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Quazi MA, Shakir MH, Faiz Z, Quraishi I, Nasrullah A, Ikram HA, Sohail AH, Sultan S, Sheikh AB. Outcomes of COVID-19 and Influenza in Cerebral Palsy Patients Hospitalized in the United States: Comparative Study of a Nationwide Database. Viruses 2024; 16:1284. [PMID: 39205258 PMCID: PMC11359358 DOI: 10.3390/v16081284] [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: 07/18/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Patients with cerebral palsy (CP) are particularly vulnerable to respiratory infections, yet comparative outcomes between COVID-19 and influenza in this population remain underexplored. Using the National Inpatient Sample from 2020-2021, we performed a retrospective analysis of hospital data for adults with CP diagnosed with either COVID-19 or influenza. The study aimed to compare the outcomes of these infections to provide insights into their impact on this vulnerable population. We assessed in-hospital mortality, complications, length of stay (LOS), hospitalization costs, and discharge dispositions. Multivariable logistic regression and propensity score matching were used to adjust for confounders, enhancing the analytical rigor of our study. The study cohort comprised 12,025 patients-10,560 with COVID-19 and 1465 with influenza. COVID-19 patients with CP had a higher in-hospital mortality rate (10.8% vs. 3.1%, p = 0.001), with an adjusted odds ratio of 3.2 (95% CI: 1.6-6.4). They also experienced an extended LOS by an average of 2.7 days. COVID-19 substantially increases the health burden for hospitalized CP patients compared to influenza, as evidenced by higher mortality rates, longer hospital stays, and increased costs. These findings highlight the urgent need for tailored strategies to effectively manage and reduce the impact of COVID-19 on this high-risk group.
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Affiliation(s)
- Mohammed A. Quazi
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM 87106, USA;
| | - Muhammad Hassan Shakir
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, USA;
| | - Zohaa Faiz
- Department of Medicine, School of Medicine, Aga Khan University, Karachi 74000, Pakistan;
| | - Ibrahim Quraishi
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA (H.A.I.); (S.S.)
| | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA;
| | - Hafiz Abdullah Ikram
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA (H.A.I.); (S.S.)
| | - Amir H Sohail
- Division of Surgical Oncology, University of New Mexico, Albuquerque, NM 87106, USA;
| | - Sulaiman Sultan
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA (H.A.I.); (S.S.)
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA (H.A.I.); (S.S.)
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Rofail D, Hussein M, Naumann U, Podolanczuk AJ, Norton T, Ali S, Mastey V, Ivanescu C, Hirshberg B, Geba GP. Patient-Reported Outcomes in COVID-19 Treatment with Monoclonal Antibodies Reveal Benefits in Return to Usual Activities. Infect Dis Ther 2024; 13:1861-1876. [PMID: 38961047 PMCID: PMC11266324 DOI: 10.1007/s40121-024-01013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION This study aimed to assess the effects of a monoclonal antibody (mAb) combination on symptoms, daily function, and overall health-related quality of life. METHODS We analyzed patient-reported outcomes data from symptomatic outpatients in a phase 1/2/3 trial. Patients with confirmed SARS-CoV-2 infection and ≥ 1 risk factor for severe COVID-19 received mAb treatment (casirivimab plus imdevimab 1200 mg) or placebo. Prespecified exploratory assessments included time to sustained symptoms resolution, usual health, and return to usual activities (assessed daily for 29 days). The trial was conducted from September 2020 to February 2021, prior to widespread COVID-19 vaccination programs and Omicron-lineage variants against which casirivimab + imdevimab is not active. RESULTS In this analysis 736 outpatients received mAb and 1341 received placebo. Median time to sustained symptoms resolution was consistently shorter with mAb versus placebo (≥ 2 consecutive days: 14 vs 17 days, [nominal p = 0.0017]; ≥ 3 consecutive days: 17 vs 21 days, [nominal p = 0.0046]). Median time to sustained return to usual health and usual activities were both consistently shorter with mAb versus placebo (≥ 2 consecutive days: 12 vs 15 days [nominal p = 0.0001] and 9 vs 11 days [nominal p = 0.0001], respectively; ≥ 3 consecutive days: 14 vs 18 days [nominal p = 0.0003] and 10 vs 13 days [nominal p = 0.0041], respectively). CONCLUSIONS mAb treatment against susceptible SARS-CoV-2 strains improved how patients feel and function, as evidenced by shortened time to sustained symptoms resolution and return to usual health and activities. Future studies are warranted to assess the patient experience with next generation mAbs. CLINICALTRIALS GOV: Registration number, NCT04425629; Submission date June 11, 2020.
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Affiliation(s)
- Diana Rofail
- Regeneron Pharmaceuticals, Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10591, USA.
| | - Mohamed Hussein
- Regeneron Pharmaceuticals, Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10591, USA
| | | | | | | | - Shazia Ali
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Vera Mastey
- Regeneron Pharmaceuticals, Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10591, USA
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Azemi NFN, Islahudin F, Khan RA, Saffian SM, Loon LC. Methylprednisolone use in hospitalised COVID-19 patients: a retrospective study. J Pharm Policy Pract 2024; 17:2337125. [PMID: 38638422 PMCID: PMC11025403 DOI: 10.1080/20523211.2024.2337125] [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: 04/20/2024] Open
Abstract
Introduction Trials have demonstrated the benefits of methylprednisolone in the treatment of coronavirus disease 2019 (COVID-19). However, data on optimal dose, duration and timing of administration are limited. This study investigates the outcome of various methylprednisolone treatment regimens among hospitalised COVID-19 patients. Methods A retrospective cohort study was conducted on hospitalised adult COVID-19 patients admitted between June and August 2021 in general COVID-19 wards, treated with methylprednisolone. Clinical outcomes evaluated include in-hospital mortality, thirty-day mortality, clinical efficacy (C-reactive protein (CRP), total white blood cells (TWBC) and oxygen requirement) as well as the safety of methylprednisolone. Results Of 278 patients, 1(0.4%) received weight-based dosing of 1 mg/kg/day, 101(36.3%) received weight-based dosing of 2 mg/kg/day, 130(46.8%) received fixed dosing methylprednisolone 250 mg/day and 46(16.5%) received fixed dosing methylprednisolone 500 mg/day. There was a significant difference in in-hospital mortality rates following different methylprednisolone doses whereby in-hospital mortality occurred in 22.5% (n = 23) of patients with 1 or 2 mg/kg/day methylprednisolone, 32.3% (n = 42) with 250 mg/day and 39.1% (n = 18) with 500 mg/day (p = 0.023). On the other hand, no significant difference in thirty-day mortality, clinical efficacy and safety was observed between different dosing regimens (p > 0.05). Conclusion The use of methylprednisolone weight-based dosing in hospitalised COVID-19 patients should be considered due to the positive outcome associated with lower in-hospital mortality.
