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Vukčević M, Šerović K, Despot M, Nikolić-Kokić A, Vujović A, Nikolić M, Blagojević D, Jovanović T, Despot D. Humoral and Cellular Immune Response after Three Doses of Sinopharm [Vero Cell]-Inactivated COVID-19 Vaccine in Combination with SARS-CoV-2 Infection Leads to Hybrid Immunity. Pharmaceuticals (Basel) 2024; 17:122. [PMID: 38256955 PMCID: PMC10818859 DOI: 10.3390/ph17010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Several vaccines against COVID-19 have been developed and licensed to enhance the immune response against SARS-CoV-2. Similarly, previous infection with SARS-CoV-2 has been shown to provide significant protection against severe infection and hospitalization. METHODS We investigated the effect of three doses of the Sinopharm vaccine and SARS-CoV-2 infection on the specific immune response in 103 volunteers, measuring neutralizing antibodies, anti-S1 IgG, anti-RBD IgM, anti-N IgM, anti-N IgG antibodies, and INF γ. RESULTS Our results showed that the presence of cardiovascular diseases increased the level of anti-N-IgG antibodies, while endocrinological diseases decreased the level of neutralizing antibodies and anti-N IgG antibodies, suggesting that these diseases alter the effect of vaccine-induced immunity. In addition, there was a significant decrease in anti-S1 IgG levels at 6 months and in anti-N IgG levels 18 months post-infection, while neutralizing antibodies and INF γ levels were constant at 3, 6, and 18 months post-infection. CONCLUSIONS Our results confirm the emergence of hybrid immunity, which is the strongest and most durable compared to natural immunity or vaccine-induced immunity. Significant positive correlations were found between humoral and cellular immunity markers: neutralizing antibodies, anti-S1 IgG and anti-N IgG antibodies, and INF γ, indicating a unique coordinated response specific to COVID-19.
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Affiliation(s)
- Marija Vukčević
- Institute for Biocides and Medical Ecology, Trebevićka 16, 11030 Belgrade, Serbia; (M.V.); (K.Š.); (D.D.)
| | - Katarina Šerović
- Institute for Biocides and Medical Ecology, Trebevićka 16, 11030 Belgrade, Serbia; (M.V.); (K.Š.); (D.D.)
| | - Mateja Despot
- Faculty of Medicine, University of Belgrade, dr Subotića starijeg 8, 11000 Belgrade, Serbia;
| | - Aleksandra Nikolić-Kokić
- Institute for Biological Research “Siniša Stanković”-National Institute of Republic of Serbia, Department of Physiology, University of Belgrade, Despota Stefana 142, 11108 Belgrade, Serbia; (A.N.-K.); (D.B.)
| | | | - Milan Nikolić
- University of Belgrade, Faculty of Chemistry, Department of Biochemistry, Studentski trg 12-16, 11158 Belgrade, Serbia;
| | - Duško Blagojević
- Institute for Biological Research “Siniša Stanković”-National Institute of Republic of Serbia, Department of Physiology, University of Belgrade, Despota Stefana 142, 11108 Belgrade, Serbia; (A.N.-K.); (D.B.)
| | - Tanja Jovanović
- Institute for Biocides and Medical Ecology, Trebevićka 16, 11030 Belgrade, Serbia; (M.V.); (K.Š.); (D.D.)
| | - Dragana Despot
- Institute for Biocides and Medical Ecology, Trebevićka 16, 11030 Belgrade, Serbia; (M.V.); (K.Š.); (D.D.)
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Yin C, Hu B, Li K, Liu X, Wang S, He R, Ding H, Jin M, Chen C. Clinical characteristics and prognostic nomograms of 12555 non-severe COVID-19 cases with Omicron infection in Shanghai. BMC Infect Dis 2023; 23:606. [PMID: 37716953 PMCID: PMC10504722 DOI: 10.1186/s12879-023-08582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Omicron variant of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has rapidly become a global threat to public health. Numerous asymptomatic and mild cases had been admitted in shelter hospitals to quickly win the fight against Omicron pandemic in Shanghai. However, little is known about influencing factors for deterioration and length of stay (LOS) in hospitals among these non-severe cases. METHODS This study included 12,555 non-severe cases with COVID-19 in largest shelter hospital of Shanghai, aiming to explore prognostic factors and build effective models for prediction of LOS. RESULTS Data showed that 75.0% of participants were initially asymptomatic. In addition, 94.6% were discharged within 10 days, only 0.3% with deterioration in hospitals. The multivariate analysis indicated that less comorbidities (OR = 1.792, P = 0.012) and booster vaccination (OR = 0.255, P = 0.015) was associated with the decreased risk of deterioration. Moreover, age (HR = 0.991, P < 0.001), number of symptoms (HR = 0.969, P = 0.005), time from diagnosis to admission (HR = 1.013, P = 0.001) and Cycle threshold (CT) values of N gene (HR = 1.081, P < 0.001) were significant factors associated with LOS. Based on these factors, a concise nomogram model for predicting patients discharged within 3 days or more than 10 days was built in the development cohort. In validation cohort, 0.75 and 0.73 of Areas under the curve (AUC) in nomograms, similar with AUC in models of simple machine learning, showed good performance in estimating LOS. CONCLUSION Collectively, this study not only provides important evidence to deeply understand clinical characteristics and risk factors of short-term prognosis in Shanghai Omicron outbreaks, but also offers a concise and effective nomogram model to predict LOS. Our findings will play critical roles in screening high-risk groups, providing advice on duration of quarantine and helping decision-makers with better preparation in outbreak of COVID-19.
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Affiliation(s)
- Chun Yin
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, the 902Nd Hospital of PLA Joint Service Support Force, Bengbu, China
| | - Bo Hu
- Department of Radiology, Air Force Hospital of Eastern Theater Command, Malujie Road, Nanjing, China
| | - Kunyan Li
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xian Liu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Shuili Wang
- Department of Cardiology, the 902Nd Hospital of PLA Joint Service Support Force, Bengbu, China
| | - Rulin He
- Department of Cardiology, the 902Nd Hospital of PLA Joint Service Support Force, Bengbu, China
| | - Haibing Ding
- Department of Cardiology, the 902Nd Hospital of PLA Joint Service Support Force, Bengbu, China
| | - Mingpeng Jin
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Cheng Chen
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Szilveszter M, Pál S, Simon-Szabó Z, Akácsos-Szász OZ, Moldován M, Réger B, Dénes L, Faust Z, Tilinca MC, Nemes-Nagy E. The Management of COVID-19-Related Coagulopathy: A Focus on the Challenges of Metabolic and Vascular Diseases. Int J Mol Sci 2023; 24:12782. [PMID: 37628963 PMCID: PMC10454092 DOI: 10.3390/ijms241612782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The course of COVID-19 is highly dependent on the associated cardiometabolic comorbidities of the patient, which worsen the prognosis of coronavirus infection, mainly due to systemic inflammation, endothelium dysfunction, and thrombosis. A search on the recent medical literature was performed in five languages, using the PubMed, Embase, Cochrane, and Google Scholar databases, for the review of data regarding the management of patients with a high risk for severe COVID-19, focusing on the associated coagulopathy. Special features of COVID-19 management are presented, based on the underlying conditions (obesity, diabetes mellitus, and cardiovascular diseases), emphasizing the necessity of a modern, holistic approach to thromboembolic states. The latest findings regarding the most efficient therapeutic approaches are included in the article, offering guidance for medical professionals in severe, complicated cases of SARS-CoV-2 infection. We can conclude that severe COVID-19 is closely related to vascular inflammation and intense cytokine release leading to hemostasis disorders. Overweight, hyperglycemia, cardiovascular diseases, and old age are important risk factors for severe outcomes of coronavirus infection, involving a hypercoagulable state. Early diagnosis and proper therapy in complicated SARS-CoV-2-infected cases could reduce mortality and the need for intensive care during hospitalization in patients with cardiometabolic comorbidities.
