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BACKGROUND: COVID-19 has been associated with high morbidity and mortality in renal transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. The outcome following vaccination in renal transplant recipients is less reported. AIM OF THE STUDY: To assess effect of vaccination in renal transplant recipients with COVID-19 METHODS: We enrolled patients who underwent kidney transplantation at our center who tested positive for COVID-19 from the beginning of the pandemic till June 2022. Patients were screened for baseline and transplant characteristics functional parameters comorbidities immunosuppressive therapies vaccination status and treatment received. COVID-19 disease severity was assessed. Patients were followed up during the pandemic until June 2022 of those admitted or home quarantined via teleconsultation. Data was collected compiled and analyzed. RESULT(S): A total of 85 renal transplant recipients with COVID-19 infection were studied. The mean age was 42.5 years. Nine were not vaccinated, 11 had taken 1 dose of vaccination, and rest completed 2 doses of vaccination. 23 had received antibody cocktail, 65 survived, and 20 succumbed to COVID-19. A total of 48 of them had graft dysfunction, 22 had severe graft dysfunction requiring hemodialysis. Among those who expired only had received antibody cocktail, all of them had severe graft dysfunction and only 2 were not vaccinated. Among those who expired most expired in the second wave of the pandemic. CONCLUSION(S): Renal transplant recipients with COVID-19 have a high risk of mortality. Comorbidities like obesity, diabetes mellitus, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. Effect of vaccination and outcome of COVID-19 infection in renal transplant recipients is under reported. There is risk of severe COVID-19 infection despite vaccination. Therefore, safety preventive measures to be continued. More work needed to find a definitive treatment for COVID-19 infection and much more efficacious vaccines and vaccination strategies to be designed.
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INTRODUCTION: Poor metabolic health increases the risk of COVID-19 acute respiratory distress syndrome (ARDS), however, its relationship with non-COVID-19 ARDS remains controversial. ARDS is often considered a heterogeneous disease caused by sepsis, pneumonia, trauma, transfusions, and aspiration. In this study, we hypothesized that metabolic inflammation may contribute to differential outcomes in ARDS primarily caused by infection. METHOD(S): This was a secondary analysis of seven studies from the ARDS and Prevention and Early Treatment of Acute Lung Injury network trials within the Biologic Specimen and Data Repository Information Coordinating Center database. A metabolic subphenotype, defined by obesity, diabetes, and hypertension, was compared to a control population. The overall results showed lower adjusted mortality with this subphenotype. In this report, we performed stratified analyses to estimate effect modification by the metabolic subphenotype. We considered metabolic inflammation to reside along the causal pathway between infection and ARDS outcomes, and as such, stratified for primary ARDS etiology (e.g., sepsis or pneumonia as compared to other primary etiologies). The primary outcome was 28-day mortality. Secondary outcomes included 90-day mortality, ventilator free days, organ-failure free days, ICU free days, and length of hospital stay. RESULT(S): Among 4,288 ARDS trial participants, 3,205 (74.7%) had primary ARDS etiologies sepsis or pneumonia and 1,083 (25.3%) aspiration, trauma, transfusions, or other causes. of those with sepsis or pneumonia, 364 (11.4%) met criteria for the subphenotype versus 2,841 (88.6%) control. In the non-infectious cohort, 90 (8.3%) met subphenotype criteria versus 993 (91.7%) control. In adjusted analyses, the subphenotype stratified by sepsis and pneumonia was associated with lower 28- and 90-day mortality (adjusted odds ratio [aOR] 0.64 [95%CI, 0.48-0.84] and aOR 0.69 [95%CI, 0.53-0.89], respectively). However, in ARDS due to other causes, analyses were not significant (mortality at 28 days, aOR 1.18 [95% CI, 0.70-1.99] and 90 days, aOR 1.26 [95% CI, 0.77-2.06]). Secondary outcomes were not significantly different. CONCLUSION(S): A metabolic subphenotype of ARDS is associated with lower risk of mortality in non-COVID ARDS primarily caused by sepsis or pneumonia.
