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1.
J Am Coll Radiol ; 17(8): 1011-1013, 2020 08.
Article in English | MEDLINE | ID: covidwho-1536620

ABSTRACT

BACKGROUND: Quarantine and stay-at-home orders are strategies that many countries used during the acute pandemic period of coronavirus disease 2019 (COVID-19) to prevent disease dissemination, health system overload, and mortality. However, there are concerns that patients did not seek necessary health care because of these mandates. PURPOSE: To evaluate the differences in the clinical presentation of acute appendicitis and CT findings related to these cases between the COVID-19 acute pandemic period and nonpandemic period. MATERIALS AND METHODS: A retrospective observational study was performed to compare the acute pandemic period (March 23, 2020, to May 4, 2020) versus the same period the year before (March 23, 2019, to May 4, 2019). The proportion of appendicitis diagnosed by CT and level of severity of the disease were reviewed in each case. Univariate and bivariate analyses were performed to identify significant differences between the two groups. RESULTS: A total of 196 abdominal CT scans performed due to suspected acute appendicitis were evaluated: 55 from the acute pandemic period and 141 from the nonpandemic period. The proportion of acute appendicitis diagnosed by abdominal CT was higher in the acute pandemic period versus the nonpandemic period: 45.5% versus 29.8% (P = .038). The severity of the diagnosed appendicitis was higher during the acute pandemic period: 92% versus 57.1% (P = .003). CONCLUSION: During the acute COVID-19 pandemic period, fewer patients presented with acute appendicitis to the emergency room, and those who did presented at a more severe stage of the disease.


Subject(s)
Appendicitis/diagnostic imaging , Appendicitis/epidemiology , Coronavirus Infections/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tomography, X-Ray Computed/statistics & numerical data , Analysis of Variance , COVID-19 , Cohort Studies , Coronavirus Infections/epidemiology , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Incidence , Male , Multivariate Analysis , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Quarantine/statistics & numerical data , Retrospective Studies , Risk Assessment , Tomography, X-Ray Computed/methods , United States
2.
Crit Care Med ; 49(9): 1439-1450, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1434523

ABSTRACT

OBJECTIVES: To evaluate the impact of ICU surge on mortality and to explore clinical and sociodemographic predictors of mortality. DESIGN: Retrospective cohort analysis. SETTING: NYC Health + Hospitals ICUs. PATIENTS: Adult ICU patients with coronavirus disease 2019 admitted between March 24, and May 12, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Hospitals reported surge levels daily. Uni- and multivariable analyses were conducted to assess factors impacting in-hospital mortality. Mortality in Hispanic patients was higher for high/very high surge compared with low/medium surge (69.6% vs 56.4%; p = 0.0011). Patients 65 years old and older had similar mortality across surge levels. Mortality decreased from high/very high surge to low/medium surge in, patients 18-44 years old and 45-64 (18-44 yr: 46.4% vs 27.3%; p = 0.0017 and 45-64 yr: 64.9% vs 53.2%; p = 0.002), and for medium, high, and very high poverty neighborhoods (medium: 69.5% vs 60.7%; p = 0.019 and high: 71.2% vs 59.7%; p = 0.0078 and very high: 66.6% vs 50.7%; p = 0.0003). In the multivariable model high surge (high/very high vs low/medium odds ratio, 1.4; 95% CI, 1.2-1.8), race/ethnicity (Black vs White odds ratio, 1.5; 95% CI, 1.1-2.0 and Asian vs White odds ratio 1.5; 95% CI, 1.0-2.3; other vs White odds ratio 1.5, 95% CI, 1.0-2.3), age (45-64 vs 18-44 odds ratio, 2.0; 95% CI, 1.6-2.5 and 65-74 vs 18-44 odds ratio, 5.1; 95% CI, 3.3-8.0 and 75+ vs 18-44 odds ratio, 6.8; 95% CI, 4.7-10.1), payer type (uninsured vs commercial/other odds ratio, 1.7; 95% CI, 1.2-2.3; medicaid vs commercial/other odds ratio, 1.3; 95% CI, 1.1-1.5), neighborhood poverty (medium vs low odds ratio 1.6, 95% CI, 1.0-2.4 and high vs low odds ratio, 1.8; 95% CI, 1.3-2.5), comorbidities (diabetes odds ratio, 1.6; 95% CI, 1.2-2.0 and asthma odds ratio, 1.4; 95% CI, 1.1-1.8 and heart disease odds ratio, 2.5; 95% CI, 2.0-3.3), and interventions (mechanical ventilation odds ratio, 8.8; 95% CI, 6.1-12.9 and dialysis odds ratio, 3.0; 95% CI, 1.9-4.7) were significant predictors for mortality. CONCLUSIONS: Patients admitted to ICUs with higher surge scores were at greater risk of death. Impact of surge levels on mortality varied across sociodemographic groups.


