cardiogenic shock (2.56% vs. 0.69%, p<0.001), and sudden cardiac arrest (5.54% vs. 3.41%, p<0.001) compared to those without HF. CONCLUSION COVID-19 patients admitted with acute HF had worse clinical outcomes, such as higher mortality, myocardial infarction, cardiogenic shock, cardiac arrest, and a higher length of stay and healthcare than patients without HF.
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Affiliation(s)
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital, Lansing, MI, USA
| | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Tarec Micho
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Krutarth K Pandya
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neel N Patel
- Department of Internal Medicine, Landmark Medical Center, Woonsocket, NY, US
| | - Dipan Uppal
- Department of Cardiology, Cleveland Clinic, Florida, US
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, USA
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Augusta University, Augusta, GA, USA
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI, USA.
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14
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Mehraeen E, Abbaspour F, Banach M, SeyedAlinaghi S, Zarebidoki A, Tamehri Zadeh SS. The prognostic significance of insulin resistance in COVID-19: a review. J Diabetes Metab Disord 2024; 23:305-322. [PMID: 38932824 PMCID: PMC11196450 DOI: 10.1007/s40200-024-01385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/31/2023] [Indexed: 06/28/2024]
Abstract
Objectives Emerging publications indicate that diabetes predisposes patients with COVID-19 to more severe complications, which is partly attributed to inflammatory condition. In the current review, we reviewed recent published literature to provide evidence on the role of insulin resistance (IR) in diabetes, the association between diabetes and COVID-19 severity and mortality, the impact of COVID-19 infection on incident new-onset diabetes, mechanisms responsible for IR in COVID-19 patients, and the predictive value of different surrogates of IR in COVID-19. Method The literature search performs to find out studies that have assessed the association between IR surrogates and morbidity and mortality in patients with COVID-19. Results We showed that there is a bulk of evidence in support of the fact that diabetes is a potent risk factor for enhanced morbidity and mortality in COVID-19 patients. COVID-19 patients with diabetes are more prone to remarkable dysglycemia compared to those without diabetes, which is associated with an unfavourable prognosis. Furthermore, SARS-COV2 can make patients predispose to IR and diabetes via activating ISR, affecting RAAS signaling pathway, provoking inflammation, and changing the expression of PPARɣ and SREBP-1. Additionally, higher IR is associated with increased morbidity and mortality in COVID-19 patients and different surrogates of IR can be utilized as a prognostic biomarker for COVID-19 patients. Conclusion Different surrogates of IR can be utilized as predictors of COVID-19 complications and death.
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Affiliation(s)
- Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Faeze Abbaspour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), 93338 Lodz, Poland
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Zarebidoki
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Saeed Tamehri Zadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box 19395-4763, Tehran, Iran
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15
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Galiatsatos P, Garibaldi B, Yao D, Xu Y, Perin J, Shahu A, Jackson JW, Piggott D, Falade-Nwulia O, Shubella J, Michtalik H, Belcher HME, Hansel NN, Golden S. Lack of racial and ethnic disparities in mortality in minority patients hospitalised with COVID-19 in a mid-Atlantic healthcare system. BMJ Open Respir Res 2024; 11:e002310. [PMID: 38692710 PMCID: PMC11086483 DOI: 10.1136/bmjresp-2024-002310] [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: 01/12/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION In the USA, minoritised communities (racial and ethnic) have suffered disproportionately from COVID-19 compared with non-Hispanic white communities. In a large cohort of patients hospitalised for COVID-19 in a healthcare system spanning five adult hospitals, we analysed outcomes of patients based on race and ethnicity. METHODS This was a retrospective cohort analysis of patients 18 years or older admitted to five hospitals in the mid-Atlantic area between 4 March 2020 and 27 May 2022 with confirmed COVID-19. Participants were divided into four groups based on their race/ethnicity: non-Hispanic black, non-Hispanic white, Latinx and other. Propensity score weighted generalised linear models were used to assess the association between race/ethnicity and the primary outcome of in-hospital mortality. RESULTS Of the 9651 participants in the cohort, more than half were aged 18-64 years old (56%) and 51% of the cohort were females. Non-Hispanic white patients had higher mortality (p<0.001) and longer hospital length-of-stay (p<0.001) than Latinx and non-Hispanic black patients. DISCUSSION In this large multihospital cohort of patients admitted with COVID-19, non-Hispanic black and Hispanic patients did not have worse outcomes than white patients. Such findings likely reflect how the complex range of factors that resulted in a life-threatening and disproportionate impact of incidence on certain vulnerable populations by COVID-19 in the community was offset through admission at well-resourced hospitals and healthcare systems. However, there continues to remain a need for efforts to address the significant pre-existing race and ethnicity inequities highlighted by the COVID-19 pandemic to be better prepared for future public health emergencies.
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Affiliation(s)
| | | | - Dapeng Yao
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Yanxun Xu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jamie Perin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andi Shahu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - John W Jackson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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Prada BS, Jadhav U, Ghewade B, Wagh P, Karnan A, Ledwani A. Comparing Glycopyrronium/Formoterol Combination Therapy With Monotherapy in Moderate-to-Severe Chronic Obstructive Pulmonary Disease (COPD): A Narrative Review. Cureus 2024; 16:e58633. [PMID: 38770495 PMCID: PMC11103448 DOI: 10.7759/cureus.58633] [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: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) imposes a significant burden on individuals and healthcare systems globally. While bronchodilators, such as glycopyrronium and formoterol, are cornerstone therapies for COPD management, combining these agents has gained attention for potentially improving outcomes compared to monotherapy. This comprehensive review aims to assess the efficacy and safety of glycopyrronium/formoterol (GFF) combination therapy versus glycopyrronium monotherapy in patients with moderate-to-severe COPD. Through a systematic evaluation of clinical trials and real-world evidence, we analyze the impact of combination therapy on lung function, symptom control, exacerbation rates, and health-related quality of life (HRQoL). Furthermore, we examine the safety profile of combination therapy, including adverse cardiovascular and respiratory events. Comparative analyses with glycopyrronium monotherapy provide insights into the relative benefits and considerations for treatment selection. Factors influencing treatment choice and future directions in COPD management are also discussed. This review underscores the potential of combination therapy in optimizing COPD treatment outcomes and highlights areas for further research and clinical practice refinement.
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Affiliation(s)
- Bollineni S Prada
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Wagh
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwin Karnan
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjana Ledwani
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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17
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Elamin MY, Maslamani YA, Alsheikh FA, Sailah MA, Samm MA, Motanbk AM, Hejri YM, Alameer AA, Khalid OH, Dahlan AA, Gosadi IM. Impact of vaccination on morbidity and mortality in adults hospitalized with COVID-19 during the omicron wave in the Jazan Region, Saudi Arabia. Saudi Med J 2024; 45:179-187. [PMID: 38309738 PMCID: PMC11115406 DOI: 10.15537/smj.2024.45.2.20230530] [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: 07/17/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To evaluate the impact of coronavirus disease-19 (COVID-19) vaccination on morbidity and mortality in adults hospitalized with COVID-19 during the omicron wave in the Jazan Region, Saudi Arabia. METHODS A 6-month record-based historical prospective study enrolled COVID-19 adult patients admitted between January and June 2022. Individuals were classified into 3 groups according to their immunity status (immunized, partially immunized, and not immunized). Death, intensive care unit (ICU) admission, and mechanical ventilation were identified as the primary outcomes, collectively referred to as "serious outcomes". On the other hand, the length of hospital stays longer than 5 days was categorized as a secondary outcome. Multiple logistic regression analysis was used to evaluate independent factors and the relationship between the outcomes and vaccination status. RESULTS Among the 634 COVID-19 patients admitted to Jazan hospitals, 46.4% were fully immunized, 19.7% were partially immunized, and 33.9% were not immunized. Not being immunized was significantly associated with ICU admission (odds ratio [OR]=1.91, 95% confidence interval [CI]: [1.17-3.11]; p=0.009), mechanical ventilation (OR=2.11, 95% CI: [1.25-3.56]; p=0.005), increased length of hospital stays (OR=1.79, 95% CI: [1.24-2.59]; p=0.002), and death (OR=3.03, 95% CI: [1.85-4.98]; p<0.001). CONCLUSION Our study underscores the importance of a comprehensive approach for managing COVID-19 patients that includes vaccination against the disease.
