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1.
Am J Prev Med ; 63(6): 1026-1030, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2117343

ABSTRACT

INTRODUCTION: Fewer cancer diagnoses have been made during the COVID-19 pandemic. Pandemic-related delays in cancer diagnosis could occur from limited access to care or patient evaluation delays (e.g., delayed testing after abnormal results). Follow-up of abnormal test results warranting evaluation for cancer was examined before and during the pandemic. METHODS: Electronic trigger algorithms were applied to the Department of Veterans Affairs electronic health record data to assess follow-up of abnormal test results before (March 10, 2019-March 7, 2020) and during (March 8, 2020-March 6, 2021) the pandemic. RESULTS: Electronic triggers were applied to 8,021,406 veterans' electronic health records to identify follow-up delays for abnormal results warranting evaluation for 5 cancers: bladder (urinalysis with high-grade hematuria), breast (abnormal mammograms), colorectal (positive fecal occult blood tests/fecal immunochemical tests or results consistent with iron deficiency anemia), liver (elevated alpha-fetoprotein), and lung (chest imaging suggestive of malignancy) cancers. Between prepandemic and pandemic periods, test quantities decreased by 12.6%-27.8%, and proportions of abnormal results lacking follow-up decreased for urinalyses (-0.8%), increased for fecal occult blood tests/fecal immunochemical test (+2.3%) and chest imaging (+1.8%), and remained constant for others. Follow-up times decreased for most tests; however, control charts suggested increased delays at 2 stages: early (pandemic beginning) for urinalyses, mammograms, fecal occult blood tests/fecal immunochemical test, iron deficiency anemia, and chest imaging and late (30-45 weeks into pandemic) for mammograms, fecal occult blood tests/fecal immunochemical test, and iron deficiency anemia. CONCLUSIONS: Although early pandemic delays in follow-up may have led to reduced cancer rates, the significant decrease in tests performed is likely a large driver of these reductions. Future emergency preparedness efforts should bolster essential follow-up and testing procedures to facilitate timely cancer diagnosis.


Subject(s)
Anemia , COVID-19 , Neoplasms , Veterans , Humans , United States/epidemiology , COVID-19/diagnosis , Pandemics , Neoplasms/diagnosis
2.
Iran Biomed J ; 26(5): 389-97, 2022 11 01.
Article in English | MEDLINE | ID: covidwho-2115605

ABSTRACT

Background: Anemia often worsens the severity of respiratory illnesses, and few studies have so far elucidated the impact of anemia on COVID-19 infection. This study aimed to evaluate the effect of anemia at admission on the overall survival of COVID-19 patients using AFT models.Methods: This registry-based, single-center retrospective cohort study was conducted in a university hospital in Ilam, the southwest of Iran, between March 2020 and September 2021. AFT models were applied to set the data of 2,441 COVID-19 patients. Performance of AFT models was assessed using AIC and Cox-Snell residual. On-admission anemia was defined as Hb concentration <120 g/l in men, <110 g/l in women, and <100 g/l in pregnant women.Results: The median in-hospital survival times for anemic and non-anemic patients were 27 and 31 days, respectively. Based on the AIC and Cox-Snell residual graph, the Weibull model had the lowest AIC and it was the best fitted model to the data set among AFT models. In the adjusted model, the results of the Weibull model suggested that the anemia (adjusted TR: 1.04; 95% CI: 1.00-1.08; p = 0.03) was the accelerated factor for progression to death in COVID-19 patients. Each unit of increase in hemoglobin in COVID-19 patients enhanced the survival rate by 4%.Conclusion: Anemia is an independent risk factor associated with the risk of mortality from COVID-19 infection. Therefore, healthcare professionals should be more sensitive to the Hb level of COVID-19 patients upon admission.


Subject(s)
Anemia , COVID-19 , Pregnancy , Male , Humans , Female , Survival Rate , Retrospective Studies , Anemia/complications , Risk Factors
3.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2362277.v1

ABSTRACT

Blood analysis, though complete blood count (CBC), is the most basic medical test for disease diagnosis and health monitoring. However, the need for bulky and expensive laboratory facilities and skilled technicians limits the universal medical practices based on blood analysis outside of well-equipped laboratory environments. Here, we proposed a multiparameter mobile blood analyzer utilizing label-free contrast-enhanced defocusing imaging (CEDI) with the assistance of machine vision for instant and on-site blood analysis. The analyzer using CEDI obtains both the blood cell morphological characteristics and hemoglobin spectrophotometric information for simultaneous five-part white blood cell differential count, red blood cell count, and hemoglobin quantification without the need for sample staining. In addition, we have designed a miniature microscope with a sub-micron spatial resolution of (~0.98 μm), which is quite small, lightweight, and cost-effective for blood imaging. We have shown that our assay can analyze a sample within 10 minutes, using just a drop of fingertip blood (~7 μl) and measurements (30 samples) from the analyzer have strong correlations with clinical reference values (significant level: P < 0.0001). The proposed mobile blood analyzer can help provide universal access to blood analysis and has great potential for integrated surveillance of various epidemic diseases, including coronavirus infection, invermination, and anemia, especially in low-and middle-income countries.