Subject(s)
COVID-19/mortality , Hospital Mortality/trends , Adolescent , Adult , Aged , Analysis of Variance , Female , Hospital Mortality/ethnology , Hospitals, Public/statistics & numerical data , Humans , Intensive Care Units , Male , Middle Aged , New York City/epidemiology , Odds Ratio , Patient Transfer/statistics & numerical data , Retrospective Studies , Young Adult
3.
Ghana Med J ; 54(4 Suppl): 16-22, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436190

ABSTRACT

Introduction: COVID-19 is a new disease, knowledge on the mode of transmission and clinical features are still evolving, new tests are being developed with inherent challenges regarding interpretation of tests results. There is generally, a gap in knowledge on the virus globally as the pandemic evolves and in Ghana, there is dearth of information and documentation on the clinical characteristics of the virus. With these in mind, we set out to profile the initial cohort of COVID-19 patients who recovered in Ghana. Methods: We reviewed clinical records of all confirmed cases of COVID-19 who had recovered from the two main treatment centres in Accra, Ghana. Descriptive data analysis was employed and presented in simple and relational tables. Independent t-test and ANOVA were used to determine differences in the mean age of the sexes and the number of days taken for the first and second retesting to be done per selected patient characteristics. Results: Of the 146 records reviewed, 54% were male; mean age of patients was 41.9 ± 17.5 years, nearly half were asymptomatic, with 9% being severely ill. The commonest presenting symptoms were cough (22.6%), headache (13%) and sore throat (11%) while the commonest co-morbidities were hypertension (25.3%), diabetes mellitus (14%) and heart disease (3.4%). Conclusion: COVID-19 affected more males than females; nearly half of those infected were asymptomatic. Cough, headache and sore throat were the commonest symptoms and mean duration from case confirmation to full recovery was 19 days. Further research is required as pandemic evolves. Funding: None declared.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , SARS-CoV-2 , Adult , Age Distribution , Analysis of Variance , COVID-19/virology , Cohort Studies , Cough/epidemiology , Cough/virology , Female , Ghana/epidemiology , Headache/epidemiology , Headache/virology , Humans , Male , Middle Aged , Pharyngitis/epidemiology , Pharyngitis/virology , Sex Distribution
4.
PLoS One ; 16(9): e0255491, 2021.
Article in English | MEDLINE | ID: covidwho-1410577

ABSTRACT

COVID-19 caused a global change in the lifestyles of people around the world. It provided a unique opportunity to examine how external circumstances impact two crucial aspects of functioning relating to "who I am" (values) and "how I feel" (well-being). Participants (N = 215) reported their values and subjective and eudaimonic well-being, nine months before the first lockdown in Poland and two weeks and four weeks into the first lockdown. We observed increased valuing of self-direction, security, conformity, humility, caring, and universalism and a decrease in valuing hedonism. Individuals experienced decreased subjective and eudaimonic well-being, with women responding with stronger negative affect intensity relative to men. Finally, we identified that individuals who were more open to change before the COVID-19 pandemic responded with higher eudaimonic well-being two weeks into lockdown relative to their less open to change peers. This study is unique in that it shows that well-being and individually held values are flexible and adaptive systems that react to external circumstances such as global critical events.


Subject(s)
COVID-19/psychology , Mental Health/statistics & numerical data , Personal Satisfaction , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Adult , Aged , Analysis of Variance , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Male , Mental Health/standards , Middle Aged , Pandemics/prevention & control , Poland/epidemiology , SARS-CoV-2/physiology , Young Adult
5.
Crit Care ; 25(1): 217, 2021 06 24.
Article in English | MEDLINE | ID: covidwho-1388810

ABSTRACT

BACKGROUND: The viral load of asymptomatic SAR-COV-2 positive (ASAP) persons has been equal to that of symptomatic patients. On the other hand, there are no reports of ST-elevation myocardial infarction (STEMI) outcomes in ASAP patients. Therefore, we evaluated thrombus burden and thrombus viral load and their impact on microvascular bed perfusion in the infarct area (myocardial blush grade, MBG) in ASAP compared to SARS-COV-2 negative (SANE) STEMI patients. METHODS: This was an observational study of 46 ASAP, and 130 SANE patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention and thrombus aspiration. The primary endpoints were thrombus dimension + thrombus viral load effects on MBG after PPCI. The secondary endpoints during hospitalization were major adverse cardiovascular events (MACEs). MACEs are defined as a composite of cardiovascular death, nonfatal acute AMI, and heart failure during hospitalization. RESULTS: In the study population, ASAP vs. SANE showed a significant greater use of GP IIb/IIIa inhibitors and of heparin (p < 0.05), and a higher thrombus grade 5 and thrombus dimensions (p < 0.05). Interestingly, ASAP vs. SANE patients had lower MBG and left ventricular function (p < 0.001), and 39 (84.9%) of ASAP patients had thrombus specimens positive for SARS-COV-2. After PPCI, a MBG 2-3 was present in only 26.1% of ASAP vs. 97.7% of SANE STEMI patients (p < 0.001). Notably, death and nonfatal AMI were higher in ASAP vs. SANE patients (p < 0.05). Finally, in ASAP STEMI patients the thrombus viral load was a significant determinant of thrombus dimension independently of risk factors (p < 0.005). Thus, multiple logistic regression analyses evidenced that thrombus SARS-CoV-2 infection and dimension were significant predictors of poorer MBG in STEMI patients. Intriguingly, in ASAP patients the female vs. male had higher thrombus viral load (15.53 ± 4.5 vs. 30.25 ± 5.51 CT; p < 0.001), and thrombus dimension (4.62 ± 0.44 vs 4.00 ± 1.28 mm2; p < 0.001). ASAP vs. SANE patients had a significantly lower in-hospital survival for MACE following PPCI (p < 0.001). CONCLUSIONS: In ASAP patients presenting with STEMI, there is strong evidence towards higher thrombus viral load, dimension, and poorer MBG. These data support the need to reconsider ASAP status as a risk factor that may worsen STEMI outcomes.


