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Feuth E, Nieminen V, Palomäki A, Ranti J, Sucksdorff M, Finnilä T, Oksi J, Vuorinen T, Feuth T. Prolonged viral pneumonia and high mortality in COVID-19 patients on anti-CD20 monoclonal antibody therapy. Eur J Clin Microbiol Infect Dis 2024; 43:723-734. [PMID: 38358552 DOI: 10.1007/s10096-024-04776-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE In clinical practice, we observed an apparent overrepresentation of COVID-19 patients on anti-CD20 monoclonal antibody therapy. The aim of this study was to characterize the clinical picture of COVID-19 in these patients. METHODS All adult patients from Turku University Hospital, Turku, Finland, with COVID-19 diagnosis and/or positive SARS-CoV-2 PCR test result up to March 2023, and with anti-CD20 therapy within 12 months before COVID-19 were included. Data was retrospectively obtained from electronic patient records. RESULTS Ninety-eight patients were identified. 44/93 patients (47.3%) were hospitalized due to COVID-19. Patients with demyelinating disorder (n = 20) were youngest (median age 36.5 years, interquartile range 33-45 years), had less comorbidities, and were least likely to be hospitalized (2/20; 10.0%) or die (n = 0). COVID-19 mortality was 13.3% in the whole group, with age and male sex as independent risk factors. Persistent symptoms were documented in 33/94 patients (35.1%) alive by day 30, in 21/89 patients (23.6%) after 60 days, and in 15/85 after 90 days (17.6%), mostly in patients with haematological malignancy or connective tissue disease. Prolonged symptoms after 60 days predisposed to persistent radiological findings (odds ratio 64.0; 95% confidence interval 6.3-711; p < 0.0001) and persistently positive PCR (odds ratio 45.5, 95% confidence interval 4.0-535; p < 0.0001). Several patients displayed rapid response to late antiviral therapy. CONCLUSION Anti-CD20 monoclonal antibody therapy is associated with high COVID-19 mortality and with a phenotype consistent with prolonged viral pneumonia. Our study provides rationale for retesting of immunocompromised patients with prolonged COVID-19 symptoms and considering antiviral therapy.
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Affiliation(s)
- Eeva Feuth
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Valtteri Nieminen
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, and Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Ranti
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Marcus Sucksdorff
- Turku PET Centre, and Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Taru Finnilä
- Department of Hospital Hygiene & Infection Control, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Thijs Feuth
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland.
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Jiao Y, Zhou L, Huo J, Li H, Zhu H, Chen D, Lu Y. Flavonoid substituted polysaccharides from Tamarix chinensis Lour. alleviate H1N1-induced acute lung injury via inhibiting complement system. J Ethnopharmacol 2024; 322:117651. [PMID: 38135232 DOI: 10.1016/j.jep.2023.117651] [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] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Viral pneumonia is a highly pathogenic respiratory infectious disease associated with excessive activation of the complement system. Our previous studies found that the anticomplement polysaccharides from some medicinal plants could significantly alleviate H1N1-induced acute lung injury (H1N1-ALI). The leaves and twigs of Tamarix chinensis Lour. are traditionally used as a Chinese medicine Xiheliu for treating inflammatory disorders. Interestingly, its crude polysaccharides (MBAP90) showed potent anticomplement activity in vitro. AIM OF THE STUDY To evaluate the therapeutic effects and possible mechanism of MBAP90 on viral pneumonia and further isolate and characterize the key active substance of MBAP90. MATERIALS AND METHODS The protective effects of MBAP90 were evaluated by survival tests and pharmacodynamic experiments on H1N1-ALI mice. Histopathological changes, viral load, inflammatory markers, and complement deposition in lungs were analyzed by H&E staining, enzyme-linked immunosorbent assay (ELISA), and immunohistochemistry (IHC), respectively. An anticomplement homogenous polysaccharide (MBAP-3) was obtained from MBAP90 by bio-guided separation, and its structure was further characterized by methylation analysis and NMR spectroscopy. RESULTS Oral administration of MBAP90 at a dose of 400 mg/kg significantly increased the survival rate of mice infected with the lethal H1N1 virus. In H1N1-induced ALI, mice treated with MBAP90 (200 and 400 mg/kg) could decrease the lung index, lung pathological injury, the levels of excessive proinflammatory cytokines (IL-6, TNF-α, MCP-1, IL-18, and IL-1β), and complement levels (C3c and C5b-9). In addition, MBAP-3 was characterized as a novel homogenous polysaccharide with potent in vitro anticomplement activity (CH50: 0.126 ± 0.002 mg/mL), containing 10.51% uronic acids and 9.67% flavonoids, which were similar to the composition of MBAP90. The backbone of MBAP-3 consisted of →4)-α-D-Glcp-(1→, →3,4,6)-α-D-Glcp-(1→, and →3,4)-α-D-Glcp-(1→, with branches comprising α-L-Araf-(1→, α-D-GlcpA-(1→, →4,6)-α-D-Manp-(1→ and →4)-β-D-Galp-(1 → . Particularly, O-6 of →4)-β-D-Galp-(1→ was conjugated with a flavonoid, myricetin. CONCLUSIONS MBAP90 could ameliorate H1N1-ALI by inhibiting inflammation and over-activation of the complement system. These polysaccharides (MBAP90 and MBAP-3) with relative high contents of uronic acid and flavonoid substituent might be vital components of T. chinensis for treating viral pneumonia.
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Affiliation(s)
- Yukun Jiao
- Department of Natural Medicine, School of Pharmacy, Fudan University, Shanghai, China.
| | - Lishuang Zhou
- Department of Natural Medicine, School of Pharmacy, Fudan University, Shanghai, China.
| | - Jiangyan Huo
- Department of Natural Medicine, School of Pharmacy, Fudan University, Shanghai, China.
| | - Hong Li
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.
| | - Haiyan Zhu
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China.
| | - Daofeng Chen
- Department of Natural Medicine, School of Pharmacy, Fudan University, Shanghai, China; Institutes of Integrative Medicine, School of Pharmacy, Fudan University, Shanghai, China.
| | - Yan Lu
- Department of Natural Medicine, School of Pharmacy, Fudan University, Shanghai, China.
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Febbo J, Revels J, Ketai L. Viral Pneumonias. Infect Dis Clin North Am 2024; 38:163-182. [PMID: 38280762 DOI: 10.1016/j.idc.2023.12.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.
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Affiliation(s)
- Jennifer Febbo
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA.
| | - Jonathan Revels
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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Kang VJW, Huang YS, Chen MC, Chiang PY, Sheng WH, Wang HC, Wang TC, Chang YC. CT findings of 144 in-hospital patients with influenza pneumonia: A retrospective analysis. J Formos Med Assoc 2024; 123:381-389. [PMID: 37640653 DOI: 10.1016/j.jfma.2023.08.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/08/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND/PURPOSE Patients with influenza infection during their period of admission may have worse computed tomography (CT) manifestation according to the clinical status. This study aimed to evaluate the CT findings of in-hospital patients due to clinically significant influenza pneumonia with correlation of clinical presentations. METHODS In this retrospective, single center case series, 144 patients were included. All in-hospital patients were confirmed influenza infection and underwent CT scan. These patients were divided into three groups according to the clinical status of the most significant management: (1) without endotracheal tube and mechanical ventilator (ETTMV) or extracorporeal membrane oxygenation (ECMO); (2) with ETTMV; (3) with ETTMV and ECMO. Pulmonary opacities were scored according to extent. Spearman rank correlation analysis was used to evaluate the correlation between clinical parameters and CT scores. RESULTS The predominant CT manifestation of influenza infection was mixed ground-glass opacity (GGO) and consolidation with both lung involvement. The CT scores were all reach significant difference among all three groups (8.73 ± 6.29 vs 12.49 ± 6.69 vs 18.94 ± 4.57, p < 0.05). The chest CT score was correlated with age, mortality, and intensive care unit (ICU) days (all p values were less than 0.05). In addition, the CT score was correlated with peak lactate dehydrogenase (LDH) level and peak C-reactive protein (CRP) level (all p values were less than 0.05). Concomitant bacterial infection had higher CT score than primary influenza pneumonia (13.02 ± 7.27 vs 8.95 ± 5.99, p < 0.05). CONCLUSION Thin-section chest CT scores correlated with clinical and laboratory parameters in in-hospital patients with influenza pneumonia.
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Affiliation(s)
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan.
| | - Mei-Chi Chen
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan.
| | - Pin-Yi Chiang
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan.
| | - Wang-Huei Sheng
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taiwan.
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taiwan; Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Teh-Chen Wang
- Department Medical Imaging, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan; Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan.
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Guo L, Bao W, Yang S, Liu Y, Lyu J, Wang T, Lu Y, Li H, Zhu H, Chen D. Rhei Radix et Rhizoma in Xuanbai-Chengqi decoction strengthens the intestinal barrier function and promotes lung barrier repair in preventing severe viral pneumonia induced by influenza A virus. Journal of Ethnopharmacology 2024; 319:117231. [PMID: 37783404 DOI: 10.1016/j.jep.2023.117231] [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] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xuanbai-Chengqi decoction (XCD) is a traditional prescription for treating multiple organ injuries, which has been used to manage pneumonia caused by various pathogens. However, the effects of XCD on repairing pulmonary/intestinal barrier damage remain unclear, and there is a need to understand the compatibility mechanism of rhubarb. AIM OF THE STUDY This work aims to investigate the protective effect and mechanism of XCD on the pulmonary/intestinal barrier guided by the theory of "gut-lung concurrent treatment". Moreover, we elucidate the compatibility mechanism of rhubarb in XCD. MATERIALS AND METHODS An H1N1 virus-infected mouse model was adopted to investigate the reparative effects of XCD on the lung-intestinal barrier by assessing lung-intestinal permeability. Additionally, the characterization of type I alveolar epithelial cells (AT1) and type II alveolar epithelial cells (AT2) was performed to evaluate the damage to the alveolar epithelial barrier. The specific barrier-protective mechanisms of XCD were elucidated by detecting tight junction proteins and the epithelial cell repair factor IL-22. The role of rhubarb in XCD to pneumonia treatment was investigated through lung tissue transcriptome sequencing and flow cytometry. RESULTS XCD significantly improved lung tissue edema, inflammation, and alveolar epithelial barrier damage by regulating IL-6, IL-10, and IL-22, which, could further improve pulmonary barrier permeability when combined with the protection of alveolar epithelial cells (AT1 and AT2) as well as inhibition of H1N1 virus replication. Simultaneously, XCD significantly reduced intestinal inflammation and barrier damage by regulating IL-6, IL-1β, and tight junction protein levels (Claudin-1 and ZO-1), improving intestinal barrier permeability. The role of rhubarb in the treatment of pneumonia is clarified for the first time. In the progression of severe pneumonia, rhubarb can significantly protect the intestinal barrier, promote the repair of AT2 cells, and inhibit the accumulation of CD11b+Ly6Gvariable aberrant neutrophils by regulating the S100A8 protein. CONCLUSION In summary, our findings suggest that rhubarb in XCD plays a critical role in protecting intestinal barrier function and promoting lung barrier repair in preventing severe viral pneumonia caused by influenza A virus.
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Affiliation(s)
- Linfeng Guo
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Weilian Bao
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Shuiyuan Yang
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Yang Liu
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Jiaren Lyu
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Ting Wang
- Department of Biological Medicines, Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong, District, Shanghai, 201203, PR China
| | - Yan Lu
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Hong Li
- Department of Pharmacology, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong, Shanghai, 201203, PR China
| | - Haiyan Zhu
- Department of Biological Medicines, Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong, District, Shanghai, 201203, PR China.
| | - Daofeng Chen
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China.
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Ishiguro T, Kobayashi Y, Shimizu Y, Uemura Y, Toriba R, Takata N, Ueda M, Shimizu Y. Prognostic factors of virus-associated pneumonia other than COVID-19 in adults. Respir Med 2024; 221:107497. [PMID: 38097142 DOI: 10.1016/j.rmed.2023.107497] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To determine prognostic factors of virus-associated pneumonia other than coronavirus disease 2019. METHODS We retrospectively studied patients suffering from virus-associated community-acquired pneumonia, and who were admitted to Saitama Cardiovascular and Respiratory Center from 2002 to 2020. Prognostic factors were analyzed by univariable and multivariable regression analysis of patient demographics, laboratory data, chest imaging, severity on admission, and initial treatment. PATIENTS HIV-positive patients, those with non-resected lung cancer or receiving chemotherapy, and those with COVID-19 were excluded. Included were 363 patients diagnosed by nucleic acid amplification method, paired sera, and rapid diagnostic tests. RESULTS A CURB-65 score of ≥3 was significant by univariable analysis for 60-day mortality but was nonsignificant by multivariable analysis. The poor prognostic factors that were significant by multivariable analysis (p < 0.05) included immunosuppressive state due to systemic corticosteroid or immunosuppressant administration, acute kidney injury on admission, and corticosteroid administration initiated within 5 days or 5 days to 2 weeks from onset. CONCLUSION A CURB-65 score of ≥3, which is considered to indicate severe pneumonia, was of limited value for predicting mortality of virus-associated pneumonia. We showed patients' underlying diseases and complications to be independent factors of poor prognosis for 60-day mortality. Timing of the initiation of corticosteroid administration remains to be elucidated.
