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Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male - 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male - 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male - 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104-11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177-18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
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The structure of the presentation will be 1) Pandemic-Epidemiology 2) General Pandemic-Management 3) HRT and COVID 4) Different spectrum of menopausal symptoms (Europe/Asia) 5) Different risks lead to different HRT. 1) Pandemic-Epidemiology: SARS-COVID-19 has got to be a new disease, China was the first to suffer from the pandemic starting in December 2019 with spread all over the world. Diagnosis, treatment and protective measures have started in Europe in March 2020;up from autumn 2022 in Europe the pandemic changed to endemic, but protective measures still should be continued in risk patients like in hospitals and nursing homes. Rehabilitation will for long-time be an issue like treatment of "Post-" and "Long-COVID". China pursued a zero-COVID-policy until Dec 2022. The sudden stop of almost all measures led to a sharp increase in infections, which shows that the disease will remain a global risk. 2) General Pandemic-Management: Protective measures like vaccination, surgical masks, screening/testing, isolation management, travel/residence history in high-risk regions, education of patients and families had to be the first priority, ahead of other issues such as the management of menopause. 3) HRT and COVID: Already the first prelimary data assessed in Wuhan/China have shown that women with low estradiol-levels had more severe infections with COVID. An analysis of health records of 68,466 COVID-positive patients from 17 countries showed that the fatality risk for women > 50 years receiving HRT was reduced by more than 50% compared to those women not taking HRT (Seeland, 2020). Likewise from a case-control study analyzing the self-reported data of 1.6 million UK menopausal women through the COVID-Symptoms Study Smartphone application (control populations adjusted for age, body mass index, and smoking status) was concluded, that HRT not only can be used, but even can protect from COVID-infections and/or their sequelae (Costeira, 2021). 4) The different spectrum of menopausal symptoms (independent of COVID-infections) comparing data in Europe (showing more vasomotor symptoms) and China (more somatic symptoms) will be presented, including own data. 5) Different risks during HRT consequently lead to different use of HRT, especially more transdermal estrogen combined with progesterone in Europe due to much higher VTE-risk, but more management of the high bleeding-problems in China using individualized (mostly oral) estrogen/progestogen combinations. Copyright © 2023
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BACKGROUND: Obesity is a condition that is often associated with an increased risk of infection for coronavirus disease 2019 or COVID-19, which can be fatal or even cause death. AIM: The study aimed to analyze the risk factors of obesity incidents in children during COVID-19 pandemic era in Gorontalo City. MATERIALS AND METHODS: The risk factors for obesity include physical activity, history of obesity, fast food consumption, sleep duration at night, and breakfast. It applied analytical observational research with a case-control study design, matching the gender and age. The case was students when measured with a body mass index (BMI) equal to or above 25 kg/m2, while the control was student when measured with a BMI of 18.5-22.9 kg/m2. At the same time, the numbers of samples were 150 children in which the sampling was carried out non-random by applying purposive sampling technique. RESULT(S): Finding denoted that all the variables examined significantly correlated with obesity incidents during COVID-19 pandemic, with odds ratio (OR) value was <1. Specifically, the physical activity variable had the highest OR value compared to other variables, namely, OR 2.939, and this meant that adolescents who do not exercise or exercise <3 times a week during the COVID-19 period were at 2.939 times risk compared to adolescents who exercise 3 times a week. CONCLUSION(S): The finding of this study concluded that in the COVID-19 pandemic era, physical activity or exercise is the most influential risk factor for the incidence of obesity compared to other variables.Copyright © 2022, Scientific Foundation SPIROSKI. All rights reserved.