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Affiliation(s)
- Nur Fatin Najwa Azemi
- Centre for Quality Management of Medicines, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Centre for Quality Management of Medicines, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Leong Chee Loon
- Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Shaban EE, Yigit Y, Elgassim M, Shaban A, Shaban A, Ameen A, Abdurabu M, Zaki HA. Comparative Clinical Assessment and Risk Stratification of COVID-19 and Influenza Infections in Adults and Children: A Comprehensive Systematic Review and Meta-Analysis. Bull Emerg Trauma 2024; 12:47-57. [PMID: 39224473 PMCID: PMC11366268 DOI: 10.30476/beat.2024.102205.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/26/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This study aimed to compare the clinical risks and outcomes of COVID-19 and influenza. Methods The search for relevant articles was conducted using both a database search method and a manual search, which involved searching through the reference lists of articles related to the topic for additional studies. The Quality assessment was carried out using the Newcastle Ottawa tool, and the data analysis was conducted using the Review Manager Software (RevMan 5.4.1). Results The meta-analysis results indicated that COVID-19 patients had similar lengths of hospital stays (SMD: -0.25; 95% CI: -0.60-0.11; p=0.17). However, COVID-19 patients had significantly higher mortality rates (RR: 0.28; 95% CI: 0.21-0.37; p<0.0001), in-hospital complications (RR: 0.57; 95% CI: 0.50-0.65; p<0.00001), intensive care unit (ICU) admissions (OR: 0.48; 95% CI: 0.37-0.61; p<0.00001), length of ICU stay (SMD: -0.45; 95% CI: -0.83-0.06; p=0.02), and mechanical ventilation use (OR: 0.36; 95% CI: 0.28-0.46; p<0.00001). Conclusion The findings suggested that COVID-19 was more severe than influenza. Therefore, "flu-like" symptoms should not be dismissed without a clear diagnosis, especially during the winter when influenza is more prevalent.
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Affiliation(s)
- Eman E. Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Hamad Medical Corporation, Doha, Qatar
| | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Elgassim
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Shaban
- Internal Medicine, Mansoura General Hospital, Mansoura, Egypt
| | - Amira Shaban
- Internal Medicine, Mansoura General Hospital, Mansoura, Egypt
| | - Amin Ameen
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abdurabu
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hany A. Zaki
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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Grønkjær CS, Christensen RHB, Kondziella D, Benros ME. Long-term neurological outcome after COVID-19 using all SARS-CoV-2 test results and hospitalisations in Denmark with 22-month follow-up. Nat Commun 2023; 14:4235. [PMID: 37454151 PMCID: PMC10349860 DOI: 10.1038/s41467-023-39973-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
Hospitalisation with COVID-19 is associated with an increased risk of neurological sequelae; however, representative nationwide studies comparing to other infections with similar severity and also including milder SARS-CoV-2 infections have been lacking. Using the nationwide Danish registers including all SARS-CoV-2 PCR test results and hospitalisations between March 1, 2020, and December 31, 2021, we estimate the risk of any first neurological disorder diagnosed in inpatient, outpatient, or emergency room settings. We show that positive tests increase the rate of neurological disorders by a hazard ratio of 1.96 (95% confidence interval: 1.88-2.05) compared to individuals not tested and by a hazard ratio of 1.11 (95% confidence interval: 1.07-1.16) compared to individuals with negative tests only. However, there is no evidence that the risk of neurological disorders is higher for individuals who test positive compared to non-COVID-19 infections treated with anti-infective medication. The risk of neurological disorders is increased after COVID-19-hospitalisation compared to no COVID-19 hospital admission; however, these risks are comparable to hospitalisation with other respiratory infections (P value 0.328). In conclusion, COVID-19 is associated with an increased risk of neurological disorders, but no more than that observed after other infections of similar severity.
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Affiliation(s)
- Clara S Grønkjær
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rune H B Christensen
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Michael E Benros
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Widhani A, Koesnoe S, Maria S, Widjanarko AL, Karjadi TH, Hasibuan AS, Yunihastuti E, Rengganis I, Djauzi S. Factors Related to Severity, Hospitalization, and Mortality of COVID-19 Infection among Patients with Autoimmune Diseases. Trop Med Infect Dis 2023; 8:tropicalmed8040227. [PMID: 37104352 PMCID: PMC10145988 DOI: 10.3390/tropicalmed8040227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
Patients with an autoimmune disease could be at higher risk of a poor outcome when contracting COVID-19 infection due to aberrant immune responses and use of immunosuppressant therapies for chronic autoimmune treatment. Here, we conducted a retrospective study to identify the factors related to severity, hospitalization, and mortality among patients with autoimmune diseases. We found 165 cases of patients with pre-existing autoimmune diseases who had contracted COVID-19 between March 2020 and September 2022. Data on demographical characteristics; autoimmune diagnosis and treatment; COVID-19 vaccination status; and time, severity, and outcome of COVID-19 infection were collected. Most of the subjects were female (93.3%) and autoimmune diagnoses included systemic lupus erythematosus (54.5%), Sjogren's syndrome (33.5%), antiphospholipid syndrome (23%), vasculitis (5.5%), autoimmune thyroid disease (3.6%), rheumatoid arthritis (3.03%), and inflammatory bowel disease (3.03%) among other autoimmune diseases. There were four COVID-19-related deaths in this study. Factors associated with moderate to severe COVID-19 infection in patients with autoimmune diseases included not being vaccinated against COVID-19, taking a steroid of ≥10 mg prednisone-equivalent per day, and having a cardiovascular disease. Taking a steroid of ≥10 mg prednisone-equivalent per day was also associated with hospitalization in the event of COVID-19 infection, while cardiovascular diseases also showed a significant correlation to mortality in patients with autoimmune diseases who had been hospitalized with COVID-19 infection.
