Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 77
Filter
Add filters

Document Type
Year range
1.
Pan Afr Med J ; 39: 275, 2021.
Article in English | MEDLINE | ID: covidwho-1485483

ABSTRACT

Fungal osteomyelitis is a life-threatening and seldom seen opportunistic infection. It is commonly an affectation of the nose and paranasal sinuses within the orofacial region. It is an aggressive infection that needs to be addressed promptly to prevent fatal consequences. The mode of infection is via the inhalation route and infection begins initially in the nose and paranasal sinuses with subsequent invasion into the vascular tissue, eventually leading to thrombosis and necrosis of nearby hard and soft tissues. Here, we report a case of a 31-year-old male who presented with pain over the upper jaw that was sudden in onset, continuous, dull aching, radiating towards forehead and neck of the left side, aggravates on mastication and relives on its own. He had a history of uncontrolled diabetes mellitus. On further investigation, using diagnostic and Interventional aids, a final diagnosis of mucormycotic osteomyelitis of the maxilla was made.


Subject(s)
COVID-19/complications , Maxillary Diseases/diagnosis , Mucormycosis/diagnosis , Osteomyelitis/diagnosis , Adult , Diabetes Mellitus/physiopathology , Humans , Male , Maxillary Diseases/microbiology , Maxillary Diseases/pathology , Mucormycosis/pathology , Opportunistic Infections/diagnosis , Opportunistic Infections/microbiology , Opportunistic Infections/pathology , Osteomyelitis/microbiology , Osteomyelitis/pathology
2.
Clin Microbiol Infect ; 26(10): 1380-1385, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1439953

ABSTRACT

OBJECTIVES: The aim was to determine the clinical characteristics of COVID-19 patients because the SARS-CoV-2 virus continues to circulate in the population. METHODS: This is a retrospective, multicentre, cohort study. Adult COVID-19 cases from four hospitals in Zhejiang were enrolled and clustered into three groups based on epidemiological history. First-generation patients had a travel history to Hubei within 14 days before disease onset; second-generation patients had a contact history with first-generation patients; third-generation patients had a contact history with second-generation patients. Demographic, clinical characteristics, clinical outcomes and duration of viral shedding were analysed. RESULTS: A total of 171 patients were enrolled, with 83, 44 and 44 patients in the first-, second-, and third-generation, respectively. Compared with the first and second generations, third-generation patients were older (61.3 vs. 48.3 and 44.0 years, p < 0.001) and had more coexisting conditions (56.8% vs. 36.1% and 27.3%, p 0.013). At 7 ± 1 days from illness onset, third-generation patients had lower lymphocyte (0.6 vs. 0.8 and 0.8 × 109/L, p 0.007), higher C-reactive protein (29.7 vs. 17.1 and 13.8 mg/L, p 0.018) and D-dimer (1066 vs. 412.5 and 549 µg/L, p 0.002) and more lesions involving the pulmonary lobes (lobes ≥5, 81.8% vs. 53.0% and 34.1%, p < 0.001). The proportions of third-generation patients developing severe illness (72.7% vs. 32.5% and 27.3%, p < 0.001), critical illness (38.6% vs. 10.8% and 6.8%, p < 0.001) and receiving endotracheal intubation (20.5% vs. 3.6% and 2.3%, p 0.002) were higher than in the other two groups. DISCUSSION: Third-generation patients were older, had more underlying comorbidities and had a higher proportion of severe or critical illness than first- and second-generation patients.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Adult , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19 , China/epidemiology , Comorbidity , Contact Tracing , Coronavirus Infections/blood , Coronavirus Infections/physiopathology , Coronavirus Infections/transmission , Diabetes Mellitus/blood , Diabetes Mellitus/physiopathology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Hypertension/blood , Hypertension/physiopathology , Interleukin-6/blood , Intubation, Intratracheal , Lymphocytes/pathology , Lymphocytes/virology , Male , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/physiopathology , Pneumonia, Viral/transmission , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/physiopathology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Travel/statistics & numerical data , Virus Shedding
3.
Pharmazie ; 75(8): 375-380, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-1435671

