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1.
Aust N Z J Psychiatry ; 54(9): 861-862, 2020 09.
Article in English | MEDLINE | ID: covidwho-1594039
2.
Med Clin (Barc) ; 157(3): 114-117, 2021 08 13.
Article in English, Spanish | MEDLINE | ID: covidwho-1574083

ABSTRACT

INTRODUCTION: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019. METHODS: Observational multicenter cohort study of 3,108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied. RESULTS: The incidence of ACS in COVID-19 patients was 3.31 ‰, significantly higher than in the 2019 period, 1.01 ‰ (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high. CONCLUSIONS: Severe COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis.


Subject(s)
Acute Coronary Syndrome , COVID-19 , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/epidemiology , Causality , Cohort Studies , Hospitalization , Humans
4.
Medicina (Kaunas) ; 57(11)2021 Nov 14.
Article in English | MEDLINE | ID: covidwho-1512491

ABSTRACT

SARS-CoV-2 neuroinvasive and neurotropic abilities may underlie delirium onset and neuropsychiatric outcomes. Only a limited number of studies have addressed the potential effect of SARS-CoV-2 infection on mental health so far. Most studies mainly reported the acute onset of mixed neuropsychiatric conditions in patients infected with SARS-CoV-2, characterized by agitated behavior, altered level of consciousness, and disorganized thinking, regardless of psychological or socioeconomic triggering factors. The present narrative review aims to analyze and discuss the mechanisms underlying the neuroinvasive/neurotropic properties of SARS-CoV-2 and the subsequent mental complications. Delirium appeared as a clinical manifestation of SARS-CoV-2 brain infection in some patients, without systemic or multiple organ failure symptoms. A small number of studies demonstrated that neuropsychiatric symptoms associated with COVID-19, initially presenting as a confused state, may subsequently evolve in a way that is consistent with the patients' neuropsychiatric history. A literature analysis on this topic prevalently showed case reports and case series of patients presenting delirium or delirium-like symptoms as the main outburst of COVID-19, plus a cognitive impairment, from mild to severe, which pre-existed or was demonstrated during the acute phase or after infection. Dementia appeared as one of the most frequent predisposing factors to SARS-CoV-2 infection complicated with delirium. Instead, contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a neuropsychiatric history. Therefore, clinicians should contemplate the possibility that COVID-19 appears as delirium followed by a psychiatric exacerbation, even without other systemic symptoms. In addition, cognitive impairment might act as a predisposing factor for COVID-19 in patients with delirium.


Subject(s)
COVID-19 , Cognitive Dysfunction , Delirium , Causality , Cognitive Dysfunction/etiology , Delirium/etiology , Humans , SARS-CoV-2
6.
Pulm Med ; 2021: 4712406, 2021.
Article in English | MEDLINE | ID: covidwho-1506246

ABSTRACT

Periodontal diseases are a range of polymicrobial infectious disorders, such as gingivitis and periodontitis, which affect tooth-supporting tissues and are linked to playing a role in the exacerbation of several pulmonary diseases. Pulmonary diseases, such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, COVID-19, and bronchiectasis, significantly contribute to poor quality of life and mortality. The association between periodontal disease and pulmonary outcomes is an important topic and requires further attention. Numerous resident microorganisms coexist in the oral cavity and lungs. However, changes in the normal microflora due to oral disease, old age, lifestyle habits, or dental intervention may contribute to altered aspiration of oral periodontopathic bacteria into the lungs and changing inflammatory responses. Equally, periodontal diseases are associated with the longitudinal decline in spirometry lung volume. Several studies suggest a possible beneficial effect of periodontal therapy in improving lung function with a decreased frequency of exacerbations and reduced risk of adverse respiratory events and morbidity. Here, we review the current literature outlining the link between the oral cavity and pulmonary outcomes and focus on the microflora of the oral cavity, environmental and genetic factors, and preexisting conditions that can impact oral and pulmonary outcomes.