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Affiliation(s)
- Mónika Szilveszter
- Clinic of Plastic Surgery, Mureș County Emergency Hospital, 540136 Târgu-Mureș, Romania;
| | - Sándor Pál
- Department of Transfusion Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Zsuzsánna Simon-Szabó
- Department of Pathophysiology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540142 Târgu-Mureș, Romania
| | - Orsolya-Zsuzsa Akácsos-Szász
- Doctoral School, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540142 Târgu-Mureș, Romania;
| | - Mihály Moldován
- Klinik für Suchttherapie, ZtP Winnenden-Haus der Gesundheit, 73525 Schwäbisch Gümund, Germany;
| | - Barbara Réger
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Lóránd Dénes
- Department of Anatomy and Embryology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540142 Târgu-Mureș, Romania;
| | - Zsuzsanna Faust
- Department of Transfusion Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Mariana Cornelia Tilinca
- Department of Internal Medicine I, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540142 Târgu-Mureș, Romania;
| | - Enikő Nemes-Nagy
- Department of Chemistry and Medical Biochemistry, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540142 Târgu-Mureș, Romania;
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Incidence of lower limb deep vein thrombosis in patients with COVID-19 pneumonia through different waves of SARS-CoV-2 pandemic: A multicenter prospective study. PLoS One 2023; 18:e0280247. [PMID: 36730264 PMCID: PMC9894444 DOI: 10.1371/journal.pone.0280247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/24/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the incidence of deep vein thrombosis (DVT) of the lower limbs in patients hospitalized with COVID-19 pneumonia in a non-ICU setting according to the different waves of the SARS-CoV-2 pandemic. METHODS Multicenter, prospective study of patients with COVID-19 pneumonia admitted to Internal Medicine units in Italy during the first (March-May 2020) and subsequent waves (November 2020 -April 2021) of the pandemic using a serial compression ultrasound (CUS) surveillance to detect DVT of the lower limbs. RESULTS Three-hundred-sixty-three consecutive patients were enrolled. The pooled incidence of DVT was 8%: 13.5% in the first wave, and 4.2% in the subsequent waves (p = 0.002). The proportion of patients with early (< 4 days) detection of DVT was higher in patients during the first wave with respect to those of subsequent waves (8.1% vs 1.9%; p = 0.004). Patients enrolled in different waves had similar clinical characteristics, and thrombotic risk profile. Less patients during the first wave received intermediate/high dose anticoagulation with respect to those of the subsequent waves (40.5% vs 54.5%; p = 0.005); there was a significant difference in anticoagulant regimen and initiation of thromboprophylaxis at home (8.1% vs 25.1%; p<0.001). CONCLUSIONS In acutely ill patients with COVID-19 pneumonia, the incidence of DVT of the lower limbs showed a 3-fold decrease during the first with respect to the subsequent waves of the pandemic. A significant increase in thromboprophylaxis initiation prior to hospitalization, and the increase of the intensity of anticoagulation during hospitalization, likely, played a relevant role to explain this observation.
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Correlation of Biomarkers of Endothelial Injury and Inflammation to Outcome in Hospitalized COVID-19 Patients. J Clin Med 2022; 11:jcm11247436. [PMID: 36556051 PMCID: PMC9785942 DOI: 10.3390/jcm11247436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
COVID-19 can trigger an intense systemic inflammation and prothrombotic state, leading to a rapid and disproportionate deterioration of lung function. An effective screening tool is essential to identify the patients at risk for severe disease. This observational study was conducted on hospitalized patients with moderate and severe COVID-19 pneumonia in a general hospital in Mexico City between 1 March 2021 and 15 March 2021. Serum samples were analyzed to explore the role of biomarkers of inflammation, coagulation, oxidative stress, and endothelial damage with the severity of the disease. Our results demonstrated that Syndecan-1 and nitrites/nitrates showed a high correlation in severely ill patients. In conclusion, COVID-19 patients with elevated levels of SDC-1 were associated with severe disease. This molecule can potentially be used as a marker for the progression or severity of COVID-19. Preservation of glycocalyx integrity may be a potential treatment for COVID-19.
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Kaiafa G, Savopoulos C, Karlafti E, Pantazi K, Paramythiotis D, Thomaidou E, Daios S, Ztriva E, Gionis M, Fyntanidou V, Argiriadou H, Didangelos T. Coagulation Profile of COVID-19 Patients. Life (Basel) 2022; 12:1658. [PMID: 36295093 PMCID: PMC9604860 DOI: 10.3390/life12101658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 12/09/2023] Open
Abstract
Coronavirus disease is a viral infection that can affect multiple systems and be expressed with many-or no-symptoms. The viral infection begins when the virus binds to the host's receptor and from that point on, it is transmitted to the rest of the body, where it causes inflammatory reactions. Among other tissues and systems, SARS-CoV-2 impacts the coagulation system, where it triggers the immunothrombotic response. Its effects are rather intense and can lead to many complications. COVID-19-associated coagulopathy is frequently observed in hospitalized patients, especially ICU patients, and can be proven detrimental. It is usually accompanied by other complications, such as sepsis-induced coagulopathy, disseminated intravascular coagulation and venous thromboembolism. Since all these conditions lead to poor prognosis for severely ill patients, thromboprophylaxis and coagulopathy prognosis are just as important as the therapeutic handling of these patients. Since the beginning of the pandemic, many biomarkers have been considered useful when trying to assess the thrombotic risk of hospitalized patients or evaluate the severity of their situation. At the same time, many drugs have already been tested-while others are still being trialed-in order to find the optimal therapy for each urgent situation.
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Affiliation(s)
- Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleni Karlafti
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Konstantina Pantazi
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, AHEPA General University Hospital, 54621 Thessaloniki, Greece
| | - Evanthia Thomaidou
- Department of Anesthesia and Intensive Care, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Stylianos Daios
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleftheria Ztriva
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Michalis Gionis
- Vascular Surgery Department, General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Varvara Fyntanidou
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Helena Argiriadou
- Department of Anesthesia and Intensive Care, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Triantafyllos Didangelos
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
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El-Kady AM, Aldakheel FM, Allemailem KS, Almatroudi A, Dbas Alharbi R, Al Hamed H, Alsulami M, Alshehri WA, El-Ashram S, Kreys E, Mohamed K, Al-Megrin WAI, Elshabrawy HA. Clinical Characteristics, Outcomes and Prognostic Factors for Critical Illness in Hospitalized COVID-19 Patients in Saudi Arabia: A Retrospective Cohort Study. Int J Gen Med 2022; 15:6945-6963. [PMID: 36068791 PMCID: PMC9441173 DOI: 10.2147/ijgm.s374090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 01/08/2023] Open
Abstract
Background A good understanding of the possible risk factors for coronavirus disease 19 (COVID‐19) severity could help clinicians in identifying patients who need prioritized treatment to prevent disease progression and adverse outcome. In the present study, we aimed to correlate clinical and laboratory characteristics of hospitalized COVID-19 patients to disease outcome in Saudi Arabia. Materials and Methods The present study included 199 COVID-19 patients admitted to King Fahd Specialist Hospital, Buraydah, Qassim, Saudi Arabia, from April to December 2020. Patients were followed-up until discharge either for recovery or death. Demographic data, clinical data and laboratory results were retrieved from electronic patient records. Results Critical COVID-19 cases showed higher mean of age and higher prevalence of co-morbid conditions. Fifty-five patients died during the observation period. Risk factors for in hospital death for COVID 19 patients were leukocytosis (OR 1.89, 95% CI 1.008–3.548, p = 0.081), lymphocytopenia (OR 2.152, 95% CI 1.079–4.295, p = 0.020), neutrophilia (OR 1.839, 95% CI 0.951–3.55, p = 0.047), thrombocytopenia (OR 2.152, 95% CI 0.852–5.430, p = 0.085), liver injury (OR 2.689, 95% CI 1.373–4.944, p = 0.003), acute kidney injury (OR 1.248, 95% CI 0.631–2.467 p = 0.319), pancreatic injury (OR 1.973, 95% CI 0.939–4.144, p = 0.056) and high D dimer (OR 2.635, 95% CI 0.747–9.287, p = 0.091). Conclusion Clinical and laboratory data of COVID-19 patients may help understanding the pathogenesis of the disease and subsequently improve of the outcome of patients by determination of the associated risk factors and recognition of high risk group who are more liable for complications and in hospital death. The present study put an eye on some parameters (laboratory and clinical) that should be alarming signs that the patient is at high risk bad prognosis.
