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Terada M, Saito S, Kutsuna S, Kinoshita-Iwamoto N, Togano T, Hangaishi A, Shiratori K, Takamatsu Y, Maeda K, Ishizaka Y, Ohtsu H, Satake M, Mitsuya H, Ohmagari N. Efficacy and Safety of Treatment with Plasma from COVID-19-Recovered Individuals. Life (Basel) 2023; 13:2184. [PMID: 38004324 PMCID: PMC10671928 DOI: 10.3390/life13112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Convalescent plasma therapy, which involves administering plasma from recovered coronavirus disease 2019 (COVID-19) patients to infected individuals, is being explored as a potential treatment for severe cases of COVID-19. This study aims to evaluate the efficacy and safety of convalescent plasma therapy in COVID-19 patients with moderate to severe illness. An open-label, single-arm intervention study was conducted without a control group. Plasma collected from recovered COVID-19 patients was administered to eligible participants. The primary endpoint was the proportion of patients who were placed on artificial ventilation or died within 14 days of transfusion. Secondary endpoints included clinical improvement, viral load measurements, and adverse event monitoring. A total of 59 cases were included in the study. The primary endpoint was evaluated by comparing the rate obtained in the study to an existing rate of 25%. The study also assessed clinical improvement, viral load changes, and safety endpoints through adverse event monitoring. Convalescent plasma therapy shows potential as a treatment option for COVID-19. This study aimed to provide evidence for the efficacy and safety of this therapy and may contribute to its future use in treating severe cases of COVID-19.
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Affiliation(s)
- Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Katsuyuki Shiratori
- Laboratory Testing Department, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Kenji Maeda
- Division of Antiviral Therapy Joint Research Center for Human Retrovirus Infection, Kagoshima University, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Yukihito Ishizaka
- Department of Intractable Diseases, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hiroshi Ohtsu
- Faculty of Health Data Science, Juntendo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahiro Satake
- Central Blood Institute, Japanese Red Cross, Tatsumi, Koto-ku, Tokyo 135-8521, Japan
| | - Hiroaki Mitsuya
- Department of Intractable Diseases, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
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Heuser J, Tolg B, Loer K, Klein A, Sprössel N, Klein J, Haralambiev L, Oldenburg M, Militzer KC, Belz L, von Münster T, Harth V, Ehlers L, de Boer J, Kleine-Kampmann S, Boldt M, Dirksen-Fischer M, Wiedemann M, Ekkernkamp A, Bakir MS. [Virtual staff teamwork during the pandemic - development of digital training formats for community emergency response during the coronavirus pandemic]. Notf Rett Med 2023:1-10. [PMID: 37363068 PMCID: PMC10267551 DOI: 10.1007/s10049-023-01164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/28/2023]
Abstract
Background In the event of emergency response to large-scale incidents, such as a mass casualty incident (MCI) or a mass casualty incident-infectious disease (MCI-ID), regular training is essential in order to have experienced emergency personnel available in the event of an incident. Due to the pandemic drills often had to be cancelled or were only possible with small groups of people. It was often not possible to simulate a large-scale emergency with actors, so that the trainees could not be offered realistic scenarios of a mass casualty or disease incident. As part of two research projects, a digital platform for conducting training was used to avoid the risk of infection between participants during the exercises, so that on-site personnel deployment could be reduced to a minimum. The goal of this work was to evaluate end-user acceptance of the digital solution approaches. Methods Within the framework of the project "Adaptive Resilience Management in Ports" (ARMIHN), a digital exercise platform was applied and evaluated with the help of participant surveys according to the focal points "implementation", "alternative possibilities", "learning effect" and "usability". The participants used the digital platform to exchange information and to communicate. For this purpose, various collaboration tools were embedded in the platform, which enabled simultaneous exchange of information in real time. Constant video communication with in-house and external authorities/teams was also established. Results The potential of the digital platform as an alternative to on-site exercises was confirmed by the participating end users in the ARMIHN project with 90% agreement. The increase in subjective skills and knowledge gained during a MCI-ID was also predominantly rated approvingly (up to 70%). Participants who rated the implementation of the online format as well performed were significantly more likely to state that subjectively their ability to handle a MCI-ID had improved (p = 0.016). In contrast, virtual staff teamwork in real crisis situations was viewed critically by about half of respondents. Conclusion Overall, the evaluation results point to the high end-user acceptance of the developed concept. Even though the aim is to evaluate the system over a longer period with a larger number of participants, the studies already conducted confirm the positive experiences in the respective projects.
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Affiliation(s)
- Julian Heuser
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
| | - Boris Tolg
- Abteilung Medizintechnik, Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Hamburg, Deutschland
| | - Karsten Loer
- Abteilung Medizintechnik, Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Hamburg, Deutschland
| | - Angelina Klein
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
| | - Nadine Sprössel
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
| | - Jonas Klein
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
| | - Lyubomir Haralambiev
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallkrankenhaus Berlin gGmbH, Berlin, Deutschland
| | - Marcus Oldenburg
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Kristina Carolin Militzer
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Lukas Belz
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Thomas von Münster
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Volker Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Lena Ehlers
- Hamburg Port Health Center (HPHC), Institut für Hygiene und Umwelt, Hamburg, Deutschland
| | - Jens de Boer
- Hamburg Port Health Center (HPHC), Institut für Hygiene und Umwelt, Hamburg, Deutschland
| | | | - Matthias Boldt
- Hamburg Port Health Center (HPHC), Institut für Hygiene und Umwelt, Hamburg, Deutschland
| | - Martin Dirksen-Fischer
- Hamburg Port Health Center (HPHC), Institut für Hygiene und Umwelt, Hamburg, Deutschland
| | - Markus Wiedemann
- Abteilung Medizintechnik, Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Hamburg, Deutschland
| | - Axel Ekkernkamp
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallkrankenhaus Berlin gGmbH, Berlin, Deutschland
| | - Mustafa Sinan Bakir
- Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald (UMG), Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallkrankenhaus Berlin gGmbH, Berlin, Deutschland
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3
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Hamza M, Alhujaily M, Alosaimi B, El Bakkouri K, AlDughaim MS, Alonazi M, Alanazi MA, Abbass B, Alshehri A, Al-Shouli ST, Alturaiki W, Awadalla M. Association between inflammatory cytokines/chemokines, clinical laboratory parameters, disease severity and in-hospital mortality in critical and mild COVID-19 patients without comorbidities or immune-mediated diseases. J Immunoassay Immunochem 2023; 44:13-30. [PMID: 35915975 DOI: 10.1080/15321819.2022.2104124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There are limited data on inflammatory cytokines and chemokines; the humoral immune response; and main clinical laboratory parameters as indicators for disease severity and mortality in patients with critical and mild COVID-19 without comorbidities or immune-mediated diseases in Saudi Arabia. We determined the expression levels of major proinflammatory cytokines and chemokines; C-reactive protein (CRP); procalcitonin; SARS-CoV-2 IgM antibody and twenty-two clinical laboratory parameters and assessed their usefulness as indicators of disease severity and in-hospital death. Our results showed a significant increase in the expression levels of SARS-CoV-2 IgM antibody; IL1-β; IL-6; IL-8; TNF-α and CRP in critical COVID-19 patients; neutrophil count; urea; creatinine and troponin were also increased. The elevation of these biomarkers was significantly associated and positively correlated with in-hospital death in critical COVID-19 patients. Our results suggest that the levels of IL1-β; IL-6; IL-8; TNF-α; and CRP; neutrophil count; urea; creatinine; and troponin could be used to predict disease severity in COVID-19 patients without comorbidities or immune-mediated diseases. These inflammatory mediators could be used as predictive early biomarkers of COVID-19 disease deterioration; shock and death among COVID-19 patients without comorbidities or immune-mediated diseases.