Subject(s)
Coronavirus Infections , Encephalitis, Arbovirus , Anemia
4.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.07.22283199

ABSTRACT

The COVID-19 pandemic directly impacted diagnostic services in the UK and globally. This exacerbated the rapid rise in demand for diagnostics that existed before the pandemic, resulting in significant numbers of patients requiring various diagnostic services and increased waiting times for diagnostics and treatment. In 2021, community diagnostic centres were launched in England. As diagnostic services account for over 85% of clinical pathways within the NHS and cost over six billion pounds per year, diagnostic centres across a broader range of diagnostic services may be effective, efficient, and cost-effective in the UK health sector. This rapid review aimed to identify and examine the evidence on the effectiveness of community diagnostic centres. A prior Research Evidence Map was used, along with the stakeholder input, to select a substantive focus for the rapid review. Comparative studies examining community diagnostic centres that accept referrals from primary care as a minimum were included. Prioritised outcomes included those relating to impact on capacity and pressure on secondary care, ensuring equity in uptake or access, and economic outcomes The review included evidence available up until August 2022. Twenty primary studies were included. Twelve individual diagnostic centres were evaluated across the 20 studies. Most studies evaluated diagnostic centres located within hospital settings. One study evaluated a mobile diagnostic ultrasound service. Most studies were specific to cancer diagnoses. Six studies covered multiple health conditions, which will have also included cancer. Other conditions reported included: severe anaemia, fever of uncertain nature, and multiple sclerosis. A range of outcomes was identified. 11 studies conducted in Spain evaluated the same type of clinic i.e. Quick Diagnostic Unit and seven studies evaluated the same centre at different time intervals. No evidence relating to equity of access was identified. The evidence relating to effectiveness appeared mixed. There is evidence to suggest that diagnostic centres can reduce various waiting times, including time to surgical consultation, time from consultation to treatment, time from cancer suspicion to treatment, time from diagnosis to specialist consultation and time from diagnosis to treatment. Diagnostic centres could help reduce pressure on secondary care by avoiding hospitalisations in stable patients. Cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Factors that could determine the costs incurred by a centre include the diagnostic and clinical complexity of patients, and the characteristics of the unit including the number of staff and contribution of staff time.


Subject(s)
Multiple Sclerosis , Anemia , COVID-19 , Fever , Neoplasms
5.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.01.22282959

ABSTRACT

The COVID-19 pandemic has resulted in increased demand and delays to diagnostic services. Community diagnostic centres (which are generally referred to as Regional Diagnostic Hubs in Wales) aim to reduce this backlog and the waiting times for patients by providing a broad range of elective diagnostic services in the community, away from acute hospital facilities. As diagnostic services account for over 85% of clinical pathways and cost the National Health Service (NHS) over six billion pounds a year (NHS 2022), community diagnostic centres across a broader range of diagnostic services may be an effective, efficient, and cost-effective introduction to the UK health sector. This Rapid Evidence Map aimed to identify, describe, and map the available evidence on the effectiveness of diagnostic centres. 50 primary studies were identified. Studies were published between 1995 and 2021: A wide range of study designs were used, and studies were conducted in a range of countries including the UK. 30 studies were specific to cancer diagnosis, whilst the remaining 20 studies focused on diagnosis associated with: anaemia, autism, cerebral palsy, intellectual disability, multiple sclerosis, respiratory conditions, shoulder pain, and unexplained fever Eleven studies reported information on multi-condition diagnostic centres, rather than a specific condition. The majority of studies were conducted within hospital settings. Two studies evaluated diagnostic centres within a community setting. The diagnostic centres offered a wide range of diagnostic tests and incorporated different staff and facilities. Participants were mainly referred by GPs, primary care centres and emergency departments. However, referrals were also made from outpatient clinics located within the same hospital as the diagnostic centre. Over 100 different outcomes were reported covering: patient data and referral outcomes, clinical outcomes, performance outcomes, economic outcomes, and patient and physician-reported outcomes. The findings of this rapid evidence map were used to select a substantive focus for a subsequent rapid review on community diagnostic centres that can be accessed by primary care teams.