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Affiliation(s)
- Alvina Widhani
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Department of Internal Medicine, Universitas Indonesia Hospital, Depok 16424, Indonesia
| | - Sukamto Koesnoe
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Suzy Maria
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Annisa Layalia Widjanarko
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Teguh Harjono Karjadi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Anshari Saifuddin Hasibuan
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Evy Yunihastuti
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Iris Rengganis
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Samsuridjal Djauzi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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Kumari A, Kumari S, Kujur M, Tirkey S, Singh SB. Acceptance Rate of COVID-19 Vaccine and Its Determinants Among Indian Pregnant Women: A Hospital-Based Cross-Sectional Analysis. Cureus 2022; 14:e30682. [DOI: 10.7759/cureus.30682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
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Venturini S, Orso D, Cugini F, Martin F, Boccato C, De Santi L, Pontoni E, Tomasella S, Nicotra F, Grembiale A, Tonizzo M, Grazioli S, Fossati S, Callegari A, del Fabro G, Crapis M. Home management of COVID-19 symptomatic patients: a safety study on COVID committed home medical teams. LE INFEZIONI IN MEDICINA 2022; 30:412-417. [PMID: 36148166 PMCID: PMC9448320 DOI: 10.53854/liim-3003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
To reduce the overburden in the hospital, during the COVID-19 pandemic, some "COVID Committed Home Medical Teams" (CCHTs) were created in Italy. These units consist of a small pool of general practitioners who aim to evaluate all patients with COVID-19 who require a medical examination directly at home. After the first visit (which can end with patient hospitalisation or home management), CCHTs periodically monitor the patients' clinical conditions and vital signs (usually a revaluation every 24-48 hours, except for a sudden worsening). However, this strategy - which reduces the pressure on hospitals - has never been evaluated for patient safety. Our study aims to determine whether a home-based monitoring and treatment strategy for non-severe COVID-19 patients was safe as direct hospital admission by the emergency department. We conducted a retrospective observational study about 1,182 patients admitted to the hospital for COVID-19 between September 2020 and April 2021, confronting in-hospital and 30-day mortality in both CCHT-referred (n=275) and directly admitted by emergency department (n=907). Patients assessed by the CCHT had lower in-hospital and 30-day mortality (18% vs 28%, p=0.001; and 20% vs 30%, p=0.002); but, in the propensity score matching comparison, there was no characteristic between the two groups turned out significantly different. CCHT did not correlate with in-hospital or 30-day mortality. CCHT is a safe strategy to reduce hospital overburden for COVID-19 during pandemic surges.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC “Santa Maria della Misericordia” University Hospital of Udine, Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy
| | - Francesco Martin
- Committed Home Medical Teams; ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Cecilia Boccato
- Committed Home Medical Teams; ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Laura De Santi
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Elisa Pontoni
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Silvia Tomasella
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Fabrizio Nicotra
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Alessandro Grembiale
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Silvia Grazioli
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Sara Fossati
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Giovanni del Fabro
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
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Serrano GE, Walker JE, Tremblay C, Piras IS, Huentelman MJ, Belden CM, Goldfarb D, Shprecher D, Atri A, Adler CH, Shill HA, Driver-Dunckley E, Mehta SH, Caselli R, Woodruff BK, Haarer CF, Ruhlen T, Torres M, Nguyen S, Schmitt D, Rapscak SZ, Bime C, Peters JL, Alevritis E, Arce RA, Glass MJ, Vargas D, Sue LI, Intorcia AJ, Nelson CM, Oliver J, Russell A, Suszczewicz KE, Borja CI, Cline MP, Hemmingsen SJ, Qiji S, Hobgood HM, Mizgerd JP, Sahoo MK, Zhang H, Solis D, Montine TJ, Berry GJ, Reiman EM, Röltgen K, Boyd SD, Pinsky BA, Zehnder JL, Talbot P, Desforges M, DeTure M, Dickson DW, Beach TG. SARS-CoV-2 Brain Regional Detection, Histopathology, Gene Expression, and Immunomodulatory Changes in Decedents with COVID-19. J Neuropathol Exp Neurol 2022; 81:666-695. [PMID: 35818336 PMCID: PMC9278252 DOI: 10.1093/jnen/nlac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Brains of 42 COVID-19 decedents and 107 non-COVID-19 controls were studied. RT-PCR screening of 16 regions from 20 COVID-19 autopsies found SARS-CoV-2 E gene viral sequences in 7 regions (2.5% of 320 samples), concentrated in 4/20 subjects (20%). Additional screening of olfactory bulb (OB), amygdala (AMY) and entorhinal area for E, N1, N2, RNA-dependent RNA polymerase, and S gene sequences detected one or more of these in OB in 8/21 subjects (38%). It is uncertain whether these RNA sequences represent viable virus. Significant histopathology was limited to 2/42 cases (4.8%), one with a large acute cerebral infarct and one with hemorrhagic encephalitis. Case-control RNAseq in OB and AMY found more than 5000 and 700 differentially expressed genes, respectively, unrelated to RT-PCR results; these involved immune response, neuronal constituents, and olfactory/taste receptor genes. Olfactory marker protein-1 reduction indicated COVID-19-related loss of OB olfactory mucosa afferents. Iba-1-immunoreactive microglia had reduced area fractions in cerebellar cortex and AMY, and cytokine arrays showed generalized downregulation in AMY and upregulation in blood serum in COVID-19 cases. Although OB is a major brain portal for SARS-CoV-2, COVID-19 brain changes are more likely due to blood-borne immune mediators and trans-synaptic gene expression changes arising from OB deafferentation.
