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Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio OR=5.618, 95% confidence interval CI) 2.136-14.776, P0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Coronavirus disease-19 (COVID-19) pandemic is a real challenge to our communities worldwide, exerting a high socioeconomic impact. The disease is associated with a great deal of co-agulation cascade disorder, with a considerable increase in D-dimer concentration in blood. Objec-tives: To assess the impact of dialysis session frequency on blood levels of D-dimer among CKD patients infected with COVID-19. Patients and Methods: The study included 40 CKD patients (22 males and 18 females) infected with COVID-19, who attended the Artificial Kidney Unit at Al Hussein Teaching Hospital, Thi-Qar, Iraq for regular dialysis. They were divided into two groups;Group I: 20 CKD patients who had COVID-19. They underwent one hemodialysis session per week. The second group, which included 20 CKD patients infected with COVID-19 underwent three dialysis sessions per week. Plasma levels of D-dimer were measured one day before the start of the study and one day after three weeks in both groups. Result(s): The results of the present study re-vealed that CKD patients infected with COVID-19 who underwent three dialysis session per week (Group II) had a significant drop in blood D-dimer level at the end of three weeks in comparison to the initial values. Furthermore, the decrease in blood D-dimer level was significantly higher among CKD patients with COVID-19 who underwent three dialysis sessions per week (Group II) in comparison to COVID-19 infected CKD patients who underwent single dialysis sessions per week (Group I). Conclusion(s): CKD patients with COVID-19 have an elevated blood level of D-dimer. Increasing the frequency of hemodialysis plays an essential role in lowering the serum D-dimer level among these patients.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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Objectives: COVID-19 infected over 150 million people and caused over 1 million deaths in the US. This study evaluates several variables thought to be associated with mortality risk in the COVID-19 population. Method(s): The IQVIA longitudinal medical and pharmacy claims databases identified 17,682,111 patients with a COVID-19 diagnosis between 4/1/2020-4/30/2022 from a population of >277 million patients in the US. Patients were linked to Veritas Data Research fact-of-death records (90% complete compared to CDC reporting) and confirmed deaths were flagged. Confirmed mortality rates (CMR) were evaluated by age group, socioeconomic status (SES) using the Area Deprivation Index (v2.0, University of Wisconsin, 2015), co-morbidities and COVID-specific (approved and unapproved) treatments. Result(s): Of the 563,744 patients (3.2%) identified as dead (3.67% in men, 2.85% in women overall), CMR was lowest in patients aged 0-17 (0.08%), highest in age 65-75 (5.92%) and >75 (16.40%). Patients in the lowest 40% of SES had CMR of 4.43% while in the highest 20% was 1.56%. Respiratory failure, pneumonia and sepsis were the most common acute diagnoses accompanying COVID-19 deaths in all SES. In patients with comorbid dementia or Alzheimer's disease, CMR were 21.62% and 23.40% respectively. Additionally, congestive heart failure (15.79%), atrial fibrillation (15.50%), chronic kidney disease (15.30%) and COPD (12.19%) were associated with high CMR. Among patients receiving approved therapies, casirivimab/imdevimab and remdesivir had CMR of 1.41% and 12.63% respectively, while for those receiving unapproved therapies, ivermectin and hydroxychloroquine had CMR of 2.54% and 2.45%. Conclusion(s): Compared to the 1.1% case-mortality rate (Johns Hopkins 2023) among US COVID-19 patients, we found CMR exceeded 3% among those with a medical claim for COVID-19. Advanced age, dementia, and cardio-renal disease were associated with mortality. Patients with the lowest SES had approximately 3 times the confirmed mortality rate compared to those in the highest SES group.Copyright © 2023