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Objective: evaluation of the clinical and economic efficiency of using Levilimab in the treatment of moderate and severe COVID-19 based on real world data (RWD). Material and methods. A single-center observational retrospective case-control study was performed. According to the matching algorithm, 834 pairs of patients with moderate and 347 pairs with severe infection were selected, similar in gender, age, vaccination status, severity of the disease and the level of C-reactive protein. Results. The clinical efficiency of Levilimab with respect to in-hospital mortality was demonstrated both for the moderate course (6% in the Levilimab group and 10% in the standard therapy group;odds ratio (OR) 1.71;95% confidence interval (CI) 1.19-2.47;p<0.01) and for the severe course of COVID-19 (63% and 82%, respectively;OR 2.70;95% CI 1.90-3.82;p<0.01). The costs per 1 treated patient were also higher in the Levilimab therapy groups: the difference in costs compared to the standard therapy group for patients with moderate disease was 54 665.30 rubles, with severe disease - 91 285.85 rubles. The estimated cost of the additional effectiveness of Levilimab for the moderate course of the disease was 13, 666.32 rubles, for the severe course - 4, 804.51 rubles. Conclusion. The use of Levilimab for the treatment of moderate and severe COVID-19 is feasible both from a clinical and economic points of view. Conducting RWD trials is an important tool to understand the effectiveness of medical technologies in real clinical practice.Copyright © 2023 IRBIS LLC. All Rights Reserved.
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Objectives: It is well known that severe COVID-19 is associated with complex immunological and inflammatory dysregulation. Both these physiopathological events translate to a high risk of major thrombotic or hemorrhagic events. In patients treated with venovenous extracorporeal membrane oxygenation (VVECMO), membrane dysfunction might affect systemic oxygenation and limit its duration-expectancy. This study aimed to assess the possible causes of extracorporeal membrane failure in COVID-19 patients and its impact on outcome. Method(s): Retrospective, single-center, observational case-control study involving adult COVID-19 patients admitted to an ECMO referral centre in a tertiary university hospital. All patients required VVECMO for acute respiratory failure, including 48 cases who needed one or more extracorporeal membrane exchanges and 45 controls (no membrane exchange). These two groups were compared for demographic characteristics, severity of the disease using validated scores (SAPS II and SOFA), duration of ECMO run, coagulation assessment, cumulative anticoagulation dose, associated complications, and outcomes (ICU and hospital mortality). Result(s): Most patients were males (71.0%) and younger than 50 years (79.5%). Median ECMO run duration was significantly longer in the case group (35.0 vs 14.0 days, p <0.001), as well as ICU length-of-stay (45.5 vs 28 days, p <0.001). Membrane exchange tended to be associated with sepsis (56% vs 33%, p=0.037), major hemorrhage (58% vs 43%, p=0.022), heparin-induced thrombocytopenia (25% vs 9%, p=0.054), higher D-dimer title (17.36 ng/dL vs 7.5 ng/dL, p=0.07) and lower platelet counts (133.000/muL vs 154.000/muL). Median SAPS II (32.0 vs 33.0, p=0.20) and the mortality (27% vs 24%, p >0.99) were similar between these groups. Conclusion(s): In patients with SARS-CoV-2 pneumonia and severe hypoxemia treated with VVECMO support the emergence of infection, coagulopathy and inflammation were associated with high risk of membrane dysfunction. No impact on mortality could be confirmed from these data. Anticoagulation monitoring and dosing strategies should be reinforced to promote membrane protection.
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Introduction. Coronavirus infection is associated with severe endotheliopathy, thromboinflammation and immunothrombosis leading to excessive release of von Willebrand factor (vWF) multimers from Weibel-Palade bodies, which can affect activity of ADAMTS-13 metalloproteinase (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) and the ADAMTS-13/vWF axis previously shown by us to be altered in non-pregnant women with severe COVID-19. Aim(s): to study a clinical role of hemostasis activation particularly ADAMTS-13/vWF axis in pregnant women after COVID-19. Materials and Methods. A prospective case-control study was conducted with pregnant women (n = 135) divided into 3 groups: group 1 included 45 women with prior COVID-19 during pregnancy, group 2 - 45 women in the acute phase of the infection during pregnancy, group 3 - 45 healthy pregnant women. The level of vWF and ADAMTS-13 was assessed in all patients. Results. The concentration of vWF antigen (vWF:Ag) in the acute period of the disease in pregnant women with COVID-19 was significantly higher compared to the control group (p < 0.001). ADAMTS-13 level in pregnant women after COVID-19 did not differ from that of in control group, while vWF level was significantly higher in 66.7 % (30/45). The ADAMTS-13/vWF ratio was increased and significantly differed both in pregnant patients during the acute period of the disease (p < 0.001) and pregnant women after infection (p = 0.0002) compared with the control group. Conclusion. Our results show that endotheliopathy was prominently manifested in pregnant women with COVID-19 and persisted for several months after disease. The ADAMTS-13/vWF ratio determines the pathway functioning, the risk of microcirculation disorders and clinical complications.Copyright © 2023 Vestnik Sankt-Peterburgskogo Universiteta, Yazyk i Literatura. All rights reserved.