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Affiliation(s)
- Geidy E Serrano
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Jessica E Walker
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Cécilia Tremblay
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Ignazio S Piras
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - Matthew J Huentelman
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona, USA
| | | | - Danielle Goldfarb
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - David Shprecher
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Alireza Atri
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charles H Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Holly A Shill
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Shyamal H Mehta
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Richard Caselli
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Bryan K Woodruff
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | - Thomas Ruhlen
- Banner Boswell Medical Center, Sun City, Arizona, USA
| | - Maria Torres
- Banner Boswell Medical Center, Sun City, Arizona, USA
| | - Steve Nguyen
- Banner Boswell Medical Center, Sun City, Arizona, USA
| | - Dasan Schmitt
- Banner Boswell Medical Center, Sun City, Arizona, USA
| | | | | | | | | | - Richard A Arce
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Michael J Glass
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Daisy Vargas
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Lucia I Sue
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Courtney M Nelson
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Javon Oliver
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Aryck Russell
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (AR)
| | | | - Claryssa I Borja
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Madison P Cline
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Sanaria Qiji
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Holly M Hobgood
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Joseph P Mizgerd
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Malaya K Sahoo
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Haiyu Zhang
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Daniel Solis
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, California, USA
| | | | - Katharina Röltgen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Scott D Boyd
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University, Stanford, California, USA
- Division of Infectious Disease & Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - James L Zehnder
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Pierre Talbot
- Laboratory of Neuroimmunology, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, Laval, Quebec, Canada
| | - Marc Desforges
- Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
- Laboratory of Virology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Michael DeTure
- Département de microbiologie, infectiologie et Immunologie, Université de Montréal, Montréal, Quebec, Canada
| | - Dennis W Dickson
- Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Thomas G Beach
- From the Banner Sun Health Research Institute, Sun City, Arizona, USA
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10
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Zarifkar P, Peinkhofer C, Benros ME, Kondziella D. Frequency of Neurological Diseases After COVID-19, Influenza A/B and Bacterial Pneumonia. Front Neurol 2022; 13:904796. [PMID: 35812108 PMCID: PMC9259944 DOI: 10.3389/fneur.2022.904796] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022] Open
Abstract
IntroductionCOVID-19 might affect the incidence of specific neurological diseases, but it is unknown if this differs from the risk following other infections. Here, we characterized the frequency of neurodegenerative, cerebrovascular, and immune-mediated neurological diseases after COVID-19 compared to individuals without COVID-19 and those with other respiratory tract infections.MethodsThis population-based cohort study utilized electronic health records covering ~50% of Denmark's population (n = 2,972,192). Between 02/2020 and 11/2021, we included individuals tested for COVID-19 or diagnosed with community-acquired bacterial pneumonia in hospital-based facilities. Additionally, we included individuals tested for influenza in the corresponding pre-pandemic period between 02/ 2018 and 11/2019. We stratified cohorts for in- and outpatient status, age, sex, and comorbidities.ResultsIn total, 919,731 individuals were tested for COVID-19, of whom 43,375 tested positive (35,362 outpatients, 8,013 inpatients). Compared to COVID-negative outpatients, COVID-19 positive outpatients had an increased RR of Alzheimer's disease (RR = 3.5; 95%CI: 2.2–5.5) and Parkinson's disease (RR = 2.6; 95%CI: 1.7–4.0), ischemic stroke (RR = 2.7; 95%CI: 2.3–3.2) and intracerebral hemorrhage (RR = 4.8; 95%CI: 1.8–12.9). However, when comparing to other respiratory tract infections, only the RR for ischemic stroke was increased among inpatients with COVID-19 when comparing to inpatients with influenza (RR = 1.7; 95%CI: 1.2–2.4) and only for those >80 years of age when comparing to inpatients with bacterial pneumonia (RR = 2.7; 95%CI: 1.2–6.2). Frequencies of multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome and narcolepsy did not differ after COVID-19, influenza and bacterial pneumonia.ConclusionThe risk of neurodegenerative and cerebrovascular, but not neuroimmune, disorders was increased among COVID-19 positive outpatients compared to COVID-negative outpatients. However, except for ischemic stroke, most neurological disorders were not more frequent after COVID-19 than after other respiratory infections.
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Affiliation(s)
- Pardis Zarifkar
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Costanza Peinkhofer
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael E. Benros
- Copenhagen Research Center for Mental Health–CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Michael E. Benros
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Daniel Kondziella
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11
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Selvaskandan H, Hull KL, Adenwalla S, Ahmed S, Cusu MC, Graham-Brown M, Gray L, Hall M, Hamer R, Kanbar A, Kanji H, Lambie M, Lee HS, Mahdi K, Major R, Medcalf JF, Natarajan S, Oseya B, Stringer S, Tabinor M, Burton J. Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open 2022; 12:e054869. [PMID: 35636784 PMCID: PMC9152624 DOI: 10.1136/bmjopen-2021-054869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. SETTING A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. PARTICIPANTS All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. EXPOSURE The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. MAIN OUTCOMES AND MEASURES Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. RESULTS 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. CONCLUSION The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Katherine L Hull
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sherna Adenwalla
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Safa Ahmed
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria-Cristina Cusu
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matt Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ammar Kanbar
- Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hemali Kanji
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark Lambie
- School of Medicine, Keele University, Keele, UK
| | - Han Sean Lee
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Mahdi
- Department of Renal Medicine, Lincoln County Hospital, Lincoln, UK
| | - Rupert Major
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Health Sciences, University Hospital of Leicester, Leicester, UK
| | - James F Medcalf
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Boavojuvie Oseya
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Tabinor
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Burton
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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12
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Nersesjan V, Fonsmark L, Christensen RHB, Amiri M, Merie C, Lebech AM, Katzenstein T, Bang LE, Kjærgaard J, Kondziella D, Benros ME. Neuropsychiatric and Cognitive Outcomes in Patients 6 Months After COVID-19 Requiring Hospitalization Compared With Matched Control Patients Hospitalized for Non-COVID-19 Illness. JAMA Psychiatry 2022; 79:486-497. [PMID: 35319743 PMCID: PMC8943626 DOI: 10.1001/jamapsychiatry.2022.0284] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022]
Abstract
Importance Prolonged neuropsychiatric and cognitive symptoms are increasingly reported in patients after COVID-19, but studies with well-matched controls are lacking. Objective To investigate cognitive impairment, neuropsychiatric diagnoses, and symptoms in survivors of COVID-19 compared with patients hospitalized for non-COVID-19 illness. Design, Setting, and Participants This prospective case-control study from a tertiary referral hospital in Copenhagen, Denmark, conducted between July 2020 and July 2021, followed up hospitalized COVID-19 survivors and control patients hospitalized for non-COVID-19 illness, matched for age, sex, and intensive care unit (ICU) status 6 months after symptom onset. Exposures Hospitalization for COVID-19. Main Outcomes and Measures Participants were investigated with the Mini-International Neuropsychiatric Interview, the Montreal Cognitive Assessment (MoCA), neurologic examination, and a semi-structured interview for subjective symptoms. Primary outcomes were total MoCA score and new onset of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychiatric diagnoses. Secondary outcomes included specific psychiatric diagnoses, subjective symptoms, and neurologic examination results. All outcomes were adjusted for age, sex, ICU admission, admission length, and days of follow-up. Secondary outcomes were adjusted for multiple testing. Results A total of 85 COVID-19 survivors (36 [42%] women; mean [SD] age 56.8 [14] years) after hospitalization and 61 matched control patients with non-COVID-19 illness (27 [44%] women, mean age 59.4 years [SD, 13]) were enrolled. Cognitive status measured by total geometric mean MoCA scores at 6-month follow-up was lower (P = .01) among COVID-19 survivors (26.7; 95% CI, 26.2-27.1) than control patients (27.5; 95% CI, 27.0-27.9). The cognitive status improved substantially (P = .004), from 19.2 (95% CI, 15.2-23.2) at discharge to 26.1 (95% CI, 23.1-29.1) for 15 patients with COVID-19 with MoCA evaluations from hospital discharge. A total of 16 of 85 patients with COVID-19 (19%) and 12 of 61 control patients (20%) had a new-onset psychiatric diagnosis at 6-month follow-up, which was not significantly different (odds ratio, 0.93; 95% CI, 0.39-2.27; P = .87). In fully adjusted models, secondary outcomes were not significantly different, except anosmia, which was more common after COVID-19 (odds ratio, 4.56; 95% CI, 1.52-17.42; P = .006); but no longer when adjusting for multiple testing. Conclusions and Relevance In this prospective case-control study, cognitive status at 6 months was worse among survivors of COVID-19, but the overall burden of neuropsychiatric and neurologic signs and symptoms among survivors of COVID-19 requiring hospitalization was comparable with the burden observed among matched survivors hospitalized for non-COVID-19 causes.