Subject(s)
Multiple Sclerosis , Anemia , COVID-19 , Cerebral Palsy , Autistic Disorder , Fever , Pain , Neoplasms
6.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.11.28.22282830

ABSTRACT

Background: Coronavirus disease (COVID-19) is an infectious disease that is caused by the SARS-CoV-2virus. The objective of this study was to determine SARS COV-2 Mortality and its associated factors in East Shewa Zone Treatment centers, Oromia, Ethiopia, 2022. The study of these types of viral infection will add new insight into the most common causes of mortality in SARS-CoV-2infection and the most common co-morbidities associated with the disease in the East Shewa Zone. Methods: The study was conducted on patients who were admitted to Adama Hospital medical college and Modjo Primary Hospital for SARS-COV 2 treatment. The study period was from March 2020- Dec 2022 GC. The study population was SARS-COV 2 patients who come to Adama Hospital and Medical College and Modjo Primary Hospital for treatment. All eligible SARS-CoV-2 patients' data were collected from Both Adama and Modjo treatment center SARS-CoV-2 accession registration book and medical record card. Result: A total of 409 patient data were collected from which 199 were from Adama Hospital and Medical College and 210 samples were collected from Modjo Primary Hospital Treatment center. The study design was a retrospective Cross-sectional study. The most affected age group in terms of mortality was the age group between 60-69 years old which suffers a 45.28% death rate. The major sign symptoms identified include cough (80.4%), Shortness of breath (66.7%) followed by fever (43.2%). SARS-CoV-2 Comorbidity was detected in 152 (37.2%) patients. Pneumonia was identified as the major comorbid disease to be recorded with 89(21.8%) cases. Other major comorbidities include Hypertension (16.9%) and Diabetes Mellites (13.9%). The least identified comorbidities were anemia (0.2%), Rectal cancer (0.2%), breast cancer (0.5%), and Chronic liver disease. Conclusion: Nearly one in four (22.7%) SARS-COV 2 patients admitted for treatment to Adama Hospital and Medical College and Modjo Primary Hospital did not make their way out of treatment Hospitals alive. Pneumonia was identified as the major comorbid disease to be recorded with 89(21.8%) cases.


Subject(s)
Rectal Neoplasms , Diabetes Mellitus , Severe Acute Respiratory Syndrome , Anemia , Communicable Diseases , End Stage Liver Disease , COVID-19 , Breast Neoplasms , Fever , Dyspnea , Virus Diseases , Hypertension
7.
Thromb Res ; 220: 12-20, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2096062

ABSTRACT

Vaccination is the most cost-effective means of preventing and even eliminating infectious diseases. However, adverse reactions after vaccination are inevitable. In addition to common vaccine-related adverse reactions, some rare but serious adverse reactions have been reported, including secondary immune thrombocytopenia (ITP). The measles-mumps-rubella (MMR) vaccine is currently the only vaccine for which a cause-effect relationship with immune thrombocytopenia has been demonstrated with an incidence of approximately 0.087-4 per 100,000 doses, and the complication is mostly observed in children. In addition, thrombocytopenia can be induced by coronavirus disease 2019 (COVID-19) vaccines following COVID-19 vaccination primarily occurs within a few weeks post-vaccination. The condition mostly occurs in elderly individuals with no sex differences. Its incidence is approximately 0.80 to 11.3 per million doses. Some patients have previously suffered from chronic ITP likely to develop exacerbation of ITP after COVID-19 vaccines, especially those who have undergone splenectomy or are being treated with >5 medications. Based on clinical practice, first-line treatments for vaccine-associated thrombocytopenia are essentially limited to those used for primary ITP, including glucocorticoids and intravenous immunoglobulin (IVIg).


Subject(s)
Anemia , COVID-19 Vaccines , COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Aged , Child , Humans , Infant , Anemia/complications , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Measles-Mumps-Rubella Vaccine/adverse effects , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Purpura, Thrombocytopenic, Idiopathic/epidemiology , Vaccination/adverse effects
8.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2302489.v1

ABSTRACT

Background Hyperuricemia, pulmonary hypertension, renal failure, and alkaline intoxication syndrome (HUPRA syndrome) is a rare autosomal recessive mitochondrial disease with prevalence of less than one in a million. Due to mutations in the mitochondrial SARS enzyme encoding seryl-tRNA synthetase on chromosome 19 (19q13.2). Case–Diagnosis/Treatment We investigated two Palestinian girls from the same village presented with progressive renal failure in infancy were diagnosed with this multisystemic disease. presented with atypical clinical manifestations of HUPRA syndrome include leukopenia, anemia, salt wasting resulting in hyponatremia and hypochloremia, renal failure with elevated blood lactate, marked hyperuricemia, hypercholesterolemia and hypertriglyceridemia but  without  pulmonary hypertension or alkaline intoxication that distinguish them from the rest of the usual cases, instead they showed acidosis in routine follow up. By using single exome sequencing analysis, we identified a two homozygous pathogenic mutation c.1175A>G (p.D392G), c.1169A>G (D390G) in SARS2 gene. This sequence identified a new variant mutation of HUPRA syndrome c.1175A>G (p.D392G) with atypical presentation, that will be added to the literature. Conclusion SARS2 gene with pathogenic homozygous mutation variants were detected in our two patients c.1175A>G (p.D392G), c.1169A>G (D390G) in exon 13, with atypical clinical manifestations of HUPRA syndrome, expanding the spectrum of SARS2 pathogenic variants with its characteristic findings, describing the differences in clinical manifestations between homozygous and compound heterozygous mutations.