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Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan.
| | - Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Riho Toriba
- Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Naomi Takata
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Miyuki Ueda
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
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Sampley S, Bhasin D, Sekhri K, Singh H, Gupta O. Effect of Aviptadil, a Novel Therapy, on Clinical Outcomes of Patients with Viral-related Severe ARDS: A Retrospective Observational Study. Indian J Crit Care Med 2024; 28:70-74. [PMID: 38510776 PMCID: PMC10949283 DOI: 10.5005/jp-journals-10071-24594] [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: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 03/22/2024] Open
Abstract
Background Dealing with life-threatening viral acute respiratory distress syndrome (ARDS) has always been challenging and with the recent COVID pandemic experience, there is still the need of newer therapies to alleviate mortality. Aviptadil, has shown significant beneficial results in covid. We share our experience with this molecule by doing a retrospective study to evaluate the effect of this drug on clinical outcomes in viral-related Ards patients. Materials and methods In this study, all patients with severe viral-related Ards received Aviptadil along with the conventional treatment. The oxygen saturation, SpO2/FiO2 (ratio of pulse oximetric saturation to fractional inspired oxygen) (S/F) ratio and PaO2/FiO2 (ratio of arterial oxygen partial pressure to fractional inspired oxygen) (p/f) ratio, before and after completion of the drug were studied. Radiological clearance and time for complete recovery from respiratory failure was noted. All variables pre- and postadministration of the drug were compared. Results A total of 68 patients with viral pneumonias were admitted to intensive care unit (Icu) and only 6 patients had severe Ards, who received Aviptadil. The mean oxygen saturation significantly improved from 87.86% before the first Aviptadil dose to 93.43% post 3 days of infusion. Similarly, improvement was seen in PaO2 values from 54.32 to 68.4 posttherapy (p-value < 0.004). SpO2/FiO2 (ratio of pulse oximetric saturation to fractional inspired oxygen) ratio hiked from 149 to 336 at the end of the 3 days infusion (p-value < 0.003). RALE scoring system was used for radiological clearance and the mean change in the score was from 6.42 to 2.5 (p-value 0.00). The average length of stay in the Icu was 12.14 days. No adverse effects were noted. Conclusion Aviptadil has shown to improve the clinical outcomes in patients with severe viral-related ards without any adverse effects. How to cite this article Sampley S, Bhasin D, Sekhri K, Singh H, Gupta O. Effect of Aviptadil, a Novel Therapy, on Clinical Outcomes of Patients with Viral-related Severe ARDS: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(1):70-74.
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Affiliation(s)
- Supriya Sampley
- Medical Intensive Care Unit, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Deepak Bhasin
- Department of Pulmonology and Critical Care, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Kavita Sekhri
- Department of Pharmacology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Punjab University, Chandigarh, India
| | - Harpal Singh
- Department of Pulmonology and Critical Care, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Onkar Gupta
- Department of Pulmonology and Critical Care, Max Super Speciality Hospital, Mohali, Punjab, India
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Fan G, Zhou Y, Zhou F, Yu Z, Gu X, Zhang X, Liu Z, Zhou M, Cao B. The mortality and years of life lost for community-acquired pneumonia before and during COVID-19 pandemic in China. Lancet Reg Health West Pac 2024; 42:100968. [PMID: 38022712 PMCID: PMC10679495 DOI: 10.1016/j.lanwpc.2023.100968] [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] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
Background Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide, but disease burden of CAP is not clear so far. We aim to explore the spatial and temporal trends of mortality and years of life lost (YLL) due to CAP during 2013-2021 in mainland China, especially the mortality changes before and during COVID-19 pandemic due to COVID-19 related non-pharmaceutical interventions (NPIs). Methods We used data from the National Mortality Surveillance System to estimate the age-standardized rates of death and YLL of CAP at national and provincial level in China during 2013-2021. Monthly and provincial NPIs data were obtained from Oxford COVID-19 Government Response Tracker. The Average annual percentage change (AAPC) and mortality reduction were estimated by log-linear regression and interrupted time series, respectively. Findings In China, most CAP that caused deaths had no clear etiology, and bacterial pneumonia and viral pneumonia were the leading 2 causes among CAP deaths with determined etiology before and during COVID-19 pandemic. The age-standardized CAP mortality rate decreased from 11.18 per 100,000 in 2013 to 8.76 per 100,000 in 2019, and to 5.74 per 100,000 in 2021 (AAPC -4.51% vs -7.89%). Trends were similar in age-standardized rate of YLL. Both rates declined more for viral pneumonia, compared with bacterial pneumonia. After adjusting for NPIs at provincial level after 2020, the NPIs for COVID-19 was associated with significant reductions in CAP mortality (-0.34 per 100,000, -0.41 to -0.27; p < 0.0001), and provinces that economically developed and conducted strict regular NPIs against COVID-19 contributed the most reduction. Interpretation We observed a decreasing trend of age-standardized CAP mortality from 2013 to 2019, and a dramatical reduction during COVID-19 pandemic, especially for viral pneumonia. Our study provided the evidence for the effectiveness of regular NPIs on the significant reductions in CAP mortality. Funding This work has been supported by Beijing Municipal Science and Technology Project Z191100006619101, Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS 2021-I2M-1-048), CAMS Institute of Respiratory Medicine Grant for Young Scholars (2023-ZF-8) and the New Cornerstone Science Foundation.
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Affiliation(s)
- Guohui Fan
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Yuchang Zhou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fei Zhou
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Zhongguang Yu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Xiaoying Gu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Xueyang Zhang
- Tsinghua University School of Medicine, Beijing, PR China
| | - Zhengping Liu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Maigeng Zhou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bin Cao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
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Cao B, Bao Y, Liu C, Qi Q, Zhao Y, Yang F. A gene polymorphism at SP-B 1580 site regulates the pulmonary surfactant tension of viral pneumonia through the cellular pyroptosis signaling pathway. Am J Transl Res 2023; 15:6949-6958. [PMID: 38186981 PMCID: PMC10767512] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Viral pneumonias, such as SARS and MERS, have been a recurrent challenge for the public healthcare system. COVID-19 posed an unprecedented global crisis. The primary impact of viral pneumonia is pathologic changes of lung tissue. However, the effect of SP-B site gene polymorphism on alveolar surface tension in viral pneumonia remains unexplored. OBJECTIVE To explore the molecular mechanism of how the gene polymorphism at SP-B 1580 site regulates the pulmonary surfactant tension of viral pneumonia through the cellular pyroptosis signaling pathway using an in vivo animal experiment and a clinical trial. METHODS We constructed a genetically modified mouse model of viral pneumonia and administered H5N1 influenza virus through intratracheal injection. After 48 hours, the survival rate of each mouse group was evaluated. Lung tissue, blood, and bronchoalveolar lavage fluid samples were collected for histopathologic analysis. Inflammatory factor concentrations were measured using ELISA. The level of apoptosis was determined using TUNEL assay. Changes in the expression of cell death-related factors were assessed using qRT-PCR and protein blotting. Additionally, blood samples from patients with viral pneumonia were analyzed to detect single nucleotide polymorphisms and explore their correlation with disease severity, inflammatory factor levels, and pulmonary surfactant protein expression. RESULTS Following H5N1 infection of mice, the model group and hSP-B-C group showed high mortality rates within 24 hours. The survival rates in the blank control group, virus model group, hSP-B-C group, and hSP-B-T group were 100%, 50%, 37.5%, and 75%, respectively. Histologic analysis revealed significant lung tissue damage, congestion, alveolar destruction, and thickened alveolar septa in the model and hSP-B-C groups. However, these pulmonary lesions were significantly alleviated in the hSP-B-T group. Inflammatory factor levels were elevated in the model and hSP-B-C groups but reduced in the hSP-B-T group. TUNEL assay demonstrated a decrease in apoptotic cells in the lungs of the hSP-B-T group. Furthermore, the expression of SP-B and cell death-related proteins was downregulated in all three groups, with the lowest expression observed in the hSP-B-C group. The clinical trial found that patients with severe viral pneumonia exhibited a higher frequency of CC genotype and C allele in, along with increased inflammatory factor levels and decreased SP-B expression compared to those with mild-to-moderate viral pneumonia. CONCLUSION SP-B polymorphism at the 1580 site regulates lung surfactant tension through the cell pyroptosis signaling pathway, thus affecting the progression of viral pneumonia.
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Affiliation(s)
- Bin Cao
- Department of Emergency, People’s Hospital Affiliated to Shandong First Medical University, Jinan Municipal Key Laboratory of Acute Lung Injury Medicine, Jinan Municipal Clinical Research Center of Critical Care Medicine, Jinan Municipal Clinical Research Center of Respiratory MedicineJinan 271199, Shandong, China
| | - Yuzhen Bao
- Department of Emergency, People’s Hospital Affiliated to Shandong First Medical University, Jinan Municipal Key Laboratory of Acute Lung Injury Medicine, Jinan Municipal Clinical Research Center of Critical Care Medicine, Jinan Municipal Clinical Research Center of Respiratory MedicineJinan 271199, Shandong, China
| | - Chunli Liu
- Department of Critical Care Medicine, Shandong Province Public Health CenterJinan 250000, Shandong, China
| | - Qian Qi
- Respiratory Department, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory DiseasesJinan 250014, Shandong, China
| | - Yuanhao Zhao
- Clinical Laboratory, People’s Hospital Affiliated to Shandong First Medical University, Jinan Municipal Clinical Research Center of Critical Care MedicineJinan 271199, Shandong, China
| | - Fengyong Yang
- Department of Emergency, People’s Hospital Affiliated to Shandong First Medical University, Jinan Municipal Key Laboratory of Acute Lung Injury Medicine, Jinan Municipal Clinical Research Center of Critical Care Medicine, Jinan Municipal Clinical Research Center of Respiratory MedicineJinan 271199, Shandong, China
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10
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Wang H, Chen L, Li R, Lv C, Xu Y, Xiong Y. Polydopamine-coated mesoporous silica nanoparticles co-loaded with Ziyuglycoside I and Oseltamivir for synergistic treatment of viral pneumonia. Int J Pharm 2023; 645:123412. [PMID: 37703956 DOI: 10.1016/j.ijpharm.2023.123412] [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] [Received: 05/05/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
Viral pneumonia (VP) is a serious health risk to humans, however, there is still a lack of specific treatments for VP. The spread of the virus in the body induces an excessive inflammatory response that can cause chronic or irreversible damage to lungs. Hence, VP treatment requires rapid clearance of the virus and sustained inflammation control. In this study, an innovative mesoporous silica medication delivery system co-loaded with Ziyuglycoside I(ZgI) and Oseltamivirv(OST) in fast and slow monomeric forms ZgI@MSNs-OST@ Polydopamine (PDA) was prepared for targeted treatment of VP. The prepared ZgI@MSNs-OST@PDA nanoparticles had a homogeneous and membrane-encapsulated spherical structure, with an average particle size of approximately 760 nm. in vitro release and in vivo pharmacokinetic studies demonstrated that ZgI@MSNs-OST@PDA achieved immediate release of OST and sustained release of ZgI, which was readily taken up by the cells. In vitro anti-H1N1 virus experiments showed that nanoparticles rapidly killed the virus in host cells, and the anti-inflammatory effect was sustained and long-lasting, providing excellent protection to host cells. In vivo antiviral pneumonia experiments confirmed the rapid clearance of influenza viruses from mouse lungs and the effective control of overactivated immune responses by ZgI@MSNs-OST@PDA nanoparticles. Through a mechanistic study, we found that the treatment of viral pneumonia with nanoparticles was associated with inhibition of the NLRP3 inflammasome pathway. In conclusion, the constructed nanoparticles achieved synergistic therapeutic effects of ZgI and OST on VP, that is, rapid killing of influenza viruses by OST and effective control of the virus-induced hyperinflammatory response by ZgI.
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Affiliation(s)
- Hong Wang
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou 563000, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Lei Chen
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou 563000, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Ruidong Li
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou 563000, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Chunmei Lv
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou 563000, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Yingshu Xu
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou 563000, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, China.
| | - Yongai Xiong
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou 563000, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, China.
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11
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Hsu CH, Po-Liang Chen A, Chen HP, Chan YJ. Outcomes of corticosteroid treatment in critical Ill adult patients with respiratory viruses-related community acquired pneumonia - a propensity-matched case control study. J Microbiol Immunol Infect 2023; 56:757-765. [PMID: 36990896 DOI: 10.1016/j.jmii.2023.02.009] [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] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES To assess the outcomes of corticosteroid treatment in critically ill patients with respiratory virus-related community-acquired pneumonia (CAP). MATERIALS/METHODS Adult patients who were admitted to the intensive care unit and had a polymerase chain reaction-confirmed diagnosis of respiratory virus-related CAP were included. Patients with and without corticosteroid treatment during the hospital course were retrospectively compared using a propensity score-matched case-control analysis. RESULTS From January 2018 to December 2020, 194 adult patients were enrolled with 1:1 matching. The 14-day and 28-day mortality rates did not differ significantly between patients treated with and without corticosteroids (14-day mortality: 7% versus 14%, P = 0.11; 28-day mortality: 15% versus 20%, P = 0.35). However, multivariate analysis by using a Cox regression model revealed that corticosteroid treatment was an independent factor predicting decreased mortality (adjusted odds ratio, 0.46; 95% confidence interval, 0.22-0.97, P = 0.04). Subgroup analysis revealed lower 14-day and 28-day mortality rates in patients younger than 70 years treated with corticosteroids than in those not treated with corticosteroids (14-day mortality: 6% versus 23%; P = 0.01 and 28-day mortality: 12% versus 27%; P = 0.04). CONCLUSIONS Non-elderly patients with severe respiratory virus-related CAP are more likely to benefit from corticosteroid treatment than elderly patients.
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Affiliation(s)
- Ching-Hao Hsu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrew Po-Liang Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Pai Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yu-Jiun Chan
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan
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12
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Abstract
How to cite this article: Bansal T. Antiviral Drugs for Viral Pneumonia. Indian J Crit Care Med 2023;27(8):600.