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Affiliation(s)
- Muaawia Hamza
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhanad Alhujaily
- Department of Clinical Laboratory, College of Applied Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Bandar Alosaimi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Karim El Bakkouri
- Department Project Manage; Microbiology Department, Laboratoire national de santé, Dudelange, Luxembourg
| | | | - Mona Alonazi
- Biochemistry Department, College of Science, King Saud University, Saudi Arabia
| | - Mona Awad Alanazi
- Second Health Cluster, Ministry of Healt, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Basma Abbass
- Department of Biological Sciences, College of Science, University of Jeddah, Saudi Arabia
| | - Abdulsalam Alshehri
- Second Health Cluster, Ministry of Healt, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Samia T Al-Shouli
- Immunology Unit, Pathology department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Wael Alturaiki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
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4
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Tachikawa H, Kubo T, Gomei S, Takahashi S, Kawashima Y, Manaka K, Mori A, Kondo H, Koido Y, Ishikawa H, Otsuru T, Nogi W. Mental health needs associated with COVID-19 on the diamond princess cruise ship: A case series recorded by the disaster psychiatric assistance team. Int J Disaster Risk Reduct 2022; 81:103250. [PMID: 36032696 PMCID: PMC9391089 DOI: 10.1016/j.ijdrr.2022.103250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Coronavirus disease 2019 (COVID-19) infection prevention measures have led to a variety of mental health issues. Although several self-care methods have been recommended for those quarantined, evidence regarding how best to support quarantined people experiencing a mental health crisis is limited. In February 2020, the Diamond Princess cruise ship was quarantined in Yokohama port, Japan following a passenger testing positive for COVID-19. We were sent to address the mental health issues as the Disaster Psychiatric Assistance Team (DPAT). In the present study, we examined the acute mental health needs of the passengers and crew collected by the DPAT using the standard Emergency Medical Team daily reporting system. We assessed 206 cases (99 men and 107 women) with generic health issues and 127 cases (39 men and 88 women) with mental health issues. Mental health issues including disaster stress-related symptoms were as frequent as physical health events associated with COVID-19. The most significant mental health issue was anxiety, as an acute psychological reaction to the quarantine situation. Women and crews most frequently needed mental health support. Mental health improved in most clients after brief counseling. Although several passengers experienced suicidal ideation, there were no cases of actual suicide attempts during the quarantine period. This case has been regarded as a well-known public health event at the beginning of the COVID-19 era. In addition to physical health support, disaster mental health support was essential to save lives. Our findings may facilitate responses to future quarantines, accidents, and mental health crises.
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Affiliation(s)
- Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, University of Tsukuba, Japan
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Hiroshima University, Hiroshima, Japan
| | - Sayaka Gomei
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University Saitama Medical Center, Japan
- DPAT Secretariat, Tokyo, Japan
| | - Sho Takahashi
- Department of Disaster and Community Psychiatry, University of Tsukuba, Japan
| | - Yuzuru Kawashima
- DPAT Secretariat, Tokyo, Japan
- National Hospital Organization Headquarter DMAT Secretariat, Tokyo, Japan
| | - Kazunori Manaka
- Ibaraki Prefectural Medical Center of Psychiatry, Ibaraki, Japan
| | | | - Hisayoshi Kondo
- National Hospital Organization Headquarter DMAT Secretariat, Tokyo, Japan
| | - Yuichi Koido
- National Hospital Organization Headquarter DMAT Secretariat, Tokyo, Japan
| | | | - Taku Otsuru
- National Hospital Organization, Ryukyu Hospital, Japan
| | - Wataru Nogi
- DPAT Secretariat, Tokyo, Japan
- Bifukai Hamadera Hospital, Osaka, Japan
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5
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Rosca EC, Heneghan C, Spencer EA, Brassey J, Plüddemann A, Onakpoya IJ, Evans D, Conly JM, Jefferson T. Transmission of SARS-CoV-2 Associated with Cruise Ship Travel: A Systematic Review. Trop Med Infect Dis 2022; 7. [PMID: 36288031 DOI: 10.3390/tropicalmed7100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Maritime and river travel may be associated with respiratory viral spread via infected passengers and/or crew and potentially through other transmission routes. The transmission models of SARS-CoV-2 associated with cruise ship travel are based on transmission dynamics of other respiratory viruses. We aimed to provide a summary and evaluation of relevant data on SARS-CoV-2 transmission aboard cruise ships, report policy implications, and highlight research gaps. Methods: We searched four electronic databases (up to 26 May 2022) and included studies on SARS-CoV-2 transmission aboard cruise ships. The quality of the studies was assessed based on five criteria, and relevant findings were reported. Results: We included 23 papers on onboard SARS-CoV-2 transmission (with 15 reports on different aspects of the outbreak on Diamond Princess and nine reports on other international cruises), 2 environmental studies, and 1 systematic review. Three articles presented data on both international cruises and the Diamond Princess. The quality of evidence from most studies was low to very low. Index case definitions were heterogeneous. The proportion of traced contacts ranged from 0.19 to 100%. Studies that followed up >80% of passengers and crew reported attack rates (AR) up to 59%. The presence of a distinct dose−response relationship was demonstrated by findings of increased ARs in multi-person cabins. Two studies performed viral cultures with eight positive results. Genomic sequencing and phylogenetic analyses were performed in individuals from three cruises. Two environmental studies reported PCR-positive samples (cycle threshold range 26.21−39.00). In one study, no infectious virus was isolated from any of the 76 environmental samples. Conclusion: Our review suggests that crowding and multiple persons per cabin were associated with an increased risk of transmission on cruise ships. Variations in design, methodology, and case ascertainment limit comparisons across studies and quantification of transmission risk. Standardized guidelines for conducting and reporting studies on cruise ships of acute respiratory infection transmission should be developed.
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Zhang W, Xie J, Gong N, Chen X, Shi W. COVID-19 outbreaks on ships: Analysis of three representative cases. Public Health in Practice 2022; 4:100320. [PMID: 36186155 PMCID: PMC9507995 DOI: 10.1016/j.puhip.2022.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Coronavirus disease (COVID-19) outbreaks occurred on ships during the global pandemic of COVID-19. Investigation of the management and outcomes of these outbreaks will help guide future prevention and control strategies for respiratory infectious diseases on ships. Study design Non-systematic narrative review. Methods PubMed and Embase databases were searched using the keywords “ship”, “cargo ship”, “fishing boat”, “cruise ship”, “yacht”, “merchant ship”, “port”, “SARS-COV-2” and “COVID-19”, connected by “OR” internally and “AND” between two keywords. After review of the titles and abstracts, and exclusion of irrelevant articles, the infection situation and details of the response measures were recorded. Cases were subsequently selected for this study based on the detailed information and records available on the COVID-19 outbreak prevention and control measures and experiences. Results Three representative cases were selected; the outbreak timeline and infection situation for these cases were summarised. Infection prevention and control measures and experiences for the three outbreaks were investigated in detail, including analysis of epidemic reports, and isolation, detection, screening, treatment and transportation procedures. Conclusions This study demonstrates that timely detection and intervention, exposure reduction, control of asymptomatic infections, treatment and transport of patients, preparation for prevention and control in advance, the communication and cooperation of various stakeholders, and the establishment of short-term and long-term response mechanisms are key elements to improve the efficiency of infection prevention and control on ships.
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Affiliation(s)
- Wangzheqi Zhang
- Basic Medical University, Naval Medical University, Shanghai, 200433, China
| | - Jianyi Xie
- Basic Medical University, Naval Medical University, Shanghai, 200433, China
| | - Na Gong
- Basic Medical University, Naval Medical University, Shanghai, 200433, China
| | - Xiaoying Chen
- Basic Medical University, Naval Medical University, Shanghai, 200433, China
| | - Wenwen Shi
- Department of Emergency Nursing, Department of Nursing, Naval Medical University, Shanghai, 200433, China
- Corresponding author.
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7
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Shirohata A, Ariyoshi R, Fujigaki S, Tanaka K, Morikawa T, Sanuki T, Kinoshita Y. A case of COVID-19 diarrhea relieved by bile acid sequestrant administration. Clin J Gastroenterol 2022; 15:393-400. [PMID: 35122223 PMCID: PMC8815721 DOI: 10.1007/s12328-022-01598-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
Patients with coronavirus disease 2019 exhibit various gastrointestinal symptoms. Although diarrhea is reported in many cases, the pathophysiology of diarrhea has not been fully clarified. Herein, we report a case of coronavirus disease 2019 with diarrhea that was successfully relieved by the administration of a bile acid sequestrant. The patient was a 59-year-old man whose pneumonia was treated by the administration of glucocorticoids and mechanical ventilation. However, beginning on the 30th hospital day, he developed severe watery diarrhea (up to 10 times a day). Colonoscopy detected ulcers in the terminal ileum and ascending colon. The oral administration of a bile acid sequestrant, colestimide, improved his diarrhea quickly. Ileal inflammation is reported to suppress expression of the gut epithelial apical sodium-dependent bile acid transporter. It decreases bile acid absorption at the distal ileum and increases colonic delivery of bile acids, resulting in bile acid diarrhea. In summary, the clinical course of the case presented in this report suggests that bile acid diarrhea is a possible mechanism of watery diarrhea observed in patients with coronavirus disease 2019.