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Affiliation(s)
- Vardan Nersesjan
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Fonsmark
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rune H. B. Christensen
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Charlotte Merie
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Terese Katzenstein
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lia E. Bang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael E. Benros
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Ghamri RA, Othman SS, Alhiniah MH, Alelyani RH, Badawi AM, Alshahrani AA. Acceptance of COVID-19 Vaccine and Associated Factors Among Pregnant Women in Saudi Arabia. Patient Prefer Adherence 2022; 16:861-873. [PMID: 35399252 PMCID: PMC8986189 DOI: 10.2147/ppa.s357653] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023] Open
Abstract
Background Coronavirus disease 19 (COVID-19) vaccination has been established as preventing severe and mortal COVID-19. Vaccination is critical strategy in controlling the COVID-19 pandemic, to restrict infections and reduce disease severity. Vaccination coverage will be more extensive if we can better identify vaccination barriers in the population, especially among vulnerable groups, of which one is pregnant women. The aim of this study was to determine the level of acceptance of COVID-19 vaccination and detect the factors that influence vaccine acceptance among pregnant women in Saudi Arabia. Methods This was a cross-sectional, web-based study conducted in Western, Eastern, North, South, and Central Regions in Saudi Arabia between July and September 2021 among pregnant women, using multi-stage sampling. All pregnant women above 18 years were invited to participate in the study. Pregnant under 18 years of age and those with a contraindication to receiving COVID-19 vaccination were excluded. Binomial logistic regression (univariate and multivariate) was used to identify the influencing factors on vaccination acceptance. Results Among the 5307 pregnant women, the acceptance level of COVID-19 vaccine was 68%. In the multivariate regression model analysis, the most common predictors of acceptance were living in North Region (P = 0.001, OR = 1.9), living in South Region (P = 0.000, OR = 3.06), and living in Central Region (P = 0.035, OR = 1.42) in comparison to living in Western Region. Gestational week (P = 0.018, OR=0.98), income more than 8000 SR (P = 0.000, OR = 0.51), education level (primary, secondary, and university; P = 0.002, 0.008, and 0.010, respectively), having had gestational diabetes mellitus (P = 0.013, OR = 1.86), being vaccinated with influenza vaccine during present pregnancy (P = 0.000, OR = 4.55, OR = 1.81), being vaccinated with tetanus vaccine during present pregnancy (P = 0.039), and believing that the COVİD-19 vaccine could harm their baby (P = 0.000, OR = 0.12). Conclusion Our study reported high acceptance of COVID-19 vaccination. The major two reasons for refusal were concerns about a lack of data on COVID-19 vaccination safety and the possibility of harming the fetus. Continued public health efforts, such as educational television programs and awareness campaigns about the safety of the COVID-19 vaccine for pregnant women, are required to raise awareness. More studies of COVID-19 vaccine safety in pregnant women would assist in overcoming these obstacles and encourage pregnant women to be vaccinated.
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Affiliation(s)
- Ranya A Ghamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Sahar S Othman
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mudhawi H Alhiniah
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Rakan H Alelyani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Atheer M Badawi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Asma A Alshahrani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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14
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Tsukada N, Inamura J, Igarashi S, Sato K. Clinical outcomes of coronavirus disease 2019 and seasonal influenza in patients with hematological disorders: a retrospective study. J Rural Med 2022; 17:158-165. [PMID: 35847759 PMCID: PMC9263957 DOI: 10.2185/jrm.2021-064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: The differences in clinical outcomes in hospitalized patients
with hematological disorders (HD) who developed either coronavirus disease 2019 (COVID-19)
or seasonal influenza (SI) are not fully understood. To examine these differences, we
retrospectively analyzed the baseline characteristics and clinical outcomes of
hospitalized patients with HD admitted from 2016 to 2021. Patients and Methods: Patients with HD who developed COVID-19 (in the past 1
year) (n=21) or SI (in the past 5 years) (n=23) in the Department of Hematology/Oncology,
Asahikawa Kosei General Hospital were evaluated. Results: The median ages of the patients with HD with either COVID-19 or SI
were 80 and 68 years, respectively (P=0.03). The groups showed no
significant differences in sex ratio, body mass index, or Eastern Cooperative Oncology
Group performance status. In the COVID-19 and SI groups, the most common primary diseases
were diffuse large B-cell lymphoma (43%) and multiple myeloma (39%), respectively. The
median numbers of days of oxygen administration (8 vs. 0 days), quarantine (25 vs. 6
days), and hospitalization (72 vs. 21 days) were significantly higher in HD patients with
COVID-19 than those in HD patients with SI (all P<0.001). The overall
90-day survival of patients with HD and COVID-19 was significantly shorter than that of
patients with HD and SI (P=0.019). Moreover, patients with HD and
COVID-19 had a higher risk of in-hospital mortality (43% vs. 9%; odds ratio, 7.50; 95%
confidence interval, 1.26–82.4; P=0.01) compared to patients with HD and
SI. Conclusion: Patients with HD and COVID-19 required longer periods of
in-hospital medical and showed poorer survival than those with SI. During the COVID-19
pandemic, hematologists should closely monitor the condition of patients with COVID-19 to
closely monitor their condition to prevent deaths.