Subject(s)
COVID-19/complications , Coronary Thrombosis/virology , Heart/physiopathology , Microcirculation/physiology , Myocardial Infarction/physiopathology , Aged , Analysis of Variance , Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Cohort Studies , Coronary Angiography/methods , Coronary Thrombosis/epidemiology , Echocardiography/methods , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/epidemiology
6.
Vet Med Sci ; 7(5): 1980-1988, 2021 09.
Article in English | MEDLINE | ID: covidwho-1351271

ABSTRACT

OBJECTIVES: This research aims to explore the factors motivate consumers to eat game meat during a multi-state disease outbreak. METHODS: It proposes a segmentation of consumers based on their attitudes toward and reveals the consumers' food beliefs that motivate their actions. Three segments of game meat consumers were identified: identity seekers, health seekers, and taste seekers. RESULTS: A survey of the potential impact that the COVID-19 crisis has on these three clusters' future food choices showed that the identity and health seekers are more open to a change in food choices. However, the taste seekers are less likely to be influenced by external factors. CONCLUSIONS: This research indicates that for the policymakers, the key is to take game meat consumers as an effective intervention entry point. It is crucial to facilitate healthy food choices and to promote socially- and culturally-appropriate food beliefs by improving public awareness of the risks of game meat, and invest in organic food. RESEARCH IMPLICATIONS: This research provides new insights into the food beliefs of game meat consumers via motivation-based segmentation.


Subject(s)
Animals, Wild/virology , COVID-19/psychology , Meat/standards , Motivation , Adult , Analysis of Variance , Animals , Anxiety , COVID-19/etiology , China , Choice Behavior , Cluster Analysis , Discriminant Analysis , Educational Status , Female , Food, Organic , Health Behavior , Humans , Income , Male , Middle Aged , Surveys and Questionnaires , Taste
7.
Can Respir J ; 2021: 6638048, 2021.
Article in English | MEDLINE | ID: covidwho-1301736

ABSTRACT

Background: High-flow nasal cannula (HFNC) oxygen therapy has been recommended for use in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure and many other clinical conditions. HFNC devices produced by different manufacturers may have varied performance. Whether there is a difference in these devices and the extent of the differences in performance remain unknown. Methods: Four HFNC devices (AIRVO 2, TNI softFlow 50, HUMID-BH, and OH-70C) and a ventilator with an HFNC module (bellavista 1000) were evaluated. The flow was set at 20, 25, 30, 35, 40, 45, 50, 60, 70, and 80 L/min, and the FiO2 was set at 21%, 26%, 30%, 35%, 40%, 45%, 50%, 60%, 70%, 80%, and 90%. Then, one side of the cannulas was clipped to simulate the compression, bending, or blocking of the nasal cannulas. The flow and FiO2 of the delivered gas were recorded and compared among settings and devices. Results: The actual-flow and actual-FiO2 delivered by different settings and devices varied. AIRVO 2 had superior performance in flow and FiO2 accuracy. bellavista 1000 and OH-70C had good performance in the accuracy of actual-flows and actual-FiO2, respectively. bellavista 1000 and HUMID-BH had a larger flow range from 10 to 80 L/min, but only bellavista 1000 could provide a stable flow with an excessive resistance up to 60 L/min. TNI softFlow 50 had the best flow compensation and could provide sufficient flow with excessive resistance at 20-50 L/min. Conclusions: The variation in flow, FiO2 settings, and devices could influence the actual-flow and actual-FiO2 delivered. AIRVO 2 and OH-70C showed better FiO2 accuracy. TNI softFlow 50, bellavista 1000, and HUMID-BH could lower the risk of insufficient flow support due to accidental compression or blocking of the cannulas. In addition, ventilators with HFNC modules provided comparable flow and FiO2 and could be an alternative to standalone HFNC devices.


