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COVID-19 , Fabry Disease , Humans , Angiotensin-Converting Enzyme 2/metabolism , Glycosylation , SARS-CoV-2ABSTRACT
Resumen El 31 de diciembre de 2019, la Comisión de Salud de la provincia China de Hubei, dio a conocer por primera vez un grupo de casos inexplicables de neumonía, que posteriormente la OMS definió como el nuevo coronavirus de 2019 (SARS-CoV-2). El SARS-CoV-2 ha presentado una transmisión rápida de persona a persona y actualmente es una pandemia mundial. En la mayor serie de casos descrita hasta la fecha de pacientes hospitalizados con enfermedad por SARS-CoV-2 (2019-nCoViD), el 26% requirió atención en una unidad de cuidados intensivos (UCI). Esta pandemia está provocando una movilización de la comunidad científica sin precedentes, lo que lleva asociado un numero exponencialmente creciente de publicaciones en relación con la misma. La presente revisión bibliográfica narrativa, tiene como objetivo reunir las principales aportaciones en el área de los cuidados intensivos hasta la fecha en relación con la epidemiología, la clínica, el diagnóstico y el manejo de 2019-nCoViD.
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Background. As other indoor sports facilities, swimming pools were closed in Italy from March to May 2020 and from October 2020 to July 2021 due to the outbreak of the COVID-19 pandemic;access to these facilities was restricted to athletes of national relevance. This decision was based on "precautionary principles” and without evidence of a high risk of SARS-COV-2 circulation among swimming pools' attendants. The aim of this paper is to describe the pattern of SARS-COV-2 circulation among swimming athletes in Apulia (Southern Italy). Study design. The study aims to investigate the hypothesis that attending a pool increases the risk of SARSCOV-2 infection. The outcome measure is the incidence of SARS-COV-2 infection among swimming athletes compared with the general population. Methods. This is a retrospective cross-sectional study carried out in Apulia, Southern Italy. The study was performed through the analysis of both the database of the Italian Swimming Federation and the SARS-COV-2 infections in Apulia Region, from July 2020 to August 2021. Results. Among 2,939 federally licensed athletes, 221 had an history of SARS-COV-2 infection from July 2020 to August 2021, with an incidence of 75.2 /1,000. In the general Apulian population, during the same time span, the incidence of SARS-COV-2 infection was 67.3/1,000 and - considering the incidence rate ratio - there is no difference between the two populations (IRR=1.1;95% CI=0.9-1.3;p>0.05). Conclusions. The incidence of SARS-COV-2 infection in Apulian swimmers showed no significant differences with the general population. © Società Editrice Universo (SEU), Roma, Italy
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Abstract: In Italy, at the beginning of the SARS-CoV-2 pandemic, the main organizational model of hospital care was represented by the physical or functional division of hospitals and wards into COVID and non-COVID areas, in order to separate SARS-CoV-2-infected patients from the others. Now that the emergency phase has reached its long-awaited end, it is necessary to develop a new hospital care paradigm that may deal with SARS-CoV-2-positive patients discriminating between those who are hospitalized because of COVID-19 and those who are diagnosed with SARS-CoV-2 infection immediately before or after the first access to healthcare facilities.
