Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 2.559
Filter
1.
Glob Heart ; 17(1): 40, 2022.
Article in English | MEDLINE | ID: covidwho-2217353

ABSTRACT

Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC). Methods: Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed. Results: Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2-4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2-3 times increased risk of death. Conclusions: The LIC, LMIC, and UMIC's have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus , Heart Failure , Aftercare , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Heart Disease Risk Factors , Hospitalization , Humans , Male , Middle Aged , Patient Discharge , Prospective Studies , Risk Factors
2.
Rev Inst Med Trop Sao Paulo ; 64: e74, 2022.
Article in English | MEDLINE | ID: covidwho-2214902

ABSTRACT

Given the magnitude of COVID-19 and the increase in hospitalization cases for severe acute respiratory syndrome (SARS), especially among patients with diabetes mellitus, it is essential to understand the epidemiological aspects inherent to the disease and the worsening of cases. Thus, this study aimed to analyze the survival of patients with diabetes mellitus hospitalized for SARS due to COVID-19 in different regions of Brazil. This is a longitudinal study, carried out based on data reported in the Influenza Epidemiological Surveillance Information System during the year 2020. The number of patients with diabetes mellitus among the hospitalized cases of SARS due to COVID-19 in the different regions of Brazil and the lethality rate among them were identified. A comparison of patient profiles of those who survived or did not survive and the Cox regression analysis were performed to evaluate the factors associated with shorter survival of patients. It was found that 51.4% of patients hospitalized with SARS due to COVID-19 had diabetes, and the case lethality rate among them was 45.0%. The Northeastern and Northern regions presented a higher proportion of patients with diabetes mellitus (56.5% and 54.3%, respectively) and a higher lethality rate (53.8% and 59.9%, respectively). The mean survival time of cases with diabetes mellitus hospitalized for SARS due to COVID-19 was estimated to be 35.7 days (0.5 days). A lower survival rate was observed among residents of the Northeastern and Northern regions with skin color reported as non-white, who required admission to Intensive Care Units and invasive mechanical ventilation, and presented respiratory symptoms such as dyspnea, respiratory distress and an oxygen saturation lower than 95%. It is concluded that diabetes mellitus was responsible for the high occurrence and lethality, mainly in the Northeastern and Northern regions, among non-white patients and those with greater clinical severity, which reinforces the importance of taking measures aimed at supporting this population.


Subject(s)
COVID-19 , Diabetes Mellitus , Humans , SARS-CoV-2 , Longitudinal Studies , Hospitalization , Diabetes Mellitus/epidemiology , Dyspnea
3.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.30.23285170

ABSTRACT

Objectives: We investigated factors associated with COVID-19 disease severity and in-hospital mortality in a low-middle income setting. Methods: Records of 197 adult COVID-19 patients admitted to the Aga Khan University Hospital, Karachi between April 2021 and February 2022 were reviewed. Clinical data including, that of SARS-CoV-2 variants was collected. Results: The median age of the patients was 55 years and 51.8% were males. 48.2 % of patients had non-severe disease, while 52.8% had severe/critical disease. Hypertension (48%) and diabetes mellitus (41.3%) were most common comorbid conditions. Omicron (55.3%), Beta (14.7%), Alpha (13.7%), Delta (12.7%) and Gamma (3.6%) were identified in patients. The risk of severe disease was higher in those aged above 50 years (OR 5.73; 95%CI [2.45-13.7]) and in diabetics (OR 4.24; 95% CI[1.82-9.85]). Full vaccination (OR 0.25; 95%CI [0.11-0.58]) or infection with Omicron variants (OR 0.42; 95% CI[0.23-0.74]) reduced disease severity. Age > 50 (OR 5.07; 95%CI [1.92-13.42]) and presence of myocardial infarction (OR 5.11; 95% CI[1.45-17.93]) was associated with increased mortality, but infection with Omicron (OR 0.22 95% CI 0.10-0.53]) reduced risk. Conclusions: Vaccination was found to protect against severe COVID-19 regardless of the infecting variant and is recommended especially, in those aged over 50 years and with co-morbid conditions.


Subject(s)
Myocardial Infarction , Diabetes Mellitus , COVID-19 , Critical Illness , Hypertension
4.
Curr Pharm Des ; 28(22): 1833-1842, 2022.
Article in English | MEDLINE | ID: covidwho-2197773

ABSTRACT

BACKGROUND: Genetically modified micro-organisms like bacteria, viruses, algae and fungi are novel approaches used in the field of healthcare due to better efficacy and targeted delivery in comparison to conventional approaches. OBJECTIVES: This review article focuses on the applications of genetically modified micro-organisms in the treatment of cancer, obesity and HIV infection. The gut microbiome causes metabolic disorders, however, the use of genetically modified bacteria alters the gut microbiota and delivers therapeutically effective drugs in the treatment of obesity. METHODS: Enhancement of the therapeutic activity of different micro-organisms is required for multiple treatments in cancer, diabetes, etc., by incorporating their fragments into the microbial filaments with the help of genetic modification approaches. Various methods like amelioration of NAPE synthesis, silica immobilization, polyadenylation and electrochemical are used to integrate the strain into the bacteria and engineer a live virus with a peptide. RESULTS: The development of novel microbial strains using genetic modifications over core strains offers higher precision, greater molecular multiplicity, better prevention from the degradation of microbes in atmospheric temperature and significant reduction of side effects for therapeutic applications. Moreover, genetically modified micro-organisms are used in multidisciplinary sectors like generation of electricity, purification of water, bioremediation process, etc., indicating the versatility and scope of genetically engineered microbes. CONCLUSION: The bioengineered micro-organisms with genetic modifications proved to be advantageous in various conditions like cancer, diabetes, malaria, organ regeneration, inflammatory bowel disease, etc. This article provides insight into various applications of genetically modified microbes in different sectors with their implementation for regulatory approval.