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INTRODUCTION: Data on obesity and diabetes in the acute respiratory distress syndrome (ARDS) are mixed. Metabolic Syndrome is a heterogeneous inflammatory state, and can be identified by metabolic risk factors. Previously, a metabolic sub-phenotype, characterized by obesity, diabetes, and hypertension, was associated with COVID-19 ARDS development and mortality. We showed this sub-phenotype was associated with lower mortality in non-COVID-19 ARDS, however, it is unclear how severity is impacted. METHOD(S): We performed a secondary analysis of individual patient-level data from seven randomized control trials in the ARDS and PETAL Networks from the Biologic Specimen and Data Repository Information Coordinating Center database. The preliminary mortality results from this study comparing the sub-phenotype to control was previously reported showing lower mortality for this sub-phenotype. Here, we studied each criterion in isolation, as an equally-weighted contributor, and also compared the outcome of severe ARDS, defined as PaO2/FiO2 ratio of less than 100 at enrollment, between cohorts. Multivariable regression models were performed. RESULT(S): Among 4,288 ARDS trial participants, 454 (10.6%) with a metabolic sub-phenotype were compared to 3,834 (89.4%) controls. Prevalence of metabolic disease was high with 2,831 (66 0%) participants carrying at least one metric of poor metabolic health (1,457-0/3 criteria, 1,398-1/3 criteria, 979-2/3 criteria, 454-3/3 criteria). The adjusted odds of dying before days 28 or 90 were progressively lower with each metabolic criterion added as compared to a nonmetabolic subgroup. Interestingly, each criterion in isolation was similarly associated with improved mortality without one particular risk factor contributing more than another, a finding supported by heterogeneity testing. Lastly, 212/454 (47%) of the metabolic sub-phenotype group met criteria for severe ARDS as compared with 1529/3834 (40%) control. The sub-phenotype was significantly associated with severe ARDS (adjusted OR 1.26 (95%CI 1.026 - 1.541). CONCLUSION(S): Obesity, diabetes, and hypertension are equal contributors to a metabolic sub-phenotype of non-COVID-19 ARDS that is significantly associated with lower mortality. However, this sub-phenotype was significantly associated with severe ARDS at enrollment.
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Background. Baricitinib is a treatment authorized by the FDA for the treatment of moderate to severe COVID-19, despite this there are few approved drugs;polymerized type I collagen (PTIC) is a drug that has been used in Mexico with great potential for treating moderate to severe cases of COVID-19. Methods. Comparative, descriptive and retrospective analysis of two populations of adult patients affected by COVID-19 confirmed by antigen test or RT-PCR as well as CO-RADS 6 CT, who consented to be treated between 2020 and 2021, a population using oral baricitinib at a dose of 4mg/day/14 days and another using polymerized type I collagen intramuscularly at a dose of 1.5ml every 12 hours for 3 days, followed by 1.5ml every 24 hours for 4 days;The most affected age and gender, comorbidities and laboratory abnormalities are analyzed, as well as improvement in inflammatory and oxygenation indices measured by pulse oximetry and SAFI (SpO2/FiO2), finally the outcome of the patients and the presence of adverse events. Results. 80 patients for each group, the most affected gender was male;the average age in the PTIC group was 51 years and in the baricitinib group it was 56 years;the main comorbidities were obesity, diabetes and hypertension in both groups;the decrease in acute phase reactants such as CRP, D-dimer and ferritin was greater in the PTIC group compared to the baricitinib group, the latter drug requiring a regimen of more days to achieve the objectives of the first drug (PTIC 7 days and baricitinib 14 days);Similarly, in oxygenation measured, the PTIC group reached goals in less time compared to the baricitinib group, which required twice as many days of treatment to achieve adequate oxygenation;Regarding the outcomes, there was a higher mortality in the baricitinib group compared to the PTIC group (6.25% vs 3.75%). Regarding adverse events reported for the PTIC group, they were minor and related to the intramuscular administration of the drug in 7 patients, while in the baricitinib group, 5 patients were reported with added bacterial pneumonia. Conclusion. Polymerized type I collagen has anti-inflammatory and immunomodulatory potential similar to baricitinib in cases of moderate to severe COVID-19, even reaching treatment goals in less time both in inflammatory indices and in oxygenation indices.
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Background. Thai government had a policy defined population groups that are at risk of severe COVID-19 infection. It is called "608 group" consisting of age more than 60 years old, obesity, diabetes mellitus, cancer, cerebrovascular disease, respiratory disease, chronic kidney disease, HIV infection, and pregnancy. But no study has evaluated performance of this policy. We aimed to develop parameter risk-based scoring system from Thai policy for diagnosis of severe COVID-19 infection. Methods. A study was carried out in 11,677 patients with confirmed COVID-19 infection were admitted to Hatyai hospital, Songkhla, Thailand from 1 April 2021 to 31 December 2021. Patients were categorized to severe COVID-19 infection if their oxygen saturation less than 94% or need oxygen supplement. Multivariable logistic regression was used to explore for predictors. The logistic coefficients were transformed to risk-based scoring system. Results. A total of 11,677 patients were included in analysis and predictive model development, 1036 (8.88%) patients were severe COVID-19 infection, and 10,631 (91.12%) patients were non-severe COVID-19 infection. Age more than 60 years old, obesity, diabetes, cancer, cerebrovascular disease, respiratory disease, chronic kidney disease, HIV infection, and pregnancy were used for derivation of the scoring system. The score-based model showed area under ROC of 0.81 (95%CI 0.79 - 0.82). The scoring system ranged from 0 to 40 was classified into 3 subcategories for clinical practicability. The sensitivity and specificity for predictive of severe COVID-19 were 81.18% and 69.83% for low risk patient, 70.56% and 80.79% in moderate risk patient, and 54.92% and 89.81% in high risk patient. Conclusion. This simplified risk-based scoring system for prediction severe COVID-19 disease could aid general physicians or internist in evaluation and triage of patients who present with COVID-19 infection and help physicians in management and prioritization of patients in outbreak situation.