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Background: Coronavirus in 2019 was recognized as one of the leading causes of death worldwide. According to reports, the mortality rate in people who need mechanical ventilation varies from 50 to 97 percent. The aim of this study was to evaluate the outcome of Covid-19 disease based on different characteristics in patients and mechanically ventilated variables. Method(s): This descriptive-analytical study was conducted on 160 patients with a definite diagnosis of Covid-19 who were under mechanical ventilation and admitted to the intensive care unit of Alzahra Hospital in Isfahan from March 2020 to March 2021. Data was collected by checklist. The checklist included demographic information, including age, gender, as well as information such as underlying diseases, disease outcome, length of hospitalization, etc. After collecting the data, they were analyzed in SPSS software version 22 and at a significance level of less than 0.05. Result(s): In this study, the overall mortality rate among mechanically ventilated patients was 62.5%. The mean age of patients was 69.99+/-17.87 years and the mean duration of hospitalization in surviving patients was 15.47+/-11.73 days and for deceased ones was 55.21+/-69.14 days. The mean age of the deceased group (65.71+/-16.59) was significantly higher than the surviving group 53+/-21.17 was (P=0.0001). The length of hospital stay in the deceased group was significantly longer than the surviving group (P=0.005). As a result, ventilator mode and inotropic agent intake during treatment increased the chance of mortality in patients under mechanical ventilation (P=0.001). There was a significant relationship between underlying diseases of hypertension, kidney disease and autoimmune disease with mortality in patients (P<0.05). Conclusion(s): Various factors including the length of stay in the hospital, comorbidities such as hypertension, renal disease and autoimmunity may affect the outcome of critically ill ICU patients under mechanical ventilation. Patients who require long-term invasive ventilation and the use of inotropic drugs to maintain their cardiovascular status while hospitalized in the ICU are at higher risk for mortality.Copyright © 2022 Shetabi et al. Published by Tehran University of Medical Sciences.
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Objectives: COVID-19 had an impact on health care, including diagnostics. Early diagnosis of MM is a critical factor for prognosis. We examined the impact of COVID-19 on incidence of NDMM patients and on characteristics in NDMM patients in US and in Germany. Method(s): 44,164 NDMM patients were identified in TriNetX federated network across 55 healthcare organizations in US between January 2018 and December 2021. A bivariate analysis examined changes in patient characteristics in two cohorts before (Cohort 1;n=25513) and after (Cohort 2;n=18.651) the start of the COVID-19 pandemic in March 2020. 4172 NDMM patients were identified in the German database in a sample of across >100 healthcare organizations in the same time period. Similarly, bivariate analysis examined changes in patient characteristics before (Cohort 1;n=2252) and after (Cohort 2;n=1920) the start of pandemic. Result(s): Analysis of US data showed a significant decrease in incidence of NDMM. Bivariate analysis revealed that NDMM patients in Cohort 2 have a significantly higher risk profile compared with patients in Cohort 1, higher incidence of renal failure (13.5% v. 15.43%), heart failure (10.3% v 11.26%), bone lesions (12.6% v. 13.05%) and anemia (26.8% v. 29.75%). The German data indicated an increased risk profile in Cohort 2, with higher reporting of renal impairment (12.3% v. 15.5%) and cardiac impairment (8.3% v. 10.9%). The higher risk profile was reflected in a significant increase of all SLiM-CRAB criteria, notably hypercalcemia (24.1 % v. 36.9%), bone marrow plasma cell infiltration (28.1% v. 36.8%) and free light chain involvement (27.3% v. 41.3%). Conclusion(s): The results provide real-world evidence of a change in risk profile for patients with NDMM during COVID-19. This higher risk profile is observed in both the US and Germany, and may negatively impact outcomes such as progression-free and five-year overall survival.Copyright © 2023