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Affiliation(s)
- Asmaa M El-Kady
- Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt
- Correspondence: Asmaa M El-Kady; Hatem A Elshabrawy, Email ;
| | - Fahad M Aldakheel
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Reem Dbas Alharbi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Hamad Al Hamed
- Department of Laboratory and Blood Bank, King Fahd Specialist Hospital, Buraydah, 52211, Saudi Arabia
| | - Muslimah Alsulami
- Department of Biology, College of Science, University of Jeddah, Jeddah, 21959, Saudi Arabia
| | - Wafa A Alshehri
- Department of Biology, College of Science, University of Jeddah, Jeddah, 21959, Saudi Arabia
| | - Saeed El-Ashram
- Faculty of Science, Kafrelsheikh University, Kafr El-Sheikh, 33516, Egypt
| | - Eugene Kreys
- Department of Clinical & Administrative Sciences, College of Pharmacy, California Northstate University, Elk Grove, CA, 95757, USA
| | - Khalil Mohamed
- Department of Epidemiology, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Wafa Abdullah I Al-Megrin
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh, 11671, Saudi Arabia
| | - Hatem A Elshabrawy
- Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX, 77304, USA
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Murugesan M, Govindarajan R, Prakash L, Murugan CK, Jasmine JJ, Krishnasamy N. In COVID-19 Patients, the Identified Gastrointestinal Symptoms in Tertiary Care Center of India. Euroasian J Hepatogastroenterol 2022; 12:24-30. [PMID: 35990860 PMCID: PMC9357525 DOI: 10.5005/jp-journals-10018-1371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim Materials and methods Results Conclusion How to cite this article
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Affiliation(s)
- Malarvizhi Murugesan
- Department of Medical Gastroenterology, KAP Viswanatham Government Medical College, Trichy, Tamil Nadu, India
| | - Ramkumar Govindarajan
- Department of Gastroenterology, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
| | - Lakshmi Prakash
- Department of Anesthesiology, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Chandra Kumar Murugan
- Department of Medicine, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - J Janifer Jasmine
- Department of Hepatology, Government General Hospital, Chennai, Tamil Nadu, India
| | - Narayanasamy Krishnasamy
- Department of Hepatology, Government Corona Hospital, Chennai, Tamil Nadu, India
- Narayanasamy Krishnasamy, Department of Hepatology, Government Corona Hospital, Chennai, Tamil Nadu, India, Phone: +91 9840415073, e-mail:
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Ashktorab H, Pizuorno A, Adeleye F, Laiyemo A, Dalivand MM, Aduli F, Sherif ZA, Oskrochi G, Angesom K, Oppong-Twene P, Challa SR, Okorie N, Moon ES, Romos E, Jones-Wonni B, Kone AM, Rankine S, Thrift C, Scholes D, Ekwunazu C, Banson A, Mitchell B, Maskalo G, Ross J, Curtis J, Kim R, Gilliard C, Ahuja G, Mathew J, Gavin W, Kara A, Hache-Marliere M, Palaiodimos L, Mani VR, Kalabin A, Gayam VR, Garlapati PR, Miller J, Chirumamilla LG, Jackson F, Carethers JM, Kamangar F, Brim H. Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans. BMC Infect Dis 2022; 22:552. [PMID: 35715729 PMCID: PMC9204073 DOI: 10.1186/s12879-022-07520-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. METHODS We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected. RESULTS The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort. CONCLUSION Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC, USA.
| | - Antonio Pizuorno
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Folake Adeleye
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Adeyinka Laiyemo
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Maryam Mehdipour Dalivand
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Farshad Aduli
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Zaki A. Sherif
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
| | - Gholamreza Oskrochi
- grid.472279.d0000 0004 0418 1945College of Engineering and Technology, American University of the Middle East, Salmiya, Kuwait
| | - Kibreab Angesom
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Philip Oppong-Twene
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Suryanarayana Reddy Challa
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Nnaemeka Okorie
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Esther S. Moon
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Edward Romos
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Boubini Jones-Wonni
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Abdoul Madjid Kone
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Sheldon Rankine
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Camelita Thrift
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Derek Scholes
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Chiamaka Ekwunazu
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Abigail Banson
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Brianna Mitchell
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Guttu Maskalo
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Jillian Ross
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Julencia Curtis
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Rachel Kim
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Chandler Gilliard
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Geetha Ahuja
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Joseph Mathew
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Warren Gavin
- grid.257413.60000 0001 2287 3919Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Areeba Kara
- grid.257413.60000 0001 2287 3919Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Manuel Hache-Marliere
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Leonidas Palaiodimos
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Vishnu R. Mani
- grid.189509.c0000000100241216Department of Trauma, Acute and Critical Care Surgery, Duke University Medical Center, Durham, NC USA
| | - Aleksandr Kalabin
- grid.21729.3f0000000419368729Dartment of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, NY USA
| | - Vijay Reddy Gayam
- grid.414783.d0000 0004 0427 3735Department of Medicine, Interfaith Medical Center, New York, NY USA
| | - Pavani Reddy Garlapati
- grid.414783.d0000 0004 0427 3735Department of Medicine, Interfaith Medical Center, New York, NY USA
| | - Joseph Miller
- grid.413103.40000 0001 2160 8953Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI USA
| | - Lakshmi Gayathri Chirumamilla
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Fatimah Jackson
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
| | - John M. Carethers
- grid.214458.e0000000086837370Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI USA
| | - Farin Kamangar
- grid.260238.d0000 0001 2224 4258Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD USA
| | - Hassan Brim
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
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10
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Soto A, Quiñones-Laveriano DM, Azañero J, Chumpitaz R, Claros J, Salazar L, Rosales O, Nuñez L, Roca D, Alcantara A. Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital. PLoS One 2022; 17:e0264789. [PMID: 35235613 PMCID: PMC8890646 DOI: 10.1371/journal.pone.0264789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital. METHODS Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO2) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. RESULTS We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89; 95%CI 1.31-2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO2<70% compared to SaO2>94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58; 95%CI 1.18-2.11) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use. CONCLUSION A high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.
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Affiliation(s)
- Alonso Soto
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Dante M. Quiñones-Laveriano
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
| | - Johan Azañero
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Rafael Chumpitaz
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - José Claros
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Lucia Salazar
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Oscar Rosales
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Liz Nuñez
- Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
| | - David Roca
- Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
| | - Andres Alcantara
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
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11
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Del Brutto OH, Mera RM, Del Brutto VJ, Recalde BY, Rumbea DA, Costa AF, Sedler MJ. Risk for Subsequent SARS-CoV-2 Infection and Severe COVID-19 Among Community-Dwellers With Pre-Existing Cervicocephalic Atherosclerosis: A Population-Based Study. J Prim Care Community Health 2022; 13:21501319211070685. [PMID: 35068245 PMCID: PMC8796101 DOI: 10.1177/21501319211070685] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19. METHODS Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity. RESULTS Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers (P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis (P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant. CONCLUSIONS Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.