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Affiliation(s)
- Mohammed Y. Elamin
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Yahya A. Maslamani
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Feras A. Alsheikh
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Mohsen A. Sailah
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Mussab A. Samm
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Ahmed M. Motanbk
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Yehya M. Hejri
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Anwar A. Alameer
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Osama H. Khalid
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Abdu A. Dahlan
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Ibrahim M. Gosadi
- From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
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Khan Z, Mlawa G, Islam S, Elshowaya S, Saleem M. A Retrospective Study on the Outcome of Coronavirus Disease 2019 (COVID-19) Patients Admitted to a District General Hospital and Predictors of High Mortality. Cureus 2024; 16:e53432. [PMID: 38435221 PMCID: PMC10908435 DOI: 10.7759/cureus.53432] [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] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The clinical features and severity of coronavirus disease 2019 (COVID-19) vary between patients and countries. Patients with certain conditions are predisposed to poor outcomes compared with those without medical conditions, such as diabetes, dementia, and hypertension (HTN). METHODS The aim of this retrospective study was to assess factors associated with higher mortality in patients with COVID-19 infections and to identify the reason for hospital admission in these patients. The study was performed on patients admitted between 1 and 31 March 2020. Data collection was done retrospectively from electronic medical records. RESULTS There were 269 patient admissions during this period, of which 147 were included in this audit. The mean age of COVID-19-positive patients was 62.8 years and 65.9 years for COVID-19-negative patients during this period. Forty-seven patients requiring hospital admission were COVID-19 positive and 93 were COVID-19 negative. There were no COVID-19 swabs in the seven patients included in the audit. Approximately 50% of the COVID-19-positive patients presented with fever and shortness of breath (sob), followed by dyspnea and cough (seven patients). The most common comorbidity was HTN, followed by type 2 diabetes mellitus (T2DM) and ischemic heart disease (IHD). The survival rate was 72.3% in COVID-19-positive patients and 80% in COVID-19-negative patients. The average length of stay was 14.4 days for COVID-19-positive survivors compared to 7.8 days for COVID-19-negative survivors. Most patients who tested positive for COVID-19 infection received oseltamivir vaccination and antibiotics. The presence of HTN, diabetes mellitus (DM), age, and organ failure was associated with a high mortality risk. CONCLUSION Our study supports the findings of previous studies that diabetes, HTN, coronary artery disease, old age, and organ failure were associated with high mortality in patients admitted to hospitals with COVID-19 infections.
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Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
| | - Gideon Mlawa
- Internal Medicine and Diabetes and Endocrinology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Saiful Islam
- General Medicine and Gastroenterology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Suhier Elshowaya
- Internal Medicine and Diabetes and Endocrinology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Mohammad Saleem
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
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19
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Taneska AC, Rambabova-Bushljetik I, Markovska ZS, Milenkova M, Vasileva AS, Zafirova B, Pushevski V, Severova G, Trajceska L, Spasovski G. Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:107-119. [PMID: 38109446 DOI: 10.2478/prilozi-2023-0054] [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] [Indexed: 12/20/2023]
Abstract
Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 - 0.958, p = 0.000; OR 0.987; 95%CI: 0.885-0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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Affiliation(s)
| | - Irena Rambabova-Bushljetik
- 1University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University, Skopje, RN Macedonia
| | | | - Mimoza Milenkova
- 1University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University, Skopje, RN Macedonia
| | | | - Biljana Zafirova
- 2Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Vladimir Pushevski
- 1University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University, Skopje, RN Macedonia
| | - Galina Severova
- 1University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University, Skopje, RN Macedonia
| | - Lada Trajceska
- 1University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University, Skopje, RN Macedonia
| | - Goce Spasovski
- 1University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University, Skopje, RN Macedonia
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20
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Zenba Y, Kobayashi A, Imai T. Psychological distress is affected by fear of COVID-19 via lifestyle disruption and leisure restriction among older adults in Japan: a cross-sectional study. Front Public Health 2023; 11:1264088. [PMID: 38026356 PMCID: PMC10643141 DOI: 10.3389/fpubh.2023.1264088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Engaging in social activities is an essential component of a healthy lifestyle for community-dwelling older adults. Critically, as with past disasters, there is concern about the effects of long-term activity restrictions due to the coronavirus disease 2019 (COVID-19) pandemic on health of older adults. However, the precise associations between fear of COVID-19, lifestyle satisfaction, leisure activities, and psychological distress are unclear. Objective The purpose of this study was to comprehensively determine the associations between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress among community-dwelling older adults in the context of the ongoing COVID-19 pandemic. Materials and methods A questionnaire survey administered by mail was conducted from October 1 to October 15, 2021. The questionnaire included the Fear of COVID-19 Scale, the Lifestyle Satisfaction Scale, the Leisure Activity Scale for Contemporary Older Adults, and the Kessler Psychological Distress Scale-6. Based on previous studies, we developed a hypothetical model for the association between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress and performed structural equation modeling to assess the relationships between these variables. Results Participants included 301 Japanese citizens (23.6% male, 76.4% female), with a mean age of 76.7 ± 4.58 years. Goodness-of-fit from structural equation modeling was generally good. Analysis of standardized coefficients revealed a significant positive relationship between fear of COVID-19 and psychological distress (β = 0.33, p < 0.001) and lifestyle satisfaction and leisure activities (β = 0.35, p < 0.001). We further observed a significant negative relationship between fear of COVID-19 and lifestyle satisfaction (β = -0.23, p < 0.001) and between leisure activities and psychological distress (β = -0.33, p < 0.001). Conclusion Fear of COVID-19 is significantly associated with psychological distress, both directly and via its effects on lifestyle satisfaction and leisure activities. That is, not only did fear of COVID-19 directly impact psychological distress of participants, it also affected psychological distress through lifestyle disruption and leisure restriction. This results may be used to better understand how a national emergency that substantially restricts daily life, such as COVID-19 or an earthquake disaster, can affect the psychological health and wellbeing of older, community-dwelling adults.
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Affiliation(s)
- Yosuke Zenba
- Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Akihiro Kobayashi
- Department of Occupational Therapy, Faculty of Rehabilitation, Gunma University of Health and Welfare, Gunma, Japan
| | - Tadanori Imai
- Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
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21
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Annareddy S, Ghewade B, Jadhav U, Wagh P. Unraveling the Predictive Potential of Rapid Scoring in Pleural Infection: A Critical Review. Cureus 2023; 15:e44515. [PMID: 37789994 PMCID: PMC10544591 DOI: 10.7759/cureus.44515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Pleural infection, or pleural empyema, is a severe medical condition associated with high morbidity and mortality rates. Timely and accurate prognostication is crucial for optimizing patient outcomes and resource allocation. Rapid scoring systems have emerged as promising tools in pleural infection prognostication, integrating various clinical and laboratory parameters to assess disease severity and quantitatively predict short-term and long-term outcomes. This review article critically evaluates existing rapid scoring systems, including CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥ 65 years), A-DROP (age (male >70 years, female >75 years), dehydration, respiratory failure, orientation disturbance, and low blood pressure), and APACHE II (acute physiology and chronic health evaluation II), assessing their predictive accuracy and limitations. Our analysis highlights the potential clinical implications of rapid scoring, including risk stratification, treatment tailoring, and follow-up planning. We discuss practical considerations and challenges in implementing rapid scoring such as data accessibility and potential sources of bias. Furthermore, we emphasize the importance of validation, transparency, and multidisciplinary collaboration to refine and enhance the clinical applicability of these scoring systems. The prospects for rapid scoring in pleural infection management are promising, with ongoing research and data science advances offering improvement opportunities. Ultimately, the successful integration of rapid scoring into clinical practice can potentially improve patient care and outcomes in pleural infection management.
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Affiliation(s)
- Srinivasulareddy Annareddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Wagh
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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22
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Vaman RS, Valamparampil MJ, Dalmita NJ, Reghukumar A, Anish TS. Immediate cause and the role of multimorbidity in deaths associated with COVID 19 among hospitalized patients in a low resource district in Kerala India: A record-based case-control analysis. J Family Med Prim Care 2023; 12:1593-1601. [PMID: 37767413 PMCID: PMC10521846 DOI: 10.4103/jfmpc.jfmpc_2061_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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India. Methods A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants. Results The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24-3.83)) and malignancy (AOR = 3.05 (1.27-7.32)) to be significantly associated with mortality as individual determinants. Hypertension-diabetes mellitus [AOR = 1.68 (1.02-2.76), P = 0.043] and hypertension-CKD [AOR = 3.49 (1.01-12.01), P = 0.48] dyads were multimorbidities significantly associated with mortality. Conclusion Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19.
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Affiliation(s)
- Raman Swathy Vaman
- Scholar, ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | | | - Aravind Reghukumar
- Department of Infectious Diseases, Government Medical College, Trivandrum, Kerala, India
| | - T. S. Anish
- Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India
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23
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Garg A, Posa MK, Kumar A. Diabetes and deaths of COVID-19 patients: Systematic review of meta-analyses. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2023; 7:100099. [PMID: 37229298 PMCID: PMC10191721 DOI: 10.1016/j.hsr.2023.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
Background COVID-19 is affecting all kinds of patients including diabetics. This article provides an overview of conducted meta-analyses regarding the effect of diabetes on the deaths of COVID-19 patients. Methodology The study was conducted as per preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Data sources The relevant meta-analyses were searched on PubMed till April 2021 and data was extracted from 24 relevant meta-analyses. The overall estimate was calculated in terms of odds ratio or relative risk with a 95% confidence interval. Results A total of 09 meta-analyses showed the association of diabetes with the death of COVID-19 patients and 15 meta-analyses have reported the association of diabetes with other comorbidities in the death of COVID-19 patients. The pooled odds ratio or relative risk has shown a significant association of diabetes alone or its associated comorbidities with deaths of COVID-19 patients. Conclusion Patients with diabetes and its associated comorbidities need more monitoring if get SARS-Cov-2 infection to reduce deaths.