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PURPOSE: Music has proven to be an effective tool in the management of anxiety during some surgical procedures. The aim of this study was to test the effect of baroque (BM) and classical era music (CM) as a nonpharmacological therapy on the control of anxiety and pain levels among patients undergoing dental implant placement surgery. METHODS: A randomized controlled clinical trial of patients attending a dental clinic was conducted. Patients with psychiatric disorders were excluded. Twenty six patients of Spanish nationality requiring single-tooth dental implant were included. Each patient was assigned to 1 of the 3 experimental groups, which acted as an independent variable: Group I (n = 8) listened to BM; Group II (n = 10) listened to CM; and Group III (n = 8) did not listen to music and was the control group (C). The dependent variables were divided into physiological variables and psychological variables. The physiological dependent variables analysed were systolic and diastolic blood pressure, heart rate, and oxygen saturation, recorded at 4 different times during surgery. The Kruskal-Wallis test compared each of these variables between the 3 experimental groups. The psychological dependent variable analyzed was the degree of anxiety, measured by the self-completed Modified Dental Anxiety Scale and Visual Analog Scale (measured before and after surgery). The Wilcoxon statistical test compared degree of anxiety before and after surgery. In all cases, the level of statistical significance was set at P < .05. RESULTS: The mean age of the sample was 46.5 ± 10.6 (range, 24-69 years), 50% male and 50% female. Statistically significant differences in degree of anxiety before and after surgery were found in the BM (P = .027, confidence interval [CI] = 0.146-6.104; BM before = 4.25 ± 3.91 and BM after = 1.13 ± 1.45) and CM groups (P = .044, CI = 0.161-3.039; CM before = 3.10 ± 2.88 and CM after = 1.50 ± 1.43) and were not found in group C (P = .180, CI = 1.104-3.604; C before = 2.63 ± 3.62 and C after = 1.38 ± 1.99). When comparing the perceived pain after the intervention among the 3 groups (C, BM, and CM), no significant differences were observed between them (P = .319; CI = -0.58-1.96; C = 0.75 ± 1.75, BM = 1.25 ± 1.75, and CM = 1.70 ± 1.70). CONCLUSION: Listening to BM and CM reduces anxiety in patients undergoing dental implant placement surgery. Musical flow should be applied in this practice.
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Background. Cell-mediated immunity (CMI) after anti-Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 vaccines has been poorly explored in recipients of allogeneic hematopoietic stem-cell transplantation (HSCT), especially with regard to the 3rd dose (booster). Aim of the study was to assess the specific T-cell responses before and after the 3rd dose of BNT162b2 mRNA vaccine in a cohort of allogeneic HSCT recipients, and compare it with healthy donors (HD). Methods. Allogenic HSCT recipients and HD were enrolled before receiving the 3rd dose of BNT162b2 mRNA vaccine. Whole blood for T-cell specific responses was collected before (T1) and 8 weeks after (T2) the booster administration. T-cell responses were assessed with an Interferon (IFN)-gamma release assay (IGRA), after overnight stimulation of heparin whole blood with pools of lyophilized peptides, covering the immunodominant sequence of the Spike (S) protein. IFN-gamma production was assessed with an enzyme linked immunosorbent assay (ELISA). Statistical analysis was performed with GraphPadPrism. Results. 14 HSCT recipients (8M, 6F) and 15 HD (7M, 8F) were enrolled (table 1). Median age was 47 [39-59] and 41 [31-48] years in the HSCT and HD groups, respectively. Time between the vaccine 2nd dose and T1 was significantly longer in HD than HSCT recipients (p< .001), while the time between T1 and T2 did not differ between the two groups. SARS-CoV-2 S specific T-cell responses at T1 were inferior in HSCT recipients compared to HD (median IFN-gamma production: 463 vs 231 ng/ml, respectively), although the difference did not reach the statistical significance. No differences were observed at T2. In a before-after analysis, SARS-CoV-2 S specific T-cell responses were significantly increased in HSCT recipients at T2 compared to T1 (median IFN-gamma production: 267 vs 881 ng/ml, p=0.02) (Figure 1). At T1, 3 HSCT recipients showed very low or no IFN-gamma production, while at T2 only 1 patient still had undetectable IFN-gamma production after S peptide stimulation. Conclusion. SARS-CoV-2 IGRA represents a useful tool to assess CMI, also in immunocompromised hosts. An additional 3rd BNT162b2 mRNA vaccine booster dose seems to enhance CMI in allogenic HSCT recipients. Further studies are needed to evaluate the duration of SARS-CoV-2 CMI in HSCT recipients compared to HD.