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Background. Coronavirus disease 2019 (COVID-19) is increasing rapidly among young adults in worldwide. Our knowledge, COVID-19 was more severe in elderly patients. Only few studies described clinical and outcome of young adults with COVID-19 infection. A recent large retrospective data in US found increasing severity of COVID-19 in young adults due to obesity, hypertension, and diabetes, however there is lacking Asian ethnicity in this study. We aimed to evaluate clinical outcome of COVID-19 infection in young adult and middle-aged group. Methods. A cohort study was carried out in 10,072 patients with confirmed COVID-19 infection were admitted to Hatyai hospital, Songkhla, Thailand from 1 April 2021 to 31 December 2021. We collected data directly from patient and medical record. The results of primary objective were compared young adults and middle-aged patients and secondary objective were analyzed risk factor of severe COVID-19 among young adult patients by multivariable logistic regression analysis. Results. The preexisting disorders were significant more observed in middleaged group. Obesity was the most common in both group, 540 [(11.66%) and 800 (14.17%) patients;p< 0.001] in young adult and middle-aged group respectively. Diabetes and hypertension were frequently observed in middle-aged group. Severe pneumonia was found [500 (9.19%) compared with 99 (2.14%);(adjusted odd ratios (aORs) 2.75;95% confident interval (CI) 2.18 - 3.49) p< 0.001] patients in middleaged group and young adult group. mortality rate was more in middle-aged group [91 (1.67%) and 11 patients (0.24%);[aORs 4.08 (95%CI 2.12 - 7.87) p< 0.001]. The risk of severe pneumonia among young adults group. Diabetes was the most increased risk (9 (9.09%) patients in severe pneumonia [aOR 16.27 (95%CI 5.82 - 45.5;p-value< 0.001)]. Conclusion. Data from our study was different than another. In US or Europe young adult was increased severity of COVID-19 due to their pre-existing disease (obesity, diabetes, and hypertension). But in Asian population co-morbidity not much as in US or Europe therefore middle-aged group still had more severe COVID-19 than young adults. The factor contributing to the severe COVID-19 among young adult group, diabetes was the most common and followed by cardiovascular disease and HIV infection.
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A subset of cancer patients is particularly vulnerable to SARS-Cov-2 infection;however, real-world outcomes-based data on primary central nervous system tumor patients is sparse. This retrospective case series describes a cohort of adult glioma patients seen at Stanford Cancer Center between 1/20/2020 through 5/24/2022 who contracted SARS-Cov-2. We identified 18 patients with a diagnosis of glioma, with a median age of 54 years, who were infected with Covid-19. One patient contracted Covid-19 twice during this two-year period. Of these patients, four had pathology confirmed low-grade glioma, defined as oligodendroglioma or astrocytoma WHO grade 2, and 14 patients had high-grade glioma, defined as astrocytoma or glioblastoma WHO grade 4. Median KPS at time of infection was 70. Six individuals had notable cardiovascular comorbidities including coronary artery disease, obesity, and/or diabetes. All but one patient was vaccinated against Covid- 19, and 6 were taking dexamethasone at the time of infection. Three patients required hospital admission for management of Covid-19 symptoms, although none required ICU-level of care. None died from Covid-related complications;however, two died from complications of their underlying cancer at the end of study. Our data suggest that glioma patients seen at Stanford Cancer Center do not experience an exceptionally high Covid-19 infectivity, hospitalization, or mortality rate, especially when compared to other vulnerable populations such as lung cancer patients. High vaccination rates, fairly low prevalence of cardiovascular comorbidities, and adherence to pandemic precautions among this cohort may have contributed to these results.