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Affiliation(s)
- Aakriti Garg
- School of Pharmaceutical Sciences, Apeejay Stya University, Sohna, Gurugram 122103, India
| | - Mahesh Kumar Posa
- School of Pharmacy and Technology Management, SVKM'S NMIMS, Polepally SEZ, Jadcherla, Hyderabad, 509301, India
| | - Anoop Kumar
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences & Research University (DPSRU) New Delhi 110017, India
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24
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Alam MS, Hasan MN, Maowa Z, Khatun F, Nazir KHMNH, Alam MZ. N-acetylcysteine reduces severity and mortality in COVID-19 patients: A systematic review and meta-analysis. J Adv Vet Anim Res 2023; 10:157-168. [PMID: 37534078 PMCID: PMC10390689 DOI: 10.5455/javar.2023.j665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives Recent clinical studies suggest that oxidative stress is one of the key players in the pathogenesis of coronavirus disease 2019 (COVID-19), and N-acetylcysteine (NAC), a potent antioxidant, has been shown to improve clinical outcomes in COVID-19 patients. We conducted a systematic review and meta-analysis of the literature published on the therapeutic intervention of NAC on COVID-19 infection. Methods We searched PubMed, Google Scholar, and Science Direct. We identified and screened eight studies with 20,503 participants, including 2,852 in the NAC-treated group and 17,651 in the placebo group, which reported the effect of NAC on COVID-19 infection. A meta-analysis was performed using forest plots under fixed effect estimates based on the standardized mean difference (SMD) and risk ratio (RR). Results Pooled analysis showed that NAC was associated with lower mortality in patients with COVID-19 compared with the placebo group [RR, 0.65; (95% CI: 0.56 to 0.75); p < 0.0001]. Similarly, C-reactive protein (CRP) [SMD, -0.32; (95% CI: -56 to -0.09); p = 0.0070] and D-dimer [SMD, -0.35, (95% CI: -0.59 to -0.10; p = 0.0062] levels were significantly decreased, and the oxygenation marker, PaO2/FiO2 ratio, was increased in the NAC-treated group compared with the placebo group [SMD, 0.76; (95% CI: 0.48 to 1.03); p < 0.0001]. Conclusion Although the number of included studies was minimal, this meta-analysis suggests that NAC may have a positive effect on COVID-19 outcomes, specifically, a significant decrease in CRP and D-dimer levels and a significant increase in oxygen saturation, which decreased mortality. We have also presented a comprehensive review of the role and mechanisms of NAC in patients with COVID-19.
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Affiliation(s)
- Mohammad Shah Alam
- Department of Anatomy and Histology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Mohammad Nazmol Hasan
- Department of Statistics, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Zannatul Maowa
- Department of Anatomy and Histology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Fahima Khatun
- Department of Pathobiology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | | | - Mohammad Zahangeer Alam
- Department of Environmental Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
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25
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Alhallak I, Paydak H, Mehta JL. Prior Statin vs In-Hospital Statin Usage in Severe COVID-19: Review and Meta-Analysis. Curr Probl Cardiol 2023:101810. [PMID: 37211301 PMCID: PMC10198742 DOI: 10.1016/j.cpcardiol.2023.101810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
Studies have shown that statins can decrease COVID-19 mortality in hospitalized patients. This paper evaluates these studies and reviews the possible mechanism of how statins modulate COVID-19 severity. Meta-analysis of 31 retrospective studies demonstrated a reduction in mortality rate among statin users (OR 0.69, 95% CI 0.56-0.86, p =0.0008) (HR 0.83, 95% CI 0.72-0.95, p =0.0078). Meta-analysis of 8 randomized control studies demonstrated a nonsignificant reduction in mortality (OR 0.90, 95% CI 0.69-1.18, p =0.461), including four studies with medications other than statins, and four studies with only statins (OR 0.88, 95% CI 95% CI 0.64-1.21, p =0.423). Prolonged statin usage decreases the extracellular localization of ACE2, along with statins' immunomodulating effects and reduction of oxidative stress, decreases COVID-19 mortality. Hospitalized patients with COVID-19 should continue statin treatment if previously prescribed, and patients should not be started on statins, as they do not seem to provide any mortality benefit.
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Affiliation(s)
- Iad Alhallak
- Department of Cardiology, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA
| | - Hakan Paydak
- Department of Cardiology, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA
| | - Jawahar L Mehta
- Department of Cardiology, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA.
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Reid J, Daya R, Zingoni ZM, Jassat W, Bayat Z, Nel J. COVID-19 in-hospital mortality during the first two pandemic waves, at Helen Joseph Hospital, South Africa. Pan Afr Med J 2023; 45:5. [PMID: 37346915 PMCID: PMC10280698 DOI: 10.11604/pamj.2023.45.5.39222] [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: 02/07/2023] [Accepted: 04/19/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction there has been significant global variation in Coronavirus Disease (COVID-19) mortality at different time points in the pandemic. Contributing factors include population demographics, comorbidities, health system capacity, prior infection with COVID-19, vaccinations, and viral variants. The study aims to describe COVID-19-related mortality of inpatients at Helen Joseph Hospital (HJH), over 12 months, during the first two waves of the COVID-19 pandemic in South Africa. The primary objectives were to describe the socio-demographic details, clinical characteristics, and hospital outcomes during the first and second waves of COVID-19. This included an assessment of the in-hospital case fatality ratio (CFR) of patients admitted with COVID-19. The secondary objectives were to compare the socio-demographic details, clinical characteristics, and outcomes between the two waves, and to determine risk factors associated with COVID-19-related mortality. Methods this is a retrospective cohort study of all inpatient laboratory-confirmed COVID-19 cases at HJH from 1st May 2020 to 31st April 2021. Data were collected by the National Institute for Communicable Diseases (NICD). Bivariate analysis was performed to describe and compare the socio-demographic characteristics, clinical characteristics, and hospital admission outcomes between the two waves. Multivariate logistic regression was used to determine risk factors for COVID-19-related mortality. Results overall, 1359 patients were admitted, 595 in wave one, and 764 in wave two. Patients were predominantly male (52.4%), of Black African race (75.1%) with a mean age of 54.6 (standard deviation 15.4) years. The median length of stay was 8 days (interquartile range 5-14 days). In total, 73.2% (995) of patients required oxygen, 5.2% (71) of patients received mechanical ventilation, and 7.1% (96) were admitted to the high care and Intensive Care Unit (ICU). The most common comorbid illnesses were hypertension (36.7%, n=499), diabetes mellitus (26.6%, n=362), Human Immunodeficiency Virus (HIV) (10.8%, n=147), and obesity (11.0%, n=149). The in-hospital CFR during the first wave was 30.4% (181/595) and 25.5% (195/764) (p<0.001) in the second wave, and overall, in-hospital CFR was 27.7% (376/1359). The adjusted odds of death were 79% higher among patients admitted during wave one compared to wave two (aOR=1.79; 95% CI: 1.35-2.38). A one-year increase in age increased the odds of death by 4% (aOR=1.04; 95% CI: 1.03-1.05). The need for oxygen (aOR=2.17, 95%CI: 1.56-3.01) and ventilation (aOR=7.23, 95% CI: 4.02-13.01) were significant risk factors for mortality. Conclusion prior to the availability of vaccines, COVID-19-related mortality was high and risk factors for mortality were consistent with national and international findings. This study reflects the impact of the pandemic on the South African public sector with limited resources and minimal ICU capacity.
