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Franchini M, Cruciani M, Casadevall A, Joyner MJ, Senefeld JW, Sullivan DJ, Zani M, Focosi D. Safety of COVID-19 convalescent plasma: A definitive systematic review and meta-analysis of randomized controlled trials. Transfusion 2024; 64:388-399. [PMID: 38156374 DOI: 10.1111/trf.17701] [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: 04/15/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Mario Cruciani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Arturo Casadevall
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, Maryland, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon W Senefeld
- Department of Kinesiology and Community Healthy, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - David J Sullivan
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, Maryland, USA
| | - Matteo Zani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
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2
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Alipour S, Mahmoudi L, Ahmadi F. Pulmonary drug delivery: an effective and convenient delivery route to combat COVID-19. Drug Deliv Transl Res 2023; 13:705-715. [PMID: 36260223 PMCID: PMC9580423 DOI: 10.1007/s13346-022-01251-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 02/05/2023]
Abstract
The recent outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China has spread rapidly around the world, leading to a widespread and urgent effort to develop and use comprehensive approaches in the treatment of COVID-19. While oral therapy is accepted as an effective and simple method, since the primary site of infection and disease progression of COVID-19 is mainly through the lungs, inhaled drug delivery directly to the lungs may be the most appropriate route of administration. To prevent or treat primary SARS-CoV-2 infections, it is essential to target the virus port of entry in the respiratory tract and airway epithelium, which requires rapid and high-intensity inhibition or control of viral entry or replication. To achieve success in this field, inhalation therapy is the most attractive treatment approach due to efficacy/safety profiles. In this review article, pulmonary drug delivery as a unique treatment option in lung diseases will be briefly reviewed. Then, possible inhalation therapies for the treatment of symptoms of COVID-19 will be discussed and the results of clinical trials will be presented. By pulmonary delivery of the currently approved drugs for COVID-19, efficacy of the treatment would be improved along with reducing systemic side effects.
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Affiliation(s)
- Shohreh Alipour
- Pharmaceutical Sciences Research Center and Department of Food & Drug Quality Control, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Ahmadi
- Center for Nanotechnology in Drug Delivery and Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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Crook H, Ramirez A, Hosseini AA, Vavougyios G, Lehmann C, Bruchfeld J, Schneider A, d'Avossa G, Lo Re V, Salmoiraghi A, Mukaetova-Ladinska E, Katshu M, Boneschi FM, Håkansson K, Geerlings M, Pracht E, Ruiz A, Jansen JF, Snyder H, Kivipelto M, Edison P. European Working Group on SARS-CoV-2: Current Understanding, Unknowns, and Recommendations on the Neurological Complications of COVID-19. Brain Connect 2023; 13:178-210. [PMID: 36719785 DOI: 10.1089/brain.2022.0058] [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] [Indexed: 02/01/2023] Open
Abstract
The emergence of COVID-19 was rapidly followed by infection and the deaths of millions of people across the globe. With much of the research and scientific advancement rightly focused on reducing the burden of severe and critical acute COVID-19 infection, the long-term effects endured by those who survived the acute infection has been previously overlooked. Now, an appreciation for the post-COVID-19 condition, including its neurological manifestations, is growing, although there remain many unknowns regarding the aetiology and risk factors of the condition, as well as how to effectively diagnose and treat it. Here, drawing upon the experiences and expertise of the clinicians and academics of the European working group on COVID-19, we have reviewed the current literature to provide a comprehensive overview of the neurological sequalae of the post-COVID-19 condition. In this review, we provide a summary of the neurological symptoms associated with the post-COVID-19 condition, before discussing the possible mechanisms which may underly and manifest these symptoms. Following this, we explore the risk factors for developing neurological symptoms as a result of COVID-19 and the post-COVID-19 condition, as well as how COVID-19 infection may itself be a risk factor for the development of neurological disease in the future. Lastly, we evaluate how the post-COVID condition could be accurately diagnosed and effectively treated, including examples of the current guidelines, clinical outcomes and tools that have been developed to aid in this process, as well as addressing the protection provided by COVID-19 vaccines against post-COVID-19 condition. Overall, this review provides a comprehensive overview of the neurological sequalae of the post-COVID-19 condition.
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Affiliation(s)
- Harry Crook
- Imperial College London, 4615, Brain Sciences, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Alfredo Ramirez
- University of Cologne, 14309, Department of Psychiatry and Psychotherapy, Koln, Nordrhein-Westfalen, Germany
- University of Bonn, 9374, Department of Neurodegenerative diseases and Geriatric Psychiatry, Bonn, Nordrhein-Westfalen, Germany
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Department of Psychiatry , San Antonio, Texas, United States
- German Centre for Neurodegenerative Diseases, 172279, Bonn, Nordrhein-Westfalen, Germany;
| | - Akram A Hosseini
- Nottingham University Hospitals NHS Trust, 9820, Department of Neurology, Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland;
| | - Georgios Vavougyios
- University of Cyprus, 54557, Department of Neurology, Nicosia, Nicosia, Cyprus;
| | - Clara Lehmann
- University of Cologne, 14309, Department of Internal Medicine, Koln, Nordrhein-Westfalen, Germany
- University of Cologne, 14309, Center for Molecular Medicine Cologne (CMMC), Koln, Nordrhein-Westfalen, Germany
- German Centre for Infection Research, 459706, Braunschweig, Niedersachsen, Germany;
| | - Judith Bruchfeld
- Karolinska University Hospital, 59562, Department of Infectious Diseases, Stockholm, Sweden;
| | - Anja Schneider
- University Hospital Bonn, 39062, Department of Neurodegenerative diseases and Geriatric Psychiatry, Bonn, Nordrhein-Westfalen, Germany
- German Centre for Neurodegenerative Diseases, 172279, Bonn, Nordrhein-Westfalen, Germany;
| | - Giovanni d'Avossa
- Bangor University, 1506, School of Psychology, Bangor, Gwynedd, United Kingdom of Great Britain and Northern Ireland;
| | | | - Alberto Salmoiraghi
- Betsi Cadwaladr University Health Board, 1507, Bangor, Gwynedd, United Kingdom of Great Britain and Northern Ireland
- Glyndwr University, 8725, Wrexham, Clwyd, United Kingdom of Great Britain and Northern Ireland;
| | - Elizabeta Mukaetova-Ladinska
- University of Leicester, 4488, Neuroscience, Psychology and Behaviour, University Road, Leicester, United Kingdom of Great Britain and Northern Ireland, LE1 7RH;
| | - Mohammad Katshu
- University of Nottingham, 6123, School of Medicine, Nottingham, Nottinghamshire, United Kingdom of Great Britain and Northern Ireland;
| | - Filippo M Boneschi
- University of Milan, 9304, Division of Neuroscience and INSPE, San Raffaele Scientific Institute, Milano, Lombardia, Italy;
| | - Krister Håkansson
- Karolinska Institute, 27106, Department of Neurobiology, Care Sciences and Society, Stockholm, Stockholm, Sweden;
| | - Mirjam Geerlings
- Utrecht University, 8125, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands;
| | - Elisabeth Pracht
- University of Cologne, 14309, Department of Psychiatry and Psychotherapy, Koln, Nordrhein-Westfalen, Germany;
| | - Agustín Ruiz
- Universitat Internacional de Catalunya, 16760, Institut Català de Neurociències Aplicades, Barcelona, Catalunya, Spain;
| | - Jacobus Fa Jansen
- Maastricht University Medical Centre+, 199236, Department of Radiology and Nuclear Medicine, Maastricht, Limburg, Netherlands;
| | - Heather Snyder
- Alzheimer's Association, 44027, Chicago, Illinois, United States;
| | - Miia Kivipelto
- Karolinska Institute, 27106, Department of Neurobiology, Care Sciences and Society, Stockholm, Stockholm, Sweden;
| | - Paul Edison
- Imperial College London, 4615, Brain Sciences, Neurology Imaging Unit, 1st Floor, B - Block, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom of Great Britain and Northern Ireland, SW7 2AZ;
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Siman-Tov R, Shalabi R, Shlomai A, Goldberg E, Essa W, Shusterman E, Ablin JN, Caspi M, Rosin-Arbesfeld R, Sklan EH. Elevated Serum Amyloid A Levels Contribute to Increased Platelet Adhesion in COVID-19 Patients. Int J Mol Sci 2022; 23:ijms232214243. [PMID: 36430724 PMCID: PMC9692251 DOI: 10.3390/ijms232214243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) patients are prone to thrombotic complications that may increase morbidity and mortality. These complications are thought to be driven by endothelial activation and tissue damage promoted by the systemic hyperinflammation associated with COVID-19. However, the exact mechanisms contributing to these complications are still unknown. To identify additional mechanisms contributing to the aberrant clotting observed in COVID-19 patients, we analyzed platelets from COVID-19 patients compared to those from controls using mass spectrometry. We identified increased serum amyloid A (SAA) levels, an acute-phase protein, on COVID-19 patients' platelets. In addition, using an in vitro adhesion assay, we showed that healthy platelets adhered more strongly to wells coated with COVID-19 patient serum than to wells coated with control serum. Furthermore, inhibitors of integrin aIIbβ3 receptors, a mediator of platelet-SAA binding, reduced platelet adhesion to recombinant SAA and to wells coated with COVID-19 patient serum. Our results suggest that SAA may contribute to the increased platelet adhesion observed in serum from COVID-19 patients. Thus, reducing SAA levels by decreasing inflammation or inhibiting SAA platelet-binding activity might be a valid approach to abrogate COVID-19-associated thrombotic complications.