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Cardiovascular complications of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection are well-described in the general population but remain limited among pregnant patients. This review summarizes data from case reports, case series, and observational studies of cardiovascular manifestations of corona virus disease 2019 (COVID-19) in pregnant patients and provides recommendations to the cardiovascular clinician regarding management considerations in this vulnerable population. Pregna is an immunocompromised state in which cardiovascular demands are increased. Cardiovascular complications of COVID-19 that have been described in pregnancy include myocardial injury, cardiomyopathy, thromboembolism, pre-eclampsia and arrhythmia. Physiologic and cardiovascular changes in pregnancy predispose pregnant patients with COVID-19 to more severe illness than the general population. Black or Hispanic race, obesity, diabetes, hypertension and lung disease are risk factors for more severe infection, maternal death and adverse perinatal outcomes. Pregnant patients with severe COVID-19 disease compared with non-pregnant age-matched women with COVID infection are more likely to be admitted to the intensive care unit (ICU), receive mechanical ventilation and require advanced mechanical circulatory support. Cardiovascular complications of COVID-19 in pregnant patients requires further attention, particularly given the anticipated increase in birth volume and ongoing nature of COVID-19 pandemic with novel variants. Clinicians should have a lower threshold for cardiac testing and multidisciplinary management in pregnant women with severe COVID-19 disease. Given the persistence of COVID-19 within our communities, diagnostic laboratory and imaging testing for high-risk pregnant patients hospitalized with COVID-19 infection should be routine. We strongly urge the implementation of a cardio-obstetric multidisciplinary team in individually managing these high-risk patients in an effort to improve maternal and fetal outcomes. Copyright: © 2022 The Author(s).
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Introduction: Patients with mental disorders mainly schizophrenia represent a vulnerable population. In Covid-19 pandemic situation , could schizophrenia be considered as a significant mortality risk factor ? Objectives: In this study, we aimed to explore the odds of significant COVID-19 mortality among schizophrenia patients Methods: Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( schizophrenia [MeSH terms]) AND (COVID-19, mortality[MeSH terms]) Results: Our review included 4 population-based cohort studies covering the period from december 2019 to May 2021. The data showed increased mortality risk among individuals with schizophrenia who have had COVID-19. Indeed, this high rate of mortality maybe associated with multiple factors such as unhealthy lifestyle , low socioeconomic status and comorbidities as obesity, diabetes and cardiovascular conditions. The use of antipsychotics can be considered as a risk factor regarded its immunomodulatory effects. Furthermore, stigma and discrimination towards mental illnesses particularly schizophrenia might have contributed to a worse prognosis . Conclusion(s): Schizophrenia is a severe mental disorder , associated with an increased high risk Covid-19. Thus, this population require enhanced preventive and disease management strategies.
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Case Diagnosis: Ulnar Mononeuropathy following COVID-19 infection. Case Description or Program Description: A 44-year-old male with history of morbid obesity presented with coronavirus disease 2019 (COVID-19) infection resulting in a prolonged hospitalization of 37 days. While admitted he was largely proned, however never required intubation. While hospitalized, he developed numbness, tingling, and weakness in digits 4-5 of his left hand exacerbated by pressure on the elbow. No symptoms were present in the contralateral arm. Setting(s): Academic Acute Care Hospital Assessment/Results: Magnetic resonance imaging of the brain and cervical spine were unremarkable. Physical examination of digits 4-5 in the left hand revealed reduced sensation to light touch, an inability to fully extend the digits, and 4/5 strength with abduction. Electrodiagnostic testing demonstrated absent left ulnar sensory nerve action potential when recorded from the left 5th digit and reduced motor conduction velocity across the elbow (39m/s) compared to the below-elbow segment (53m/s) when recorded from the left ulnar abductor digiti minimi, consistent with conduction block. He declined needle electromyography due to potential pain. His hemoglobin A1c was 7.3%. Discussion (relevance): Peripheral nerve injuries (PNIs) may occur in up to 14.5% of patients with COVID-19 who undergo prone positioning, and the ulnar nerve is the most frequently affected. We present a case of ulnar mononeuropathy during COVID-19 hospitalization. Etiology is likely multifactorial, with prone positioning, similar risk factors, or direct pathogenicity contributing. Compressive injuries of the ulnar nerve have been associated with improper prone positioning. Additionally, PNI shares risk factors with severe COVID-19, namely obesity and diabetes in this patient. The hyperinflammatory state associated with COVID- 19 also increases the risk of PNI. Lastly, COVID-19 invades cells by binding angiotensinogen converting enzyme-2 receptors, which are present in the nervous system. Conclusion(s): COVID-19 infection may be associated with an increased risk of peripheral nerve injuries through a multifactorial mechanism. Further research is needed to establish the association.