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Affiliation(s)
- Tapesh Bansal
- Department of Intensive Care and Medicine, Gurugram, Haryana, India
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13
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Yin L, Zhang Y, Zheng Y, Luo Q, Zhao L, Ni W, Xu Y, Gao Z. Early Detection of Aspergillus Species in Lower Respiratory Tract is Associated with Higher Mortality in Viral Community-Acquired Pneumonia: A Multicenter Prospective Cohort Study in China. Lung 2023; 201:387-396. [PMID: 37480410 DOI: 10.1007/s00408-023-00638-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Community-acquired pneumonia (CAP) is a leading cause of adult mortality worldwide and poses a significant global burden. Previous studies have indicated a tendency for viral pneumonia, particularly severe influenza virus pneumonia, to be complicated by Aspergillus superinfection. However, the clinical features and prognostic implications of Aspergillus detection in early-onset viral CAP remain unclear. METHODS We conducted a prospective multicenter observational cohort study in China involving CAP patients. Adult patients with CAP from six hospitals were enrolled between January 2017 and October 2018. Within 72 h of admission, lower respiratory tract specimens, including sputum and alveolar lavage fluid, were collected. Comprehensive pathogenic testing, utilizing molecular biology techniques, was performed on the collected specimens, encompassing bacteria, atypical pathogens, viruses, and fungi. Patient clinical data were collected through a unified electronic medical record website system. RESULTS A total of 382 adult CAP patients were included in the study. The viral detection rate was 38% (145/382), with Aspergillus identified in 11.0% (16/145) of viral CAP cases. Mortality among Aspergillus-positive patients was significantly higher (25%, 4/16) compared to Aspergillus-negative patients (5.4%, 7/129) in viral CAP (P = 0.021). Multivariable logistic regression models demonstrated that the presence of Aspergillus at admission might increase the mortality risk in viral CAP [OR (95%CI) = 7.34 (0.92-58.65), P = 0.06]. Furthermore, Aspergillus-positive patients exhibited a significantly lower lymphocyte count than Aspergillus-negative patients (P = 0.047). CONCLUSION Positive detection of Aspergillus in lower respiratory tract specimens might be associated with higher mortality in early-onset viral CAP. TRIAL REGISTRATION ClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017.
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Affiliation(s)
- Lu Yin
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Ying Zhang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yali Zheng
- Department of Respiratory and Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361101, China
| | - Qiongzhen Luo
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Lili Zhao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wentao Ni
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Yu Xu
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Li X, Li W, Sun L, Ren J, Xu Y, Zheng Y, Bai W. Efficacy of low-intensity pulsed ultrasound for the treatment of viral pneumonia: study protocol for a randomized controlled trial. Trials 2023; 24:389. [PMID: 37296443 DOI: 10.1186/s13063-023-07382-1] [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: 01/13/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Viral pneumonia has always been a problem faced by clinicians because of its insidious onset, strong infectivity, and lack of effective drugs. Patients with advanced age or underlying diseases may experience more severe symptoms and are prone to severe ventilation dysfunction. Reducing pulmonary inflammation and improving clinical symptoms is the focus of current treatment. Low-intensity pulsed ultrasound (LIPUS) can mitigate inflammation and inhibit edema formation. We aimed to investigate the efficacy of therapeutic LIPUS in improving lung inflammation in hospitalized patients with viral pneumonia. METHODS Sixty eligible participants with clinically confirmed viral pneumonia will be assigned to either (1) intervention group (LIPUS stimulus), (2) control group (null stimulus), or (3) self-control group (LIPUS stimulated areas versus non-stimulated areas). The primary outcome will be the difference in the extent of absorption and dissipation of lung inflammation on computed tomography. Secondary outcomes include changes in lung inflammation on ultrasonography images, pulmonary function, blood gas analysis, fingertip arterial oxygen saturation, serum inflammatory factor levels, the sputum excretion volume, time to the disappearance of pulmonary rales, pneumonia status score, and course of pneumonia. Adverse events will be recorded. DISCUSSION This study is the first clinical study of the efficacy of therapeutic LIPUS in the treatment of viral pneumonia. Given that the current clinical recovery mainly depends on the body's self-limiting and conventional symptomatic treatment, LIPUS, as a new therapy method, might be a major advance in the treatment of viral pneumonia. TRIAL REGISTRATION ChiCTR2200059550 Chinese Clinical Trial Registry, May 3, 2022.
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Affiliation(s)
- Xiao Li
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Wen Li
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Lianjie Sun
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Wutaishan Road 1677, Qingdao, 266555, China
| | - Junyi Ren
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Ying Xu
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China.
| | - Wenkun Bai
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China.
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Kuzmin B, Movsisyan A, Praetsch F, Schilling T, Lux A, Fadel M, Azizzadeh F, Crackau J, Keyser O, Awad G, Hachenberg T, Wippermann J, Scherner M. Outcomes of patients with coronavirus disease versus other lung infections requiring venovenous extracorporeal membrane oxygenation. Heliyon 2023; 9:e17441. [PMID: 37366524 PMCID: PMC10276501 DOI: 10.1016/j.heliyon.2023.e17441] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patients with Coronavirus Disease (COVID-19) often develop severe acute respiratory distress syndrome (ARDS) requiring prolonged mechanical ventilation (MV), and venovenous extracorporeal membrane oxygenation (V-V ECMO).Mortality in COVID-19 patients on V-V ECMO was exceptionally high; therefore, whether survival can be ameliorated should be investigated. Methods We collected data from 85 patients with severe ARDS who required ECMO support at the University Hospital Magdeburg from 2014 to 2021. The patients were divided into the COVID-19 group (52 patients) and the non-COVID-19 group (33 patients). Demographic and pre-, intra-, and post-ECMO data were retrospectively recorded. The parameters of mechanical ventilation, laboratory data before using ECMO, and during ECMO were compared. Results There was a significant difference between the two groups regarding survival: 38.5% of COVID-19 patients and 63.6% of non-COVID-19 patients survived 60 days (p = 0.024). COVID-19 patients required V-V ECMO after 6.5 days of MV, while non-COVID-19 patients required V-V ECMO after 2.0 days of MV (p = 0.048). The COVID-19 group had a greater proportion of patients with ischemic heart disease (21.2% vs 3%, p = 0.019). The rates of most complications were comparable in both groups, whereas the COVID-19 group showed a significantly higher rate of cerebral bleeding (23.1 vs 6.1%, p = 0.039) and lung bacterial superinfection (53.8% vs 9.1%, p = <0.001). Conclusion The higher 60-days mortality among patients with COVID-19 with severe ARDS was attributable to superinfection, a higher risk of intracerebral bleeding, and the pre-existing ischemic heart disease.
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Affiliation(s)
- Boris Kuzmin
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Arevik Movsisyan
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Florian Praetsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Magdeburg, Germany
| | - Thomas Schilling
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, University Hospital, Magdeburg, Germany
| | - Mohammad Fadel
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Faranak Azizzadeh
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Julia Crackau
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Olaf Keyser
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - George Awad
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Thomas Hachenberg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Magdeburg, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, University Hospital, Magdeburg, Germany
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Clemente I, Santini SJ, Vittorini P, Pallotta E, Sinatti G, Fontana A, Mammarella L, Rancitelli E, Balsano C. Fall of viral and bacterial pneumonia hospitalizations following COVID-19 pandemic mitigation strategies: a central Italian Region retrospective study. Intern Emerg Med 2023; 18:1181-1189. [PMID: 36750536 PMCID: PMC9904871 DOI: 10.1007/s11739-023-03213-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
Community-Acquired Pneumonia (CAP) represents one of the first causes of hospitalization and death in the elderly all over the world and weighs heavily on public health system. Since the beginning of the COVID-19 (CoronaVirus Disease-19) pandemic, everybody's behavior was forced to change, as the result of a global lockdown strategy and the obligation of using personal protection equipment (PPE). We aimed to evaluate how the mitigation strategies adopted to fight SARS-CoV-2 (Severe Acute Respiratory Coronavirus Syndrome 2) infection have influenced hospitalizations due to CAP in two different Local Health Boards (LHBs) of central Italy. We considered two main periods of observation: before and after the national start of lockdown, in two Abruzzo's LHBs. We analyzed 19,558 hospital discharge records of bacterial and viral CAP. Excluding SARS-CoV2 infection, a significant decrease in CAP hospitalizations was observed. Through the analysis of Diagnosis Related Group (DRG) values, we highlighted a significant saving of founds for the Regional Health Service. The enactment of social distancing measures to contain COVID-19 spread, brought down admissions for bacterial and viral pneumonia. Our study emphasizes that costs for hospitalizations due to CAP could be drastically reduced by mask wearing and social distancing.
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Affiliation(s)
- Irma Clemente
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvano Junior Santini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| | - Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Pallotta
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gaia Sinatti
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonella Fontana
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Leondino Mammarella
- U.O.S.D. Servizio Gestione Flussi Informativi e Statistica Sanitaria, L'Aquila, Italy
| | | | - Clara Balsano
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy.
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy.
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Li R, Qu S, Qin M, Huang L, Huang Y, Du Y, Yu Z, Fan F, Sun J, Li Q, So KF. Immunomodulatory and antiviral effects of Lycium barbarum glycopeptide on influenza a virus infection. Microb Pathog 2023; 176:106030. [PMID: 36773941 DOI: 10.1016/j.micpath.2023.106030] [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] [Received: 09/11/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
Influenza is caused by a respiratory virus and has a major global impact on human health. Influenza A viruses in particular are highly pathogenic to humans and have caused multiple pandemics. An important consequence of infection is viral pneumonia, and with serious complications of excessive inflammation and tissue damage. Therefore, simultaneously reducing direct damage caused by virus infection and relieving indirect damage caused by excessive inflammation would be an effective treatment strategy. Lycium barbarum glycopeptide (LbGp) is a mixture of five highly branched polysaccharide-protein conjuncts (LbGp1-5) isolated from Lycium barbarum fruit. LbGp has pro-immune activity that is 1-2 orders of magnitude stronger than that of other plant polysaccharides. However, there are few reports on the immunomodulatory and antiviral activities of LbGp. In this study, we evaluated the antiviral and immunomodulatory effects of LbGp in vivo and in vitro and investigated its therapeutic effect on H1N1-induced viral pneumonia and mechanisms of action. In vitro, cytokine secretion, NF-κB p65 nuclear translocation, and CD86 mRNA expression in LPS-stimulated RAW264.7 cells were constrained by LbGp treatment. In A549 cells, LbGp can inhibit H1N1 infection by blocking virus attachment and entry action. In vivo experiments confirmed that administration of LbGp can effectively increase the survival rate, body weight and decrease the lung index of mice infected with H1N1. Compared to the model group, pulmonary histopathologic symptoms in lung sections of mice treated with LbGp were obviously alleviated. Further investigation revealed that the mechanism of LbGp in the treatment of H1N1-induced viral pneumonia includes reducing the viral load in lung, regulating the phenotype of pulmonary macrophages, and inhibiting excessive inflammation. In conclusion, LbGp exhibits potential curative effects against H1N1-induced viral pneumonia in mice, and these effects are associated with its good immuno-regulatory and antiviral activities.
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Affiliation(s)
- Runwei Li
- College of Life Science and Technology, Beijing Advanced Innovation Centre for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China; Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No.4 Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Shuang Qu
- College of Life Science and Technology, Beijing Advanced Innovation Centre for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Meng Qin
- College of Life Science and Technology, Beijing Advanced Innovation Centre for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Lu Huang
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, 510632, China
| | - Yichun Huang
- College of Life Science and Technology, Beijing Advanced Innovation Centre for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Yi Du
- Center of Clinical Evaluation and Analysis, Pharmacy Department, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Zhexiong Yu
- Ningxia Tianren Goji Biotechnology, Ningxia, 755100, China
| | - Fu Fan
- Ningxia Tianren Goji Biotechnology, Ningxia, 755100, China
| | - Jing Sun
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No.4 Yinghua East Road, Chaoyang District, Beijing, 100029, China.
| | - Qiushuang Li
- Center of Clinical Evaluation and Analysis, Pharmacy Department, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China.
| | - Kwok-Fai So
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, 510632, China
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18
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Wu X, Xiang M, Jing H, Liu L, Wang C, Novakovic VA, Shi J. Early antithrombotic therapy for another highly lethal viral pneumonia pandemic. Clin Microbiol Infect 2023; 29:284-7. [PMID: 36414204 DOI: 10.1016/j.cmi.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
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19
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Zubieta-Calleja GR, Zubieta-DeUrioste N, de Jesús Montelongo F, Sanchez MGR, Campoverdi AF, Rocco PRM, Battaglini D, Ball L, Pelosi P. Morphological and functional findings in COVID-19 lung disease as compared to Pneumonia, ARDS, and High-Altitude Pulmonary Edema. Respir Physiol Neurobiol 2023; 309:104000. [PMID: 36460252 PMCID: PMC9707029 DOI: 10.1016/j.resp.2022.104000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Coronavirus disease-2019 (COVID-19) may severely affect respiratory function and evolve to life-threatening hypoxia. The clinical experience led to the implementation of standardized protocols assuming similarity to severe acute respiratory syndrome (SARS-CoV-2). Understanding the histopathological and functional patterns is essential to better understand the pathophysiology of COVID-19 and then develop new therapeutic strategies. Epithelial and endothelial cell damage can result from the virus attack, thus leading to immune-mediated response. Pulmonary histopathological findings show the presence of Mallory bodies, alveolar coating cells with nuclear atypia, reactive pneumocytes, reparative fibrosis, intra-alveolar hemorrhage, moderate inflammatory infiltrates, micro-abscesses, microthrombus, hyaline membrane fragments, and emphysema-like lung areas. COVID-19 patients may present different respiratory stages from silent to critical hypoxemia, are associated with the degree of pulmonary parenchymal involvement, thus yielding alteration of ventilation and perfusion relationships. This review aims to: discuss the morphological (histopathological and radiological) and functional findings of COVID-19 compared to acute interstitial pneumonia, acute respiratory distress syndrome (ARDS), and high-altitude pulmonary edema (HAPE), four entities that share common clinical traits, but have peculiar pathophysiological features with potential implications to their clinical management.