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Affiliation(s)
- Ronen Siman-Tov
- Department of Clinical Microbiology and Immunology, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rulla Shalabi
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Amir Shlomai
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Medicine D, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Elad Goldberg
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Wesam Essa
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Eden Shusterman
- Department of Internal Medicine H, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Jacob N. Ablin
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Internal Medicine H, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Michal Caspi
- Department of Clinical Microbiology and Immunology, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rina Rosin-Arbesfeld
- Department of Clinical Microbiology and Immunology, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ella H. Sklan
- Department of Clinical Microbiology and Immunology, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-6408197
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Tizazu AM, Mengist HM, Demeke G. Aging, inflammaging and immunosenescence as risk factors of severe COVID-19. IMMUNITY & AGEING 2022; 19:53. [PMID: 36369012 PMCID: PMC9650172 DOI: 10.1186/s12979-022-00309-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 10/13/2022] [Indexed: 11/13/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is characterized by having a heterogeneous disease course, ranging from asymptomatic and mild symptoms to more severe and critical cases. In most cases the severity of COVID-19 is related to host factors, especially deregulation of the immune response in patients. Even if COVID-19 indiscriminately affects individuals of different age group, ethnicity and economic status; most severe cases and disproportional mortality occur in elderly individuals. This point out that aging is one risk factor for unfavourable clinical outcomes among COVID-19 patients. The biology of aging is a complex process; Aging can alter the structure and function of cells, tissues, and organs resulting in impaired response to stress. Alongside with other systems, the immune system is also affected with the aging process. Immunosenescence is an age associated change in the immune system that affects the overall response to immunological challenges in the elderly. Similarly, apart from the normal inflammatory process, aging is associated with a low grade, sterile, chronic inflammation which is termed as inflammaging. We hypothesized that inflammaging and immunosenescence could play an important role in SARS-CoV-2 pathogenesis and poor recovery from COVID-19 in elderly individuals. This review summarizes the changes in the immune system with age and how these changes play part in the pathogenesis of SARS-CoV-2 and clinical outcome of COVID-19 which could add to the understanding of age associated targeted immunotherapy in the elderly.
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GÜNAY N, BAŞLILAR Ş. Evaluation of cardio-pulmonary functions of previously healthy adults with moderate-severe COVID-19 pneumonia after discharge. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1152747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Persistent dyspnea is one of the most frequent post-COVID symptoms. We aimed to evaluate the cardiopulmonary functions of COVID-19 survivors with moderate to severe COVID-19 pneumonia without comorbidity, during the first wave of pandemics.
Material and Method: The study was conducted retrospectively in a single center. The electronic data of patients applied with dyspnea one month after hospital discharge, without any comorbidities, and who were evaluated with pulmonary function test (PFT) and echocardiography were included in the study. A total of adult 88 patients who suffered from COVID-19 pneumonia (46 moderate and 42 severe) were enrolled. Results of biochemical, hematological and radiological examinations, PFT parameters and echocardiography were recorded and compared between moderate and severe cases.
Results: The mean age of 88 patients included in the study was 48±13 years. Sixty-seven (74.4%) of the patients were male. Pulmonary thromboembolism was not detected in both groups. PFT parameters performed were similar in the two groups and there was no statistically significant difference. Pulmonary function test of the patients with moderate COVID-19 pneumonia revealed mild restriction in 21.7% and moderate restriction in 2% of the patients. In the severe group, 38.1% of the patients had mild and 4.8% of the patients had a moderate restrictive pattern. Small airway obstruction was detected in 37% of the moderate group and in 38.1% of the severe group. Conventional echocardiographic parameters of the two groups were normal. Pulmonary arterial pressures were 22.6±8.3 vs 22.1±6.8; p=0.8 was found. Tricuspid annular plane systolic excursion were within normal limits.
Conclusıon: The persistent dyspnea following COVID-19 pneumonia may be related to disturbances in PFT even in patients without comorbidities. We concluded that; the detailed evaluation of the patients with prolonged respiratory symptoms might help to detect the cardiopulmonary functional disturbances.
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Affiliation(s)
- Nuran GÜNAY
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ÜMRANİYE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF CARDIOLOGY
| | - Şeyma BAŞLILAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL ÜMRANİYE SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
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7
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SARS-CoV-2 and Endothelial Cells: Vascular Changes, Intussusceptive Microvascular Growth and Novel Therapeutic Windows. Biomedicines 2022; 10:biomedicines10092242. [PMID: 36140343 PMCID: PMC9496230 DOI: 10.3390/biomedicines10092242] [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: 08/17/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Endothelial activation in infectious diseases plays a crucial role in understanding and predicting the outcomes and future treatments of several clinical conditions. COVID-19 is no exception. Moving from basic principles to novel approaches, an evolving view of endothelial activation provides insights into a better knowledge of the upstream actors in COVID-19 as a crucial future direction for managing SARS-CoV-2 and other infections. Assessing the function of resting and damaged endothelial cells in infection, particularly in COVID-19, five critical processes emerged controlling thrombo-resistance: vascular integrity, blood flow regulation, immune cell trafficking, angiogenesis and intussusceptive microvascular growth. Endothelial cell injury is associated with thrombosis, increased vessel contraction and a crucial phenomenon identified as intussusceptive microvascular growth, an unprecedented event of vessel splitting into two lumens through the integration of circulating pro-angiogenic cells. An essential awareness of endothelial cells and their phenotypic changes in COVID-19 inflammation is pivotal to understanding the vascular biology of infections and may offer crucial new therapeutic windows.
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Tsagkaris C, Bilal M, Aktar I, Aboufandi Y, Tas A, Aborode AT, Suvvari TK, Ahmad S, Shkodina A, Phadke R, Emhamed MS, Baig AA, Alexiou A, Ashraf GM, Kamal MA. Cytokine storm and neuropathological alterations in patients with neurological manifestations of COVID-19. Curr Alzheimer Res 2022; 19:CAR-EPUB-126211. [PMID: 36089786 DOI: 10.2174/1567205019666220908084559] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/05/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022]
Abstract
The COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), a respiratory pathogen with neuroinvasive potential. Neurological COVID-19 manifestations include loss of smell and taste, headache, dizziness, stroke, and potentially fatal encephalitis. Several studies found elevated proinflammatory cytokines such as TNF-α, IFN-γ, IL-6 IL-8, IL-10 IL-16, IL-17A, and IL-18 in severely and critically ill COVID-19 patients, which may persist even after apparent recovery from infection. Biomarker studies on CSF and plasma and serum from COVID-19 patients have also shown a high level of IL-6, intrathecal IgG, neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), and tau protein. Emerging evidence on the matter has established the concept of COVID-19 associated neuroinflammation, in the context of COVID-19 associated cytokine storm. While the short-term implications of this condition are extensively documented, its long-term implications are yet to be understood. The association of the aforementioned cytokines with the pathogenesis of neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, Huntington disease, and amyotrophic lateral sclerosis, may increase COVID-19 patients' risk to develop neurodegenerative diseases. Analysis of proinflammatory cytokines and CSF biomarkers in patients with COVID-19 can contribute to the early detection of the disease's exacerbation, monitoring the neurological implications of the disease and devising risk scales, and identifying treatment targets.
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Affiliation(s)
| | - Muhammad Bilal
- College of Pharmacy, Liaquat University of Medical and health Sciences, Jamshoro, Pakistan
| | - Irem Aktar
- Istanbul University, Istanbul Faculty of Medicine, Istanbul,Turkey
| | | | - Ahmet Tas
- Istanbul University, Istanbul Faculty of Medicine, Istanbul,Turkey
| | | | | | - Shoaib Ahmad
- Punjab Medical College, Faisalabad, Pakistan
- Faisalabad Medical University, Faisalabad, Pakistan
| | | | | | | | - Atif Amin Baig
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Malaysia
| | - Athanasios Alexiou
- Novel Global Community Educational Foundation, Hebersham, 2770 NSW, Australia
- AFNP Med Austria, 1010 Wien, Austria
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, 21589 Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, 22254 Jeddah, Saudi Arabia
| | - Mohammad Amjad Kamal
- West China School of Nursing / Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, P. O. Box 80216, Jeddah 21589, Saudi Arabia
- Enzymoics, 7 Peterlee Place, Hebersham, NSW 2770; Novel Global Community Educational Foundation, Australia
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Jalali KS, Basala A, Habeb M. Arterio-Venous Thrombosis and Spontaneous Bleeding in COVID-19-Associated Coagulopathy: A Case Report. Cureus 2022; 14:e27770. [PMID: 36106271 PMCID: PMC9450432 DOI: 10.7759/cureus.27770] [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: 08/08/2022] [Indexed: 11/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome which was declared a global pandemic in 2019 causing significant morbidities and mortalities. COVID-19 is a multi-systemic disease and is not primarily limited to the respiratory system. Thrombus formation is one of its distinct features. However, renal complications associated with COVID-19 are rarely reported in the literature due to limited occurrence and research. We report a rare case of right retroperitoneal hematoma in a COVID-19 patient. We report a 51-year-old male patient who was received at the emergency department (ED). The patient was positive for COVID-19 and had a Glasgow coma scale of 12/15. The patient was initially managed on IV anticoagulation due to cavernous sinus thrombosis and was placed on mechanical ventilation which helped him to improve. After two weeks, a sudden drop in hemoglobin was observed. CT scan of abdomen and pelvis showed the presence of a right retroperitoneal hematoma, and right renal artery non-occlusive filling defect. The patient was successfully managed with conservative treatment. Retroperitoneal hematoma although a rare occurrence in COVID-19 patient should be observed and monitored closely in case of bleeding or anemia, as early management and intervention is beneficial.
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10
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Kılıçarslan O, Çebi AY, Uçar D. Central retinal vein occlusion and occlusive vasculopathy at macula in a patient with recent COVID-19 infection. Taiwan J Ophthalmol 2022; 12:477-481. [PMID: 36660120 PMCID: PMC9843571 DOI: 10.4103/tjo.tjo_15_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: 01/24/2021] [Accepted: 03/03/2022] [Indexed: 01/22/2023] Open
Abstract
We described a post-COVID-19 patient who presented with central retinal vein occlusion and macular ischemia. A 50-year-old male presented with decreased vision for a month in his right eye (RE). The patient had no systemic risk factors for vascular disease but recent COVID-19 infection. Fundus examination revealed dense intraretinal dot hemorrhages especially at macula and ischemia-related retinal whitening in the posterior pole in RE. Expanding of foveal avascular zone was also detected in optical coherence tomography angiography (OCTA) sections. After systemic steroid therapy, subretinal fluid resolved but visual acuity did not increase. Depending on the fundus fluorescein angiography and OCTA findings, clinical picture was compatible with previous central retinal vein occlusion with superimposed occlusive vasculopathy at macula. COVID-19 patients with visual problems must be considered with care in regard to thrombotic retinal diseases.