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Background: COVID-19 continues to spread worldwide with considerable morbidity and mortality. CKD is among the most prevalent diseases related to COVID-19 mortality. AKI is a common COVID-19 complication. Distinct pandemic waves were observed as a function of specific COVID-19 variants, public health policies and vaccination status. Studies reported changing patient characteristics and outcomes by different waves. However, changes in the effect of clinical risk factors as a function of each wave have not been well studied. Here, we examine the temporal effects of pre-existing CKD (also KDIGO A and G stages) on COVID-19 outcomes by waves. Method(s): We used estimated effective reproduction numbers with US data to define distinct waves. We designed a COVID-19 algorithm based on WHO guidelines, N3C COVID-19 V2.2 and local data characteristics as having >=1 positive SARSCov- 2 RT-PCR or antibody test, or >=3 diagnosis or problem codes if no relevant tests. Comorbidities and outcomes were captured electronically using published algorithms. We used logistic regression and survival analysis to identify predictors of COVID-19 outcomes for each wave. Result(s): Five national waves were identified and mapped to 4 distinct NYC waves observed at Columbia University Medical Center (CUMC). We identified 64246 COVID-19 cases at CUMC, 8% were severe, 18% were hospitalized. The risk of severe COVID-19 was associated with pre-existing CKD, heart disease, diabetes and hypertension in most waves;and lung disease, obesity and cancer in at least one wave. AKI occurred in 49% of severe cases and 35% of hospitalized ones. The risk of AKI was associated with heart failure, obesity, diabetes and cancer in most waves;and CKD, CAD, hypertension and stroke in one or two waves. The risk of AKI was not associated with pre-existing lung disease. A and G stages independently predicted severe COVID-19 and COVID-19 related AKI across all waves. Pre-existing albuminuria significantly predicted COVID-19 mortality independent of G-stage, diabetes, obesity, hypertension, cancer or cardiovascular disease throughout the entire pandemic. Conclusion(s): Pre-existing kidney disease was among the strongest and most consistent clinical predictors of poor COVID-19 outcomes regardless of the pandemic wave. Even in the pandemic late phase, patients with decreased kidney function or albuminuria were at a higher risk of severe COVID-19, AKI and death.
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Background: Some factors associated with severe COVID-19 outcomes have been identifed in patients with psoriasis (PsO) and infammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specifcities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifcally licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking. Objectives: To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA. Methods: This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defned as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, lefunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects. Results: A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56;other CVD alone: 1.89, 1.22-2.94;vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71;DM alone: 1.85, 1.39-2.47;obesity and DM: 1.89, 1.34-2.67;vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82;moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72;moderate/severe disease activity and GC intake 2.30, 1.41-3.74;vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51;1 January 2021 onwards: 0.52, 0.41-0.67;vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65;vs PsA), and exposure to TNFi (0.58, 0.45-0.75;vs no DMARDs), IL17i (0.63, 0.45-0.88;vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997;vs no DMARDs) and NSAIDs (0.77, 0.60-0.98;vs no NSAIDs). Conclusion: More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.
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Introduction Obesity and diabetes mellitus are often regarded as risk factors for poorer outcomes in various infections. This study was conducted to determine the impact of diabetes mellitus and obesity on clinical outcome of COVID-19 infected patients. METHODOLOGY A prospective study was conducted from April 2021 to October 2021 among patients aged >18 years, admitted to Hospital Sarikei with confirmed SARS-CoV-2 infection stratified as categories 4 and 5. Pregnant women and patients with existing lung pathology were excluded. Demographic data, comorbidities, BMI, and clinical outcome parameters such as number of days on oxygen supplementation, need for mechanical ventilation and mortality were recorded. Results A total of 458 patients were included, mean age was 61.6 ± 14.2 years and 231 (50.4%) participants were male. Almost half, 211 (46.1%) were diabetics and 165 (36.0%) were found to be obese. Diabetic patients were on oxygen supplementation for a mean duration of 7.30 ± 5.63 days, significantly longer than nondiabetic patients with a mean duration 6.01 ± 4.90 days, p=0.009. There was no significant difference in number of days on oxygen between obese and non-obese patients. A higher proportion of obese patients were mechanically ventilated, 38.2% vs 25.3% non-obese patients, p=0.004. There was no increase in mechanical ventilation among diabetic patients. The rate of mortality in the obese group was also significantly higher than non-obese patients, 23.0% vs 12.6% respectively, p=0.009. The mortality rate among diabetics was not significantly different from that of nondiabetics. Conclusion Diabetic patients required oxygen supplementation for a significantly longer duration than nondiabetics. The rates of mechanical ventilation and mortality were significantly higher among obese patients compared to non-obese patients. These findings suggest that vigilant monitoring and better management for obese and diabetic patients with COVID-19 infection are important to improve clinical outcome.