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Affiliation(s)
| | | | | | | | | | - Aldo F Costa
- Hospital Universitario Reina Sofía, Córdoba, Spain
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12
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Meybeck A, Huleux T, Tétart M, Thill P, Derdour V, Bocket L, Alidjinou EK, Patoz P, Robineau O, Ajana F. History of COVID-19 Symptoms and Seroprevalence of SARS-CoV-2 Antibodies in HIV-Infected Patients in Northern France after the First Wave of the Pandemic. Microorganisms 2021; 9:microorganisms9122491. [PMID: 34946093 PMCID: PMC8705918 DOI: 10.3390/microorganisms9122491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
To assess the prevalence of COVID-19 in people living with HIV (PLWHIV), we performed an epidemiological survey from 1 April through 1 August 2020 in an HIV reference center in Northern France. PLWHIV completed a questionnaire about risk exposures and symptoms consistent with COVID-19 and performed a SARS-CoV-2 serology. Among the 600 PLWHIV included, 16 have been infected with SARS-CoV-2. Symptoms consistent with COVID-19 were frequent both in SARS-CoV-2 positive and negative patients (67% vs. 32%, p = 0.02). Among SARS-CoV-2 infected patients, one (6%) has been hospitalized and five (31%) have been asymptomatic. Close contact with a confirmed COVID-19 case was the only factor associated with COVID-19 acquisition (40% vs. 13%, p = 0.01). The prevalence of COVID-19 in PLWHIV was 2.5%, half of the overall population estimate after the first wave of the pandemic in France. In conclusion, proportion of asymptomatic COVID-19 was high in PLWHIV. The prevalence of COVID-19 in PLWHIV was two times lower than in the general population.
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Affiliation(s)
- Agnès Meybeck
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
- Correspondence: ; Tel.: +33-320694605
| | - Thomas Huleux
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
| | - Macha Tétart
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
| | - Pauline Thill
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
| | - Vincent Derdour
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
| | - Laurence Bocket
- Laboratoire de Virologie, CHRU de Lille, 59000 Lille, France; (L.B.); (E.K.A.)
| | | | - Pierre Patoz
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
| | - Olivier Robineau
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
| | - Faiza Ajana
- Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France; (T.H.); (M.T.); (P.T.); (V.D.); (P.P.); (O.R.); (F.A.)
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13
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Endamena GB, Temgoua MN, Chanseaume S, Hilic E, Camus L, Chanseaume A, Mischie A, Kane K, Diallo N, Assi S, Eschalier R. When COVID-19 delays the management of an urgent heart condition: A rare case of a spontaneous dissection of two coronary arteries. Clin Case Rep 2021; 9:e04708. [PMID: 34484755 PMCID: PMC8405420 DOI: 10.1002/ccr3.4708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Some severe life-threatening conditions could be misdiagnosed during the current COVID-19 pandemic.
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Affiliation(s)
| | - Mazou Ngou Temgoua
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
- Department of Internal Medicine and SpecialitiesFaculty of Medicine and Biomedical SciencesYaoundéCameroon
| | | | - Enver Hilic
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Lise Camus
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | | | | | - Karamoko Kane
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Nouhoun Diallo
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Sami Assi
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Romain Eschalier
- Department of CardiologyClermont‐Ferrand University HospitalClermont‐FerrandFrance
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14
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Kowall B, Standl F, Oesterling F, Brune B, Brinkmann M, Dudda M, Pflaumer P, Jöckel KH, Stang A. Excess mortality due to Covid-19? A comparison of total mortality in 2020 with total mortality in 2016 to 2019 in Germany, Sweden and Spain. PLoS One 2021; 16:e0255540. [PMID: 34343210 PMCID: PMC8330914 DOI: 10.1371/journal.pone.0255540] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/17/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. METHODS Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. RESULTS In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974-0.978), and 1.030 (1.023-1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144-1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007-1.011) and 1.083 (1.076-1.090), respectively, whereas results for Spain were virtually unchanged. CONCLUSION In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy.
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Affiliation(s)
- Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Fabian Standl
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | | | - Bastian Brune
- Medical Emergency Service of the City of Essen, Essen, Germany
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Essen, Germany
| | - Marcus Brinkmann
- Center for Clinical Trials, University Hospital Essen, Essen, Germany
| | - Marcel Dudda
- Medical Emergency Service of the City of Essen, Essen, Germany
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Essen, Germany
| | - Peter Pflaumer
- Faculty of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States of America
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15
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Ielapi N, Caprino F, Malizia B, Sisinni A, Ssempijja L, Andreucci M, Licastro N, Serra R. Infection, Infectious Agents and Vascular Disease. Rev Recent Clin Trials 2021; 16:262-271. [PMID: 33823769 DOI: 10.2174/1574887116666210325124045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/29/2021] [Accepted: 02/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Infectious agents may be involved in the pathogenesis of vascular disease and related complications. The aim of this review is to analyze the most relevant information on the common infections related to vascular disease, discussing the main pathophysiological mechanisms. METHODS In the current review, the most important evidence on the issue of infections and vascular disease is searched on Medline, Scopus, and ScienceDirect database. RESULTS Among infectious agents, herpesviruses, parvovirus B19, hepatitis viruses, human immunodeficiency virus, severe acute respiratory syndrome coronavirus 2, treponema pallidum, mycobacterium tuberculosis, pseudomonas aeruginosa, staphylococcus aureus, and candida albicans seem to particularly related to vascular disease. CONCLUSION Infectious agents may affect vessel's homeostasis and functionality, both on the arterial and venous side, by means of several pathophysiological mechanisms such as dysregulation in vasomotor function, thromboembolic complications, initiation and progression of atherosclerosis, alteration of perivascular adipose tissue, recruiting inflammatory cells and molecules.
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Affiliation(s)
- Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Francesco Caprino
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Biagio Malizia
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Antonio Sisinni
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Lwanga Ssempijja
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Noemi Licastro
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy
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16
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Mokarram P, Dalivand MM, Pizuorno A, Aligolighasemabadi F, Sadeghdoust M, Sadeghdoust E, Aduli F, Oskrochi G, Brim H, Ashktorab H. Clinical characteristics, gastrointestinal manifestations and outcomes of COVID-19 patients in Iran; does the location matters? World J Clin Cases 2021; 9:4654-4667. [PMID: 34222432 PMCID: PMC8223834 DOI: 10.12998/wjcc.v9.i18.4654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) started in Asia, and Iran was one of its first epicenters.
AIM To study the gastrointestinal (GI) symptoms and comorbidities associated with this pandemic in four different regions of Iran.
METHODS We analyzed data from severe acute respiratory syndrome coronavirus 2 positive patients evaluated at four hospitals of Iran (n = 91), including South (Shiraz), Southeast (Dezful), Rasht (North), and Northwest (Mashhad) between April and September 2020. Demographics, comorbidities and clinical findings including GI symptoms were collected. Statistical descriptive analysis and correlation analyses of symptoms, comorbidities, and mortality were performed.
RESULTS The average age of COVID-19 patients was 51.1 years, and 56% were male. Mortality rate was 17%. Cough with 84.6%, shortness of breath with 71.4%, fever with 52.7%, and loss of appetite with 43.9% were the main symptoms. Overall cardiac disease was the most common comorbidity with an average of 28.5% followed by hypertension (28.5%) and diabetes (25.2%). The highest comorbidity in North (Rasht) was diabetes (30%) and in South (Dezful) hypertension (37%). Shiraz leads cardiac disease with 43.4%. The most reported GI symptoms included nausea, diarrhea, vomiting, and abdominal pain, with 42.8%, 31.8%, 26.8%, and 12% prevalence, respectively. In addition, albumin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were elevated in 26.3%.
CONCLUSION Our results show hypertension and diabetes as the most common comorbidities, but their distribution was different in COVID-19 patients in the four studied regions of Iran. Nausea, diarrhea, and elevated liver enzymes were the most common GI symptoms. There was also a high mortality rate that was associated with high infection rates in Iran at the beginning of the pandemic.
