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1.
J Am Acad Dermatol ; 85(5): 1274-1284, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1531500

ABSTRACT

Dermatologists diagnose and treat many immune-mediated inflammatory diseases (IMID). Understanding the inherent immune dysregulation of these diseases as well as the additional disruption that comes as a result of IMID treatments has been important during the COVID-19 pandemic. With vaccines becoming widely available, dermatologists need to be familiar with the risks and benefits of vaccination in these patients, particularly those taking biologics, in order to have informed discussions with their patients. In this review, we present the current evidence related to COVID-19 vaccine safety and efficacy in patients with IMID and review existing recommendations for vaccination against SARS-CoV-2. Given the current evidence, there is minimal concern that these patients are at any greater risk of harm from COVID-19 vaccination compared to healthy controls. For most, the benefit of avoiding severe COVID-19 through vaccination will outweigh the theoretical risk of these vaccines. A question that is still outstanding is whether patients on biologics will generate a sufficient immune response to the vaccine, which may be dependent on the specific biologic therapy and indication being treated. This underscores the importance of following patients with IMID after vaccination to determine the safety, efficacy, and duration of the vaccine in this population.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Dermatitis/immunology , Immunocompromised Host , Biological Products/therapeutic use , Contraindications, Drug , Dermatitis/drug therapy , Humans , Immunologic Factors/therapeutic use , SARS-CoV-2
2.
Pediatrics ; 148(4)2021 10.
Article in English | MEDLINE | ID: covidwho-1398985

ABSTRACT

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of the influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2021-2022 season. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during circulation of severe acute respiratory syndrome coronavirus 2, which is expected to continue during this influenza season. In this technical report, we summarize recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, vaccination coverage, and detailed guidance on storage, administration, and implementation. We also provide background on inactivated and live attenuated influenza vaccine recommendations, vaccination during pregnancy and breastfeeding, diagnostic testing, and antiviral medications for treatment and chemoprophylaxis.


Subject(s)
Influenza Vaccines , Influenza, Human/prevention & control , Antiviral Agents/therapeutic use , Breast Feeding , Child , Contraindications, Drug , Drug Resistance, Viral , Drug Storage , Female , Hospitalization , Humans , Influenza Vaccines/administration & dosage , Influenza Vaccines/adverse effects , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Influenza, Human/mortality , Mass Vaccination , Risk Factors , United States/epidemiology , Vaccines, Attenuated/administration & dosage , Vaccines, Attenuated/adverse effects , Vaccines, Inactivated/administration & dosage , Vaccines, Inactivated/adverse effects
3.
Br J Haematol ; 196(2): 351-355, 2022 01.
Article in English | MEDLINE | ID: covidwho-1373796

ABSTRACT

The COVID-19 pandemic has created many challenges in the management of immune thrombocytopenic purpura (ITP). The recommendation for avoidance of steroids by WHO led to the off-licence use, supported by NHS England, of thrombopoietin mimetics (TPO-RA) for newly diagnosed or relapsed ITP. This is a real-world prospective study which investigated the treatment patterns and outcomes in this setting. Twenty-four hospitals across the UK submitted 343 cases. Corticosteroids remain the mainstay of ITP treatment, but TPO-RAs were more effective. Incidental COVID-19 infection was identified in a significant number of patients (9·5%), while 14 cases were thought to be secondary to COVID-19 vaccination.


Subject(s)
COVID-19/epidemiology , Pandemics , Purpura, Thrombocytopenic, Idiopathic/therapy , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Autoimmune Diseases/complications , COVID-19/blood , COVID-19 Vaccines/adverse effects , Combined Modality Therapy , Comorbidity , Connective Tissue Diseases/complications , Contraindications, Drug , Disease Management , Female , Hemorrhage/epidemiology , Hemorrhage/etiology , Hospitals, District/statistics & numerical data , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Neoplasms/complications , Off-Label Use , Platelet Transfusion , Prospective Studies , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/epidemiology , Purpura, Thrombocytopenic, Idiopathic/etiology , Tertiary Care Centers/statistics & numerical data , Thromboembolism/epidemiology , Thromboembolism/etiology , Thrombopoietin/agonists , Tranexamic Acid/therapeutic use , Treatment Outcome , United Kingdom/epidemiology , Young Adult
4.
Future Oncol ; 17(26): 3477-3484, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1372053