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Affiliation(s)
| | | | - Felipe de Jesús Montelongo
- Critical and Neurointensive Care Unit and Pathology Department, Hospital General de Ecatepec “Las Américas”, Instituto de Salud del Estado de México, México
| | - Manuel Gabriel Romo Sanchez
- Critical and Neurointensive Care Unit and Pathology Department, Hospital General de Ecatepec “Las Américas”, Instituto de Salud del Estado de México, México
| | | | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,COVID-19 Virus Network, Ministry of Science, Technology, and Innovation, Brasilia, Brazil
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy,Corresponding author
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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20
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Abstract
The lungs are an immunologically unique environment; they are exposed to innumerable pathogens and particulate matter daily. Appropriate clearance of pathogens and response to pollutants is required to prevent overwhelming infection, while preventing tissue damage and maintaining efficient gas exchange. Broadly, the innate immune system is the collection of immediate, intrinsic immune responses to pathogen or tissue injury. In this review, we will examine the innate immune responses of the lung, with a particular focus on their role in pneumonia. We will discuss the anatomic barriers and antimicrobial proteins of the lung, pathogen and injury recognition, and the role of leukocytes (macrophages, neutrophils, and innate lymphocytes) and lung stromal cells in innate immunity. Throughout the review, we will focus on new findings in innate immunity as well as features that are unique to the lung.
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Affiliation(s)
- Filiz T Korkmaz
- Department of Medicine, Division of Immunology & Infectious Disease, University of Massachusetts, Worcester, MA, USA
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Katrina E Traber
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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21
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Bernard A, Serna-Higuita LM, Martus P, Mirakaj V, Koeppen M, Zarbock A, Marx G, Putensen C, Rosenberger P, Haeberle HA. COVID-19 does not influence functional status after ARDS therapy. Crit Care 2023; 27:48. [PMID: 36740717 PMCID: PMC9899507 DOI: 10.1186/s13054-023-04330-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Health-related quality of life after surviving acute respiratory distress syndrome has come into focus in recent years, especially during the coronavirus disease 2019 pandemic. OBJECTIVES A total of 144 patients with acute respiratory distress syndrome caused by COVID-19 or of other origin were recruited in a randomized multicenter trial. METHODS Clinical data during intensive care treatment and data up to 180 days after study inclusion were collected. Changes in the Sequential Organ Failure Assessment score were used to quantify disease severity. Disability was assessed using the Barthel index on days 1, 28, 90, and 180. MEASUREMENTS Mortality rate and morbidity after 180 days were compared between patients with and without COVID-19. Independent risk factors associated with high disability were identified using a binary logistic regression. MAIN RESULTS The SOFA score at day 5 was an independent risk factor for high disability in both groups, and score dynamic within the first 5 days significantly impacted disability in the non-COVID group. Mortality after 180 days and impairment measured by the Barthel index did not differ between patients with and without COVID-19. CONCLUSIONS Resolution of organ dysfunction within the first 5 days significantly impacts long-term morbidity. Acute respiratory distress syndrome caused by COVID-19 was not associated with increased mortality or morbidity.
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Affiliation(s)
- Alice Bernard
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Lina Maria Serna-Higuita
- grid.10392.390000 0001 2190 1447Institute for Clinical Epidemiology and Applied Biometry, Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- grid.10392.390000 0001 2190 1447Institute for Clinical Epidemiology and Applied Biometry, Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Valbona Mirakaj
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Michael Koeppen
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Alexander Zarbock
- grid.5949.10000 0001 2172 9288Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Gernot Marx
- grid.412301.50000 0000 8653 1507Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Putensen
- grid.15090.3d0000 0000 8786 803XDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Helene Anna Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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22
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Dillon K, Garnick B, Fortier M, Felicia B, Fulton A, Dumont C, Dorval B, Gardella K. The Management of Infectious Pulmonary Processes in the Emergency Department: Pneumonia. Physician Assist Clin 2023; 8:123-37. [PMID: 36448036 DOI: 10.1016/j.cpha.2022.08.005] [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] [Indexed: 11/27/2022]
Abstract
Pneumonia is a common diagnosis encountered by emergency medicine providers. It is crucial that an accurate and timely diagnosis is established in order to appropriately manage each patient. Following the outbreak of SARS-CoV-2 in 2019, the frequency of patient visits to the emergency department for symptoms consistent with pneumonia have increased and overwhelmed virtually all hospital systems. The rapid identification of COVID-19 patients is imperative for patient care and to these hospital systems experiencing the pandemic. Community-acquired bacterial pneumonia continues to be prevalent and clinical decision-making tools are useful aids to assist the appropriate disposition of patients.
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23
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Huo J, Wang T, Wei B, Shi X, Yang A, Chen D, Hu J, Zhu H. Integrated network pharmacology and intestinal flora analysis to determine the protective effect of Xuanbai-Chengqi decoction on lung and gut injuries in influenza virus-infected mice. J Ethnopharmacol 2022; 298:115649. [PMID: 35987410 DOI: 10.1016/j.jep.2022.115649] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/03/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xuanbai-Chengqi decoction (XBCQ) is a traditional Chinese medicine (TCM) compound used in the treatment of pulmonary infection in China. Despite the popular usage of XBCQ, its underlying protective roles and the associated molecular mechanisms with the gut-lung axis in influenza remain unclear. AIM OF THE STUDY We aimed to explore the protective effects and the underlying mechanism of XBCQ efficacy on lung and intestine injuries induced by influenza A virus as well as to identify the main active components through integrated network pharmacology, intestinal flora analysis and pathway validation. MATERIALS AND METHODS The potential active components and therapeutic targets of XBCQ in the treatment of influenza were hypothesized through a series of network pharmacological strategies, including components screening, targets prediction and bioinformatics analysis. Inflammatory cytokines and pathway proteins were assayed to validate the results of network pharmacology. Then the mechanism of XBCQ alleviating lung and intestine injuries was further explored via intestinal flora analysis. The important role of Rhubarb in the formula was verified by removing Rhubarb. RESULTS XBCQ could significantly improve the survival rate in IAV-infected mice. The network pharmacology results demonstrated that JUN, mitogen-activated protein kinase (MAPK), and tumor necrosis factor (TNF) are the key targets of XBCQ that can be useful in influenza treatment as it contains the core components luteolin, emodin, and aloe-emodin, which are related to the pathways of TNF, T-cell receptor (TCR), and NF-κB. Verification experiments demonstrated that XBCQ could significantly alleviate the immune injury of the lungs and the gut of the mice, which is attributable to the inhibition of the release of inflammatory cytokines (such as TNF-α, IL-6, and IL-1β), the downregulation of the protein expression levels of Toll-like receptors-7 (TLR7), MyD88, and p-NF-κB65, and the reduction in the relative abundance of Enterobacteriaceae and Proteus, while an increase in that of Firmicutes and Lachnospiraceae. The overall protective role of XBCQ contributing to the treatment of the lungs and the gut was impaired when Rhubarb was removed from XBCQ. CONCLUSIONS Our results suggest that the efficacy of XBCQ is related to the inhibition of the immune injury and remodeling of the intestinal flora, wherein Rhubarb plays an important role, which cumulatively provide the evidence applicable for the treatment of viral pneumonia induced by a different respiratory virus with XBCQ.
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Affiliation(s)
- Jinlin Huo
- Preclinical Medicine College, Shanghai University of Traditional Chinese Medicine, 1200# Cailun Rd., Pudong District, Shanghai, 201203, PR China
| | - Ting Wang
- Department of Biological Medicines, Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Bokai Wei
- Preclinical Medicine College, Shanghai University of Traditional Chinese Medicine, 1200# Cailun Rd., Pudong District, Shanghai, 201203, PR China
| | - Xunlong Shi
- Department of Biological Medicines, Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China
| | - Aidong Yang
- Preclinical Medicine College, Shanghai University of Traditional Chinese Medicine, 1200# Cailun Rd., Pudong District, Shanghai, 201203, PR China
| | - Daofeng Chen
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China.
| | - Jing Hu
- Preclinical Medicine College, Shanghai University of Traditional Chinese Medicine, 1200# Cailun Rd., Pudong District, Shanghai, 201203, PR China.
| | - Haiyan Zhu
- Department of Biological Medicines, Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728# Jinke Rd., Pudong District, Shanghai, 201203, PR China.
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24
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Lyons PG, Bhavani SV, Mody A, Bewley A, Dittman K, Doyle A, Windham SL, Patel TM, Raju BN, Keller M, Churpek MM, Calfee CS, Michelson AP, Kannampallil T, Geng EH, Sinha P. Hospital trajectories and early predictors of clinical outcomes differ between SARS-CoV-2 and influenza pneumonia. EBioMedicine 2022; 85:104295. [PMID: 36202054 PMCID: PMC9527494 DOI: 10.1016/j.ebiom.2022.104295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/27/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A comparison of pneumonias due to SARS-CoV-2 and influenza, in terms of clinical course and predictors of outcomes, might inform prognosis and resource management. We aimed to compare clinical course and outcome predictors in SARS-CoV-2 and influenza pneumonia using multi-state modelling and supervised machine learning on clinical data among hospitalised patients. METHODS This multicenter retrospective cohort study of patients hospitalised with SARS-CoV-2 (March-December 2020) or influenza (Jan 2015-March 2020) pneumonia had the composite of hospital mortality and hospice discharge as the primary outcome. Multi-state models compared differences in oxygenation/ventilatory utilisation between pneumonias longitudinally throughout hospitalisation. Differences in predictors of outcome were modelled using supervised machine learning classifiers. FINDINGS Among 2,529 hospitalisations with SARS-CoV-2 and 2,256 with influenza pneumonia, the primary outcome occurred in 21% and 9%, respectively. Multi-state models differentiated oxygen requirement progression between viruses, with SARS-CoV-2 manifesting rapidly-escalating early hypoxemia. Highly contributory classifier variables for the primary outcome differed substantially between viruses. INTERPRETATION SARS-CoV-2 and influenza pneumonia differ in presentation, hospital course, and outcome predictors. These pathogen-specific differential responses in viral pneumonias suggest distinct management approaches should be investigated. FUNDING This project was supported by NIH/NCATS UL1 TR002345, NIH/NCATS KL2 TR002346 (PGL), the Doris Duke Charitable Foundation grant 2015215 (PGL), NIH/NHLBI R35 HL140026 (CSC), and a Big Ideas Award from the BJC HealthCare and Washington University School of Medicine Healthcare Innovation Lab and NIH/NIGMS R35 GM142992 (PS).
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Affiliation(s)
- Patrick G. Lyons
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States,Healthcare Innovation Lab, BJC HealthCare, St. Louis, MO, United States,Corresponding author at: Washington University School of Medicine, 660 South Euclid Avenue, MSC 8052-43-14, St. Louis, MO 63110, United States.
| | | | - Aaloke Mody
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Alice Bewley
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Katherine Dittman
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Aisling Doyle
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Samuel L. Windham
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Tej M. Patel
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Bharat Neelam Raju
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew Keller
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew M. Churpek
- Department of Medicine, University of Wisconsin School of Medicine, Madison, WI, United States
| | - Carolyn S. Calfee
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, CA, United States
| | - Andrew P. Michelson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States,Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States
| | - Thomas Kannampallil
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States,Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Elvin H. Geng
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Pratik Sinha
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
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25
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Schmandt M, Putensen C, Stiehl T, Wagenpfeil J, Schewe JC, Ehrentraut SF. Be Patient: Prolonged Extracorporeal Membrane Oxygenation Support Including Full System Switch With Favorable Outcome. J Med Cases 2022; 13:483-490. [PMID: 36407859 PMCID: PMC9635769 DOI: 10.14740/jmc3979] [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] [Received: 07/03/2022] [Accepted: 09/21/2022] [Indexed: 01/25/2023] Open
Abstract
Despite tremendous advances in treatment, acute respiratory distress syndrome (ARDS) remains a disease with high mortality (42-48%). Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is often used as a last treatment option, which poses complex problems for the treatment team, especially with prolonged ECMO support. We report an interesting case of a 40-year-old female patient who developed influenza pneumonia leading to ARDS and subsequently requiring ECMO. Due to severe clotting complications, a prolonged ECMO run time with numerous filter changes was required. After a total of 56 days of ECMO therapy, the patient was successfully weaned. Fortunately, further in the course of treatment, complete recovery with restitutio ad integrum was achieved. A distinguishing feature of this case report is the description of a complete ECMO system change and the concurrent use of two ECMO systems for the same patient. Additionally, we provide data on the patient's current health-related quality of life as measured using the World Health Organization Disability Assessment Schedule 2.0.