Subject(s)
Hypertriglyceridemia , Leukopenia , Hypertension, Pulmonary , Neoplastic Syndromes, Hereditary , Acidosis , Renal Insufficiency , Hyponatremia , Anemia , Hyperuricemia , Disease , Alcoholic Intoxication , Hypercholesterolemia , Mitochondrial Diseases
9.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.11.04.22281934

ABSTRACT

Introduction Severe malaria remains a deadly disease for many young children in low- and middle-income countries. Levels of Interleukin-6 (IL-6) have been shown to identify cases of severe malaria and associate with severity, but it is unknown if this association is causal, or whether manipulation of IL-6 might alter outcomes in severe malaria. Methods A single nucleotide polymorphism (SNP, rs2228145) in the IL-6 receptor ( IL6R) was chosen as a genetic variant that is known to alter IL-6 signalling. We measured the association between the minor allele of this SNP (C) and C-reactive protein (CRP) levels, a marker of IL-6 signalling in the non-European ancestry population recruited to UK Biobank. We then took this forward as an instrument to perform Mendelian randomisation (MR) in MalariaGEN, a large cohort study of patients with severe malaria at eleven worldwide sites. As a secondary approach, we identified cis protein quantitative trait loci ( cis -pQTL) for IL6R itself and other markers of IL-6 signalling in a recently published GWAS of the plasma proteome performed in African Americans. We then performed MR using these instruments in the African MalariaGEN sites (9/11). Analyses were performed at each site, and meta-analysed using inverse variance weighting. Additional analyses were performed for specific sub-phenotypes of severe malaria: cerebral malaria and severe malarial anaemia. Results The minor allele (C) of rs2228145 was associated with decreased CRP across all tested continental ancestries in UK Biobank. There was no evidence of heterogeneity of effect and a large overall effect (beta -0.11 per standard deviation of normalised CRP per C allele, p = 7.55 × 10 −255 ) In Mendelian randomisation studies using this SNP, we did not identify an effect of decreased IL-6 signalling on severe malaria case status (Odds ratio 1.14, 95% CI 0.56 – 2.34, p = 0.713). Estimates of the association with any severe malaria sub-phenotype were similarly null although there was significant imprecision in all estimates. Using an alternative instrument ( cis -pQTLs for IL6R ), which included 3 SNPS (including rs2228145), we identified the same null effect, but with greater precision (Odds ratio 1.02, 95% CI 0.95 – 1.10), and no effect on any severe malaria subtypes. Conclusions Mendelian randomisation analyses using a SNP in the IL-6 receptor known to alter IL-6 signalling do not support a causal role for IL-6 signalling in the development of severe malaria, or any severe malaria sub-phenotype. This result suggests IL-6 may not be causal for severe outcomes in malaria, and that therapeutic manipulation of IL-6 may not be a suitable treatment for severe malaria.


Subject(s)
Anemia , Malaria , Malaria, Cerebral
10.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2247921.v1

ABSTRACT

Introduction This case report represents, to our knowledge, the first suspected case of Light Chain Deposition Disease (LCDD) relapse associated with mRNA COVID-19 vaccination. It must be made clear that timing is the only link between the vaccination and the relapse of LCDD, and since millions of individuals received these vaccines, an event like this may be due to chance. At the same time, this case report may be an entry point into further explorations of the pathogenesis of LCDD, given the mechanism of action of the vaccine and the pathophysiology of the disease, as it is currently understood. Case presentation The 75-year-old female patient of Greek ethnicity was admitted into our clinic for the investigation of worsening renal function that was detected on routine lab examinations two weeks after she received the second dose of the moderna COVID vaccine (mRNA-1273). Rapidly progressive glomerulonephritis and anemia were the most notable findings upon admission. She had a history of Light Chain Deposition Disease (LCDD) which had remained stable under management for four years. Serum protein electrophoresis was performed and showed monoclonal kappa zones, while bone marrow biopsy revealed 5% plasma cell infiltration. All the above, along with other investigations, established the diagnosis of LCDD recurrence. She was started on chemotherapy, which improved her immunological profile but not her renal function. The patient has remained on hemodialysis since. Conclusions The association between mRNA vaccinations and LCDD relapse may be ground for investigations into the pathophysiology of MGRS, given the patient’s previous long-term remission. In this context, we want to stress once again the importance of following standardized routine mandates on COVID vaccination, especially in immunocompromised patients. This case report is not intended to directly inform changes in clinical practice.