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Affiliation(s)
- Joanna Reid
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reyna Daya
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zvifadzo Matsena Zingoni
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Waasila Jassat
- National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), South Africa
- Right to Care, Centurion, South Africa
| | - Zaheer Bayat
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremy Nel
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Krishnan A, Kumar R, Amarchand R, Mohan A, Kant R, Agarwal A, Kulshreshtha P, Panda PK, Bhadoria AS, Agarwal N, Biswas B, Nair R, Wig N, Malhotra R, Bhatnagar S, Aggarwal R, Soni KD, Madan N, Trikha A, Tiwari P, Singh AR, Wyawahare M, Gunasekaran V, Sekar D, Misra S, Bhardwaj P, Goel AD, Dutt N, Kumar D, Nagarkar NM, Galhotra A, Jindal A, Raj U, Behera A, Siddiqui S, Kokane A, Joshi R, Pakhare A, Farooque F, Pawan S, Deshmukh P, Solanki R, Rathod B, Dutta V, Mohapatra PR, Panigrahi MK, Barik S, Guleria R. Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study. Am J Trop Med Hyg 2023; 108:727-733. [PMID: 36913920 PMCID: PMC10077017 DOI: 10.4269/ajtmh.22-0705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/12/2023] [Indexed: 03/15/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December-March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46-59 years, 3.4 [95% CI: 1.5-7.7]; 60-74 years, 4.1 [95% CI: 1.7-9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0-30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2-2.9]); malignancy (aOR: 3.1 [95% CI: 1.3-7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2-8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4-3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7-11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6-3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | - Neeraj Agarwal
- Department of Community & Family Medicine, AIIMS, Patna, India
| | - Bijit Biswas
- Department of Community & Family Medicine, AIIMS, Patna, India
| | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| | - Rajesh Malhotra
- Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia, BRAIRCH, AIIMS, New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Kapil Dev Soni
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Nirupam Madan
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | | | - Mukta Wyawahare
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India
| | | | - Dineshbabu Sekar
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India
| | | | - Pankaj Bhardwaj
- Department of Community & Family Medicine, AIIMS, Jodhpur, India
| | | | - Naveen Dutt
- Department of Pulmonary Medicine, AIIMS, Jodhpur, India
| | | | | | | | - Atul Jindal
- Department of Paediatrics, AIIMS, Raipur, India
| | - Utsav Raj
- National Tuberculosis Elimination Program, AIIMS, Raipur, India
| | - Ajoy Behera
- Department of Pulmonary Medicine, AIIMS, Raipur, India
| | | | - Arun Kokane
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | | | - Abhijit Pakhare
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Farhan Farooque
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Sai Pawan
- Department of Medicine, AIIMS, Bhopal, India
| | | | - Ranjan Solanki
- Department of Community & Family Medicine, AIIMS, Nagpur, India
| | | | | | | | | | - Sadananda Barik
- Department of Trauma & Emergency Medicine, AIIMS, Bhubaneswar, India
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Misganaw S, Eshetu B, Adane A, Solomon T. Predictors of death among severe COVID-19 patients admitted in Hawassa City, Sidama, Southern Ethiopia: Unmatched case-control study. PLoS One 2023; 18:e0282478. [PMID: 36857375 PMCID: PMC9977030 DOI: 10.1371/journal.pone.0282478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Since COVID-19 was announced as a worldwide pandemic, the world has been struggling with this disease. In Ethiopia, there is some information on the epidemiological characteristics of the disease and treatment outcomes of COVID-19 patients. But, there is limited evidence related to predictors of death in COVID-19 patients. OBJECTIVE To assess the predictor of death among severely ill COVID-19 patients admitted in Hawassa city COVID-19 treatment centers. METHODS An institution-based unmatched case-control study was conducted at Hawassa city COVID-19 treatment centers from May 2021 to June 2021. All severe COVID-19-related deaths from May 2020 to May 2021 were included in the case group whereas randomly selected discharged severe COVID-19 patients were included in the control group. Extracted information was entered into Epi-data 4.6 and exported to SPSS 25 for analysis. Multivariable binary logistic regression was run to assess predictors. The result was presented as an adjusted odds ratio with a 95% confidence interval. Variables with a 95% confidence interval which not included one were considered statistically significant. RESULT A total of 372 (124 cases and 248 controls) patients were included in the study. Multivariable analysis revealed age ≥ 65 years (AOR = 2.62, 95% CI = 1.33-5.14), having shortness of breath (AOR = 1.87, 95% CI = 1.02-3.44), fatigue (AOR 1.78, 95% CI = 1.09-2.90), altered consciousness (AOR 3.02, 95% CI = 1.40, 6.49), diabetic Mellitus (AOR = 2.79, 95% CI = 1.16-6.73), chronic cerebrovascular disease (AOR = 2.1, 95% CI = 1.23, 3.88) were found to be predictors of death. CONCLUSION Older age, shortness of breath, fatigue, altered consciousness, and comorbidity were predictors of death in Severe COVID-19 patients.
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Affiliation(s)
- Samuel Misganaw
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Betelhem Eshetu
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Adugnaw Adane
- Department of Human Physiology, Faculty of Medical Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tarekegn Solomon
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Muehlenbein M, Gassen J, Nowak T, Henderson A, Morris B, Weaver S, Baker E. Age-Dependent Relationships Between Disease Risk and Testosterone Levels: Relevance to COVID-19 Disease. Am J Mens Health 2023; 17:15579883221130195. [PMID: 36935555 PMCID: PMC10028446 DOI: 10.1177/15579883221130195] [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] [Indexed: 03/21/2023] Open
Abstract
Testosterone levels in men appear to be prognostic of a number of disease outcomes, including severe COVID-19 disease. Testosterone levels naturally decline with age and are lower in individuals with a number of comorbidities and chronic conditions. Low testosterone may therefore be both a cause and a consequence of illness, including COVID-19 disease. The present project examines whether preexisting conditions for severe COVID-19 disease were themselves related to serum-free testosterone levels in men who had not been infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. A clinical risk score for severe COVID-19 disease was computed based on the results of previously published meta-analyses and cohort studies, and relationships between this score and testosterone levels were tested in 142 men ages 19 to 82 years. Greater burden of preexisting conditions for severe COVID-19 disease was related to lower testosterone levels among men younger than 40 years of age. In older men, the decrease in testosterone that accompanies aging attenuated the effect of the clinical risk score on free testosterone levels. Given that older age itself is a predictor of COVID-19 disease severity, these results together suggest that the presence of preexisting conditions may confound the relationship between testosterone levels and COVID-19 disease outcomes in men. Future research examining relationships among testosterone and outcomes related to infectious and chronic diseases should consider potential confounds, such as the role of preexisting conditions.
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Garcia LR, Garzesi AM, Sinatora JB, Grotto RMT, Passaroni AC, de Campos NLKL, Martins AS, Felicio ML, Brito FDS. Orthotopic Heart Transplantation in a Covid-19 Recipient. Arq Bras Cardiol 2023; 120:e20220234. [PMID: 37018788 PMCID: PMC10392859 DOI: 10.36660/abc.20220234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/03/2022] [Accepted: 09/21/2022] [Indexed: 04/07/2023] Open
Affiliation(s)
- Leonardo Rufino Garcia
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - André Monti Garzesi
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Julia Bazzo Sinatora
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Rejane Maria Tommasini Grotto
- Laboratório de Biotecnologia AplicadaHospital das Clínicas de BotucatuUNESPBotucatuSPBrasilLaboratório de Biotecnologia Aplicada do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Andréia Cristina Passaroni
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Nelson Leonardo Kerdahi Leite de Campos
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Antônio Sérgio Martins
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Marcello Laneza Felicio
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Flávio de Souza Brito
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
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Lung Ultrasound Is Useful for Evaluating Lung Damage in COVID-19 Patients Treated with Bamlanivimab and Etesevimab: A Single-Center Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020203. [PMID: 36837405 PMCID: PMC9962749 DOI: 10.3390/medicina59020203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Background and Objectives: COVID-19 induces massive systemic inflammation. Researchers have spent much time and effort finding an excellent and rapid image tool to evaluate COVID-19 patients. Since the pandemic's beginning, lung ultrasound (LUS) has been identified for this purpose. Monoclonal antibodies (mAb) were used to treat mild patients and prevent respiratory disease worsening. Materials and Methods: We evaluated 15 Caucasian patients with mild COVID-19 who did not require home oxygen, treated with Bamlanivimab and Etesevimab (Group 1). A molecular nose-throat swab test confirmed the diagnosis. All were office patients, and nobody was affected by respiratory failure. They were admitted to receive the single-day infusion of mAb treatment in agreement with the Italian Drug Agency (AIFA) rules for approval. LUS was performed before the drug administration (T0) and after three months (T1). We compared LUS at T1 in other outpatients who came for follow-up and were overlapping at the time of diagnosis for admittance criteria to receive mAb (Group 2). Results: Our COVID-19 outpatients reported no hospitalization in a follow-up visit after recovery. All patients became SARS-CoV-2 negative within one month since T0. LUS score at T0 was 8.23 ± 6.46. At T1 we found a significant decrease in Group 1 LUS score (5.18 ± 4.74; p < 0.05). We also found a significant decrease in the LUS score of Group 1 T1 compared to Group2 T1 (5.18 ± 4.74 vs 7.82 ± 5.21; p < 0.05). Conclusion: Early treatment of the SARS-CoV-2 virus effectively achieves a better recovery from disease and reduces lung involvement after three months as evaluated with LUS. Despite extrapolation to the general population may be done with caution, based on our data this ultrasound method is also effective for evaluating and following lung involvement in COVID-19 patients.
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Gatto NM, Freund D, Ogata P, Diaz L, Ibarrola A, Desai M, Aspelund T, Gluckstein D. Correlates of Coronavirus Disease 2019 Inpatient Mortality at a Southern California Community Hospital With a Predominantly Hispanic/Latino Adult Population. Open Forum Infect Dis 2023; 10:ofad011. [PMID: 36726553 PMCID: PMC9887269 DOI: 10.1093/ofid/ofad011] [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: 12/15/2022] [Accepted: 12/06/2023] [Indexed: 01/11/2023] Open
Abstract
Background Studies of inpatient coronavirus disease 2019 (COVID-19) mortality risk factors have mainly used data from academic medical centers or large multihospital databases and have not examined populations with large proportions of Hispanic/Latino patients. In a retrospective cohort study of 4881 consecutive adult COVID-19 hospitalizations at a single community hospital in Los Angeles County with a majority Hispanic/Latino population, we evaluated factors associated with mortality. Methods Data on demographic characteristics, comorbidities, laboratory and clinical results, and COVID-19 therapeutics were abstracted from the electronic medical record. Cox proportional hazards regression modeled statistically significant, independently associated predictors of hospital mortality. Results Age ≥65 years (hazard ratio [HR] = 2.66; 95% confidence interval [CI] = 1.90-3.72), male sex (HR = 1.31; 95% CI = 1.07-1.60), renal disease (HR = 1.52; 95% CI = 1.18-1.95), cardiovascular disease (HR = 1.45; 95% CI = 1.18-1.78), neurological disease (HR = 1.84; 95% CI = 1.41-2.39), D-dimer ≥500 ng/mL (HR = 2.07; 95% CI = 1.43-3.0), and pulse oxygen level <88% (HR = 1.39; 95% CI = 1.13-1.71) were independently associated with increased mortality. Patient household with (1) multiple COVID-19 cases and (2) Asian, Black, or Hispanic compared with White non-Hispanic race/ethnicity were associated with reduced mortality. In hypoxic COVID-19 inpatients, remdesivir, tocilizumab, and convalescent plasma were associated with reduced mortality, and corticosteroid use was associated with increased mortality. Conclusions We corroborate several previously identified mortality risk factors and find evidence that the combination of factors associated with mortality differ between populations.