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Affiliation(s)
- Mathias Schmandt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany,Corresponding Author: Mathias Schmandt, Department of Anesthesiology and Intensive Care Medicine, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Tatjana Stiehl
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Julia Wagenpfeil
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Jens-Christian Schewe
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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26
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Hsu CH, Chen HP, Chen PL, Chan YJ. Detection of influenza and non-influenza respiratory viruses in lower respiratory tract specimens among hospitalized adult patients and analysis of the clinical outcome. J Microbiol Immunol Infect 2022; 55:820-828. [PMID: 34974992 DOI: 10.1016/j.jmii.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is one of the most fatal diseases for adults. Influenza is a well-recognized cause of severe pneumonia; however, the outcomes of LRTI caused by non-influenza respiratory viruses (NIRVs) have not been sufficiently investigated. This study aimed to describe the characteristics and outcomes of LRTI associated with respiratory viruses (RVs) in adults. MATERIALS/METHODS A retrospective review was performed using medical records of adult patients whose lower respiratory tract (LRT) specimens (endotracheal aspirate and bronchoalveolar lavage fluid) tested positive for RVs using multiplex PCR. Underlying comorbidities, laboratory data, and clinical outcomes were analyzed. RESULTS Among the 808 LRT specimens collected from 666 adult patients, RV was identified in 115 specimens (14%) from 106 patients (16%). The underlying comorbidities and laboratory data did not differ between patients with influenza- and NIRV-related LRTI. The 14-day and 30-day mortality rates were higher in the influenza group than in the NIRV group (24% versus 7%, p = 0.03 and 33% versus 13%, p = 0.02, respectively), whereas the 90-day mortality rate did not. In a multivariate Cox model to predict 90-day mortality, shock and acute kidney injury independently predicted a higher mortality rate (hazard ratio (HR): 4.28, 95% CI: 1.46-12.58, p = 0.01 and HR: 2.80, 95% CI: 1.28-6.15, p = 0.01, respectively), whereas the detection of influenza did not. CONCLUSIONS Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians.
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Affiliation(s)
- Ching-Hao Hsu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Pai Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Po-Liang Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jiun Chan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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27
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Shi C, Zhou L, Li H, Shi X, Zhang Y, Lu Y, Zhu H, Chen D. Intestinal microbiota metabolizing Houttuynia cordata polysaccharides in H1N1 induced pneumonia mice contributed to Th17/Treg rebalance in gut-lung axis. Int J Biol Macromol 2022; 221:288-302. [PMID: 36084869 DOI: 10.1016/j.ijbiomac.2022.09.015] [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] [Received: 02/18/2022] [Revised: 08/26/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022]
Abstract
Influenza A virus is intricately linked to dysregulation of gut microbiota and host immunity. Previous study revealed that Houttuynia cordata polysaccharides (HCP) exert the therapeutic effect on influenza A virus inducing lung and intestine damage via regulating pulmonary and intestinal mucosal immunity. However, whether this result was due to the regulation of gut microbiota in the gut-lung axis remains unclear. Here, we firstly found that the elimination of gut microbiota using antibiotic cocktails led to both loss of the protective effect of HCP on intestine and lung injury, and reduction of the efficacy on regulating Th17/Treg balance in gut-lung axis. Fecal microbiota transplantation study confirmed that the gut microbiota fermented with HCP under pathological conditions (H1N1 infection) was responsible for reducing pulmonary and intestinal injury. Moreover, the interaction of HCP and gut microbiota under pathological conditions exhibited not only much more abundant gut microbial diversity, but also higher content of the acetate. Our results demonstrated that the underlying mechanism to ameliorate viral pneumonia in mice involving Th17/Treg rebalance via the gut microbiota and HCP metabolite (acetate) metabolized in pneumonia mice. Our results provided a new insight for macromolecular polysaccharides through targeting intestinal microenvironment reducing distant pulmonary infection.
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Affiliation(s)
- Chenchen Shi
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China
| | - Lishuang Zhou
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China
| | - Hong Li
- Department of Pharmacology, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China
| | - Xunlong Shi
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China
| | - Yunyi Zhang
- Department of Pharmacology, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China
| | - Yan Lu
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China
| | - Haiyan Zhu
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China.
| | - Daofeng Chen
- Department of Natural Medicine, School of Pharmacy, Fudan University, 3728 Jinke Road, Shanghai, China.
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28
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Tatlisuluoglu D, Alay GH, Bulut K, Demir NS, Turan G. Is there a relationship between the intensive care scores of patients and depression and anxiety? Braz J Psychiatry 2022; 45:112-116. [PMID: 36095160 PMCID: PMC10154019 DOI: 10.47626/1516-4446-2022-2700] [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] [Received: 05/21/2022] [Accepted: 07/16/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Coronaviruses that cause respiratory infections in people are known to be neuropathogenic. The purpose of this study is to determine whether there is an association between the severity of viral pneumonia and the anxiety and depression levels of patients in the intensive care unit (ICU). MATERIAL AND METHODS 165 patients were included in the study prospectively, and 70 patients were intubated at follow-up. According to the intubation status, the patients were divided into two groups: intubated and non-intubated. RESULTS The GAD-7 score was 10.37±3.75 (p<0.001) in patients who were intubated after the first 7 days. The length of stay in the ICU was 25±22.3/day (p<0.001), and the length of stay in the hospital was 28.28±23.37/day, which was longer than those who were not intubated (p<0.001). APACHE and SOFA scores, as well as GAD-7 and PHQ-9, were found to be positively related to ICU and hospital length of stay (p<0.01). CONCLUSION The presence and exacerbation of anxiety and depression symptoms can provide information about the aggravation and progression of the underlying disease.
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Affiliation(s)
- Derya Tatlisuluoglu
- Department of Intesive Care Unit, Basaksehir Cam and Sakura Education and Research City Hospital, Istanbul, Turkey
| | - Gulcin Hilal Alay
- Department of Intesive Care Unit, Basaksehir Cam and Sakura Education and Research City Hospital, Istanbul, Turkey
| | - Kadir Bulut
- Department of Intesive Care Unit, Basaksehir Cam and Sakura Education and Research City Hospital, Istanbul, Turkey
| | - Nuriye Selin Demir
- Department of Intesive Care Unit, Basaksehir Cam and Sakura Education and Research City Hospital, Istanbul, Turkey
| | - Guldem Turan
- Department of Intesive Care Unit, Basaksehir Cam and Sakura Education and Research City Hospital, Istanbul, Turkey
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Campelo FS, de Aguiar Cordeiro R, Moura FEA. The role of human bocavirus as an agent of community-acquired pneumonia in children under 5 years of age in Fortaleza, Ceará (Northeast Brazil). Braz J Microbiol 2022; 53:1915-1924. [PMID: 35933553 PMCID: PMC9679084 DOI: 10.1007/s42770-022-00806-1] [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] [Received: 04/25/2022] [Accepted: 07/21/2022] [Indexed: 01/13/2023] Open
Abstract
The human bocavirus (HBoV) is an agent of upper and lower respiratory infections, affecting mainly children under 5 years of age. Community-acquired pneumonia (CAP) is an important public health problem in developing countries, representing one of the main causes of hospitalizations and deaths in children. The aim of this study was to describe the prevalence of HBoV and the clinical and epidemiological characteristics in children diagnosed with CAP. For this purpose, nasopharyngeal aspirates were collected from 545 children aged 0 to 60 months diagnosed with CAP between January 2013 and December 2014 in a reference pediatric hospital in Fortaleza, Ceará, Brazil. The samples were subjected to PCR for detection of HBoV and parainfluenza 4 (PIV4) and indirect immunofluorescence for detection of respiratory syncytial virus (RSV), adenovirus (AdV), influenza A and B (FLU A and FLU B), and parainfluenza 1, 2, and 3 (PIV1, PIV2, PIV3). Clinically, most CAP were non-complicated (487/545; 89.3%); however, 10.7% (58/545) of children were treated in the ICU/resuscitation sector. Among the total samples analyzed, 359 (65.8%) were positive for at least one virus surveyed and 105 (19.2%) samples had two or more viruses. HBoV was detected in 87 samples (15.9%), being the second most prevalent virus. RSV, AdV, FLU A, FLU B, and PIV 1-3 were detected in 150 (27.5%), 45 (8.2%), 30 (5.5%), 3 (0.5%), and 131 (24%) samples, respectively. The age average was 12.1 months in children infected with HBoV, and the most frequent symptoms were dyspnea and cough. In addition, 90.6% of HboV-positive children received antibiotics as empirical treatment. HBoV did not show any circulation pattern; however, it seemed to be more frequent in the first half of the year, totaling 68.9% of the cases. HBoV is a frequent agent of pneumonia in the child population studied.
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Affiliation(s)
- Felipe Serra Campelo
- Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Brazil
| | - Rossana de Aguiar Cordeiro
- Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Brazil ,Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Brazil
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Mahfuz A, Khan MA, Sajib EH, Deb A, Mahmud S, Hasan M, Saha O, Islam A, Rahaman MM. Designing potential siRNA molecules for silencing the gene of the nucleocapsid protein of Nipah virus: A computational investigation. Infect Genet Evol 2022; 102:105310. [PMID: 35636695 DOI: 10.1016/j.meegid.2022.105310] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Nipah virus (NiV), a zoonotic virus, engenders severe infections with noticeable complications and deaths in humans and animals. Since its emergence, it is frightening, this virus has been causing regular outbreaks in various countries, particularly in Bangladesh, India, and Malaysia. Unfortunately, no efficient vaccine or drug is available now to combat this baneful virus. NiV employs its nucleocapsid protein for genetic material packaging, which is crucial for viral replication inside the host cells. The small interfering RNAs (siRNAs) can play a central role in inhibiting the expression of disease-causing viral genes by hybridization and subsequent inactivation of the complementary target viral mRNAs through the RNA interference (RNAi) pathway. Therefore, potential siRNAs as molecular therapeutics against the nucleocapsid protein gene of NiV were designed in this study. First, ten prospective siRNAs were identified using the conserved nucleocapsid gene sequences among all available NiV strains collected from various countries. After that, off-target binding, GC (guanine-cytosine) content, secondary structure, binding affinity with the target, melting temperature, efficacy analysis, and binding capacity with the human argonaute protein 2 (AGO2) of these siRNAs were evaluated to predict their suitability. These designed siRNA molecules bear promise in silencing the NiV gene encoding the nucleocapsid protein and thus can alleviate the severity of this dangerous virus. Further in vivo experiments are recommended before using these designed siRNAs as alternative and effective molecular therapeutic agents against NiV.
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Affiliation(s)
- Amub Mahfuz
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Dhaka 1209, Bangladesh
| | - Md Arif Khan
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Dhaka 1209, Bangladesh; Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh.
| | - Emran Hossain Sajib
- Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Anamika Deb
- Department of Pharmaceuticals and Industrial Biotechnology, Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Shafi Mahmud
- Microbiology Laboratory, Bioinformatics Division, Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Mahmudul Hasan
- Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet 3100, Bangladesh; Department of Pharmaceuticals and Industrial Biotechnology, Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Otun Saha
- Department of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Ariful Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh; EcoHealth Alliance, New York, NY 10018, USA
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Sánchez-Montalvá A, Sellarés-Nadal J, Espinosa-Pereiro J, Fernández-Hidalgo N, Pérez-Hoyos S, Salvador F, Durà X, Miarons M, Antón A, Eremiev-Eremiev S, Sempere-González A, Monforte-Pallarés A, Bosch-Nicolau P, Augustin S, Sampol J, Guillén-del-Castillo A, Almirante B. Early outcomes in adults hospitalized with severe SARS-CoV-2 infection receiving tocilizumab. Med Clin (Barc) 2022; 158:509-518. [PMID: 34544604 PMCID: PMC8448395 DOI: 10.1016/j.medcli.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/20/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Modulation of the immune system to prevent lung injury is being widely used against the new coronavirus disease (COVID-19). The primary endpoint was mortality at 7 days after tocilizumab administration. Secondary endpoints were admission to the intensive care unit, development of ARDS and respiratory insufficiency among others. METHODS We report the preliminary results from the Vall d'Hebron cohort study at Vall d'Hebron University Hospital, in Barcelona (Spain), including all consecutive patients who had a confirmed SARS-CoV-2 infection and who were treated with tocilizumab until March 25th. RESULTS 82 patients with COVID-19 received at least one dose of tocilizumab. The mean (± SD) age was 59.1 (19.8) years, 63% were male, 22% were of non-Spanish ancestry, and the median (IQR) age-adjusted Charlson index at baseline was 3 (1-4) points. Respiratory failure and ARDS developed in 62 (75.6%) and 45 (54.9%) patients, respectively. Median time from symptom onset to ARDS development was 8 (5-11) days. Mortality at 7 days was 26.8%. Hazard ratio for mortality was 3.3; 95% CI, 1.3-8.5 (age-adjusted hazard ratio for mortality 2.1; 95% CI, 0.8-5.8) if tocilizumab was administered after the onset of ARDS. CONCLUSION Early administration of tocilizumab in patients needing oxygen supplementation may be critical to patient recovery. Our preliminary data could inform bedside decisions until more data regarding the precise timing in of initiation of the treatment with tocilizumab.
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Affiliation(s)
- Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain,Tropical Medicine Spanish Research Network (RICET), Madrid, Spain,Corresponding author
| | - Júlia Sellarés-Nadal
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,Infectous Diseases Spanish Research Network (REIPI), Madrid, Spain
| | | | - Fernando Salvador
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain,Tropical Medicine Spanish Research Network (RICET), Madrid, Spain
| | - Xavier Durà
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés Antón
- Infectous Diseases Spanish Research Network (REIPI), Madrid, Spain,Microbiology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Simeón Eremiev-Eremiev
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Abiu Sempere-González
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Monforte-Pallarés
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador Augustin
- Hepatology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Júlia Sampol
- Pneumology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alfredo Guillén-del-Castillo
- Internal Medicine Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,Infectous Diseases Spanish Research Network (REIPI), Madrid, Spain
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Abstract
The COVID-19 pandemic has drawn considerable attention to viral pneumonia from clinicians, public health authorities, and the general public. With dozens of viruses able to cause pneumonia in humans, differentiating viral from bacterial pneumonia can be very challenging in clinical practice using traditional diagnostic methods. Precision medicine is a medical model in which decisions, practices, interventions, and therapies are adapted to the individual patient on the basis of their predicted response or risk of disease. Precision medicine approaches hold promise as a way to improve outcomes for patients with viral pneumonia. This review describes the latest advances in the use of precision medicine for diagnosing and treating viral pneumonia in adults and discusses areas where further research is warranted.
