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Toma L, Zgura A, Isac T, Simu R, Mercan-Stanciu A, Dodot M, Iliescu E. COVID-19 AND THE THYROID FUNCTION IN PATIENTS WITH HCV- ASSOCIATED HEPATOCELLULAR CARCINOMA. Acta Endocrinol (Buchar) 2022; 18:392-396. [PMID: 36699175 PMCID: PMC9867823 DOI: 10.4183/aeb.2022.392] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Context COVID-19 is more than a respiratory infection, with deep implications regarding multiple systems and organs. Thyroid damage is frequent in COVID-19 and may overlap previous HCV or HCC associated diseases. Objective The objective of this study is to determine the effects of COVID-19 in patients with HCV associated HCC and thyroid comorbidities. Design We performed a retrospective study of the thyroid function tests and autoantibodies in patients with HCV-associated HCC prior and during COVID-19. Subjects and Methods We included 52 consecutive patients with HCV-associated HCC and documented thyroid disease, diagnosed with COVID -19 between April and October 2020. Serum values of thyroid-stimulating hormone, free T3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxydase antibodies were determined and compared to baseline levels. Results At baseline, 44 patients had positive antithyroid antibodies, 6 had hypothyroidism in substitution and 2 had hyperthyroidism under treatment. During COVID-19 we found an increase in serum values of antithyroid antibodies, and decreased levels of TSH, freeT3 and freeT4 levels. Specific therapies were discontinued in one patient with hyperthyroidism and 3 patients with hypothyroidism. Conclusion There is a significant impact of COVID-19 on the thyroid homeostasis; a long-term prognostic value for patients with HCC infected with COVID-19 required further extensive research.
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Affiliation(s)
- L. Toma
- Fundeni Clinical Institute, Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A. Zgura
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - T. Isac
- Fundeni Clinical Institute, Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - R. Simu
- Fundeni Clinical Institute, Department of Internal Medicine II, Bucharest, Romania
| | - A. Mercan-Stanciu
- Fundeni Clinical Institute, Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M. Dodot
- Fundeni Clinical Institute, Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - E.L. Iliescu
- Fundeni Clinical Institute, Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Toma L, Dodot M, Zgura A, Bacalbasa N, Silaghi A, Simu R, Isac T, Mercan-Stanciu A. Calprotectin in viral systemic infections-COVID-19 versus hepatitis C virus. Clin Exp Med 2022; 22:311-317. [PMID: 34254197 PMCID: PMC8274470 DOI: 10.1007/s10238-021-00743-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
This study aims to evaluate differences in serum and fecal calprotectin in patients with HCV chronic hepatitis and COVID-19 infection and compare them to a control group. This observational study was performed between April 2020 and October 2020 in a single Internal Medicine center. We determined serum and fecal calprotectin, as well as levels of transaminases, C-reactive protein, ferritin, in 25 patients with COVID-19 infection, 30 patients with active HCV chronic infection and 38 patients with cured HCV infection. Serum levels of ALT, AST, C-reactive protein and ferritin were significantly higher in patients with COVID-19 infection (mean values of 127 IU/mL, 135 IU/mL, 123 mg/L and 1034 ng/mL, respectively) than in patients with active HCV infection (mean values of 68 IU/mL, 51 IU/mL, 17 mg/L and 528 ng/mL, respectively) or in patients with cured HCV infection (37 IU/mL, 29 IU/mL, 3.4 mg/L and 274 ng/mL, respectively). Also, serum and fecal calprotectin had increased concentrations in patients with COVID-19 (7.3 µg/mL and 394 µg/mg) versus patients with active hepatitis (2.4 µg/mL and 217 µg/mg) and patients with cured hepatitis (1.2 µg/mL and 38 µg/mg). Values were significantly higher in patients with digestive symptoms related to COVID-19. Serum and fecal calprotectin can be used as inflammatory markers in patients with active viral infections. In COVID-19, calprotectin concentrations can be correlated to the severity of disease, particularly in patients with digestive symptoms.