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Affiliation(s)
- Akira Shirohata
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan.
| | - Ryusuke Ariyoshi
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Seiji Fujigaki
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Katsuhide Tanaka
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Teruhisa Morikawa
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Tsuyoshi Sanuki
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
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8
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Gallo CG, Fiorino S, Posabella G, Antonacci D, Tropeano A, Pausini E, Pausini C, Guarniero T, Hong W, Giampieri E, Corazza I, Federico L, de Biase D, Zippi M, Zancanaro M. COVID-19, what could sepsis, severe acute pancreatitis, gender differences, and aging teach us? Cytokine 2021; 148:155628. [PMID: 34411989 PMCID: PMC8343368 DOI: 10.1016/j.cyto.2021.155628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a potentially life-threatening disease, defined as Coronavirus Disease 19 (COVID-19). The most common signs and symptoms of this pathological condition include cough, fever, shortness of breath, and sudden onset of anosmia, ageusia, or dysgeusia. The course of COVID-19 is mild or moderate in more than 80% of cases, but it is severe or critical in about 14% and 5% of infected subjects respectively, with a significant risk of mortality. SARS-CoV-2 related infection is characterized by some pathogenetic events, resembling those detectable in other pathological conditions, such as sepsis and severe acute pancreatitis. All these syndromes are characterized by some similar features, including the coexistence of an exuberant inflammatory- as well as an anti-inflammatory-response with immune depression. Based on current knowledge concerning the onset and the development of acute pancreatitis and sepsis, we have considered these syndromes as a very interesting paradigm for improving our understanding of pathogenetic events detectable in patients with COVID-19. The aim of our review is: 1)to examine the pathogenetic mechanisms acting during the emergence of inflammatory and anti-inflammatory processes in human pathology; 2)to examine inflammatory and anti-inflammatory events in sepsis, acute pancreatitis, and SARS-CoV-2 infection and clinical manifestations detectable in patients suffering from these syndromes also according to the age and gender of these individuals; as well as to analyze the possible common and different features among these pathological conditions; 3)to obtain insights into our knowledge concerning COVID-19 pathogenesis. This approach may improve the management of patients suffering from this disease and it may suggest more effective diagnostic approaches and schedules of therapy, depending on the different phases and/or on the severity of SARS-CoV-2 infection.
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Affiliation(s)
- Claudio G Gallo
- Emilian Physiolaser Therapy Center, Castel S. Pietro Terme, Bologna, Italy.
| | - Sirio Fiorino
- Internal Medicine Unit, Budrio Hospital Azienda USL, Bologna, Italy
| | | | - Donato Antonacci
- Medical Science Department, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (FG), Italy
| | | | | | | | | | - Wandong Hong
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang, The People's Republic of China
| | - Enrico Giampieri
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Ivan Corazza
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Lari Federico
- Internal Medicine Unit, Budrio Hospital Azienda USL, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
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Funakoshi K, Morita T, Kumanogoh A. Longer Prehospitalization and Preintubation Periods in Intubated Non-survivors and ECMO Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:727101. [PMID: 34722567 PMCID: PMC8554002 DOI: 10.3389/fmed.2021.727101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose: There is no clear consensus on the clinical course of critical COVID-19 patients. We examined the clinical course among intubated survivors, non-survivors, and extracorporeal membrane oxygenation (ECMO) patients to reveal the standard clinical course and the difference among critical COVID-19 patients. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, and Scopus for original studies published until December 11, 2020, including case accumulation and clinical course reporting. Pregnant patients and children were excluded. We followed PRISMA guidelines and registered them with PROSPERO (CRD42021235534). Results: Of the 11,716 studies identified, 94 met the selection criteria, and 2,549 cases were included in this meta-analysis. The times from intubation to extubation and death were 12.07 days (95% confidence interval 9.80–14.33 days) and 10.14 days (8.18–12.10 days), respectively, and the ECMO duration was 14.72 days (10.57–18.87 days). The time from symptom onset to hospitalization (prehospitalization period) of intubated survivors, non-survivors, and ECMO patients was 6.15 (4.61–7.69 days), 6.45 (4.55–8.34 days), and 7.15 days (6.48–7.81 days), and that from symptom onset to intubation (preintubation period) was 8.58 (7.36–9.80 days), 9.14 (7.26–11.01 days), and 10.54 days (9.18–11.90 days), respectively. Sensitivity analysis showed that the time from intubation to extubation and death was longer in the US and Europe than in East Asia. Conclusion: For COVID-19, we hypothesize that prehospitalization and preintubation periods are longer in intubated non-survivors and ECMO patients than in intubated survivors. These periods may serve as a predictor of disease severity or death and support therapeutic strategy determination.
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Affiliation(s)
- Kenji Funakoshi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan.,Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Japan
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10
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Walker LJ, Codreanu TA, Armstrong PK, Goodwin S, Trewin A, Spencer E, Colquhoun SM, Stephens DM, Baird RW, Douglas NM, Cribb D, Owen R, Kelly P, Kirk MD. SARS-CoV-2 infections among Australian passengers on the Diamond Princess cruise ship: A retrospective cohort study. PLoS One 2021; 16:e0255401. [PMID: 34492022 PMCID: PMC8423262 DOI: 10.1371/journal.pone.0255401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Prolonged periods of confined living on a cruise ship increase the risk for respiratory disease transmission. We describe the epidemiology and clinical characteristics of a SARS-CoV-2 outbreak in Australian passengers on the Diamond Princess cruise ship and provide recommendations to mitigate future cruise ship outbreaks. METHODS We conducted a retrospective cohort study of Australian passengers who travelled on the Diamond Princess from 20 January until 4 February 2020 and were either hospitalised, remained in Japan or repatriated. The main outcome measures included an epidemic curve, demographics, symptoms, clinical and radiological signs, risk factors and length of time to clear infection. RESULTS Among 223 Australian passengers, 56 were confirmed SARS-CoV-2 positive. Forty-nine cases had data available and of these over 70% had symptoms consistent with COVID-19. Of symptomatic cases, 17% showed signs and symptoms before the ship implemented quarantine and a further two-thirds had symptoms within one incubation period of quarantine commencing. Prior to ship-based quarantine, exposure to a close contact or cabin mate later confirmed SARS-CoV-2 positive was associated with a 3.78 fold (95% CI, 2.24-6.37) higher risk of COVID-19 acquisition compared to non-exposed passengers. Exposure to a positive cabin mate during the ship's quarantine carried a relative risk of 6.18 (95% CI, 1.96-19.46) of developing COVID-19. Persistently asymptomatic cases represented 29% of total cases. The median time to the first of two consecutive negative PCR-based SARS-CoV-2 assays was 13 days for asymptomatic cases and 19 days for symptomatic cases (p = 0.002). CONCLUSION Ship based quarantine was effective at reducing transmission of SARS-CoV-2 amongst Australian passengers, but the risk of infection was higher if an individual shared a cabin or was a close contact of a confirmed case. Managing COVID-19 in cruise ship passengers is challenging and requires enhanced health measures and access to onshore quarantine and isolation facilities.