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Affiliation(s)
- Richard R Watkins
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
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Refay ASE, Shehata MA, Sherif LS, Nady HGE, Kholoussi N, Kholoussi S, Baroudy NRE, Gomma MR, Mahmoud SH, Shama NMA, Bagato O, Taweel AE, kandeil A, Ali MA. Prevalence of viral pathogens in a sample of hospitalized Egyptian children with acute lower respiratory tract infections: a two-year prospective study. Bull Natl Res Cent 2022; 46:103. [PMID: 35431533 PMCID: PMC9006499 DOI: 10.1186/s42269-022-00790-4] [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] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Viral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children. RESULTS This prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza-3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus. CONCLUSIONS Viral infection is prevalent in the childhood period; however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses.
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Affiliation(s)
- Amira S. El Refay
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Manal A. Shehata
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Lobna S. Sherif
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Hala G. El Nady
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Naglaa Kholoussi
- Immunogenetics Department, National Research Centre, Dokki, Egypt
| | - Shams Kholoussi
- Immunogenetics Department, National Research Centre, Dokki, Egypt
| | | | - Mokhtar R. Gomma
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Sara H. Mahmoud
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Noura M. Abo Shama
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Ola Bagato
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Ahmed El Taweel
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Ahmed kandeil
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Mohamed A. Ali
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
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Krishnan A, Muthusamy S, Fernandez FB, Kasoju N. Mesenchymal Stem Cell-Derived Extracellular Vesicles in the Management of COVID19-Associated Lung Injury: A Review on Publications, Clinical Trials and Patent Landscape. Tissue Eng Regen Med 2022. [PMID: 35384633 DOI: 10.1007/s13770-022-00441-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/02/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 02/07/2023] Open
Abstract
The unprecedented COVID-19 pandemic situation forced the scientific community to explore all the possibilities from various fields, and so far we have seen a lot of surprises, eureka moments and disappointments. One of the approaches from the cellular therapists was exploiting the immunomodulatory and regenerative potential of mesenchymal stromal cells (MSCs), more so of MSC-derived extracellular vesicles (EVs)—particularly exosomes, in order to alleviate the cytokine storm and regenerate the damaged lung tissues. Unlike MSCs, the EVs are easier to store, deliver, and are previously shown to be as effective as MSCs, yet less immunogenic. These features attracted the attention of many and thus led to a tremendous increase in publications, clinical trials and patent applications. This review presents the current landscape of the field and highlights some interesting findings on MSC-derived EVs in the context of COVID-19, including in silico, in vitro, in vivo and case reports. The data strongly suggests the potential of MSC-derived EVs as a therapeutic regime for the management of acute lung injury and associated complications in COVID-19 and beyond.
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Poletti J, Bach M, Yang S, Sexauer R, Stieltjes B, Rotzinger DC, Bremerich J, Walter Sauter A, Weikert T. Automated lung vessel segmentation reveals blood vessel volume redistribution in viral pneumonia. Eur J Radiol 2022; 150:110259. [PMID: 35334245 DOI: 10.1016/j.ejrad.2022.110259] [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] [Received: 09/17/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE It is known from histology studies that lung vessels are affected in viral pneumonia. However, their diagnostic potential as a chest CT imaging parameter has only rarely been exploited. The purpose of this study is to develop a robust method for automated lung vessel segmentation and morphology analysis and apply it to a large chest CT dataset. METHODS In total, 509 non-enhanced chest CTs (NECTs) and 563 CT pulmonary angiograms (CTPAs) were included. Sub-groups were patients with healthy lungs (group_NORM, n = 634) and those RT-PCR-positive for Influenza A/B (group_INF, n = 159) and SARS-CoV-2 (group_COV, n = 279). A lung vessel segmentation algorithm (LVSA) based on traditional image processing was developed, validated with a point-of-interest approach, and applied to a large clinical dataset. Total blood vessel volume in lung (TBV) and the blood vessel volume percentage (BV%) of three blood vessel size types were calculated and compared between groups: small (BV5%, cross-sectional area < 5 mm2), medium (BV5-10%, 5-10 mm2) and large (BV10%, >10 mm2). RESULTS Sensitivity of the LVSA was 84.6% (95 %CI: 73.9-95.3) for NECTs and 92.8% (95 %CI: 90.8-94.7) for CTPAs. In viral pneumonia, besides an increased TBV, the main finding was a significantly decreased BV5% in group_COV (n = 14%) and group_INF (n = 15%) compared to group_NORM (n = 18%) [p < 0.001]. At the same time, BV10% was increased (group_COV n = 15% and group_INF n = 14% vs. group_NORM n = 11%; p < 0.001). CONCLUSION In COVID-19 and Influenza, the blood vessel volume is redistributed from small to large vessels in the lung. Automated LSVA allows researchers and clinicians to derive imaging parameters for large amounts of CTs. This can enhance the understanding of vascular changes, particularly in infectious lung diseases.
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Affiliation(s)
- Julien Poletti
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Michael Bach
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Shan Yang
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Raphael Sexauer
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Bram Stieltjes
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Alexander Walter Sauter
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Thomas Weikert
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Abstract
Recognition of COVID-19 is a challenging task which consistently requires taking a gander at clinical images of patients. In this paper, the transfer learning technique has been applied to clinical images of different types of pulmonary diseases, including COVID-19. It is found that COVID-19 is very much similar to pneumonia lung disease. Further findings are made to identify the type of pneumonia similar to COVID-19. Transfer Learning makes it possible for us to find out that viral pneumonia is same as COVID-19. This shows the knowledge gained by model trained for detecting viral pneumonia can be transferred for identifying COVID-19. Transfer Learning shows significant difference in results when compared with the outcome from conventional classifications. It is obvious that we need not create separate model for classifying COVID-19 as done by conventional classifications. This makes the herculean work easier by using existing model for determining COVID-19. Second, it is difficult to detect the abnormal features from images due to the noise impedance from lesions and tissues. For this reason, texture feature extraction is accomplished using Haralick features which focus only on the area of interest to detect COVID-19 using statistical analyses. Hence, there is a need to propose a model to predict the COVID-19 cases at the earliest possible to control the spread of disease. We propose a transfer learning model to quicken the prediction process and assist the medical professionals. The proposed model outperforms the other existing models. This makes the time-consuming process easier and faster for radiologists and this reduces the spread of virus and save lives.
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Sheikh D, Tripathi N, Chandler TR, Furmanek S, Bordon J, Ramirez JA, Cavallazzi R. Clinical outcomes in patients with COPD hospitalized with SARS-CoV-2 versus non- SARS-CoV-2 community-acquired pneumonia. Respir Med 2021; 191:106714. [PMID: 34915396 PMCID: PMC8654722 DOI: 10.1016/j.rmed.2021.106714] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022]
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have poor outcomes in the setting of community-acquired pneumonia (CAP) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary objective is to compare outcomes of SARS-CoV-2 CAP and non-SARS-CoV-2 CAP in patients with COPD. The secondary objective is to compare outcomes of SARS-CoV-2 CAP with and without COPD. Methods In this analysis of two observational studies, three cohorts were analyzed: (1) patients with COPD and SARS-CoV-2 CAP; (2) patients with COPD and non-SARS-CoV-2 CAP; and (3) patients with SARS-CoV-2 CAP without COPD. Outcomes included length of stay, ICU admission, cardiac events, and in-hospital mortality. Results Ninety-six patients with COPD and SARS-CoV-2 CAP were compared to 1129 patients with COPD and non-SARS-CoV-2 CAP. 536 patients without COPD and SARS-CoV-2 CAP were analyzed for the secondary objective. Patients with COPD and SARS-CoV-2 CAP had longer hospital stay (15 vs 5 days, p < 0.001), 4.98 higher odds of cardiac events (95% CI: 3.74–6.69), and 7.31 higher odds of death (95% CI: 5.36–10.12) in comparison to patients with COPD and non-SARS-CoV-2 CAP. In patients with SARS-CoV-2 CAP, presence of COPD was associated with 1.74 (95% CI: 1.39–2.19) higher odds of ICU admission and 1.47 (95% CI: 1.05–2.05) higher odds of death. Conclusion In patients with COPD and CAP, presence of SARS-CoV-2 as an etiologic agent is associated with more cardiovascular events, longer hospital stay, and seven-fold increase in mortality. In patients with SARS-CoV-2 CAP, presence of COPD is associated with 1.5-fold increase in mortality.
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Affiliation(s)
- Daniya Sheikh
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
| | - Nishita Tripathi
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Thomas R Chandler
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Stephen Furmanek
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Jose Bordon
- Washington Health Institute, George Washington University, Washington, DC, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine and Sleep Disorders, University of Louisville, Louisville, KY, USA
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Battisti S, Napoli N, Pedone C, Lombardi M, Leanza G, Tramontana F, Faraj M, Agnoletti V, Verna M, Viola L, Giampalma E, Strollo R. Vertebral fractures and mortality risk in hospitalised patients during the COVID-19 pandemic emergency. Endocrine 2021; 74:461-469. [PMID: 34529239 PMCID: PMC8444515 DOI: 10.1007/s12020-021-02872-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Bone fragility has been linked to COVID-19 severity. The objective of this study was to evaluate whether a diagnosis of vertebral fracture (VF) increased mortality risk in COVID-19 patients and whether this effect was greater than in those without COVID-19. METHODS We assessed VFs by computed tomography (CT) in a cohort of 501 patients consecutively admitted to the emergency department (ED) for clinical suspicion of SARS-CoV-2 infection during the first wave of pandemic emergency. Of those, 239 had a confirmed diagnosis of COVID-19. RESULTS VF prevalence was similar between COVID-19 and non-COVID-19 groups (22.2 vs. 19%; p = 0.458). Death rates were similar between COVID-19 and non-COVID-19 groups at both 30 (15.8 vs. 12.2%; p = 0.234) and 120 days (21.8 vs. 17.6%; p = 0.236). The mortality risk was higher in COVID-19 patients either with one or multiple fractures compared to those without VFs, at 30 and 120 days, but statistical significance was reached only in those with multiple VFs (30-day HR 3.03, 95% CI 1.36-6.75; 120-day HR 2.91, 95% CI 1.43-5.91). In the non-COVID-19 group, the 30-day mortality risk was significantly higher in patients either with one (HR 7.46, 95% CI 3.12-17.8) or multiple fractures (HR 6.2, 95% CI 2.75-13.98) compared to those without VFs. A similar effect was observed at 120 days. After adjustment for age, sex and bone density, mortality risk remained associated with VFs in the non-COVID-19 group only. CONCLUSIONS VFs were not independently associated with short-term mortality in patients with COVID-19, but they strongly increased mortality risk in those without COVID-19.
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Affiliation(s)
- Sofia Battisti
- Radiology Department, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
- Radiology Unit, Scientific Institute of Romagna for the Study and Treatment of Tumors (IRST) IRCCS, Meldola, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum-Università di Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA
| | - Claudio Pedone
- Department of Medicine, Unit of Geriatrics, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Giulia Leanza
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Flavia Tramontana
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Malak Faraj
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Martina Verna
- Radiology Department, ASST Mantova "Carlo Poma" Hospital, Mantova, Italy
| | - Lorenzo Viola
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | | | - Rocky Strollo
- Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Rome, Italy.
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Manolis AS, Manolis AA, Manolis TA, Apostolaki NE, Melita H. COVID-19 infection and body weight: A deleterious liaison in a J-curve relationship. Obes Res Clin Pract 2021; 15:523-535. [PMID: 34799284 PMCID: PMC8563353 DOI: 10.1016/j.orcp.2021.10.006] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 10/10/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023]
Abstract
During the course of the COVID-19 pandemic, obesity has been shown to be an independent risk factor for high morbidity and mortality. Obesity confers poor outcomes in younger (<60 years) patients, an age-group considered low-risk for complications, a privilege that is negated by obesity. Findings are consistent, the higher the body mass index (BMI) the worse the outcomes. Ectopic (visceral) obesity also promotes proinflammatory, prothrombotic, and vasoconstrictive states, thus enhancing the deleterious effects of COVID-19 disease. Less, albeit robust, evidence also exists for a higher risk of COVID-19 infection incurred with underweight. Thus, the relationship of COVID-19 and BMI has a J-curve pattern, where patients with both overweight/obesity and underweight are more susceptible to the ailments of COVID-19. The pathophysiology underlying this link is multifactorial, mostly relating to the inflammatory state characterizing obesity, the impaired immune response to infectious agents coupled with increased viral load, the overexpression in adipose tissue of the receptors and proteases for viral entry, an increased sympathetic activity, limited cardiorespiratory reserve, a prothrombotic milieu, and the associated comorbidities. All these issues are herein reviewed, the results of large studies and meta-analyses are tabulated and the pathogenetic mechanisms and the BMI relationship with COVID-19 are pictorially illustrated.