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A global spreading corona virus at 2019 (COVID-19) declared as emergent worldwide, due to its quick spreading and high rates of mortality that serious disruptions. The objective of this research is to explore further into effect of different types of covid-19 vaccinations (Pfizer, AstraZeneca and Sinopharm) on some coagulation parameters from random samples of students in college of pharmacy/ university of Ker-bala. A case-control study was carried out with Iraqis living in Kerbala city particularly college students in Kerbala University/ College of Pharmacy from 2021/1/16 to 2022/4/16. This study was done to encompass quantitative and qualitative analysis of covid 19 vaccination types and possible thrombosis that occur after vaccination. The enrolled sixty participants of male and female were aged 18years and above. A questionnaire was made questions pertaining age were inquired to make sure participants fulfilled the criteria for in-clusion, past medical history, previous infection with covid 19 were incorporated into the survey. The scien-tific and ethical committee provided their ethical approval in college of pharmacy at University of Kerbala. Our results in this study indicate significant differences in coagulation parameters readings of (Pt, Ptt) between vaccination groups and control by using ANOVA statistical analysis of SPSS. Our study showed that the difference between the vaccinated and unvaccinated groups was considerable (Pfizer, AstraZeneca & Sinopharm Covid 19 vaccines) and control group in thrombotic measurements time and platelet mean value. The most effective and economical method of preventing COVID-19 infection is still vaccination. A number of COVID-19 vaccines have been developed quickly, but more research needs to be done on any side effects that may appear.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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The coronavirus illness (COVID-19) is caused by serious acute respiratory disorder coronavirus 2 (SARS-CoV-2), moreover known as the COVID-19 virus. After the first-ever reports of COVID-19 in December 2019, the malady spread quickly. In January 2020, the WHO announced the outbreak a Public Health Emergency of Worldwide Concern, and by March 2020, the WHO characterized the episode as a global widespread . The current study aimed to detect the effect of SARS-CoV-2 infection in heart patients and study their immune response by detecting the levels of some cytokines, which may end in a cytokine storm and may lead to death. In this study, one hundred-eight subjects were enrolled on two comparison case-control groups, the case group included 54 patients suffering from SARS-COV2, all were selected from those who were admitted to the Intensive Care Unit (ICU), and were diagnosed by a specialist physician with severe acute respiratory syndrome due to SARS-COV2 documented by Real-Time Polymerase Chain Reaction( RT-PCR ) besides other clinical and laboratory criteria in Marjan Medical City in Babylon province, AL-Amal Hospital for Communicable Diseases and AL-Hakeem Hospital, Najaf/Iraq, for a period from March 2022 to October 2022 to evaluate the role of some selected serological among patients with SARA-COV2 . The control group in this study included 54 subjects, divided into three groups (Apparent Healthy, patients suffered from SARS-COV2, patients suffered from CVD). Blood samples were examined through immunological methods, and an enzyme-linked immunosorbent assay (ELISA) was adopted for the detection of the concentration of TNF-alpha, IL6, IL-10,1L-12 and CCL2 .The immunological evaluation to clarify the theory of cytokines storm carried in the present study revealed that (TNF-alpha, IL6, IL-10,1L-12, and CCL2) for patients with COVID-19 and CVD was significantly higher than all the comparison group. The study reported that interleukin (6, 10, 12) and TNF-a are significantly increased in patients with covid19, CVD, and COVID-19 patients only, compared to healthy people. furthermore, IL-6 and IL-12 levels increased in patients with CVD only when compared to healthy people. There is a significant increase in CCL2 in all study groups compared to healthy people who have lower levels and this study indicated that the infection with Covid disease was severe and critical in most patients with CVD. This increased the number of deaths among them.Copyright © 2021 Muslim OT et al.