Subject(s)
Diabetes Mellitus , Gastrointestinal Microbiome , HIV Infections , Bacteria , Biotechnology , Humans , Obesity
5.
Rev Endocr Metab Disord ; 23(2): 205-213, 2022 04.
Article in English | MEDLINE | ID: covidwho-2174759

ABSTRACT

Diabetes mellitus and/or hyperglycemia are highly prevalent medical conditions in patients hospitalized for coronavirus disease 2019 (COVID-19) and are associated with adverse outcomes. In addition, COVID-19 itself can provoke fluctuating and high glucose levels that can be difficult to manage upon hospitalization. Hospitalized patients with COVID-19 are at high risk of malnutrition due to an increase in nutritional requirements and a severe acute inflammatory response. The management of patients with diabetes/hyperglycemia and COVID-19 is challenging and requires a specific nutritional approach, the purpose of which is to fulfill the nutritional requirements while maintaining an optimal glycemic control. In this study, an expert group of nutritional endocrinologists carried out a qualitative literature review and provided recommendations based on evidence and guidelines, when available, or on their own experience. The optimal care based on these recommendations was compared with the routine bedside care as reported by a panel of physicians (mainly, endocrinologists, geriatricians, and internists) treating patients with diabetes/hyperglycemia and COVID-19 in their daily practice. Early screening and diagnosis, a diabetes-specific therapeutic approach, and a close malnutrition monitoring are essential to improve the clinical outcomes of these patients. In conclusion, the proposed recommendations are intended to provide a useful guide on the clinical management of malnutrition in patients with COVID-19 and diabetes/hyperglycemia, in order to improve their outcomes and accelerate their recovery. The comparison of the recommended optimal care with routine clinical practice could aid to identify gaps in knowledge, implementation difficulties, and areas for improvement in the management of malnutrition in this population.


Subject(s)
COVID-19 , Diabetes Mellitus , Hyperglycemia , Malnutrition , COVID-19/complications , COVID-19/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Humans , Hyperglycemia/complications , Hyperglycemia/therapy , Malnutrition/therapy , SARS-CoV-2
6.
Arq. ciências saúde UNIPAR ; 26(3): 350-366, set-dez. 2022.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-2205388

ABSTRACT

Introdução: No final do ano de 2019 surgiu na China uma doença infectocontagiosa de característica respiratória e alto grau de disseminação até então desconhecida. No Brasil o primeiro caso de Covid-19 foi confirmado no final de fevereiro de 2020 e a primeira morte em meados de março. Segundo dados da plataforma Coronavírus Brasil, em 17 de março de 2021, houve registro de 11.603.535 casos confirmados e 282.127 óbitos. Objetivo: Descrever o perfil de pessoas que morreram tendo como causa básica do óbito a Covid-19, em um município do Sudoeste do Paraná, entre os anos de 2020 e 2021. Metodologia: Trata-se de um estudo transversal, descritivo, documental de caráter quantitativo que foi realizado na prefeitura municipal de Francisco Beltrão. Resultados: Houve prevalência de óbitos em pacientes do sexo masculino, idosos, com presença de alguma comorbidade associada, sendo hipertensão a mais citada (50,8%). Os sintomas mais prevalentes foram tosse (74,4%), dispneia (56,3%) e saturação < 95% (48,3%), necessitando ainda de hospitalização em algum período da doença (94,1%), sendo os leitos de Sistema Único de Saúde os mais procurados (74,4%). Quanto à taxa de ocupação 49,6% dos casos necessitou apenas de leitos de enfermaria e 42% unidades de terapia intensiva. Discussão: Diversas pesquisas apontam que o sexo masculino é o mais acometido por condições graves de saúde, devido à demora na busca de assistência médica. No que se refere à idade, neste estudo, a prevalência de óbitos se deu entre 71 e 75 anos (15,1%) o que justifica que o envelhecimento é um fator de risco elevado para complicações da doença. Durante a análise dos dados, notou- se que grande parte dos pacientes que tiveram como desfecho o óbito, possuíam algum fator associado, dentre os mais citados, verificou-se a Hipertensão Arterial Sistêmica (50,8%) Diabetes Mellitus (24,8%), doenças cardiovasculares (23,9%) e obesidade (14,7%). No que diz respeito à hospitalização, nesse estudo notou-se que 74,4% da amostra foram hospitalizadas em leitos de SUS, 18,5% em hospitais particulares e 7,1% não possuíam essa informação. Conclusão: É possível observar a importância do estudo epidemiológico para identificar o perfil da população em risco, podendo auxiliar no planejamento do atendimento, rastreamento e controle da doença, além de conhecer a evolução da patologia, a fim de buscar ações adequadas para seu enfrentamento.