Subject(s)
Photophobia , Paraproteinemias , Anemia , Immunoproliferative Small Intestinal Disease , Glomerulonephritis , COVID-19
11.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.10.06.22280775

ABSTRACT

Abstract Objective To assess whether there is an association between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) infection and the incidence of immune mediated inflammatory diseases (IMIDs). Design Matched cohort study. Setting Primary care electronic health record data from the Clinical Practice Research Datalink Aurum database. Participants The exposed cohort included 458,147 adults aged 18 years and older with a confirmed SARS CoV-2 infection by reverse transcriptase polymerase chain reaction (RT-PCR) or lateral flow antigen test, and no prior diagnosis of IMIDs. They were matched on age, sex, and general practice to 1,818,929 adults in the unexposed cohort with no diagnosis of confirmed or suspected SARS CoV-2 infection and no prior diagnosis of IMIDs. Main Outcome Measures The primary outcome measure was a composite of the incidence of any of the following IMIDs: 1. autoimmune thyroiditis, 2. coeliac disease, 3. inflammatory bowel disease (IBD), 4. myasthenia gravis, 5. pernicious anaemia, 6. psoriasis, 7. rheumatoid arthritis (RA), 8. Sjogrens syndrome, 9. systemic lupus erythematosus (SLE), 10. type 1 diabetes mellitus (T1DM), and 11. vitiligo. The secondary outcomes were the incidence of each of these conditions separately. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the primary and secondary outcomes comparing the exposed to the unexposed cohorts, and adjusting for age, sex, ethnic group, smoking status, body mass index, relevant infections, and medications. Results 537 patients (0.11%) in the exposed cohort developed an IMID during the follow-up period over 0.29 person years, giving a crude incidence rate of 3.54 per 1000 person years. This was compared 1723 patients (0.09%) over 0.29 person years in the unexposed cohort, with an incidence rate of 2.82 per 1000 person years. Patients in the exposed cohort had a 22% relative increased risk of developing an IMID, compared to the unexposed cohort (aHR 1.22, 95% CI 1.10 to 1.34). The incidence of three IMIDs were statistically significantly associated with SARS CoV-2 infection. These were T1DM (aHR 1.56, 95% CI 1.09 to 2.23), IBD (1.52, 1.23 to 1.88), and psoriasis (1.23, 1.05 to 1.42). Conclusions SARS CoV-2 was associated with an increased incidence of IMIDs including T1DM, IBD and psoriasis. Further research is needed to replicate these findings in other populations and to measure autoantibody profiles in cohorts of individuals with COVID-19, including Long COVID and matched controls.


Subject(s)
Thyroiditis, Autoimmune , Arthritis, Rheumatoid , Diabetes Mellitus , Severe Acute Respiratory Syndrome , Coronavirus Infections , Anemia , Sjogren's Syndrome , Psoriasis , Lupus Erythematosus, Systemic , COVID-19 , Myasthenia Gravis , Inflammatory Bowel Diseases
12.
PLoS One ; 17(9): e0273720, 2022.
Article in English | MEDLINE | ID: covidwho-2021940

ABSTRACT

Myasthenia gravis (MG) is the most common autoimmune neuromuscular disorder, and is more common in women than in men. Anemia is also more common in women. The purpose of this study was to investigate factors associated with anemia and the negative impact of anemia in female MG patients. We investigated factors related to MG and anemia in 215 female patients with MG, who were attending the MG clinic of Keio Hospital between January and December 2021. We statistically evaluated clinical factors related to anemia in patients with and without anemia. Eighty-five patients (40%) had anemia in the past, and 130 patients did not have anemia in the past. There were no significant differences in age at study, age at MG onset, body mass index, or frequency of autoantibodies between the anemia and non-anemia groups. MG severity evaluated by the MG Foundation of America classification was greater in the anemia group than in the non-anemia group. History of anemia was associated with immunosuppressive treatment, such as prednisolone and calcineurin inhibitor treatment. There was a correlation between hemoglobin levels and the MG-quality of life score. Long term immunosuppressive therapy can cause anemia in female MG patients. Anemia may negatively affect the quality of life of female MG patients.