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According to domestic and foreign studies, diabetes mellitus (DM) is a significant risk factor for infection with the SARS-CoV-2 vi-rus, a severe course of the disease, and an adverse outcome. Trend analysis of epidemiological and clinical characteristics of DM patients living in the Samara region in the initial period of the spread of the new coronavirus infection can help to assess the effectiveness of medical care for DM patients in a challenging epidemiological setting and to determine the directions for its improvement. Objective. To assess the trends in the prevalence, incidence, and mortality of DM patients living in the Samara region and to iden-tify the changes in the structure of vascular complications and the status of glycemic control from 2018 to 2020. Material and methods. The study of the medical and epidemiological DM indicators was performed according to the design of a continuous retrospective observational study covering the period from 2018 to 2020;the object was the adult population of the Samara region. Results. The total number of DM patients in the Samara region in 2020 was 118,623 people (3.73% of the population), of which type 1 diabetes was detected in 5.2% (6118 people) and type 2 diabetes in 94.2% (111,700 people). The trends of the prevalence of type 1 DM were 186.3->192.4/100,000 population, type 2 DM 3132.5->3153.1/100,000 population;the dynamics of primary morbidity with type 1 diabetes mellitus 8.8->6.2/100,000 population, with type 2 DM 259.1->196.4/100,000 population;mortality with type 1 diabetes mellitus 3.2->4.2/100,000 population, with type 2 diabetes mellitus 120.7->174.5/100,000 population. The most common causes of death were cardiovascular diseases: 30.3% in type 1 DM, 39.7% in type 2 DM;there is a trend towards increasing in death <<from DM>> without indicating the immediate cause of death for both types of DM;<<from COVID-19>> 3.8% with type 1 DM and 3.7% with type 2 DM. The incidence of vascular complications in type 1 and type 2 DM was 31.4% and 11.5% for reti-nopathy, and 21.4 and 11.5% for nephropathy, respectively. Trends in the proportion of patients with HbA1c <7%: 28.1%->51.1% in type 1 DM, 15.7%->62.4% in type 2 DM;with HbA1c >=9.0%: 25.4%->12.1% in type 1 DM, 39.8%->7.1% in type 2 DM. Conclusion. The study demonstrates the importance of a comparative sequential assessment of the epidemiological characteristics of diabetes mellitus and the clinical status of patients living in the Samara region in challenging epidemiological settings to assess the prospects for optimizing follow-up.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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The pandemic caused by COVID-19 has led to radical lifestyle changes worldwide, particularly in the Republic of Bulgaria, and was a factor for global changes in economics, politics, healthcare and daily life. Aim(s): The aim of the study was to analyze the public attitudes, awareness and fears related to the COVID-19 disease in the Republic of Bulgaria. Material(s) and Method(s): The survey was conducted between August 1st, 2022 and September 1st, 2022 via an anonymous questionnaire consisting of 24 closed questions. A total of 1861 people, aged 18-69 years and older, took part in the survey after being selected randomly. The data were statistically processed via MS Excel. Result(s): The main source of information to the respondents on issues related to COVID-19 was the Internet (29,8%), followed by TV (26%) and the specialized website (Single information portal) - 15,9%. More than one-third (35,1%) of the respondents was afraid of getting infected and an equal share of participants reported that they have been infected with COVID-19. More than half of the respondents (52,5%) adhered to all the provisions of the governmental bodies related to limiting the COVID-19 pandemic. The most frequent symptom of post- COVID-19 syndrome was being easily fatigued (26,7%), followed by shortness of breath (13,4%) and persistent cough (11,6%). Conclusion(s): The survey could be useful in understanding what were the public attitudes, awareness and fears related to the COVID-19 disease in the Republic of Bulgaria during the pandemic.Copyright © 2023 D. Penchev et al., published by Sciendo.
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We present how we used ultrasound to improve our diagnosis of lung Covid 19 and use ultrasound to diagnose the complications of Covid 19. Ultrasound was more sensitive in detecting early Covid 19 than chest radiograph. The complications of Covid 19 include renal impairment, liver impairment and vascular complications, mainly large vessel venous thrombosis, including renal vein thrombosis. We are all suffering from post-viral fatigue but lessons can be learnt from this pandemic and the use of ultrasound.