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Affiliation(s)
- Liz J. Walker
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tudor A. Codreanu
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Paul K. Armstrong
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Sam Goodwin
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Abigail Trewin
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Emma Spencer
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Samantha M. Colquhoun
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Dianne M. Stephens
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Rob W. Baird
- Territory Pathology, Department of Health, Darwin, Northern Territory, Australia
| | - Nicholas M. Douglas
- Territory Pathology, Department of Health, Darwin, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Danielle Cribb
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Rhonda Owen
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Paul Kelly
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Martyn D. Kirk
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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11
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Miyake S, Higurashi T, Kato H, Yamaoka Y, Kessoku T, Kato S, Ogawa F, Oi Y, Nakajima A, Yamamoto T, Takeuchi I, Ryo A, Maeda S. Evaluation of a combination protocol of CT-first triage and active telemedicine methods by a selected team tackling COVID-19: An experimental research study. J Infect Public Health 2021; 14:1212-7. [PMID: 34425358 DOI: 10.1016/j.jiph.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Many health care workers around the world tackled with COVID-19, however sadly, the infection of many medical care workers were reported. To reduce the risk of infection, we launched selected team (Team COVID) of non-specialists and brought in active telemedicine method and computed tomography (CT)-first protocol. We describe our actual practice and the health status of medical doctors dealing with COVID-19 patients. METHODS Between April 17, 2020 and May 24, 2020, 10 doctors worked with COVID-19 patients as part of Team COVID. The Team COVID doctors used a CT-first triage protocol for outpatients and telemedicine for inpatients and outpatients. We evaluated paired serum-specific antibodies for SARS-CoV-2 at the initial and end of the study duration and PCR results for SARS-CoV-2 at the end of the study duration. Furthermore, 36-item short-form of the Medical Outcome Study Questionnaire (SF-36) at the beginning and end of the study period were evaluated. RESULTS Ten doctors worked as Team COVID: seven internal medicine doctors and three surgeons. During the study period, Team COVID treated 165 individuals in the outpatient clinic and isolated hospitalized patients for 315 person-days. There were no positive results of serum-specific antibody testing and PCR testing for SARS-CoV-2 in Team COVID doctors. Furthermore, the SF-36 showed no deterioration in physical and mental QOL status. No in-hospital infection occurred during the study period. CONCLUSIONS The Team COVID fulfilled the treatment using the active telemedicine and CT-first triage protocol without in hospital infection and excess stress. The combination strategy seems acceptable for both the protection and stress relief among the medical staff.
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12
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Kusumawardhani N, Dewi IP, Dharmadjati BB. Extracorporeal Membrane Oxygenation Used in Acute Respiratory Distress Syndrome with COVID-19: A Systematic Review and Meta-Analysis. J Saudi Heart Assoc 2021; 33:177-185. [PMID: 34307014 PMCID: PMC8294133 DOI: 10.37616/2212-5043.1261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Protective pulmonary mechanical ventilation, higher positive end-expiratory pressure, neuromuscular blockade, prone positioning, and pulmonary recruitment procedures are all strategies in severe COVID-19 cases. Extracorporeal Membrane Oxygenation (ECMO) can be seen as an alternative to traditional treatment in certain patients when conventional therapy fails. We present a study that intends to systematically review and meta-analysis ECMO use in COVID-19 patients. Methods We search major medical databases (Cochrane Library, PubMed, EMBASE, MedRxiv) for clinical trials that were released between January 2020 until February 2021, had full-text availability, were written in English, and humans studies. We used National Heart, Lung, and Blood Institute (NHLBI) quality evaluation methods for retrospective cohort and cross-sectional studies to evaluate the quality of the articles. In addition, we used the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4. Results A total of 33 studies involving 3090 patients were included in the systematic review and six studies in the meta-analysis. There were 828 patients admitted to the ICU, of which 779 patients had ARDS (94%). Of the total study, 527 patients received ECMO therapy (17%). ARDS incidence was associated with complications during ICU care compared to non-ICU care (OR 107.98; 95% CI 55.51–210.03; p < 0.00001). Indirect comparisons, the incidence of mortality was associated with ECMO compared with non-ECMO (OR 15.79; 95% CI 4.21–59.28; p < 0.0001). Conclusion The incidence of ARDS was associated with complications during ICU stay, and the incidence of mortality was associated with ECMO. Further study about mechanisms involving illness and death of patients from COVID-19 is needed.
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Affiliation(s)
- Novia Kusumawardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ivana Purnama Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr. Soetomo General Hospital, Surabaya, Indonesia
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13
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Arnold DT, Attwood M, Barratt S, Morley A, Elvers KT, McKernon J, Donald C, Oates A, Noel A, MacGowan A, Maskell NA, Hamilton FW. Predicting outcomes of COVID-19 from admission biomarkers: a prospective UK cohort study. Emerg Med J 2021; 38:543-548. [PMID: 34021028 PMCID: PMC8206177 DOI: 10.1136/emermed-2020-210380] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 03/30/2021] [Accepted: 04/10/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION COVID-19 has an unpredictable clinical course, so prognostic biomarkers would be invaluable when triaging patients on admission to hospital. Many biomarkers have been suggested using large observational datasets but sample timing is crucial to ensure prognostic relevance. The DISCOVER study prospectively recruited patients with COVID-19 admitted to a UK hospital and analysed a panel of putative prognostic biomarkers on the admission blood sample to identify markers of poor outcome. METHODS Consecutive patients admitted to hospital with proven or clinicoradiological suspected COVID-19 were consented. Admission bloods were extracted from the clinical laboratory. A panel of biomarkers (interleukin-6 (IL-6), soluble urokinase plasminogen activator receptor (suPAR), Krebs von den Lungen 6, troponin, ferritin, lactate dehydrogenase, B-type natriuretic peptide, procalcitonin) were performed in addition to routinely performed markers (C reactive protein (CRP), neutrophils, lymphocytes, neutrophil:lymphocyte ratio). Age, National Early Warning Score (NEWS2), CURB-65 and radiographic severity score on initial chest radiograph were included as comparators. All biomarkers were tested in logistic regression against a composite outcome of non-invasive ventilation, intensive care admission or death, with area under the curve (AUC) (figures calculated). RESULTS 187 patients had 28-day outcomes at the time of analysis. CRP (AUC: 0.69, 95% CI: 0.59 to 0.78), lymphocyte count (AUC: 0.62, 95% CI: 0.53 to 0.72) and other routine markers did not predict the primary outcome. IL-6 (AUC: 0.77, 0.65 to 0.88) and suPAR (AUC: 0.81, 0.72 to 0.88) showed some promise, but simple clinical features alone such as NEWS2 score (AUC: 0.70, 0.60 to 0.79) or age (AUC: 0.70, 0.62 to 0.77) performed nearly as well. DISCUSSION Admission blood biomarkers have only moderate predictive value for predicting COVID-19 outcomes, while simple clinical features such as age and NEWS2 score outperform many biomarkers. IL-6 and suPAR had the best performance, and further studies should focus on the additive value of these biomarkers to routine care.
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Affiliation(s)
- David T Arnold
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Marie Attwood
- Bristol Centre for Antimicrobial Research, North Bristol NHS Trust, Bristol, UK
| | - Shaney Barratt
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Karen T Elvers
- Medicines Discovery Institute Cardiff, Cardiff University, Cardiff, UK
| | | | | | - Adrian Oates
- Biochemistry, North Bristol NHS Trust, Bristol, UK
| | - Alan Noel
- Bristol Centre for Antimicrobial Research, North Bristol NHS Trust, Bristol, UK
| | - Alasdair MacGowan
- Bristol Centre for Antimicrobial Research, North Bristol NHS Trust, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
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14
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SARI N, ARSLAN N, BAYRAM DEĞER V. Common and atypical otorhinolaryngological findings of Covid-19. Cukurova Medical Journal 2021. [DOI: 10.17826/cumj.871808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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15
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Miyake S, Higurashi T, Jono T, Akimoto T, Ogawa F, Oi Y, Tanaka K, Hara Y, Kobayashi N, Kato H, Yamashiro T, Utsunomiya D, Nakajima A, Yamamoto T, Maeda S, Kaneko T, Takeuchi I. Real-world evaluation of a computed tomography-first triage strategy for suspected Coronavirus disease 2019 in outpatients in Japan: An observational cohort study. Medicine (Baltimore) 2021; 100:e26161. [PMID: 34087874 PMCID: PMC8183760 DOI: 10.1097/md.0000000000026161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs 1037.0 minutes, P < .001).Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.