Subject(s)
Anemia , Myasthenia Gravis , Anemia/complications , Anemia/drug therapy , Autoantibodies , Calcineurin Inhibitors/therapeutic use , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Myasthenia Gravis/drug therapy , Quality of Life
13.
PLoS One ; 17(8): e0272641, 2022.
Article in English | MEDLINE | ID: covidwho-2002307

ABSTRACT

OBJECTIVES: Sri Lanka is a developing country where the majority of households still rely on firewood for cooking. Furthermore, the prevalence of anemia among reproductive-aged women is of moderate public health importance, according the classification of World Health Organization. Despite the researchers' ongoing efforts to investigate a link between solid fuel smoke exposure and anemia, the veracity of their findings remains uncertain. As a result, the purpose of this study was to examine the relationship between biomass fuel smoke exposure and anemia in non-pregnant reproductive-aged women in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among 382 non-pregnant reproductive-aged (15 to 49 years) women in Central Province, Sri Lanka. Data was collected using a standardized interviewer-administered questionnaire, and exposure was assessed using a breath carbon monoxide monitor. Drabkin's cynomethhemoglobin technique was used to determine blood hemoglobin concentration. RESULTS: The overall prevalence of anemia was 36.1%. The logistic regression model revealed no effect of cooking fuel type on anemic or non-anemic status after adjusting for potential confounding factors (p > 0.05). The multivariate regression analysis also discovered that cooking fuel type had no effect on women's blood hemoglobin concentration. CONCLUSIONS: The study results suggest no impact of solid fuel smoke exposure on anemia among non-pregnant, reproductive-aged women. Larger scale prospective cohort studies are recommended. The reasons behind the high prevalence of anemia among reproductive-aged women should be further investigated, and corrective measures should be implemented urgently.


Subject(s)
Air Pollution, Indoor , Anemia , Adult , Air Pollution, Indoor/adverse effects , Air Pollution, Indoor/analysis , Anemia/epidemiology , Anemia/etiology , Biomass , Cooking/methods , Cross-Sectional Studies , Female , Hemoglobins/analysis , Humans , Prospective Studies , Smoke/adverse effects , Smoke/analysis
14.
Am J Hematol ; 97(11): 1404-1412, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1976682

ABSTRACT

Coronavirus Disease (COVID-19) can be considered as a human pathological model of inflammation combined with hypoxia. In this setting, both erythropoiesis and iron metabolism appear to be profoundly affected by inflammatory and hypoxic stimuli, which act in the opposite direction on hepcidin regulation. The impact of low blood oxygen levels on erythropoiesis and iron metabolism in the context of human hypoxic disease (e.g., pneumonia) has not been fully elucidated. This multicentric observational study was aimed at investigating the prevalence of anemia, the alterations of iron homeostasis, and the relationship between inflammation, hypoxia, and erythropoietic parameters in a cohort of 481 COVID-19 patients admitted both to medical wards and intensive care units (ICU). Data were collected on admission and after 7 days of hospitalization. On admission, nearly half of the patients were anemic, displaying mild-to-moderate anemia. We found that hepcidin levels were increased during the whole period of observation. The patients with a higher burden of disease (i.e., those who needed intensive care treatment or had a more severe degree of hypoxia) showed lower hepcidin levels, despite having a more marked inflammatory pattern. Erythropoietin (EPO) levels were also lower in the ICU group on admission. After 7 days, EPO levels rose in the ICU group while they remained stable in the non-ICU group, reflecting that the initial hypoxic stimulus was stronger in the first group. These findings strengthen the hypothesis that, at least in the early phases, hypoxia-driven stimuli prevail over inflammation in the regulation of hepcidin and, finally, of erythropoiesis.


Subject(s)
Anemia , COVID-19 , Erythropoietin , Erythropoiesis/physiology , Hepcidins , Humans , Hypoxia , Inflammation , Iron
15.
Drug Saf ; 45(9): 1003-1008, 2022 09.
Article in English | MEDLINE | ID: covidwho-1971896

ABSTRACT

INTRODUCTION: Thrombotic thrombocytopenia syndrome (TTS) events were reported very rarely following the coronavirus disease 2019 (COVID-19) vaccine AstraZeneca (Vaxzevria). Clinical and demographic characteristics of the affected people, including the outcomes of TTS events, need to be examined using available information to better understand aspects of this association. OBJECTIVE: To analyse clinical and demographic information of TTS events, including calculating the case fatality of reported cases of TTS by age and sex, using spontaneously reported data from the UK's Yellow Card spontaneous reporting system of suspected adverse drug reactions. METHODS: TTS events reported to the Yellow Card scheme were extracted at weekly time points between 12 May 2021 and 25 May 2022. Cumulative numbers of TTS cases and deaths were recorded for each weekly interval, overall and stratified by age, sex, and vaccine dose. RESULTS: To 25 May 2022, 443 cases (81 fatal, 18.28%) had been reported in the UK. Events more frequently occurred following the first vaccine dose. No trends were observed for case fatality overall, or by age or sex. CONCLUSION: In the UK, case fatality of TTS events reported to the Medicines and Health products Regulatory Agency (MHRA) following Vaxzevria has been approximately 17-18% since May 2021. There were no statistical differences in fatality based on age or sex. Most reports followed the first vaccine dose; none have been reported following a third dose to date, although Vaxzervia was not recommended for a third dose of COVID-19 vaccine in the UK. TTS remains very rare, and benefits of vaccination outweigh the risks.