Subject(s)
Microbiota , Mouth/microbiology , Periodontal Diseases/complications , Pulmonary Disease, Chronic Obstructive/complications , Causality , Environment , Humans
10.
Nutrients ; 13(10)2021 Sep 29.
Article in English | MEDLINE | ID: covidwho-1444283

ABSTRACT

BACKGROUND: Alcohol is a teratogen and prenatal exposure may adversely impact the developing fetus, increasing risk for negative outcomes, including Fetal Alcohol Spectrum Disorder (FASD). Global trends of increasing alcohol use among women of childbearing age due to economic development, changing gender roles, increased availability of alcohol, peer pressure and social acceptability of women's alcohol use may put an increasing number of pregnancies at risk for prenatal alcohol exposure (PAE). This risk has been exacerbated by the ongoing COVID-19 pandemic in some countries. METHOD: This literature review presents an overview on the epidemiology of alcohol use among childbearing age and pregnant women and FASD by World Health Organization regions; impact of PAE on fetal health, including FASD; associated comorbidities; and social outcomes. RESULTS/CONCLUSION: The impact of alcohol on fetal health and social outcomes later in life is enormous, placing a huge economic burden on countries. Prevention of prenatal alcohol exposure and early identification of affected individuals should be a global public health priority.


Subject(s)
Alcohol Drinking/epidemiology , Alcohol Drinking/pathology , Ethanol/adverse effects , Fetal Alcohol Spectrum Disorders/epidemiology , Fetal Alcohol Spectrum Disorders/pathology , Prenatal Exposure Delayed Effects/epidemiology , Prenatal Exposure Delayed Effects/pathology , Causality , Female , Humans , Pregnancy
11.
Int J Legal Med ; 135(6): 2335-2345, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1442101

ABSTRACT

Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted. In 13 deceased, the cause of death was attributed to preexisting diseases while postmortem investigations did not indicate a causal relationship to the vaccination. In one case after vaccination with Comirnaty, myocarditis was found to be the cause of death. A causal relationship to vaccination was considered possible, but could not be proven beyond doubt. VITT was found in three deceased persons following vaccination with Vaxzevria and one deceased following vaccination with Janssen. Of those four cases with VITT, only one was diagnosed before death. The synopsis of the anamnestic data, the autopsy results, laboratory diagnostic examinations, and histopathological and neuropathological examinations revealed that VITT was the very likely cause of death in only two of the four cases. In the other two cases, no neuropathological correlate of VITT explaining death was found, while possible causes of death emerged that were not necessarily attributable to VITT. The results of our study demonstrate the necessity of postmortem investigations on all fatalities following vaccination with COVID-19 vaccines. In order to identify a possible causal relationship between vaccination and death, in most cases an autopsy and histopathological examinations have to be combined with additional investigations, such as laboratory tests and neuropathological examinations.


Subject(s)
COVID-19 Vaccines , Forensic Medicine , Vaccination/adverse effects , Adult , Aged , Aged, 80 and over , Anaphylaxis/mortality , Autopsy , Causality , Cause of Death , Female , Germany/epidemiology , Humans , Male , Middle Aged , Myocarditis/mortality , Purpura, Thrombocytopenic, Idiopathic/mortality
12.
Drug Saf ; 44(11): 1125-1149, 2021 11.
Article in English | MEDLINE | ID: covidwho-1415119