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Objective: To determine the impact of Covid-19 vaccines on sperm quality. Study Design: Case control study Place and Duration of Study: Department of Diabetes & Endocrinology, Chandka Medical College Hospital Larkana from 1st July 2022 to 31st December 2022. Methodology: Patients were enrolled as 50 those who had PCR confirmed Covid 19 history and 50 those who never got Covid-19. On this basis those cases who had a Covid-19 history were placed in group A while those who did not had Covid-19 history were placed in Group B. Patients clinical history including anamnesis, marital status, cryptorchidism, operative varicocele, or any chronic ailment were documented. A counting chamber was used for sperm count in a 100 square area. Spermatozoa was measured as either rapid-progressively motile (Type a), or as slow-progressively-motile (Type b), or as situ motile (Type c), and finally as immobile (Type d). The total semen sperm count was gained by multiplication of concentration of sperm with its volume. Result(s): Volume and concentration was significantly different in both study groups. Difference in tail anomaly was also observed. In group A, it was 29.20 +/- 10.26 while 27.59 +/- 12.31 was the value of group B. Almost equal number of participants were married. Azoospermia was only found among Covid patients. Conclusion(s): Azoospermia was only found in Covid patients and no such results were obtained from Covid negative patients.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Intro: Ritonavir-boosted nirmatrelvir has shown efficacy in reducing the rate of hospitalisation and 28-day mortality among unvaccinated populations with COVID-19. The role of Ritonavir-boosted nirmatrelvir among high risk hospitalised COVID-19 patients remained uncertain. Our study aimed to assess the efficacy of Ritonavir-boosted nirmatrelvir in reducing disease progression among high-risk hospitalised COVID-19 patients. Method(s): This is a retrospective case-control study (ratio 1:1) among hospitalised COVID-19 patients with mild-moderate severity, within 5 days of illness, and had at least one risk factor for severe disease. Treatment group (case) received Nirmatrelvir and Ritonavir twice daily for 5 days. Historical controls before the introduction of Ritonavir-boosted nirmatrelvir were obtained in the same hospital. Both groups received standard of care. The primary outcome was rate of clinical progression from non-hypoxia to hypoxia. Finding(s): 200 patients from January to July 2022 were included in the analysis, where 108 (54%) were male, mean age of 63.7 (SD 17.1), 95% completed primary COVID-19 vaccination and 91 (45.5%) had evidence of pneumonia (moderate severity). Most common comorbids were hypertension(65%), diabetes mellitus(40%) and overweight(36%). Clinical progression to hypoxia was significantly lower in the treatment group (4%) compared to the control group (18%) (OR=0.190, 95% CI: 0.0618 - 0.583). Comparing case to control, the rates of ICU admission were 1% vs 3%, mechanical ventilation 0% vs 2% and inpatient mortality 2% vs 2%. 97% patients completed Ritonavir-boosted nirmatrelvir in the treatment group. Conclusion(s): Among high-risk hospitalised COVID-19 patients who received ritonavir-boosted nirmatrevir, they were 81% less likely to experience desaturation. Ritonavir-boosted Nirmatrelvir remains beneficial among highly vaccinated populations during the Omicron wave in COVID-19 pandemic.Copyright © 2023