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Affiliation(s)
- Oğuzhan Kılıçarslan
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Didar Uçar
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey,Address for correspondence: Dr. Didar Uçar, Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34098 Fatih, Istanbul, Turkey. E-mail:
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11
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Tufek M, Capraz M, Kaya AT, Aydin N, Nalcacioglu P. Retrobulbar Ocular Blood Flow and Choroidal Vascular Changes in Patients Recovering from COVID-19 Infection. Photodiagnosis Photodyn Ther 2022; 39:102976. [PMID: 35724935 PMCID: PMC9212774 DOI: 10.1016/j.pdpdt.2022.102976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Background To evaluate the effects of COVID-19 infection on the ocular vascular structure including choroidal thickness and retrobulbar blood flow values in comparison with healthy subjects. Methods Ninety eyes of 90 patients were included in this study. Participants were divided into Group 1 (n = 30) with mild COVID-19 infection, Group 2 (n = 31) with moderate disease, and Group 3 with age- and sex-matched healthy subjects (n = 29). Choroidal thickness was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm, using the enhanced depth imaging (EDI) technique of spectral coherence tomography (SD-OCT). The peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography (CDU). Results The choroidal thickness was significantly thinner in Group 1 and Group 2 than in Group 3 at all measurement points (p <0.001). This difference was not present between Group 1 and Group 2 who had COVID-19 disease of different severity (p>0.05).Among the retrobulbar blood flow parameters, OA PSV value was significantly lower in Group 1 and Group 2 compared to Group 3 (p = 0.025, p = 0.016, respectively). However, the CRA PSV and EDV and OA EDV values, and the CRA and OA PI and RI values were not statistically different between the groups (p> 0.05). Conclusion COVID-19 infection may predispose patients to ocular vascular pathologies by affecting both choroidal and retrobulbar blood flow.
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Affiliation(s)
- Melek Tufek
- Department of Ophthalmology, Amasya University, Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey.
| | - Mustafa Capraz
- Department of Internal Medicine, Amasya University, Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Ahmet Turan Kaya
- Department of Radiology, Amasya University, Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Nihat Aydin
- Department of Ophthalmology, Amasya University, Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Pinar Nalcacioglu
- Department of Ophthalmology, Yıldırım Beyazıt University Medical School, Ankara, Turkey
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12
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Howell M, Loera S, Kirkland-Kyhn H. Cutaneous Anomalies of the Critically Ill Patient. AACN Adv Crit Care 2022; 33:165-172. [PMID: 35657760 DOI: 10.4037/aacnacc2022402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Critically ill patients are at high risk for organ failure, including that of the integumentary system. Nurses working in intensive care are adept at performing comprehensive assessments that include the skin. Although pressure injury is a well-known complication associated with critical illness, patients may also have debilitating and life-threatening dermatoses. Conditions such as skin failure and medical adhesive-related skin damage are commonly seen in the critically ill. Infectious processes, such as Fournier gangrene, invasive candidiasis, mucormycosis, and herpetic lesions, can result in severe or superimposed critical illness and elude detection. Similarly, cutaneous manifestations of COVID-19 may develop prior to commonly recognized symptoms of infection. Nurses and providers caring for critically ill patients should be aware of common, but less widely known, skin conditions to facilitate early detection and treatment.
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Affiliation(s)
- Melania Howell
- Melania Howell is Wound Ostomy Continence Specialist, Emanuel Medical Center, 825 Delbon Avenue, Turlock, CA 95382
| | - Salomé Loera
- Salomé Loera is Clinical Nurse Specialist, Adult Critical Care Services, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Holly Kirkland-Kyhn
- Holly Kirkland-Kyhn is Director of Wound Care, University of California, Davis Medical Center, Sacramento, California
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13
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Ashkenazy N, Patel NA, Sridhar J, Yannuzzi NA, Belin PJ, Kaplan R, Kothari N, Benitez Bajandas GA, Kohly RP, Roizenblatt R, Pinhas A, Mundae R, Rosen RB, Ryan EH, Chiang A, Chang LK, Khurana RN, Finn AP. Hemi- and Central Retinal Vein Occlusion Associated with COVID-19 Infection in Young Patients without Known Risk Factors. Ophthalmol Retina 2022; 6:520-530. [PMID: 35278727 PMCID: PMC8907133 DOI: 10.1016/j.oret.2022.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Venous thromboembolic complications have been reported in association with coronavirus disease 2019 (COVID-19) infection. We raised awareness regarding a potential temporal association between COVID-19 infection and retinal vein occlusion (RVO). DESIGN Multicenter, retrospective, nonconsecutive case series. SUBJECTS Patients presenting with hemi-RVO (HRVO) or central RVO (CRVO) between March 2020 and March 2021, with confirmed COVID-19 infection, were included. The exclusion criteria were as follows: age >50 years, hypertension, diabetes, glaucoma, obesity, underlying hypercoagulable states, and those requiring intubation during hospitalization. METHODS This was a multicenter, retrospective, nonconsecutive case series including patients presenting with hemi-RVO (HRVO) or central RVO (CRVO) between March 2020 and March 2021, with confirmed COVID-19 infection. The exclusion criteria were as follows: age >50 years, hypertension, diabetes, glaucoma, obesity, underlying hypercoagulable states, and those requiring intubation during hospitalization. MAIN OUTCOME MEASURES Ophthalmic findings, including presenting and final visual acuity (VA), imaging findings, and clinical course. RESULTS Twelve eyes of 12 patients with CRVO (9 of 12) or HRVO (3 of 12) after COVID-19 infection were included. The median age was 32 years (range, 18-50 years). Three patients were hospitalized, but none were intubated. The median time from COVID-19 diagnosis to ophthalmic symptoms was 6.9 weeks. The presenting VA ranged from 20/20 to counting fingers, with over half (7 of 12) having a VA of ≥20/40. OCT revealed macular edema in 42% of the eyes; of these, 80% (4 of 5) were treated with anti-VEGF injections. Ninety-two percent (11 of 12) had partial or complete resolution of ocular findings at final follow-up. Four eyes (33%) had retinal thinning, as determined using OCT, by the end of the study interval. The final VA ranged from 20/20 to 20/60, with 11 of the 12 (92%) eyes achieving a VA of ≥20/40 at a median final follow-up period of 13 weeks (range, 4-52 weeks). CONCLUSIONS Although we acknowledge the high seroprevalence of COVID-19 and that a causal relationship cannot be established, we reported this series to raise awareness regarding the potential risk of retinal vascular events due to a heightened thromboinflammatory state associated with COVID-19 infection.
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Affiliation(s)
- Noy Ashkenazy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | - Radha P Kohly
- Department of Ophthalmology, Sunnybrook Health Sciences Center, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | | | - Alexander Pinhas
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Rusdeep Mundae
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Edwin H Ryan
- VitreoRetinal Surgery, PLLC, Minneapolis, Minnesota
| | - Allen Chiang
- Mid Atlantic Retina, Wills Eye Hospital Retina Service, Philadelphia, Pennsylvania
| | - Louis K Chang
- Northern California Retina Vitreous Associates, Mountain View, California
| | - Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Avni P Finn
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee.
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14
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Hafez W, Ziade MA, Arya A, Saleh H, Ali S, Rao SR, Fdl Alla O, Ali M, Zouhbi MA, Abdelrahman A. Reduced ADAMTS13 Activity in Correlation with Pathophysiology, Severity, and Outcome of COVID-19: A Retrospective Observational Study. Int J Infect Dis 2022; 117:334-344. [PMID: 35167969 PMCID: PMC8839807 DOI: 10.1016/j.ijid.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low ADAMTS13 activity has been suggested to be an interplaying factor in the pathogenesis of COVID-19, considering that it is a thromboinflammatory disease with high risk of microthrombosis. OBJECTIVES The study aimed to explore the correlation between ADAMTS13 activity and the pathophysiological pathway of COVID-19. METHODS We carried out a retrospective observational study of 87 patients with COVID-19 in NMC Royal Hospital, Abu Dhabi, UAE. ADAMTS13 activity was measured and compared with patients' characteristics and clinical outcomes. RESULTS Low ADAMTS13 activity was associated with pneumonia (p = 0.007), severity of COVID-19 (p <0.001), and mechanical ventilation rates (p = 0.018). Death was more frequently observed among patients (5 patients) with low ADAMTS13 activity compared with normal activity (1 patient), as well as inflammatory markers. Decreased ADAMTS13 activity increased with the risk of pneumonia, severity of COVID-19, need for mechanical ventilation, and use of anticoagulants ([OR = 4.75, 95% CI 1.54-18.02, p = 0.011], [OR = 6.50, 95% CI 2.57-17.74; p <0.001], [OR = 4.10, 95% CI 1.29-15.82; p = 0.024], [OR = 8.00, 95% CI 3.13-22.16; p <0.001], respectively). The low ADAMTS13 activity group had a slightly longer time to viral clearance than the normal ADAMTS13 activity group, but it was not statistically significant (20 days, 95% CI 16-27 days vs 17 days, 95% CI 13-22 days; p = 0.08; Log rank = 3.1). CONCLUSIONS Low ADAMTS13 activity has been linked to pneumonia, COVID-19 severity, use of anticoagulants, and need for mechanical ventilation but not to mortality. We propose rADAMTS13 as a novel treatment for severe COVID-19.