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Background: COVID-19 pandemic significantly increases morbidity and mortality in vulnerable veteran populations. This observation cohort study evaluates nutrition risk factors associated with mortality in COVID-19 patients admitted to VA Level 1A complexity ICU. Methods: 508 COVID-19 patients requiring VAMC ICU admission 02/2020-07/2021 were retrospectively reviewed. We hypothesized that Covid19 may cause significant malnutrition. Survivors and mortality cohorts were assessed with five nutrition and physiology risk assessment algorithms: APACHE II, SOFA, ASA, NRI and GNRI, and co-morbidities: age, gender, race, obesity, diabetes, hypertension, coronary disease, and malnutrition. Results: Mortality: 111 of 508 patients (21.85%). Low admission NRI (45.27±2.1) and GNRI (60.73) indicated malnutrition in all patients. Both scores lower in mortality vs. survivors (NRI:42.45±4.1 vs. 46.06±3.49, p≤0.004) (GNRI: 56.4±12.56vs 61.9±25.88, p≤0.003). Nutritional markers lower in mortality vs. survivors: Albumin (2.9±0.5 vs. 3.4±0.6, p≤0.001), total lymphocyte count (1.23±1.8 vs. 2.5±1.9, p≤0.005), Hematocrit (33.2±9.9 vs 38.9±7.4, p≤0.01.) Physiology risk assessment scores were higher in mortality vs survivors: SOFA (4.24±1.73 vs. 2.54±0.88, p≤0.0005), APACHE II (12.3±4.64 vs. 7.19±2.48, p≤0.0002), and ASA (3.86±0.53 vs. 2.9±0.75, p≤0.0003). Comorbidities were higher in mortality vs. survivor: age (72.3±9.5 vs 67.8±12.9y/o, p≤0.001), obesity (87.39% vs. 42.06%, p≤0.04), diabetes (58.5% vs. 47.6%, p≤0.05), Hypertension (34.2% vs 11.58%, p≤0.04), Coronary disease (61.26% vs. 32.74%, p<0.002). No mortality difference between genders: (21.86% male, 21.74% female, p=NS), or races:(21.48%AA, 22.08% W, 22.08 UNK. p=NS) Conclusion: All COVID-19 patients were malnourished on ICU admission. Malnutrition low NRI score, high risk assessment scores, with comorbidities directly predict COVID-19 mortality risk regardless of gender or race. Low NRI scores indicate need for nutritional support to critically ill COVID-19 patients.
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More than half of the human body consists of non-human microbes such as bacteria and viruses. Microbes can cause infection, inflammation, immune system disorders, obesity, diabetes, respiratory and cardiovascular illnesses, even heart failure. Microbes are governed by the cycles of nature, including the cycles of day and night, and are influenced by what and when we eat. Research has shown intermittent fasting to be a promising approach for reducing inflammation, improving metabolic health and reducing risk factors for cardiovascular disease, possibly through influencing gut microbial composition. This article explores the role of the microbiome and intermittent fasting on human health from the perspective of traditional Chinese medicine (TCM).
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Background and Aim of the study: Since the beginning of the COVID-19 pandemic, our hospital (G.O.M. of Reggio Calabria) has admitted all patients affected by SARS-CoV-2 disease (COVID19) who needed hospitalization within the province of Reggio Calabria. The purpose of this study is to evaluate the characteristics of gender, age, average hospitalization and comorbidities. Materials and Methods: All patients admitted to our hospital for COVID-19 in 2021 were evaluated. Results: The total number of patients was 1523. The average age was 63.1, of which 844 males (55.4%) and 679 females (44.6%);the mean hospitalization period was 16.4 days. There were 316 deaths, equal to 20.7% of the hospitalized. The average age of the deceased was 77.4, with an average hospitalization of 14.3 days. The distribution of deaths by age group does not reveal any death under the age of 40 and a concentration in the more advanced ages, about 90% of deaths in patients over 60. Only 15 of 316 deceased patients (4.7%) did not have comorbidities, most of the patients had 3 or more comorbidities (51%), the most frequent were cardiovascular diseases, chronic respiratory diseases, neurological diseases, obesity, diabetes, chronic renal failure. Conclusions: Collecting this data is useful for re-evaluating the work done and comparing it with other areas of our country. We intend to elaborate these data with respect to the different pandemic waves and the different times of the vaccination campaign.