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Intro: Dysregulated inflammation plays a key role in the development of severe SARS-CoV-2 infection. One of the key cellular signaling pathway involved in the inflammatory response is JAK/STAT signaling. Among the hospitalized Covid patients with hypoxia to reduce the progression to ARDS, immunomodulators have a definite role. Baricitinib is an oral selective Janus kinase 1/2 inhibitor with anti-inflammatory properties. This study evaluates the efficacy and all-cause mortality among moderate to severe Covid patients who received Baricitinib. Method(s): A retrospective case-control study was carried out among moderate to severe Covid patients who had received Baricitinib. COVID severity matched group from the same time period was selected as the control. We evaluated the efficacy (based on WHO-ordinal scale) and difference in all-cause mortality among case and control groups. Baseline characteristics and outcome variables were retrospectively captured from the hospital health information system. Finding(s): During our study period, 2547 active Covid patients have admitted, out of which 105 patients received Baricitinib. Based on the retrospective analysis 75 patients were selected as the case group and 75 covidpositive patients of similar age and sex were identified by a simple random selection technique to serve as a control group. The age group of the baricitinib group 60.82 (+/- 13) and the Control group 62.34 (+/-13). Among the participants, 62.66% were severe (58% Baricitinib group & 66% control), 36% were with moderate severity (40% Baricitinib group & 33.33% control). The all-cause mortality of cohort was 43% (n=64), 36% (n=27) of cases as compared to 49.3% (n=37) of control group, (P Value= 0.06). Improvement in WOS score by at least 1-point cases 47% and 37.3 % in controls, (P Value= 0.09). Conclusion(s): Baricitinib when combined with standard of care, among hospitalized patients with moderate to severe Covid infection, showed a trend towards clinical improvement and decreased all-cause mortality.Copyright © 2023
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Objectives: To assess the immunological [Lymphocyte populations (LP) and Autoantibodies (Ab)] and clinical profile of rheumatoid arthritis (RA) patients who suffered from COVID-19 compared with non-COVID-19 RA patients. Method(s): A nested case-control study of RA patients treated under a strict follow-up model. RA patients and confirmed COVID-19 infection (last 24 months) and RA patients without the infection were included. Subgroups of cases: Long COVID (LC): symptoms after infection for >=4 weeks;Post COVID syndrome (PCS): symptoms for >=12 weeks;and patients with symptoms alpha4 weeks. Sociodemographic, clinical, and paraclinical variables of RA and COVID-19 infection (in cases) were captured. Antinuclear antibodies (ANA), anticardiolipin antibodies, lymphocyte populations (BD FACSDuetTM-BDFACSLyricTMmultiparameter flow cytometry) T cells, B cells, and NK were evaluated. Univariate and bivariate analyzes (STATA 17) were done. Result(s): 300 patients were included (148 cases/152 controls;87.3% women). Median age 59 years (IQR 11). 71.86% were in low disease activity. There were no significant differences in sociodemographic and clinical characteristics between cases and controls. Cases had a time since infection of 18.5 months (IQR 7). Of the total cases, 69%presented LC and 63%PCS.No significant differences were found between cases and controls in the lymphocyte population nor in the antibodies evaluated. There were no differences in the immune profile when comparing patients with LC and PCS with those with symptoms alpha4 weeks after COVID-19 infection. Conclusion(s): No differences were found in the behavior of the immunological profile (independent of symptoms of LC and PCS) in RA patients under strict follow up, evaluated long-term after infection with those who did not have COVID-19. This suggest that patients returned to their baseline homeostatic state, something that has not yet been reported up to now. These results should be replicated in populations with different RA characteristics.