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Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Medical Research Division, Department of Internal Medicine, The National Research Centre, 33 El Buhouth St, Ad Doqi, Dokki, Cairo Governorate 12622, Egypt.
| | - Mohamad Azzam Ziade
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Arun Arya
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Husam Saleh
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Sara Ali
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Srinivasa Raghu Rao
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Osman Fdl Alla
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mohamed Ali
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mouhamad Al Zouhbi
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ahmed Abdelrahman
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Internal Medicine Department, Zagazig School of medicine, Zagazig, Egypt
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15
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Tudoran C, Tudoran M, Abu-Awwad A, Cut TG, Voiță-Mekereș F. Spontaneous Hematomas and Deep Vein Thrombosis during the Recovery from a SARS-CoV-2 Infection: Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58020230. [PMID: 35208553 PMCID: PMC8878215 DOI: 10.3390/medicina58020230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The frequent occurrence of thromboembolic events in patients infected with the severe acute respiratory syndrome CoV2 (SARS-CoV-2) virus is a well-recognized fact in the medical literature, but less data is available about possible hemorrhagic incidents. Methods: We report the case of a 76-year-old patient who suffered from a mild COVID-19 infection in September 2021 and after four weeks, experienced a completely spontaneous popliteal hematoma followed by deep vein thrombosis (DVT). Therapy with low molecular weight heparins (LMWH) was started, but subsequently, the patient developed a massive sub-pectoral and calf hematoma leading to moderate post-hemorrhagic anemia and acute kidney injury. This patient was treated completely conservatively. Conclusions: Considering the continuous spread of the infection with various, continuously evolving strains of this virus and the extended use of LWMH in clinical practice, such cases were seldom described in the medical literature, but should be considered as a potential cause for hemorrhagic events.
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Affiliation(s)
- Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania
| | - Mariana Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722-310-302 (M.T.)
| | - Ahmed Abu-Awwad
- Department XV-Orthopedics Traumatology, Urology and Medical Imaging Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Center for Ethics in Human Genetic Identifications, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722-310-302 (M.T.)
| | - Florica Voiță-Mekereș
- Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania;
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16
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Kröker A, Tirzīte M. Repurposed pharmacological agents for the potential treatment of COVID-19: a literature review. Respir Res 2021; 22:304. [PMID: 34838020 PMCID: PMC8626754 DOI: 10.1186/s12931-021-01885-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background The COVID-19 pandemic has affected the world extraordinarily. This disease has a potential to cause a significantly severe course of disease leading to respiratory complications, multiple organ failure and possibly death. In the fight against this pandemic-causing disease, medical professionals around the world are searching for pharmacological agents that could treat and prevent disease progression and mortality. To speed the search of promising treatment options, already existing pharmacological agents are repurposed for the potential treatment of COVID-19 and tested in clinical trials. The aim of this literature review is to investigate the efficacy and safety of repurposed pharmacological agents for the treatment of COVID-19 at different pathophysiologic stages of the disease. For this literature review, online-databases PubMed and Google Scholar were utilised. Keywords “COVID-19”, “SARS-CoV-2”, “pathogenesis”, “drug targets”, “pharmacological treatment”, “cytokine storm”, “coagulopathy” and individual drug names were used. Scientific articles, including reviews, clinical trials, and observational cohorts, were collected and analysed. Furthermore, these articles were examined for references to find more clinical trials testing for the potential treatment of COVID-19. In total, 97 references were used to conduct this research paper. Results The most beneficial pharmacological agent for the treatment of COVID-19 are corticosteroids, especially dexamethasone, for the treatment of mechanically ventilated COVID-19 patients. Other promising agents are remdesivir for the treatment of patients with COVID-19 pneumonia requiring minimal supplemental oxygen therapy, and IL-6 receptor antagonist monoclonal antibodies in severe COVID-19. Lopinavir/ritonavir, as well as chloroquine or hydroxychloroquine with or without azithromycin demonstrate the least efficacy in the treatment of COVID-19. The clinical benefits of the treatment of a COVID-19-specific coagulopathy with increased dosing of anticoagulation need further research and confirmation of randomised controlled trials. Conclusion The search for pharmacological treatment of COVID-19 has elicited great controversy. Whereas drugs like chloroquine, hydroxychloroquine, and lopinavir/ritonavir have not shown proven benefit, the agents remdesivir and dexamethasone are recommended for clinical use for the treatment of COVID-19. Further randomised trials for other pharmacological treatment strategies are awaited.
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Affiliation(s)
| | - Madara Tirzīte
- Riga Stradins University, Riga, Latvia.,Riga East University Hospital, Clinical Centre "Gailezers", Riga, Latvia
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17
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Chowdhry E, Moshman J, Carroll S. A Case of COVID-19 Related Coagulopathy Complications and Heparin Resistance. Cureus 2021; 13:e18265. [PMID: 34722046 PMCID: PMC8547601 DOI: 10.7759/cureus.18265] [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] [Accepted: 09/25/2021] [Indexed: 01/08/2023] Open
Abstract
Mechanisms of COVID-19 coagulopathy have been speculated and are not definitively understood; the current speculation is that there is elaborate crosstalk between the inflammatory and hemostatic systems which contributes to the overall increased thrombotic risk in the setting of COVID-19 resulting in a hypercoagulable state. A few documented reports regarding cases of apparent heparin resistance in patients with COVID-19 with complications of thromboembolic events occurring in the setting of heparin anticoagulation have been described. This phenomenon of heparin resistance has been observed in patients with active, severe COVID-19 infection. However, we describe a unique case of a patient who had recovered from a recent, mild COVID-19 infection that did not require hospitalization and presented with acute limb ischemia and demonstrated heparin resistance. The patient was managed by specialists in vascular surgery, intensivists, cardiologists, hematology, and physical medicine and rehabilitation (PMR). We present the case of a patient who had successfully recovered from COVID-19 yet demonstrated post-COVID-19 complications related to coagulopathy and heparin resistance.
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Affiliation(s)
- Erum Chowdhry
- Family Medicine, University of Nevada, Reno School of Medicine, Reno, USA
| | - Jennifer Moshman
- Internal Medicine, Providence Newberg Medical Center, Newberg, USA
| | - Stacey Carroll
- Family Medicine, University of Nevada, Reno School of Medicine, Reno, USA
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18
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Santosa YP, Yuwono A. Two Different Clinical Presentations of Acute Limb Ischemia Caused by Acute Thrombotic Events in COVID-19. Cureus 2021; 13:e17916. [PMID: 34660110 PMCID: PMC8511142 DOI: 10.7759/cureus.17916] [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] [Accepted: 09/12/2021] [Indexed: 01/15/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coagulopathy is frequently found in severe cases of COVID-19 and is usually manifested as a prothrombotic state. Hyperinflammation, endotheliitis, and immobilization during illness are hypothesized to play a role. Acute limb ischemia (ALI) is one of the presentations of arterial thrombosis in COVID-19. We present two cases of middle-aged men with COVID-19 infection, who developed ALI. The first patient developed ALI after 16 days from the initial COVID-19 diagnosis, and the second patient was admitted to the emergency ward due to sudden discoloration of his right lower limb, and COVID-19 was diagnosed during the evaluation.
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Affiliation(s)
- Yudistira P Santosa
- Department of Internal Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, IDN
| | - Angelina Yuwono
- Department of Internal Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, IDN
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19
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Lamponi S. Bioactive Natural Compounds with Antiplatelet and Anticoagulant Activity and Their Potential Role in the Treatment of Thrombotic Disorders. Life (Basel) 2021; 11:life11101095. [PMID: 34685464 PMCID: PMC8540276 DOI: 10.3390/life11101095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022] Open
Abstract
Natural anticoagulant drugs can be obtained from plants, rich in secondary bioactive metabolites which, in addition to being effective antioxidants, also possess anticoagulant and antiplatelet properties and, for this reason, can be excellent candidates for the treatment of thrombotic diseases. This review reports an overview of the hemostatic process and thrombotic disorders together with data on plants, more and less common from around the world, containing bioactive compounds characterized by antiplatelet and anticoagulant activity. The reported literature was obtained from Medline, PubMed, Elsevier, Web of Science, Google Scholar considering only articles in the English language, published in peer-reviewed journals. The number of citations of the articles and the impact factor of the journals were other parameters used to select the scientific papers to be included in the review. The analysis of the literature data selected demonstrates that many plants’ bioactive compounds show antiplatelet and anticoagulant activity that make them potential candidates to be used as new natural compounds able to interfere with both primary and secondary hemostasis. Moreover, they could be used together with anticoagulants currently administered in clinical practice to increase their efficacy and to reduce complications in the treatment of thrombotic disorders.