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Safaee Fakhr B, Di Fenza R, Gianni S, Wiegand SB, Miyazaki Y, Araujo Morais CC, Gibson LE, Chang MG, Mueller AL, Rodriguez-Lopez JM, Ackman JB, Arora P, Scott LK, Bloch DB, Zapol WM, Carroll RW, Ichinose F, Berra L. Inhaled high dose nitric oxide is a safe and effective respiratory treatment in spontaneous breathing hospitalized patients with COVID-19 pneumonia. Nitric Oxide 2021; 116:7-13. [PMID: 34400339 PMCID: PMC8361002 DOI: 10.1016/j.niox.2021.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/19/2021] [Revised: 06/21/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inhaled nitric oxide (NO) is a selective pulmonary vasodilator. In-vitro studies report that NO donors can inhibit replication of SARS-CoV-2. This multicenter study evaluated the feasibility and effects of high-dose inhaled NO in non-intubated spontaneously breathing patients with Coronavirus disease-2019 (COVID-19). METHODS This is an interventional study to determine whether NO at 160 parts-per-million (ppm) inhaled for 30 min twice daily might be beneficial and safe in non-intubated COVID-19 patients. RESULTS Twenty-nine COVID-19 patients received a total of 217 intermittent inhaled NO treatments for 30 min at 160 ppm between March and June 2020. Breathing NO acutely decreased the respiratory rate of tachypneic patients and improved oxygenation in hypoxemic patients. The maximum level of nitrogen dioxide delivered was 1.5 ppm. The maximum level of methemoglobin (MetHb) during the treatments was 4.7%. MetHb decreased in all patients 5 min after discontinuing NO administration. No adverse events during treatment, such as hypoxemia, hypotension, or acute kidney injury during hospitalization occurred. In our NO treated patients, one patient of 29 underwent intubation and mechanical ventilation, and none died. The median hospital length of stay was 6 days [interquartile range 4-8]. No discharged patients required hospital readmission nor developed COVID-19 related long-term sequelae within 28 days of follow-up. CONCLUSIONS In spontaneous breathing patients with COVID-19, the administration of inhaled NO at 160 ppm for 30 min twice daily promptly improved the respiratory rate of tachypneic patients and systemic oxygenation of hypoxemic patients. No adverse events were observed. None of the subjects was readmitted or had long-term COVID-19 sequelae.
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Affiliation(s)
- Bijan Safaee Fakhr
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Raffaele Di Fenza
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Stefano Gianni
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Steffen B Wiegand
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Yusuke Miyazaki
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Caio C Araujo Morais
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Lauren E Gibson
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Marvin G Chang
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Ariel L Mueller
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Josanna M Rodriguez-Lopez
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Jeanne B Ackman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Tinsley Harrison Tower, Suite 311, 1900 University Boulevard, Birmingham, AL, 35233, USA
| | - Louie K Scott
- Critical Care Medicine, Department of Medicine, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Donald B Bloch
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Center for Immunology and Inflammatory Diseases and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Warren M Zapol
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Ryan W Carroll
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Fumito Ichinose
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Lorenzo Berra
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Respiratory Care Services, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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Yu W, Zeng M, Xu P, Liu J, Wang H. Effect of paeoniflorin on acute lung injury induced by influenza A virus in mice. Evidences of its mechanism of action. Phytomedicine 2021; 92:153724. [PMID: 34509953 DOI: 10.1016/j.phymed.2021.153724] [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] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Influenza often leads to acute lung injury (ALI). Few therapeutics options such as vaccines and other antiviral drugs are available. Paeoniflorin is a monoterpene glucoside isolated from the roots of Paeonia lactiflora Pall. that has showed good anti-inflammatory and anti-fibrotic effects. However, it is not known whether paeoniflorin has an effect on influenza virus-induced ALI. PURPOSE To investigative the protective effect and potential mechanism of paeoniflorin on ALI induced by influenza A virus (IAV). STUDY DESIGN AND METHODS The anti-influenza activity of paeoniflorin in vitro was investigated. Influenza virus A/FM/1/47 was intranasally infected in mice to induce ALI, and paeoniflorin (50 and 100 mg/kg) was given orally to mice during 5 days, beginning 2 h after infection. On day 6 post-infection, body and lung weights, histology and survival were observed, and the lungs were examined for viral load, cytokine and cellular pathway protein expression. RESULTS Results showed that paeoniflorin (50 and 100 mg/kg) reduced IAV-induced ALI. It reduces pulmonary oedema and improves histopathological changes in the lung, and also diminishes the accumulation of inflammatory cells in the lung. It was shown that paeoniflorin (50 and 100 mg/kg) alleviated IAV-induced ALI, as evidenced by improved survival in infected mice (40% and 50%, respectively), reduced viral titer in lung tissue, improved histological changes, and reduced lung inflammation. Paeoniflorin also improves pulmonary fibrosis by reducing the levels of pulmonary fibrotic markers (collagen type IV, alpha-smooth muscle actin, hyaluronic acid, laminin, and procollagen type III) and downregulating the expression levels of type I collagen (Col I) and type III collagen (Col III) in the lung tissues. Additionally, paeoniflorin inhibits the expression of αvβ3, TGF-β1, Smad2, NF-κB, and p38MAPK in the lung tissues. CONCLUSION The results showed that paeoniflorin (50 and 100 mg/kg) protected against IAV-induced ALI, and the underlying mechanism may be related to the reduction of pro-inflammatory cytokine production and lung collagen deposition through down-regulation of activation of αvβ3/TGF-β1 pathway in lung tissue.
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Affiliation(s)
- Wendi Yu
- Institute of Tropical Medicine, Guangzhou University of Chinese Medicine, 12 Jichang Rd., San Yuanli St., Bai Yun Dist., Guangzhou, Guangdong 510405, PR China
| | - Maosen Zeng
- Institute of Tropical Medicine, Guangzhou University of Chinese Medicine, 12 Jichang Rd., San Yuanli St., Bai Yun Dist., Guangzhou, Guangdong 510405, PR China
| | - Peiping Xu
- Institute of Tropical Medicine, Guangzhou University of Chinese Medicine, 12 Jichang Rd., San Yuanli St., Bai Yun Dist., Guangzhou, Guangdong 510405, PR China.
| | - Jinyuan Liu
- Basic Medical College, Guangzhou University of Chinese Medicine, Guangzhou, PR China.
| | - Huixian Wang
- Institute of Tropical Medicine, Guangzhou University of Chinese Medicine, 12 Jichang Rd., San Yuanli St., Bai Yun Dist., Guangzhou, Guangdong 510405, PR China
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Asalkar M, Thakkarwad S, Rumani I, Sharma N. Prevalence of Maternal Mortality and Clinical Course of Maternal Deaths in COVID-19 Pneumonia-A Cross-Sectional Study. J Obstet Gynaecol India 2021; 72:208-217. [PMID: 34629786 PMCID: PMC8492816 DOI: 10.1007/s13224-021-01545-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/06/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction After initial studies suggested that pregnant women were not at a higher risk of complications due to COVID‐19 infection. Recent investigations from Sweden and the US have indicated that pregnant and postpartum women are at increased risk of severe complications associated with COVID‐19. This study aims to find out the prevalence of maternal mortality and the clinical course of maternal mortality cases due to COVID-19 pneumonia. Methodology A cross-sectional study was conducted from May 1st, 2020, to April 30th, 2021, at Postgraduate Institute and YCM Hospital Pimpri Pune (Maharashtra), a dedicated COVID hospital during COVID pandemic. During study period, all pregnant women who were diagnosed to have COVID-19 infection by RT PCR/Rapid Antigen Test were admitted and were enrolled for the study. Aim To audit the maternal mortality due to COVID-19 infection. Primary To estimate the prevalence of maternal mortality due to COVID-19 infection in obstetric patients. Secondary To systematically study and analyze the clinical course of infection in mothers who had mortality due to COVID-19 pneumonia. Data collected in standard format regarding Demography, clinical presentation, need for ICU/HDU, CXR findings, laboratory parameters and cases with maternal mortality were studied in detail to fulfill the study objectives. Results Among 871 COVID-19 cases diagnosed during pregnancy, nine patients had maternal mortality due to covid pneumonia. There was no obvious obstetric cause for mortality in these cases. The prevalence of maternal mortality was 0.01 (1.03%). Cases with maternal mortality were mostly in 3rd Trimester (5 of 9 cases) and presented with moderate to severe illness with breathlessness and myalgia in all 9 cases, cough and fever in 7 out of 9 cases, Tachypneoa was noted in all patients. Saturation below 90 in 6 cases and below 94 in 3 cases. Chest X-ray showed bilateral lung affection in all 9 cases. Leukocytosis with raised N:L ratio was predominantly seen, thrombocytopenia noted in 5 cases and elevated levels of acute phase reactants and inflammatory markers such as CRP, S. ferritin, ESR, LDH, D-dimer and S. fibrinogen was observed. None of the study participants received vaccine for COVID-19. Conclusions COVID-19 pneumonia is an additional toll for maternal mortality. Obstetric patients in 2nd and 3rd trimester having COVID-19 infection with late presentation to hospital, moderate to severe disease (RR > 30 min), with raised inflammatory markers (N:L ratio, CRP, Ferritin, d-Dimer, etc.) at presentation, having bilateral lung affection are at risk of poor maternal outcome.
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Affiliation(s)
- Mahesh Asalkar
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, MS 411018 India
| | - Smita Thakkarwad
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, MS 411018 India
| | - Ilaaf Rumani
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, MS 411018 India
| | - Nitika Sharma
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, MS 411018 India
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Fu B, Wu Z, Huang L, Chai Z, Zheng P, Sun Q, Gu S, Xu Q, Feng H, Tang L. A comparison of demographic, epidemiological and clinical characteristics of hospital influenza-related viral pneumonia patients. BMC Infect Dis 2021; 21:1002. [PMID: 34563110 PMCID: PMC8466655 DOI: 10.1186/s12879-021-06485-x] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Through the comparison of the demographic, epidemiological, and clinical characteristics of hospital human influenza (influenza A (H1N1) pdm09, H3N2, and B)-related and hospitalized avian-origin influenza A (H7N9)-related viral pneumonia patients, find the different between them. Methods A retrospective study was conducted in hospitalized influenza-related viral pneumonia patients. Results Human influenza A-related patients in the 35–49-year-old group were more than those with B pneumonia patients (p = 0.027), and relatively less in the ≥ 65-year-old group than B pneumonia patients (p = 0.079). The proportion of comorbid condition to human influenza A pneumonia was 58%, lower than B pneumonia and H7N9 pneumonia patients (78% vs. 77.8%; p = 0.013). The proportion of invasive mechanical ventilation (IMV), lymphocytopenia, elevated lactate dehydrogenase to hospitalized human influenza A-related viral pneumonia patients was higher than B pneumonia patients (p < 0.05), but lower than H7N9 pneumonia patients (p < 0.05). In the multivariate analysis, pulmonary consolidation (odds ratio (OR): 13.67; 95% confidence interval (CI) 1.54–121.12; p = 0.019) and positive bacterial culture (sputum) (OR: 7.71; 95% CI 2.48–24.03; p < 0.001) were independently associated with IMV, while shock (OR: 13.16; 95% CI 2.06–84.07; p = 0.006), white blood cell count > 10,000/mm3 (OR: 7.22; 95% CI 1.47–35.58; p = 0.015) and positive bacterial culture(blood or sputum) (OR: 6.27; 95% CI 1.36–28.85; p = 0.018) were independently associated with death in the three types hospitalized influenza-related viral pneumonia patients. Conclusions Hospital influenza B-related viral pneumonia mainly affects the elderly and people with underlying diseases, while human influenza A pneumonia mainly affects the young adults; however, the mortality was similar. The hospitalized human influenza A-related viral pneumonia patients was severer than B pneumonia patients, but milder than H7N9 pneumonia patients. Pulmonary consolidation and positive bacterial culture (sputum) were independently associated with IMV, while shock, white blood cell count > 10,000/mm3, and positive bacterial culture (blood or sputum) were independently associated with death to three types hospitalized influenza-related viral pneumonia patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06485-x.
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Affiliation(s)
- Bin Fu
- Department of Infectious Diseases, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310007, People's Republic of China
| | - Zhengjie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Lingtong Huang
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Zhaohui Chai
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Peidong Zheng
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Qinmiao Sun
- Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Qiaomai Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Haiting Feng
- Department of Nosocomial Infection, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Lingling Tang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Shulan(Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, 310006, People's Republic of China.
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Segrelles-Calvo G, de S Araújo GR, Llopis-Pastor E, Carrillo J, Hernández-Hernández M, Rey L, Melean NR, Escribano I, Antón E, Zamarro C, García-Salmones M, Frases S. Candida spp. co-infection in COVID-19 patients with severe pneumonia: Prevalence study and associated risk factors. Respir Med 2021; 188:106619. [PMID: 34555702 PMCID: PMC8445759 DOI: 10.1016/j.rmed.2021.106619] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022]
Abstract
Background Invasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet. Objectives We aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis. Patients/methods We designed a study including patients with a confirmed diagnosis of COVID-19. Results The prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1β and Lopinavir-Ritonavir. Conclusions Results suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.