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Affiliation(s)
- Nodoka Tsukada
- Department of Hematology/Oncology, Asahikawa Kosei General Hospital, Japan
| | - Junki Inamura
- Department of Hematology/Oncology, Asahikawa Kosei General Hospital, Japan
| | - Sho Igarashi
- Department of Hematology/Oncology, Asahikawa Kosei General Hospital, Japan
| | - Kazuya Sato
- Department of Hematology/Oncology, Asahikawa Kosei General Hospital, Japan
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Sluis WM, Linschoten M, Buijs JE, Biesbroek JM, den Hertog HM, Ribbers T, Nieuwkamp DJ, van Houwelingen RC, Dias A, van Uden IW, Kerklaan JP, Bienfait HP, Vermeer SE, de Jong SW, Ali M, Wermer MJ, de Graaf MT, Brouwers PJ, Asselbergs FW, Kappelle LJ, van der Worp HB, Algra AM. Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study. Stroke 2021; 52:3978-3986. [PMID: 34732073 PMCID: PMC8607920 DOI: 10.1161/strokeaha.121.034787] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19. METHODS We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke. RESULTS We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke. CONCLUSIONS In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
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Affiliation(s)
- Wouter M. Sluis
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marijke Linschoten
- Department of Cardiology, Division of Heart and Lungs (M.L., F.W.A.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Julie E. Buijs
- Department of Neurology, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands (J.E.B.)
| | - J. Matthijs Biesbroek
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands (J.M.B.)
| | | | - Tessa Ribbers
- Department of Neurology, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands (T.R., D.J.N.)
| | - Dennis J. Nieuwkamp
- Department of Neurology, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands (T.R., D.J.N.)
| | | | - Andreas Dias
- Department of Neurology, Ikazia Hospital, Rotterdam, the Netherlands (A.D.)
| | | | - Joost P. Kerklaan
- Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands (J.P.K.)
| | - H. Paul Bienfait
- Department of Neurology, Gelre Hospital, Apeldoorn, the Netherlands (H.P.B.)
| | - Sarah E. Vermeer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (S.E.V.)
| | - Sonja W. de Jong
- Department of Neurology, St. Jansdal Hospital, Harderwijk, the Netherlands (S.W.d.J.)
| | - Mariam Ali
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A.)
| | - Marieke J.H. Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.)
| | - Marieke T. de Graaf
- Department of Neurology, Zaans Medisch Centrum, Zaandam, the Netherlands (M.T.d.G.)
| | - Paul J.A.M. Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands (P.J.A.M.B.)
| | - Folkert W. Asselbergs
- Department of Cardiology, Division of Heart and Lungs (M.L., F.W.A.), University Medical Center Utrecht, Utrecht University, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.), University College London, United Kingdom
- Health Data Research UK and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | - L. Jaap Kappelle
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - H. Bart van der Worp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Annemijn M. Algra
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Beghi E, Giussani G, Westenberg E, Allegri R, Garcia-Azorin D, Guekht A, Frontera J, Kivipelto M, Mangialasche F, Mukaetova-Ladinska EB, Prasad K, Chowdhary N, Winkler AS. Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions. J Neurol 2021; 269:2265-2274. [PMID: 34674005 PMCID: PMC8528941 DOI: 10.1007/s00415-021-10848-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022]
Abstract
Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.
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Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Erica Westenberg
- Department of Neurology, Centre for Global Health, Technical University of Munich, Munich, Germany
| | - Ricardo Allegri
- Department of Cognitive Neurology, Instituto de Investigaciones Neurológicas Fleni, Buenos Aires, Argentina
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry & Russian National Research Medical University, Moscow, Russia
| | | | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Kameshwar Prasad
- Deapartment of Neurology, and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, 834009, India
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andrea Sylvia Winkler
- Department of Neurology, Centre for Global Health, Technical University of Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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17
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Piras IS, Huentelman MJ, Walker JE, Arce R, Glass MJ, Vargas D, Sue LI, Intorcia AJ, Nelson CM, Suszczewicz KE, Borja CL, Desforges M, Deture M, Dickson DW, Beach TG, Serrano GE. Olfactory Bulb and Amygdala Gene Expression Changes in Subjects Dying with COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.09.12.21263291. [PMID: 34545375 PMCID: PMC8452114 DOI: 10.1101/2021.09.12.21263291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this study we conducted RNA sequencing on two brain regions (olfactory bulb and amygdala) from subjects who died from COVID-19 or who died of other causes. We found several-fold more transcriptional changes in the olfactory bulb than in the amygdala, consistent with our own work and that of others indicating that the olfactory bulb may be the initial and most common brain region infected. To some extent our results converge with pseudotime analysis towards common processes shared between the brain regions, possibly induced by the systemic immune reaction following SARS-CoV-2 infection. Changes in amygdala emphasized upregulation of interferon-related neuroinflammation genes, as well as downregulation of synaptic and other neuronal genes, and may represent the substrate of reported acute and subacute COVID-19 neurological effects. Additionally, and only in olfactory bulb, we observed an increase in angiogenesis and platelet activation genes, possibly associated with microvascular damages induced by neuroinflammation. Through coexpression analysis we identified two key genes (CAMK2B for the synaptic neuronal network and COL1A2 for the angiogenesis/platelet network) that might be interesting potential targets to reverse the effects induced by SARS-CoV-2 infection. Finally, in olfactory bulb we detected an upregulation of olfactory and taste genes, possibly as a compensatory response to functional deafferentation caused by viral entry into primary olfactory sensory neurons. In conclusion, we were able to identify transcriptional profiles and key genes involved in neuroinflammation, neuronal reaction and olfaction induced by direct CNS infection and/or the systemic immune response to SARS-CoV-2 infection.