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Affiliation(s)
- Stefania Lamponi
- Department of Biotechnologies, Chemistry and Pharmacy and SienabioACTIVE, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy
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20
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Arévalos V, Ortega-Paz L, Rodríguez-Arias JJ, Calvo López M, Castrillo-Golvano L, Salazar-Rodríguez A, Sabaté-Tormos M, Spione F, Sabaté M, Brugaletta S. Acute and Chronic Effects of COVID-19 on the Cardiovascular System. J Cardiovasc Dev Dis 2021; 8:jcdd8100128. [PMID: 34677197 PMCID: PMC8541609 DOI: 10.3390/jcdd8100128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has shown significant morbidity with the involvement of multiple systems, including the cardiovascular system. Cardiovascular manifestations in the acute phase can include myocardial injury itself, myocardial infarction, venous thromboembolic events, myocarditis, Takotsubo syndrome, and different arrhythmic events. Myocardial injury defined by the rise of cardiac biomarkers in blood has been found in multiple studies with a prevalence of about 20%. Its presence is related to worse clinical outcomes and in-hospital mortality. The mechanisms of myocardial injury have been the subject of intense research but still need to be clarified. The characterization of the cardiac affectation with echocardiography and cardiac magnetic resonance has found mixed results in different studies, with a striking incidence of imaging criteria for myocarditis. Regarding post-acute and chronic follow-up results, the persistence of symptoms and imaging changes in recovered COVID-19 patients has raised concerns about the duration and the possible significance of these findings. Even though the knowledge about this disease has increased incredibly in the last year, many aspects are still unclear and warrant further research.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Margarita Calvo López
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Leticia Castrillo-Golvano
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Anthony Salazar-Rodríguez
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Marta Sabaté-Tormos
- Department of Medicine, Medical School, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Francesco Spione
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-227-9305
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21
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Kaya MO, Pamukçu E, Yakar B. The role of vitamin D deficiency on COVID-19: a systematic review and meta-analysis of observational studies. Epidemiol Health 2021; 43:e2021074. [PMID: 34607398 PMCID: PMC8769802 DOI: 10.4178/epih.e2021074] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Although vaccination has started, coronavirus disease 2019 (COVID-19) poses a continuing threat to public health. Therefore, in addition to vaccination, the use of supplements to support the immune system may be important. The purpose of this study was to synthesize evidence on the possible effect of low serum vitamin D levels (25[OH]D<20 ng/mL or 50 nmol/L) on COVID-19 infection and outcomes. METHODS We searched Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect without any language restrictions for articles published between January 1 and December 15, 2020. We performed 3 meta-analyses (called vitamin D and COVID-19 infection meta-analysis [D-CIMA], vitamin D and COVID-19 severity meta-analysis [D-CSMA], and vitamin D and COV ID-19 mortality meta-analysis [D-CMMA] for COVID-19 infection, severity, and mortality, respectively) to combine odds ratio values according to laboratory measurement units for vitamin D and the measured serum 25(OH)D level. RESULTS Twenty-one eligible studies were found to be relevant to the relationship between vitamin D and COVID-19 infection/outcomes (n=205,869). The D-CIMA meta-analysis showed that individuals with low serum vitamin D levels were 1.64 times (95% confidence interval [CI], 1.32 to 2.04; p<0.001) more likely to contract COVID-19. The D-CSMA meta-analysis showed that people with serum 25(OH)D levels below 20 ng/mL or 50 nmol/L were 2.42 times (95% CI, 1.13 to 5.18; p=0.022) more likely to have severe COVID-19. The D-CMMA meta-analysis showed that low vitamin D levels had no effect on COVID-19 mortality (OR, 1.64; 95% CI, 0.53 to 5.06, p=0.390). CONCLUSIONS According to our results, vitamin D deficiency may increase the risk of COVID-19 infection and the likelihood of severe disease. Therefore, we recommend vitamin D supplementation to prevent COVID-19 and its negative outcomes.
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Affiliation(s)
- Mehmet Onur Kaya
- Department of Biostatistics and Medical Informatics, Firat University School of Medicine, Elazığ, Turkey
| | - Esra Pamukçu
- Department of Statistics, Faculty of Science, Fırat University, Elazığ, Turkey
| | - Burkay Yakar
- Department of Family Medicine, Firat University School of Medicine, Elazığ, Turkey
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22
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Alhomoud M, Alhobayb T, Armitage K. COVID-19 infection triggering Thrombotic Thrombocytopenic Purpura. IDCases 2021; 26:e01256. [PMID: 34458098 PMCID: PMC8383479 DOI: 10.1016/j.idcr.2021.e01256] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 01/22/2023] Open
Abstract
We present a 62-year-old gentleman with history of Crohn’s disease, G6PD deficiency, who presented with immune-mediated thrombotic thrombocytopenia purpura (iTTP) one week after the diagnosis of COVID-19 infection. He was admitted with worsening dyspnea, acute renal failure, and profound thrombocytopenia with marked schistocytosis on peripheral smear. ADAMTS13 level was severely deficient. He was treated with oral prednisone, plasma exchange and rituximab with complete clinical resolution. Given the temporal association of this recurrent episode of iTTP with COVID-19 infection and no other discernible cause, COVID-19 infection was the most likely trigger.
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Affiliation(s)
- Mohammad Alhomoud
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Tamara Alhobayb
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Keith Armitage
- Division of Infectious Diseases, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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23
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Focosi D, Franchini M, Pirofski LA, Burnouf T, Fairweather D, Joyner MJ, Casadevall A. COVID-19 Convalescent Plasma Is More than Neutralizing Antibodies: A Narrative Review of Potential Beneficial and Detrimental Co-Factors. Viruses 2021; 13:1594. [PMID: 34452459 PMCID: PMC8402718 DOI: 10.3390/v13081594] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 convalescent plasma (CCP) is currently under investigation for both treatment and post-exposure prophylaxis. The active component of CCP mediating improved outcome is commonly reported as specific antibodies, particularly neutralizing antibodies, with clinical efficacy characterized according to the level or antibody affinity. In this review, we highlight the potential role of additional factors in CCP that can be either beneficial (e.g., AT-III, alpha-1 AT, ACE2+ extracellular vesicles) or detrimental (e.g., anti-ADAMTS13, anti-MDA5 or anti-interferon autoantibodies, pro-coagulant extracellular vesicles). Variations in these factors in CCP may contribute to varied outcomes in patients with COVID-19 and undergoing CCP therapy. We advise careful, retrospective investigation of such co-factors in randomized clinical trials that use fresh frozen plasma in control arms. Nevertheless, it might be difficult to establish a causal link between these components and outcome, given that CCP is generally safe and neutralizing antibody effects may predominate.
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Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy
| | - Massimo Franchini
- Division of Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering & International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Arturo Casadevall
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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24
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Arévalos V, Ortega-Paz L, Fernandez-Rodríguez D, Alfonso Jiménez-Díaz V, Rius JB, Campo G, Rodríguez-Santamarta M, de Prado AP, Gómez-Menchero A, Díaz Fernández JF, Scardino C, Gonzalo N, Pernigotti A, Alfonso F, Jesús Amat-Santos I, Silvestro A, Ielasi A, María de la Torre J, Bastidas G, Gómez-Lara J, Sabaté M, Brugaletta S. Long-term effects of coronavirus disease 2019 on the cardiovascular system, CV COVID registry: A structured summary of a study protocol. PLoS One 2021; 16:e0255263. [PMID: 34324524 PMCID: PMC8320971 DOI: 10.1371/journal.pone.0255263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients presenting with the coronavirus-2019 disease (COVID-19) may have a high risk of cardiovascular adverse events, including death from cardiovascular causes. The long-term cardiovascular outcomes of these patients are entirely unknown. We aim to perform a registry of patients who have undergone a diagnostic nasopharyngeal swab for SARS-CoV-2 and to determine their long-term cardiovascular outcomes. STUDY AND DESIGN This is a multicenter, observational, retrospective registry to be conducted at 17 centers in Spain and Italy (ClinicalTrials.gov number: NCT04359927). Consecutive patients older than 18 years, who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions, will be included since March 2020, to August 2020. Patients will be classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome will be cardiovascular mortality at 1 year. The secondary outcomes will be acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias, at 1 year. Outcomes will be compared between the two groups. Events will be adjudicated by an independent clinical event committee. CONCLUSION The results of this registry will contribute to a better understanding of the long-term cardiovascular implications of the COVID19.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
| | | | | | - Jordi Bañeras Rius
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Gianluca Campo
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | | | - Claudia Scardino
- Department of Cardiology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Nieves Gonzalo
- Department of Cardiology, Hospital Universitario Clínico San Carlos Madrid, Madrid, Spain
| | - Alberto Pernigotti
- Department of Cardiology, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Antonio Silvestro
- Department of Cardiology, Ospedale Bolognini di Seriate, Bérgamo, Italy
| | - Alfonso Ielasi
- Department of Cardiology, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | | | - Gabriela Bastidas
- Department of Cardiology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Josep Gómez-Lara
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
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25
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Cotabarren J, Ozón B, Claver S, Garcia-Pardo J, Obregón WD. Purification and Identification of Novel Antioxidant Peptides Isolated from Geoffroea decorticans Seeds with Anticoagulant Activity. Pharmaceutics 2021; 13:1153. [PMID: 34452114 PMCID: PMC8399481 DOI: 10.3390/pharmaceutics13081153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Geoffroea decorticans is a xerophilous deciduous tree present in most arid forests of southern South America, which is commonly used in traditional medicine. The seeds of this tree have been previously investigated for their singular chemical composition, but their protein content has been poorly investigated. Herein, we report the isolation, purification, and characterization of a set of thermostable peptides derived from Geoffroea decorticans seeds (GdAPs) with strong antioxidant and anticoagulant activities. The most potent antioxidant peptides showed a half maximal inhibitory concentration (IC50) of 35.5 ± 0.3 µg/mL determined by 1,1-diphenyl-2-picrylhydrazyl (DPPH). They also caused a dose-dependent prolongation of the aPTT clotting time with an IC50 value of ~82 µg/mL. Interestingly, MALDI-TOF/MS analysis showed the presence of three major peptides with low molecular weights of 2257.199 Da, 2717.165 Da, and 5422.002 Da. The derived amino-acid sequence of GdAPs revealed their unique structural features, exhibiting homology with various proteins present in the genome of Arachis hypogaea. All in all, our data suggest a direct applicability of GdAPs for pharmaceutical purposes.
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Affiliation(s)
- Juliana Cotabarren
- Centro de Investigación de Proteínas Vegetales (CIPROVE), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de la Plata, Buenos Aires B1900, Argentina; (B.O.); (S.C.)
| | - Brenda Ozón
- Centro de Investigación de Proteínas Vegetales (CIPROVE), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de la Plata, Buenos Aires B1900, Argentina; (B.O.); (S.C.)
| | - Santiago Claver
- Centro de Investigación de Proteínas Vegetales (CIPROVE), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de la Plata, Buenos Aires B1900, Argentina; (B.O.); (S.C.)
| | - Javier Garcia-Pardo
- Institut de Biotecnologia i Biomedicina and Departament de Bioquimica i Biologia Molecular, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Walter David Obregón
- Centro de Investigación de Proteínas Vegetales (CIPROVE), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de la Plata, Buenos Aires B1900, Argentina; (B.O.); (S.C.)