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Affiliation(s)
- Pooneh Mokarram
- Autophagy Research Center, Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz 71348, Iran
| | | | - Antonio Pizuorno
- Department of Medicine, La Universidad del Zulia, Faculty of Medicine, Maracaibo 4002, Venezuela
| | - Farnaz Aligolighasemabadi
- Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad 13131, Iran
| | - Mohammadamin Sadeghdoust
- Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad 13131, Iran
| | - Ebtesam Sadeghdoust
- Department of Internal Medicine, School of Medicine, Dezful University of Medical Sciences, Dezful 64616, Iran
| | - Farshad Aduli
- Department of Medicine, Howard University, Washington, DC 20060, United States
| | - Gholamreza Oskrochi
- Collage of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait
| | - Hassan Brim
- Department of Medicine, Howard University, Washington, DC 20060, United States
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC 20060, United States
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17
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Herzog AL, von Jouanne-Diedrich HK, Wanner C, Weismann D, Schlesinger T, Meybohm P, Stumpner J. COVID-19 and the kidney: A retrospective analysis of 37 critically ill patients using machine learning. PLoS One 2021; 16:e0251932. [PMID: 34015009 PMCID: PMC8136725 DOI: 10.1371/journal.pone.0251932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is evidence that SARS-CoV2 has a particular affinity for kidney tissue and is often associated with kidney failure. METHODS We assessed whether proteinuria can be predictive of kidney failure, the development of chronic kidney disease, and mortality in 37 critically ill COVID-19 patients. We used machine learning (ML) methods as decision trees and cut-off points created by the OneR package to add new aspects, even in smaller cohorts. RESULTS Among a total of 37 patients, 24 suffered higher-grade renal failure, 20 of whom required kidney replacement therapy. More than 40% of patients remained on hemodialysis after intensive care unit discharge or died (27%). Due to frequent anuria proteinuria measured in two-thirds of the patients, it was not predictive for the investigated endpoints; albuminuria was higher in patients with AKI 3, but the difference was not significant. ML found cut-off points of >31.4 kg/m2 for BMI and >69 years for age, constructed decision trees with great accuracy, and identified highly predictive variables for outcome and remaining chronic kidney disease. CONCLUSIONS Different ML methods and their clinical application, especially decision trees, can provide valuable support for clinical decisions. Presence of proteinuria was not predictive of CKD or AKI and should be confirmed in a larger cohort.
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Affiliation(s)
- Anna Laura Herzog
- Division of Nephrology, Medizinische Klinik I, Transplantationszentrum, University of Würzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Holger K. von Jouanne-Diedrich
- Faculty of Engineering, Competence Centre for Artificial Intelligence, TH Aschaffenburg (University of Applied Sciences), Aschaffenburg, Germany
| | - Christoph Wanner
- Division of Nephrology, Medizinische Klinik I, University of Würzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Dirk Weismann
- Intensive Care Unit, Medizinische Klinik I, University of Würzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Tobias Schlesinger
- Department of Anaesthesiology and Intensive Care, University of Würzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology and Intensive Care, University of Würzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Jan Stumpner
- Department of Anaesthesiology and Intensive Care, University of Würzburg, University Hospital Wuerzburg, Würzburg, Germany
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Abstract
The aim of this study was to evaluate the impact of 2 lockdown periods during coronavirus disease 2019 (COVID-19) on the course and management of nonhealing vascular ulcers of lower limbs. A total of 41 patients were included in the study. Before the pandemic began they had been seen at our unit at weekly intervals. During lockdown from March 9, 2020, to May 18, 2020 subjects were not allowed to enter the hospital unless they needed urgency or emergency surgery, or oncological management. During the second lockdown, from October 19, 2020, to December 11, 2020 patients could be followed up at distance by direct outreach including telephoning contacts. Data obtained early after each lockdown were compared with those obtained prior to the pandemic. Data for the first lockdown show that pain intensified and there was an increase in the recurrence rate of wounds, of their severity, and of superimposed infections as compared with the prelockdown period. The risk of lower-limb amputation was also considerably greater. During the second and less restrictive lockdown, patients were followed up by telemedicine and data indicate that skin lesions had not worsened any further. The management of vascular wounds was impacted by the pandemic unfavorably with health care failures in the hospital as well as in the primary care settings. In conclusion, the treatment of vascular leg ulcers is challenged by the COVID-19 pandemic as this spreads worldwide. This seems to be in keeping with what happens for other diseases. The data we obtained indicate that the pandemic-related lockdown has a deleterious effect on vascular skin wounds, with an increase of severity and mortality risk. The impact appears to be proportional to the number and the degree of limitations imposed on people.
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Affiliation(s)
- Marianna Sallustro
- Vascular and Endovascular Surgery Unit, 165474University of Naples Federico II, Naples, Italy
| | - Anna Florio
- Vascular and Endovascular Surgery Unit, 165474University of Naples Federico II, Naples, Italy.,Vascular Surgery Unit, 507855University of Campania "Luigi Vanvitelli", Medical School, Naples, Italy
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Treatment profiles and clinical outcomes of COVID-19 patients at private hospital in Jakarta. PLoS One 2021; 16:e0250147. [PMID: 33861777 PMCID: PMC8051784 DOI: 10.1371/journal.pone.0250147] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a virus that causes COVID-19, which has become a worldwide pandemic. However, until now, there is no vaccine or specific drug to prevent or treat COVID-19. OBJECTIVES To find out the effective treatment as an antiviral agent for COVID-19, to determine the correlation between sociodemography with clinical outcomes and duration of treatment, and to determine the relationship between comorbidities with clinical outcomes and duration of treatment for COVID-19 patients. METHODS A prospective cohort study was conducted in this study. This study included only confirmed COVID-19 patients who were admitted to the hospital during April-May 2020. Convenience sampling was used to select 103 patients, but only 72 patients were suitable for inclusion. RESULTS The survival analysis for COVID-19 patients using the Kaplan Meier method showed that patients receiving Oseltamivir + Hydroxychloroquine had an average survival rate of about 83% after undergoing treatment of about ten days. Gender (p = 0.450) and age (p = 0.226) did not have a significant correlation with the duration of treatment for COVID-19 patients. Gender (p = 0.174) and age (p = 0.065) also did not have a significant correlation with clinical outcome of COVID-19 patients. Comorbidities showed a significant correlation with duration of treatment (p = 0.002) and clinical outcome (p = 0.014) of COVID-19 patients. CONCLUSION The most effective antiviral agent in this study based on treatment duration was the combination of Oseltamivir + Hydroxychloroquine. The higher the patient's average treatment duration is, the lower the average survival rate for COVID-19 patients.
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Betti M, Bertolotti M, Ferrante D, Roveta A, Pelazza C, Giacchero F, Penpa S, Massarino C, Bolgeo T, Cassinari A, Mussa M, Chichino G, Maconi A. Baseline clinical characteristics and prognostic factors in hospitalized COVID-19 patients aged ≤ 65 years: A retrospective observational study. PLoS One 2021; 16:e0248829. [PMID: 33760885 PMCID: PMC7990225 DOI: 10.1371/journal.pone.0248829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individual differences in susceptibility to SARS-CoV-2 infection, symptomatology and clinical manifestation of COVID-19 have thus far been observed but little is known about the prognostic factors of young patients. METHODS A retrospective observational study was conducted on 171 patients aged ≤ 65 years hospitalized in Alessandria's Hospital from 1st March to 30th April 2020 with laboratory confirmed COVID-19. Epidemiological data, symptoms at onset, clinical manifestations, Charlson Comorbidity Index, laboratory parameters, radiological findings and complications were considered. Patients were divided into two groups on the basis of COVID-19 severity. Multivariable logistic regression analysis was used to establish factors associated with the development of a moderate or severe disease. FINDINGS A total of 171 patients (89 with mild/moderate disease, 82 with severe/critical disease), of which 61% males and a mean age (± SD) of 53.6 (± 9.7) were included. The multivariable logistic model identified age (50-65 vs 18-49; OR = 3.23 CI95% 1.42-7.37), platelet count (per 100 units of increase OR = 0.61 CI95% 0.42-0.89), c-reactive protein (CPR) (per unit of increase OR = 1.12 CI95% 1.06-1.20) as risk factors for severe or critical disease. The multivariable logistic model showed a good discriminating capacity with a C-index value of 0.76. INTERPRETATION Patients aged ≥ 50 years with low platelet count and high CRP are more likely to develop severe or critical illness. These findings might contribute to improved clinical management.