Subject(s)
Acute Kidney Injury/therapy , COVID-19 , Cannula , Inhalation/physiology , Oxygen Inhalation Therapy , Acute Kidney Injury/etiology , Analysis of Variance , COVID-19/complications , COVID-19/therapy , Cannula/classification , Cannula/standards , Comparative Effectiveness Research , Humans , Materials Testing/methods , Maximal Respiratory Pressures , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/methods , SARS-CoV-2 , Tidal Volume/physiology
8.
Res Nurs Health ; 44(5): 776-786, 2021 10.
Article in English | MEDLINE | ID: covidwho-1287388

ABSTRACT

The COVID-19 pandemic poses significant challenges to healthcare systems worldwide. A key consideration is the adverse psychological impact on healthcare workers (HCWs). This study aimed to investigate the variable levels of psychological distress, perceived safety, trust, and self- and collective-efficacy during the COVID-19 crisis amongst varied HCWs. A survey was disseminated to nurses, physicians, interns, and administrative and logistical staff at an acute-care hospital in Israel during the first wave of COVID-19. The survey consisted of items on a 5-point Likert scale, measuring HCW's perceptions concerning the aforementioned variables as well as demographic information. A total of 716 hospital personnel completed the survey. Nurses reported higher levels of psychological distress and lower levels of trust in the hospital's COVID-19 guidelines compared to physicians (2.3 vs. 2.0 and 3.7 vs. 4.0, respectively). Nurses and interns felt the least safe when working in the hospital. Nurses reported the highest levels of concern regarding fear of uncontrollable spread, infection, and family transmission of the virus. Interns reported the lowest levels of self- and collective-efficacy. In a regression model, the variables that predicted 32% of distress among nurses were age, gender, level of religiosity, indices of perceived safety, and self-efficacy. This study demonstrated differences in distress and perceived safety, trust, and efficacy between varied HCWs during COVID-19. This variability should be considered when designing policies to protect HCWs' wellbeing during future pandemics.


Subject(s)
COVID-19/complications , Health Personnel/psychology , Perception , Adult , Analysis of Variance , COVID-19/prevention & control , COVID-19/psychology , Cross-Sectional Studies , Female , Health Personnel/statistics & numerical data , Humans , Male , Middle Aged , Patient Safety/standards , Patient Safety/statistics & numerical data , Self Efficacy , Stress, Psychological , Surveys and Questionnaires , Trust/psychology
9.
Nutr Hosp ; 38(5): 1068-1074, 2021 Oct 13.
Article in Spanish | MEDLINE | ID: covidwho-1285624

ABSTRACT

Introduction: Introduction: coronavirus disease 2019 (COVID-19) encompasses a wide spectrum of symptoms, including respiratory, gastrointestinal, hematological, and dermatological manifestations. The virus interaction with cells located in the respiratory tract causes the release of inflammatory mediators, whose involvement could be exacerbated by co-existing obesity, diabetes, and cardiovascular events. Objectives: the objective of this research was to analyze the clinically metabolic status in patients who have suffered COVID-19 disease in order to predict the outcome. Methods: this research is a retrospective study based on a cohort of 165 consecutively admitted patients with criteria for COVID-19 pneumonia according to WHO guidelines at the Hospital Universitario Puerta de Hierro between March and April 2020. Recorded variables included demographic and epidemiological data plus diagnoses as well as morbid complications during hospitalization. The Biochemistry Unit Laboratory carried out laboratory analyses according to validated operational procedures. The statistical tests included univariate and multivariate models adjusted for baseline characteristics and clinically relevant features. Results: the most frequent comorbidity in our cohort was arterial hypertension (44.0 %), followed by dyslipidemia (32.1 %), obesity (30.9 %), and diabetes mellitus (20.0 %). The association between admission to the intensive care unit (ICU) with body mass index (BMI) in a multivariate model was statistically significant, evidencing that obese subjects (BMI ≥ 30 kg/m2) have a 19 % higher risk of requiring ICU care. The univariate model revealed a statistically significant association between obesity and ICU admission and length of hospital stay (p < 0.05). The relationship between baseline blood glucose and in-hospital mortality was also statistically significant (p = 0.03), as well as with total cholesterol and ICU admission (p = 0.007). Conclusions: obesity is related to a longer time of hospitalization and a higher rate of admissions to the ICU. Low total cholesterol levels and abnormal baseline blood glucose were risk factors for ICU requirement and in-hospital mortality. Patient categorization based on obesity could be valuable in the development of a precision medicine model within the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Dyslipidemias/epidemiology , Metabolic Syndrome/epidemiology , Analysis of Variance , Blood Glucose/metabolism , Body Mass Index , COVID-19/mortality , Comorbidity , Diabetes Mellitus/epidemiology , Female , Hospital Mortality , Humans , Hypertension/epidemiology , Intensive Care Units , Length of Stay , Male , Metabolic Syndrome/blood , Metabolic Syndrome/mortality , Middle Aged , Obesity/epidemiology , Obesity/mortality , Retrospective Studies , Risk Factors , Spain/epidemiology
10.
Repert. med. cir ; 30(suplemento): 16-20, 2021. graf.
Article in English, Spanish | LILACS (Americas) | ID: covidwho-1270344