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Intro: While the pediatric population has largely remained free of severe COVID- 19, in some situations SARS-CoV-2 infection has been associated with complications like Multiple Inflammatory Syndrome in children (MIS-C). Recently, cases of hepatitis in children have caused tremendous worry across the globe, we describe a unique presentation from 2021, subsequent to asymptomatic infection of SARS-CoV-2, a unique form of severe hepatitis designated by us as COVID-19 Associated Hepatitis in Children (CAH-C). The clinical presentations, temporal association, and viral parameters of CAH-C cases, and contrast to that of MIS-C cases are presented here. Method(s): As a retrospective and follow-up case-control study we reviewed all children within 14 years presenting with "sudden onset of hepatitis, elevated transaminases, non-obstructive jaundice. After performing all routine tests among them, those lacking marked inflammatory responses and without evidence of (a) other known causes of acute hepatitis (A-E) or previous underlying liver disease, and (b) multi-system involvement", being unique such cases were classified as CAH-C, and are described here. Finding(s): Among 475 children who tested positive, 37/47 cases had features of CAH-C, having symptoms of hepatitis only, with un-elevated inflammatory markers, 100% positivity for SARS-CoV-2 antibodies, and uneventful recovery. The remaining 10/47 having MIS-C had protracted illness, multiple system involvement, required admission to critical care, and a mortality rate of 30%. Among controls, only 26/50 (52%) had SARS-CoV-2 antibodies. Discussion(s): During the pandemic, various COVID-19 complications have been observed posing safety concerns, where our study identified a unique form of acute hepatitis in children designated as CAH-C. Conclusion(s): With the emergence of newer variants, including the Delta variant which predominated the second wave of infections in India and spread worldwide with changing presentations and complications, CAH-C is such new entity in children. It needs early identification and differentiation from other emerging syndromes during the ongoing pandemic for preventing adversities through timely intervention.Copyright © 2023
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Introduction: The COVID-19 vaccination campaign was implemented in Sibu, Malaysia in February 2021. We assessed the effectiveness of the CoronaVac vaccine against severe acute respiratory infections (SARI) hospitalisation associated with laboratory-confirmed SARS-CoV-2 by time since vaccination. Method(s): A test-negative case-control design was employed using a web-based national information system for PCR results of SARS-CoV-2 infection and COVID-19 vaccination, and the hospitalisation dataset in Sibu Hospital. Eligible SARI cases with SARS-CoV-2 RT-PCR positive were matched to those SARI cases with negative RT-PCR tests by age and workplace. Vaccine effectiveness was measured by conditional logistic regression with adjustment for gender, comorbidity, smoking and education level. Result(s): Between 15 March and 30 September 2021, in the dominance of lineages B.1.466.2 and B.1.617.2 (Delta variant), a total of 838 eligible SARI patients were identified. Vaccine effectiveness was 42.4% (95% confidence interval [CI]: -28.3, 74.1), and 76.5% (95% CI: 45.6, 89.8) for partial vaccination (after the first dose through 14 days after the second dose) and complete vaccination (at 15 days or more after receipt of the second dose), respectively. Sensitivity analysis using propensity score matching yielded a conservative estimate of 57.4% (95% CI: 9.2, 80.1) for complete vaccination. Conclusion(s): Primary immunisation with two doses of CoronaVac vaccine provided satisfactory protection against SARI caused by SARS-CoV-2 in the short term. However, the duration of protection, incremental effectiveness induced by boosting, as well as performance against new variants need to be studied continuously.
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OBJECTIVE: To explore the medical evidence published until April 20, 2022, about the efficacy and safety of tocilizumab in COVID-19 patients. METHODOLOGY: Scoping review that included PubMed and Scopus, searching for clinical trials and observational studies in English and Spanish. Additionally, records of clinical trials from the International Clinical Trials Registry Platform were analyzed. RESULT(S): Fifty-four documents were included: retrospective cohort studies (n = 20), randomized clinical trials (n = 16), case control studies (n = 7), non-randomized clinical trials (n = 5) and prospective cohort studies (n = 6), with a total study population of 20,007 patients. There were 15 records of clinical trials of which 10 were registered in the US National Library of Medicine. CONCLUSION(S): Tocilizumab could be effective and safe to treat patients with moderate to critical COVID-19, in conjunction with additional immunomodulators and antivirals. A greater number of randomized clinical trials, however, are needed to explore the efficacy and safety of tocilizumab.Copyright © 2023 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Introduction: COVID-19 seems to induce ischemic stroke