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26
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Zaffanello M, Piacentini G, Nosetti L, Ganzarolli S, Franchini M. Thrombotic risk in children with COVID-19 infection: A systematic review of the literature. Thromb Res 2021; 205:92-98. [PMID: 34293539 PMCID: PMC8284063 DOI: 10.1016/j.thromres.2021.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/23/2023]
Abstract
Objective Coagulation and inflammatory parameters are mildly altered in children with SARS-CoV-2 (COVID-19) infection, and laboratory evidence of a proinflammatory and procoagulant state has been noted in multisystem inflammatory syndrome in children (MIS-C). It is not clear whether this pediatric condition is related to thrombotic events. With this study we reviewed the literature for thrombotic complications in children with COVID-19 infection and MIS-C. Data sources We searched the Medline PubMed Advanced Search Builder, Scopus, Web Of Science, and Google Scholar electronic databases (until 1 January 2021) using the medical subject headings (MeSH) terms and text words (their combinations and truncated synonyms): (THROMBOSIS OR THROMBOPHILIA) AND (CHILD OR CHILDREN OR INFANT) AND (COVID-19 OR SARS-CoV-2). Study eligibility criteria Inclusion criteria were children with COVID-19 or SARS-COV-2 infection. The search was limited to articles published in English. Exclusion criteria were: reviews of published studies, studies published only as abstracts, letters or conference proceedings, discussion papers, animal studies, or editorials. Results After screening for duplicates, the initial search yielded 86 records: 12 were case reports involving 19 children; comorbidities were absent or mild in 73.7%. The most common site of thrombosis the lung (21%); the most often used drug was heparin (42%). Two studies were an international survey (n = 337 patients) and a large multicenter study (n = 186 patients with MIS-C). The risk of ischemic stroke in SARS-CoV-2 infection (0.82%) and deep venous thrombosis in MIS-C (4.3%) was lower in children than in adults. Conclusions Thrombodic or thromboembolic events are rare in pediatric patients with COVID-19 infection and MIS-C. Nonetheless, as in adults, a high index of suspicion should be maintained in children with COVID-19 infection or MIS-C, particularly in those with comorbidities predisposing to thrombotic events.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Luana Nosetti
- Lombardy Regional SIDS Center, Division of Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy.
| | - Stefania Ganzarolli
- Pediatric Division, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy.
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27
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García de Guadiana-Romualdo L, Morell-García D, Favaloro EJ, Vílchez JA, Bauça JM, Alcaide Martín MJ, Gutiérrez Garcia I, de la Hera Cagigal P, Egea-Caparrós JM, Pérez Sanmartín S, Gutiérrez Revilla JI, Urrechaga E, Álamo JM, Hernando Holgado AM, Lorenzo-Lozano MC, Canalda Campás M, Juncos Tobarra MA, Morales-Indiano C, Vírseda Chamorro I, Pastor Murcia Y, Sahuquillo Frías L, Altimira Queral L, Nuez-Zaragoza E, Adell Ruiz de León J, Ruiz Ripa A, Salas Gómez-Pablos P, Cebreiros López I, Fernández Uriarte A, Larruzea A, López Yepes ML, Sancho-Rodríguez N, Zamorano Andrés MC, Pedregosa Díaz J, Sáenz L, Esparza Del Valle C, Baamonde Calzada MC, García Muñoz S, Vera M, Martín Torres E, Sánchez Fdez-Pacheco S, Vicente Gutiérrez L, Jiménez Añón L, Pérez Martínez A, Pons Castillo A, González Tamayo R, Férriz Vivancos J, Rodríguez-Fraga O, Díaz-Brito V, Aguadero V, García Arévalo MG, Arnaldos Carrillo M, González Morales M, Núñez Gárate M, Ruiz Iruela C, Esteban Torrella P, Vila Pérez M, Acevedo Alcaraz C, Blázquez-Manzanera AL, Galán Ortega A. Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study). J Thromb Thrombolysis 2021; 53:103-112. [PMID: 34272635 PMCID: PMC8284690 DOI: 10.1007/s11239-021-02527-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/20/2022]
Abstract
Coagulopathy is a key feature of COVID-19 and D-dimer has been reported as a predictor of severity. However, because D-dimer test results vary considerably among assays, resolving harmonization issues is fundamental to translate findings into clinical practice. In this retrospective multicenter study (BIOCOVID study), we aimed to analyze the value of harmonized D-dimer levels upon admission for the prediction of in-hospital mortality in COVID-19 patients. All-cause in-hospital mortality was defined as endpoint. For harmonization of D-dimer levels, we designed a model based on the transformation of method-specific regression lines to a reference regression line. The ability of D-dimer for prediction of death was explored by receiver operating characteristic curves analysis and the association with the endpoint by Cox regression analysis. Study population included 2663 patients. In-hospital mortality rate was 14.3%. Harmonized D-dimer upon admission yielded an area under the curve of 0.66, with an optimal cut-off value of 0.945 mg/L FEU. Patients with harmonized D-dimer ≥ 0.945 mg/L FEU had a higher mortality rate (22.4% vs. 9.2%; p < 0.001). D-dimer was an independent predictor of in-hospital mortality, with an adjusted hazard ratio of 1.709. This is the first study in which a harmonization approach was performed to assure comparability of D-dimer levels measured by different assays. Elevated D-dimer levels upon admission were associated with a greater risk of in-hospital mortality among COVID-19 patients, but had limited performance as prognostic test.
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Affiliation(s)
- Luis García de Guadiana-Romualdo
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, C/ Mezquita, s/n, Paraje Los Arcos, Santa Lucía, 30202, Cartagena, Spain.
| | - Daniel Morell-García
- Laboratory Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Emmanuel J Favaloro
- Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Juan A Vílchez
- Laboratory Medicine Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Josep M Bauça
- Laboratory Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | - Sonia Pérez Sanmartín
- Laboratory Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Jose M Álamo
- Biochemical Laboratory, Hospital Marina Baixa, Villajoyosa, Spain
| | | | | | | | - María A Juncos Tobarra
- Laboratory Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristian Morales-Indiano
- Laboratory Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | | | - Yolanda Pastor Murcia
- Laboratory Medicine Department, Consorci Hospital General Universitari de València, Valencia, Spain
| | | | - Laura Altimira Queral
- Laboratory Medicine Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Elisa Nuez-Zaragoza
- Clinical Laboratory Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Alicia Ruiz Ripa
- Laboratory Medicine Department, Laboratori de Referència de Catalunya. Hospital de Mataró, Mataró, Spain
| | | | - Iria Cebreiros López
- Laboratory Medicine Department, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain
| | | | - Alex Larruzea
- Laboratory Medicine Department, Hospital Fundació Sanitària Hospital de Mollet, Barcelona, Spain
| | | | | | | | | | - Luis Sáenz
- Laboratory Medicine Department, Hospital General Universitario Rafael Méndez, Lorca, Spain
| | - Clara Esparza Del Valle
- Laboratory Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Sara García Muñoz
- Laboratory Medicine Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Marina Vera
- Biochemical Laboratory, Hospital Marina Baixa, Villajoyosa, Spain
| | | | | | - Luis Vicente Gutiérrez
- Laboratory Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Laura Jiménez Añón
- Laboratory Medicine Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | | | | | - Ruth González Tamayo
- Laboratory Medicine Department, Hospital Universitario de Torrevieja, Torrevieja, Spain
| | - Jorge Férriz Vivancos
- Laboratory Medicine Department, Consorci Hospital General Universitari de València, Valencia, Spain
| | | | - Vicens Díaz-Brito
- Internal Medicine Department, Parc Sanitari Sant Joan de Déu,, Sant Boi de Llobregat, Spain
| | - Vicente Aguadero
- Clinical Laboratory Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - M G García Arévalo
- Laboratory Medicine Department, Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | | | - Mercedes González Morales
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, C/ Mezquita, s/n, Paraje Los Arcos, Santa Lucía, 30202, Cartagena, Spain
| | | | - Cristina Ruiz Iruela
- Laboratory Medicine Department, Hospital Fundació Sanitària Hospital de Mollet, Barcelona, Spain
| | | | - Martí Vila Pérez
- Laboratory Medicine Department, Hospital Verge de La Cinta, Tortosa, Spain
| | - Cristina Acevedo Alcaraz
- Laboratory Medicine Department, Hospital Universitario Los Arcos del Mar Menor, San Javier, Spain
| | | | - Amparo Galán Ortega
- Comisión de Magnitudes Biológicas Relacionadas Con La Urgencia Médica, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
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28
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Arévalos V, Ortega-Paz L, Rodríguez-Arias JJ, Calvo M, Castrillo L, Salazar A, Roque M, Dantas AP, Sabaté M, Brugaletta S. Myocardial Injury in COVID-19 Patients: Association with Inflammation, Coagulopathy and In-Hospital Prognosis. J Clin Med 2021; 10:2096. [PMID: 34068127 PMCID: PMC8152726 DOI: 10.3390/jcm10102096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
The exact mechanisms leading to myocardial injury in the coronavirus disease 2019 (COVID-19) are still unknown. In this retrospective observational study, we include all consecutive COVID-19 patients admitted to our center. They were divided into two groups according to the presence of myocardial injury. Clinical variables, Charlson Comorbidity Index (CCI), C-reactive protein (CRP), CAC (COVID-19-associated coagulopathy), defined according to the ISTH score, treatment and in-hospital events were collected. Between March and April 2020, 331 COVID-19 patients were enrolled, 72 of them (21.8%) with myocardial injury. Patients with myocardial injury showed a higher CCI score (median (interquartile range), 5 (4-7) vs. 2 (1-4), p = 0.001), higher CRP values (18.3 (9.6-25.9) mg/dL vs. 12.0 (5.4-19.4) mg/dL, p ˂ 0.001) and CAC score (1 (0-2) vs. 0 (0-1), p = 0.001), and had lower use of any anticoagulant (57 patients (82.6%) vs. 229 patients (90.9%), p = 0.078), than those without. In the adjusted logistic regression, CRP, myocardial injury, CCI and CAC score were positive independent predictors of mortality, whereas anticoagulants resulted as a protective factor. Myocardial injury in COVID-19 patients is associated with inflammation and coagulopathy, resulting in a worse in-hospital prognosis. Treatment with anticoagulant agents may help to improve in-hospital outcomes.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Margarita Calvo
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
| | - Leticia Castrillo
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
| | - Anthony Salazar
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
| | - Merce Roque
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Ana Paula Dantas
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
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29
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ABO blood group and COVID-19: an updated systematic literature review and meta-analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:317-326. [PMID: 34059188 DOI: 10.2450/2021.0049-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Following the first reports in the literature, the association between the ABO blood group and SARS-CoV-2 infection has been investigated by a number of studies, although with varying results. The main object of this systematic review was to assess the relationship between the ABO blood group and the occurrence and severity of COVID-19. MATERIALS AND METHODS A systematic literature search using appropriate MeSH terms was performed through Medline and PubMed. The outcomes considered were the prevalence of the blood group O vs non-O types in SARS-CoV-2 infected and non-infected subjects, and the severity of SARS-CoV-2 infection according to ABO group. The methodological quality of the studies included in the analysis was assessed with the Newcastle-Ottawa Scale, and the overall quality of the available evidence using the GRADE system. Benchmarks used to evaluate the effect size were odd ratios (ORs) for case control studies and risk ratios (RRs) for cohort studies. RESULTS Twenty-one studies were included in the analysis. Overall, individuals with group O had a lower infection rate compared to individuals of non-O group (OR: 0.81; 95% CI: 0.75, 0.86). However, the difference in the effect size was significantly lower in cohort studies compared to case control studies. No evidence was found indicating an effect of the O type on the disease severity in the infected patients. DISCUSSION We have found low/very low evidence that group O individuals are less susceptible to SARS-CoV-2 infection compared to those in the non-O group. No evidence was found indicating an effect of the O type on disease severity in SARS-CoV-2 infection.