Introduction: At the end of 2019, a previously unknown infectious disease with respiratory characteristics and a high degree of dissemination emerged in China. In Brazil the first case of Covid-19 was confirmed in late February 2020 and the first death in mid-March. According to data from the Coronavirus Brazil platform, as of March 17, 2021, 11,603,535 confirmed cases and 282,127 deaths were recorded. Objective: To describe the profile of people who died with Covid-19 as the underlying cause of death in a city in southwestern Paraná between the years 2020 and 2021. Methodology: This is a cross-sectional, descriptive, documental, quantitative study carried out at the Francisco Beltrão City Hall. Results: There was a prevalence of deaths in male patients, elderly, with the presence of some associated comorbidity, hypertension being the most cited (50.8%). The most prevalent symptoms were cough (74.4%), dyspnea (56.3%) and saturation < 95% (48.3%), requiring hospitalization in some period of the disease (94.1%), and the Unified Health System beds were the most sought (74.4%). As for the occupancy rate, 49.6% of the cases required only ward beds and 42% intensive care units. Discussion: Several studies show that men are the most affected by serious health conditions, due to the delay in seeking medical assistance. Regarding age, in this study, the prevalence of deaths was between 71 and 75 years (15.1%), which justifies that aging is a high risk factor for disease complications. During data analysis, it was noted that most patients who died had some associated factor, among the most cited were systemic arterial hypertension (50.8%), diabetes mellitus (24.8%), cardiovascular diseases (23.9%) and obesity (14.7%). Regarding hospitalization, in this study it was noted that 74.4% of the sample were hospitalized in SUS beds, 18.5% in private hospitals, and 7.1% did not have this information. Conclusion: It is possible to observe the importance of the epidemiological study to identify the profile of the population at risk, which can help in planning care, tracking and control of the disease, besides knowing the evolution of the pathology in order to seek appropriate actions for its confrontation


Introducción: A finales del año 2019 apareció en China una enfermedad infecto- contagiosa de característica respiratoria y alto grado de diseminación desconocida hasta entonces. En Brasil se confirmó el primer caso de Covid-19 a finales de febrero de 2020 y la primera muerte a mediados de marzo. Según los datos de la plataforma Coronavirus Brasil, hasta el 17 de marzo de 2021, había 11.603.535 casos confirmados y 282.127 muertes. Objetivo: Describir el perfil de las personas fallecidas con Covid-19 como causa subyacente de muerte en una ciudad del sudoeste de Paraná entre los años 2020 y 2021. Metodología: Se trata de un estudio transversal, descriptivo, documental de carácter cuantitativo que se realizó en la prefectura municipal de Francisco Beltrão. Resultados: Hubo una prevalencia de muertes en pacientes masculinos, de edad avanzada, con presencia de alguna comorbilidad asociada, siendo la hipertensión la más citada (50,8%). Los síntomas más prevalentes fueron la tos (74,4%), la disnea (56,3%) y la saturación < 95% (48,3%), requiriendo hospitalización en algún periodo de la enfermedad (94,1%), siendo las camas del Sistema Único de Salud las más solicitadas (74,4%). En cuanto a la tasa de ocupación, el 49,6% de los casos sólo necesitaban camas de sala y el 42% unidades de cuidados intensivos. Discusión: Varias investigaciones señalan que el género masculino es el más afectado por las condiciones de salud graves, debido al retraso en la búsqueda de asistencia médica. En cuanto a la edad, en este estudio, la prevalencia de muertes se produjo entre los 71 y los 75 años (15,1%), lo que justifica que el envejecimiento sea un factor de riesgo elevado para las complicaciones de la enfermedad. Durante el análisis de los datos, se observó que la mayoría de los pacientes que fallecieron tenían algún factor asociado, entre los más citados estaban la Hipertensión Arterial Sistémica (50,8%), la Diabetes Mellitus (24,8%), las enfermedades cardiovasculares (23,9%) y la obesidad (14,7%). En lo que respecta a la hospitalización, en este estudio se observó que el 74,4% de la muestra estaba hospitalizada en camas del SUS, el 18,5% en hospitales privados y el 7,1% no tenía esta información. Conclusión: Es posible observar la importancia del estudio epidemiológico para identificar el perfil de la población en riesgo, pudiendo ayudar en la planificación de la atención, el rastreo y el control de la enfermedad, además de conocer la evolución de la patología, con el fin de buscar las acciones adecuadas para su enfrentamiento.