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Affiliation(s)
- Nicole M Gatto
- Correspondence: Nicole M. Gatto, MPH, PhD, Adjunct Research Assistant Professor Department of Population and Public Health Sciences Keck School of Medicine University of Southern California 1845 N Soto St, Los Angeles, CA 90032, USA ()
| | - Debbie Freund
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA,Department of Economic Sciences, Claremont Graduate University, Claremont, California, USA,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Pamela Ogata
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA
| | - Lisa Diaz
- Pomona Valley Hospital and Medical Center, Pomona, California, USA
| | - Ace Ibarrola
- Pomona Valley Hospital and Medical Center, Pomona, California, USA
| | - Mamta Desai
- Pomona Valley Hospital and Medical Center, Pomona, California, USA
| | - Thor Aspelund
- Center for Public Health Sciences, University of Iceland, Reykjavik, Iceland
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Ngere P, Onsongo J, Langat D, Nzioka E, Mudachi F, Kadivane S, Chege B, Kirui E, Were I, Mutiso S, Kibisu A, Ihahi J, Mutethya G, Mochache T, Lokamar P, Boru W, Makayotto L, Okunga E, Ganda N, Haji A, Gathenji C, Kariuki W, Osoro E, Kasera K, Kuria F, Aman R, Nabyonga J, Amoth P. Characterization of COVID-19 cases in the early phase (March to July 2020) of the pandemic in Kenya. J Glob Health 2022; 12:15001. [PMID: 36583253 PMCID: PMC9801068 DOI: 10.7189/jogh.12.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Kenya detected the first case of COVID-19 on March 13, 2020, and as of July 30, 2020, 17 975 cases with 285 deaths (case fatality rate (CFR) = 1.6%) had been reported. This study described the cases during the early phase of the pandemic to provide information for monitoring and response planning in the local context. Methods We reviewed COVID-19 case records from isolation centres while considering national representation and the WHO sampling guideline for clinical characterization of the COVID-19 pandemic within a country. Socio-demographic, clinical, and exposure data were summarized using median and mean for continuous variables and proportions for categorical variables. We assigned exposure variables to socio-demographics, exposure, and contact data, while the clinical spectrum was assigned outcome variables and their associations were assessed. Results A total of 2796 case records were reviewed including 2049 (73.3%) male, 852 (30.5%) aged 30-39 years, 2730 (97.6%) Kenyans, 636 (22.7%) transporters, and 743 (26.6%) residents of Nairobi City County. Up to 609 (21.8%) cases had underlying medical conditions, including hypertension (n = 285 (46.8%)), diabetes (n = 211 (34.6%)), and multiple conditions (n = 129 (21.2%)). Out of 1893 (67.7%) cases with likely sources of exposure, 601 (31.8%) were due to international travel. There were 2340 contacts listed for 577 (20.6%) cases, with 632 contacts (27.0%) being traced. The odds of developing COVID-19 symptoms were higher among case who were aged above 60 years (odds ratio (OR) = 1.99, P = 0.007) or had underlying conditions (OR = 2.73, P < 0.001) and lower among transport sector employees (OR = 0.31, P < 0.001). The odds of developing severe COVID-19 disease were higher among cases who had underlying medical conditions (OR = 1.56, P < 0.001) and lower among cases exposed through community gatherings (OR = 0.27, P < 0.001). The odds of survival of cases from COVID-19 disease were higher among transport sector employees (OR = 3.35, P = 0.004); but lower among cases who were aged ≥60 years (OR = 0.58, P = 0.034) and those with underlying conditions (OR = 0.58, P = 0.025). Conclusion The early phase of the COVID-19 pandemic demonstrated a need to target the elderly and comorbid cases with prevention and control strategies while closely monitoring asymptomatic cases.
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Affiliation(s)
- Philip Ngere
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya,Washington State University, Global Health, Kenya
| | | | - Daniel Langat
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | - Elizabeth Nzioka
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Faith Mudachi
- Department of Promotive and Preventive Health, Ministry of Health, Kenya
| | - Samuel Kadivane
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | - Bernard Chege
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Elvis Kirui
- National Public Health Laboratory Services, Ministry of Health, Kenya
| | - Ian Were
- Office of the Director General, Ministry of Health, Kenya
| | - Stephen Mutiso
- Department of Promotive and Preventive Health, Ministry of Health, Kenya
| | - Amos Kibisu
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Josephine Ihahi
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Gladys Mutethya
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | | | - Peter Lokamar
- National Public Health Laboratory Services, Ministry of Health, Kenya
| | - Waqo Boru
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Lyndah Makayotto
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | - Emmanuel Okunga
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | | | - Adam Haji
- World Health Organization, Nairobi Kenya
| | | | | | - Eric Osoro
- Washington State University, Global Health, Kenya
| | - Kadondi Kasera
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Francis Kuria
- Directorate of Public Health, Ministry of Health, Kenya
| | - Rashid Aman
- Cabinet Administrative Secretary, Ministry of Health, Kenya
| | | | - Patrick Amoth
- Office of the Director General, Ministry of Health, Kenya
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Horne BD, Bunker T. Pathogenic Mechanisms of the Severe Acute Respiratory Syndrome Coronavirus 2 and Potential Direct and Indirect Counteractions by Intermittent Fasting. Nutrients 2022; 15:20. [PMID: 36615679 PMCID: PMC9823718 DOI: 10.3390/nu15010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented burden on human health and on the function and interaction of societies across the globe. Public health preventive measures, vaccines, and antivirals were key components of the world-wide response to the health emergency. Due to the uncoordinated and variably successful response to COVID-19 and the ability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to rapidly mutate, SARS-CoV-2 continues to create considerable difficulty for humanity today. Additional preventive or therapeutic modalities are needed to help people to achieve the best possible health outcomes in the context of the evolving COVID-19 threat. Intermittent fasting is a potential complementary therapy that not only impacts chronic disease risk but also has good evidence of an impact on infectious diseases. While the data regarding fasting and COVID-19 outcomes are very limited, the conceptual connection of fasting to better outcomes includes a variety of mechanisms in human biology. This paper reviews the known mechanisms of disease impacted by SARS-CoV-2 infection and the potential or likely direct or indirect counteractions that fasting may provide that may reduce the severity of COVID-19 and help to realize the best possible health outcomes. Furthermore, fasting adds no financial cost to a care plan and, when practiced safely, is available to most adults without limitation. Further research is needed on the impact of intermittent fasting on human health in the fight against infectious diseases including COVID-19.
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Affiliation(s)
- Benjamin D. Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA 94305, USA
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Khairy Y, Naghibi D, Moosavi A, Sardareh M, Azami-Aghdash S. Prevalence of hypertension and associated risks in hospitalized patients with COVID-19: a meta-analysis of meta-analyses with 1468 studies and 1,281,510 patients. Syst Rev 2022; 11:242. [PMID: 36397129 PMCID: PMC9672558 DOI: 10.1186/s13643-022-02111-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Since the COVID-19 outbreak, preliminary research has shown that some risk-associated conditions increase death and severe complications of the disease, hypertension being one of them. Thus, numerous meta-analyses have been conducted to explore this issue. Therefore, this umbrella review aims to perform a meta-analysis of the meta-analyses to estimate the prevalence and associated risks of hypertension in patients with COVID-19. METHODS PubMed, Scopus, Web of Knowledge, Embase, and Cochrane databases were searched for the published meta-analyses up to January 1, 2022. Google Scholar, citation check, reference check, and Grey literature were also manually searched. A random-effect model approach was used for analysis. RESULTS The overall death rate was estimated at 12%. Hypertension was present in 25% of the patients as a comorbid disease. The overall RR for death, disease severity, and the possibility of ICU admission were estimated at 1.79 [1.68-1.89 with 95% CI], 1.74 [1.66-1.83 with 95% CI], and 1.91 [1.48-2.34 with 95% CI], respectively. The meta-regression results showed that being "male" significantly increases the risk of disease severity and ICU admission. CONCLUSIONS The results indicated that hypertension is a common comorbid disease in hospitalized patients with COVID-19, which significantly increases mortality risk, the severity of the disease, and the probability of ICU admission. SYSTEMATIC REVIEW REGISTRATION This study has been registered in PROSPERO (CRD42021231844).