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Affiliation(s)
- Shigeta Miyake
- Team COVID-19, Yokohama City University Hospital
- Department of Neurosurgery
| | - Takuma Higurashi
- Team COVID-19, Yokohama City University Hospital
- Department of Gastroenterology and Hepatology
| | - Takashi Jono
- Team COVID-19, Yokohama City University Hospital
- Department of Neurology and Stroke Medicine
| | - Taisuke Akimoto
- Team COVID-19, Yokohama City University Hospital
- Department of Neurosurgery
| | - Fumihiro Ogawa
- Team COVID-19, Yokohama City University Hospital
- Department of Emergency Medicine
| | - Yasufumi Oi
- Team COVID-19, Yokohama City University Hospital
- Department of Emergency Medicine
| | - Katsushi Tanaka
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Yu Hara
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Nobuaki Kobayashi
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Hideaki Kato
- Team COVID-19, Yokohama City University Hospital
- Infection Prevention and Control Department, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa
| | - Atsushi Nakajima
- Team COVID-19, Yokohama City University Hospital
- Department of Gastroenterology and Hepatology
| | - Tetsuya Yamamoto
- Team COVID-19, Yokohama City University Hospital
- Department of Neurosurgery
| | - Shin Maeda
- Team COVID-19, Yokohama City University Hospital
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Japan
| | - Takeshi Kaneko
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Ichiro Takeuchi
- Team COVID-19, Yokohama City University Hospital
- Department of Emergency Medicine
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16
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Oliveira TFD, Rocha CADO, Santos AGGD, Silva LCF, Aquino SHSD, Cunha EJOD, Alcântara RC, Mesquita RDR, Arnozo GM, Santana FMS, Silva ERD, Souza CDFD. Extracorporeal Membrane Oxygenation in COVID-19 Treatment: a Systematic Literature Review. Braz J Cardiovasc Surg 2021; 36:388-396. [PMID: 33355811 PMCID: PMC8357376 DOI: 10.21470/1678-9741-2020-0397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The present study intends to systematically review the literature on the use of extracorporeal membrane oxygenation (ECMO) in patients with coronavirus disease 2019 (COVID-19). METHODS The research was carried out according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). Studies were selected from PubMed/MEDLINE and LILACS databases between December 2019 and May 17 2020, using the descriptors "ECMO AND COVID-19", "Extracorporeal Membrane Oxygenation AND COVID-19", "ECLS AND COVID-19", and "Extracorporeal Life Support AND COVID-19". Exclusion criteria were government epidemiological bulletins, comments, literature reviews, and articles without full access to content. RESULTS Two hundred and thirty-three scientific productions were found, however only 18 did not met the exclusion criteria and could be included in this study, amouting to a total of 911 patients - 624 (68.5%) men, 261 (28.6%) women, and 26 (2.8%) without sex information. The mean age of the patients was 53.7 years. ECMO was necessary in 274 (30.1%) people (200 [73%] submitted to veno-venous ECMO, nine [3.3%] to veno-arterial ECMO, and seven [2.5%] moved between these two types or needed a more specific ECMO according to the disease prognosis). Five studies did not specify the type of ECMO used, amounting 57 (20.8%) patients. Five patients (1.8%) were discharged, 77 (28.1%) died, 125 (45.6%) remained hospitalized until publication time of their respective studies, and 67 patients (24.4%) had no outcome information. CONCLUSION It is evident that more research, covering larger populations, must be carried out in order to clearly elucidate the role of ECMO in the treatment of COVID-19.
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17
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Kordsmeyer AC, Mojtahedzadeh N, Heidrich J, Militzer K, von Münster T, Belz L, Jensen HJ, Bakir S, Henning E, Heuser J, Klein A, Sproessel N, Ekkernkamp A, Ehlers L, de Boer J, Kleine-Kampmann S, Dirksen-Fischer M, Plenge-Bönig A, Harth V, Oldenburg M. Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships. Int J Environ Res Public Health 2021; 18:ijerph18105195. [PMID: 34068311 PMCID: PMC8153346 DOI: 10.3390/ijerph18105195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.
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Affiliation(s)
- Ann-Christin Kordsmeyer
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
- Correspondence:
| | - Natascha Mojtahedzadeh
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Jan Heidrich
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Kristina Militzer
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Thomas von Münster
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Lukas Belz
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Hans-Joachim Jensen
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Esther Henning
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Julian Heuser
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Angelina Klein
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Nadine Sproessel
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Lena Ehlers
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Jens de Boer
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Scarlett Kleine-Kampmann
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Martin Dirksen-Fischer
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Anita Plenge-Bönig
- Infectious Diseases Surveillance Center, Institute for Hygiene and Environment, 20539 Hamburg, Germany;
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Marcus Oldenburg
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
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18
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Goto A, Go H, Miyakawa K, Yamaoka Y, Ohtake N, Kubo S, Jeremiah SS, Mihara T, Senuki K, Miyazaki T, Ikeda S, Ogura T, Kato H, Matsuba I, Sanno N, Miyakawa M, Ozaki H, Kikuoka M, Ohashi Y, Ryo A, Yamanaka T. Sustained Neutralizing Antibodies 6 Months Following Infection in 376 Japanese COVID-19 Survivors. Front Microbiol 2021; 12:661187. [PMID: 34025615 PMCID: PMC8137897 DOI: 10.3389/fmicb.2021.661187] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: There is scarce evidence regarding the long-term persistence of neutralizing antibodies among coronavirus disease 2019 (COVID-19) survivors. This study determined neutralizing antibody titers (NT50) and antibodies against spike protein (SP) or nucleocapsid protein (NP) antigens approximately 6 months after the diagnosis of COVID-19. Methods: COVID-19 survivors in Japan were recruited. Serum samples and data related to patients' characteristics and COVID-19 history were collected. NT50 and titers of antibodies against NP and SP antigens were measured at 20-32 weeks after the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results. Factors associated with NT50 were identified using the multivariable linear regression and the correlations among NT50 and titers of immunoglobulin G (IgG) and total immunoglobulins (Igs) against NP and SP were assessed by Spearman's correlation. Results: Among 376 participants (median [range] days after testing positive for SARS-CoV-2, 180 (147-224); median [range] years of age, 50 (20-78); 188 [50%] male), most tested positive for NT50 (n = 367, 98%), SP-IgG (n = 344, 91%), SP-total Ig (n = 369, 98%), NP-IgG (n = 314, 84%), and NP-total Ig (n = 365, 97%). Regression analysis indicated that higher BMI, fever, and the requirement of mechanical ventilation or extracorporeal membrane oxygenation were significantly associated with higher NT50. Anti-SP antibodies correlated moderately with NT50 (Spearman's correlation: 0.63 for SP IgG; 0.57 for SP-total Ig), while the correlation was weak for anti-NP antibodies (0.37 for NP IgG; 0.32 for NP-total Ig). Conclusions: Most COVID-19 survivors had sustained neutralizing antibodies and tested positive for SP-total Ig and NP-total Ig approximately 6 months after infection.
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Affiliation(s)
- Atsushi Goto
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Hirofumi Go
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kei Miyakawa
- Department of Microbiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yutaro Yamaoka
- Department of Microbiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Life Science Laboratory, Technology and Development Division, Kanto Chemical Co, Inc., Kanagawa, Japan
| | - Norihisa Ohtake
- Bioscience Division, Research and Development Department, Tosoh Corporation, Tokyo Research Center, Kanagawa, Japan
- Advanced Medical Research Center, Yokohama City University, Yokohama, Japan
| | - Sousuke Kubo
- Department of Microbiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Kotaro Senuki
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan
| | - Tomoyuki Miyazaki
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | | | | | | | | | | | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Akihide Ryo
- Department of Microbiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeharu Yamanaka
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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19
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Tsikala Vafea M, Zhang R, Kalligeros M, Mylona EK, Shehadeh F, Mylonakis E. Mortality in mechanically ventilated patients with COVID-19: a systematic review. Expert Rev Med Devices 2021; 18:457-471. [PMID: 33836621 DOI: 10.1080/17434440.2021.1915764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The use of mechanical ventilation associated with acute hypoxemic respiratory failure, the most common complication in critically ill COVID-19 patients, defines a high risk population that requires specific consideration of outcomes and treatment practices.Areas covered: This review evaluates existing information about mortality rates and effectiveness of antiviral, immune-modulating, and anticoagulation treatments in COVID-19 patients who received mechanical ventilation. The mortality rate and follow-up periods in patients receiving mechanical ventilation ranged widely. Antivirals, including remdesivir and convalescent plasma, have shown no definitive mortality benefit in this population despite positive results in other COVID-19 patients. Dexamethasone was associated with an absolute reduction in 28-day mortality by 12.3% (95% CI, 6.3 to 17.6), after adjusting for age. Reduced mortality has been demonstrated with tocilizumab use alongside corticosteroids. Evidence is inconclusive for therapeutic anticoagulation, and further studies are needed to determine the comparative benefit of prophylactic anticoagulation.Expert opinion: Significant variation and high mortality rates in mechanically ventilated patients necessitate more standardized outcome measurements, increased consideration of risk factors to reduce intubation, and improved treatment practices. Anticoagulation and dexamethasone should be incorporated in the treatment of patients receiving invasive mechanical ventilation, while more rigorous studies are required for other potential treatments.