ABSTRACT

Diabetes mellitus (DM) is one of the major risk factors for COVID-19 complications as it is one of the chronic immune-compromising conditions especially if patients have uncontrolled diabetes, poor HbA1c and/or irregular blood glucose levels. Diabetic patients' mortality rates with COVID-19 are higher than those of cardiovascular or cancer patients. Recently, Bacillus Calmette-Guérin (BCG) vaccine has shown successful results in reversing diabetes in both rats and clinical trials based on different mechanisms from aerobic glycolysis to beta cells regeneration. BCG is a multi-face vaccine that has been used extensively in protection from tuberculosis (TB) and leprosy and has been repositioned for treatment of bladder cancer, diabetes and multiple sclerosis. Recently, COVID-19 epidemiological studies confirmed that universal BCG vaccination reduced morbidity and mortality in certain geographical areas. Countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies that have shown low numbers of reported COVID-19 cases. Some countries have started clinical trials that included a single dose BCG vaccine as prophylaxis from COVID-19 or an attempt to minimize its side effects. This proposed research aims to use BCG vaccine as a double-edged weapon countering both COVID-19 and diabetes, not only as protection but also as therapeutic vaccination. The work includes a case study of regenerated pancreatic beta cells based on improved C-peptide and PCPRI laboratory findings after BCG vaccination for a 9 year old patient. The patient was re-vaccinated based on a negative tuberculin test and no scar at the site of injection of the 1st BCG vaccination at birth. The authors suggest and invite the scientific community to take into consideration the concept of direct BCG re-vaccination (after 4 weeks) because of the reported gene expressions and exaggerated innate immunity consequently. As the diabetic MODY-5 patient (mutation of HNF1B, Val2Leu) was on low dose Riomet® while eliminating insulin gradually, a simple analytical method for metformin assay was recommended to ensure its concentration before use as it is not approved yet by the Egyptian QC labs.


Subject(s)
BCG Vaccine/administration & dosage , Coronavirus Infections/immunology , Diabetes Mellitus/immunology , Insulin-Secreting Cells/cytology , Pneumonia, Viral/immunology , Animals , BCG Vaccine/immunology , COVID-19 , Child , Coronavirus Infections/complications , Diabetes Mellitus/physiopathology , Humans , Male , Pandemics , Pneumonia, Viral/complications , Rats , Regeneration/immunology , Risk Factors , Vaccination/methods
4.
Rev Med Virol ; 31(6): e2288, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384306

ABSTRACT

SARS Coronavirus-2 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary. We performed a comprehensive systematic review of all studies that met our standardised criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analysed separately using raw mean and single proportion methods. We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analysed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95% CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95% CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively. This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.


Subject(s)
COVID-19/pathology , Cough/pathology , Dyspnea/pathology , Fatigue/pathology , Fever/pathology , SARS-CoV-2/pathogenicity , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , COVID-19/virology , Comorbidity , Cough/drug therapy , Cough/mortality , Cough/virology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Dyspnea/drug therapy , Dyspnea/mortality , Dyspnea/virology , Fatigue/drug therapy , Fatigue/mortality , Fatigue/virology , Fever/drug therapy , Fever/mortality , Fever/virology , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Immunologic Factors/therapeutic use , Prognosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology , Severity of Illness Index , Smoking/physiopathology , Survival Analysis
5.
J Clin Endocrinol Metab ; 106(9): e3364-e3368, 2021 08 18.
Article in English | MEDLINE | ID: covidwho-1362074

ABSTRACT

CONTEXT: Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear. OBJECTIVE: To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. DESIGN SETTING AND PARTICIPANTS: We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020. MAIN OUTCOME MEASURE(S): The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. RESULTS: Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]). CONCLUSIONS: Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/physiopathology , Hospital Mortality/trends , Hospitalization/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Aged , Aged, 80 and over , COVID-19/virology , Female , France/epidemiology , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors
6.
Cardiol Rev ; 29(6): 292-295, 2021.
Article in English | MEDLINE | ID: covidwho-1310959