ABSTRACT

The COVID-19 pandemic has lasted over 1 year and will not disappear in a short time. There is no specific remedy against the virus as yet. Vaccination is thus far one of the most important strategies for preventing COVID-19. Cancer patients with COVID-19 have a higher mortality because of immunosuppression. Immune checkpoint inhibitors (ICIs) are a novel anticancer strategy for blocking inhibitory pathways, which are related to the immune response. There is a question regarding whether COVID-19 vaccination and ICI treatment impact each other in cancer patients. This review explores both sides of the relationship between ICI treatment and COVID-19 vaccination and suggests good efficacy and safety of ICI treatment after COVID-19 vaccination as well as little impact on the virus protection and toxicity associated with COVID-19 vaccination during ICI treatment.


Lay abstract The COVID-19 pandemic has lasted over 1 year. Vaccination is a promising strategy for preventing COVID-19. Cancer patients are prone to infection with COVID-19, and these patients have high mortality. Immune checkpoint inhibitors (ICIs) are a novel anticancer strategy. Whether COVID-19 vaccination and ICI treatment impact each other in cancer patients remains unknown. This review explores both sides of the relationship between ICI treatment and COVID-19 vaccination and suggests good efficacy and safety of ICI treatment after COVID-19 vaccination as well as little impact on the virus protection and toxicity associated with COVID-19 vaccination during ICI treatment.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Immune Checkpoint Inhibitors/adverse effects , Neoplasms/drug therapy , SARS-CoV-2/pathogenicity , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Clinical Decision-Making , Contraindications, Drug , Humans , Immune Checkpoint Inhibitors/administration & dosage , Immunogenicity, Vaccine , Neoplasms/immunology , Pandemics/prevention & control , Patient Selection , SARS-CoV-2/immunology , Treatment Outcome
5.
Rheumatol Int ; 41(10): 1839-1843, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1363732

ABSTRACT

The outcomes of COVID-19 in patients treated with biologic agents are a subject of intense investigation. Recent data indicated that patients under rituximab (RTX) may carry an increased risk of serious disease. We performed an electronic search in Medline and Scopus using the keywords rituximab and COVID-19. We present a rare case of severe, protracted COVID-19 pneumonia in a patient with mixed connective tissue disease (MCTD) who was infected a few days following RTX treatment. In a relevant literature search, we identified 18 cases of patients with rheumatic diseases (6 RA, 8 ANCA vasculitis, 3 systemic sclerosis and 1 polymyositis) treated with RTX who experienced an atypical and/or prolonged course of COVID-19 pneumonia with no evidence of cytokine storm. Our case indicates that RTX may unfavorably affect outcomes following SARS-CoV-2 infection. B cell depletion may dampen the humoral response against the virus; we may hypothesize that B cell-depleted patients may be protected from cytokine storm but on the other hand may have difficulties in virus clearance leading to a protracted course. Taking into account that COVID-19 vaccines are available we may consider delaying RTX infusions at least in patients without life threatening disease, until vaccination is completed.


Subject(s)
Antirheumatic Agents/adverse effects , COVID-19/immunology , Contraindications, Drug , Mixed Connective Tissue Disease/drug therapy , Rituximab/adverse effects , Aged , Antirheumatic Agents/administration & dosage , COVID-19/diagnosis , Fatal Outcome , Female , Humans , Infusions, Intravenous , Male , Rituximab/administration & dosage , SARS-CoV-2
6.
Future Oncol ; 17(26): 3477-3484, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1288755

ABSTRACT

The COVID-19 pandemic has lasted over 1 year and will not disappear in a short time. There is no specific remedy against the virus as yet. Vaccination is thus far one of the most important strategies for preventing COVID-19. Cancer patients with COVID-19 have a higher mortality because of immunosuppression. Immune checkpoint inhibitors (ICIs) are a novel anticancer strategy for blocking inhibitory pathways, which are related to the immune response. There is a question regarding whether COVID-19 vaccination and ICI treatment impact each other in cancer patients. This review explores both sides of the relationship between ICI treatment and COVID-19 vaccination and suggests good efficacy and safety of ICI treatment after COVID-19 vaccination as well as little impact on the virus protection and toxicity associated with COVID-19 vaccination during ICI treatment.