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Affiliation(s)
- Maria Tsikala Vafea
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raina Zhang
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Markos Kalligeros
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evangelia K Mylona
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
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20
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Anand S, Montez-Rath ME, Han J, Garcia P, Bozeman J, Kerschmann R, Beyer P, Parsonnet J, Chertow GM. Laboratory correlates of SARS-CoV-2 seropositivity in a nationwide sample of patients on dialysis in the U.S. PLoS One 2021; 16:e0249466. [PMID: 33857168 PMCID: PMC8049224 DOI: 10.1371/journal.pone.0249466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Patients on dialysis are at high risk for death due to COVID-19, yet a significant proportion do survive as evidenced by presence of SARS-CoV-2 antibodies in 8% of patients in the U.S. in July 2020. It is unclear whether patients with seropositivity represent the subgroup with robust health status, who would be more likely to mount a durable antibody response. Using data from a July 2020 sample of 28,503 patients receiving dialysis, we evaluated the cross-sectional association of SARS-CoV-2 seropositivity with laboratory surrogates of patient health. In separate logistic regression models, we assessed the association of SARS-CoV-2 seropositivity with seven laboratory-based covariates (albumin, creatinine, hemoglobin, sodium, potassium, phosphate, and parathyroid hormone), across the entire range of the laboratory and in comparison to a referent value. Models accounted for age, sex, region, race and ethnicity, and county-level COVID-19 deaths per 100,000. Odds of seropositivity for albumin 3 and 3.5 g/dL were 2.1 (95% CI 1.9-2.3) and 1.3 (1.2-1.4) respectively, compared with 4 g/dL. Odds of seropositivity for serum creatinine 5 and 8 mg/dL were 1.8 (1.6-2.0) and 1.3 (1.2-1.4) respectively, compared with 12.5 mg/dL. Lower values of hemoglobin, sodium, potassium, phosphate, and parathyroid hormone were associated with higher odds of seropositivity. Laboratory values associated with poorer health status and higher risk for mortality were also associated with higher likelihood of SARS-CoV-2 antibodies in patients receiving dialysis.
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Affiliation(s)
- Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Jialin Han
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Pablo Garcia
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Julie Bozeman
- Ascend Clinical Laboratory, Redwood City, California, United States of America
| | - Russell Kerschmann
- Ascend Clinical Laboratory, Redwood City, California, United States of America
| | - Paul Beyer
- Ascend Clinical Laboratory, Redwood City, California, United States of America
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, United States of America
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21
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Kazemi E, Soldoozi Nejat R, Ashkan F, Sheibani H. The laboratory findings and different COVID-19 severities: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2021; 20:17. [PMID: 33726761 PMCID: PMC7962428 DOI: 10.1186/s12941-021-00420-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Abnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to investigate the effect of the level of some laboratory factors (C-reactive protein (CRP), creatinine, leukocyte count, hemoglobin, and platelet count) on the severity and outcome of coronavirus disease 2019 (COVID-19). Methods We searched PubMed, Web of Science, Scopus, and Google Scholar. We collected the articles published before May 26, 2020. We gathered the laboratory factors in groups of patients with COVID-19, and studied the relation between level of these factors with severity and outcome of the disease. Results Mean CRP level, creatinine, hemoglobin, and the leukocytes count in the critically ill patients were significantly higher than those of the other groups (non-critical patients); mean CRP = 54.81 mg/l, mean creatinine = 86.82 μmol/l, mean hemoglobin = 144.05 g/l, and mean leukocyte count = 7.41 × 109. The lymphocyte count was higher in patients with mild/moderate disease (mean: 1.32 × 109) and in the invasive ventilation group (mean value of 0.72 × 109), but it was considerably lower than those of the other two groups. The results showed that the platelet count was higher in critically ill patients (mean value of 205.96 × 109). However, the amount was lower in the invasive ventilation group compared with the other groups (mean level = 185.67 × 109). Conclusion With increasing disease severity, the leukocyte count and the level of CRP increase significantly and the lymphocyte count decreases. There seems to be a significant relation between platelet level, hemoglobin, and creatinine level with severity of the disease. However, more studies are required to confirm this.
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Affiliation(s)
- Erfan Kazemi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Reihane Soldoozi Nejat
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fatemeh Ashkan
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hossein Sheibani
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
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22
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Cano EJ, Fonseca Fuentes X, Corsini Campioli C, O'Horo JC, Abu Saleh O, Odeyemi Y, Yadav H, Temesgen Z. Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis. Chest 2021; 159:1019-40. [PMID: 33129791 DOI: 10.1016/j.chest.2020.10.054] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial. RESEARCH QUESTION What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients? STUDY DESIGN AND METHODS We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group. RESULTS A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens. INTERPRETATION Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.
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23
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Ardic A, Turan E. Nursing care management based on the Omaha system for inpatients diagnosed with COVID-19: An electronic health record study. J Adv Nurs 2021; 77:2709-2717. [PMID: 33644905 PMCID: PMC8013593 DOI: 10.1111/jan.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 12/12/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to identify the clinical characteristics of patients diagnosed with COVID-19 and the existing nursing problems based on the Omaha System, and to establish a comprehensive nursing care management plan by determining the nursing interventions and care outcomes. DESIGN This study used a descriptive cross-sectional design. METHODS This study was conducted in a training and research hospital with 25 non-intubated COVID-19 inpatients between 6 April and 13 May 2020 in Turkey. Data were collected using a Socio-demographic and Clinical Characteristics Form, the COVID-19 Response Separate Guidelines and the Omaha System and Nightingale Notes software. Data were analysed using descriptive statistical tests and the chi-square method. RESULTS Using the Omaha System, it was shown that the patients' most common problems were communicable/infectious condition, respiration, circulation, pain, nutrition, personal care and substance use respectively. The most common signs and symptoms were signs of infection, fever, cough, respiratory distress and pain. The interventions that were performed most frequently to the patients included infection precautions, medication action/side effects, signs/symptoms-physical, dietary management and nursing care targets for intervention. These interventions were applied using the category of teaching, guidance and counselling. A significant improvement was observed in the patients' pre- and post-intervention knowledge, behaviour and status scores. CONCLUSIONS The results showed that the Omaha System provided effective guidelines for diagnosing the problems, planning and implementing appropriate interventions for the COVID-19 patients. Therefore, it is recommended to use the Omaha System in nursing care of COVID-19 patients. IMPACT This is the first study to identify the nursing problems of COVID-19 patients and to evaluate the outcomes of nursing interventions and care using an international taxonomy along with electronic health record software. The findings of this study can provide evidence-based guidelines addressing the nursing problems, interventions and outcomes of COVID-19 patients.
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Affiliation(s)
- Aysun Ardic
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ebru Turan
- Istanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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24
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Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16:e0245294. [PMID: 33428676 PMCID: PMC7799779 DOI: 10.1371/journal.pone.0245294] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to investigate the psychological effects of the COVID-19 outbreak and associated factors on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. This cross-sectional, survey-based study collected demographic data, mental health measurements, and stress-related questionnaires from workers in 2 hospitals in Yokohama, Japan, from March 23, 2020, to April 6, 2020. The prevalence rates of general psychological distress and event-related distress were assessed using the 12-item General Health Questionnaire (GHQ-12) and the 22-item Impact of Event Scale-Revised (IES-R), respectively. Exploratory factor analysis was conducted on the 26-item stress-related questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes for workers both at high- and low-risk for infection of COVID-19. A questionnaire was distributed to 4133 hospital workers, and 2697 (65.3%) valid questionnaires were used for analyses. Overall, 536 (20.0%) were high-risk workers, 944 (35.0%) of all hospital workers showed general distress, and 189 (7.0%) demonstrated event-related distress. Multivariable logistic regression analyses revealed that 'Feeling of being isolated and discriminated' was associated with both the general and event-related distress for both the high- and low-risk workers. In this survey, not only high-risk workers but also low-risk workers in the hospitals admitting COVID-19 patients reported experiencing psychological distress at the beginning of the outbreak.