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Affiliation(s)
- Yousof Khairy
- Center for the Development of Interdisciplinary Research in Islamic Sciences and Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Deniz Naghibi
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Mehran Sardareh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Makhfudli M, Machin A, Nasir A, Wahyudi AS, Harianto S, Rindayati R, Muhalla HI, Sulpat E, Okviasanti F, Susanto J, Ilkafah I, Kartini Y. Understanding Patients with COVID in the Isolation Rooms from the Perspective of Care: A Qualitative Study. J Multidiscip Healthc 2022; 15:2539-2551. [PMID: 36388629 PMCID: PMC9642087 DOI: 10.2147/jmdh.s386066] [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: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Being treated in isolation rooms for people infected with COVID-19, creates various perceptions of uncertainty, especially when strict "health protocols" are applied. This study aims to determine the understanding patients with COVID in the intensive care unit from the perspective of care. MATERIALS AND METHODS The research design used phenomenological qualitative with in-depth interviews. Purposive sampling was used with interpretive phenomenological analysis. Participants were 25 patients who had been exposed to COVID-19, consisting of 10 men and 15 women. RESULTS This study resulted in the theme of the perception of COVID-19 sufferers while undergoing treatment in isolation rooms, with four themes, namely, 1) mental attacks, 2) feel like fighting alone, 3) expecting Concern, 4) positive attitude. CONCLUSION This analysis shows that various perceptions of uncertainty that are felt while being treated in the isolation room due to suffering from COVID-19 disease can be anticipated by increasing the awareness of nurses to be closer to patients through caring-based nursing practices by emphasizing meaningful interpersonal relationships.
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Affiliation(s)
| | - Abdulloh Machin
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Abd Nasir
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | | | - Susilo Harianto
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Rindayati Rindayati
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Hafna Ilmy Muhalla
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Emuliana Sulpat
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Fanni Okviasanti
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Joko Susanto
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Ilkafah Ilkafah
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Yanis Kartini
- Department of Nursing, and Midwifery Faculty, Universitas Nahdlatul Ulama Surabaya, East Java, Indonesia
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Hamilton MA, Liu Y, Calzavara A, Sundaram ME, Djebli M, Darvin D, Baral S, Kustra R, Kwong JC, Mishra S. Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2. Influenza Other Respir Viruses 2022; 16:1072-1081. [PMID: 35611399 PMCID: PMC9347457 DOI: 10.1111/irv.13004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Shared and divergent predictors of clinical severity across respiratory viruses may support clinical and community responses in the context of a novel respiratory pathogen. METHODS We conducted a retrospective cohort study to identify predictors of 30-day all-cause mortality following hospitalization with influenza (N = 45,749; 2010-09 to 2019-05), respiratory syncytial virus (RSV; N = 24 345; 2010-09 to 2019-04), or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; N = 8988; 2020-03 to 2020-12; pre-vaccine) using population-based health administrative data from Ontario, Canada. Multivariable modified Poisson regression was used to assess associations between potential predictors and mortality. We compared the direction, magnitude, and confidence intervals of risk ratios to identify shared and divergent predictors of mortality. RESULTS A total of 3186 (7.0%), 697 (2.9%), and 1880 (20.9%) patients died within 30 days of hospital admission with influenza, RSV, and SARS-CoV-2, respectively. Shared predictors of increased mortality included older age, male sex, residence in a long-term care home, and chronic kidney disease. Positive associations between age and mortality were largest for patients with SARS-CoV-2. Few comorbidities were associated with mortality among patients with SARS-CoV-2 as compared with those with influenza or RSV. CONCLUSIONS Our findings may help identify patients at greatest risk of illness secondary to a respiratory virus, anticipate hospital resource needs, and prioritize local prevention and therapeutic strategies to communities with higher prevalence of risk factors.
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Affiliation(s)
- Mackenzie A. Hamilton
- ICESTorontoOntarioCanada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | | | | | - Maria E. Sundaram
- ICESTorontoOntarioCanada
- Centre for Clinical Epidemiology and Population HealthMarshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | | | - Dariya Darvin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Stefan Baral
- Department of EpidemiologyJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Rafal Kustra
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Jeffrey C. Kwong
- ICESTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
- University Health NetworkTorontoOntarioCanada
- Centre for Vaccine Preventable DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
- Department of Medicine, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Institute of Medical SciencesUniversity of TorontoTorontoOntarioCanada
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Sikhosana ML, Jassat W, Makatini Z. Characteristics of hospitalised COVID-19 patients during the first two pandemic waves, Gauteng. S Afr J Infect Dis 2022; 37:434. [PMID: 36254313 PMCID: PMC9557933 DOI: 10.4102/sajid.v37i1.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background Gauteng province (GP) was one of the most affected provinces in the country during the first two pandemic waves in South Africa. We aimed to describe the characteristics of coronavirus disease 2019 (COVID-19) patients admitted in one of the largest quaternary hospitals in GP during the first two waves. Objectives Study objectives were to determine factors associated with hospital admission during the second wave and to describe factors associated with in-hospital COVID-19 mortality. Method Data from a national hospital-based surveillance system of COVID-19 hospitalisations were used. Multivariable logistic regression models were conducted to compare patients hospitalised during wave 1 and wave 2, and to determine factors associated with in-hospital mortality. Results The case fatality ratio was the highest (39.95%) during wave 2. Factors associated with hospitalisation included age groups 40–59 years (adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.08–4.27), 60–79 years (aOR: 2.49, 95% CI: 1.23–5.02) and ≥ 80 years (aOR: 3.39, 95% CI: 1.35–8.49). Factors associated with in–hospital mortality included age groups 60–79 years (aOR: 2.55, 95% CI: 1.11–5.84) and ≥ 80 years (aOR: 5.66, 95% CI: 2.12–15.08); male sex (aOR: 1.56, 95% CI: 1.22–1.99); presence of an underlying comorbidity (aOR: 1.76, 95% CI: 1.37–2.26), as well as being admitted during post–wave 2 (aOR: 2.42, 95% CI: 1.33–4.42). Conclusion Compared to the recent omicron-driven pandemic waves characterised by lower admission rates and less disease severity among younger patients, COVID-19 in-hospital mortality during the earlier waves was associated with older age, being male and having an underlying comorbidity. Contribution This study showed how an active surveillance system can contribute towards identifying changes in disease trends.
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Affiliation(s)
- Mpho L. Sikhosana
- Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Waasila Jassat
- Department of Public Health and Outbreak Response, National Institute of Communicable Diseases, Johannesburg, South Africa
| | - Zinhle Makatini
- Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Clerbaux LA, Mayasich SA, Muñoz A, Soares H, Petrillo M, Albertini MC, Lanthier N, Grenga L, Amorim MJ. Gut as an Alternative Entry Route for SARS-CoV-2: Current Evidence and Uncertainties of Productive Enteric Infection in COVID-19. J Clin Med 2022; 11:5691. [PMID: 36233559 PMCID: PMC9573230 DOI: 10.3390/jcm11195691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
The gut has been proposed as a potential alternative entry route for SARS-CoV-2. This was mainly based on the high levels of SARS-CoV-2 receptor expressed in the gastrointestinal (GI) tract, the observations of GI disorders (such as diarrhea) in some COVID-19 patients and the detection of SARS-CoV-2 RNA in feces. However, the underlying mechanisms remain poorly understood. It has been proposed that SARS-CoV-2 can productively infect enterocytes, damaging the intestinal barrier and contributing to inflammatory response, which might lead to GI manifestations, including diarrhea. Here, we report a methodological approach to assess the evidence supporting the sequence of events driving SARS-CoV-2 enteric infection up to gut adverse outcomes. Exploring evidence permits to highlight knowledge gaps and current inconsistencies in the literature and to guide further research. Based on the current insights on SARS-CoV-2 intestinal infection and transmission, we then discuss the potential implication on clinical practice, including on long COVID. A better understanding of the GI implication in COVID-19 is still needed to improve disease management and could help identify innovative therapies or preventive actions targeting the GI tract.
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Affiliation(s)
| | - Sally A. Mayasich
- University of Wisconsin-Madison Aquatic Sciences Center at US EPA, Duluth, MN 55804, USA
| | - Amalia Muñoz
- European Commission, Joint Research Centre (JRC), 2440 Geel, Belgium
| | - Helena Soares
- Laboratory of Human Immunobiology and Pathogenesis, iNOVA4Health, Faculdade de Ciências Médicas—Nova Medical School, Universidade Nova de Lisboa, 1099-085 Lisbon, Portugal
| | | | | | - Nicolas Lanthier
- Laboratory of Hepatogastroenterology, Service d’Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| | - Lucia Grenga
- Département Médicaments et Technologies pour la Santé, Commissariat à l’Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université Paris-Saclay, 91190 Paris, France
| | - Maria-Joao Amorim
- Instituto Gulbenkian de Ciência, 2780-156 Lisbon, Portugal
- Católica Biomedical Research Centre, Católica Medical School, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
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d'Albis H, Etner J, Thuilliez J. Vaccination under pessimistic expectations in clinical trials and immunization campaigns. JOURNAL OF PUBLIC ECONOMIC THEORY 2022; 25:JPET12617. [PMID: 36246735 PMCID: PMC9538933 DOI: 10.1111/jpet.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
We provide one of the first formalizations of a vaccination campaign in a decision-theoretic framework. We analyze a model where an ambiguity-averse individual must decide how much effort to invest into prevention in the context of a rampant disease. We study how ambiguity aversion affects the effort and the estimation of the vaccine efficacy in clinical trials and immunization campaigns. We find that the behaviors of individuals participating in a clinical trial differ from individuals not participating. Individuals who are more optimistic toward vaccination participate more in trials. Their behaviors and efforts are also affected. As a result, because vaccine efficacy depends on unobserved behaviors and efforts, the biological effect of the vaccine becomes difficult to evaluate. During the scale-up phase of a vaccination campaign, provided that vaccine efficacy is established, we show that vaccine hesitancy may still be rational.