ABSTRACT

Introducción: : El síndrome respiratorio agudo severo por coronavirus (SARS-CoV-2), el virus que origina la enfermedad 2019 (COVID-19) se ha diseminado con rapidez por todo el mundo desde que surgió en Wuhan, China, a finales de 2019. Objetivo: describir el comportamiento de positividad de muestras tomadas para SARS-CoV-2. Metodología: esta investigación se centró en las muestras de PCR y antígeno procesadas para COVID-19, con la información proveniente del Instituto Nacional de Salud en el periodo comprendido entre el 1 de enero a 31 de marzo 2021. Resultados: para la prueba de PCR en cada uno de los meses de enero a marzo 2021 en Colombia, se detalló que los días con mayor porcentaje de casos positivos fueron 12 de enero 56,3%, 7 de enero 44,9%, 6 de enero 45,1%, 5 de enero 43,7%, 2 de enero 38,1%, 24 de marzo 35,2%, y 26 de marzo con 31,3%. Para la prueba de antígeno en cada uno de los meses de enero a marzo 2021 en Colombia, se anota que los días con mayor porcentaje de casos positivos fueron 11 de enero 32,7%, 4 de enero 31,0%, 15 de enero 28,9%, 18 de enero 22,4%, 22 de marzo 21,1%, 28 de marzo 20,7%, y 17 de febrero 20,1%. Conclusión: hay que continuar la búsqueda activa de contagiados a través de la práctica de mayor número de pruebas de PCR, antígeno viral y molecular, la última con un alto nivel de precisión por parte de las EPS, y que a su vez aceleren el proceso de entrega de resultados.


Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19) has spread rapidly around the world since it emerged in Wuhan, China, in late 2019. Objective: to describe the positivity rates of samples tested for SARS-CoV-2. Methodology: the research focused on PCR and antigen tests processed for COVID-19, using the information released by the National Institute of Health between January 1 and March 31 2021. Results: the highest positivity rate for PCR testing for each month between January to March 2021 in Colombia was found on the following days: January 12: 56.3%, January 7: 44.9%, January 6: 45.1%, January 5: 43.7%, January 2: 38.1%, March 24: 35.2% and March 26: (31.3%. The days with the highest percentage of positive cases found by antigen testing for each month from January to March 2021 in Colombia, were January 11: 32.7%, January 4: 31.0%, January 15: 28.9%, January 18: 22.4%, March 22: 21.1%, March 28: 20.7% and February 17: 20.1%. Conclusion: an active search of infected people must be continued through the practice of a greater number of PCR and viral antigen and molecular tests. The latter has been reported by the EPS to show very high accuracy, which accelerates the result delivery process.


Subject(s)
Humans , Correlation of Data , COVID-19/diagnosis , Analysis of Variance , Colombia , COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19 Serological Testing/statistics & numerical data , SARS-CoV-2/immunology , COVID-19/transmission
11.
Crit Care ; 25(1): 202, 2021 06 10.
Article in English | MEDLINE | ID: covidwho-1266500

ABSTRACT

BACKGROUND: The mechanisms driving acute kidney injury (AKI) in critically ill COVID-19 patients are unclear. We collected kidney biopsies from COVID-19 AKI patients within 30 min after death in order to examine the histopathology and perform mRNA expression analysis of genes associated with renal injury. METHODS: This study involved histopathology and mRNA analyses of postmortem kidney biopsies collected from patients with COVID-19 (n = 6) and bacterial sepsis (n = 27). Normal control renal tissue was obtained from patients undergoing total nephrectomy (n = 12). The mean length of ICU admission-to-biopsy was 30 days for COVID-19 and 3-4 days for bacterial sepsis patients. RESULTS: We did not detect SARS-CoV-2 RNA in kidney biopsies from COVID-19-AKI patients yet lung tissue from the same patients was PCR positive. Extensive acute tubular necrosis (ATN) and peritubular thrombi were distinct histopathology features of COVID-19-AKI compared to bacterial sepsis-AKI. ACE2 mRNA levels in both COVID-19 (fold change 0.42, p = 0.0002) and bacterial sepsis patients (fold change 0.24, p < 0.0001) were low compared to control. The mRNA levels of injury markers NGAL and KIM-1 were unaltered compared to control tissue but increased in sepsis-AKI patients. Markers for inflammation and endothelial activation were unaltered in COVID-19 suggesting a lack of renal inflammation. Renal mRNA levels of endothelial integrity markers CD31, PV-1 and VE-Cadherin did not differ from control individuals yet were increased in bacterial sepsis patients (CD31 fold change 2.3, p = 0.0006, PV-1 fold change 1.5, p = 0.008). Angiopoietin-1 mRNA levels were downregulated in renal tissue from both COVID-19 (fold change 0.27, p < 0.0001) and bacterial sepsis patients (fold change 0.67, p < 0.0001) compared to controls. Moreover, low Tie2 mRNA expression (fold change 0.33, p = 0.037) and a disturbed VEGFR2/VEGFR3 ratio (fold change 0.09, p < 0.0001) suggest decreased microvascular flow in COVID-19. CONCLUSIONS: In a small cohort of postmortem kidney biopsies from COVID-19 patients, we observed distinct histopathological and gene expression profiles between COVID-19-AKI and bacterial sepsis-AKI. COVID-19 was associated with more severe ATN and microvascular thrombosis coupled with decreased microvascular flow, yet minimal inflammation. Further studies are required to determine whether these observations are a result of true pathophysiological differences or related to the timing of biopsy after disease onset.