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Affiliation(s)
- Letitia Toma
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania.
| | - Mihai Dodot
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Anca Zgura
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrei Silaghi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Simu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Teodora Isac
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Adriana Mercan-Stanciu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
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Toma L, Zgura A, Isac T, Mercan-Stanciu A, Dodot M, Iliescu L. The impact of COVID 19 infection on HCV-induced thyroid disease. Acta Endocrinol (Buchar) 2021; 17:372-376. [PMID: 35342479 PMCID: PMC8919480 DOI: 10.4183/aeb.2021.372] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CONTEXT As we progress into the COVID-19 pandemic, it has become apparent that this infection is associated with a multitude of systemic effects, some involving the thyroid gland. The thyroid is also frequently affected in the HCV chronic infection. OBJECTIVE The objective of this study is to determine the effects of COVID-19 infection on the presence and severity of thyroid disorders associated with chronic HCV infection, at short and mid-term follow-up. DESIGN We prospectively evaluated patients with documented HCV- associated thyroid disease (with sustained virologic response after antiviral therapy). SUBJECTS AND METHODS The study group consisted of 42 patients with HCV- associated thyroid disease, diagnosed with COVID -19 infection between April and October 2020. We determined serum values of thyroid-stimulating hormone, freeT3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies at one and three months after resolution of infection and compared them to the baseline characteristics of the patient. We also evaluated the changes in thyroid substitution treatments or antithyroid drugs. RESULTS At baseline, out of the 42 patients, 5 presented hypothyroidism under levothyroxine substitution therapy, while 2 presented hyperthyroidism under methimazole therapy; 37 patients had positive antithyroid antibodies. At one month follow-up, we note an increase in serum values of antibodies, with a decrease in TSH, freeT3 and freeT4 levels, correlated with the severity of COVID-19 infection. Two patients required discontinuation of levothyroxine. At 3 months follow-up, lower levels of antithyroid antibodies were recorded, with an increase in TSH levels. No medication doses were adjusted at this time. CONCLUSION Among the systemic effects of COVID-19, the impact of thyroid dysfunction should not be underestimated, especially in the presence of pre-existing conditions, such as HCV infection.
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Affiliation(s)
- L. Toma
- “Fundeni” Clinical Institute - Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A. Zgura
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - T. Isac
- “Fundeni” Clinical Institute - Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A. Mercan-Stanciu
- “Fundeni” Clinical Institute - Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M. Dodot
- “Fundeni” Clinical Institute - Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - L. Iliescu
- “Fundeni” Clinical Institute - Department of Internal Medicine II, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Hsu WT, Yang DH, Liao CC, Chen JW, Hsu WH, Kuo CW, Hsu HC, Chang SH, Chen LM. Blood Glucose and Renal Function Evaluation in Patients with Viral Hepatitis. Diabetes Metab Syndr Obes 2021; 14:3337-3344. [PMID: 34321900 PMCID: PMC8312512 DOI: 10.2147/dmso.s303252] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the blood glucose and renal function, determine the prevalence of hyperglycemia/diabetes mellitus (DM) and renal disease (nephropathy), and investigate the association between hyperglycemia/DM and renal disease in patients with viral hepatitis (VH). PATIENTS AND METHODS A total of 491 subjects were included in the study. Patients with VH were further divided into the hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, and HBV-HCV co-infection subgroups. Fasting blood glucose, glycated hemoglobin (HbA1c), glycated albumin (GA), glutamic oxaloacetic transaminase (GOT), creatinine (Cr), and cystatin C (Cys C) levels were measured. Urine microalbumin levels were also assessed. Formulas for estimated average glucose calculated using glycated albumin(eAG(GA)), estimated average glucose calculated using HbA1c (eAG(HbA1c)), and estimated glomerular filtration rate calculated using cystatin C (eGFRcys) were used to evaluate the average glucose and renal function. RESULTS The prevalence of hyperglycemia/DM and renal disease was significantly higher in the VH group, especially in the HCV subgroup. The prevalence of renal disease was significantly higher in patients with VH with eAG(GA) ≥200 mg/dL. CONCLUSION Our study used multiple parameters to evaluate blood glucose and renal function in patients with VH and found that hyperglycemia/DM and renal disease are closely associated with VH, especially in subjects with HCV infection. Patients with VH, especially those with HCV infection and hyperglycemia/DM, were particularly vulnerable to renal disease.