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Background: As we remember the therapeutic development of insulin one hundred years ago, in Tulsa, Oklahoma we remember a race massacre in the same year. Are these connected? How? Elbert Huang, University of Chicago’s Center for Chronic Disease Research and Policy, writes that diabetes has been called a “slow moving pandemic.” As U.S. outbreaks surge, a study finds 40% of people who have died with COVID-19 had diabetes (Terhune et al, 7/24/2020 Reuters). The Center for Disease Control (2020) shows the prevalence of diabetes is highest among American Indians/Alaska Natives (14.7%) Hispanics (12.5%), non-Hispanic Blacks (11.7%), and non-Hispanic whites (7.5%). American Indians, Latinos and Blacks are suffering from COVID-19 in the same disproportionate numbers. COVID-19 can grow vigorously in a high blood sugar environment and may cause new cases of diabetes. A woman with diabetes loses a longtime relationship when her friend refuses to wear a mask around her. There are complex interactions between previously adaptive survival mechanisms, pre-Columbian culture and diet. Conquest by Europeans resulted in genocide, great poverty and oppression of indigenous peoples across the Americas. It brought slavery to the Americas when large numbers were needed to grow tobacco and sugar cane from new demands. During high or chronic levels of stress, the adaptive mechanism known as fight or flight allows people to protect themselves in emergency conditions, becomes destructive when people are not allowed to fight or flee. Cortisol, produced during these times, becomes toxic to the body and the brain, impairs immune systems, increases heart and vascular diseases, and lowers resistance to diabetes. In the extreme situation of genocide and slavery, stress becomes chronic and the levels of cortisol remain elevated. In times of famine, the ability of the individual to “store” fat in the abdomen was critical. In times of feast, the survival mechanism is no longer adaptive and can result in obesity, diabetics and death. What then are the factors that make these populations vulnerable to obesity, diabetes and Covid? Violence, poverty and racism remain for peoples whose once adaptive survival responses now contribute to disease and death. Many in the Hispanic community have the same story of conquest. The majority are poor. To the extent that they are considered to be “undocumented aliens,” their lives are precarious. “Black Lives Matter” is the response not only to poverty and racism but violence, especially the killing of innocent blacks by law enforcement. The legitimate fear of driving while black and brown is part of daily life. Native Americans have the highest numbers of violence of any group. It is statistically Caucasian male against Native male and female. Present examples are the large numbers of trafficking and murder of Native American women. These concerns are important to understand in our Native American organization with minority clients. Their concerns are about obesity, genetics, intergenerational/ongoing trauma, medication side effects, racism, community mistrust, lack of education, blame, confusion about diets, surgical intervention, family/friend support, and possibility of remission.
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Background: Some in vitro, animal, and epidemiological data suggest that tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) might be an efficacious treatment for COVID-19 Methods: In a multicenter open-label, pragmatic, randomized trial in 25 hospitals in Spain we included participants with symptomatic SARS-CoV-2 detected by PCR or antigenic test, with a creatinine clearance > 60 mL/min, > 60 years or younger if they had at least 2 comorbidities (hypertension, obesity, diabetes, cirrhosis, chronic neurologic disease, active cancer, heart failure, coronary heart disease or COPD). Participants were randomized to receive or not TDF/FTC. Randomization was stratified by age group, symptoms duration (< or ≥ 5 days) and health care setting (hospitalized, long-term care facility, ambulatory). Primary outcome was 28 days mortality. Secondary outcomes were disease progression (increased O2 requirements, need for mechanical ventilation or increase in medical therapy: steroid dose, need for tocilizumab). At any moment during the trial participants with room air O2 saturation < 95% and ≥ 1 increased inflammatory biomarker could be randomized to dexamethasone (D) or dexamethasone plus baricitinib (DB) Results: 355 participants included (TDF/FTC n=177, no TDF/FTC n=178), median age 67 years (IQR 62-73), male (64.5%), median days of symptoms 8 (IQR 5-10), 29% with < 5 days of symptoms, 96.9% hospitalized, 35.5% with 1 and 36.6 % with ≥ 2 comorbidities (62.8% hypertension, 9.3% diabetes, 1.7% obesity), median room air SaO2 95% (IQR 94-96), 63% receiving O2 and 11.8% Remdesivir. 74% of participants were simultaneously randomized to D or DB. There were not statistically significant differences in endpoints in participants not treated vs.treated with TDF/FTC: mortality 2.2%/4.0%, disease progression 23.6%/22.0%, deferred randomization to D or DB 6.7%/6.2%, mechanical ventilation (invasive or noninvasive) 22.5%/20.3%, days since randomization until discharge (median [IQR]) 7 [5,14]/6 [4,12], discharge before 28 days 91.9%/89.7%. By Cox regression Hazard Ratio (95% CI) of 28-day mortality was 1.96 (0.55-7.01) for participants treated with TDF/FTC. Serious adverse events occurred in 6.18%/5.65% of participants not treated/treated with TDF/FTC. Adverse events leading to TDF/FTC discontinuation occurred in 2.26%. Conclusion: In this clinical trial of high-risk patients with COVID-19 TDF/FTC did not improve disease outcomes. Overall mortality was unexpectedly low.