ABSTRACT

Drug-induced liver injury (DILI) remains an important, yet challenging diagnosis for physicians. Each year, additional drugs are implicated in DILI and this year was no different, with more than 1400 articles published on the subject. This review examines some of the most significant highlights and controversies in DILI-related research over the past year and their implications for clinical practice. Several new drugs were approved by the US Food and Drug Administration including a number of drugs implicated in causing DILI, particularly among the chemotherapeutic classes. The COVID-19 pandemic was also a major focus of attention in 2020 and we discuss some of the notable aspects of COVID-19-related liver injury and its implications for diagnosing DILI. Updates in diagnostic and causality assessments related to DILI such as the Roussel Uclaf Causality Assessment Method are included, mindful that there is still no single biomarker or diagnostic tool to unequivocally diagnose DILI. Glutamate dehydrogenase received renewed attention as being more specific than alanine aminotransferase. There were a few new reports of previously unrecognized hepatotoxins, including immune modulators and novel gene therapy drugs that we highlight. Updates and new developments of previously described hepatotoxins, such as immune checkpoint inhibitors and anti-tuberculosis drugs are reviewed. Finally, novel technologies such as organoid culture systems to better predict DILI preclinically may be coming of age and determinants of hepatocyte loss, such as calculating PALT are poised to improve our current means of estimating DILI severity and the risk of acute liver failure.


Subject(s)
COVID-19/drug therapy , Chemical and Drug Induced Liver Injury , Causality , Humans , Risk Factors , SARS-CoV-2 , United States
13.
J Int Med Res ; 49(9): 3000605211043413, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1398808

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 has caused a devastating pandemic lasting for more than a year. To date, 47 million individuals have been infected and 1.2 million individuals have died worldwide. Some of the most important coinfections in patients with coronavirus disease 2019 (COVID-19) are opportunistic invasive fungal infections (OIFIs), which are sometimes not rapidly diagnosed and are often diagnosed after death. Aspergillosis and candidiasis are the most prevalent OIFIs in patients with COVID-19. Mycormycosis, cryptococcosis, and other fungal diseases have also been documented more rarely. This review aimed to summarize factors affecting COVID-19 transmission, prevalence, morbidity, and mortality in Iran as well as to review common OIFIs in patients with COVID-19. Immunological factors, underlying diseases, and social, cultural, and environmental factors can affect COVID-19 transmission. There is a need to improve diagnostic and therapeutic criteria for OIFIs and to optimize management procedures so that patients with OIFIs can receive treatment as rapidly as possible. Screening of patients with confirmed COVID-19 for OIFIs at the treating physician's discretion could enable early OIFI diagnosis, treatment, and mortality reduction.


Subject(s)
COVID-19 , Coinfection , Causality , Humans , Pandemics , SARS-CoV-2
15.
Medicina (Kaunas) ; 57(2)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1389436

ABSTRACT

Uncertainty analysis is the process of identifying limitations in knowledge and evaluating their implications for scientific conclusions. Uncertainty analysis is a stable component of risk assessment and is increasingly used in decision making on complex health issues. Uncertainties should be identified in a structured way and prioritized according to their likely impact on the outcome of scientific conclusions. Uncertainty is inherent to the rare diseases (RD) area, where research and healthcare have to cope with knowledge gaps due to the rarity of the conditions; yet a systematic approach toward uncertainties is not usually undertaken. The uncertainty issue is particularly relevant to multifactorial RD, whose etiopathogenesis involves environmental factors and genetic predisposition. Three case studies are presented: the newly recognized acute multisystem inflammatory syndrome in children and adolescents associated with SARS-CoV-2 infection; the assessment of risk factors for neural tube defects; and the genotype-phenotype correlation in familial Mediterranean fever. Each case study proposes the initial identification of the main epistemic and sampling uncertainties and their impacts. Uncertainty analysis in RD may present aspects similar to those encountered when conducting risk assessment in data-poor scenarios; therefore, approaches such as expert knowledge elicitation may be considered. The RD community has a main strength in managing uncertainty, as it proactively develops stakeholder involvement, data sharing and open science. The open science approaches can be profitably integrated by structured uncertainty analysis, especially when dealing with multifactorial RD involving environmental and genetic risk factors.