Lay abstract The COVID-19 pandemic has lasted over 1 year. Vaccination is a promising strategy for preventing COVID-19. Cancer patients are prone to infection with COVID-19, and these patients have high mortality. Immune checkpoint inhibitors (ICIs) are a novel anticancer strategy. Whether COVID-19 vaccination and ICI treatment impact each other in cancer patients remains unknown. This review explores both sides of the relationship between ICI treatment and COVID-19 vaccination and suggests good efficacy and safety of ICI treatment after COVID-19 vaccination as well as little impact on the virus protection and toxicity associated with COVID-19 vaccination during ICI treatment.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Immune Checkpoint Inhibitors/adverse effects , Neoplasms/drug therapy , SARS-CoV-2/pathogenicity , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Clinical Decision-Making , Contraindications, Drug , Humans , Immune Checkpoint Inhibitors/administration & dosage , Immunogenicity, Vaccine , Neoplasms/immunology , Pandemics/prevention & control , Patient Selection , SARS-CoV-2/immunology , Treatment Outcome
7.
Transfus Apher Sci ; 60(5): 103200, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1284583

ABSTRACT

Psoriasis is a chronic inflammatory skin disease that is characterized by well-demarcated erythematous plaques with a silver scale. Although many new and emerging therapeutic agents are often sufficient to control the disease, there is still a need for alternative treatment options in challenging cases. Extracorporeal photopheresis (ECP) has been applied to many T-cell-mediated diseases to restore immune homeostasis and treat psoriasis effectively. In this paper, we present a psoriasis patient who did not respond to methotrexate, narrowband ultraviolet B, or acitretin. Because of a diagnosis of non-Hodgkin lymphoma, the patient had contraindications for cyclosporine, fumaric acid esters, and biologics but achieved remission with a total of 12 sessions of ECP in two and a half months. Although exacerbation was recorded after polymerase chain reaction (PCR) confirmed coronavirus 2019 (COVID-19) disease infection at the end of the first month, scores from the psoriasis area severity index (PASI) and dermatological life quality index (DLQI) were regressed significantly within two and a half months. ECP seems to provide an effective and rapid response for psoriasis and should be considered for psoriasis patients who fail to respond or have contraindications to existing treatments.


Subject(s)
COVID-19/complications , Lymphoma, Non-Hodgkin/complications , Pandemics , Photopheresis , Psoriasis/drug therapy , SARS-CoV-2 , Acitretin/therapeutic use , Chemical and Drug Induced Liver Injury/etiology , Combined Modality Therapy , Contraindications, Drug , Cyclosporine/adverse effects , Humans , Male , Methotrexate/adverse effects , Methotrexate/therapeutic use , Middle Aged , Nails/pathology , Psoriasis/complications , Psoriasis/pathology , Psoriasis/radiotherapy , Quality of Life , Severity of Illness Index , Ultraviolet Therapy
8.
High Blood Press Cardiovasc Prev ; 28(4): 405-416, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1283824

ABSTRACT

INTRODUCTION: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic. METHODS: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR). RESULTS: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes. CONCLUSIONS: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/virology , Renin-Angiotensin System/drug effects , SARS-CoV-2/pathogenicity , Aged , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , Contraindications, Drug , Disease Progression , Female , Host-Pathogen Interactions , Humans , Male , Middle Aged , Observational Studies as Topic , Prognosis , Randomized Controlled Trials as Topic , Risk Assessment , Risk Factors
9.
Int J Infect Dis ; 106: 265-268, 2021 May.
Article in English | MEDLINE | ID: covidwho-1279605

ABSTRACT

INTRODUCTION: Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. METHODS: A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. RESULTS: The survey involved 305 patients [median age 71 (interquartile range 59-81) years]. The majority of patients (n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs (n = 188, 62%) and haematologic/haemato-oncologic diseases (n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes (n = 86, 28%), renal insufficiency (n = 69, 23%) and heart failure (n = 58, 19%). CONCLUSION: The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.