ABSTRACT
Background: Recent studies suggest that baricitinib added to dexamethasone may reduce mortality in hospitalized COVID-19 patients requiring supplemental oxygen Methods: In a multicenter open-label, pragmatic, randomized clinical trial in 25 hospitals in Spain we included symptomatic participants with SARS-CoV-2 detected by PCR or antigenic test, with a creatinine clearance >60 mL/min, > 60 years or younger if they had at least two comorbidities (hypertension, obesity, diabetes, cirrhosis, chronic neurologic disease, active cancer, heart failure, coronary heart disease or COPD). Participants were initially randomized to receive or not tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). At any moment during the trial participants with room air 02 saturation < 95% and at least one increased inflammatory biomarker could be randomized to dexamethasone (D) or dexamethasone plus baricitinib (DB). Primary outcome was 28 days mortality. Secondary outcomes were disease progression (increase of O2 requirements, mechanical ventilation or increase in medical therapy: steroid dose, need for starting tocilizumab) Results: Out of the 355 participants included in the trial 287 (80.8%) were randomized to D (n=142) or DB (n=145), 264 (91.9%) simultaneously with the TDF/FTC randomization and 23 (8.1%) later on. Median age 67 years (IQR 62, 73), male (65.5%), with median 8 days of symptoms (IQR 5-10), 28.6% with ≤ 5 days of symptoms, 100% hospitalized, 31.6% with one and 38.7% with ≥ 2 comorbidities (most common: 35.9% hypertension, 9.4% diabetes, 1.7 % obesity), 14.3% receiving remdesivir and 49.1% TDF/FTC. Endpoints in participants treated with D vs. those treated with DB favored DB without achieving statistical significance: mortality 4.9%/2.1%, disease progression 27.5%/24.8%, mechanical ventilation (invasive or noninvasive) 25.4%/23.4%, days since randomization until discharge (median [IQR]) 7 [5, 12]/7 [5, 13.5], discharge before 28 days 89%/94.2%. By Cox regression Hazard Ratio (95% CI) of 28-day mortality was 0.51 (0.13-2.06) for participants treated with DB. Serious adverse events occurred in 9.9%/9.7% of participants treated with D or DB respectively. Adverse events leading to B discontinuation occurred in 3.45% of participants. Conclusion: In this clinical trial of high-risk patients with COVID-19 all disease outcomes favored baricitinb added to dexamethasone but differences did not reach statistical significance. Overall mortality was unexpectedly low.
ABSTRACT
Introduction. Pneumomediastinum is a frequent complication in patients with COVID-19, caused in the context of a major inflammatory process Methodology. A descriptive, retrospective and cross-sectional study was conducted. We reviewed the chest CT scans and medical records of patients with/without a diagnosis of COVID-19 between April 1 and July 30, 2020. Results. We identified 66 patients with pneumomediastinum and a diagnosis of COVID-19. The prevalence found was 3.2%, 81.8% corresponded to males, the average age was 53.4 years, the average length of stay in hospital was 22.98 days, the most frequent comorbidities were obesity, diabetes and hypertension. 95.5% did not report smoking and 89.4% were not on mechanical ventilation. The most frequent symptoms were dyspnea, non-productive cough and chest pain. 69.7% of patients had a fatal outcome. Pulmonary tomography showed that 43. 9% presented moderate grade pneumomediastinum and with respect to pulmonary involvement 97% presented a typical bilateral pattern, the peak and progressive stage presented in 56.1% and 31.8% respectively and the most frequent percentage of pulmonary involvement was severe (53%). A percentage of lung involvement higher than 50% correlated directly with the severity of the pneumomediastinum (p<0.05). The average ferritin was 884.58 ug/ml, D-dimer 5.1 mg/ml, DHL 595. 55 IU/L, PCR 150.7 mg/L, lymphocytes 825.1 c/mm3, lactic acid 1.99 mmol/L, PCT 0.78 ng/ml, IL6 313 pg/ml and PaFiO2 171.5 mmHg. Conclusion. Spontaneous pneumomediastinum is a frequent complication in patients with COVID-19, being an indicator of poor evolution.