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This study aimed to assess kidney function and its significance for the development of in-hospital complications in patients hospitalized with acute cardiovascular pathology infected with COVID-19. Methods. This prospective cohort single-center study included 139 patients with acute cardiovascular pathology diagnosed with COVID-19. Sixty-nine (49.6%) patients had acute coronary syndrome (47 with acute myocardial infarction (AMI), 33 (23.7%) patients had hypertension urgencies, 24 (17.3%) patients had acute decompensated heart failure, 9 (6.5%) patients had tachysystolic paroxysms of atrial fibrillation, 2 (1.4%) patients had an acute pulmonary embolism, and 2 (1.4%) patients had syncope. The mean age was 67.9±12.7 years, and 70 (50.4%) patients were male. Arterial hypertension was present in 87.1% of patients, diabetes mellitus in 20.9%, congestive heart failure in 30.9%, chronic obstructive pulmonary disease in 9.4%, AMI in 20.1%, and ischemic stroke in 9.4%. Results. The initial creatinine level was 110.7±66.1 μmol/l and eGFR (CKD-EPI) was 63.3±20.3 ml/min/1.73m2 (eGFR<60 ml/min/1.73m2 was diagnosed in 46.0% of the patients). The patients with eGFR<60 ml/min/1.73m2 were older, more often female, frequently had a history of atrial fibrillation, had lower hemoglobin and blood pressure on admission, a greater number of complications (need for noninvasive ventilation, inotropic therapy), and higher in-hospital mortality (25.0% vs. 5.3 %, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (increase in creatinine level ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR<60 ml/min/1.73m2, p<0.05). These patients did not differ significantly in basic clinical and anamnestic data from patients without AKI but had lower spO2 on admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), venous thromboembolism (14.3% vs. 0.9%, p=0.070), death from all causes (47.6% vs. 7.0%, p=0.002) and more often required organ supportive therapy: non-invasive/invasive pulmonary ventilation (52.4% vs. 11.3%, p<0.001), inotropic therapy (57.1% versus 5.2%, p<0.001). Using the simplified criterion of AKI, the category of patients at high risk for hospital complications and death could also be distinguished (37.9% vs. 8.2%, p=0.004). Vaccination against COVID-19 (at least 2 weeks before hospitalization) prevented the development of AKI (16.5% vs. 5.0%, p=0.046) and tended to prevent in-hospital mortality (15.7% vs. 5.0%, p=0.076). Conclusions. Renal dysfunction in patients with acute cardiovascular pathology infected with COVID-19 is associated with in-hospital complications and can be prevented by prophylactic vaccination. © Y. Lutai, O. Parkhomenko, O. Irkin, D. Khomyakov, 2023. All rights reserved.
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This purpose of this study is to help students developing problem-solving skills by using Problem-based Learning (PBL) as a teaching model, combining with the Objective Structured Clinical Examination (OSCE) as a training tool to evaluate students' clinical competencies. Sixty-five college junior students from a therapeutic nutrition course were participated. The topics of PBL included diabetes, kidney disease, cancer, and cardiovascular disease. For each disease, pre- and post-test quiz and after class exam were assessed to evaluate the students' learning effectiveness. Due to the impact of the COVID-19 epidemic, OSCE was performed online. The focus group interview and learning effectiveness questionnaire were conducted by the end of this course for all participants. Moreover, 37 students who attended the dietitian internship filled in the learning effectiveness questionnaire again after the internship. The results indicated that after the PBL, the post quiz score for each disease was increased, and through the online OSCE training, students' abilities to master nutrition education and counseling had been upgraded. Students indicated that both PBL and OSCE training could contributed to the learning effectiveness. The better academic performance students were, the more willing they are to work in nutrition-related fields in the future. For those who finished the dietitian internship agreed that they could understand the work content better in general regional and regional hospitals than in teaching ones. In conclusion, PBL teaching model combined with OSCE training could effectively improve students' learning motivation, learning effectiveness and practical application in a therapeutic nutrition course.Copyright © 2022 Nutrition Society in Taipei. All rights reserved.
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Objective: A new generation of vaccine technology platform has been developed to combat the COVID- 19 pandemic, the mRNA vaccine. The EMA granted the Pfizer- BioNTech COVID-19 vaccine an emergency use authorization in December 2020 with limited clinical experience, especially in the pediatric population. Method(s): Here, we present a case-report of a 17-yearold girl, who was vaccinated with the mRNA-COVID vaccine in October 2021, and developed a gross hematuria and proteinuria the day after the vaccination. Result(s): The patient presented at our outpatient clinic three days after the vaccination with new-onset hematuria and proteinuria. Up to this date, she had no former known medical conditions and the family history was negative regarding kidney diseases. We excluded nephrolithiasis, autoimmune glomerulonephritis and urinary tract infection as causes. The laboratory chemistry of the kidney was within normal range. The proteinuria dissolved spontaneously, and a microhematuria persisted. One day after the second dose of Cominarty in November 2021, the gross hematuria with proteinuria relapsed. A treatment with an ACE-inhibitor did not have any effect on the proteinuria. At this point, only a few casereports of patients with a comparable clinical course, especially from Japan, were published. In suspicion of a vaccine-triggered nephritis we started a prednisolon therapy which dissolved the proteinuria and induced a regression of the haematuria to a minimal stage. Conclusion(s): Within the last year, the medical community has gained more insights concerning mRNA vaccines. There is growing evidence, that mRNA vaccines can trigger de novo or relapse IgA nephropathy. But more systematic research and long-term evaluation is desirable to elucidate the underling pathophysiology as well as the influence on kidney survival of affected patients in the future. Furthermore, patient education should incorporate the risk of hematuria and proteinuria in children when applying mRNA vaccines.
