ABSTRACT
Introduction: Prominent prognostic parameters that reflect the severity of coronavirus disease 2019 (COVID-19) to adopt an appropriate therapeutic approach are not fully identified. This systematic review and meta-analysis aimed to explore the association between lymphocyte variation and disease severity in COVID-19 individuals. Methods: We searched Web of Science, Scopus, PubMed, EMBASE and WHO website to retrieve studies investigating lymphocyte subset counts in non-severe and severe cases of COVID-19. The pooled standardized mean difference (SMD) between two groups and the pooled average count of each lymphocyte subset were assessed by employing a random-effect model. Results: Thirty-nine investigations on 5087 participants, including 3578 non-severe patients and 1509 severe patients, were included. The pooled analysis showed that non-severe patients had higher total T lymphocytes (SMD = 1.01;95% CI: 0.82, 1.20;I2 = 75.7%), T helper cells (SMD = 1.07;95% CI: 0.85, 1.28;I2 = 85.4%), T cytotoxic cells (SMD = 1.07;95% CI: 0.82, 1.32;I2 = 87.1%), B cells (SMD = 0.72;95% CI: 0.45, 0.98;I2 = 79.7%), and natural killer cells (SMD = 0.65;95% CI: 0.47, 0.84;I2 = 63.1%) than severe patients and the average count of the corresponding lymphocyte signatures in non-severe patients/severe patients were 878.88/448.40, 493.12/268.96, 311.91/158.91, 177.09/110.37, and 155.02/103.09 cells/mu L, respectively. Conclusion: Lymphopenia may be a dilemma in COVID-19 management because over-activation of lymphocytes may lead to cytokine storm or acute respiratory distress syndrome (ARDS). In contrast, lymphopenia may increase SARS-CoV-2 amplification and COVID-19 severity. Therefore, novel therapies targeting lymphocyte proliferation or contraction may counterbalance lymphocyte counts in these patients.
ABSTRACT
Objective: We aimed to investigate the extent of pulmonary involvement and adverse outcomes in patients receiving angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) versus who did not, in hospitalized coronavirus infectious disease 2019 (COVID-19) patients. Method: All COVID-19 patients with a positive polymerase chain reaction (PCR) test, who were admitted to our tertiary referral hospitals in Tehran, Iran between January 2021 and May 2021, and had an on-admission chest computed tomography (CT) scan, were included. The patients were divided into two groups (receiving ACEI/ARB and who did not) for further analysis. The outcomes of interest in our study were the extent of pulmonary involvement, intensive care unit (ICU) admission, and death. Results: A total of 893 participants (mean age of 58.6±15.4 years;female, 522 (58.4%)) were enrolled. Among them, 368 (41.2%) participants had hypertension, and use of ACEI/ARB was reported in 183 (20.5%) participants. Of all, 409 (45.8%) participants required ICU admission, and 259 (29%) participants succumbed to death. We found that participants who received ACEI/ARB were less likely to progress critical disease and experienced significantly lower ICU admission (P=0.022) and death (P<0.001). On multivariable analysis adjusting for age, sex, and comorbidities, this relationship remained statistically significant for death (odds ratio (OR): 0.23 [0.14-0.38], P<0.001) and ICU admission (OR: 0.49 [0.32-0.73], P=0.001). Conclusion: Our findings showed that COVID-19 patients who receiving ACEI/ARB prior to hospitalization vs. those who did not, had more favorable outcomes. © 2022 Tehran University of Medical Sciences.
ABSTRACT
Coronavirus infectious disease 2019 (COVID-19) is confirmed to develop neurocognitive complications. In the present paper, we describe two patients with laboratory-confirmed COVID-19 and excessive daytime sleepiness. In the present study, we reported two laboratory-confirmed cases of COVID-19 with excessive daytime sleepiness. Patients had drowsiness and mild confusion on presentation. In both cases, CNS infections, including meningitis and encephalitis, were ruled out. Both patients’ symptoms remarkably improved following the therapeutic course indicating the direct effect of SARS-CoV2 in sleep modulating centers on the brain. COVID-19 should be considered in patients with excessive daytime sleepiness and drowsiness in the current outbreak.