by several potential mechanisms including promoting hypercoagulability, and worse functional outcomes have been reported in patients with stroke and the infection with SARS-CoV-2. Objective(s): Determine the association between functional outcome and COVID-19 in patients with stroke. Patients and Methods: We performed a case control study comparing patients admitted to a neurological reference center in Peru with a diagnosis of stroke before (controls) and after (cases) the onset of the COVID-19 pandemic. There were 31 cases diagnosed with COVID-19 and 62 controls without COVID-19. Bivariate analysis and conditional fixed-effects Poisson regression analysis were used to evaluate the association between the functional outcome of the stroke and COVID-19. Result(s): Cases had higher baseline serum glucose (133.5, IQR: 117.5-174 versus 117, IQR: 101-130, p = 0.033) than controls, higher neutrophil counts (7.91, IQR: 5.93-9.57 versus 5.96, IQR: 4.41-7.79, p = 0.008), lower lymphocyte counts (1.48, IQR: 1.04-1.8 versus 1.83, IQR: 1.26-2.32, p = 0.025), higher neutrophil/lymphocyte ratios (5.44, IQR: 4.0-8.1 versus 3.29, IQR: 2.25-6.02, p = 0.011), higher NIH stroke scale/score (NIHSS) (14, IQR: 9-18 versus 7 IQR: 5-11, p = 0.000), and higher modified Rankin scores at discharge (4, IQR: 4-5 versus 2, IQR: 1-4), p = 0.001). Seven (21.88%) participants died in the group of cases versus 1 (1.56%) in the controls (p = 0.014). The odds ratio of having a bad functional outcome at discharge was 1.344 (CI: 1.079-4.039;p = 0.029), adjusted by NIHSS at admission. Conclusion(s): Our findings suggest that ischemic strokes associated with COVID-19 are more severe, have worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.Copyright © 2023 Sociedad Neurologica Argentina
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Introduction: We have previously described decreased renal perfusion in acute kidney injury (AKI) due to critical COVID-19 [1]. The objective of this study was to compare the effects of plasma expansion with a standardized fluid bolus on renal perfusion in patients with AKI compared to similar patients without AKI. Method(s): A case control study design was used to investigate group differences before and after a standardized intervention. ICU-treated COVID-19 patients without underlying kidney disease were assigned to two groups based on KDIGO Creatinine criteria for AKI. Renal perfusion was assessed by magnetic resonance imaging using phase contrast and arterial spin labeling before and directly after plasma expansion with 7.5 ml/kg Ringer's Acetate (Baxter). Mean arterial pressure (MAP) was recorded before plasma infusion and compared with maximum value after. Data was analyzed with a mixed model repeated measures ANOVA for all kidneys using a random effect to account for research subjects. Result(s): Nine patients with AKI and eight without were included in the study. Patients in both groups were of similar mean age and weight, 66 (SD 8) years and 94 (SD 22) kg in AKI group and 64 (SD 15) years and 93 (SD 20) kg in patients without AKI. The response to plasma expansion was similar with increased MAP by 18 (CI 8-28) mmHg and 20 (CI 10-31) mmHg respectively (Table 1). Total renal perfusion and cortical perfusion was not significantly changed by plasma expansion, however there was a reduction of medullary perfusion in patients without AKI (Table 1). Conclusion(s): Plasma expansion with a standardized fluid bolus did not increase renal perfusion in critically ill patients with ARDS due to COVID-19.
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Background and Objectives: The aim of our study is to compare the children between the ages of 6 and 16 being in quarantine or hospitalised for at least 14 days with suspicion of COVID-19 and their parents and the children without suspicion of COVID-19 and their parents in terms of their mental exposure level. Method(s): A list of questions, investigating post-traumatic stress disorder (PTSD) symptoms in children and parents and prepared by arranging DSM-5 diagnostic criteria, The Revised Child Anxiety and Depression Scale - Parent Form, DSM-5 Level 2 Sleep Disorder Scale 6-17 Age Parents Form and Hospital Anxiety Depression Scale, were answered by parents. Result(s): The mean score of DSM-5 Level 2 Sleep Disorder Scale (respectively 16.72+/-8.31, 14.34+/-6.37) and the rate of confrontation of DSM-5 PTSD diagnostic criteria (respectively 8.5%, 2.9%) were statistically significantly higher in the study group of children compared to the control group (p<0.05). Mean score of the depression scale (respectively 8.37+/-3.70 and 6.97+/-3.63) and the rate of confrontation of DSM-5 PTSD diagnostic criteria (respectively 16.3%, 7.9%) were statistically notably higher in the parents of study group compared to the control group (p<0.05). In addition to this, a statistically important positive correlation was found between anxiety and depression levels of the parents and anxiety, depression and sleep scores of the children for all of them (p<0.05). Conclusion(s): Direct exposure to COVID-19 poses a higher risk for both children and their parents in the emergence of psychiatric symptoms than those without any direct exposure.Copyright © 2023, Medcom Limited. All rights reserved.