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Background: patients with Diabetes Mellitus 2 (DM2) and advanced stages of Diabetic Kidney Disease (DKD) are at high risk for the lethal outcome of COVID-19. The causes of high mortality and the prognostic signifi cance of the new onset of renal replacement therapy (hemodialysis de novo, HD de novo) among these patients are still points of debate. Aim: the identifi cation of risk factors (RF) of lethal outcome in patients with DKD 4-5D stages and evaluation of the prognostic value of HD de novo in patients not receiving HD at the time of hospital admission. Methods: the patients with COVID-19 and advanced stages of DKD were included in a retrospective observational study from 04.01. to 10.30.2020. The endpoints were the outcome of hospitalization (discharge/death) and HD de novo initiation during the inpatient course. Several demographic, DM2, DKD, and COVID-19-associated signs and laboratory parameters were analyzed as independent variables. The subgroup of patients with HD de novo was selected from the general cohort. Results: 120 patients with DKD 4-5D stages were included, with a mean age of 69±10 y, females - 52%. Initially, the observation cohort was divided into subgroups: DKD 4-5 and DKD 5D on maintenance hemodialysis (MHD). The mortality among patients with DKD 4-5 was comparable with the patients on MHD (38,2% vs 38,5%, р=0,975). The independent predictors of lethal outcome in group DKD 4-5 were: age ≥65 y (OR 12,30;95% CI 1,40-33,5;р=0,009), initial prandial glycemia ≥10 mmol/l (OR 14,5;95% CI 3,7-55,4;р<0,001), albuminemia at admission ≤35 g/l (OR 5,17;95% CI 1,52-17,50;р=0,012), Charlson comorbidity index (CCI) ≥10 (OR 6,69;95% CI 1,95-23,00;р=0,002), News2 >4 at admission (OR 7,58;95% CI 2,18-26,37;р=0,001), lung damage CT 3-4 at admission (OR 3,39;95% CI 1,09-10,58;р=0,031). In subgroup DKD 5D the independent predictors of lethal outcome were prandial glycemia at admission ≥10 mmol/l (OR 28,5;95% CI 7,1-33,5;р<0,001), lung damage at admission CT 3-4 (OR 8,35;95% CI 2,64-26,40;р<0,001), CCI ≥10 (OR 6,00;95% CI 1,62-22,16;р=0,006). To determine the risk of lethal outcome predictive models were created using identifi ed risk factors and variables. The predictive value for DKD 4-5 group was 93%, and for DKD 5D was 88%. The assessment of the overall predictive value of these models was carried out using ROC analysis. The mortality among patients with DKD 4-5 without HD de novo was 21,6% vs 72,2% in patients with initiated HD de novo (р<0,001). The independent predictors of HD de novo during the inpatient course were: prandial glycemia at admission ≥10 mmol/l (OR 3,38;95% CI 1,04-10,98;р=0,050), albuminemia at admission ≤35 г/л (OR 3,41;95% CI 1,00-11,55;р=0,050), News2 >4 at admission (OR 5,60;95% CI 1,67-19,47;р=0,006), eGFR ≤20 ml/min/1,73 m2 at admission (OR 4,24;95% CI 1,29-13,99;р=0,020). HD de novo was identifi ed as an independent predictor of adverse outcomes (OR 9,42;95% CI 2,58-34,4;р=0,001). The analysis of cumulative survival demonstrated comparable results in DKD 4-5 without HD de novo group and DKD 5D group. The cumulative 55-day survival in the subgroup with HD de novo was only 10%. Conclusion: the need to start HD de novo is one of the most powerful predictors of adverse outcomes of COVID-19 in patients with advanced DKD. The comparable mortality rate in DKD 4-5 and DKD 5D groups is due to extremely high mortality in the subgroup with HD de novo. The strict control and correction of HD de novo risk factors could turn them into modifi able ones and thus improve the survival prognosis of patients with advanced stages of DKD. © 2023 JSC Vidal Rus. All rights reserved.