Subject(s)
COVID-19/drug therapy , Hydroxychloroquine/adverse effects , SARS-CoV-2 , Aged , Aged, 80 and over , Comorbidity , Contraindications, Drug , Drug Interactions , Female , Germany/epidemiology , Humans , Male , Middle Aged , Retrospective Studies
10.
Cytokine Growth Factor Rev ; 60: 52-60, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1252646

ABSTRACT

Antiphospholipid antibodies (aPLs), present in 1-5 % of healthy individuals, are associated with the risk of antiphospholipid syndrome (APS), which is the most common form of acquired thrombophilia. APLs may appear following infections or vaccinations and have been reported in patients with COronaVIrus Disease-2019 (COVID-19). However, their association with COVID-19 vaccination is unclear. Notably, a few cases of thrombocytopenia and thrombotic events resembling APS have been reported to develop in recipients of either adenoviral vector- or mRNA-based COVID-19 vaccines. The aim of this review is therefore to speculate on the plausible role of aPLs in the pathogenesis of these rare adverse events. Adenoviral vector-based vaccines can bind platelets and induce their destruction in the reticuloendothelial organs. Liposomal mRNA-based vaccines may instead favour activation of coagulation factors and confer a pro-thrombotic phenotype to endothelial cells and platelets. Furthermore, both formulations may trigger a type I interferon response associated with the generation of aPLs. In turn, aPLs may lead to aberrant activation of the immune response with participation of innate immune cells, cytokines and the complement cascade. NETosis, monocyte recruitment and cytokine release may further support endothelial dysfunction and promote platelet aggregation. These considerations suggest that aPLs may represent a risk factor for thrombotic events following COVID-19 vaccination, and deserve further investigations.


Subject(s)
Antibodies, Antiphospholipid/analysis , Antibodies, Antiphospholipid/immunology , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , Thrombophilia/etiology , Antiphospholipid Syndrome/etiology , Antiphospholipid Syndrome/immunology , Contraindications, Drug , Humans , Thrombophilia/immunology
12.
J Mycol Med ; 31(2): 101125, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1164245

ABSTRACT

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.


Subject(s)
COVID-19/complications , Heart Transplantation , Invasive Fungal Infections/complications , Mucormycosis/complications , Postoperative Complications/etiology , Rhizopus/isolation & purification , Aged , Anti-Infective Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , COVID-19/therapy , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Coinfection/drug therapy , Coinfection/microbiology , Combined Modality Therapy , Contraindications, Drug , Debridement , Dermatomycoses/drug therapy , Dermatomycoses/etiology , Disease Susceptibility , Fatal Outcome , Heart Failure/surgery , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Intra-Aortic Balloon Pumping/instrumentation , Invasive Fungal Infections/drug therapy , Male , Mucormycosis/drug therapy , Mucormycosis/microbiology , Negative-Pressure Wound Therapy , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Postoperative Complications/virology , Surgical Wound Infection/complications , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiology , Surgical Wound Infection/surgery
13.
Australas J Dermatol ; 62(2): 151-156, 2021 May.
Article in English | MEDLINE | ID: covidwho-1160975

ABSTRACT

As the phase III COVID-19 vaccine trials excluded patients on immunosuppressive treatments, or patients with significant autoimmunity, the Australasian Medical Dermatology Group make the following preliminary recommendations around COVID-19 vaccination in dermatology patients on immunomodulatory and/or biologic agents. Vaccination against COVID-19 is strongly encouraged for all patients on immunomodulatory drugs and/or biologic agents. There are currently insufficient data to recommend one COVID-19 vaccine or vaccine type (mRNA, recombinant, inactivated virus) over another. No specific additional risk in patients on immunomodulatory or biologic therapies has so far been identified. Data on vaccine efficacy in patients on immunomodulatory or biologic therapies are missing, so standard vaccination protocols are recommended until otherwise advised.


Subject(s)
Biological Products , COVID-19 Vaccines , COVID-19/prevention & control , Immunologic Factors , Vaccination/standards , Biological Products/therapeutic use , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , Contraindications, Drug , Humans , Immunologic Factors/therapeutic use , SARS-CoV-2 , Skin Diseases/drug therapy
14.
Expert Rev Anti Infect Ther ; 19(10): 1331-1339, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1157981

ABSTRACT

BACKGROUND: Hydroxychloroquine (HCQ) was one of the earliest drugs to be recommended for tackling the COVID-19 threat leading to its widespread usage. We provide preliminary findings of the system, established in a tertiary care academic center for the administration of HCQ prophylaxis to healthcare workers (HCW) based on Indian Council of Medical Research (ICMR) advisory. METHODS: A dedicated clinical pharmacology and internal medicine team screened for contraindications, administered informed consent, maintained compliance and monitored for adverse events. RESULTS: Among the 194 HCWs screened for ruling out contraindications for prophylaxis, 9 were excluded and 185 were initiated on HCQ. A total of 55 adverse events were seen in 38 (20.5%) HCWs out of which 70.9%, 29.1% were mild and moderate & none were severe. Before the completion of therapy, a total of 23 participants discontinued. Change in QTc interval on day 2 was 5 (IQR: -3.75, 11) ms and the end of week 1 was 15 ms (IQR: 2, 18). Out of the 5 HCW who turned positive for COVID-19, 2 were on HCQ. CONCLUSION: HCQ prophylaxis was found to be safe and well tolerated in HCW when administered after appropriate screening and with monitoring for adverse events.