Subject(s)
Anemia , COVID-19 Vaccines , COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , Adverse Drug Reaction Reporting Systems , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , ChAdOx1 nCoV-19 , Humans , Thrombocytopenia/chemically induced , Thrombocytopenia/epidemiology , United Kingdom/epidemiology
16.
Ann Palliat Med ; 11(6): 2017-2024, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1934826

ABSTRACT

BACKGROUND: Current studies have limited data on long-term treatment safety and medication compliance of roxadustat for renal anemia in peritoneal dialysis (PD) patients. We aimed to analyze the long-term efficacy, safety, and medication compliance of roxadustat in the treatment of renal anemia in patients with PD who discontinued recombinant human erythropoietin (rhEPO) treatment due to the corona virus disease 2019 (COVID-19) outbreak. METHODS: We retrospectively collected patients who were switched from rhEPO to roxadustat in our hospital due to the pandemic. The criteria for subject inclusion: aged >18 years with a dialysis vintage >3 months, without malignant tumor, no severe cardiovascular and cerebrovascular diseases, and not combined hemodialysis. Patients were followed up until the end of December 2021. Hemoglobin (Hb), red blood cell (RBC) and hematocrit (Hct) were recorded at baseline, month 1-12 and month 20, and iron parameters at baseline, 3, 6, 9, 12, and 20 months were collected. The Morisky Medication Adherence Scale-8 (MMAS-8) was used to score medication compliance during rhEPO treatment and roxadustat treatment, and adverse reactions occurred during treatment were collected. The efficacy and medication compliance of roxadustat were analyzed using Wilcoxon rank sum test or t-test. RESULTS: The median follow-up time was 21.1 (20.6, 21.7) months. After 1 month of treatment, the Hb level was significantly increased by 9.4 g/L (95% CI: 6.0-12.8 g/L) compared with the baseline, follow up at 20 months showed the Hb level had remained stable, increased by 20.7 g/L (95% CI: 15.9-25.4 g/L) compared with before treatment. At the beginning of treatment, total iron binding capacity increased, transferrin saturation and serum ferritin decreased, serum iron remained stable during treatment. During roxadustat treatment, no patient discontinued treatment due to the pandemic, and the Morisky score was improved compared with that during rhEPO treatment [5.75 (4.25, 6.00) vs. 6.75 (5.75, 7.00), P=0.000]. There were no serious adverse events associated with roxadustat were observed. CONCLUSIONS: Roxadustat can effectively improve anemia and had good tolerance in patients undergoing PD who have difficult using rhEPO, and the medication compliance was better than rhEPO during the COVID-19.


Subject(s)
Anemia , COVID-19 , Peritoneal Dialysis , Anemia/drug therapy , Anemia/etiology , COVID-19/complications , Chronic Disease , Glycine/analogs & derivatives , Humans , Iron , Isoquinolines , Medication Adherence , Pandemics , Renal Dialysis , Retrospective Studies
17.
Drugs ; 82(11): 1207-1212, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1930609

ABSTRACT

Desidustat (Oxemia™) is an orally bioavailable, small molecule, hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitor developed by Zydus Cadila for the treatment of anaemia associated with chronic kidney disease (CKD), COVID-2019 infections and chemotherapy induced anaemia. Desidustat inhibits prolyl hydroxylase domain enzymes, resulting in the stabilisation of hypoxia-inducible factor which stimulates erythropoietin production and erythropoiesis. In March 2022, desidustat received its first approval in India for the treatment of anaemia in adults with CKD who are either on dialysis or not on dialysis. Desidustat is in clinical development in China for the treatment of anaemia in patients with CKD, in Mexico for the management of COVID-2019 infections and in the USA for the treatment of chemotherapy induced anaemia. This article summarizes the milestones in the development of desidustat leading to this first approval for anaemia associated with CKD.


Subject(s)
Anemia , Antineoplastic Agents , COVID-19 , Quinolones , Renal Insufficiency, Chronic , Adult , Anemia/drug therapy , Antineoplastic Agents/therapeutic use , COVID-19/drug therapy , Erythropoietin , Humans , Hypoxia/complications , Hypoxia/drug therapy , Prolyl Hydroxylases , Prolyl-Hydroxylase Inhibitors/therapeutic use , Quinolones/therapeutic use , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/drug therapy
18.
Am J Emerg Med ; 58: 281-285, 2022 08.
Article in English | MEDLINE | ID: covidwho-1906653