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(1) Background: Data on COVID-19 outcomes and disease course as a function of different medications used to treat cardiovascular disease and chronic kidney disease (CKD), as well as the presence of different comorbidities in primarily Black cohorts, are lacking. (2) Methods: We conducted a retrospective medical chart review on 327 patients (62.6% Black race) who were admitted to the Detroit Medical Center, Detroit, MI. Group differences (CKD vs. non-CKD) were compared using the Pearson χ2 test. We conducted univariate and multivariate regression analyses for factors contributing to death during hospitalization due to COVID-19 (primary outcome) and ICU admission (secondary outcome), adjusting for age, sex, different medications, and comorbidities. A sub-analysis was also completed for CKD patients. (3) Results: In the fully adjusted model, a protective effect of ACEi alone, but not in combination with ARB or CCB, for ICU admission was found (OR = 0.400, 95% CI [0.183–0.874]). Heart failure was significantly associated with the primary outcome (OR = 4.088, 95% CI [1.1661–14.387]), as was COPD (OR = 3.747, 95% CI [1.591–8.828]). (4) Conclusions: Therapeutic strategies for cardiovascular disease and CKD in the milieu of different comorbidities may need to be tailored more prudently for individuals with COVID-19, especially Black individuals. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Diabetic kidney disease (DKD) is the leading cause of morbidity and mortality in patients with diabetes. Moreover, chronic kidney disease (CKD) is associated with cardiovascular disease (CVD) in these patients. Of interest, DKD patients express a chronic systemic inflammation that contributes to the immunosuppressed state that accounts for infectious complications. Hospital admissions and mortality from the coronavirus disease 2019 (COVID-19) pandemic are spreading throughout the world. Risk factors for severe COVID-19 include diabetes, CKD, and CVD. In susceptible patients, preexisting immune deficiency and other chronic conditions can promote the well-known "cytokine storm” observed in COVID-19. As with many other organs, the kidneys are susceptible to be affected since they express the ACE2 receptor (SARS-CoV-2 cell receptor). Beyond the reported acute kidney involvement, growing evidence showed that CKD progression might be accelerated due to the associated chronic endothelial dysfunction observed in COVID-19 patients. This chapter explores the existing evidence regarding the COVID-19 pandemic crashing with the old diabetes pandemic. Likewise, a special approach to the possible benefits of antidiabetic and other drugs is discussed. © Springer Nature Switzerland AG 2014, 2022.
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Introduction: SARS-CoV-2 is responsible for the current global pandemic. SARS-CoV-2 infection underlies the novel viral condition coronavirus disease 2019 (COVID-19). COVID-19 causes significant pulmonary sequelae contributing to serious morbidities. The pathogenesis of COVID-19 is complex with a multitude of factors leading to varying levels of injury numerous extrapulmonary organs. This review of 124 published articles documenting COVID- 19 autopsies included 1,142 patients. Method(s): A PubMed search was conducted for COVID-19 autopsy reports published before March 2021 utilizing the query COVID-19 Autopsy. There was no restriction regarding age, sex, or ethnicity of the patients. Duplicate cases were excluded. Findings were listed by organ system from articles that met selection criteria. Result(s): Pulmonary pathology (72% of articles;866/1142 patients): diffuse alveolar damage (563/866), alveolar edema (251/866), hyaline membrane formation (234/866), type II pneumocyte hyperplasia (165/866), alveolar hemorrhage (164/866), and lymphocytic infiltrate (87/866). Vascular pathology (41% of articles;771/1142 patients): vascular thrombi (439/771)-microvascular predominance (294/439)-and inflammatory cell infiltrates (116/771). Cardiac pathology (41% of articles;502/1142 patients): cardiac inflammation (186/502), fibrosis (131/502), cardiomegaly (100/502), hypertrophy (100/502), and dilation (35/502). Hepatic pathology (33% of articles;407/1142 patients): steatosis (106/402) and congestion (102/402). Renal pathology (30% of articles;427/1142 patients): renal arteries arteriosclerosis (111/427), sepsis-associated acute kidney injury (81/427) and acute tubular necrosis (77/427). Conclusion(s): This review revealed anticipated pulmonary pathology, along with significant extrapulmonary involvement secondary to COVID-19, indicating widespread viral tropism throughout the human body. These diverse effects require additional comprehensive longitudinal studies to characterize short-term and long-term COVID-19 sequelae and inform COVID-19 treatment.