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Aribawa IGNM, Hidayat L, Dewi PU, Ryalino C. Progressive COVID-19-Associated Coagulopathy Despite Treatment with Therapeutic Anticoagulation and Thrombolysis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930667. [PMID: 33967265 PMCID: PMC8126589 DOI: 10.12659/ajcr.930667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) has been associated with a hypercoagulability state. Clinical presentation can range from asymptomatic to severe illness and mortality. Thrombotic complications in COVID-19 have been associated with mortality. The incidence of systemic hypercoagulation in COVID-19 is associated with the process of severe inflammation. The majority of severely ill patients have developed coagulopathy, and this condition is associated with poor outcomes. CASE REPORT A 72-year-old man presented with respiratory symptoms and was diagnosed with a COVID-19 infection. He presented with tachypnea, tachycardia, increased blood pressure, and 74% peripheral oxygen saturation under 15 L/min oxygen per non-rebreather mask. Initial laboratory test results showed severe hypoxemia as per blood gas analysis (pH 7.42, pCO₂ 23 mmHg, pO₂ 43 mmHg, HCO₃ 15 mmol/L, base deficit -9 mmol/L), with increased procalcitonin, high-sensitivity C-reactive protein, D-dimer, fibrinogen, creatine kinase myocardial band, and Troponin I. He subsequently developed thrombosis of the pulmonary arteries and multiple branches of the pulmonary vein despite therapeutic anticoagulation. We initiated heparin therapy (average dose 25 191 units per day, mean activated partial thromboplastin time, 64.35 seconds). Radiological investigations revealed multiple thromboses on pulmonary arteries and pulmonary veins, as well as multiple locations of brain infarction. Rescue thrombolytic therapy was given, but unfortunately, the patient died due to multiple end-organ failures. CONCLUSIONS Controlling coagulopathy, and thrombolytic therapy type and timing, are critical issues, and new strategies must be sought to lower its morbidity and mortality rates further.
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Affiliation(s)
- I Gusti Ngurah M Aribawa
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Leonard Hidayat
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Putu Utami Dewi
- Department of Radiology, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Christopher Ryalino
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
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Synowiec A, Szczepański A, Barreto-Duran E, Lie LK, Pyrc K. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): a Systemic Infection. Clin Microbiol Rev 2021; 34:e00133-20. [PMID: 33441314 PMCID: PMC7849242 DOI: 10.1128/cmr.00133-20] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To date, seven identified coronaviruses (CoVs) have been found to infect humans; of these, three highly pathogenic variants have emerged in the 21st century. The newest member of this group, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected at the end of 2019 in Hubei province, China. Since then, this novel coronavirus has spread worldwide, causing a pandemic; the respiratory disease caused by the virus is called coronavirus disease 2019 (COVID-19). The clinical presentation ranges from asymptomatic to mild respiratory tract infections and influenza-like illness to severe disease with accompanying lung injury, multiorgan failure, and death. Although the lungs are believed to be the site at which SARS-CoV-2 replicates, infected patients often report other symptoms, suggesting the involvement of the gastrointestinal tract, heart, cardiovascular system, kidneys, and other organs; therefore, the following question arises: is COVID-19 a respiratory or systemic disease? This review aims to summarize existing data on the replication of SARS-CoV-2 in different tissues in both patients and ex vivo models.
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Affiliation(s)
- Aleksandra Synowiec
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Artur Szczepański
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
- Microbiology Department, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Emilia Barreto-Duran
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Laurensius Kevin Lie
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Krzysztof Pyrc
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
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Ten-Caten F, Gonzalez-Dias P, Castro Í, Ogava RLT, Giddaluru J, Silva JCS, Martins F, Gonçalves ANA, Costa-Martins AG, Araujo JD, Viegas AC, Cunha FQ, Farsky S, Bozza FA, Levin AS, Pannaraj PS, de Silva TI, Minoprio P, Pinheiro da Silva F, Andrade BB, Nakaya HI. In-depth analysis of laboratory parameters reveals the interplay between sex, age, and systemic inflammation in individuals with COVID-19. Int J Infect Dis 2021; 105:579-587. [PMID: 33713813 PMCID: PMC7944763 DOI: 10.1016/j.ijid.2021.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The progression and severity of COVID-19 vary significantly in the population. While the hallmarks of SARS-CoV-2 and severe COVID-19 within routine laboratory parameters are emerging, the impact of sex and age on these profiles is still unknown. METHODS A multidimensional analysis was performed involving millions of records of laboratory parameters and diagnostic tests for 178 887 individuals from Brazil, of whom 33 266 tested positive for SARS-CoV-2. Analyzed data included those relating to complete blood cell count, electrolytes, metabolites, arterial blood gases, enzymes, hormones, cancer biomarkers, and others. FINDINGS COVID-19 induced similar alterations in laboratory parameters in males and females. CRP and ferritin were increased, especially in older men with COVID-19, whereas abnormal liver function tests were common across several age groups, except for young women. Low peripheral blood basophils and eosinophils were more common in the elderly with COVID-19. Both male and female COVID-19 patients admitted to intensive care units displayed alterations in the coagulation system, and higher values for neutrophils, CRP, and lactate dehydrogenase. CONCLUSIONS Our study uncovered the laboratory profiles of a large cohort of COVID-19 patients, which formed the basis of discrepancies influenced by aging and biological sex. These profiles directly linked COVID-19 disease presentation to an intricate interplay between sex, age, and immune activation.
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Affiliation(s)
- Felipe Ten-Caten
- Department of Infectious and Parasitic Diseases, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Patrícia Gonzalez-Dias
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ícaro Castro
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodrigo L T Ogava
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jeevan Giddaluru
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Juan Carlo S Silva
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Felipe Martins
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - André N A Gonçalves
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - André G Costa-Martins
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - José D Araujo
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Viegas
- Division of Nephrology, Medicine Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Q Cunha
- Center of Research in Inflammatory Diseases (CRID), University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Sandra Farsky
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Anna S Levin
- Department of Infectious Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pia S Pannaraj
- Division of Infectious Diseases, Children's Hospital Los Angeles and Department of Pediatrics, Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Thushan I de Silva
- The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Paola Minoprio
- Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - Fabiano Pinheiro da Silva
- Departamento de Emergências Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil.
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil; Center of Research in Inflammatory Diseases (CRID), University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
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Franchini M, Glingani C, Liumbruno GM. Potential mechanisms of action of convalescent plasma in COVID-19. ACTA ACUST UNITED AC 2021; 8:413-420. [PMID: 33652503 DOI: 10.1515/dx-2020-0161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic will be remembered as one of the worst catastrophic events in human history. Unfortunately, no universally recognized effective therapeutic agents are currently available for the treatment of severe SARS-CoV-2 infection. In this context, the use of convalescent plasma from recovered COVID-19 patients has gained increasing interest thanks to the initially positive clinical reports. A number of mechanisms of action have been proposed for convalescent plasma, including direct neutralization and suppression of viremia, anti-inflammatory and immunomodulation effects and mitigation of the COVID-19-associated hypercoagulable state. These immune and non-immune mechanisms will be critically discussed in this narrative review.