Subject(s)
COVID-19/pathology , Gene Expression/genetics , Kidney/pathology , Kidney/physiopathology , Sepsis/pathology , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Adult , Aged , Aged, 80 and over , Analysis of Variance , COVID-19/genetics , COVID-19/physiopathology , Critical Illness/therapy , Female , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Sepsis/genetics , Sepsis/physiopathology , Simplified Acute Physiology Score
12.
Microbiol Immunol ; 64(1): 33-51, 2020 Jan.
Article in English | MEDLINE | ID: covidwho-1262996

ABSTRACT

The spike (S) protein of coronavirus, which binds to cellular receptors and mediates membrane fusion for cell entry, is a candidate vaccine target for blocking coronavirus infection. However, some animal studies have suggested that inadequate immunization against severe acute respiratory syndrome coronavirus (SARS-CoV) induces a lung eosinophilic immunopathology upon infection. The present study evaluated two kinds of vaccine adjuvants for use with recombinant S protein: gold nanoparticles (AuNPs), which are expected to function as both an antigen carrier and an adjuvant in immunization; and Toll-like receptor (TLR) agonists, which have previously been shown to be an effective adjuvant in an ultraviolet-inactivated SARS-CoV vaccine. All the mice immunized with more than 0.5 µg S protein without adjuvant escaped from SARS after infection with mouse-adapted SARS-CoV; however, eosinophilic infiltrations were observed in the lungs of almost all the immunized mice. The AuNP-adjuvanted protein induced a strong IgG response but failed to improve vaccine efficacy or to reduce eosinophilic infiltration because of highly allergic inflammatory responses. Whereas similar virus titers were observed in the control animals and the animals immunized with S protein with or without AuNPs, Type 1 interferon and pro-inflammatory responses were moderate in the mice treated with S protein with and without AuNPs. On the other hand, the TLR agonist-adjuvanted vaccine induced highly protective antibodies without eosinophilic infiltrations, as well as Th1/17 cytokine responses. The findings of this study will support the development of vaccines against severe pneumonia-associated coronaviruses.


Subject(s)
Adjuvants, Immunologic/pharmacology , Coronavirus Infections/prevention & control , Gold/chemistry , Immunoglobulin G/immunology , Lung/immunology , Metal Nanoparticles/chemistry , Severe Acute Respiratory Syndrome/prevention & control , Spike Glycoprotein, Coronavirus/immunology , Analysis of Variance , Animals , Antibodies, Viral/immunology , Chlorocebus aethiops , Coronavirus/immunology , Coronavirus Infections/immunology , Coronavirus Infections/virology , Cytokines/metabolism , Disease Models, Animal , Female , Immunization , Lung/pathology , Mice , Mice, Inbred BALB C , Recombinant Proteins/immunology , SARS Virus/immunology , Severe Acute Respiratory Syndrome/immunology , Severe Acute Respiratory Syndrome/virology , Spike Glycoprotein, Coronavirus/genetics , Toll-Like Receptors , Vaccination , Vaccines, Synthetic , Vero Cells , Viral Envelope Proteins/genetics , Viral Envelope Proteins/immunology , Viral Vaccines/immunology , Viral Vaccines/pharmacology , Viral Vaccines/therapeutic use
13.
J Infect Dev Ctries ; 15(5): 618-624, 2021 05 31.
Article in English | MEDLINE | ID: covidwho-1262625

ABSTRACT

INTRODUCTION: This study was planned to assess the trends of epidemiological indicators and demographic determinants related to the COVID-19 in India. METHODOLOGY: This was a descriptive analysis of the COVID-19 cases and their outcomes between 1st March to 31st May 2020 in India. Unpaired t-test and ANOVA were used to determine the statistical differences. Linear regression models were prepared to estimate the effect of testing on the fatalities. The Infection Fatality Rate (IFR)/Case Fatality Rate (CFR), doubling time, and Basic Reproduction Number (R0) per week were calculated. RESULTS: Two-thirds of the cases were between 21-50 years of age, while three-fourth of deaths were among people above 50-years of age. The mean age of people infected with COVID-19 was declining throughout the study period. The mean age of infected males and females was significantly different. The male-female ratio of both infection and deaths due to COVID-19 was near about 2:1. IFR/CFR was 3.31 (95% CI = 3.13-3.50) in April, which reduced to 2.84 (95% CI = 2.77-2.92) in May. An incremental trend was observed in the recovery rates (9.42% to 48.18%), tests conducted / million population (12 / million to 2708 / million) and doubling time (3.59 to 17.71 days). The number of tests was significantly influencing the fatalities (ß = 0.016, 95% CI = 0.012-0.020). The overall R0 was found to be 1.72. CONCLUSIONS: Public health interventions were likely effective in containing the spread of COVID-19. There is a need to further improve the testing capacity. The high-risk category of individuals being prioritized for hospital admission should be redefined to include individuals older than 50 years.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/mortality , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , COVID-19/diagnosis , Child , Female , Humans , India/epidemiology , Male , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2 , Sex Distribution , Young Adult
14.
Ann Vasc Surg ; 73: 86-96, 2021 May.
Article in English | MEDLINE | ID: covidwho-1258320