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The proceedings contain 115 papers. The topics discussed include: clinical and genetic predictors of sickle cell nephropathy in Malawi;clinicohematological characteristics of iron deficiency anemia and hemoglobinopathies in Pakistan;an experience of non-hospital based laboratory;assessment of hematological parameters of petrol filling workers at petrol stations in Ethiopia: a comparative cross-sectional study;burden and risk factor to acute myocardial ischemia in children with sickle cell anemia;dyslipidemia in transfusion-dependent-thalassemia patients and its correlation with serum vitamin D level;impact of COVID-19 pandemic to pre-transfusion hemoglobin level and frequency of transfusion in transfusion-dependent thalassemia patients in Indonesia;retinopathy in Egyptian patients with sickle cell disease;and dietary pattern, socio-demographic characteristics and nutritional status of pregnant women attending Barau Dikko teaching hospital and the need to develop recommended dietary allowance and dietary reference intakes for sickle cell disease patients.
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Objectives: To assess the characteristics of FDA renal toxicity boxed warnings (formerly called Black Box Warning) included in the labels of drugs approved by the FDA and marked in the US. Method(s): We extracted the labels of human prescription drugs with renal toxicity boxed warnings from the "FDA Label: Full-Text Search of Drug Product Labeling" database, FDA regulatory information from drugs@FDA as of September 1, 2022. We extracted the therapeutic classification from the WHO ATC system. We conducted a descriptive analysis of the data. Result(s): The FDA listed 86 drugs including 72 active ingredients and 14 combinations with a boxed warning mentioning renal toxicity. Three drugs had emergency use authorizations for COVID-19, and all combinations included metformin. There were 8 (8.7%) drugs with renal toxicity boxed warnings approved before 1970, 6 (6.5%) in the 1970s, 14 (15.2%) in the 1980s, 34 (37.0%) in the 1990s, 17 (18.5%) in the 2000s, 9 (9.8%) in the 2010s, and 4 (4.3%) in 2020-Sep 2022. The therapeutic classes with the largest number of renal toxicity boxed warning included anti-infectives for systemic use 24 (26.1%), antineoplastic and immunomodulating agents 22 (23.9%), and alimentary tract and metabolism 17 (18.5%). The most common boxed warnings included renal impairment (n=21, 22.8%), nephrotoxicity (10, 10.9%), and nephrogenic systemic fibrosis (7, 7.6%). Additionally, 9 (9.8%) boxed warnings referred to the potential problems for patients with kidney transplants. Conclusion(s): Most drugs with a boxed warning were approved in the 1990s and 2000s. The therapeutic classes with the highest number of renal toxicity warnings were anti-infective for systemic use, antineoplastic and immunomodulating agents, and alimentary tract and metabolism. The most common warnings were renal impairment, nephrotoxicity, nephrogenic systemic fibrosis, and issues for patients with kidney transplants. Future research could expand the analysis to renal toxicity warnings, interactions, and precautions.Copyright © 2023
ABSTRACT
Objective: The impact of social media on public health has been examined in various studies. However, none have explored user engagement based on the type of Facebook posts related to renal disease. Therefore, the present study sought to determine which type of nephrology-related posts have greater user engagement. Setting(s): Facebook pages. Method(s): The posts on a specific Facebook page curated by a team of nephrologists in Malaysia were examined in this cross-sectional study. The type of post, likes, comments, shares of a post and reach of a post were used for data analysis. Analysis of variance was used to quantify the relative contribution of each independent variable to the odds of the post being highly liked or shared. The Kruskal-Wallis test was used to compare links, photos, shared videos, status and videos for parameters such as reach, the number of times a specific piece of content has been displayed on a screen (impressions), and user engagement. Result(s): Shared videos and photos received the highest median reach of 5,862 and 5,880, respectively. People who 'liked' the page in 2019, 2020 and 2021 numbered 193, 4,196 and 2,835, respectively. Among the types of content on the Facebook page, photos and shared videos received the highest median lifetime reach of the post compared to links, status and videos in terms of 'people who liked the page'. Conclusion(s): The study findings suggest that posting a video or photo maximises the chance of engagement and meaningfully impacts public health outcomes.Copyright © The Author(s) 2023.