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
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The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis. Int J Cardiovasc Imaging 2021; 37:1883-1890. [PMID: 33555535 PMCID: PMC7868518 DOI: 10.1007/s10554-021-02171-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023]
Abstract
It has been reported that myocardial damage and heart failure are more common in COVID-19 patients with severe symptoms. The aim of our study was to measure the right ventricular functions of COVID-19 patients 30 days after their discharge, and compare them to the right ventricular functions of healthy volunteers. Fifty one patients with COVID-19 and 32 healthy volunteers who underwent echocardiographic examinations were enrolled in our study. 29 patients were treated for severe and 22 patients were treated for moderate COVID-19 pneumonia. The study was conducted prospectively, in a single center, between 15 May 2020 and 15 July 2020. We analyzed the right ventricular functions of the patients using conventional techniques and two-dimensional speckle-tracking. Right ventricular end-diastolic and end-systolic area were statistically higher than control group. The right ventricular fractional area change (RVFAC) was significantly lesser in the patient group compared to the control group. Tricuspid annular plane systolic motion (TAPSE) was within normal limits in both groups, it was lower in the patient group compared to the control group. Pulmonary artery pressure was found to be significantly higher in the patient group. Right ventricular global longitudinal strain (RV-GLS) was lesser than the control group (- 15.7 [(- 12.6)-(- 18.7)] vs. - 18.1 [(- 14.8)-(- 21)]; p 0.011). Right ventricular free wall strain (RV-FWS) was lesser in the patient group compared to the control group (- 16 [(- 12.7)-(- 19)] vs - 21.6 [(- 17)-(- 25.3)]; p < 0.001). We found subclinical right ventricular dysfunction in the echocardiographies of COVID-19 patients although there were no risk factors.
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Kounis NG, Koniari I, Gogos C, Assimakopoulos SF. Ηypercoagulation and myocardial injury as risk factors for mortality in patients with COVID-19 pneumonia. Am J Emerg Med 2021; 47:313-314. [PMID: 33494959 PMCID: PMC7816584 DOI: 10.1016/j.ajem.2021.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Christos Gogos
- Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
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Manolis AS, Manolis TA, Manolis AA, Papatheou D, Melita H. COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management. J Cardiovasc Pharmacol Ther 2021; 26:12-24. [PMID: 32924567 PMCID: PMC7492826 DOI: 10.1177/1074248420958973] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus-2019 (COVID-19) predisposes patients to arterial and venous thrombosis commonly complicating the clinical course of hospitalized patients and attributed to the inflammatory state, endothelial dysfunction, platelet activation and blood stasis. This viral coagulopathy may occur despite thromboprophylaxis and raises mortality; the risk appears highest among critically ill inpatients monitored in the intensive care unit. The prevalence of venous thromboembolism in COVID-19 patients has been reported to reach ∼10-35%, while autopsies raise it to nearly 60%. The most common thrombotic complication is pulmonary embolism, which though may occur in the absence of a recognizable deep venous thrombosis and may be due to pulmonary arterial thrombosis rather than embolism, resulting in thrombotic occlusion of small- to mid-sized pulmonary arteries and subsequent infarction of lung parenchyma. This micro-thrombotic pattern seems more specific for COVID-19 and is associated with an intense immuno-inflammatory reaction that results in diffuse occlusive thrombotic micro-angiopathy with alveolar damage and vascular angiogenesis. Furthermore, thrombosis has also been observed in various arterial sites, including coronary, cerebral and peripheral arteries. Biomarkers related to coagulation, platelet activation and inflammation have been suggested as useful diagnostic and prognostic tools for COVID-19-associated coagulopathy; among them, D-dimer remains a key biomarker employed in clinical practice. Various medical societies have issued guidelines or consensus statements regarding thromboprophylaxis and treatment of these thrombotic complications specifically adapted to COVID-19 patients. All these issues are detailed in this review, data from meta-analyses and current guidelines are tabulated, while the relevant mechanisms of this virus-associated coagulopathy are pictorially illustrated.
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Affiliation(s)
- Antonis S. Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Pivonello R, Auriemma RS, Pivonello C, Isidori AM, Corona G, Colao A, Millar RP. Sex Disparities in COVID-19 Severity and Outcome: Are Men Weaker or Women Stronger? Neuroendocrinology 2020; 111:1066-1085. [PMID: 33242856 PMCID: PMC7900484 DOI: 10.1159/000513346] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health issue which has profound effects on most aspects of societal well-being, including physical and mental health. A plethora of studies globally have suggested the existence of a sex disparity in the severity and outcome of COVID-19 patients, mainly due to mechanisms of virus infection, immune response to the virus, development of systemic inflammation, and consequent systemic complications, particularly thromboembolism. Epidemiological data report a sex difference in the severity of COVID-19, with a more favorable course of the disease in women compared to men regardless of age, although the rate of SARS-CoV-2 infection seems to be similar in both sexes. Sex hormones, including androgens and estrogens, may not only impact virus entry and load, but also shape the clinical manifestations, complications, and ultimately the outcome of the disease. The current review comprehensively summarizes the current literature on sex disparities in susceptibility and outcome of COVID-19 as well as the literature underpinning the pathophysiological and molecular mechanisms, which may provide a rationale to a sex disparity. These mechanisms include sex hormone influence on factors that facilitate virus entry and priming, immune and inflammatory response, as well as coagulation and thrombosis diathesis. Based on present evidence, women appear to be relatively protected from COVID-19 because of a more effective immune response and a less pronounced systemic inflammation, with consequent moderate clinical manifestations of the disease, together with a lesser predisposition to thromboembolism. Conversely, men appear to be particularly susceptible to COVID-19 because of a less effective immune response with consequent severe clinical manifestations of the disease, together with a greater predisposition to thromboembolism. In the elderly, generally characterized by the phenomenon of inflammaging, sex disparities in overall mortality following SARS-CoV-2 infection are even more palpable as elderly men appear to be more prone to severe COVID-19 because of a greater predisposition to infections, a weaker immune defense, and an enhanced thrombotic state compared to women. The information revealed from the review highlights potential novel therapeutic approaches employing the administration of hormonal or antihormonal therapy in combination with antiviral drugs in COVID-19 patients.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy,
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy,
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Annamaria Colao
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Robert P Millar
- Centre for Neuroendocrinology, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Neurosciences Institute and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Prasanna PG, Woloschak GE, DiCarlo AL, Buchsbaum JC, Schaue D, Chakravarti A, Cucinotta FA, Formenti SC, Guha C, Hu DJ, Khan MK, Kirsch DG, Krishnan S, Leitner WW, Marples B, McBride W, Mehta MP, Rafii S, Sharon E, Sullivan JM, Weichselbaum RR, Ahmed MM, Vikram B, Coleman CN, Held KD. Low-Dose Radiation Therapy (LDRT) for COVID-19: Benefits or Risks? Radiat Res 2020; 194:452-464. [PMID: 33045077 PMCID: PMC8009137 DOI: 10.1667/rade-20-00211.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022]
Abstract
The limited impact of treatments for COVID-19 has stimulated several phase 1 clinical trials of whole-lung low-dose radiation therapy (LDRT; 0.3-1.5 Gy) that are now progressing to phase 2 randomized trials worldwide. This novel but unconventional use of radiation to treat COVID-19 prompted the National Cancer Institute, National Council on Radiation Protection and Measurements and National Institute of Allergy and Infectious Diseases to convene a workshop involving a diverse group of experts in radiation oncology, radiobiology, virology, immunology, radiation protection and public health policy. The workshop was held to discuss the mechanistic underpinnings, rationale, and preclinical and emerging clinical studies, and to develop a general framework for use in clinical studies. Without refuting or endorsing LDRT as a treatment for COVID-19, the purpose of the workshop and this review is to provide guidance to clinicians and researchers who plan to conduct preclinical and clinical studies, given the limited available evidence on its safety and efficacy.
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Affiliation(s)
| | | | | | | | | | - Arnab Chakravarti
- Ohio State University, James Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | - Dale J. Hu
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Mohammad K. Khan
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | | | | | | | - Brian Marples
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | - Ralph R. Weichselbaum
- University of Chicago Medicine and Ludwig Center for Metastasis Research, Chicago, IL
| | | | | | | | - Kathryn D. Held
- National Council on Radiation Protection and Measurements, Bethesda, MD and Massachusetts General Hospital/Harvard Medical School, Boston, MA
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Parsons N, Outsikas A, Parish A, Clohesy R, Thakkar N, D'Aprano F, Toomey F, Advani S, Poudel G. Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33106811 DOI: 10.1101/2020.10.21.20215640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Neuropathology caused by the coronavirus disease 2019 (COVID-19) has been reported across several studies. The characterisation of the spatial distribution of these pathology remains critical to assess long and short-term neurological sequelae of COVID-19. To this end, Mathematical models can be used to characterise the location and aetiologies underlying COVID-19-related neuropathology. Method We performed a systematic review of the literature to quantify the locations of small neurological events identified with magnetic resonance imaging (MRI) among COVID-19 patients. Neurological events were localised into the Desikan-Killiany grey and white matter atlases. A mathematical network diffusion model was then used to test whether the spatial distribution of neurological events could be explained via a linear spread through the structural connectome of the brain. Findings We identified 35 articles consisting of 123 patients that assessed the spatial distribution of small neurological events among COVID-19 patients. Of these, 91 patients had grey matter changes, 95 patients had white matter changes and 72 patients had confirmed cerebral microbleeds. White matter events were observed within 14 of 42 white matter bundles from the IIT atlas. The highest proportions (26%) of events were observed within the bilateral corticospinal tracts. The splenium and middle of the corpus callosum were affected in 14% and 9% of the cases respectively. Grey matter events were spatially distributed in the 41 brain regions within the Desikan-Killiany atlas. The highest proportions (∼10%) of the events were observed in areas including the bilateral superior temporal, precentral, and lateral occipital cortices. Sub-cortical events were most frequently identified in the Pallidum. The application of a mathematical network diffusion model suggested that the spatial pattern of the small neurological events in COVID-19 can be modelled with a linear diffusion of spread from epicentres in the bilateral cerebellum and basal ganglia (Pearson's r =0.41, p <0.001, corrected). Interpretation To our knowledge, this is the first study to systematically characterise the spatial distribution of small neurological events in COVID-19 patients and test whether the spatial distribution of these events can be explained by a linear diffusion spread model. The location of neurological events is consistent with commonly identified neurological symptoms including alterations in conscious state among COVID-19 patients that require brain imaging. Given the prevalence and severity of these manifestations, clinicians should carefully monitor neurological symptoms within COVID-19 patients and their potential long-term sequelae .
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