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Introduction. Coronavirus infection is associated with severe endotheliopathy, thromboinflammation and immunothrombosis leading to excessive release of von Willebrand factor (vWF) multimers from Weibel-Palade bodies, which can affect activity of ADAMTS-13 metalloproteinase (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) and the ADAMTS-13/vWF axis previously shown by us to be altered in non-pregnant women with severe COVID-19. Aim(s): to study a clinical role of hemostasis activation particularly ADAMTS-13/vWF axis in pregnant women after COVID-19. Materials and Methods. A prospective case-control study was conducted with pregnant women (n = 135) divided into 3 groups: group 1 included 45 women with prior COVID-19 during pregnancy, group 2 - 45 women in the acute phase of the infection during pregnancy, group 3 - 45 healthy pregnant women. The level of vWF and ADAMTS-13 was assessed in all patients. Results. The concentration of vWF antigen (vWF:Ag) in the acute period of the disease in pregnant women with COVID-19 was significantly higher compared to the control group (p < 0.001). ADAMTS-13 level in pregnant women after COVID-19 did not differ from that of in control group, while vWF level was significantly higher in 66.7 % (30/45). The ADAMTS-13/vWF ratio was increased and significantly differed both in pregnant patients during the acute period of the disease (p < 0.001) and pregnant women after infection (p = 0.0002) compared with the control group. Conclusion. Our results show that endotheliopathy was prominently manifested in pregnant women with COVID-19 and persisted for several months after disease. The ADAMTS-13/vWF ratio determines the pathway functioning, the risk of microcirculation disorders and clinical complications.Copyright © 2023 Vestnik Sankt-Peterburgskogo Universiteta, Yazyk i Literatura. All rights reserved.
ABSTRACT
Purpose of Study: Teledermatology, defined as the use of technology to provide dermatology services to individuals in a remote setting, has grown considerably in popularity since the onset of the COVID-19 era. Teledermoscopy utilizes a dermatoscope attachment paired with a smartphone camera to visualize colors and microstructures within the epidermis and superficial dermis that cannot be seen with the naked eye alone. When combined with store-and-forward technology, teledermoscopy of lesions concerning for skin cancer can improve virtual referral and triage workflow. Methods Used: Our retrospective case-control study evaluated the efficacy of a smartphone dermatoscope borrow program in the remote triage of individuals with self-selected skin lesions of concern and its effect on subsequent in-person follow-up visits. A retrospective medical record review was conducted of all Oregon Health and Science University (OHSU) Department of Dermatology spot check image submissions utilizing the smartphone dermatoscopes between August 2020-2022. Dermoscopic images of skin lesions that included corresponding non-dermoscopic clinical images in their submission were included in our review (n=70). A blinded expert dermoscopist then reviewed the clinical and dermoscopic images separately and utilized standard clinical algorithms for skin cancer (ABCD criteria: asymmetry, irregular borders, multiple colors, diameter>= 6mm for clinical images;3-point checklist: dermoscopic asymmetry, atypical network, blue-white structures for dermoscopy images) to determine whether the imaged lesion should translate to an in-person visit for further evaluation. Summary of Results: Of the 70 skin lesions submitted, 59 warranted in-person evaluation from clinical (non-dermoscopic) image review compared to 29 warranting in-person evaluation from dermoscopic images of the same lesion. Thus, this is a 51% reduction of conversion to in-person consultation with the addition of smartphone dermatoscope images in virtual lesion triage (P<0.001, McNemar's Test). Conclusion(s): Implementing patient-led teledermoscopy may reduce frequency of in-person visits for benign lesions, and thus, may decrease wait times for other patients with concerning and possibly malignant lesions. Decreasing the frequency of unnecessary visits may not only improve patient quality of life, but also promote cost-effective expenditures for health systems at large.