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Background. Several studies reported an increased rate of indeterminate QuantiFERON-TB Gold Plus (QFT-P) assay results in patients with severe Coronavirus Disease (COVID)-19. Methods. Aim of the study was to longitudinally evaluate QFT-P responses in patients who survived COVID-19, with a previous indeterminate result. Results. We observed 223 patients with an indeterminate QFT-P assay among 949 patients hospitalized because of COVID-19 (23,5%) during 2020 and 2021. 36 patients among those with an indeterminate QFT-P assay were enrolled for reassessing the test. In 12 patients peripheral blood lymphocyte subsets were also reassessed. Considering disease severity, 30 were classified as severe and 6 as non-severe. Median age was 57,5 (interquartile range [IQR]: 49,5-63,8), with a prevalence of male sex (M/F: 24/12);median Charlson Comorbidity Index was 2 (IQR: 1-3). The second QFT-P assay was performed after at least 1 month from the first assay (median time 7 months, IQR: 5-12 months). All QFT-P assays gave a determined result: 2 positive (5.5%) and 34 negatives (94,4%). A statistically significant difference was observed after comparing the laboratory parameters at the time of the first and the second QFT-P assay: the absolute counts of total lymphocyte, total CD3+, CD4+ and CD8+ T-lymphocytes were significantly increased (p< 0.001) while neutrophil absolute counts, neutrophil to lymphocyte (N/L) ratio, D-dimer,fibrinogen, ferritin, C-reactive protein (CRP) were significantly reduced (p< 0.0001). Concerning the QFT-P assay, interferon gamma (INF-gamma) production in the Mitogen-Nil, TB1-Nil and TB2-Nil conditions were significantly increased (p< 0.0001;p=0.0019;p=0.0205, respectively) (Table 1 and Figure 1). Conclusion. Once the acute phase of COVID-19 is resolved, inflammatory markers and peripheral blood leucocyte counts tend to normalize with an effective INF-gamma production after specific and nonspecific stimulation. All the 36 QFT-P showed a determinate result. Moreover, we observed 2 positive QFT-P assay, supporting the importance of retesting patients with indeterminate result to identify latent tuberculosis infection and monitor patients for possible reactivation because of the immunesuppression associated with COVID-19.
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A 75-year-old man with a history of chronic ischemic heart disease with a previously normal blood count, presented to the emergency room with fever and tachycardia. There was no hepatosplenomegaly or lymphadenopathy. An electrocardiogram showed left bundle branch block. Because of the fever the patient underwent SARS-CoV-2 RNA testing with positive result. The patient's blood count showed a WBC of 10.46 x 109/L, lymphocytes 4.51 x 109/L, hemoglobin 129 g/ L, and platelet count 233 x 109/L. D-Dimer was 659 mug/L (normal range <500) and IL6 was 76.3 pg/ml (normal range <6.4). A computed tomography scan of the chest showed bilateral interstitial infiltrates associated with multiple enlarged mediastinal lymph nodes. Following a rapid and unexpected increase of the WBC to 17.49 x 109/L with lymphocyte count of 8.37 x 109/L, a blood film and immunotyping were performed. The film showed small/medium sized lymphocytes, with a variable N: C ratio and moderately basophilic cytoplasm. Smear cells were present. About 25% of the lymphocytes showed the negative images of one to three rodshaped crystals (average 2 per cell). Some immature monocytes and neutrophils showed mild toxic granulation or abnormal nuclear shapes, consistent with COVID-19. Flow cytometric immunotyping showed an increased number of circulating B cells (93% of lymphocytes, 7.78 x 109/L) with lambda light chain restriction and expressing CD19, CD5, CD23, weak CD20, CD43, and CD200;CD10, CD79b, CD81, FMC7, and CD38 were negative. At this stage the clinical picture could not be distinguished from chronic lymphocytic leukemia (CLL). Two months later the WBC and lymphocyte count returned to normal and immuno typing showed only 0.63 x 109/L CD5-positive clonal B cells. Lymphocytes with cytoplasmic crystals were still present. A diagnosis of monoclonal B-cell lymphocytosis (MBCL) was made. Patients with CLL in whom COVID-19 led to a marked but transient increase in the lymphocyte count have been reported. In our case, COVID-19 in a patient with MBCL led to an increase in the lymphocyte count simulating CLL but follow-up indicated the correct diagnosis. We report here the observation of endocellular crystals, attributable to crystallization of immunoglobulin, in MCBL, a phenomenon previously reported in CLL.
