COVID-19 and liver injury in individuals with obesity.

Coronavirus disease 2019 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 that manifests as a variety of clinical manifestations, including liver damage commonly detected by a hepatocellular pattern from liver function tests. Liver injury is associated with a worse prognosis overall. Conditions associated with the severity of the disease include obesity and cardiometabolic comorbidities, which are also associated with nonalcoholic fatty liver disease (NAFLD). The presence of NAFLD, similarly to obesity, is associated with an unfavourable impact on the coronavirus disease 2019 outcome. Individuals with these conditions could present with liver damage and elevated liver function tests due to direct viral cytotoxicity, systemic inflammation, ischemic or hypoxic liver damage or drug side effects. However, liver damage in the setting of NAFLD could also be attributed to a pre-existing chronic low-grade inflammation associated with surplus and dysfunctional adipose tissue in these individuals. Here we investigate the hypothesis that a pre-existing inflammatory status is exacerbated after severe acute respiratory syndrome coronavirus 2 infection, which embodies a second hit to the underestimated liver damage.

COVID-19-associated pneumonia in Swyer-James-MacLeod syndrome: A case report.

Coronavirus disease 2019 (COVID-19) exerts differential effects on various individuals. The majority of infected individuals experience mild-to-moderate disease and usually recover, without requiring hospitalization. It has been reported that those who have underlying chronic diseases are more susceptible to infection and may thus develop significantly more serious illness. As a result, COVID-19 may aggravate pre-existing respiratory illnesses, such as interstitial lung disease, chronic obstructive pulmonary disease and asthma. Swyer-James-MacLeod syndrome is an uncommon clinical condition marked by post-infectious infantile bronchiolitis obliterans. Traditionally, the diagnosis is made in infancy following an investigation for reoccurring respiratory infections, although in rare cases, the diagnosis is made in adulthood. The present study describes the case of a 45-year-old patient with Swyer-James-MacLeod syndrome hospitalized due to COVID-19, which is the first one to be reported. To the best of our knowledge, there are currently no data available on the effects of COVID-19 in these individuals, stheir optimal therapy, or the impact of COVID-19 vaccination on their clinical course. Thus, it is hoped that the present study sheds some light into this condition.

COVID-19-associated pneumonia in Swyer-James-MacLeod syndrome: A case report

Coronavirus disease 2019 (COVID-19) exerts differential effects on various individuals. The majority of infected individuals experience mild-to-moderate disease and usually recover, without requiring hospitalization. It has been reported that those who have underlying chronic diseases are more susceptible to infection and may thus develop significantly more serious illness. As a result, COVID-19 may aggravate pre-existing respiratory illnesses, such as interstitial lung disease, chronic obstructive pulmonary disease and asthma. Swyer-James-MacLeod syndrome is an uncommon clinical condition marked by post-infectious infantile bronchiolitis obliterans. Traditionally, the diagnosis is made in infancy following an investigation for reoccurring respiratory infections, although in rare cases, the diagnosis is made in adulthood. The present study describes the case of a 45-year-old patient with Swyer-James-MacLeod syndrome hospitalized due to COVID-19, which is the first one to be reported. To the best of our knowledge, there are currently no data available on the effects of COVID-19 in these individuals, stheir optimal therapy, or the impact of COVID-19 vaccination on their clinical course. Thus, it is hoped that the present study sheds some light into this condition.

Biomarkers predicting the 30­day mortality of patients who underwent elective surgery and were infected with SARS­CoV­2 during the post­operative period: A retrospective study.