ABSTRACT

OBJECTIVE: This study aimed to evaluate whether there was a significant relationship between anemia and the risk for mortality among coronavirus disease 2019 (COVID-19) patients by a quantitative meta-analysis based on the adjusted effect estimates. METHODS: A systematic search was conducted in electronic databases to identify all published literature. A random-effects meta-analysis model was used to estimate the pooled effect size and 95% confidence interval (CI). Heterogeneity test, Begg's test, subgroup analysis and meta-regression were performed. RESULTS: Twenty-three articles with 573,928 COVID-19 patients were included in the quantitative meta-analysis. There was a significant association between anemia and an elevated risk of COVID-19 mortality (pooled effect size = 1.47, 95% CI [1.30-1.67]). We observed this significant association in the further subgroup analyses by age, proportion of males, sample size, study design, region and setting. Sensitivity analysis exhibited that our results were reliable. Begg's test showed that there was no publication bias. Meta-regression indicated that the tested variables might not be the source of heterogeneity. CONCLUSION: Our meta-analysis based on risk factors-adjusted effect estimates indicated that anemia was independently associated with a significantly elevated risk for mortality among COVID-19 patients.


Subject(s)
Anemia , COVID-19 , Anemia/complications , Anemia/epidemiology , Data Management , Humans , Male , Risk Factors
19.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1784802.v1

ABSTRACT

Background: Premature rupture of membranes is the spontaneous leakage of amniotic fluid from the amniotic sac that occurs at least one hour before the onset of labor. It is a common complication of pregnancy that leads to neonatal and maternal morbidity and mortality. There is little evidence of the prevalence and associated factors among pregnant women admitted to the obstetrics ward in the study area.. Objective: To assess the prevalence and associated factors among pregnant women admitted to Dire Dawa hospitals in eastern Ethiopia. Method: A facility-based cross-sectional study was conducted from May 17 to June 17, 2021. A systematic random sampling technique was used to select 392 pregnant women admitted to an obstetric ward. Data was collected using an interviewer-administered questionnaire and checklist to obtain data from the medical record. Data was collected with Kobo tool software and exported to SPSS version 24. The crude odds ratio and the AOR with 95% CI were calculated to assess the association among variables and control the confounding factors. The level of significance was declared at a p-value < 0.05. Result: All 392 (100%) pregnant women were included in the study. The prevalence of PROM was found to be 22.4%. Pregnant women who had a history of previous preterm labor (AOR = 2.449, 95% CI: 1.422, 4.217), history of PROM (AOR = 2.663, 95% CI: 1.567, 4.526), history of anemia (AOR = 2.497, 95% CI: 1.371, 4.550), history of UTI (AOR = 2.715, 95% CI: 1.575, 4.679) and history of chewing khat (AOR = 1.936, 95% CI: 1.055, 3.552) were significantly associated with pre-labor rupture of membrane. Conclusion: The prevalence of pre-labor rupture of membranes in the study was high when compared to previous studies. An intervention that focuses on strengthening the integration of messages on health promotion and disease prevention, routine early screening, diagnosis and quick treatments of UTI and anemia, nutritional counseling, iron supplementation, and giving information regarding substance use during pregnancy should be recommended.


Subject(s)
COVID-19 , Anemia
20.
Vaccine ; 40(31): 4116-4120, 2022 07 29.
Article in English | MEDLINE | ID: covidwho-1867883

ABSTRACT

BACKGROUND: On February 27, 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization for Ad.26.COV2.S COVID-19 vaccine. As part of post-authorization safety surveillance, the FDA has identified a potential safety concern for thrombocytopenia following receipt of Ad.26.COV2.S COVID-19 vaccine. METHODS: Reports of thrombocytopenia were identified in a passive reporting system (Vaccine Adverse Event Reporting System; VAERS) February-December 2021. Demographics, clinical characteristics, laboratory values, and relevant medical history were reviewed. The reporting rate was analyzed, including calculation of the observed-to-expected ratio based on vaccine administration data and the background rate of thrombocytopenia in the general (unvaccinated) population. RESULTS: As of December 31, 2021, 100 reports of thrombocytopenia were identified in VAERS following vaccination with Ad.26.COV2.S. The median platelet count was 33,000 per µL (interquartile range 8,000-86,000). Fifteen reports (15%) documented a platelet count of 5,000 per µL or lower. The median time to onset of thrombocytopenia was 9 days (interquartile range 3-18.5), with most cases (69; 69%) beginning within 14 days after vaccination. A large majority of cases (84; 84%) were serious, including six deaths. With approximately 16,292,911 doses of Ad.26.COV2.S administered to adults in the US, the crude reporting rate was 0.61 cases of thrombocytopenia per 100,000 doses administered. The overall estimated observed-to-expected rate ratio was 2.43 (95% CI 1.97, 2.95). CONCLUSIONS: These findings suggest an increased risk of thrombocytopenia following receipt of Ad.26.COV2.S.


Subject(s)
Anemia , COVID-19 , Thrombocytopenia , Vaccines , Adult , Adverse Drug Reaction Reporting Systems , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Thrombocytopenia/chemically induced , Thrombocytopenia/epidemiology , United States/epidemiology , Vaccines/adverse effects
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