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Background: Seraph-100 Blood Filter (ExThera Medical) is a hemoperfusion device designed to treat bloodstream infections. Its membrane binds pathogens, reducing bacterial and viral blood titers. The device received an authorization for emergency use in critically-ill COVID-19 patients by the FDA. We summarize the efficacy and safety profile of the device in a sample of COVID-19 ICU patients. Method(s): 25 consecutive COVID-19 patients admitted in the ICU between Nov 2021 and Feb 2022 were retrospectively reviewed. 11 patients received a single treatment with Seraph-100 plus standard care. Subjects in the control group received standard care only. Result(s): We found no differences between groups regarding age, sex or comorbidities. Treatment with Seraph was well tolerated and was associated with no modifications of leukocyte count or CRP levels. No differences regarding in-hospital mortality (LR=0.37;P=0.54) or length of ICU stay were observed. Patients treated with Seraph suffered Gram-positive associated pneumonia less frequently. Conclusion(s): Seraph hemoperfusion was not associated with better results in our sample. This may be due to small sample size and high heterogeneity present in parameters such as disease severity, other complications, length of ICU stay or hemoperfusion dosage. To improve results it is necessary to better define the most appropriate timing and dosage for each case.
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Coronavirus disease-19 (COVID-19) has triggered the worst public health crisis of modern times. The prothrombotic state induced by the infection is considered directly and substantially related to acute lung damage and other medical complications, including death. This scoping review summarises and critically assesses the existing evidence on the association between thrombosis and COVID-19, and is based on a systematic literature search of all articles published up to May 5th, 2020, included in the following databases: PubMed, Scopus, Cochrane, and Clinicaltrials.gov. A total of 26 articles were included, and their quality evaluated using STROBE guidelines. The main symptoms presented by patients that had been diagnosed with COVID-19 are dyspnoea, fever, cough, diarrhoea, and vomiting. In the laboratory findings, it is characteristic to observe an increase in D-dimer, fibrinogen, prothrombin time, and lymphopenia. Ultrasound and computed axial tomography were the radiological techniques most used for diagnosing pulmonary thromboembolism, deep vein thrombosis, and other thrombotic phenomena. In conclusion, there is still limited scientific evidence on COVID-19 and its thrombotic complications. This review summarises the body of evidence, assesses its quality, and offers conclusions that should help in the next steps in this highly relevant and expanding research area. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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Critical clinical forms of COVID-19 infection often include Acute Kidney Injury (AKI), requiring kidney replacement therapy (KRT) in up to 20% of patients, further worsening the outcome of the disease. No specific medical therapies are available for the treatment of COVID-19, while supportive care remains the standard treatment with the control of systemic inflammation playing a pivotal role, avoiding the disease progression and improving organ function. Extracorporeal blood purification (EBP) has been proposed for cytokines removal in sepsis and could be beneficial in COVID-19, preventing the cytokines release syndrome (CRS) and providing Extra-corporeal organ support (ECOS) in critical patients. Different EBP procedures for COVID-19 patients have been proposed including hemoperfusion (HP) on sorbent, continuous kidney replacement therapy (CRRT) with adsorbing capacity, or the use of high cut-off (HCO) membranes. Depending on the local experience, the multidisciplinary capabilities, the hardware, and the available devices, EBP can be combined sequentially or in parallel. The purpose of this paper is to illustrate how to perform EBPs, providing practical support to extracorporeal therapies in COVID-19 patients with AKI.