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Affiliation(s)
- Marta Betti
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
- * E-mail:
| | - Marinella Bertolotti
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of “Piemonte Orientale” and Cancer Epidemiology, CPO Piemonte, Novara, Italy
| | - Annalisa Roveta
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Carolina Pelazza
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Fabio Giacchero
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Serena Penpa
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Costanza Massarino
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Tatiana Bolgeo
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Antonella Cassinari
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Marco Mussa
- Infectious Diseases Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Guido Chichino
- Infectious Diseases Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
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Chard L. Welcome to the 15th volume of Biomarkers in Medicine. Biomark Med 2021; 15:1-4. [PMID: 33427500 DOI: 10.2217/bmm-2020-0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lucy Chard
- Commissioning Editor, Future Medicine, 2 Unitec House, Albert Place, London, N3 1QB, UK
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Ielapi N, Andreucci M, Licastro N, Faga T, Grande R, Buffone G, Mellace S, Sapienza P, Serra R. Precision Medicine and Precision Nursing: The Era of Biomarkers and Precision Health. Int J Gen Med 2020; 13:1705-1711. [PMID: 33408508 PMCID: PMC7781105 DOI: 10.2147/ijgm.s285262] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022] Open
Abstract
Precision health, by means of the support of precision medicine and precision nursing, is able to support clinical decision making in order to tailor optimal health-care decisions, around the individual characteristics of patients. The operational arm of precision health is represented by the use of biomarkers that can give useful information about disease susceptibility, exposure, evolution and response to treatment. Omics, imaging and clinical biomarkers are actually studied for their ability to positively impact health-care management. In this article, we try to address the role of biomarkers in the context of modern medicine and nursing with the view of improving patients care.
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Affiliation(s)
- Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.,Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy
| | - Michele Andreucci
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Noemi Licastro
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Teresa Faga
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Raffaele Grande
- Department of Surgery "P. Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Gianluca Buffone
- Department of Vascular Surgery, Health Agency of Trento, Trento, Italy
| | - Sabrina Mellace
- Department of Patient's Service, Civic Health Agency of Trento, Trento, Italy
| | - Paolo Sapienza
- Department of Surgery "P. Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
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23
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Matangila JR, Nyembu RK, Telo GM, Ngoy CD, Sakobo TM, Massolo JM, Muyembe BM, Mvwala RK, Ilunga CK, Limbole EB, Ntalaja JM, Kongo RM. Clinical characteristics of COVID-19 patients hospitalized at Clinique Ngaliema, a public hospital in Kinshasa, in the Democratic Republic of Congo: A retrospective cohort study. PLoS One 2020; 15:e0244272. [PMID: 33338063 PMCID: PMC7748279 DOI: 10.1371/journal.pone.0244272] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To describe the clinical characteristics of patients infected with SARS-CoV-2 at Clinique Ngaliema, a public hospital, in Kinshasa, in the Democratic Republic of Congo (DRC). METHODS This retrospective study analyzed medical records including socio-demographics, past medical history, clinical manifestation, comorbidities, laboratory data, treatment and disease outcome of 160 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection. RESULTS The median age of patients was 54 years (IQR: 38-64), and there was no significant gender difference (51% of male). The most common comorbidities were hypertension (55 [34%]), diabetes (31 [19%]) and obesity (13 [8%]). Fever (93 [58%]), cough (92 [57%]), fatigue (87 [54%]), shortness of breath (72 [45%]) and myalgia (33 [21%]) were the most common symptoms, upon admission. Patients were categorized into mild (92 [57%]), moderate (19 [12%]) and severe (49 [31%]). Severe patients were older and were more likely to have comorbidities, compared to mild ones. The majority of patients (92% [147 of 160]) patients received hydroxychloroquine or chloroquine phosphate. Regression model revealed that older age, lower SpO2, higher heart rate and elevated AST at admission were all risk factors associated with in-hospital death. The prevalence of COVID-19 and malaria co-infection was 0.63% and 70 (44%) of all patients received antimalarial treatment before hospitalization. CONCLUSION Our findings indicated that the epidemiological and clinical feature of COVID-19 patients in Kinshasa are broadly similar to previous reports from other settings. Older age, lower SpO2, tachycardia, and elevated AST could help to identify patients at higher risk of death at an early stage of the illness. Plasmodium spp co-infection was not common in hospitalized COVID-19 patients.
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Affiliation(s)
- Junior Rika Matangila
- Clinique Ngaliema, Kinshasa, République Démocratique du Congo
- Département de Médecine Tropicale, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Ritha Kibambe Nyembu
- Clinique Ngaliema, Kinshasa, République Démocratique du Congo
- Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | | | | | | | | | | | | | - Cedric Kabemba Ilunga
- Clinique Ngaliema, Kinshasa, République Démocratique du Congo
- Département de Médecine Interne, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
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Wang J, Guo S, Zhang Y, Gao K, Zuo J, Tan N, Du K, Ma Y, Hou Y, Li Q, Xu H, Huang J, Huang Q, Na H, Wang J, Wang X, Xiao Y, Zhu J, Chen H, Liu Z, Wang M, Zhang L, Wang W. Clinical features and risk factors for severe inpatients with COVID-19: A retrospective study in China. PLoS One 2020; 15:e0244125. [PMID: 33332437 PMCID: PMC7745975 DOI: 10.1371/journal.pone.0244125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background A worldwide outbreak of coronavirus disease (COVID-19), since 2019, has brought a disaster to people all over the world. Many researchers carried out clinical epidemiological studies on patients with COVID-19 previously, but risk factors for patients with different levels of severity are still unclear. Methods 562 patients with laboratory-confirmed COVID-19 from 12 hospitals in China were included in this retrospective study. Related clinical information, therapies, and imaging data were extracted from electronic medical records and compared between patients with severe and non-severe status. We explored the risk factors associated with different severity of COVID-19 patients by logistic regression methods. Results Based on the guideline we cited, 509 patients were classified as non-severe and 53 were severe. The age range of whom was 5–87 years, with a median age of 47 (IQR 35.0–57.0). And the elderly patients (older than 60 years old) in non-severe group were more likely to suffer from fever and asthma, accompanied by higher level of D-dimer, red blood cell distribution width and low-density lipoprotein. Furthermore, we found that the liver and kidney function of male patients was worse than that of female patients in both severe and non-severe groups with different age levels, while the severe females had faster ESR and lower inflammatory markers. Of major laboratory markers in non-severe cases, baseline albumin and the lymphocyte percentage were higher, while the white blood cell and the neutrophil count were lower. In addition, severe patients were more likely to be accompanied by an increase in cystatin C, mean hemoglobin level and a decrease in oxygen saturation. Besides that, advanced age and indicators such as count of white blood cell, glucose were proved to be the most common risk factors preventing COVID-19 patients from aggravating. Conclusion The potential risk factors found in our study have shown great significance to prevent COVID-19 patients from aggravating and turning to critical cases during treatment. Meanwhile, focusing on gender and age factors in groups with different severity of COVID-19, and paying more attention to specific clinical symptoms and characteristics, could improve efficacy of personalized intervention to treat COVID-19 effectively.