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Affiliation(s)
- Keiko Ide
- Department of Psychiatry, Yokohama City University Hospital, Yokohama, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Health Management Office, Yokohama City University Hospital, Yokohama, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University Hospital, Yokohama, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akira Suda
- Department of Psychiatry, Yokohama City University Hospital, Yokohama, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Asuka Yoshimi
- Department of Psychiatry, Yokohama City University Hospital, Yokohama, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Junichi Fujita
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Department of Child Psychiatry, Yokohama City University Hospital, Yokohama, Japan
| | - Munetaka Nomoto
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Psychiatric Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomohide Roppongi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Psychiatric Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kousuke Hino
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Advanced Emergency Medical Service Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichi Takahashi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Yokohama East Area Habilitation Center for Children, Yokohama, Japan
| | - Kaori Watanabe
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Tomoko Shimada
- Patient Care and Safety Management Department, Yokohama City University Hospital, Yokohama, Japan
| | - Toyoko Hamasaki
- Patient Care and Safety Management Department, Yokohama City University Hospital, Yokohama, Japan
| | - Emi Endo
- Nursing Department, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoko Kaneko
- Nursing Department, Yokohama City University Medical Center, Yokohama, Japan
| | - Michiko Suzuki
- Nursing Department, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazumi Kubota
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- Advanced Emergency Medical Service Center, Yokohama City University Medical Center, Yokohama, Japan
- Advanced Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Michiko Aihara
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Hospital, Yokohama, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
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25
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Langford BJ, So M, Raybardhan S, Leung V, Soucy JR, Westwood D, Daneman N, MacFadden DR. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27:520-31. [PMID: 33418017 DOI: 10.1016/j.cmi.2020.12.018] [Citation(s) in RCA: 412] [Impact Index Per Article: 137.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
Background The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. Objective The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. Data Sources We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. Study Eligibility Criteria We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. Participants The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). Methods The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. Results We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Conclusions Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
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Martucci G, Słomka A, Lebowitz SE, Raffa GM, Malvindi PG, Coco VL, Swol J, Żekanowska E, Lorusso R, Wierzba W, Suwalski P, Kowalewski M, on behalf of Thoracic Research Centre. COVID-19 and Extracorporeal Membrane Oxygenation. Coronavirus Therapeutics – Volume II 2021. [DOI: 10.1007/978-3-030-85113-2_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Elsayed HH, Hassaballa AS, Ahmed TA, Gumaa M, Sharkawy HY, Moharram AA. Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: A systematic review and meta-analysis. PLoS One 2021; 16:e0252760. [PMID: 34086779 PMCID: PMC8177443 DOI: 10.1371/journal.pone.0252760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/22/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries. METHODS CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched up to August 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365. FINDINGS Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p = 0.23) (95% CI = 0.94-1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p = 0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43-0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age had no statistically significant effect on mortality (p = 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger's test with p = 0.714 and Begg&Mazumdar test with p = 0.334. INTERPRETATION The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.
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Affiliation(s)
- Hany Hasan Elsayed
- Thoracic Surgery Department (ARDS Taskforce), Ain Shams University, Cairo, Egypt
- * E-mail:
| | | | - Taha Aly Ahmed
- Cardiothoracic Surgery Department, Ain Shams University, Cairo, Egypt
| | | | | | - Assem Adel Moharram
- Anaethesia, Pain and Intensive Care Department, Ain Shams University, Cairo, Egypt
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McConeghy KW, White E, Panagiotou OA, Santostefano C, Halladay C, Feifer RA, Blackman C, Rudolph JL, Mor V, Gravenstein S. Temperature Screening for SARS-CoV-2 in Nursing Homes: Evidence from Two National Cohorts. J Am Geriatr Soc 2020; 68:2716-2720. [PMID: 33034046 PMCID: PMC7675320 DOI: 10.1111/jgs.16876] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Infection screening tools classically define fever as 38.0°C (100.4°F). Frail older adults may not mount the same febrile response to systemic infection as younger or healthier individuals. We evaluate temperature trends among nursing home (NH) residents undergoing diagnostic SARS-CoV-2 testing and describe the diagnostic accuracy of temperature measurements for predicting test-confirmed SARS-CoV-2 infection. DESIGN Retrospective cohort study evaluating diagnostic accuracy of pre-SARS-CoV-2 testing temperature changes. SETTING Two separate NH cohorts tested diagnostically (e.g., for symptoms) for SARS-CoV-2. PARTICIPANTS Veterans residing in Veterans Affairs (VA) managed NHs and residents in a private national chain of community NHs. MEASUREMENTS For both cohorts, we determined the sensitivity, specificity, and Youden's index with different temperature cutoffs for SARS-CoV-2 polymerase chain reaction results. RESULTS The VA cohort consisted of 1,301 residents in 134 facilities from March 1, 2020, to May 14, 2020, with 25% confirmed for SARS-CoV-2. The community cohort included 3,368 residents spread across 282 facilities from February 18, 2020, to June 9, 2020, and 42% were confirmed for SARS-CoV-2. The VA cohort was younger, less White, and mostly male. A temperature testing threshold of 37.2°C has better sensitivity for SARS-CoV-2, 76% and 34% in the VA and community NH, respectively, versus 38.0°C with 43% and 12% sensitivity, respectively. CONCLUSION A definition of 38.0°C for fever in NH screening tools should be lowered to improve predictive accuracy for SARS-CoV-2 infection. Stakeholders should carefully consider the impact of adopting lower testing thresholds on testing availability, cost, and burden on staff and residents. Temperatures alone have relatively low sensitivity/specificity, and we advocate any threshold be used as part of a screening tool, along with other signs and symptoms of infection.
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Affiliation(s)
- Kevin W McConeghy
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Elizabeth White
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Orestis A Panagiotou
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christopher Santostefano
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christopher Halladay
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | | | | | - James L Rudolph
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vince Mor
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Stefan Gravenstein
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Sharifian-Dorche M, Huot P, Osherov M, Wen D, Saveriano A, Giacomini PS, Antel JP, Mowla A. Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci 2020; 417:117085. [PMID: 32871412 DOI: 10.1016/j.jns.2020.117085] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. METHODS This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. RESULTS Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. CONCLUSION There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.
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Moore SC, Penrice-Randal R, Alruwaili M, Randle N, Armstrong S, Hartley C, Haldenby S, Dong X, Alrezaihi A, Almsaud M, Bentley E, Clark J, García-Dorival I, Gilmore P, Han X, Jones B, Luu L, Sharma P, Shawli G, Sun Y, Zhao Q, Pullan ST, Carter DP, Bewley K, Dunning J, Zhou EM, Solomon T, Beadsworth M, Cruise J, Crook DW, Matthews DA, Davidson AD, Mahmood Z, Aljabr W, Druce J, Vipond R, Ng L, Renia L, Openshaw PJM, Baillie JK, Carroll MW, Stewart J, Darby A, Semple M, Turtle L, Hiscox JA. Amplicon-Based Detection and Sequencing of SARS-CoV-2 in Nasopharyngeal Swabs from Patients With COVID-19 and Identification of Deletions in the Viral Genome That Encode Proteins Involved in Interferon Antagonism. Viruses 2020; 12:E1164. [PMID: 33066701 DOI: 10.3390/v12101164] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/12/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Sequencing the viral genome as the outbreak progresses is important, particularly in the identification of emerging isolates with different pathogenic potential and to identify whether nucleotide changes in the genome will impair clinical diagnostic tools such as real-time PCR assays. Although single nucleotide polymorphisms and point mutations occur during the replication of coronaviruses, one of the biggest drivers in genetic change is recombination. This can manifest itself in insertions and/or deletions in the viral genome. Therefore, sequencing strategies that underpin molecular epidemiology and inform virus biology in patients should take these factors into account. A long amplicon/read length-based RT-PCR sequencing approach focused on the Oxford Nanopore MinION/GridION platforms was developed to identify and sequence the SARS-CoV-2 genome in samples from patients with or suspected of COVID-19. The protocol, termed Rapid Sequencing Long Amplicons (RSLAs) used random primers to generate cDNA from RNA purified from a sample from a patient, followed by single or multiplex PCRs to generate longer amplicons of the viral genome. The base protocol was used to identify SARS-CoV-2 in a variety of clinical samples and proved sensitive in identifying viral RNA in samples from patients that had been declared negative using other nucleic acid-based assays (false negative). Sequencing the amplicons revealed that a number of patients had a proportion of viral genomes with deletions.