ABSTRACT
Background and Objectives: Kidneys are one of the main targets for SARS-CoV-2. Early recognition and precautionary management are essential in COVID-19 patients due to the multiple origins of acute kidney injury and the complexity of chronic kidney disease management. The aims of this research were to investigate the association between COVID-19 infection and renal injury in a regional hospital. Materials and Methods: The data of 601 patients from the Vilnius regional university hospital between 1 January 2020 and 31 March 2021 were collected for this cross-sectional study. Demographic data (gender, age), clinical outcomes (discharge, transfer to another hospital, death), length of stay, diagnoses (chronic kidney disease, acute kidney injury), and laboratory test data (creatinine, urea, C-reactive protein, potassium concentrations) were collected and analyzed statistically. Results: Patients discharged from the hospital were younger (63.18 ± 16.02) than those from the emergency room (75.35 ± 12.41, p < 0.001), transferred to another hospital (72.89 ± 12.06, p = 0.002), or who died (70.87 ± 12.83, p < 0.001). Subsequently, patients who died had lower creatinine levels on the first day than those who survived (185.00 vs. 311.17 µmol/L, p < 0.001), and their hospital stay was longer (Spearman's correlation coefficient = -0.304, p < 0.001). Patients with chronic kidney disease had higher first-day creatinine concentration than patients with acute kidney injury (365.72 ± 311.93 vs. 137.58 ± 93.75, p < 0.001). Patients with acute kidney injury and chronic kidney disease complicated by acute kidney injury died 7.81 and 3.66 times (p < 0.001) more often than patients with chronic kidney disease alone. The mortality rate among patients with acute kidney injury was 7.79 (p < 0.001) times higher than among patients without these diseases. Conclusions: COVID-19 patients who developed acute kidney injury and whose chronic kidney disease was complicated by acute kidney injury had a longer hospital stay and were more likely to die.
Subject(s)
Acute Kidney Injury , COVID-19 , Renal Insufficiency, Chronic , Humans , COVID-19/complications , SARS-CoV-2 , Creatinine , Cross-Sectional Studies , Renal Insufficiency, Chronic/complications , Kidney , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/diagnosis , Hospitals , Retrospective Studies , Hospital Mortality , Risk FactorsABSTRACT
Chronic kidney disease (CKD) patients have an increased risk of morbidity and mortality following SARS-CoV-2 infection. Vaccination in these patients is prioritized, and monitoring of the immune response is paramount to define further vaccination strategies. This prospective study included a cohort of 100 adult CKD patients: 48 with kidney transplant (KT) and 52 on hemodialysis without prior COVID-19. The patients were assessed for humoral and cellular immune responses after four months of an anti-SARS-CoV-2 primary two-dose vaccination scheme (CoronaVac or BNT162b2) and one month after a booster third dose of BNT162b2 vaccine. We identified poor cellular and humoral immune responses in the CKD patients after a primary vaccination scheme, and these responses were improved by a booster. Robust polyfunctional CD4+ T cell responses were observed in the KT patients after a booster, and this could be attributed to a higher proportion of the patients having been vaccinated with homologous BNT162b2 schemes. However, even after the booster, the KT patients exhibited lower neutralizing antibodies, attributable to specific immunosuppressive treatments. Four patients suffered severe COVID-19 despite three-dose vaccination, and all had low polyfunctional T-cell responses, underscoring the importance of this functional subset in viral protection. In conclusion, a booster dose of SARS-CoV-2 mRNA vaccine in CKD patients improves the impaired humoral and cellular immune responses observed after a primary vaccination scheme.