Subject(s)
Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Health Profile , Epidemiologic Studies , Epidemiology/statistics & numerical data , Coronavirus Infections/mortality , Coronavirus Infections/rehabilitation , Coronavirus Infections/transmission , Coronavirus Infections/epidemiology , Death , Unified Health System , Aged , Aging/pathology , Cardiovascular Diseases , Global Health/statistics & numerical data , Prevalence , Cough , Diabetes Mellitus , Dyspnea , Oxygen Saturation , Hospitalization , Hypertension , Intensive Care Units/statistics & numerical data , Obesity
7.
authorea preprints; 2023.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.167516102.26003022.v1

ABSTRACT

ABSTRACT Introduction: Influenza is an acute viral infection with significant morbidity and mortality. Its occur annually each winter is called seasonal influenza and is preventable through safe vaccine. Aim: To know the epidemiological pattern of patients with seasonal influenza in Iraqi sentinel sites. Methods: A cross- sectional study carried out on records of patients who attended four sentinel sites and registered to have influenza-like illness (ILI) or severe acute respiratory infection (SARI), and laboratory investigated. Results: The total number of cases was 1124, 36.2% of them aged 19-39 years; 53.9% were female; 74.9% lived in urban areas; 64.3% diagnosed as ILI and 35.7% as SARI. 15.9% had diabetes, 12.7% had heart disease, 4.8% had asthma, 3% had a chronic lung disease, and 2% had hematological disease. 94.6% did not get influenza vaccine. About COVID-19 vaccine, 69.4% did not vaccinated, 3.5% get only 1 dose, and 27.1% completed 2 doses. Only the SARI cases needed admission, among them 95.7% were cured. 6.5% were diagnosed as influenza- A virus, 26.1% had COVID-19, and 67.5% were negative. Among those with influenza, 97.3% had H3N2 subtype, and 2.7% had H1N1 pdm09. Conclusions: The percentage of influenza virus in Iraq is relatively small. The age, classification of case (ILI or SARI), having diabetes, heart disease, or immunological disease, and taking COVID-19 vaccine have a significant association with influenza. Recommendations: It’s needed for similar sentinel sites in other health directorates and for rising health education about seasonal influenza and its vaccine.


Subject(s)
Respiratory Tract Infections , Hematologic Diseases , Diabetes Mellitus , Severe Acute Respiratory Syndrome , Heart Diseases , Asthma , COVID-19 , Lung Diseases , Immune System Diseases , Virus Diseases
8.
biorxiv; 2023.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2023.01.30.526275

ABSTRACT

Covid-19 can lead to the onset of type-II diabetes which is associated with aggregation of islet amyloid polypeptides, also called amylin. Using molecular dynamics simulations, we investigate how the equilibrium, between amylin monomers in its functional form and fibrils associated with diabetes, is altered in presence of SARS-COV-2 protein fragments. For this purpose, we study the interaction between the fragment SFYVYSRVK of the Envelope protein or the fragment FKNIDGYFKI of the Spike protein with the monomer and two amylin fibril models. Our results are compared with earlier work studying such interactions for two different proteins.


Subject(s)
Diabetes Mellitus , Diabetes Mellitus, Type 2 , COVID-19
9.
authorea preprints; 2023.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.167505846.69987964.v1

ABSTRACT

Purpose: — To evaluate hypoglycemia incidence rate during treatment with a fixed-dose combination of glimepiride and metformin in patients non-responders to metformin monotherapy. Data were collected during customary specialized practice in Peru where access to effective and safe, but low-cost medications, is needed. Methods— This was an observational, prospective, active pharmacovigilance, cohort study with in-person medical assessments. Medical assessments were conducted every 3-months, with monthly follow-up through phone calls. Data regarding use and administration of treatment were recorded by patients. Adverse events (AE) reported by patients and/or ascertained by attending physicians during the period of 18 months along with treatment-related events were identified. Cumulative incidence and hypoglycemia incidence rate were estimated. Poisson and logistic regression models were applied to study their relationship with risk factors and patterns of use. Results— 206 patients were enrolled in the study from 10 centers and were followed for a median duration of 12 months (range, 2-18 months). Forty treatment-related AEs were reported (cumulative incidence = 19.4%). No severe hypoglycemic events were observed. Most common AE found was non-severe hypoglycemia (cumulative incidence = 2.4%; incidence rate = 2.6/100 person/years). Self-administration of a higher dose than prescribed was associated with a higher probability of an AE (p=0.03). Conclusions— Administration of a fixed-dose combination of glimepiride plus metformin was associated with low incidence of non-severe hypoglycemia, and no incidence of severe hypoglycemia. These results advocate the use of fixed-dose combination of glimepiride plus metformin in low- and middle-income countries with limited resources, even more so in wake of COVID-19 pandemic.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypoglycemia
10.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.24.23284975

ABSTRACT

There is a demand for more comprehensive studies related to diabetes management in Indian settings covering; incidence, multimorbidity and complications in diabetes patients, clinical progression, medication, and treatment-seeking patterns. CHIPS study aims to bridge this research gap through a systematic analysis of the medical records maintained under an employees contributory health services scheme (CHSS). The CHSS based in an urban metropolitan area has 89,204 beneficiaries. The hospital information management system (HIMS) has records of lab reports, clinical summaries, prescriptions, and drugs and other medical consumables, supplied for every interaction with CHSS. Firstly, a cohort of 835 patients newly diagnosed as diabetic in the year 2011-2012 was identified from the HIMS. Their 10-year (2011-2021) medical history after getting diagnosed as a diabetic patient was elicited from the HIMS in a retrospective manner. For comparison needs another cohort of 1670 age-sex matched non-diabetic beneficiaries was created and similar 10-year medical history was created. A total of 144,511 lab records and 247,473 drug records from the HIMS for the period 2010-2012 were scrutinized to identify newly diabetic patients and their non-diabetic counterparts. The reconstructed 10-year medical history of these two groups will be used to investigate the burden of diabetes in the community, transitions from a non-diabetic and pre-diabetic to a diabetic, excess morbidity in diabetic patients, seasonal variation in glycaemic levels, association between glycaemic control and frequency of health care utilization, and COVID-19-induced temporal changes in glycaemic control.