ABSTRACT

OBJECTIVES: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS: This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across Spain and Andorra between March and May 2020. The primary end point was 30-day mortality. Clinical Trials registry number NCT04333693. RESULTS: The mean age was 70.9 (45-94) and 58 (77.0%) patients were male. Around 70.7% had postoperative complications, 36.0% of patients experienced respiratory failure, 22.7% acute renal failure, and 22.7% acute respiratory distress syndrome (ARDS). All-cause 30-days mortality rate was 37.3%. Multivariate analysis identified age >65 years (P = 0.009), American Society of Anesthesiologists (ASA) classification IV (P = 0.004), preoperative lymphocyte count <0.6 (×109/L) (P = 0.001) and lactate dehydrogenase (LDH) >500 (UI/L) (P = 0.004), need for invasive ventilation (P = 0.043), postoperative acute renal failure (P = 0.001), ARDS (P = 0.003) and major amputation (P = 0.009) as independent variables associated with mortality. Preoperative coma (P = 0.001), quick Sepsis Related Organ Failure Assessment (qSOFA) score ≥2 (P = 0.043), lymphocytes <0.6 (×109/L) (P = 0.019) leucocytes >11.5 (×109/L) (P = 0.007) and serum ferritin >1800 mg/dL (P = 0.004), bilateral lung infiltrates on thorax computed tomography (P = 0.025), and postoperative acute renal failure (P = 0.009) increased the risk of postoperative ARDS. qSOFA score ≥2 was the only risk factor associated with postoperative sepsis (P = 0.041). CONCLUSIONS: Patients with COVID-19 infection undergoing vascular surgery procedures showed poor 30-days survival. Age >65 years, preoperative lymphocytes <0.6 (x109/L) and LDH >500 (UI/L), and postoperative acute renal failure, ARDS and need for major amputation were identified as prognostic factors of 30-days mortality.


Subject(s)
COVID-19/complications , Postoperative Complications/epidemiology , Vascular Surgical Procedures/adverse effects , Acute Kidney Injury/etiology , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , Andorra/epidemiology , COVID-19/mortality , Cohort Studies , Female , Humans , L-Lactate Dehydrogenase/blood , Lymphocyte Count , Male , Middle Aged , Postoperative Complications/mortality , Prognosis , Respiratory Distress Syndrome/etiology , Risk Factors , Spain/epidemiology , Treatment Outcome
15.
J Clin Pharmacol ; 61(11): 1406-1414, 2021 11.
Article in English | MEDLINE | ID: covidwho-1241509

ABSTRACT

Glucocorticoids are frequently prescribed in inflammatory diseases and have recently experienced a boom in the treatment of COVID-19. Small studies have shown an effect of glucocorticoids on inflammatory marker levels, but definitive proof is lacking. We investigated the influence of prednisone on inflammatory biomarkers in a previous multicenter, randomized, placebo-controlled trial that compared a 7-day treatment course of 50-mg prednisone to placebo in patients hospitalized with community-acquired pneumonia. We compared levels of C-reactive protein (CRP), procalcitonin (PCT), leukocyte and neutrophil count between patients with and without glucocorticoid treatment at baseline and on days 3, 5, and 7 and at discharge by Wilcoxon tests and analysis of variance. A total of 356 patient data sets in the prednisone group and 355 in the placebo group were available for analysis. Compared to placebo, use of prednisone was associated with reductions in levels of CRP on days 3, 5, and 7 (mean difference of 46%, P < .001 for each time point). For PCT, no such difference was observed. Leukocyte and neutrophil count were higher in the prednisone group at all time points (mean difference of 27% for leukocytes and 33% for neutrophils, P <.001 for all time points). We conclude that after administration of glucocorticoids in community-acquired pneumonia, patients had lower CRP levels and increased leukocyte and neutrophil count as compared to the placebo group. PCT levels were not different between treatment groups. PCT levels thus may more appropriately mirror the resolution of infection compared to more traditional inflammatory markers.


Subject(s)
C-Reactive Protein/analysis , COVID-19 , Community-Acquired Infections , Leukocyte Count/methods , Pneumonia , Prednisone/administration & dosage , Procalcitonin/blood , Aged, 80 and over , Analysis of Variance , Biomarkers, Pharmacological/blood , COVID-19/drug therapy , COVID-19/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Drug Monitoring/methods , Female , Glucocorticoids/administration & dosage , Humans , Male , Pneumonia/blood , Pneumonia/drug therapy , Pneumonia/epidemiology , Pneumonia/etiology , SARS-CoV-2 , Statistics, Nonparametric
18.
Epidemiol Infect ; 149: e107, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-1220258

ABSTRACT

Student's t test is valid for statistical inference under the normality assumption or asymptotically. By contrast, although the bootstrap t test was proposed in 1993, it is seldom adopted in medical research. We aim to demonstrate that the bootstrap t test outperforms Student's t test under normality in data. Using random data samples from normal distributions, we evaluated the testing performance, in terms of true-positive rate (TPR) and false-positive rate and diagnostic abilities, in terms of the area under the curve (AUC), of the bootstrap t test and Student's t test. We explore the AUC of both tests with varying sample size and coefficient of variation. We compare the testing outcomes using the COVID-19 serial interval (SI) data in Shenzhen and Hong Kong, China, for demonstration. With fixed TPR, the bootstrap t test maintained the equivalent accuracy in TPR, but significantly improved the true-negative rate from the Student's t test. With varying TPR, the diagnostic ability of bootstrap t test outperformed or equivalently performed as Student's t test in terms of the AUC. The equivalent performances are possible but rarely occur in practice. We find that the bootstrap t test outperforms by successfully detecting the difference in COVID-19 SI, which is defined as the time interval between consecutive transmission generations, due to sex and non-pharmaceutical interventions against the Student's t test. We demonstrated that the bootstrap t test outperforms Student's t test, and it is recommended to replace Student's t test in medical data analysis regardless of sample size.