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Affiliation(s)
- Ignazio S. Piras
- Translational Genomics Research Institute, Neurogenomics Division
| | | | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Daisy Vargas
- Banner Sun Health Research Institute, Sun City, AZ
| | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | | | - Marc Desforges
- Centre Hospitalier Universitaire Sainte-Justine, Laboratory of Virology, Montreal, Canada
| | - Michael Deture
- Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Dennis W. Dickson
- Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL
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18
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Rechavi Y, Shashar M, Lellouche J, Yana M, Yakubovich D, Sharon N. Occurrence of BNT162b2 Vaccine Adverse Reactions Is Associated with Enhanced SARS-CoV-2 IgG Antibody Response. Vaccines (Basel) 2021; 9:977. [PMID: 34579214 PMCID: PMC8470796 DOI: 10.3390/vaccines9090977] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023] Open
Abstract
Promoting SARS-CoV-2 vaccination has been a global mission since the first vaccines were approved for emergency use. Alongside the excitement following the possibility of eradicating SARS-CoV-2 and ending the COVID-19 pandemic, there has been ample vaccine hesitancy, some due to the abundant reporting of adverse reactions. We report here that the occurrence of BNT162b2 vaccine adverse reactions is associated with enhanced antibody response. We found a statistically significant correlation between having an adverse reaction, whether local or systemic, and higher antibody levels. No sex difference was observed in antibody levels. However, as was recently reported, the antibody response was found to be lower among older vaccinees. The demonstration of a clear correlation between adverse reactions and antibody levels may help reduce vaccination hesitancy by reassuring that the presence of such reactions is an indication of a well-functioning immune system.
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Affiliation(s)
- Yoav Rechavi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Moshe Shashar
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel;
- Nephrology Section, Laniado Hospital, Netanya 4244916, Israel
| | - Jonathan Lellouche
- Clinical Laboratories Department, Laniado Hospital, Netanya 4244916, Israel;
| | - Moshe Yana
- Pediatric Hemato-Oncology Department, Laniado Hospital, Netanya 4244916, Israel; (M.Y.); (N.S.)
| | - Daniel Yakubovich
- Department of Neonatology, Schneider Children’s Hospital, Petach Tikva 4920235, Israel;
- Preterm Follow-Up Clinic, Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel
| | - Nechama Sharon
- Pediatric Hemato-Oncology Department, Laniado Hospital, Netanya 4244916, Israel; (M.Y.); (N.S.)
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19
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Hedberg P, Karlsson Valik J, van der Werff S, Tanushi H, Requena Mendez A, Granath F, Bell M, Mårtensson J, Dyrdak R, Hertting O, Färnert A, Ternhag A, Naucler P. Clinical phenotypes and outcomes of SARS-CoV-2, influenza, RSV and seven other respiratory viruses: a retrospective study using complete hospital data. Thorax 2021; 77:154-163. [PMID: 34226206 PMCID: PMC8260304 DOI: 10.1136/thoraxjnl-2021-216949] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 12/29/2022]
Abstract
Background An understanding of differences in clinical phenotypes and outcomes COVID-19 compared with other respiratory viral infections is important to optimise the management of patients and plan healthcare. Herein we sought to investigate such differences in patients positive for SARS-CoV-2 compared with influenza, respiratory syncytial virus (RSV) and other respiratory viruses. Methods We performed a retrospective cohort study of hospitalised adults and children (≤15 years) who tested positive for SARS-CoV-2, influenza virus A/B, RSV, rhinovirus, enterovirus, parainfluenza viruses, metapneumovirus, seasonal coronaviruses, adenovirus or bocavirus in a respiratory sample at admission between 2011 and 2020. Results A total of 6321 adult (1721 SARS-CoV-2) and 6379 paediatric (101 SARS-CoV-2) healthcare episodes were included in the study. In adults, SARS-CoV-2 positivity was independently associated with younger age, male sex, overweight/obesity, diabetes and hypertension, tachypnoea as well as better haemodynamic measurements, white cell count, platelet count and creatinine values. Furthermore, SARS-CoV-2 was associated with higher 30-day mortality as compared with influenza (adjusted HR (aHR) 4.43, 95% CI 3.51 to 5.59), RSV (aHR 3.81, 95% CI 2.72 to 5.34) and other respiratory viruses (aHR 3.46, 95% CI 2.61 to 4.60), as well as higher 90-day mortality, ICU admission, ICU mortality and pulmonary embolism in adults. In children, patients with SARS-CoV-2 were older and had lower prevalence of chronic cardiac and respiratory diseases compared with other viruses. Conclusions SARS-CoV-2 is associated with more severe outcomes compared with other respiratory viruses, and although associated with specific patient and clinical characteristics at admission, a substantial overlap precludes discrimination based on these characteristics.
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Affiliation(s)
- Pontus Hedberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Suzanne van der Werff
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Hideyuki Tanushi
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Ana Requena Mendez
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Max Bell
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Dyrdak
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Paediatric Infectious Diseases, Astrid Lindgren's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Färnert
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Anders Ternhag
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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20
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Mose A, Yeshaneh A. COVID-19 Vaccine Acceptance and Its Associated Factors Among Pregnant Women Attending Antenatal Care Clinic in Southwest Ethiopia: Institutional-Based Cross-Sectional Study. Int J Gen Med 2021; 14:2385-2395. [PMID: 34135622 PMCID: PMC8197585 DOI: 10.2147/ijgm.s314346] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 vaccination is a safe and effective approach to control the pandemic and to prevent its associated morbidity and mortality. To our knowledge, there is no study conducted to assess the prevalence of COVID-19 vaccine acceptance among pregnant women in Ethiopia. Therefore, the main objective of this study was to assess the prevalence of COVID-19 vaccine acceptance and its associated factors among pregnant women attending antenatal care clinic in Southwest Ethiopia. METHODS An institution-based cross-sectional study was employed from January 1 up to 30, 2021. A systematic random sampling technique was used to select 396 study participants. A structured and face-to-face interview was used to collect data. Data were entered into Epi-data version 4.2.0 and exported to SPSS version 23 for analysis. Bivariate and multivariate analyses were used to identify factors associated with COVID-19 vaccine acceptance. P values <0.05 result were considered as a statistically significant association. RESULTS The COVID-19 vaccine acceptance was found to be 70.7% (95% CI, 66.7%-74.7%). Maternal age (34-41) years [AOR=1.464, (95% CI; 1.218-5.129)], primary maternal educational status [AOR=3.476, (95% CI; 1.520-7.947), good knowledge [AOR=5.946, (95% CI; 3.147-7.065)], and good practice [AOR =9.15, (95% CI; 8.734-12.189)] of pregnant women towards COVID-19 and its preventive measures were factors associated with COVID-19 vaccine acceptance. CONCLUSION COVID-19 vaccine acceptance was found to be 70.9%. Maternal age (34-41) years, primary maternal educational status, good knowledge, and good practice of pregnant women towards COVID-19 and its preventive measures were factors associated with COVID-19 vaccine acceptance. Health care workers should provide health education to pregnant women to increase their knowledge about the diseases and disseminate leaflets regarding COVID-19 preventive measures. Moreover, before initiation of COVID-19 vaccine administration to pregnant women they must promote the safety and effectiveness of COVID-19 vaccine.