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Affiliation(s)
| | - Johanna Etner
- EconomiX, UPL, Paris Nanterre UniversityCNRSParisFrance
| | - Josselin Thuilliez
- CNRS—Centre d'Economie de la Sorbonne, UMR8174Université Panthéon‐Sorbonne‐CNRSParisFrance
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Clerbaux LA, Fillipovska J, Muñoz A, Petrillo M, Coecke S, Amorim MJ, Grenga L. Mechanisms Leading to Gut Dysbiosis in COVID-19: Current Evidence and Uncertainties Based on Adverse Outcome Pathways. J Clin Med 2022; 11:5400. [PMID: 36143044 PMCID: PMC9505288 DOI: 10.3390/jcm11185400] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
Alteration in gut microbiota has been associated with COVID-19. However, the underlying mechanisms remain poorly understood. Here, we outlined three potential interconnected mechanistic pathways leading to gut dysbiosis as an adverse outcome following SARS-CoV-2 presence in the gastrointestinal tract. Evidence from the literature and current uncertainties are reported for each step of the different pathways. One pathway investigates evidence that intestinal infection by SARS-CoV-2 inducing intestinal inflammation alters the gut microbiota. Another pathway links the binding of viral S protein to angiotensin-converting enzyme 2 (ACE2) to the dysregulation of this receptor, essential in intestinal homeostasis-notably for amino acid metabolism-leading to gut dysbiosis. Additionally, SARS-CoV-2 could induce gut dysbiosis by infecting intestinal bacteria. Assessing current evidence within the Adverse Outcome Pathway framework justifies confidence in the proposed mechanisms to support disease management and permits the identification of inconsistencies and knowledge gaps to orient further research.
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Affiliation(s)
| | | | - Amalia Muñoz
- European Commission, Joint Research Centre (JRC), 2440 Geel, Belgium
| | | | - Sandra Coecke
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy
| | - Maria-Joao Amorim
- Instituto Gulbenkian de Ciência, 2780-156 Oerias, Portugal
- Católica Medical School, Católica Biomedical Research Centre, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Lucia Grenga
- Département Médicaments et Technologies pour la Santé, Commissariat à l’Énergie Atomique et Aux Énergies Alternatives (CEA), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université Paris-Saclay, 30200 Bagnols-sur-Cèze, France
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Noninvasive nasopharyngeal proteomics of COVID-19 patient identify abnormalities related to complement and coagulation cascade and mucosal immune system. PLoS One 2022; 17:e0274228. [PMID: 36094909 PMCID: PMC9467311 DOI: 10.1371/journal.pone.0274228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Serum or plasma have been the primary focus of proteomics studies for COVID-19 to identity biomarkers and potential drug targets. The nasal mucosal environment which consists of lipids, mucosal immune cells, and nasal proteome, has been largely neglected but later revealed to have critical role combating SARS-CoV-2 infection. We present a bottom-up proteomics investigation of the host response to SARS-CoV-2 infection in the nasopharyngeal environment, featuring a noninvasive approach using proteins in nasopharyngeal swabs collected from groups of 76 SARS-CoV-2 positive and 76 negative patients. Results showed that 31 significantly down-regulated and 6 up-regulated proteins were identified (p < 0.05, log2 FC > 1.3) in SARS-CoV-2 positive patient samples as compared to the negatives; these proteins carry potential value as markers for the early detection of COVID-19, disease monitoring, as well as be drug targets. The down-regulation of coagulation factor 5 indicates a thrombotic abnormality in COVID-19 patients and the decreased IgG4 suggests an abnormal immune response at the point of entry in human nasopharyngeal environment, which is in consistent with KEGG and GO pathway analysis. Our study also demonstrated that mass spectrometry proteomics analysis of nasopharyngeal swabs can be used as a powerful early approach to evaluate host response to SARS-CoV-2 viral infection.
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I TJ, Tsai YL, Cheng YY. Predictors of Basic Activity in Daily Living and Length of Hospitalization in Patients with COVID-19. Healthcare (Basel) 2022; 10:healthcare10081589. [PMID: 36011246 PMCID: PMC9408349 DOI: 10.3390/healthcare10081589] [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: 06/05/2022] [Revised: 07/16/2022] [Accepted: 08/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Patients recovered from COVID-19 often suffer from the sequelae of the disease, which can hinder the patients’ activity in daily living. Early recognition of the patients at risk of prolonged hospitalization and impaired physical functioning is crucial for early intervention. We aim to identify the predictors of prolonged hospitalization and impaired activity in daily living in this study. Methods: COVID-19 patients hospitalized in a medical center were divided into two groups according to the Barthel index three months after discharge and the median length of hospital stay, respectively. Chi-square test and Mann–Whitney U test were performed to check the differences between the two groups in patient characteristics as well as hematology tests at the emergency department, the intensive care unit mobility scale (ICUMS), and the medical research council sum score (MRCSS). Logistic regression and the receiver operating characteristic curve analysis were further performed for the factors with significant differences between the two groups. Results: Both ICUMS and MRCSS showed significant differences between the groups. The ICUMS had an odds ratio of 0.61 and the MRCSS of 0.93 in predicting a Barthel index score less than 100 three months after discharge. The MRCSS had an odds ratio of 0.82 in predicting a prolonged length of hospital stay. Conclusion: Both ICUMS and MRCSS upon admission are predictive of a Barthel index score of less than 100 three months after discharge. On the other hand, only MRCSS has predictive value of a prolonged hospitalization.
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Affiliation(s)
- Ting-Jie I
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 407224, Taiwan
- Correspondence:
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HDL cholesterol levels and susceptibility to COVID-19. EBioMedicine 2022; 82:104166. [PMID: 35843172 PMCID: PMC9284176 DOI: 10.1016/j.ebiom.2022.104166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background Host cell-membrane cholesterol, an important player in viral infections, is in constant interaction with serum high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C). Low serum lipid levels during hospital admission are associated with COVID-19 severity. However, the effect of antecedent serum lipid levels on SARS-CoV-2 infection risk has not been explored. Methods From our retrospective cohort from the Arkansas Clinical Data-Repository, we used log-binomial regression to assess the risk of SARS-CoV-2 infection among the trajectories of lipid levels during the 2 years antecedent to COVID-19 testing, identified using group-based-trajectory modelling. We used mixed-effects linear regression to assess the serum lipid level trends followed up to the time of, and 2-months following COVID-19 testing. Findings Among the 11001 individuals with a median age of 59 years (IQR 46-70), 1340 (12.2%) tested positive for COVID-19. The highest trajectory for antecedent serum HDL-C was associated with the lowest SARS-CoV-2 infection risk (RR 0.63, 95%CI 0.46-0.86). Antecedent serum LDL-C, total cholesterol (TC), and triglycerides (TG) were not independently associated with SARS-CoV-2 infection risk. In COVID-19 patients, serum HDL-C (-7.7, 95%CI -9.8 to -5.5 mg/dL), and LDL-C (-6.29, 95%CI -12.2 to -0.37 mg/dL), but not TG levels, decreased transiently at the time of testing. Interpretation Higher antecedent serum HDL-C, but not LDL-C, TC, or TG, levels were associated with a lower SARS-CoV-2 infection risk. Serum HDL-C, and LDL-C levels declined transiently at the time of infection. Further studies are needed to determine the potential role of lipid-modulating therapies in the prevention and management of COVID-19. Funding Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1 TR003107.
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Clerbaux LA, Albertini MC, Amigó N, Beronius A, Bezemer GFG, Coecke S, Daskalopoulos EP, del Giudice G, Greco D, Grenga L, Mantovani A, Muñoz A, Omeragic E, Parissis N, Petrillo M, Saarimäki LA, Soares H, Sullivan K, Landesmann B. Factors Modulating COVID-19: A Mechanistic Understanding Based on the Adverse Outcome Pathway Framework. J Clin Med 2022; 11:4464. [PMID: 35956081 PMCID: PMC9369763 DOI: 10.3390/jcm11154464] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
Addressing factors modulating COVID-19 is crucial since abundant clinical evidence shows that outcomes are markedly heterogeneous between patients. This requires identifying the factors and understanding how they mechanistically influence COVID-19. Here, we describe how eleven selected factors (age, sex, genetic factors, lipid disorders, heart failure, gut dysbiosis, diet, vitamin D deficiency, air pollution and exposure to chemicals) influence COVID-19 by applying the Adverse Outcome Pathway (AOP), which is well-established in regulatory toxicology. This framework aims to model the sequence of events leading to an adverse health outcome. Several linear AOPs depicting pathways from the binding of the virus to ACE2 up to clinical outcomes observed in COVID-19 have been developed and integrated into a network offering a unique overview of the mechanisms underlying the disease. As SARS-CoV-2 infectibility and ACE2 activity are the major starting points and inflammatory response is central in the development of COVID-19, we evaluated how those eleven intrinsic and extrinsic factors modulate those processes impacting clinical outcomes. Applying this AOP-aligned approach enables the identification of current knowledge gaps orientating for further research and allows to propose biomarkers to identify of high-risk patients. This approach also facilitates expertise synergy from different disciplines to address public health issues.