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Affiliation(s)
- Juan Wang
- Department of Education Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Shuzhen Guo
- Department of Scientific Research, Beijing University of Chinese Medicine, Beijing, China
| | - Yili Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Kuo Gao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jiacheng Zuo
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nannan Tan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Kangjia Du
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Ma
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yong Hou
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Quntang Li
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Hongming Xu
- Department of Infectious Disease, Daqing Second Hospital, Daqing, Heilongjiang, China
| | - Jin Huang
- Department of Traditional Chinese Medicine, The People’s Hospital of GuangXi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qiuhua Huang
- Department of Traditional Chinese Medicine, The People’s Hospital of GuangXi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hui Na
- Department of Infectious Disease, Harbin Infectious Disease Hospital, Harbin, Heilongjiang, China
| | - Jingwei Wang
- Department of Infectious Disease, Harbin Infectious Disease Hospital, Harbin, Heilongjiang, China
| | - Xiaoyan Wang
- Department of Infectious Disease, Jinzhong Infectious Disease Hospital, Jinzhong, Shanxi, China
| | - Yanhua Xiao
- Department of Traditional Chinese Medicine, Mudanjiang Kangan Hospital, Mudanjiang, Heilongjiang, China
| | - Junteng Zhu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Hong Chen
- President’s Office, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, China
| | - Zhang Liu
- Department of Traditional Chinese Medicine, The First Hospital of Suihua City, Suihua, Heilongjiang, China
| | - Mingxuan Wang
- Department of Traditional Chinese Medicine, Suining Central Hospital, Suining, Sichuan, China
| | - Linsong Zhang
- Department of Traditional Chinese Medicine, Hospital (T·C·M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Wei Wang
- President’s Office, Beijing University of Chinese Medicine, Beijing, China
- * E-mail:
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25
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Characteristics associated with COVID-19 or other respiratory viruses' infections at a single-center emergency department. PLoS One 2020; 15:e0243261. [PMID: 33270790 PMCID: PMC7714208 DOI: 10.1371/journal.pone.0243261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/19/2020] [Indexed: 12/25/2022] Open
Abstract
Background Rapid identification of patients with high suspicion of COVID-19 will become a challenge with the co-circulation of multiple respiratory viruses (RVs). We have identified clinical or biological characteristics to help distinguish SARS-CoV-2 from other RVs. Methods We used a prospective cohort including all consecutive patients admitted through the emergency department’s (ED) and presenting respiratory symptoms from November 2019 to April 2020. Patients were tested for RV using multiplex polymerase chain reaction (mPCR) and SARS-CoV-2 RT-PCR. Results 203/508 patients were positive for an RV during the non-SARS-CoV-2 epidemic period (November to February), and 268/596 patients were SARS-CoV-2 positive during the SARS-CoV-2 epidemic (March to April). Younger age, male gender, fever, absence of expectoration and absence of chronic lung disease were statistically associated with SARS-CoV-2 detection. Combining these variables allowed for the distinguishing of SARS-CoV-2 infections with 83, 65, 75 and 76% sensitivity, specificity, PPV and NPV, respectively. Conclusion Patients’ characteristics associated with a positive PCR are common between SARS-CoV-2 and other RVs, but a simple discrimination of strong SARS-CoV-2 suspicion with a limited set of clinical features seems possible. Such scoring could be useful but has to be prospectively evaluated and will not eliminate the need for rapid PCR assays.
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26
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Yang L, Jin J, Luo W, Gan Y, Chen B, Li W. Risk factors for predicting mortality of COVID-19 patients: A systematic review and meta-analysis. PLoS One 2020; 15:e0243124. [PMID: 33253244 PMCID: PMC7703957 DOI: 10.1371/journal.pone.0243124] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early and accurate prognosis prediction of the patients was urgently warranted due to the widespread popularity of COVID-19. We performed a meta-analysis aimed at comprehensively summarizing the clinical characteristics and laboratory abnormalities correlated with increased risk of mortality in COVID-19 patients. METHODS PubMed, Scopus, Web of Science, and Embase were systematically searched for studies considering the relationship between COVID-19 and mortality up to 4 June 2020. Data were extracted including clinical characteristics and laboratory examination. RESULTS Thirty-one studies involving 9407 COVID-19 patients were included. Dyspnea (OR = 4.52, 95%CI [3.15, 6.48], P < 0.001), chest tightness (OR = 2.50, 95%CI [1.78, 3.52], P<0.001), hemoptysis (OR = 2.00, 95%CI [1.02, 3.93], P = 0.045), expectoration (OR = 1.52, 95%CI [1.17, 1.97], P = 0.002) and fatigue (OR = 1.27, 95%CI [1.09, 1.48], P = 0.003) were significantly related to increased risk of mortality in COVID-19 patients. Furthermore, increased pretreatment absolute leukocyte count (OR = 11.11, 95%CI [6.85,18.03], P<0.001) and decreased pretreatment absolute lymphocyte count (OR = 9.83, 95%CI [6.72, 14.38], P<0.001) were also associated with increased mortality of COVID-19. We also compared the mean value of them between survivors and non-survivors, and found that non-survivors showed significantly raise in pretreatment absolute leukocyte count (WMD: 3.27×109/L, 95%CI [2.34, 4.21], P<0.001) and reduction in pretreatment absolute lymphocyte count (WMD = -0.39×109/L, 95%CI [-0.46, -0.33], P<0.001) compared with survivors. The results of pretreatment lactate dehydrogenase (LDH), procalcitonin (PCT), D-Dimer and ferritin showed the similar trend with pretreatment absolute leukocyte count. CONCLUSIONS Among the common symptoms of COVID-19 infections, fatigue, expectoration, hemoptysis, dyspnea and chest tightness were independent predictors of death. As for laboratory examinations, significantly increased pretreatment absolute leukocytosis count, LDH, PCT, D-Dimer and ferritin, and decreased pretreatment absolute lymphocyte count were found in non-survivors, which also have an unbeneficial impact on mortality among COVID-19 patients. Motoring these indicators during the hospitalization plays a very important role in predicting the prognosis of patients.
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Affiliation(s)
- Lan Yang
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Jin
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenxin Luo
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuncui Gan
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bojiang Chen
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Association of SARS-CoV-2 genomic load trends with clinical status in COVID-19: A retrospective analysis from an academic hospital center in New York City. PLoS One 2020; 15:e0242399. [PMID: 33201912 PMCID: PMC7671536 DOI: 10.1371/journal.pone.0242399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
The Infectious Diseases Society of America has identified the use of SARS-CoV-2 genomic load for prognostication purposes as a key research question. We designed a retrospective cohort study that included adult patients with COVID-19 pneumonia who had at least 2 positive nasopharyngeal tests at least 24 hours apart to study the correlation between the change in the genomic load of SARS-CoV-2, as reflected by the Cycle threshold (Ct) value of the RT-PCR, with change in clinical status. The Sequential Organ Failure Assessment (SOFA) score was used as a surrogate for patients’ clinical status. Among 457 patients with COVID-19 pneumonia between 3/31/2020-4/10/2020, we identified 42 patients who met the inclusion criteria. The median initial SOFA score was 2 (IQR 2–3). 20 out of 42 patients had a lower SOFA score on their subsequent tests. We identified a statistically significant inverse correlation between the change in SOFA score and change in the Ct value with a decrease in SOFA score by 0.05 (SE 0.02; p<0.05) for an increase in Ct values by 1. This correlation was independent of the duration of symptoms. Our findings suggest that an increasing Ct value in sequential tests may be of prognostic value for patients diagnosed with COVID-19 pneumonia.
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Javanmardi F, Keshavarzi A, Akbari A, Emami A, Pirbonyeh N. Prevalence of underlying diseases in died cases of COVID-19: A systematic review and meta-analysis. PLoS One 2020; 15:e0241265. [PMID: 33095835 PMCID: PMC7584167 DOI: 10.1371/journal.pone.0241265] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Underlying disease have a critical role in vulnerability of populations for a greater morbidity and mortality when they suffer from COVID-19. The aim of current study is evaluating the prevalence of underlying disease in died people with COVID-19. METHODS The current study have been conducted according to PRISMA guideline. International database including PubMed, Scopus, Web of Science, Cochrane and google scholar were searched for relevant studies up to 1 June. All relevant articles that reported underlying disease in died cases of COVID-19 were included in the analysis. RESULTS After screening and excluding duplicated and irrelevant studies, 32 articles included in the analysis. The most prevalent comorbidities were hypertension, diabetes, cardiovascular disease, liver disease, lung disease, malignancy, cerebrovascular disease, COPD and asthma. Among all reported underlying disease, highest and lowest prevalence was related to hypertension and asthma which were estimated 46% (37% - 55%) and 3% (2%- 6%), respectively. CONCLUSION In summary, underlying disease have a critical role in poor outcomes, severity of disease and high mortality rate of COVID-19 cases. Patients with hypertension, cardiovascular disease and diabetes should be carefully monitored and be aware of health protocols.