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Affiliation(s)
- Gonzalo Segrelles-Calvo
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Biomédica, Fundación Jiménez Díaz, Madrid, Spain
| | - Glauber R de S Araújo
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidad Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Javier Carrillo
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Servicio de Neumología, Hospital Universitario Infanta Elena, Madrid, Spain
| | | | - Laura Rey
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | | | - Inés Escribano
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Biomédica, Fundación Jiménez Díaz, Madrid, Spain
| | - Esther Antón
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Celia Zamarro
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Mercedes García-Salmones
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Servicio de Neumología, Hospital Universitario Infanta Elena, Madrid, Spain
| | - Susana Frases
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidad Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Salva O, Doreski PA, Giler CS, Quinodoz DC, Guzmán LG, Muñoz SE, Carrillo MN, Porta DJ, Ambasch G, Coscia E, Diaz JLT, Bueno GD, Fandi JO, Maldonado MA, Peña Chiappero LE, Fournier F, Pérez HA, Quiroga MA, Sala Mercado JA, Martínez Picco C, Beltrán MA, Argañarás LA, Ríos NM, Kalayan GI, Beltramo DM, García NH. Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program. Infect Dis Ther 2021; 10:2511-2524. [PMID: 34460083 PMCID: PMC8404026 DOI: 10.1007/s40121-021-00527-2] [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: 04/14/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Sodium ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects, with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients. METHODS NaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care (SOC) to hospitalized COVID-19 patients until oxygen saturation levels of > 94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 4 and October 31, 2020, are summarized. Results were compared with a retrospective contemporaneous control (CC) group of hospitalized COVID-19 patients with SOC alone during the same time frame from a subset of participating hospitals from Córdoba and Buenos Aires. RESULTS The evolution of 383 patients treated with SOC + NaIHS [56 on mechanical ventilation (MV) at baseline] and 195 CC (21 on MV at baseline) are summarized. At baseline, NaIHS-treated patients had basal oxygen saturation of 90.7 ± 0.2% (74.3% were on supplemental oxygen at baseline) and a basal respiratory rate of 22.7 ± 0.3 breath/min. In the CC group, basal oxygen saturation was 92.6 ± 0.4% (52.1% were on oxygen supplementation at baseline) and respiratory rate was 19.3 ± 0.3 breath/min. Despite greater pulmonary compromise at baseline in the NaIHS-treated group, the length of treatment (LOT) was 9.1 ± 0.2 gs with an average length of stay (ALOS) of 11.5 ± 0.3 days, in comparison with an ALOS of 13.3 ± 0.9 days in the CC group. In patients on MV who received NaIHS, the ALOS was lower than in the CC group. In both NaIHS-treated groups, a rapid reversal of deterioration in oxygenation and NEWS2 scores was observed acutely after initiation of NaIHS therapy. No serious adverse events were considered related to ibuprofen therapy. Mortality was lower in both NaIHS groups compared with CC groups. CONCLUSIONS Treatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS s worthy of further study in randomized, placebo-controlled trials (ClinicalTrials.gov: NCT04382768).
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Affiliation(s)
- Oscar Salva
- Clínica Independencia, Munro, Buenos Aires, Argentina
| | | | - Celia S Giler
- Clínica Independencia, Munro, Buenos Aires, Argentina
| | | | | | - Sonia E Muñoz
- Instituto de Investigaciones en Ciencias de la Salud, Ciudad Universitaria, Córdoba, Argentina
| | - Mariana N Carrillo
- Instituto de Investigaciones en Ciencias de la Salud, Ciudad Universitaria, Córdoba, Argentina
| | - Daniela J Porta
- Instituto de Investigaciones en Ciencias de la Salud, Ciudad Universitaria, Córdoba, Argentina
| | - Germán Ambasch
- Sanatorio Mayo Privado SA, Ciudad de Córdoba, Córdoba, Argentina
| | - Esteban Coscia
- Sanatorio Mayo Privado SA, Ciudad de Córdoba, Córdoba, Argentina
| | | | - Germán D Bueno
- Sanatorio Mayo Privado SA, Ciudad de Córdoba, Córdoba, Argentina
| | - Jorge O Fandi
- Clínica Independencia, Munro, Buenos Aires, Argentina
| | | | | | | | - Hernán A Pérez
- Sanatorio Alive, Ciudad de Córdoba, Córdoba, Argentina.,Department of Diagnostic Radiology and Nuclear Medicine, Center for Advanced Imaging Research, Maryland University, Baltimore, MD, USA
| | - Mauro A Quiroga
- Instituto Modelo de Cardiología, Ciudad de Córdoba, Córdoba, Argentina
| | | | | | | | | | | | - Galia I Kalayan
- CEPROCOR, Ciudad de Santa María de Punilla, Córdoba, Argentina
| | - Dante M Beltramo
- CEPROCOR, Ciudad de Santa María de Punilla, Córdoba, Argentina.,CONICET, Ciudad de Santa María de Punilla, Córdoba, Argentina
| | - Néstor H García
- Instituto de Investigaciones en Ciencias de la Salud, Ciudad Universitaria, Córdoba, Argentina. .,CEPROCOR, Ciudad de Santa María de Punilla, Córdoba, Argentina.
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Hariri W, Narin A. Deep neural networks for COVID-19 detection and diagnosis using images and acoustic-based techniques: a recent review. Soft comput 2021; 25:15345-15362. [PMID: 34456618 PMCID: PMC8382671 DOI: 10.1007/s00500-021-06137-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Accepted: 08/07/2021] [Indexed: 01/12/2023]
Abstract
The new coronavirus disease (COVID-19) has been declared a pandemic since March 2020 by the World Health Organization. It consists of an emerging viral infection with respiratory tropism that could develop atypical pneumonia. Experts emphasize the importance of early detection of those who have the COVID-19 virus. In this way, patients will be isolated from other people and the spread of the virus can be prevented. For this reason, it has become an area of interest to develop early diagnosis and detection methods to ensure a rapid treatment process and prevent the virus from spreading. Since the standard testing system is time-consuming and not available for everyone, alternative early screening techniques have become an urgent need. In this study, the approaches used in the detection of COVID-19 based on deep learning (DL) algorithms, which have been popular in recent years, have been comprehensively discussed. The advantages and disadvantages of different approaches used in literature are examined in detail. We further present the databases and major future challenges of DL-based COVID-19 detection. The computed tomography of the chest and X-ray images gives a rich representation of the patient’s lung that is less time-consuming and allows an efficient viral pneumonia detection using the DL algorithms. The first step is the preprocessing of these images to remove noise. Next, deep features are extracted using multiple types of deep models (pretrained models, generative models, generic neural networks, etc.). Finally, the classification is performed using the obtained features to decide whether the patient is infected by coronavirus or it is another lung disease. In this study, we also give a brief review of the latest applications of cough analysis to early screen the COVID-19 and human mobility estimation to limit its spread.
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Affiliation(s)
- Walid Hariri
- Labged Laboratory, Computer Science Department, Badji Mokhtar Annaba University, Annaba, Algeria
| | - Ali Narin
- Department of Electrical and Electronics Engineering, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Schmid B, Feuerstein D. [Lung ultrasound-noninvasive tool for the management of patients with respiratory symptoms in the emergency department during the SARS-CoV-2 pandemic]. Med Klin Intensivmed Notfmed 2021; 116:537-539. [PMID: 34402918 PMCID: PMC8369871 DOI: 10.1007/s00063-021-00840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Bonaventura Schmid
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland.
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
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48
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Ganesan G, Ponniah S, Sundaram V, Marimuthu PK, Pitchaikannu V, Chandrasekaran M, Thangarasu J, Kannupaiyan G, Ramamoorthy P, Thangaraj B, Shree Vaishnavi R. Whole lung irradiation as a novel treatment for COVID-19: Interim results of an ongoing phase 2 trial in India. Radiother Oncol 2021; 163:83-90. [PMID: 34391759 PMCID: PMC8359565 DOI: 10.1016/j.radonc.2021.08.001] [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: 06/03/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 01/13/2023]
Abstract
Background and purpose The main cause of death in COVID-19 pneumonia is acute respiratory distress syndrome which is preceded by massive cytokine release. Low-dose radiation therapy (LDRT) has anti-inflammatory and immunomodulatory effects that can interfere with the inflammatory cascade, reducing the severity of associated cytokine release. Material & methods 25 patients with RT-PCR proven COVID-19 pneumonia were enrolled between November 2020 and May 2021. All patients had SpO2 < 94 % on room air, respiratory frequency > 24/min and SpO2/FiO2 ratio (SF ratio) of >89 but <357. Patients were treated according to standard COVID-19 management guidelines along with single fraction LDRT of 0.5 Gy to bilateral whole lungs within 10 days of symptom onset and 5 days of hospital admission. Results LDRT was well tolerated by all patients. There was a statistically significant improvement in oxygenation as given by the SF ratio between pre-RT and day 2 (p < 0.05), day 3 (p < 0.001) and day 7 (p < 0.001) post RT. Demand for supplemental oxygen showed statistically significant reduction between pre-RT and day 2 (p < 0.05), day 3 (p < 0.001), day 7 (p < 0.001) post RT. 88 % patients attained clinical recovery within 10 days post LDRT and median time to hospital discharge from day of LDRT was 6 days. Three patients deteriorated and died. Conclusion As per our initial experience, LDRT appears to be a promising modality of treatment with rapid relief of respiratory distress in selected patients with moderate to severe COVID-19 pneumonia. This translates to early clinical recovery and hospital discharge in the selected patient group.
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Affiliation(s)
- Govindaraj Ganesan
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India.
| | - Sasipriya Ponniah
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India
| | | | | | | | | | | | | | - Prabhu Ramamoorthy
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India
| | - Brindha Thangaraj
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India
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49
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Abdelmajid A, Osman W, Musa H, Elhiday H, Munir W, Al.Maslamani MA, Elmekaty EZ. Remdesivir therapy causing bradycardia in COVID-19 patients: Two case reports. IDCases 2021; 26:e01254. [PMID: 34401329 PMCID: PMC8359645 DOI: 10.1016/j.idcr.2021.e01254] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/29/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been an enormous public health challenge. The pursuit for an effective therapy led to the use of the antiviral drug Remdesivir for hospitalized patients with severe COVID-19 pneumonia. We reported two cases of patients with severe COVID-19 pneumonia and worsening oxygen requirements. Both patients developed sinus bradycardia following the initiation of Remdesivir therapy and reverted after stopping it. One of the patients developed QTc interval prolongation and required intensive care unit admission. The proposed mechanism for Remdesivir-induced bradycardia and cardiac toxicity could be due to the intrinsic electrophysiological properties and the effect on the AV node; yet, further large observational studies are warranted for better understanding and correlation of Remdesivir with cardiac adverse events. Till then, healthcare providers need to be alert of this potential adverse event and to monitor their COVID-19 patients closely while on Remdesivir therapy.
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Affiliation(s)
- Alaaeldin Abdelmajid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wala Osman
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Huda Musa
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elhiday
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Waqar Munir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Muna A. Al.Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Eman Zeyad Elmekaty
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Correspondence to: Dr. Eman Zeyad Ibrahim Elmekaty, BSc (Pharm), PharmD, SIDP/ASCP. Clinical Pharmacy Department - Infectious Disease. Communicable Disease Center at Hamad Medical Corporation (HMC). Box 3050 Doha, Qatar.
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50
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Li L, Hsu SH, Wang C, Li B, Sun L, Shi J, Ren Y, Wang J, Zhang X, Liu J. Characteristics of viral pneumonia in non-HIV immunocompromised and immunocompetent patients: a retrospective cohort study. BMC Infect Dis 2021; 21:767. [PMID: 34362320 PMCID: PMC8343364 DOI: 10.1186/s12879-021-06437-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Concerning viral pneumonia, few large-scale comparative studies have been published describing non-HIV immunocompromised and immunocompetent patients, but the epidemiological characteristics of different viruses or underlying diseases in immunocompromised hosts are lacking. METHODS We retrospectively recruited patients hospitalised with viral pneumonia from six academic hospitals in China between August 2016 and December 2019. We measured the prevalence of comorbidities, coinfections, nosocomial infections, and in-hospital mortalities. RESULTS Of the 806 patients, 370 were immunocompromised and 436 were immunocompetent. The disease severity and in-hospital mortality of immunocompromised patients were higher than those of immunocompetent patients. During the influenza season, an increased number of cases of influenza virus (IFV) infection were found in the immunocompromised group, followed by cases of cytomegalovirus (CMV) and respiratory syncytial virus (RSV) infection. During the non-influenza season, CMV was the main virus detected in the immunocompromised group, while RSV, adenovirus (AdV), parainfluenza virus (PIV), and rhinovirus (HRV) were the main viruses detected in the immunocompetent group. Pneumonia caused by Pneumocystis jirovecii (22.4%), Aspergillus spp. (14.1%), and bacteria (13.8%) were the most frequently observed coinfections in immunocompromised patients but not in immunocompetent patients (Aspergillus spp. [10.8%], bacteria [7.1%], and Mycoplasma spp. [5.3%]). CMV infection and infection with two-or-more viruses were associated with a higher in-hospital mortality rate than non-IFV infection. However, patients with IFV and non-IFV infection in immunocompromised patients had similar disease severity and prognosis. CONCLUSIONS Immunocompromised patients have a high frequency of coinfections, and a higher mortality rate was observed among those infected with CMV and two-or-more viruses. In addition, patients with IFV and non-IFV infection in immunocompromised patients had similar same disease severity and prognosis. The type of viral infection varied with seasons.
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Affiliation(s)
- Lijuan Li
- Department of Pulmonary and Critical Care Medicine, National Center for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, 2 Yinghuayuan E St, Chaoyang District, Beijing, 100029, China.
| | - Steven H Hsu
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Chunlei Wang
- Department of Pulmonary and Critical Care Medicine, National Center for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, 2 Yinghuayuan E St, Chaoyang District, Beijing, 100029, China
| | - Binbin Li
- Department of Pulmonary and Critical Care Medicine, National Center for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, 2 Yinghuayuan E St, Chaoyang District, Beijing, 100029, China
| | - Lingxiao Sun
- Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, 100029, China
| | - Jinying Shi
- Department of Pulmonary and Critical Care Medicine, First Hospital of Shijiazhuang, Shijiazhuang, 050011, China
| | - Yali Ren
- Department of Pulmonary and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jinxiang Wang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital of Capital Medical University, Beijing, 101100, China
| | - Xiaoqi Zhang
- Department of Pulmonary and Critical Care Medicine, Second People's Hospital of Weifang, Weifang, 261041, China
| | - Jiangbo Liu
- Department of Pulmonary and Critical Care Medicine, Tianjin First Central Hospital, Tianjin, 300192, China
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