The coronavirus disease 2019 (COVID-19) pandemic is a significant global concern that has had major implications for the healthcare system. Patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) undergoing elective or emergency surgical procedures have a substantial risk of mortality and peri-operative complications. The present study aimed to describe the characteristics of patients who underwent elective surgery and developed nosocomial SARS-CoV-2 infection post-surgery. Patients who underwent thoracic, upper and lower abdominal or peripheral elective surgery with a polymerase chain reaction diagnosis of COVID-19, at 3-7 days after the surgery, were enrolled in the present retrospective study. Demographics, vaccination status against SARS-CoV-2, Charlson comorbidity index (CCI) and laboratory data were recorded upon admission to the hospital unit. In total, 116 subjects (80 males, 36 females; mean age, 67.31±16.83 years) fulfilling the inclusion criteria were identified. Among the 116 participants, 14 (12.1%) were intubated. From the 116 individuals analyzed, 84 were alive after 30 days (survivors), and 32 had succumbed to the disease (non-survivors). The mortality rate was 27.6% (32/116). The non-survivors had an older age and a higher CCI score. At the evaluation upon admission to the hospital unit, the survivors presented with higher serum albumin levels and a higher number of blood lymphocytes. In addition, the survivors exhibited lower levels of lactate dehydrogenase, aspartate aminotransferase, alkaline phosphatase (ALP) and C-reactive protein (CRP), as well as a higher neutrophil to lymphocyte ratio (NLR) and CRP to albumin ratio (CAR) (P<0.05). The patients that were intubated had higher levels of gamma glutamyl-transferase (GGT), ALP and ferritin, as well as a higher NLR and platelet to lymphocyte ratio upon admission to the hospital unit (P<0.05). According to the Cox proportional hazards multivariate regression analysis, the only independent predictors of mortality and intubation were ALP and GGT upon admission, respectively (P<0.05). On the whole, the findings of the present study suggest that more stringent guidelines are required in order to prevent infection during the post-operative period.

Onodera's prognostic nutritional index: Comparison of its role in the severity and outcomes of patients with COVID­19 during the periods of alpha, delta and omicron variant predominance.

Coronavirus disease 2019 (COVID-19) has posed a severe public health threat worldwide, affecting the function of multiple organs in affected individuals, in addition to respiratory function. Several strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been circulating worldwide since it first arose, with some of these having the ability to escape from natural or vaccine-mediated immunity. The Onodera's prognostic nutritional index (OPNI), which is derived from the peripheral lymphocyte count and serum albumin, has been reported to be significantly associated with a poor survival rate and post-operative complications in patients with various diseases and in some studies on patients with COVID-19. The aim of the present retrospective study was to evaluate and compare the efficacy of OPNI as a prognostic indicator in patients with COVID-19 during the periods of alpha, delta and omicron variant predominance. Adult patients who visited or were hospitalized due to SARS-CoV-2 infection were included, covering the second, third (alpha variant), fourth (delta variant) and fifth (omicron variant) pandemic waves. According to the results obtained, OPNI exhibited a statistically significant difference among patients with mild/moderate, severe and critical disease, with the lowest values observed in patients with critical disease in all the pandemic waves examined. Moreover, OPNI was found to be an independent prognostic biomarker of intubation and mortality in patients with COVID-19, according to multivariate logistic regression analysis, including as confounders an age >65 years, the male sex and the presence of comorbidities in all periods examined.

Onodera's prognostic nutritional index: Comparison of its role in the severity and outcomes of patients with COVID‑19 during the periods of alpha, delta and omicron variant predominance

Coronavirus disease 2019 (COVID-19) has posed a severe public health threat worldwide, affecting the function of multiple organs in affected individuals, in addition to respiratory function. Several strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been circulating worldwide since it first arose, with some of these having the ability to escape from natural or vaccine-mediated immunity. The Onodera's prognostic nutritional index (OPNI), which is derived from the peripheral lymphocyte count and serum albumin, has been reported to be significantly associated with a poor survival rate and post-operative complications in patients with various diseases and in some studies on patients with COVID-19. The aim of the present retrospective study was to evaluate and compare the efficacy of OPNI as a prognostic indicator in patients with COVID-19 during the periods of alpha, delta and omicron variant predominance. Adult patients who visited or were hospitalized due to SARS-CoV-2 infection were included, covering the second, third (alpha variant), fourth (delta variant) and fifth (omicron variant) pandemic waves. According to the results obtained, OPNI exhibited a statistically significant difference among patients with mild/moderate, severe and critical disease, with the lowest values observed in patients with critical disease in all the pandemic waves examined. Moreover, OPNI was found to be an independent prognostic biomarker of intubation and mortality in patients with COVID-19, according to multivariate logistic regression analysis, including as confounders an age >65 years, the male sex and the presence of comorbidities in all periods examined.

Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients.

Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients' self-inflicted lung injury. Moreover, NMBAs can harmonize the patient-ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the "war" conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS.