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1.
Open Heart ; 8(2)2021 12.
Article in English | MEDLINE | ID: covidwho-1582998

ABSTRACT

OBJECTIVE: Soluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes. METHODS: We enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death. RESULTS: Concentrations of sST2 at baseline was median 48 (IQR 37-67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36-59) ng/mL; ICU 67 (39-104) ng/mL and non-survivors 107 (72-116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9 . CONCLUSIONS: sST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19. TRIAL REGISTRATION NUMBER: NCT04314232.


Subject(s)
COVID-19 , Hypoxia , Interleukin-1 Receptor-Like 1 Protein/analysis , SARS-CoV-2/isolation & purification , Viremia , Aged , Biomarkers/analysis , COVID-19/blood , COVID-19/mortality , COVID-19/physiopathology , Comorbidity , Correlation of Data , Female , Hospital Mortality , Humans , Hypoxia/diagnosis , Hypoxia/etiology , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Norway/epidemiology , Prognosis , Risk Factors , Severity of Illness Index , Smoking/epidemiology , Viremia/diagnosis , Viremia/etiology
2.
Sci Rep ; 11(1): 15110, 2021 07 23.
Article in English | MEDLINE | ID: covidwho-1322504

ABSTRACT

The lockdown measures that were taken to combat the COVID-19 pandemic minimized anthropogenic activities and created natural laboratory conditions for studying air quality. Both observations and WRF-Chem simulations show a 20-50% reduction (compared to pre-lockdown and same period of previous year) in the concentrations of most aerosols and trace gases over Northwest India, the Indo Gangetic Plain (IGP), and the Northeast Indian regions. It is shown that this was mainly due to a 70-80% increase in the height of the boundary layer and the low emissions during lockdown. However, a 60-70% increase in the pollutants levels was observed over Central and South India including the Arabian sea and Bay of Bengal during this period, which is attributed to natural processes. Elevated (dust) aerosol layers are transported from the Middle East and Africa via long-range transport, and a decrease in the wind speed (20-40%) caused these aerosols to stagnate, enhancing the aerosol levels over Central and Southern India. A 40-60% increase in relative humidity further amplified aerosol concentrations. The results of this study suggest that besides emissions, natural processes including background meteorology and dynamics, play a crucial role in the pollution concentrations over the Indian sub-continent.


Subject(s)
Air Pollutants/analysis , Air Pollution/analysis , Environmental Monitoring/methods , Vehicle Emissions/analysis , Aerosols/analysis , Africa , Bays , COVID-19 , Communicable Disease Control , Correlation of Data , Dust/analysis , Environmental Pollution/analysis , Humans , India , Meteorology , Middle East , Oceans and Seas , Pandemics
3.
Sci Rep ; 11(1): 14387, 2021 07 13.
Article in English | MEDLINE | ID: covidwho-1309467

ABSTRACT

This study aims to evaluate the monitoring and predictive value of web-based symptoms (fever, cough, dyspnea) searches for COVID-19 spread. Daily search interests from Turkey, Italy, Spain, France, and the United Kingdom were obtained from Google Trends (GT) between January 1, 2020, and August 31, 2020. In addition to conventional correlational models, we studied the time-varying correlation between GT search and new case reports; we used dynamic conditional correlation (DCC) and sliding windows correlation models. We found time-varying correlations between pulmonary symptoms on GT and new cases to be significant. The DCC model proved more powerful than the sliding windows correlation model. This model also provided better at time-varying correlations (r ≥ 0.90) during the first wave of the pandemic. We used a root means square error (RMSE) approach to attain symptom-specific shift days and showed that pulmonary symptom searches on GT should be shifted separately. Web-based search interest for pulmonary symptoms of COVID-19 is a reliable predictor of later reported cases for the first wave of the COVID-19 pandemic. Illness-specific symptom search interest on GT can be used to alert the healthcare system to prepare and allocate resources needed ahead of time.


Subject(s)
COVID-19/diagnosis , Search Engine/statistics & numerical data , Correlation of Data , France , Humans , Italy , Spain , Turkey , United Kingdom
4.
Intern Emerg Med ; 16(5): 1113-1119, 2021 08.
Article in English | MEDLINE | ID: covidwho-1287454

ABSTRACT

The amazing effort of vaccination against COVID-19, with more than 2 billion vaccine doses administered all around the world as of 16 June 2021, has changed the history of this pandemic, drastically reducing the number of severe cases or deaths in countries were mass vaccination campaign have been carried out. However, the people's rising enthusiasm has been blunted in late February 2021 by the report of several cases of unusual thrombotic events in combination with thrombocytopenia after vaccination with ChAdOx1 nCov-19 (Vaxzevria), and a few months later also after Ad26.COV2. S vaccines. Of note, both products used an Adenovirus-based (AdV) platform to deliver the mRNA molecule - coding for the spike protein of SARS-CoV-2. A clinical entity characterized by cerebral and/or splanchnic vein thrombosis, often associated with multiple thromboses, with thrombocytopenia and bleeding, and sometimes disseminated intravascular coagulation (DIC), was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). VITT was mainly observed in females under 55 years of age, between 4 and 16 days after receiving only Adenovirus-based vaccine and displayed a seriously high fatality rate. This prompted the Medicine Regulatory Agencies of various countries to enforce the pharmacovigilance programs, and to provide some advices to restrict the use of AdV-based vaccines to some age groups. This point-of view is aimed at providing a comprehensive review of epidemiological issues, pathogenetic hypothesis and treatment strategies of this rare but compelling syndrome, thus helping physicians to offer an up-to dated and evidence-based counseling to their often alarmed patients.


Subject(s)
COVID-19 Vaccines/adverse effects , Thrombocytopenia/etiology , Vaccination/statistics & numerical data , Biomarkers/analysis , COVID-19 Vaccines/pharmacokinetics , COVID-19 Vaccines/therapeutic use , Correlation of Data , Expert Testimony , Humans , Thrombocytopenia/physiopathology , Vaccination/adverse effects , Vaccination/methods
5.
Repert. med. cir ; 30(suplemento): 16-20, 2021. graf.
Article in English, Spanish | LILACS (Americas) | ID: covidwho-1270344

ABSTRACT

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


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


Subject(s)
Humans , Correlation of Data , COVID-19/diagnosis , Analysis of Variance , Colombia , COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19 Serological Testing/statistics & numerical data , SARS-CoV-2/immunology , COVID-19/transmission
6.
Clin Transl Gastroenterol ; 12(6): e00367, 2021 06 04.
Article in English | MEDLINE | ID: covidwho-1259761

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 infection has been associated with both endotoxemia and thrombosis of small and large vessels, but the relationship between these 2 phenomena has not been pursued. Oliva et al. in this issue of Clinical and Translational Gastroenterology demonstrate an association between the 2 findings and suggest that increased intestinal permeability is a possible mechanism to explain the endotoxemia. Although the evidence to support this hypothesis is only suggestive, the role of the small intestine in the illness produced by the virus needs to be further explored.


Subject(s)
COVID-19 , Endotoxemia , Intestine, Small , SARS-CoV-2 , Thrombosis , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , Correlation of Data , Endotoxemia/diagnosis , Endotoxemia/metabolism , Endotoxemia/virology , Humans , Intestine, Small/metabolism , Intestine, Small/virology , Permeability , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Thrombosis/blood , Thrombosis/diagnosis , Thrombosis/etiology
7.
Clin Transl Gastroenterol ; 12(6): e00348, 2021 06 04.
Article in English | MEDLINE | ID: covidwho-1259760

ABSTRACT

INTRODUCTION: Patients with community-acquired pneumonia display enhanced levels of lipopolysaccharides (LPS) compared with controls, suggesting that low-grade endotoxemia may be implicated in vascular disturbances. It is unknown whether this occurs in patients with coronavirus 2019 (COVID-19) and its impact on thrombotic complications. METHODS: We measured serum levels of zonulin, a marker of gut permeability, LPS, and D-dimer in 81 patients with COVID-19 and 81 healthy subjects; the occurrence of thrombotic events in COVID-19 during the intrahospital stay was registered. RESULTS: Serum LPS and zonulin were higher in patients with COVID-19 than in control subjects and, in COVID-19, significantly correlated (R = 0.513; P < 0.001). Among the 81 patients with COVID-19, 11 (14%) experienced thrombotic events in the arterial (n = 5) and venous circulation (n = 6) during a median follow-up of 18 days (interquartile range 11-27 days). A logistic regression analysis showed that LPS (P = 0.024) and D-dimer (P = 0.041) independently predicted thrombotic events. DISCUSSION: The study reports that low-grade endotoxemia is detectable in patients with COVID-19 and is associated with thrombotic events. The coexistence of low-grade endotoxemia with enhanced levels of zonulin may suggest enhanced gut permeability as an underlying mechanism.


Subject(s)
COVID-19 , Endotoxemia , Haptoglobins/metabolism , Intestinal Mucosa , Protein Precursors/metabolism , SARS-CoV-2 , Thrombosis , Biomarkers/blood , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , Correlation of Data , Endotoxemia/diagnosis , Endotoxemia/metabolism , Endotoxemia/virology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Intestinal Mucosa/metabolism , Intestinal Mucosa/virology , Lipopolysaccharides/analysis , Male , Middle Aged , Permeability , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Thrombosis/blood , Thrombosis/diagnosis , Thrombosis/etiology
8.
Sci Rep ; 11(1): 11302, 2021 05 28.
Article in English | MEDLINE | ID: covidwho-1246400

ABSTRACT

COVID-19 pandemic continues to obstruct social lives and the world economy other than questioning the healthcare capacity of many countries. Weather components recently came to notice as the northern hemisphere was hit by escalated incidence in winter. This study investigated the association between COVID-19 cases and two components, average temperature and relative humidity, in the 16 states of Germany. Three main approaches were carried out in this study, namely temporal correlation, spatial auto-correlation, and clustering-integrated panel regression. It is claimed that the daily COVID-19 cases correlate negatively with the average temperature and positively with the average relative humidity. To extract the spatial auto-correlation, both global Moran's [Formula: see text] and global Geary's [Formula: see text] were used whereby no significant difference in the results was observed. It is evident that randomness overwhelms the spatial pattern in all the states for most of the observations, except in recent observations where either local clusters or dispersion occurred. This is further supported by Moran's scatter plot, where states' dynamics to and fro cold and hot spots are identified, rendering a traveling-related early warning system. A random-effects model was used in the sense of case-weather regression including incidence clustering. Our task is to perceive which ranges of the incidence that are well predicted by the existing weather components rather than seeing which ranges of the weather components predicting the incidence. The proposed clustering-integrated model associated with optimal barriers articulates the data well whereby weather components outperform lag incidence cases in the prediction. Practical implications based on marginal effects follow posterior to model diagnostics.


Subject(s)
COVID-19/epidemiology , Cluster Analysis , Cold Temperature , Computer Simulation , Correlation of Data , Germany/epidemiology , Humans , Humidity , Incidence , Pandemics , Regression Analysis , Seasons , Spatio-Temporal Analysis , Weather
9.
Diabetes Metab Syndr ; 15(3): 993-999, 2021.
Article in English | MEDLINE | ID: covidwho-1226283

ABSTRACT

BACKGROUND AND AIMS: In India, COVID-19 case fatality rates (CFRs) have consistently been very high in states like Punjab and Maharashtra and very low in Kerala and Assam. To investigate the discrepancy in state-wise CFRs, datasets on various factors related to demography, socio-economy, public health, and healthcare capacity have been collected to study their association with CFR. METHODS: State-wise COVID-19 data was collected till April 22, 2021. The latest data on the various factors have been collected from reliable sources. Pearson correlation, two-tailed P test, Spearman rank correlation, and Artificial Neural Network (ANN) structures have been used to assess the association between various factors and CFR. RESULTS: Life expectancies, prevalence of overweight, COVID-19 test positive rates, and H1N1 fatality rates show a significant positive association with CFR. Human Development Index, per capita GDP, public affairs index, health expenditure per capita, availability of govt. doctors & hospital beds, prevalence of certain diseases, and comorbidities like diabetes and hypertension show insignificant association with CFR. Sex ratio, health expenditure as a percent of GSDP, and availability of govt. hospitals show a significant negative correlation with CFR. CONCLUSION: The study indicates that older people, males of younger age groups, and overweight people are at more fatality risk from COVID-19. Certain diseases and common comorbidities like diabetes and hypertension do not seem to have any significant effect on CFR. States with better COVID-19 testing rates, health expenditure, and healthcare capacity seem to perform better with regard to COVID-19 fatality rates.


Subject(s)
COVID-19/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Artificial Intelligence , COVID-19/complications , COVID-19/diagnosis , Child , Child, Preschool , Chronic Disease/epidemiology , Chronic Disease/mortality , Comorbidity , Correlation of Data , Epidemiologic Factors , Female , Humans , India/epidemiology , Infant , Infant, Newborn , Life Expectancy , Male , Middle Aged , Mortality , Neural Networks, Computer , Risk Factors , SARS-CoV-2/physiology , Socioeconomic Factors , Young Adult
10.
Global Health ; 17(1): 54, 2021 05 07.
Article in English | MEDLINE | ID: covidwho-1220233

ABSTRACT

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


Subject(s)
COVID-19/psychology , Social Stigma , Socioeconomic Factors , Adult , Analysis of Variance , COVID-19/complications , COVID-19/epidemiology , China/epidemiology , Correlation of Data , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics/statistics & numerical data
11.
J Trauma Acute Care Surg ; 90(4): 700-707, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1203800

ABSTRACT

BACKGROUND: The large-scale social distancing efforts to reduce SARS-CoV-2 transmission have dramatically changed human behaviors associated with traumatic injuries. Trauma centers have reported decreases in trauma volume, paralleled by changes in injury mechanisms. We aimed to quantify changes in trauma epidemiology at an urban Level I trauma center in a county that instituted one of the earliest shelter-in-place orders to inform trauma care during future pandemic responses. METHODS: A single-center interrupted time-series analysis was performed to identify associations of shelter-in-place with trauma volume, injury mechanisms, and patient demographics in San Francisco, California. To control for short-term trends in trauma epidemiology, weekly level data were analyzed 6 months before shelter-in-place. To control for long-term trends, monthly level data were analyzed 5 years before shelter-in-place. RESULTS: Trauma volume decreased by 50% in the week following shelter-in-place (p < 0.01), followed by a linear increase each successive week (p < 0.01). Despite this, trauma volume for each month (March-June 2020) remained lower compared with corresponding months for all previous 5 years (2015-2019). Pediatric trauma volume showed similar trends with initial decreases (p = 0.02) followed by steady increases (p = 0.05). Reductions in trauma volumes were due entirely to changes in nonviolent injury mechanisms, while violence-related injury mechanisms remained unchanged (p < 0.01). CONCLUSION: Although the shelter-in-place order was associated with an overall decline in trauma volume, violence-related injuries persisted. Delineating and addressing underlying factors driving persistent violence-related injuries during shelter-in-place orders should be a focus of public health efforts in preparation for future pandemic responses. LEVEL OF EVIDENCE: Epidemiological study, level III.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Physical Abuse/statistics & numerical data , Physical Distancing , Trauma Centers/statistics & numerical data , Wounds and Injuries , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Correlation of Data , Female , Humans , Interrupted Time Series Analysis , Male , Retrospective Studies , SARS-CoV-2 , San Francisco/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/etiology , Wounds and Injuries/therapy
12.
Crit Care Med ; 49(6): e624-e633, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1191503

ABSTRACT

OBJECTIVES: No standard therapy, including anticoagulation regimens, is currently recommended for coronavirus disease 2019. Aim of this study was to evaluate the efficacy of anticoagulation in coronavirus disease 2019 hospitalized patients and its impact on survival. DESIGN: Multicenter international prospective registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019). SETTING: Hospitalized patients with coronavirus disease 2019. PATIENTS: Five thousand eight hundred thirty-eight consecutive coronavirus disease 2019 patients. INTERVENTIONS: Anticoagulation therapy, including prophylactic and therapeutic regimens, was obtained for each patient. MEASUREMENTS AND MAIN RESULTS: Five thousand four hundred eighty patients (94%) did not receive any anticoagulation before hospitalization. Two-thousand six-hundred one patients (44%) during hospitalization received anticoagulation therapy and it was not associated with better survival rate (81% vs 81%; p = 0.94) but with higher risk of bleeding (2.7% vs 1.8%; p = 0.03). Among patients admitted with respiratory failure (49%, n = 2,859, including 391 and 583 patients requiring invasive and noninvasive ventilation, respectively), anticoagulation started during hospitalization was associated with lower mortality rates (32% vs 42%; p < 0.01) and nonsignificant higher risk of bleeding (3.4% vs 2.7%; p = 0.3). Anticoagulation therapy was associated with lower mortality rates in patients treated with invasive ventilation (53% vs 64%; p = 0.05) without increased rates of bleeding (9% vs 8%; p = 0.88) but not in those with noninvasive ventilation (35% vs 38%; p = 0.40). At multivariate Cox' analysis mortality relative risk with anticoagulation was 0.58 (95% CI, 0.49-0.67) in patients admitted with respiratory failure, 0.50 (95% CI, 0.49-0.67) in those requiring invasive ventilation, 0.72 (95% CI, 0.51-1.01) in noninvasive ventilation. CONCLUSIONS: Anticoagulation therapy in general population with coronavirus disease 2019 was not associated with better survival rates but with higher bleeding risk. Better results were observed in patients admitted with respiratory failure and requiring invasive ventilation.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/drug therapy , Outcome Assessment, Health Care , Registries , COVID-19/mortality , Case-Control Studies , Correlation of Data , Cross-Cultural Comparison , Hemorrhage/chemically induced , Hemorrhage/mortality , Hospitalization , Humans , Multicenter Studies as Topic , Prospective Studies , Respiration, Artificial , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/mortality , Risk , Survival Rate , Treatment Outcome
13.
J Thromb Thrombolysis ; 52(2): 497-503, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1188149

ABSTRACT

The coronavirus disease 2019 (COVID-19) increases thrombotic risk. The mechanisms that lead to this prothrombotic state are not well established. The main aim was to evaluate the von Willebrand factor (VWF) antigen and plasma ADAMTS13 activity as endothelial injury markers in COVID-19. We present a prospective study in COVID-19 patients recruited in our institution. VWF antigen, ADAMTS13 activity, D-dimer, and fibrinogen were measured during the first week once COVID-19 was diagnosed. Fifty COVID-19 inpatients [44% in the intensive care unit (ICU)] and 102 COVID-19 outpatients were enrolled. Thirty age and gender matched non-COVID-19 ward inpatients and 30 non-COVID-19 healthy individuals were recruited. The COVID-19 inpatients had higher D-dimer, fibrinogen, and VWF antigen levels and a lower ADAMTS13 activity compared with the COVID-19 outpatients (p < 0.05). ICU patients had higher D-dimer and VWF antigen levels compared with the ward patients and the lowest ADAMTS13 activity (p < 0.05). An imbalance in VWF antigen/ADAMTS13 ratio was observed in COVID-19, reaching the highest in ICU patients. In contrast to other ward non-COVID-19 inpatients, a significative reduction in ADAMTS13 activity was observed in all COVID-19 patients. There is an increase in VWF antigen and an ADAMTS13 activity reduction in COVID-19 related to disease severity and could predict poor clinical outcomes. The ADAMTS13 activity reduction could be a marker associated with COVID-19 compared to other non-critical medical conditions.


Subject(s)
ADAMTS13 Protein/blood , COVID-19 , Endothelium, Vascular , Risk Assessment , Thrombophilia , von Willebrand Factor/analysis , Aged , Ambulatory Care/statistics & numerical data , Biomarkers/analysis , Biomarkers/blood , COVID-19/blood , COVID-19/diagnosis , COVID-19/epidemiology , Correlation of Data , Endothelium, Vascular/metabolism , Endothelium, Vascular/physiopathology , Female , Fibrin Fibrinogen Degradation Products/analysis , Fibrinogen/analysis , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Prospective Studies , Risk Assessment/methods , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Spain/epidemiology , Thrombophilia/blood , Thrombophilia/diagnosis , Thrombophilia/virology
14.
Pediatrics ; 148(1)2021 07.
Article in English | MEDLINE | ID: covidwho-1183695

ABSTRACT

OBJECTIVES: Increased rates of firearm ownership, school closures, and a suspected decrease in supervision during the coronavirus disease 2019 (COVID-19) pandemic place young children at increased risk of firearm injuries. We measured trends in firearm injuries in children and inflicted by children discharging a firearm during the pandemic and correlated these changes with a rise in firearm acquisition. METHODS: In this cross-sectional study with an interrupted time series analysis, we used multiyear data from the Gun Violence Archive. We compared trends in (1) firearm injuries in children younger than 12 years old and (2) firearm injuries inflicted by children younger than 12 years old during the pre-COVID-19 period (March to August in the years 2016-2019) and during the first 6 months of the COVID-19 pandemic (March 2020 to August 2020). Linear regression models were developed to evaluate the relationship between firearm injuries and new firearm acquisitions. RESULTS: There was an increased risk of (1) firearm injuries in young children (relative risk = 1.90; 95% confidence interval 1.58 to 2.29) and (2) firearm injuries inflicted by young children (relative risk = 1.43; 95% confidence interval 1.14 to 1.80) during the first 6 months of the COVID-19 pandemic as compared to the pre-COVID-19 study period. These increased incidents correlate with an increase in new firearm ownership (P < .03). CONCLUSIONS: There has been a surge in firearm injuries in young children and inflicted by young children during the first 6 months of the COVID-19 pandemic. There is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.


Subject(s)
COVID-19 , Firearms/statistics & numerical data , Wounds, Gunshot/epidemiology , Child , Correlation of Data , Cross-Sectional Studies , Humans , Interrupted Time Series Analysis , United States/epidemiology
15.
BMC Cardiovasc Disord ; 21(1): 158, 2021 03 30.
Article in English | MEDLINE | ID: covidwho-1159221

ABSTRACT

INTRODUCTION: The cause-and-effect relationship of QTc prolongation in Coronavirus disease 2019 (COVID-19) patients has not been studied well. OBJECTIVE: We attempt to better understand the relationship of QTc prolongation in COVID-19 patients in this study. METHODS: This is a retrospective, hospital-based, observational study. All patients with normal baseline QTc interval who were hospitalized with the diagnosis of COVID-19 infection at two hospitals in Ohio, USA were included in this study. RESULTS: Sixty-nine patients had QTc prolongation, and 210 patients continued to have normal QTc during hospitalization. The baseline QTc intervals were comparable in the two groups. Patients with QTc prolongation were older (mean age 67 vs. 60, P 0.003), more likely to have underlying cardiovascular disease (48% versus 26%, P 0.001), ischemic heart disease (29% versus 17%, P 0.026), congestive heart failure with preserved ejection fraction (16% versus 8%, P 0.042), chronic kidney disease (23% versus 10%, P 0.005), and end-stage renal disease (12% versus 1%, P < 0.001). Patients with QTc prolongation were more likely to have received hydroxychloroquine (75% versus 59%, P 0.018), azithromycin (18% vs. 14%, P 0.034), a combination of hydroxychloroquine and azithromycin (29% vs 7%, P < 0.001), more than 1 QT prolonging agents (59% vs. 32%, P < 0.001). Patients who were on angiotensin-converting enzyme inhibitors (ACEi) were less likely to develop QTc prolongation (11% versus 26%, P 0.014). QTc prolongation was not associated with increased ventricular arrhythmias or mortality. CONCLUSION: Older age, ESRD, underlying cardiovascular disease, potential virus mediated cardiac injury, and drugs like hydroxychloroquine/azithromycin, contribute to QTc prolongation in COVID-19 patients. The role of ACEi in preventing QTc prolongation in COVID-19 patients needs to be studied further.


Subject(s)
COVID-19/drug therapy , Cardiovascular Diseases/epidemiology , Electrocardiography , Long QT Syndrome , Renal Insufficiency, Chronic/epidemiology , Age Factors , Aged , COVID-19/classification , COVID-19/complications , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Correlation of Data , Electrocardiography/methods , Electrocardiography/statistics & numerical data , Female , Humans , Long QT Syndrome/diagnosis , Long QT Syndrome/epidemiology , Long QT Syndrome/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Risk Assessment/methods , SARS-CoV-2/isolation & purification , Survival Analysis , United States/epidemiology
16.
Eur Rev Med Pharmacol Sci ; 25(5): 2409-2414, 2021 03.
Article in English | MEDLINE | ID: covidwho-1148418

ABSTRACT

The COVID-19 (Corona Virus Disease 2019) outbreak, which seriously affected people's lives across the world, has not been effectively controlled. Previous studies have demonstrated that SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) infecting host cells mainly rely on binding to receptor proteins, namely ACE2 and TMPRSS2. COVID-19 transmission is faster than the severe acute respiratory syndrome (SARS) pneumonia outbreak in 2002. This is mainly attributed to the different pathways of virus-infected host cells, coupled with patients' atypical clinical characteristics. SARS-CoV-2 is mainly transmitted through respiratory droplets and contact, infecting lung tissues before damaging other body organs, such as the liver, brain, kidney and heart. The present study identified potential target genes for SARS-COV-2 receptors, ACE2 and TMPRSS2, in normal human lung tissue. The findings provide novel insights that will guide future drug development approaches for treatment of COVID-19.


Subject(s)
Angiotensin-Converting Enzyme 2/genetics , COVID-19/genetics , Receptors, Virus/genetics , Serine Endopeptidases/genetics , Angiotensin-Converting Enzyme 2/biosynthesis , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/metabolism , COVID-19/virology , Correlation of Data , Gene Expression , Humans , Receptors, Virus/biosynthesis , Receptors, Virus/metabolism , SARS-CoV-2/isolation & purification , SARS-CoV-2/metabolism , Serine Endopeptidases/biosynthesis , Serine Endopeptidases/metabolism
17.
JAMA Netw Open ; 4(3): e214302, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1144219

ABSTRACT

Importance: Accumulating evidence suggests that children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to manifest mild symptoms and are at a lower risk of developing severe respiratory disease compared with adults. It remains unknown how the immune response in children differs from that of adolescents and adults. Objective: To investigate the association of age with the quantity and quality of SARS-CoV-2 antibody responses. Design, Setting, and Participants: This cross-sectional study used 31 426 SARS-CoV-2 antibody test results from pediatric and adult patients. Data were collected from a New York City hospital from April 9 to August 31, 2020. The semiquantitative immunoglobin (Ig) G levels were compared between 85 pediatric and 3648 adult patients. Further analysis of SARS-CoV-2 antibody profiles was performed on sera from 126 patients aged 1 to 24 years. Main Outcomes and Measures: SARS-CoV-2 antibody positivity rates and IgG levels were evaluated in patients from a wide range of age groups (1-102 years). SARS-CoV-2 IgG level, total antibody (TAb) level, surrogate neutralizing antibody (SNAb) activity, and antibody binding avidity were compared between children (aged 1-10 years), adolescents (aged 11-18 years), and young adults (aged 19-24 years). Results: Among 31 426 antibody test results (19 797 [63.0%] female patients), with 1194 pediatric patients (mean [SD] age, 11.0 [5.3] years) and 30 232 adult patients (mean [SD] age, 49.2 [17.1] years), the seroprevalence in the pediatric (197 [16.5%; 95% CI, 14.4%-18.7%]) and adult (5630 [18.6%; 95% CI, 18.2%-19.1%]) patient populations was similar. The SARS-CoV-2 IgG level showed a negative correlation with age in the pediatric population (r = -0.45, P < .001) and a moderate but positive correlation with age in adults (r = 0.24, P < .001). Patients aged 19 to 30 years exhibited the lowest IgG levels (eg, aged 25-30 years vs 1-10 years: 99 [44-180] relative fluorescence units [RFU] vs 443 [188-851] RFU). In the subset cohort aged 1 to 24 years, IgG, TAb, SNAb and avidity were negatively correlated with age (eg, IgG: r = -0.51; P < .001). Children exhibited higher median (IQR) IgG levels, TAb levels, and SNAb activity compared with adolescents (eg, IgG levels: 473 [233-656] RFU vs 191 [82-349] RFU; P < .001) and young adults (eg, IgG levels: 473 [233-656] RFU vs 85 [38-150] RFU; P < .001). Adolescents also exhibited higher median (IQR) TAb levels, IgG levels, and SNAb activity than young adults (eg, TAb levels: 961 [290-2074] RFU vs 370 [125-697]; P = .006). In addition, children had higher antibody binding avidity compared with young adults, but the difference was not significant. Conclusions and Relevance: The results of this study suggest that SARS-CoV-2 viral specific antibody response profiles are distinct in different age groups. Age-targeted strategies for disease screening and management as well as vaccine development may be warranted.


Subject(s)
Antibodies, Neutralizing/blood , Antibodies, Viral/blood , Antibody Affinity/immunology , Antibody Formation/immunology , COVID-19 , SARS-CoV-2 , Age Factors , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Serological Testing/methods , COVID-19 Serological Testing/statistics & numerical data , Child , Correlation of Data , Cross-Sectional Studies , Female , Humans , Immunoglobulin G/blood , Male , Middle Aged , New York City/epidemiology , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification
18.
JAMA Netw Open ; 4(3): e214117, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1141276

ABSTRACT

Importance: Deficient (ie, <20 ng/mL) or insufficient (ie, 20 to <30 ng/mL) 25-hydroxyvitamin D (also known as calcifediol) levels are more common in Black individuals than White individuals and are associated with increased coronavirus disease 2019 (COVID-19) risk. Whether COVID-19 risk is associated with differences in vitamin D levels of 30 ng/mL or greater is not known. Objective: To examine whether COVID-19 test results are associated with differences in vitamin D levels of 30 ng/mL or greater, including for White individuals and for Black individuals. Design, Setting, and Participants: This retrospective cohort study was conducted at an academic medical center in Chicago, Illinois. Participants included individuals with data on vitamin D level within 365 days before COVID-19 testing, which was conducted from March 3 to December 30, 2020. Data were analyzed from September 11, 2020, to February 5, 2021. Exposures: The last vitamin D level before COVID-19 testing was categorized as less than 20 ng/mL (ie, deficient), 20 to less than 30 ng/mL (ie, insufficient), 30 to less than 40 ng/mL, or 40 ng/mL or greater. Treatment was defined by vitamin D type and dose 14 days before COVID-19 testing and treatment changes after last vitamin D level. Main Outcomes and Measures: The main outcome was a positive result for COVID-19 in polymerase chain reaction testing. Multivariable analyses tested whether previously measured vitamin D level was associated with having test results positive for COVID-19 in White individuals and in Black individuals, controlling for months and treatment changes since the vitamin D level was measured, as well as demographic characteristics and comorbidity indicators. Results: A total of 4638 individuals (mean [SD] age 52.8 [19.5] years; 3205 [69%] women) had data for a vitamin D level within 1 year before COVID-19 testing, including 2288 (49%) Black individuals, 1999 (43%) White individuals, and 351 individuals (8%) who were another race/ethnicity (eg, Asian, Mideast Indian, >1 race). Stratified by vitamin D level, 1251 individuals (27%) had less than 20 ng/mL, 1267 individuals (27%) had 20 to less than 30 ng/mL, 1023 individuals (22%) had 30 to less than 40 ng/mL, and 1097 individuals (24%) had 40 ng/mL or greater. Lower vitamin D levels were more common in Black individuals (<20 ng/mL: 829 of 2288 Black individuals [36%]) than White individuals (<20 ng/mL: 315 of 1999 White individuals [16%]). A total of 333 individuals (7%) had test results positive for COVID-19, including 102 White individuals (5%) and 211 Black individuals (9%). Multivariate analysis controlling for time since last vitamin D level measurement was used to estimate the outcomes associated with levels 14 days before COVID-19 testing. A positive test result for COVID-19 was not significantly associated with vitamin D levels in White individuals but was associated with vitamin D levels in Black individuals (compared with ≥40 ng/mL: <20 ng/mL incidence rate ratio [IRR], 2.55 [95% CI, 1.26-5.15]; P = .009; 20 to <30 ng/mL IRR, 1.69 [95% CI, 0.75-3.84]; P = .21; 30 to <40 ng/mL IRR, 2.64 [95% CI, 1.24-5.66]; P = .01). Stratified by vitamin D level, estimated COVID-19 positivity rates in Black individuals were 9.72% (95% CI, 6.74%-13.41%) for individuals with a vitamin D level less than 20 ng/mL, 6.47% (95% CI, 3.33%-10.28%) for individuals with a vitamin D level of 20 to less than 30 ng/mL, 10.10% (95% CI, 6.00%-15.47%) for individuals with a vitamin D level of 30 to less than 40 ng/mL, and 3.82% (95% CI, 1.78%-6.68%) for individuals with a vitamin D level of 40 ng/mL or higher. Multivariate analysis in individuals with a vitamin D level of 30 ng/mL or greater found that the IRR of a positive COVID-19 test result was 0.97 (95% CI, 0.94-0.99; P = .008) per 1-ng/mL increase in vitamin D overall and 0.95 (95% CI, 0.91-0.98; P = .003) per 1-ng/mL increase in vitamin D in Black individuals. Conclusions and Relevance: In this single-center retrospective cohort study, COVID-19 risk increased among Black individuals with vitamin D level less than 40 ng/mL compared with those with 40 ng/mL or greater and decreased with increasing levels among individuals with levels greater than 30 ng/mL. No significant associations were noted for White individuals. Randomized clinical trials should examine whether increasing vitamin D level to greater than 40 ng/mL affects COVID-19 risk.


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19 , SARS-CoV-2/isolation & purification , Vitamin D Deficiency , Vitamin D/analogs & derivatives , /statistics & numerical data , COVID-19/blood , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Chicago/epidemiology , Cohort Studies , Comorbidity , Correlation of Data , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Assessment/ethnology , Vitamin D/analysis , Vitamin D Deficiency/blood , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/ethnology , /statistics & numerical data
20.
Int J Mol Sci ; 22(5)2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1129735

ABSTRACT

We observed substantial differences in predicted Major Histocompatibility Complex II (MHCII) epitope presentation of SARS-CoV-2 proteins for different populations but only minor differences in predicted MHCI epitope presentation. A comparison of this predicted epitope MHC-coverage revealed for the early phase of infection spread (till day 15 after reaching 128 observed infection cases) highly significant negative correlations with the case fatality rate. Specifically, this was observed in different populations for MHC class II presentation of the viral spike protein (p-value: 0.0733 for linear regression), the envelope protein (p-value: 0.023), and the membrane protein (p-value: 0.00053), indicating that the high case fatality rates of COVID-19 observed in some countries seem to be related with poor MHC class II presentation and hence weak adaptive immune response against these viral envelope proteins. Our results highlight the general importance of the SARS-CoV-2 structural proteins in immunological control in early infection spread looking at a global census in various countries and taking case fatality rate into account. Other factors such as health system and control measures become more important after the early spread. Our study should encourage further studies on MHCII alleles as potential risk factors in COVID-19 including assessment of local populations and specific allele distributions.


Subject(s)
COVID-19/mortality , Histocompatibility Antigens Class II/genetics , Histocompatibility Antigens Class II/immunology , SARS-CoV-2/chemistry , Viral Structural Proteins/chemistry , Adaptive Immunity , Alleles , COVID-19/immunology , COVID-19/transmission , Computational Biology/methods , Correlation of Data , Epitopes, B-Lymphocyte/genetics , Epitopes, B-Lymphocyte/immunology , Epitopes, T-Lymphocyte/genetics , Epitopes, T-Lymphocyte/immunology , HLA Antigens/genetics , Histocompatibility Antigens Class I/genetics , Histocompatibility Antigens Class I/immunology , Humans , Mortality , SARS-CoV-2/immunology , Viral Structural Proteins/immunology
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