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Affiliation(s)
- Fatemeh Javanmardi
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolkhalegh Keshavarzi
- Surgery Department, General Surgery, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbari
- Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Emami
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pirbonyeh
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Understanding factors influencing the length of hospital stay among non-severe COVID-19 patients: A retrospective cohort study in a Fangcang shelter hospital. PLoS One 2020; 15:e0240959. [PMID: 33085709 PMCID: PMC7577449 DOI: 10.1371/journal.pone.0240959] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
As a novel concept of responding to disease epidemics, Fangcang shelter hospitals were deployed to expand the health system’s capacity and provide medical services for non-severe COVID-19 patients during the outbreak in Wuhan. To give insights on patient management within Fangcang hospitals, we conducted a retrospective analysis to: 1) describe the characteristics of the patients admitted to Fangcang hospitals and 2) explore risk factors for longer length of stay (LOS). We enrolled 136 confirmed COVID-19 patients, including asymptomatic patients and those with mild symptoms, who were hospitalized in the Wuti Fangcang Hospital. 58 patients completed the treatment and discharged before 1 March 2020. After describing patients’ demographic and clinical characteristics, exposure history, treatment received and time course of the disease, we conducted linear regression analysis to identify factors influencing LOS. We found that patients having fever before admission were hospitalized 3.5 days (95%CI 1.39 to 5.63, p = 0.002) longer than those without fever and that patients having bilateral pneumonia were hospitalized 3.4 days (95%CI 0.49 to 6.25, p = 0.023) longer than those with normal CT scan results. We also found weak evidence suggesting that patients with diabetes were hospitalized 3.2 days longer than those without diabetes (95%CI -0.2 to 6.56, p = 0.065). However, we observed no significant differences in LOS between symptomatic and asymptomatic patients and between patients who received treatment and those without treatment. Longer duration of hospitalization among non-severe COVID-19 patients is associated with having fever, bilateral pneumonia on CT scan and diabetes. However, being asymptomatic and using supportive medications at the early stage of infection do not have significant influences on LOS. Our study is a single-centered study with relatively small sample size. The findings provide evidence for predicting hospital bed demand in a novel response scenario and may help decision-makers in preparing for ramping up the health system capacity.
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Martini K, Blüthgen C, Walter JE, Nguyen-Kim TDL, Thienemann F, Frauenfelder T. Patterns of organizing pneumonia and microinfarcts as surrogate for endothelial disruption and microangiopathic thromboembolic events in patients with coronavirus disease 2019. PLoS One 2020; 15:e0240078. [PMID: 33017451 PMCID: PMC7535037 DOI: 10.1371/journal.pone.0240078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/20/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To evaluate chest-computed-tomography (CT) scans in coronavirus-disease-2019 (COVID-19) patients for signs of organizing pneumonia (OP) and microinfarction as surrogate for microscopic thromboembolic events. METHODS Real-time polymerase-chain-reaction (RT-PCR)-confirmed COVID-19 patients undergoing chest-CT (non-enhanced, enhanced, pulmonary-angiography [CT-PA]) from March-April 2020 were retrospectively included (COVID-19-cohort). As control-groups served 175 patients from 2020 (cohort-2020) and 157 patients from 2019 (cohort-2019) undergoing CT-PA for pulmonary embolism (PE) during the respective time frame at our institution. Two independent readers assessed for presence and location of PE in all three cohorts. In COVID-19 patients additionally parenchymal changes typical of COVID-19 pneumonia, infarct pneumonia and OP were assessed. Inter-reader agreement and prevalence of PE in different cohorts were calculated. RESULTS From 68 COVID-19 patients (42 female [61.8%], median age 59 years [range 32-89]) undergoing chest-CT 38 obtained CT-PA. Inter-reader-agreement was good (k = 0.781). On CT-PA, 13.2% of COVID-19 patients presented with PE whereas in the control-groups prevalence of PE was 9.1% and 8.9%, respectively (p = 0.452). Up to 50% of COVID-19 patients showed changes typical for OP. 21.1% of COVID-19 patients suspected with PE showed subpleural wedge-shaped consolidation resembling infarct pneumonia, while only 13.2% showed visible filling defects of the pulmonary artery branches on CT-PA. CONCLUSION Despite the reported hypercoagulability in critically ill patients with COVID-19, we did not encounter higher prevalence of PE in our patient cohort compared to the control cohorts. However, patients with suspected PE showed a higher prevalence of lung changes, resembling patterns of infarct pneumonia or OP and CT-signs of pulmonary-artery hypertension.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Joan Elias Walter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Thi Dan Linh Nguyen-Kim
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Friedrich Thienemann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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31
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Grande R, Fiori G, Russo G, Fioramonti P, Campagnol M, di Marzo L. A multistage combined approach to promote diabetic wound healing in COVID-19 era. Int Wound J 2020; 17:1863-1870. [PMID: 32820598 PMCID: PMC7461201 DOI: 10.1111/iwj.13476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022] Open
Abstract
When diabetes mellitus is not properly controlled with drugs and a healthy lifestyle, it exposes patients with advanced peripheral arterial disease or critical limb ischaemia (CLI) to the most serious complications, in particular lower limb ulcers. Surgical or endovascular treatments represent the first line of intervention; in addition, the adequate management of ulcers can guarantee not only a faster wound healing but also the improvement of the patient's prognosis. To speed up this process, negative pressure wound therapy (NPWT), platelet-rich plasma (PRP), and other advanced moist wound dressing have been proposed. During Coronavirus disease 2019 (COVID-19) pandemic, many patients with CLI and diabetes mellitus had difficult access to advanced treatments with a significant reduction in life expectancy. We report the cases of patients with non-healing ulcers and CLI treated with an empiric multistage approach after successful endovascular revascularisation; the postoperative course was eventful in all patients, and foot ulcers are currently in an advanced state of healing. The association between adequate revascularisation, systemic anti-inflammatory, and antibiotic therapy with the multistage advanced medications ensures healing of ulcers, limb salvage, and improvement of patient prognosis.
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Affiliation(s)
- Raffaele Grande
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Giulia Fiori
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Giulia Russo
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Fioramonti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Monica Campagnol
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Luca di Marzo
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
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Gagliardi I, Patella G, Michael A, Serra R, Provenzano M, Andreucci M. COVID-19 and the Kidney: From Epidemiology to Clinical Practice. J Clin Med 2020; 9:E2506. [PMID: 32759645 PMCID: PMC7464116 DOI: 10.3390/jcm9082506] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023] Open
Abstract
The new respiratory infectious disease coronavirus disease 2019 (COVID-19) that originated in Wuhan, China, in December 2019 and caused by a new strain of zoonotic coronavirus, named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), to date has killed over 630,000 people and infected over 15,000,000 worldwide. Most of the deceased patients had pre-existing comorbidities; over 20% had chronic kidney disease (CKD). Furthermore, although SARS-CoV-2 infection is characterized mainly by diffuse alveolar damage and acute respiratory failure, acute kidney injury (AKI) has developed in a high percentage of cases. As AKI has been shown to be associated with worse prognosis, we believe that the impact of SARS-CoV-2 on the kidney should be investigated. This review sets out to describe the main renal aspects of SARS-CoV-2 infection and the role of the virus in the development and progression of kidney damage. In this article, attention is focused on the epidemiology, etiology and pathophysiological mechanisms of kidney damage, histopathology, clinical features in nephropathic patients (CKD, hemodialysis, peritoneal dialysis, AKI, transplantation) and prevention and containment strategies. Although there remains much more to be learned with regards to this disease, nonetheless it is our hope that this review will aid in the understanding and management of SARS-CoV-2 infection.
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Affiliation(s)
- Ida Gagliardi
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Gemma Patella
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Ashour Michael
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Michele Provenzano
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
| | - Michele Andreucci
- Renal Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (G.P.); (A.M.); (M.P.)
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