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Affiliation(s)
- Laure-Alix Clerbaux
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | | | - Núria Amigó
- Biosfer Teslab SL., 43204 Reus, Spain;
- Department of Basic Medical Sciences, Universitat Rovira i Virgili (URV), 23204 Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Anna Beronius
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Gillina F. G. Bezemer
- Impact Station, 1223 JR Hilversum, The Netherlands;
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Sandra Coecke
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Evangelos P. Daskalopoulos
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Giusy del Giudice
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE), Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland; (G.d.G.); (D.G.); (L.A.S.)
| | - Dario Greco
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE), Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland; (G.d.G.); (D.G.); (L.A.S.)
| | - Lucia Grenga
- Département Médicaments et Technologies pour la Santé (DMTS), Université Paris-Saclay, CEA, INRAE, SPI, F-30200 Bagnols-sur-Ceze, France;
| | - Alberto Mantovani
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Amalia Muñoz
- European Commission, Joint Research Centre (JRC), 2440 Geel, Belgium;
| | - Elma Omeragic
- Faculty of Pharmacy, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Nikolaos Parissis
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Mauro Petrillo
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Laura A. Saarimäki
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE), Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland; (G.d.G.); (D.G.); (L.A.S.)
| | - Helena Soares
- Laboratory of Immunobiology and Pathogenesis, Chronic Diseases Research Centre, Faculdade de Ciências Médicas Medical School, University of Lisbon, 1649-004 Lisbon, Portugal;
| | - Kristie Sullivan
- Physicians Committee for Responsible Medicine, Washington, DC 20016, USA;
| | - Brigitte Landesmann
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
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Keri VC, Jorwal P, Verma R, Ranjan P, Upadhyay AD, Aggarwal A, Sarda R, Sharma K, Sahni S, Rajanna C. Novel Scoring Systems to Predict the Need for Oxygenation and ICU Care, and Mortality in Hospitalized COVID-19 Patients: A Risk Stratification Tool. Cureus 2022; 14:e27459. [PMID: 36060343 PMCID: PMC9424646 DOI: 10.7759/cureus.27459] [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] [Accepted: 07/29/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them. Methodology: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors. Results: The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR) >4 was a common independent predictor of the need for oxygen (p<0.001), need for ICU transfer (p=0.04), and mortality (p=0.06). Clinical risk scores were developed (10*c-reactive protein (CRP) + 14.8*NLR + 12*urea), (10*aspartate transaminase (AST) + 15.7*NLR + 14.28*CRP), (10*NLR + 10.1*creatinine) which, if ≥14.8, ≥25.7, ≥10.1 predicted need for oxygenation, need for ICU transfer and mortality with a sensitivity and specificity (81.6%, 70%), (73.3%, 75.7%), (61.1%, 75%), respectively. Conclusion: The NLR, CRP, urea, creatinine, and AST are independent predictors in identifying patients with poor outcomes. An objective scoring system can be used at the bedside for appropriate triaging of patients and utilization of resources.
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Aleman RT, Rauch J, Desai J, Chaiban JT. COVID-19 Vaccine-Associated Lymphadenopathy in Breast Imaging Recipients: A Review of Literature. Cureus 2022; 14:e26845. [PMID: 35974844 PMCID: PMC9375123 DOI: 10.7759/cureus.26845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
The unpredictability of the coronavirus disease 2019 (COVID-19) pandemic has created an ongoing global healthcare crisis. Implementation of a mass vaccination program to accelerate disease control remains in progress. Although injection site soreness, fatigue, and fever are the most common adverse reactions reported after a COVID-19 vaccination, ipsilateral lymph node enlargement has increasingly been observed. In patients undergoing routine screening and surveillance for breast cancer, interpreting lymphadenopathy (LAP) is challenging in the setting of a recent COVID-19 vaccination. With a growing proportion of the population receiving the vaccine, a multifaceted approach is necessary to avoid unnecessary and costly workup. In this comprehensive review, we summarize the existing literature on COVID-19 vaccine-associated LAP in breast imaging patients.
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Olum R, Baluku JB. Commentary: Factors Associated With Mortality Among the COVID-19 Patients Treated at Gulu Regional Referral Hospital. Front Public Health 2022; 10:931309. [PMID: 35865243 PMCID: PMC9294281 DOI: 10.3389/fpubh.2022.931309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ronald Olum
- Department of Internal Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
- *Correspondence: Ronald Olum
| | - Joseph Baruch Baluku
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
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Horne BD, May HT, Muhlestein JB, Le VT, Bair TL, Knowlton KU, Anderson JL. Association of periodic fasting with lower severity of COVID-19 outcomes in the SARS-CoV-2 prevaccine era: an observational cohort from the INSPIRE registry. BMJ Nutr Prev Health 2022; 5:145-153. [PMID: 36619318 PMCID: PMC9813631 DOI: 10.1136/bmjnph-2022-000462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives Intermittent fasting boosts some host defence mechanisms while modulating the inflammatory response. Lower-frequency fasting is associated with greater survival and lower risk from COVID-19-related comorbidities. This study evaluated associations of periodic fasting with COVID-19 severity and, secondarily, initial infection by SARS-CoV-2. Design Prospective longitudinal observational cohort study. Setting Single-centre secondary care facility in Salt Lake City, Utah, USA with follow-up across a 24-hospital integrated healthcare system. Participants Patients enrolled in the INSPIRE registry in 2013-2020 were studied for the primary outcome if they tested positive for SARS-CoV-2 during March 2020 to February 2021 (n=205) or, for the secondary outcome, if they had any SARS-CoV-2 test result (n=1524). Interventions No treatment assignments were made; individuals reported their personal history of routine periodic fasting across their life span. Main outcome measures A composite of mortality or hospitalisation was the primary outcome and evaluated by Cox regression through February 2021 with multivariable analyses considering 36 covariables. The secondary outcome was whether a patient tested positive for SARS-CoV-2. Results Subjects engaging in periodic fasting (n=73, 35.6%) did so for 40.4±20.6 years (max: 81.9 years) prior to COVID-19 diagnosis. The composite outcome occurred in 11.0% of periodic fasters and 28.8% of non-fasters (p=0.013), with HR=0.61 (95% CI 0.42 to 0.90) favouring fasting. Multivariable analyses confirmed this association. Other predictors of hospitalisation/mortality were age, Hispanic ethnicity, prior MI, prior TIA and renal failure, with trends for race, smoking, hyperlipidaemia, coronary disease, diabetes, heart failure and anxiety, but not alcohol use. In secondary analysis, COVID-19 was diagnosed in 14.3% of fasters and 13.0% of non-fasters (p=0.51). Conclusions Routine periodic fasting was associated with a lower risk of hospitalisation or mortality in patients with COVID-19. Fasting may be a complementary therapy to vaccination that could provide immune support and hyperinflammation control during and beyond the pandemic. Trial registration Clinicaltrials.gov, NCT02450006 (the INSPIRE registry).
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Affiliation(s)
- Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA,Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Heidi T May
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA,Department of Internal Medicine, Cardiology Division, University of Utah, Salt Lake City, Utah, USA
| | - Viet T Le
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA,Department of Physician Assistant Studies, Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Tami L Bair
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Kirk U Knowlton
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA,Department of Medicine, Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA,Department of Internal Medicine, Cardiology Division, University of Utah, Salt Lake City, Utah, USA
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Gogolewski K, Miasojedow B, Sadkowska-Todys M, Stepień M, Demkow U, Lech A, Szczurek E, Rabczenko D, Rosińska M, Gambin A. Data-driven case fatality rate estimation for the primary lineage of SARS-CoV-2 in Poland. Methods 2022; 203:584-593. [PMID: 35085741 PMCID: PMC8785264 DOI: 10.1016/j.ymeth.2022.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 12/28/2022] Open
Abstract
After more than one and a half year since the COVID-19 pandemics outbreak the scientific world is constantly trying to understand its dynamics. In this paper of the case fatality rates (CFR) for COVID-19 we study the historic data regarding mortality in Poland during the first six months of pandemic, when no SARS-CoV-2 variants of concern were present among infected. To this end, we apply competing risk models to perform both uni- and multivariate analyses on specific subpopulations selected by different factors including the key indicators: age, sex, hospitalization. The study explores the case fatality rate to find out its decreasing trend in time. Furthermore, we describe the differences in mortality among hospitalized and other cases indicating a sudden increase of mortality among hospitalized cases at the end of the 2020 spring season. Exploratory and multivariate analysis revealed the real impact of each variable and besides the expected factors indicating increased mortality (age, comorbidities) we track more non-obvious indicators. Recent medical care as well as the identification of the source contact, independently of the comorbidities, significantly impact an individual mortality risk. As a result, the study provides a twofold insight into the COVID-19 mortality in Poland. On one hand we explore mortality in different groups with respect to different variables, on the other we indicate novel factors that may be crucial in reducing mortality. The later can be coped, e.g. by more efficient contact tracing and proper organization and management of the health care system to accompany those who need medical care independently of comorbidities or COVID-19 infection.
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Affiliation(s)
- Krzysztof Gogolewski
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Błażej Miasojedow
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Małgorzata Sadkowska-Todys
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Małgorzata Stepień
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Lech
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Szczurek
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Daniel Rabczenko
- Department for Monitoring and Analysis of Population Health Status, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Magdalena Rosińska
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Anna Gambin
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
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