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Affiliation(s)
- Wen-Tung Hsu
- Division of Laboratory, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Deng-Ho Yang
- Division of Laboratory, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Chun-Cheng Liao
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Family Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Jia -Wen Chen
- Medicine Laboratory, Ministry of Health and Welfare Feng Yuan Hospital, Taichung, Taiwan, Republic of China
| | - Wen-Hsiu Hsu
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Gastroenterology, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Wen Kuo
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Nephrology, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
| | - Hung-Chang Hsu
- Division of Laboratory, Ching Chyuan Hospital, Taichung, Taiwan, Republic of China
| | - Sheng-Huang Chang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, Republic of China
| | - Li-Mien Chen
- Department of Internal Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Correspondence: Li-Mien Chen Department of Internal Medicine, Taichung Armed Force General Hospital, No. 348, Sec. 2, Chung-Shan Road, Taiping, Taichung, Taiwan, Republic of China Email
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Iliescu EL, Mercan-Stanciu A, Toma L. Safety and efficacy of direct-acting antivirals for chronic hepatitis C in patients with chronic kidney disease. BMC Nephrol 2020; 21:21. [PMID: 31948406 PMCID: PMC6966843 DOI: 10.1186/s12882-020-1687-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This is a real-world evidence study that aims to analyze the efficacy, tolerability and safety profile of paritaprevir/ombitasvir/ritonavir and dasabuvir, in patients with renal impairment. METHODS We conducted an observational prospective study, on 232 patients with chronic kidney disease, undergoing treatment with paritaprevir/ombitasvir/ritonavir and dasabuvir, for chronic hepatitis C infection - genotype 1b. Renal and liver function were assessed at the beginning of therapy, monthly during treatment and three months after therapy completion. RESULTS All patients achieved sustained virologic response. Common side effects were nausea, fatigue and headache. Close monitoring of tacrolimus blood levels and dose reduction was required in kidney transplant recipients. CONCLUSIONS HCV therapy in the setting of renal dysfunction has always been a challenging topic. Direct-acting antivirals have shown promising effects, demonstrating good tolerance and efficacy in patients with HCV infection and renal impairment. Sustained virologic response within our study population was 100%.
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Affiliation(s)
- Elena Laura Iliescu
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328, Bucharest, Romania.
| | - Adriana Mercan-Stanciu
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328, Bucharest, Romania
| | - Letitia Toma
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328, Bucharest, Romania
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Bacalbasa N, Balescu I, Vilcu M, Dima S, Diaconu C, Iliescu L, Filipescu A, Brezean I. Total Exenteration En Bloc with a Nephrectomy for Locally Advanced Cervical Cancer Invading a Pelvic Kidney-a Case Report and Literature Review. ACTA ACUST UNITED AC 2020; 56:E33. [PMID: 31952297 DOI: 10.3390/medicina56010033] [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: 11/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/01/2022]
Abstract
Introduction: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. Case Presentation: A 54-year-old female patient, diagnosed with locally advanced cervical cancer in the presence of a pelvic kidney, was submitted to surgery with curative intent. A large, abscessed cervical tumor invading the urinary bladder and the rectum was found, so a total exenteration was planned. Intraoperatively, tumor invasion of the left kidney, which was found in an ectopic, pelvic position was also encountered; therefore, total pelvic exenteration in association with a left nephrectomy was successfully performed. Conclusions: The presence of an ectopic, pelvic disposition of the kidney makes it susceptible to be invaded by locally advanced pelvic tumors; in such cases, a nephrectomy might also be needed.
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