Subject(s)
Cross Infection , COVID-19 , Diabetes Mellitus
11.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2516078.v1

ABSTRACT

Introduction: In patients suffering from COVID-19, immunocompromised conditions or immunosuppressive medications such as corticosteroids may predispose them to early or delayed invasive fungal infections that invade cerebral components. This study, for the first time, describes a case of COVID-19 disease diagnosed with rhinocerebral mucormycosis through cerebrospinal fluid (CSF) analysis.Case presentation: A 32-year-old woman with a history of referral and hospitalization due to COVID-19 about a month ago was being treated with immunosuppressive drugs, manifested by lower extremity plegia. In the imaging assessment, intracranial hemorrhage (thalamus zone) and mass like lesion were revealed. In cytological assessment, acute inflammations associated with fungal infection in accordance with the diagnosis of mucormycosis were definitively confirmed. Despite antifungal medication, consciousness declined one week later, and the patient developed thromboembolism and died.Conclusion In patients with a COVID-19 background of immunosuppressive therapy or clinical situations related to immunosuppression such as uncontrolled diabetes, rhinocerebral mucormycosis will always be an ambush. Therefore, screening and prevention measures should be considered.


Subject(s)
Paralysis , Diabetes Mellitus , Thromboembolism , Mycoses , COVID-19 , Mucormycosis , Inflammation , Intracranial Hemorrhages
12.
preprints.org; 2023.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202301.0433.v1

ABSTRACT

During the COVID-19 pandemic, the high prevalence of comorbidities in Mexico, as well as the disparities between public and private health subsystems, substantially contributed to the severe impact it had in the country. The objective of this study was to evaluate and compare risk factors present at admission for mortality of hospitalized patients with COVID-19. A 2-year retrospective cohort study of hospitalized adult patients with COVID-19 was conducted at a private tertiary care center. The study population consisted of 1,258 patients with a median age of 56 ± 16.5 years, of whom 1,093 recovered (86.8%) and 165 died (13.1%). In the univariate analysis, older age (p <0.001), comorbidities such as hypertension (p <0.001) and diabetes (p <0.001), signs and symptoms of respiratory distress, and markers of acute inflammatory response were significantly more frequent in non-survivors. The multivariate analysis showed that older age (p <0.001), the presence of cyanosis (p 0.005) and previous myocardial infarction (p 0.032) were independent predictors for mortality. In the studied cohort, risk factors present at admission associated with an increased risk of death were older age, cyanosis and a previous myocardial infarction, which can be used as valuable predictors for patients’ outcomes. To our knowledge, this is the first study analyzing predictors of mortality in COVID-19 patients attended on a private tertiary hospital in Mexico.


Subject(s)
Myocardial Infarction , Diabetes Mellitus , Cyanosis , Death , COVID-19 , Hypertension
13.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.20.23284812

ABSTRACT

People with weak immune systems are more likely to develop severe COVID-19, less likely to be included in vaccine controlled studies but more likely to be under-vaccinated. We review post-marketing studies to examine the immunogenicity, safety and effectiveness of BNT162b2 vaccine in immunocompromised adolescents and young adults (AYA). We searched more than three international databases from 2020 to 30 May 2022 and used the ROBINS-I for bias assessment. Random effect model was used to estimate pooled proportion, log RR, and mean difference. Egger's regression and Begg's rank correlation were used to examine publication bias. 47 full texts were reviewed, and nine were included. Conditions studied were rheumatic diseases, diabetes mellitus, Down syndrome, solid tumours, neurodisability, and cystic fibrosis. Eight studies used cohort designs and one used cross-sectional designs. Europe led most of the investigations. Most studies had unclear risk of bias and none could rule out selection bias, ascertainment bias, or selective outcome reporting. The overall estimated proportion of combined local and systemic reactions after the first BNT162b2 vaccination was 30%[95% CI: 17-42%] and slightly rose to 32% [95% CI: 19-44%] after the second dose. Rheumatic illnesses had the highest rate of AEFI (40%[95% CI: 16-65%]), while cystic fibrosis had the lowest (27%[95% CI: 17%-38%]). Hospitalizations for AEFIs were rare. Healthy controls exhibited higher levels of neutralizing antibodies and measured IgG than immunocompromised AYA, although pooled estimations did not demonstrate a statistically significant difference after primary dose. BNT162b2 is safe and effective in immunocompromised AYA, with no significant difference to healthy controls. However, current evidence is low to moderate due to high RoB. Our research advocates for improving methodology in studies including specific AYA population.


Subject(s)
Rheumatic Diseases , Diabetes Mellitus , Fibrosis , COVID-19 , Cystic Fibrosis , Neoplasms
14.
preprints.org; 2023.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202301.0341.v1

ABSTRACT

Predicting Length of Stay (LoS) and understanding its underlying factors is essential to minimize the risk of hospital-acquired conditions, improve financial, operational, and clinical outcomes, and to better manage future pandemics. The purpose of this study is to forecast patients’ LoS using a deep learning model and analyze cohorts of risk factors minimizing or maximizing LoS. We employed various pre-processing techniques, SMOTE-N to balance data, and Tab-Transformer model to forecast LoS. Finally, Apriori algorithm was applied to analyze cohorts of risk factors influencing LoS at hospital. The Tab-Transformer outperformed the base Machine Learning models with an F1-score (.92), precision (.83), recall (.93), and accuracy (.73) for discharge dataset, and F1-score (.84), precision (.75), recall (.98), and accuracy (.77) for deceased dataset. The association mining algorithm was able to identify significant risk factors/indicators belonging to lab, X-Ray, and clinical data such as elevated LDH, and D-Dimer, lymphocytes count, and comorbidities such as hypertension and diabetes responsible for extending patients LoS. It also reveals what treatments has reduced the symptoms of COVID-19 patients leading to reduction in LoS particularly when no vaccines or medication such as Paxlovid were available.


Subject(s)
Diabetes Mellitus , COVID-19 , Hypertension
15.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2495890.v1

ABSTRACT

The outbreak of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) through the latest waves of the pandemic in several countries gathered attention to this rare fungal infection. This prospective observational study aims to evaluate the demographic and medical profile, clinical signs and symptoms (with a special focus on ophthalmic findings), imaging features, and the outcome of CA-ROCM patients. The collaborative study of COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis in Iran (CA-ROCM-IR) has been conducted in 8 tertiary referral ophthalmology centers among different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination, and underwent standard accepted treatment strategy based on the disease stage. The present report is the preliminary results of this project study. Two hundred seventy-four CA-ROCM patients, including 150 males (54.7%), who had a mean age of 56.8 ± 12.44 years, were enrolled. Diabetes mellitus was the most prevalent (82.8%) medical disease among the patients. Supplemental oxygen administration and corticosteroid use due to COVID-19 were present in a large proportion of the patients (68.2%, and 73.7% respectively). The most common primary complaints were facial pain (47.4%), facial swelling (38.3%), and nasal discharge (32.5%). Ptosis (58%), periorbital swelling (46%), and nasal congestion (40.5%) were common signs and symptoms among CA-ROCM patients. A majority of the patients (80.3%) were diagnosed at stage 3 or higher of ROCM and the rate of ocular involvement in whom was 92.3%. The most affected paranasal sinus was the ethmoid sinus (75.2%), followed by the maxillary sinus (70.8%). A total of 30 patients (10.9%) had expired before discharge from hospitals. Patients with a history of cigarette smoking (OR = 7.25), ICU admission (OR = 87.36), higher stage of the ROCM (OR = 4.22), receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (TRAMB) (OR = 4.20), and bilateral ocular involvement (OR = 2.94) had upper odds for death before discharge from hospital. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (OR = 0.058, P = 0.006). Also, GEE analysis showed statistically significant higher mean LogMAR visual acuity score among expired patients (3.71, 95% CI: 3.04–4.38) compared to patients who were discharged from hospitals (2.42, 95% CI: 2.16–2.68) (P < 0.001).


Subject(s)
Headache , Diabetes Mellitus , Mycoses , COVID-19 , Edema , Mucormycosis , Facial Pain
16.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.17.23284684

ABSTRACT

Background: COVID-19 would kill fewer people if health programs can predict who is at higher risk of mortality because resources can be targeted to protect those people from infection. We predict mortality in a very large population in Mexico with machine learning using demographic variables and pre-existing conditions. Methods: We conducted a population-based cohort study with over 1.4 million laboratory-confirmed COVID-19 patients using the Mexican social security database. Analysis is performed on data from March 2020 to November 2021 and over three phases: (1) from March to October in 2020, (2) from November 2020 to March 2021, and (3) from April to November 2021. We predict mortality using an ensemble machine learning method, super learner, and independently estimate the adjusted mortality relative risk of each pre-existing condition using targeted maximum likelihood estimation. Results: Super learner fit has a high predictive performance (C-statistic: 0.907), where age is the most predictive factor for mortality. After adjusting for demographic factors, renal disease, hypertension, diabetes, and obesity are the most impactful pre-existing conditions. Phase analysis shows that the adjusted mortality risk decreased over time while relative risk increased for each pre-existing condition. Conclusions: While age is the most important predictor of mortality, younger individuals with hypertension, diabetes and obesity are at comparable mortality risk as individuals who are 20 years older without any of the three conditions. Our model can be continuously updated to identify individuals who should most be protected against infection as the pandemic evolves.


Subject(s)
Diabetes Mellitus , COVID-19 , Kidney Diseases , Obesity , Hypertension
17.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.18.23284602

ABSTRACT

Background: The impact of COVID-19 goes beyond the acute phase of infection. It is imperative to evaluate health related quality of life (HRQoL) pre-COVID-19 , but there is currently no evidence of the retrospective application of the EQ-5D-5L for COVID-19 studies. Methods: Subjects with at least 1 self-reported symptom and positive RT-PCR for SARS-CoV-2 at CVS Health US test sites were recruited between 01/31/2022-04/30/2022. On the day of enrollment which was around day 3 after testing positive, consented participants completed the EuroQol 5D-5L (EQ-5D-5L) questionnaire twice: a modified version where all the questions were past tense to retrospectively assess pre-COVID-19 baseline QoL, and the standard version in present tense to assess current HRQoL. Duncan's new multiple range test was adopted for post analysis of variance pairwise comparisons of EQ-VAS means between problem levels for each of 5 domains. A linear mixed model was applied to check whether the relationship between EQ visual analog scale (VAS) and utility index (UI) was consistent pre-COVID-19 and during COVID-19. Matching-adjusted indirect comparison was used to compare pre-COVID-19 UI and VAS scores with those of the US population. Cohen's d was used to quantify the magnitude of difference in means between two groups. Results: Of 676 participants, 10.2% were age 65 or more years old, 73.2% female and 71.9% white. Diabetes was reported by 4.7% participants and hypertension by 11.2%. The pre-COVID-19 baseline mean UI was 0.924 and the mean VAS was 87.4. The estimated coefficient for the interaction of UI-by-retrospective collection indicator (0=standard prospective collection for Day 3 after COVID-19 testing, 1=retrospective for pre-COVID-19), -4.2 (SE: 3.2), P=0.197, indicates that retrospective collection does not significantly alter the relationship between EQ-VAS and UI. After adjusting for age, gender, diabetes, hypertension, and percent of mobility problems, predicted means of pre-COVID-19 baseline VAS and UI were 84.6 and 0.866, respectively. Both of these means were close to published US population norms (80.4 and 0.851) than those observed (87.4 and 0.924). After adjusting for age, gender, diabetes, and hypertension, 19.0% patients with COVID-19 had mobility problems, which was significantly lower than US population norm 25.2%, P<0.001. The calculated ES for UI and VAS were 0.15 and 0.39, respectively. Conclusion: At a group level the retrospectively collected pre-COVID-19 EQ-5D-5L is adequate and makes it possible to directly evaluate the impact of COVID-19 on HRQoL. Future studies are encouraged that are tailored to directly compare standard prospective assessment with retrospective assessment on the EQ-5D-5L during pre-COVID-19.


Subject(s)
Hypertension , COVID-19 , Diabetes Mellitus
18.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2488233.v1

ABSTRACT

Cognizance of the implication of Covid-19 pandemic on health and well-being resulted in an upsurge is use of several dietary and herbal supplements (DHS) for the prevention and/or prophylaxis against the new disease.  Objectives: To evaluate the pattern of DHS consumption among Nigerians with Non-communicable Diseases (NCD) for the prevention and treatment of COVID-19.  Design: Cross-sectional questionnaire survey. Setting: Adolescents, and adults residing in Nigeria.  Participants:Participants with NCD (n = 165) from a larger study (n=645) were recruited from different geo-political zones and various ethnic groups.  Primary and Secondary Outcomes: Prevalence and determinants for the use of different DHS for the prevention and treatment of COVID-19 in Nigeria, and sources of information for DHS use.  Results: Hypertension was the most prevalent NCD (63.6%) in the study and both breast cancer and anxiety disorder were the least (0.6%). A minimum (75.2%) of the respondents had less than 8 hours of sleep daily and almost all did not smoke cigarette at all. The proportion of male and female hypertensives who believed that dietary supplements are necessary during infectious disease outbreak such as Covid-19 was moderately high (55.2%), higher among asthmatics (65.0%), diabetes (58/105, 68.4%), those with kidney disease (100.0%), ulcer (83.3%) and liver disease. Almost all the respondents with hypertension (101/105, 96.2%), asthma (19/20, 95.0%), diabetes (19/19, 100.0%) and kidney disease (6/6, 100.0%), consumed supplements more during Covid-19 pandemic in Nigeria. The proportion of those who consumed supplements more during the pandemic in Nigeria was higher among male hypertensives (57/101, 56.4%) than among the female (44/101, 43.6%), though the difference was not significant (χ²=2.93, P-value=0.09). Vitamin C was the commonest vitamin taken by respondents with ulcer (83.3%), kidney disease (83.3%), diabetes (57.9%), asthma (50.0%), hypertension (48.6%) and the two respondents with breast cancer (1, 100.0%) and anxiety disorder (1, 100.0%) respectively. Calcium and zinc were the commonest minerals taken by respondents with ulcer (50.0%, 16.7%), diabetes (10.5%, 5.3%), asthma (30.0%, 10.0%) and hypertension (13.3%, 11.4%) respectively. High proportions (83.3%, 80.0%) of those with kidney disease and with asthma consumed DHS to maintain good health. Health workers were the dominant source of information for most on the use of supplements during Covid-19 pandemic in Nigeria.  Conclusions: The findings showed widespread use of DHS for the prevention and treatment of COVID-19 among persons with NCD. The use of DHS in this study was mainly guided by health workers with a marginal role of social media and Mass media. These findings call for a more robust consolidative tactic towards DHS to ensure its proper and safe use.


Subject(s)
Diabetes Mellitus , Liver Diseases , Asthma , Communicable Diseases , Anxiety Disorders , Ulcer , COVID-19 , Breast Neoplasms , Kidney Diseases , Hypertension
19.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.13.23284524

ABSTRACT

COVID-19 syndrome does not occur in all who are infected with SARS-CoV-2, and symptoms vary. The anti-SARS CoV-2 Spike immune responses is confounded by the Spike proteins ability to bind Ig{gamma}3 heavy chains. This appears to be via sialic acid glycans found on the O-Linked glycosylation moieties of this heavy chain extended neck domain. Furthermore glycosylation of light chains, particularly Kappa ({kappa}), is an associated feature of antibodies binding to SARS-CoV-2 antigens nucleocapsid and Spike protein. COVID-19 recovered patients had increased IgG1 and IgM levels and un-glycosylated {kappa} {lambda} light chains; possibly In order to counter this immune system subjugation of IgG3. These molecular finding, together with our previous finding that Spike protein binds glycated human serum albumin (HSA), may explain the micro-vascular inflammatory clots that are a causative feature of COVID-19 acute respiratory syndrome (ARDS). The postulated molecular sequelae are that SARS-CoV-2 virion, entering the blood circulation, being coated with IgG3 and glycated HSA forms a colloid and deposits into micro-focal clots which are also inflammatory. It is not that all IgG3 and albumin is being bound by the virus; this depends on the affinity the SARS-CoV2 virion has for binding an individual IgG3 and albumin due to glycosylation and glycation status. The degree of glycosylation and terminal sialyation of an individuals antibodies is both a genetic and age-maturity dependant feature of the immune system. The degree of HSA glycation is also age related feature particularly related to type 2 diabetes. Thereby establishing the molecular basis of the association of severe COVID-19 disease syndrome and deaths with diabetes, metabolic disorders, and old age. Furthermore, already having cardiovascular disease, with hardened arteries, SARS-CoV2-glycated HSA-IgG3 deposition is going to exacerbate an already compromised circulatory physiology. The binding of IgG3 might also drives a shift in the immune repertoire response to SAR-CoV-2 anti-spike antibodies of increased IgG1 and prolonged IgM levels. This may be associated with Long Covid. In summary, SARS-CoV-2 Spike protein binding of IgG3, via sialic acid glycan residues, along with increased glycosylated {kappa}-light chains and glycated-HSA may form a focal amyloid-like precipitate within blood vessels which in turn leads to the inflammatory micro-thrombosis characteristic of COVID-19 immuno-pathology.


Subject(s)
Diabetes Mellitus , Metabolic Diseases , Cardiovascular Diseases , Death , Severe Acute Respiratory Syndrome , Thrombosis , COVID-19 , Congenital Disorders of Glycosylation
20.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.13.23284305

ABSTRACT

BackgroundThe global estimated prevalence of long COVID-19 is 43%, and the most common symptoms found globally are fatigue, confusion, or lack of confusion, and dyspnea, with prevalence rates of 23%, 14%, and 13%, respectively. However, long COVID still lacks an overall review in African populations. The aim of this review was to determine the prevalence of long COVID, its most common symptoms, comorbidities, and pathophysiological mechanisms. MethodsA systematic review of long COVID in African populations was conducted. The random effects model was used to calculate the pooled prevalence rates (95% CI). If the results could not be pooled, a narrative synthesis was performed. ResultsWe included 14 studies from 7 African countries, totaling 6,030 previously SARS-CoV-2 infected participants and 2,954 long COVID patients. Long COVID had a pooled prevalence of 41% [26%-56%]. Fatigue, dyspnea, and confusion or lack of concentration were the most common symptoms, with prevalence rates (95% CI) of 41% [26%-56%], 25% [12%-38%], and 40% [12%-68%], respectively. Long COVID was associated with advanced age, being female, more than three long COVID symptoms in the acute phase, initial fatigue and dyspnea, post-recovery stress, sadness, and sleep disturbances, and loss of appetite at symptoms onset, mild, moderate, and severe, pre-existing obesity, hypertension, diabetes mellitus, and the presence of any chronic illness (P [≤]0.05). According to our review, high micro clot and platelet poor plasma (PPP) viscosity explain the pathophysiology of long COVID. ConclusionLong COVID prevalence in Africa was comparable to the global prevalence. However, the prevalence of the most common symptoms was higher in Africa. Comorbidities associated with long COVID may lead to additional complications in African populations due to hypercoagulation and thrombosis.


Subject(s)
Diabetes Mellitus , Severe Acute Respiratory Syndrome , Confusion , Sleep Wake Disorders , COVID-19 , Thrombophilia , Obesity , Dyspnea , Hypertension , Fatigue
SELECTION OF CITATIONS
SEARCH DETAIL