Subject(s)
COVID-19/epidemiology , Familial Mediterranean Fever/epidemiology , Neural Tube Defects/epidemiology , Rare Diseases/epidemiology , Systemic Inflammatory Response Syndrome/epidemiology , Uncertainty , Causality , Familial Mediterranean Fever/genetics , Genotype , Humans , Knowledge , Phenotype , Rare Diseases/etiology , Risk Assessment , Risk Factors , SARS-CoV-2
16.
Med Hypotheses ; 146: 110396, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1386308

ABSTRACT

We have reviewed a considerable amount of recent scientific papers relating inflammation caused by air pollution with chronic and severe medical conditions. Furthermore, there are evidences relating organ inflammation caused by not only outdoor long-term but also short-term inhaled radioisotopes contained in high polluted air or in household natural radioactive background aerosols, in addition to SARS-COV-2 attached to bioaerosols, which are related with a worst evolution of severe acute respiratory syndrome patients. Reactive oxygen species (ROS) production induced by the interaction with environmental ionizing radiation contained in pollution is pointed out as a critical mechanism that predispose mainly to elder population, but not excluding young subjects, presenting previous chronic conditions of lung inflammation or neuroinflammation, which can lead to the most serious consequences.


Subject(s)
Air Pollution, Radioactive/adverse effects , COVID-19/etiology , Climate Change , Inflammation/etiology , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , SARS-CoV-2/pathogenicity , Aerosols , Air Microbiology , COVID-19/mortality , Causality , Humans , Inflammasomes/metabolism , Inflammasomes/radiation effects , Models, Biological , Nervous System Diseases/etiology , Pandemics , Particle Size , Particulate Matter/adverse effects , Pneumonia/etiology
19.
Psychiatriki ; 32(3): 219-223, 2021 Sep 20.
Article in English | MEDLINE | ID: covidwho-1357715

ABSTRACT

People with mental illness are known to have poorer physical health outcomes. Among them, patients with schizophrenia spectrum disorders are disproportionately burdened. A number of recent studies have highlighted that patients with schizophrenia are particularly at risk from COVID-19. The aim of this systematic review is to clarify whether patients with schizophrenia spectrum disorders are at greater risk for poor COVID-19 outcomes. We conducted a systematic review of the literature following the PRISMA guidelines, using PubMed, PsycINFO (via Ovid) and Scopus as databases, to identify all studies which investigated infection and/or mortality rate from SARS-CoV-2 in patients with schizophrenia spectrum disorders. Following a formal screening process, seven studies met our inclusion criteria. The results of these seven studies were reported using odds ratios or adjusted odds ratios. The collective results indicated a moderate, but statistically significant effect for higher infection rates, and a strong statistically significant effect for higher mortality rates in patients with schizophrenia. Our findings indicate that people with schizophrenia have a high risk of being infected by the new coronavirus and have a significantly higher mortality rate than the general population. There are contradictory findings concerning other outcomes, including the frequency of intensive care unit admissions for this group. Collectively, these results indicate that people with schizophrenia spectrum disorders may be more vulnerable to being infected and more likely to die due to COVID-19, and yet their access to Intensive Care Units does not seem to be higher. We conclude that patients with schizophrenia constitute a vulnerable group for COVID-19 related infection and mortality, consequently there is a necessity for this vulnerable group of people to have better access to healthcare, including priority in nationwide COVID-19 vaccination programs and expedited intensive care treatment. Our conclusion adds to the ongoing debate arguing for equitable access to healthcare for people with schizophrenia spectrum disorders.


Subject(s)
COVID-19 , Schizophrenia , Vulnerable Populations , COVID-19/mortality , COVID-19/prevention & control , COVID-19/psychology , COVID-19/therapy , Causality , Healthcare Disparities , Humans , Intensive Care Units/statistics & numerical data , Mortality , SARS-CoV-2 , Schizophrenia/epidemiology , Schizophrenia/physiopathology , Vulnerable Populations/psychology , Vulnerable Populations/statistics & numerical data
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