ABSTRACT

The coronavirus 2019 (COVID-19) pandemic has presented many new challenges to the healthcare community with the sheer number of individuals affected and the range of symptoms at presentation. Early findings have shown that increased age is an independent risk factor for COVID-19 severity. Diabetes and hypertension were also found to be strong independent risk factors for severe COVID-19. It was later discovered that obesity is a strong risk factor for severe disease as well. Possible mechanisms for the increased risk associated with metabolic disease include the increased prevalence of acute respiratory syndrome, immune cell dysfunction, and chronic inflammatory states associated with obesity and diabetes. Acknowledging these risk factors has consequences for addressing vaccination strategies as well as healthcare disparities.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Obesity/epidemiology , COVID-19/metabolism , COVID-19/mortality , COVID-19/physiopathology , Comorbidity , Diabetes Mellitus/metabolism , Diabetes Mellitus/physiopathology , Humans , Hypertension/metabolism , Hypertension/physiopathology , Inflammation/metabolism , Obesity/metabolism , Obesity/physiopathology , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/physiopathology , Risk Factors , SARS-CoV-2 , Severity of Illness Index
7.
Diabetes Metab Syndr ; 15(4): 102196, 2021.
Article in English | MEDLINE | ID: covidwho-1293738

ABSTRACT

AIMS: Diabetes Mellitus predisposes patients to invasive fungal infections. There has been a recent surge of Mucormycosis with COVID 19 infection particularly in patients with diabetes. This study aims to study the clinical spectrum of CAM (COVID -associated Mucormycosis) with diabetes and subsequent outcomes. MATERIAL AND METHODS: This was a descriptive study conducted at a single COVID Care Centre in India in patients with COVID Associated Mucormycosis from April 12, 2021 to May 31, 2021. RESULTS: Among 953 hospitalized patients with COVID 19 infection, 32 patients had CAM with an incidence of 3.36%. In patients with CAM, 87.5% had Diabetes Mellitus as the most common co-morbidity. The majority of the patients had poor glycemic control with a mean HbA1c of 9.06%. Out of the total study population, 93% had prior exposure to high dose corticosteroids. During the study period, 12.5% patients of CAM did not survive. CONCLUSION: Mucormycosis is an angioinvasive fungal infection with high mortality. The disease has surged in COVID 19 pandemic due to uncontrolled diabetes and improper corticosteroid use.


Subject(s)
COVID-19/complications , Diabetes Mellitus/physiopathology , Hospitalization/statistics & numerical data , Mucormycosis/mortality , SARS-CoV-2/isolation & purification , COVID-19/transmission , COVID-19/virology , Diabetes Mellitus/virology , Female , Humans , India/epidemiology , Male , Middle Aged , Mucormycosis/epidemiology , Mucormycosis/pathology , Mucormycosis/virology , Prognosis , Risk Factors , Survival Rate
8.
J Clin Endocrinol Metab ; 106(9): e3364-e3368, 2021 08 18.
Article in English | MEDLINE | ID: covidwho-1249569

ABSTRACT

CONTEXT: Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear. OBJECTIVE: To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. DESIGN SETTING AND PARTICIPANTS: We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020. MAIN OUTCOME MEASURE(S): The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. RESULTS: Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]). CONCLUSIONS: Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/physiopathology , Hospital Mortality/trends , Hospitalization/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Aged , Aged, 80 and over , COVID-19/virology , Female , France/epidemiology , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors
9.
Vascul Pharmacol ; 139: 106879, 2021 08.
Article in English | MEDLINE | ID: covidwho-1243242

ABSTRACT

Toll-like receptor 4 (TLR4) contributes to the pathophysiology of diabetes. This happens, at least in part, because TLR4 modulates the enzyme NADPH oxidase, a primary source of ROS in vascular structures. Increased oxidative stress disrupts key vascular signaling mechanisms and drives the progression of diabetes, elevating the likelihood of cardiovascular diseases. Recently, it has been shown that patients with diabetes are also at a higher risk of developing severe coronavirus disease 2019 (COVID-19). Given the importance of the interaction between TLR4 and NADPH oxidase to the disrupted diabetic vascular system, we put forward the hypothesis that TLR4-mediated NADPH oxidase-derived ROS might be a critical mechanism to help explain why this disparity appears in diabetic patients, but unfortunately, conclusive experimental evidence still lacks in the literature. Herein, we focus on discussing the pathological implications of this signaling communication in the diabetic vasculature and exploring this crosstalk in the context of diabetes-associated severe COVID-19.


Subject(s)
Blood Vessels/enzymology , COVID-19/virology , Diabetes Mellitus/enzymology , Diabetic Angiopathies/enzymology , NADPH Oxidases/metabolism , SARS-CoV-2/pathogenicity , Toll-Like Receptor 4/metabolism , Animals , Blood Vessels/physiopathology , Blood Vessels/virology , COVID-19/enzymology , COVID-19/physiopathology , Diabetes Mellitus/physiopathology , Diabetic Angiopathies/physiopathology , Enzyme Activation , Host-Pathogen Interactions , Humans , Oxidative Stress , Prognosis , Reactive Oxygen Species/metabolism , Signal Transduction
10.
J Med Virol ; 93(2): 726-732, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196407

ABSTRACT

Since its first appearance in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world and has become a global pandemic. Several medical comorbidities have been identified as risk factors for coronavirus disease 2019 (COVID-19). However, it remains unclear whether people living with human immunodefeciency virus (PLWH) are at an increased risk of COVID-19 and severe disease manifestation, with controversial suggestion that HIV-infected individuals could be protected from severe COVID-19 by means of antiretroviral therapy or HIV-related immunosuppression. Several cases of coinfection with HIV and SARS-CoV-2 have been reported from different parts of the globe. This review seeks to provide a holistic overview of SARS-CoV-2 infection in PLWH.


Subject(s)
Anti-HIV Agents/therapeutic use , COVID-19/epidemiology , HIV Infections/epidemiology , Immunocompromised Host , Pandemics , SARS-CoV-2/pathogenicity , Adult , Antiretroviral Therapy, Highly Active/statistics & numerical data , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/virology , COVID-19/immunology , COVID-19/mortality , COVID-19/virology , Coinfection , Comorbidity , Diabetes Mellitus/epidemiology , Diabetes Mellitus/physiopathology , Female , HIV/drug effects , HIV/growth & development , HIV/pathogenicity , HIV Infections/drug therapy , HIV Infections/mortality , HIV Infections/virology , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Male , Middle Aged , SARS-CoV-2/immunology , Survival Analysis , Treatment Outcome
11.
Kidney Blood Press Res ; 46(2): 152-161, 2021.
Article in English | MEDLINE | ID: covidwho-1146996

ABSTRACT

BACKGROUND: Vitamin D is a hormone regulating not only calcium and phosphate homeostasis but also, at the same time, exerting many other extraskeletal functions via genomic effects (gene transcription) and probably by non-genomic effects as well. Availability is ensured by dietary intake of its precursors and by de novo production via sunlight. Yet, vitamin D deficiency and insufficiency are very common across the globe and are connected to many pathophysiological states, for example, diabetes mellitus, allergies, autoimmune diseases, pregnancy complications, and recently have also been associated with worse COVID-19 clinical outcomes. SUMMARY: In this review, we summarize current knowledge about vitamin D metabolism in general, its role in diabetes mellitus (mainly type 2) and diabetic complications (mainly diabetic kidney disease), and potential therapeutic perspectives including vitamin D signalling as a druggable target. Key Messages: Vitamin D is not only a vitamin but also a hormone involved in many physiological processes. Its insufficiency or deficiency can lead to many pathological states.


Subject(s)
Diabetes Mellitus/metabolism , Diabetic Nephropathies/metabolism , Vitamin D Deficiency/metabolism , Vitamin D/metabolism , Animals , COVID-19/metabolism , Diabetes Mellitus/drug therapy , Diabetes Mellitus/etiology , Diabetes Mellitus/physiopathology , Diabetic Nephropathies/drug therapy , Diabetic Nephropathies/etiology , Diabetic Nephropathies/physiopathology , Humans , Signal Transduction/drug effects , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/physiopathology , Vitamins/metabolism , Vitamins/therapeutic use
12.
J Diabetes Investig ; 12(9): 1718-1722, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1127488

ABSTRACT

To clarify the association between lifestyle changes as a result of coronavirus disease 2019 containment measures and changes in metabolic and glycemic status in patients with diabetes, a cross-sectional, single-center, observation study was carried out. A self-reported questionnaire was provided to ascertain the frequency of various lifestyle activities before and after the coronavirus disease 2019 containment measures in Japan. Among 463 patients, change in glycated hemoglobin was significantly associated with change in bodyweight. After stratification by age 65 years, binary logistic regression analysis showed that increased frequency of snack eating increased bodyweight (odds ratio 1.709, P = 0.007) and glycated hemoglobin (odds ratio 1.420, P = 0.025) in the younger group, whereas in the older patients, reduced walking activities resulted in weight gain (odds ratio 0.726, P = 0.010). In conclusion, changes in eating behavior and physical activity increased bodyweight and reduced glycemic control among diabetes patients, but by different processes depending on age under the coronavirus disease 2019 containment measures in Japan.


Subject(s)
COVID-19 , Communicable Disease Control , Diabetes Mellitus , Life Style , Adult , Aged , Aged, 80 and over , Body Weight/physiology , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Cross-Sectional Studies , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Diabetes Mellitus/physiopathology , Exercise/physiology , Feeding Behavior/physiology , Female , Glycemic Control , Health Policy , Humans , Japan/epidemiology , Male , Middle Aged , Pandemics , Quarantine , SARS-CoV-2
13.
Pan Afr Med J ; 35(Suppl 2): 139, 2020.
Article in English | MEDLINE | ID: covidwho-1106485

ABSTRACT

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.


Subject(s)
Anemia, Megaloblastic/blood , Betacoronavirus , Coronavirus Infections/epidemiology , Diabetes Mellitus/blood , Hearing Loss, Sensorineural/blood , Pandemics , Pneumonia, Viral/epidemiology , Thiamine Deficiency/congenital , Thrombocytopenia/etiology , Acute Coronary Syndrome/diagnosis , Anemia, Megaloblastic/drug therapy , Anemia, Megaloblastic/physiopathology , COVID-19 , Chest Pain/etiology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/physiopathology , Diagnosis, Differential , Glycated Hemoglobin A/analysis , Health Services Accessibility , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sensorineural/physiopathology , Hemoglobins/analysis , Humans , Male , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Recurrence , SARS-CoV-2 , Thiamine/supply & distribution , Thiamine/therapeutic use , Thiamine Deficiency/blood , Thiamine Deficiency/drug therapy , Thiamine Deficiency/physiopathology , Tunisia , Young Adult
14.
PLoS One ; 16(2): e0246793, 2021.
Article in English | MEDLINE | ID: covidwho-1079373

ABSTRACT

BACKGROUND: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina. RESEARCH QUESTION: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality? STUDY DESIGN AND METHODS: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. RESULTS: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects. INTERPRETATION: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/physiopathology , Adult , Argentina/epidemiology , Asthma/epidemiology , Asthma/physiopathology , COVID-19/diagnosis , Comorbidity , Cough/epidemiology , Cough/physiopathology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/physiopathology , Female , Fever/epidemiology , Fever/physiopathology , Headache/epidemiology , Headache/physiopathology , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Intensive Care Units , Male , Middle Aged , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Young Adult
16.
Clin Pharmacol Ther ; 109(4): 1092-1103, 2021 04.
Article in English | MEDLINE | ID: covidwho-1051200