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BACKGROUND: Gitelman's and Bartter's syndromes (GS/BS) are rare genetic tubulopathies characterized by electrolyte imbalance and activation of the renin-angiotensin-aldosterone system (RAAS). These syndromes have intriguing biochemical and hormonal abnormalities that lead them to be protected from hypertension and cardiovascular and renal remodeling. SUMMARY: In this review, we explore the biochemical/molecular mechanisms induced by the activation of the RAAS and its counterregulatory arm which is particularly activated in GS/BS patients, in the context of blood pressure regulation. In addition, we report our findings in the context of the COVID-19 pandemic where we observed GS/BS subjects being protected from infection. KEY MESSAGES: The intracellular pathways induced by Ang II, starting from induction of oxidative stress and vasoconstriction, are crucial for the progression toward cardiovascular-renal remodeling and might be useful targets in order to reduce/halt the progression of Ang II/oxidative stress-induced cardiovascular-renal morbidity in several diseases.
Subject(s)
Bartter Syndrome , COVID-19 , Gitelman Syndrome , Hypertension , Bartter Syndrome/genetics , Bartter Syndrome/metabolism , Electrolytes , Gitelman Syndrome/genetics , Gitelman Syndrome/metabolism , Humans , Hypertension/genetics , PandemicsABSTRACT
Over 60 countries have integrated wastewater-based epidemiology (WBE) in their COVID-19 surveillance programs, focusing on wastewater treatment plants (WWTP). In this paper, we piloted the assessment of SARS-CoV-2 WBE as a complementary public health surveillance method in susceptible communities in a highly urbanized city without WWTP in the Philippines by exploring the extraction and detection methods, evaluating the contribution of physico-chemical-anthropogenic factors, and attempting whole-genome sequencing (WGS). Weekly wastewater samples were collected from sewer pipes or creeks in six communities with moderate-to-high risk of COVID-19 transmission, as categorized by the City Government of Davao from November to December 2020. Physico-chemical properties of the wastewater and anthropogenic conditions of the sites were noted. Samples were concentrated using a PEG-NaCl precipitation method and analyzed by RT-PCR to detect the SARS-CoV-2 N, RdRP, and E genes. A subset of nine samples were subjected to WGS using the Minion sequencing platform. SARS-CoV-2 RNA was detected in twenty-two samples (91.7%) regardless of the presence of new cases. Cycle threshold values correlated with RNA concentration and attack rate. The lack of a sewershed map in the sampled areas highlights the need to integrate this in the WBE planning. A combined analysis of wastewater physico-chemical parameters such as flow rate, surface water temperature, salinity, dissolved oxygen, and total dissolved solids provided insights on the ideal sampling location, time, and method for WBE, and their impact on RNA recovery. The contribution of fecal matter in the wastewater may also be assessed through the coliform count and in the context of anthropogenic conditions in the area. Finally, our attempt on WGS detected single-nucleotide polymorphisms (SNPs) in wastewater which included clinically reported and newly identified mutations in the Philippines. This exploratory report provides a contextualized framework for applying WBE surveillance in low-sanitation areas.