Subject(s)
Antimalarials/adverse effects , COVID-19/prevention & control , Hydroxychloroquine/adverse effects , Mass Drug Administration/methods , Adult , Antimalarials/administration & dosage , Contraindications, Drug , Electrocardiography , Female , Humans , Hydroxychloroquine/administration & dosage , India , Informed Consent , Long QT Syndrome/chemically induced , Male , Personnel, Hospital , Preliminary Data , SARS-CoV-2 , Tertiary Care Centers , Young Adult
15.
Pan Afr Med J ; 35(Suppl 2): 150, 2020.
Article in English | MEDLINE | ID: covidwho-1106496

ABSTRACT

The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Adult , Atrial Fibrillation/complications , Azithromycin/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Chloroquine/adverse effects , Chloroquine/therapeutic use , Clinical Laboratory Techniques , Combined Modality Therapy , Contraindications, Drug , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Early Diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Male , Muscle Weakness/etiology , Nasopharynx/virology , Olfaction Disorders/etiology , Oxygen Inhalation Therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Quadriplegia/etiology , Respiration, Artificial , SARS-CoV-2 , Urinary Incontinence/etiology
17.
Prog Urol ; 31(5): 243-244, 2021 04.
Article in French | MEDLINE | ID: covidwho-1038161
18.
Ann Hematol ; 100(3): 667-673, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1030503

ABSTRACT

The severe pneumonia caused by the human coronavirus (hCoV)-SARS-CoV-2 has inflicted heavy casualties, especially among the elderly and those with co-morbid illnesses irrespective of their age. The high mortality in African-Americans and males, in general, raises the concern for a possible X-linked mediated process that could affect the viral pathogenesis and the immune system. We hypothesized that G6PD, the most common X-linked enzyme deficiency, associated with redox status, may have a role in severity of pneumonia. Retrospective chart review was performed in hospitalized patients with COVID19 pneumonia needing supplemental oxygen. A total of 17 patients were evaluated: six with G6PD deficiency (G6PDd) and 11 with normal levels. The two groups (normal and G6PDd) were comparable in terms of age, sex, co-morbidities, and laboratory parameters-LDH, IL-6, CRP, and ferritin, respectively. Thirteen patients needed ventilatory support ; 8 in the normal group and 5 in the G6PDd group (72% vs.83%). The main differences indicating increasing severity in normal vs. G6PDd groups included G6PD levels (12.2 vs. 5.6, P = 0.0002), PaO2/FiO2 ratio (159 vs. 108, P = 0.05), days on mechanical ventilation (10.25 vs. 21 days P = 0.04), hemoglobin level (10 vs. 8.1 P = 0.03), and hematocrit (32 vs. 26 P = 0.015). Only one patient with G6PDd died; 16 were discharged home. Our clinical series ascribes a possible biological role for G6PDd in SARS-CoV2 viral proliferation. It is imperative that further studies are performed to understand the interplay between the viral and host factors in G6PDd that may lead to disparity in outcomes. KEY POINTS: • COVID19 studies show higher mortality in men, due to severe pneumonia and ARDS, indicating possible X-linked mediated differences • G6PD, the most common X-linked enzymopathy, highly prevalent in African Americans and Italians, maintains redox homeostasis. • Preclinical studies using G6PD deficient (G6PDd) cells infected with human coronavirus (hCoV), show impaired cellular responses, viral proliferation and worsening oxidative damage. • Retrospective chart review in hospitalized patients with COVID19 pneumonia needing supplemental oxygen shows differences between the two groups (Normal and G6PDd) in hematological indices; the G6PDdgroup demonstrated prolonged PaO2/FiO2 ratio, and longer days on mechanical ventilation indicating the severity of the pneumonia.