Subject(s)
COVID-19/epidemiology , Models, Statistical , Analysis of Variance , Area Under Curve , COVID-19/transmission , China/epidemiology , Female , Humans , Male , ROC Curve , SARS-CoV-2 , Sample Size
19.
Global Health ; 17(1): 54, 2021 05 07.
Article in English | MEDLINE | ID: covidwho-1220233

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is closely associated with physical and mental health problems; however, little is known about the severity of stigma caused by COVID-19 among its survivors. Thus, the aim of this study was to compare differences in stigma experiences of COVID-19 survivors versus healthy controls after the COVID-19 outbreak peak in China. METHODS: This cross-sectional study comprised 154 COVID-19 survivors and 194 healthy controls recruited through consecutive and convenience sampling methods, respectively. COVID-19 related stigma was measured by the Social Impact Scale (SIS). Stigma differences between the two groups were compared with analysis of covariance (ANCOVA) and a generalized linear model (GLM) was used to identify independent correlates of COVID-19-related stigma in this study. RESULTS: Compared with healthy controls, COVID-19 survivors reported more overall stigma (F(1,347) = 60.82, p < 0.001), and stigma in domains of social rejection (F(1,347) = 56.54, p < 0.001), financial insecurity (F(1,347) = 19.96, p < 0.001), internalized shame (F(1,347) = 71.40, p < 0.001) and social isolation (F(1,347) = 34.73, p < 0.001). Status as a COVID-19 survivor, having family members infected with COVID-19, being married, economic loss during the COVID-19 pandemic, and depressive symptoms were positively associated with higher overall stigma levels (all p values < 0.05). CONCLUSION: COVID-19-related stigma is commonly experienced among COVID-19 survivors even though the outbreak has been well-contained in China. Routine assessment of stigma experiences should be conducted on COVID-19 survivors and appropriate psychological assistance, public education, and anti-stigma campaigns and policies should be enforced to reduce stigma within this vulnerable subpopulation.


Subject(s)
COVID-19/psychology , Social Stigma , Socioeconomic Factors , Adult , Analysis of Variance , COVID-19/complications , COVID-19/epidemiology , China/epidemiology , Correlation of Data , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics/statistics & numerical data
20.
Crit Care ; 25(1): 23, 2021 01 09.
Article in English | MEDLINE | ID: covidwho-1151679

ABSTRACT

BACKGROUND: Biomarkers of disease severity might help individualizing the management of patients with the acute respiratory distress syndrome (ARDS). Whether the alveolar compartmentalization of biomarkers has a clinical significance in patients with pneumonia-related ARDS is unknown. This study aimed at assessing the interrelation of ARDS/sepsis biomarkers in the alveolar and blood compartments and explored their association with clinical outcomes. METHODS: Immunocompetent patients with pneumonia-related ARDS admitted between 2014 and 2018 were included in a prospective monocentric study. Bronchoalveolar lavage (BAL) fluid and blood samples were obtained within 48 h of admission. Twenty-two biomarkers were quantified in BAL fluid and serum. HLA-DR+ monocytes and CD8+ PD-1+ lymphocytes were quantified using flow cytometry. The primary clinical endpoint of the study was hospital mortality. Patients undergoing a bronchoscopy as part of routine care were included as controls. RESULTS: Seventy ARDS patients were included. Hospital mortality was 21.4%. The BAL fluid-to-serum ratio of IL-8 was 20 times higher in ARDS patients than in controls (p < 0.0001). ARDS patients with shock had lower BAL fluid-to-serum ratio of IL-1Ra (p = 0.026), IL-6 (p = 0.002), IP-10/CXCL10 (p = 0.024) and IL-10 (p = 0.023) than others. The BAL fluid-to-serum ratio of IL-1Ra was more elevated in hospital survivors than decedents (p = 0.006), even after adjusting for SOFA and driving pressure (p = 0.036). There was no significant association between alveolar or alveolar/blood monocytic HLA-DR or CD8+ lymphocytes PD-1 expression and hospital mortality. CONCLUSIONS: IL-8 was the most compartmentalized cytokine and lower BAL fluid-to-serum concentration ratios of IL-1Ra were associated with hospital mortality in patients with pneumonia-associated ARDS.


Subject(s)
Biomarkers/analysis , Bronchoalveolar Lavage Fluid/immunology , Pulmonary Alveoli/drug effects , Aged , Analysis of Variance , Biomarkers/blood , Bronchoalveolar Lavage/methods , Cohort Studies , Female , Flow Cytometry/methods , France , Humans , Male , Middle Aged , Pneumonia/complications , Prospective Studies , Respiratory Distress Syndrome , Statistics, Nonparametric
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