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COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Humans , Philippines/epidemiology , Pilot Projects , RNA, Viral , SARS-CoV-2/genetics , Wastewater , Wastewater-Based Epidemiological MonitoringABSTRACT
BACKGROUND AND AIMS: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been in our daily practice for almost 2 years now. Since the beginning of the pandemic, we have aimed to study its most immediate effects on patients to find the best line of treatment or, at least, mitigate its worst outcomes. Nevertheless, we also know some long-term health consequences such as fatigue, sleep difficulties, headache, among others, but its long-term kidney effects are not entirely clear yet. The aim of this study was to describe if coronavirus disease's (COVID- 19) severity increases the risk of chronic kidney disease (CKD) progression after a previous hospitalization and observe if there are any additional risk factors that could help us predict this outcome. METHOD: In this study, a sample of consecutive patients who required admission due to COVID-19 during the first wave of the pandemic (from March to May of 2020) was recruited. Patients were followed for 12 months since initial admission. The composite outcome of the study included either death or CKD progression. CKD progression was defined as incremental progression to a higher KDIGO CKD stage compared to baseline pre COVID-19 renal function [(in mL/min/1.73 m2): estimated glomerular filtration rate (eGFR) ≥60;stage 3a: 45-59;stage 3b: 30-44;stage 4: 15-29;stage 5: <15], or dialysis initiation. Cardiovascular disease was defined as a history of myocardial infarction, stroke, or peripheral vascular disease. Chronic lung diseases included asthma, chronic obstructive pulmonary disease and chronic bronchitis. RESULTS: The sample was composed of 93 patients, of which 14 (15.1%) died during follow-up. Of those alive 12 months after initial admission, 17 (21.5%) suffered CKD progression. No patient required renal replacement therapy. Patients that suffered the composite outcome presented a higher prevalence of cancer, tended to be slightly older and suffered from additional comorbidities more frequently (Table). In multivariate logistic regression analysis, previous history of CKD [odds ratio (OR): 1.066 (0.433- 2.624);P = 0.889], severe or critical COVID-19 on admission [OR: 0.657 (0.24-1.8);P =0.414] or ICU admission [OR: 0.986 (0.082-11.898);P = 0.991] failed to predict the composite outcome. CONCLUSION: Our main hypothesis was that COVID-19 sequelae should be due to an exaggerated activation of the immune system against the virus. Thus, patients that suffered severe COVID-19 should be expected to develop more long-term health consequences of the infection when compared with those with milder disease. However, we failed to prove any link between COVID-19 severity and long-term CKD progression. History of CKD or ICU admission was also unable to predict the composite outcome. Previous studies have described a relationship between COVID-19 severity and adverse renal outcomes, a relationship that we failed to observe. These discrepancies could be due to the small sample size of our study and the different definition of CKD progression applied. In addition, age could act as a potential modifier of CKD progression after admission due to COVID. More studies are required to further clarify the mechanisms and long-term renal consequences of COVID-19 and define potential lines of treatment. (Table Presented).
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BACKGROUND AND AIMS: During the last 2 years, we have witnessed several waves of the COVID-19 pandemic characterized by massive infections among the general population, sudden increases in the number of hospitalizations and variable rates of complications and mortality among patients. Acute kidney injury (AKI) has been described as a common and serious complication of COVID-19. However, multiple factors that are involved in the development of this complication have been modified throughout these months, including the appearance of new variants of the virus, the modification of treatment protocols or the advancement of vaccination among the general population. In this study, we aimed to compare the rates of AKI among patients who required admission due to COVID-19 in the first and current (sixth) waves of the pandemic. METHOD: Consecutive patients that required admission due to COVID-19 in a tertiary referral hospital during the first (March to May 2020) and current (December 2021) waves of the pandemic were enrolled in the study. Patient characteristics, rates of AKI incidence, 28-day mortality and in-hospital length of stay were compared between groups. Viral infection was confirmed by real-time RT-qPCR in all cases. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines using peak serum creatinine and acute dialysis criteria. Multivariate logistic regression was performed to define potential predictors of AKI. RESULTS: Table 1 summarizes demographic and clinical characteristics among enrolled patients. Compared with the current wave, patients admitted during the first wave were older, had higher baseline serum creatinine and lower baseline eGFR. During the first wave, patients presented higher peak serum creatinine values and a higher incidence of in-hospital AKI. Age, male sex, hypertension, diabetes, CKD and pandemic wave were included in multivariate logistic regression analysis as potential predictors of AKI. Only past history of hypertension [OR 2.867;95% confidence interval (95% CI) 1.279-6.424;P-value: .011] and CKD (OR 2.418;95% CI 1.237-4.73;P-value: .01) independently predicted AKI in the sample. CONCLUSION: Despite multiple changes that have occurred throughout the pandemic, including new treatment protocols, the appearance of new variants of the virus with different clinical profiles or the extensive application of vaccines, these changes have not translated into a significant decrease in the risk of AKI among patients admitted due to COVID-19, which appears to still be conditioned mainly by comorbidities of each patient, including past history of CKD. (Table Presented).