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Affiliation(s)
- Ayenew Mose
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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21
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Beach TG, Sue LI, Intorcia AJ, Glass MJ, Walker JE, Arce R, Nelson CM, Serrano GE. Acute Brain Ischemia, Infarction and Hemorrhage in Subjects Dying with or Without Autopsy-Proven Acute Pneumonia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.22.21254139. [PMID: 33791728 PMCID: PMC8010760 DOI: 10.1101/2021.03.22.21254139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stroke is one of the most serious complications of Covid-19 disease but it is still unclear whether stroke is more common with Covid-19 pneumonia as compared to non-Covid-19 pneumonia. We investigated the concurrence rate of autopsy-confirmed acute brain ischemia, acute brain infarction and acute brain hemorrhage with autopsy-proven acute non-Covid pneumonia in consecutive autopsies in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), a longitudinal clinicopathological study of normal aging and neurodegenerative diseases. Of 691 subjects with a mean age of 83.4 years, acute pneumonia was histopathologically diagnosed in 343 (49.6%); the concurrence rates for histopathologically-confirmed acute ischemia, acute infarction or subacute infarction was 14% and did not differ between pneumonia and non-pneumonia groups while the rates of acute brain hemorrhage were 1.4% and 2.0% of those with or without acute pneumonia, respectively. In comparison, in reviews of Covid-19 publications, reported clinically-determined rates of acute brain infarction range from 0.5% to 20% while rates of acute brain hemorrhage range from 0.13% to 2%. In reviews of Covid-19 autopsy studies, concurrence rates for both acute brain infarction and acute brain hemorrhage average about 10%. Covid-19 pneumonia and non-Covid-19 pneumonia may have similar risks tor concurrent acute brain infarction and acute brain hemorrhage when pneumonia is severe enough to cause death. Additionally, acute brain ischemia, infarction or hemorrhage may not be more common in subjects dying of acute pneumonia than in subjects dying without acute pneumonia.
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Affiliation(s)
| | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ
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22
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Thelen JM, Buenen AGN, van Apeldoorn M, Wertheim HF, Hermans MHA, Wever PC. Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study. BMC Infect Dis 2021; 21:199. [PMID: 33618663 PMCID: PMC7897875 DOI: 10.1186/s12879-021-05902-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. Methods We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. Results A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1). Conclusions We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.
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Affiliation(s)
- Julinha M Thelen
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. .,Radboud University Nijmegen, Nijmegen, the Netherlands.
| | - A G Noud Buenen
- Department of Emergency Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Marjan van Apeldoorn
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Heiman F Wertheim
- Department of Medical Microbiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Mirjam H A Hermans
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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23
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Spangler D, Blomberg H, Smekal D. Prehospital identification of Covid-19: an observational study. Scand J Trauma Resusc Emerg Med 2021; 29:3. [PMID: 33407750 PMCID: PMC7786859 DOI: 10.1186/s13049-020-00826-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses. Methods Data for all patients with dispatch, ambulance, and hospital records between January 1–August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records. Results A total of 11,894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. Six thousand seven hundred seventy-six records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71–80) and 82% (78–86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85–87) and 78% (77–79). Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.
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Affiliation(s)
- Douglas Spangler
- Uppsala Center for Prehospital Research, Department of Surgical Sciences - Anesthesiology and Intensive care, Uppsala University, 751 85, Uppsala, Sweden.
| | - Hans Blomberg
- Uppsala Center for Prehospital Research, Department of Surgical Sciences - Anesthesiology and Intensive care, Uppsala University, 751 85, Uppsala, Sweden
| | - David Smekal
- Uppsala Center for Prehospital Research, Department of Surgical Sciences - Anesthesiology and Intensive care, Uppsala University, 751 85, Uppsala, Sweden
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24
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Kim HK, Cho YJ, Lee SY. Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea. J Clin Neurol 2021; 17:435-442. [PMID: 34184452 PMCID: PMC8242315 DOI: 10.3988/jcn.2021.17.3.435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose To investigate the incidence and characteristics of neurological manifestations associated with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of the consecutive patients with COVID-19 who were admitted to the central infectious diseases hospital designated for the treatment of COVID-19 in South Korea between March 2020 and September 2020. Newly developed neurological manifestations associated with COVID-19 were investigated. The frequency and clinical features of the neurological manifestations were analyzed according to disease severity, which was classified according to World Health Organization interim guidance. Results Of the 306 symptomatic patients, 186 (60.8%) developed at least one neurological manifestation during hospitalization. The most common neurological symptom was headache (n=102, 33.3%), followed by myalgia (n=96, 31.4%) and anosmia/ageusia (n=54, 17.6%). Acute stroke (all ischemic stroke) occurred in three (1.0%) patients, and new-onset seizures occurred in two (0.7%). Neurological manifestation was a presenting symptom of COVID-19 in 72 (23.5%) patients, and was the only symptom of COVID-19 in 12 (3.9%). Stroke, seizure, and impaired consciousness were significantly associated with severe to critical COVID-19, whereas headache and anosmia/ageusia were frequently found in patients with mild to moderate disease. Conclusions Neurological manifestations were commonly observed in patients with COVID-19. During the current pandemic, when patients present with new-onset neurological symptoms, COVID-19 may be considered as part of the differential diagnosis. Attention to severe neurological complications is needed, especially in patients with severe or critical COVID-19.
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Affiliation(s)
- Hyun Kyung Kim
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Yeo Jeong Cho
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Seo Young Lee
- Department of Neurology, School of Medicine, Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea.
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