Subject(s)
COVID-19/complications , Glucosephosphate Dehydrogenase Deficiency/complications , Respiratory Distress Syndrome/etiology , SARS-CoV-2 , African Americans , COVID-19/blood , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Contraindications, Drug , Critical Care , Female , Genetic Predisposition to Disease , Glucosephosphate Dehydrogenase Deficiency/blood , Glucosephosphate Dehydrogenase Deficiency/ethnology , Glucosephosphate Dehydrogenase Deficiency/physiopathology , Humans , Hydroxychloroquine/adverse effects , Hydroxychloroquine/therapeutic use , Male , Middle Aged , Oxidative Stress , Respiration, Artificial , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/therapy , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index , Sex Distribution
19.
Vitae (Medellín) ; 27(3): 1-14, 2020-09-02. Ilustraciones
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-994731

ABSTRACT

Background: The elderly people have high morbimortality associated with respiratory disorders, in addition to the presence of other safety risk factors, such as the use of potentially inappropriate medication and the occurrence of drug interactions. Objective: Considering the current pandemic scenario, it was intended to identify explicit criteria-based tools that reported drug interactions between potentially inappropriate medication and respiratory system disorders and possibly worse prognosis of COVID-19 infection. Methods: A systematic scoping review was conducted until February 2020. Study characteristics of explicit criteria-based tools, and potentially inappropriate medication, drug interactions, and therapeutic management, were extracted. Results: Nineteen explicit criteria-based tools were included. Nineteen drug interactions and 17 potentially inappropriate medications with concerns for three respiratory disorders (asthma, chronic pulmonary obstructive disease, and respiratory failure) were identified. The most frequent pharmacological classes reported were benzodiazepines and beta-blockers. For clinical management, the tools recommend using cardioselective beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type I receptor blockers and benzodiazepines with a short or intermediate half-life. Conclusion: Considering the increased risk of COVID-19 infection in the elderly, drug interactions and the use of potentially inappropriate medication associated with the occurrence of adverse drug events in the respiratory system may also worsening COVID-19 infection in patients with uncontrolled respiratory disorders. Thus, it is essential to assess drug therapy in use, to identify safety risks and monitor the elderly in general and those with a worse prognosis concerning COVID-19, promoting patient safety.


Antecedentes: Los ancianos tienen alta morbimortalidad asociada a trastornos respiratorios, además de la presencia de otros factores de riesgo de seguridad, como el uso de medicación potencialmente inapropiada y la ocurrencia de interacciones medicamentosas. Objetivo: Teniendo en cuenta el escenario pandémico actual, se pretendía identificar herramientas explícitas basadas en criterios que informaran interacciones farmacológicas entre medicamentos potencialmente inapropiados y trastornos del sistema respiratorio y posiblemente un peor pronóstico de la infección por COVID-19. Métodos:Se realizó una revisión sistemática del alcance hasta febrero de 2020. Se extrajeron las características del estudio de las herramientas explícitas basadas en criterios y la medicación potencialmente inapropiada, las interacciones entre medicamentos y el manejo terapéutico. Resultados: Se incluyeron diecinueve herramientas explícitas basadas en criterios. Se identificaron diecinueve interacciones farmacológicas y 17 medicamentos potencialmente inapropiados con preocupaciones por tres trastornos respiratorios (asma, enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria). Las clases farmacológicas más frecuentes comunicadas fueron las benzodiacepinas y los betabloqueantes. Para el manejo clínico, las herramientas recomiendan el uso de betabloqueantes cardioselectivos, bloqueadores de los canales de calcio, inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina II tipo I y benzodiacepinas con una vida media corta o intermedia. Conclusión: Teniendo en cuenta el mayor riesgo de infección por COVID-19 en los ancianos, las interacciones farmacológicas y el uso de medicamentos potencialmente inapropiados asociados con la aparición de eventos farmacológicos adversos en el sistema respiratorio también pueden empeorar la infección por COVID-19 en pacientes con trastornos respiratorios no controlados. Por tanto, es fundamental evaluar la farmacoterapia en uso, identificar los riesgos de seguridad y monitorizar a los ancianos en general y a aquellos con peor pronóstico en relación con el COVID-19, promoviendo la seguridad del paciente.


Subject(s)
Humans , Coronavirus Infections , Respiratory Tract Diseases , Risk Management , Drug-Related Side Effects and Adverse Reactions , Inappropriate Prescribing , Potentially Inappropriate Medication List , Contraindications, Drug
20.
Anaesth Crit Care Pain Med ; 39(3): 351-353, 2020 06.
Article in English | MEDLINE | ID: covidwho-986871
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