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Ribeiro R, Wainstein AJA, de Castro Ribeiro HS, Pinheiro RN, Oliveira AF. Perioperative Cancer Care in the Context of Limited Resources during the COVID-19 Pandemic: Brazilian Society of Surgical Oncology Recommendations. Ann Surg Oncol 2020; 28:1289-1297. [PMID: 32980998 PMCID: PMC7519702 DOI: 10.1245/s10434-020-09098-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND As the COVID-19 pandemic moves from rich to poor nations, the healthcare systems of developing countries have to deal with this extra burden. As cancer care cannot stop and surgery is the main mechanism for cure and palliation, it is important to provide safe and rational access to cancer surgery during the COVID-19 pandemic. METHODS From April 1st to May 1st, the committee of the Brazilian Society of Surgical Oncology (BSSO) was responsible for reviewing the literature and writing recommendations for perioperative cancer care in the context of limited resources during the pandemic. The recommendations were submitted to the BSSO board of directors. The orientations that were not consensual were removed and the suggestions were added to the text. From May 15 to 30th, the committee revised the recommendations, aligned them with the objectives of the work and standardize the text. DISCUSSION The rational use of resources to reduce the risk of surgical cancer patients being operated on during the incubation period of a corona virus infection is important in this context. Prevalence of corona virus in the region, the need for surgery, surgical complexity, patient age and comorbidities, and availability of corona virus testing are central aspects in this matter and are discussed. CONCLUSIONS We present a protocol, focused on the patients' outcomes, for safe and rational use of resources to reduce the risk of surgical cancer patients being operated on during the virus incubation period, in the context of areas with limited resources.
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Affiliation(s)
- Reitan Ribeiro
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil. .,Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil.
| | - Alberto Julius Alves Wainstein
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,School of Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Heber Salvador de Castro Ribeiro
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,Abdominal Surgery Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Rodrigo Nascimento Pinheiro
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,Department of Surgical Oncology, Base Institute Hospital, Brasília, Brazil
| | - Alexandre Ferreira Oliveira
- Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,Department of Surgery, Juiz de Fora Federal University, Juiz de Fora, Brazil
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Ishii M, Terai H, Kabata H, Masaki K, Chubachi S, Tateno H, Nakamura M, Nishio K, Koh H, Watanabe R, Ueda S, Terashima T, Suzuki Y, Yagi K, Miyao N, Minematsu N, Inoue T, Nakachi I, Namkoong H, Okamori S, Ikemura S, Kamata H, Yasuda H, Kawada I, Hasegawa N, Fukunaga K. Clinical characteristics of 345 patients with coronavirus disease 2019 in Japan: A multicenter retrospective study. J Infect 2020; 81:e3-e5. [PMID: 32920063 PMCID: PMC7482596 DOI: 10.1016/j.jinf.2020.08.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Division of Translational Research, Clinical and Translational Research Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroki Kabata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroki Tateno
- Department of Pulmonary Medicine, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama City, Saitama 336-8522, Japan
| | - Morio Nakamura
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 1-4-17, Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Kazumi Nishio
- Department of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, 2-27-1, Ida, Nakahara-ku, Kawasaki-shi, Kanagawa 211-0035, Japan
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22, Nishiki-cho, Tachikawa-shi, Tokyo 190-8531, Japan
| | - Risa Watanabe
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Soichiro Ueda
- Department of Internal Medicine, Saitama Medical Center, 4-9-3, Kitaurawa, Urawa-ku, Saitama-shi, Saitama 330-0074, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, Japan Chiba 272-0824, Japan
| | - Yusuke Suzuki
- Department of Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1, Shirokane, Minato-ku, Tokyo 108-8642, Japan
| | - Kazuma Yagi
- Department of Internal Medicine, Keiyu Hospital, 3-7-3, Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa 220-8521, Japan
| | - Naoki Miyao
- Department of Internal Medicine, Nihon Koukan Hospital, 1-2-1, Koukan-douri, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0852, Japan
| | - Naoto Minematsu
- Department of Internal Medicine, Hino Municipal Hospital, 4-3-1, Tamadaira, Hino-shi, Tokyo 191-0062, Japan
| | - Takashi Inoue
- Sano Kousei General Hospital, 1728 Horigome-cho, Sano-shi, Tochigi 327-8511, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya-shi, Tochigi 321-0974, Japan
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 11S261, Bethesda, MD 20814, USA
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Helleberg M, Niemann CU, Moestrup KS, Kirk O, Lebech AM, Lane C, Lundgren J. Persistent COVID-19 in an Immunocompromised Patient Temporarily Responsive to Two Courses of Remdesivir Therapy. J Infect Dis 2020; 222:1103-1107. [PMID: 32702095 PMCID: PMC7454684 DOI: 10.1093/infdis/jiaa446] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
The antiviral drug remdesivir has been shown clinically effective for treatment of COVID-19. We here demonstrate suppressive but not curative effect of remdesivir in an immunocompromised patient. A man in his fifties treated with chemoimmunotherapy for chronic lymphocytic leukemia experienced a 9-week course of COVID-19 with high fever and severe viral pneumonia. During two 10-day courses of remdesivir starting 24 and 45 days after fever onset, pneumonia and spiking fevers remitted, but relapsed after discontinuation. Kinetics of temperature, C-reactive protein, and lymphocyte counts mirrored the remitting/relapsing SARS-CoV-2 infection. Combination therapy or longer treatment duration may be needed in immunocompromised patients.
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Affiliation(s)
- Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Clifford Lane
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jens Lundgren
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Abstract
Since its first appearance in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world and has become a global pandemic. Several medical comorbidities have been identified as risk factors for coronavirus disease 2019 (COVID-19). However, it remains unclear whether people living with human immunodefeciency virus (PLWH) are at an increased risk of COVID-19 and severe disease manifestation, with controversial suggestion that HIV-infected individuals could be protected from severe COVID-19 by means of antiretroviral therapy or HIV-related immunosuppression. Several cases of coinfection with HIV and SARS-CoV-2 have been reported from different parts of the globe. This review seeks to provide a holistic overview of SARS-CoV-2 infection in PLWH.
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Affiliation(s)
- Osman N Kanwugu
- Department of Technology for Organic Synthesis, Institute of Chemical Engineering, Ural Federal University, Yekaterinburg, Russia
| | - Parise Adadi
- Department of Food Science, University of Otago, Dunedin, New Zealand
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Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has resulted in > 500,000 deaths worldwide, including > 125,000 deaths in the U.S. since its emergence in late December 2019 and June 2020. Neither curative anti-viral drugs nor a protective vaccine is currently available for the treatment and prevention of COVID-19. Recently, new clinical syndromes associated with coagulopathy and vasculopathy have emerged as a cause of sudden death and other serious clinical manifestations in younger patients infected with SARS-CoV-2 infection. Angiotensin converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 and other coronaviruses, is a transmembrane protein expressed by lung alveolar epithelial cells, enterocytes, and vascular endothelial cells, whose physiologic role is to induce the maturation of angiotensin I to generate angiotensin 1-7, a peptide hormone that controls vasoconstriction and blood pressure. In this review, we provide the general context of the molecular and cellular mechanisms of SARS-CoV-2 infection with a focus on endothelial cells, describe the vasculopathy and coagulopathy syndromes in patients with SARS-CoV-2, and outline current understanding of the underlying mechanistic aspects.
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Affiliation(s)
- Nazzarena Labò
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Leidos Biochemical Research Inc., Frederick, MD 21702, USA;
| | - Hidetaka Ohnuki
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Giovanna Tosato
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
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