ABSTRACT

ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are standard-of-care treatments for hypertension and diabetes, common comorbidities among hospitalized patients with coronavirus disease 2019 (COVID-19). Their use in the setting of COVID-19 has been heavily debated due to potential interactions with ACE2, an enzyme that links the pro-inflammatory and anti-inflammatory arms of the renin angiotensin system, but also the entryway by which severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) invades cells. ACE2 expression is altered by age, hypertension, diabetes, and the virus itself. This study integrated available information about the renin angiotensin aldosterone system (RAAS) and effects of SARS-CoV-2 and its comorbidities on ACE2 into a mechanistic mathematical model and aimed to quantitatively predict effects of ACEi/ARBs on the RAAS pro-inflammatory/anti-inflammatory balance. RAAS blockade prior to SARS-CoV-2 infection is predicted to increase the mas-AT1 receptor occupancy ratio up to 20-fold, indicating that in patients already taking an ACEi/ARB before infection, the anti-inflammatory arm is already elevated while the pro-inflammatory arm is suppressed. Predicted pro-inflammatory shifts in the mas-AT1 ratio due to ACE2 downregulation by SARS-CoV-2 were small relative to anti-inflammatory shifts induced by ACEi/ARB. Predicted effects of changes in ACE2 expression with comorbidities of diabetes, hypertension, or aging on mas-AT1 occupancy ratio were also relatively small. Last, predicted changes in the angiotensin (Ang(1-7)) production rate with ACEi/ARB therapy, comorbidities, or infection were all small relative to exogenous Ang(1-7) infusion rates shown experimentally to protect against acute lung injury, suggesting that any changes in the ACE2-Ang(1-7)-mas arm may not be large enough to play a major role in COVID-19 pathophysiology.


Subject(s)
Angiotensin Receptor Antagonists/pharmacology , Angiotensin-Converting Enzyme Inhibitors/pharmacology , COVID-19/physiopathology , Receptor, Angiotensin, Type 1/physiology , Renin-Angiotensin System/physiology , Age Factors , Aging/physiology , Diabetes Mellitus/physiopathology , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Inflammation Mediators/metabolism , Models, Theoretical , SARS-CoV-2
17.
Diabet Med ; 38(5): e14498, 2021 05.
Article in English | MEDLINE | ID: covidwho-975494

ABSTRACT

AIM: To describe diabetes nurses' perspectives on the impact of the COVID-19 pandemic on people with diabetes and diabetes services across Europe. METHODS: An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks. RESULTS: Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID-19 pandemic had impacted 'a lot' on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased 'a lot': anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty-seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self-management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID-19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively. CONCLUSION: The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID-19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID-19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.


Subject(s)
COVID-19 , Delivery of Health Care , Diabetes Mellitus/physiopathology , Nurse Specialists , Psychological Distress , Anxiety/psychology , Attitude of Health Personnel , Depression/psychology , Diabetes Mellitus/metabolism , Diabetes Mellitus/nursing , Diabetes Mellitus/psychology , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/nursing , Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 1/psychology , Diabetes Mellitus, Type 2/metabolism , Diabetes Mellitus, Type 2/nursing , Diabetes Mellitus, Type 2/physiopathology , Diabetes Mellitus, Type 2/psychology , Diabetic Foot/physiopathology , Europe , Humans , Hyperglycemia/metabolism , SARS-CoV-2 , Self-Management , Surveys and Questionnaires
18.
Front Public Health ; 8: 593256, 2020.
Article in English | MEDLINE | ID: covidwho-972770

ABSTRACT

Objectives: We aimed to describe the epidemiological and clinical characteristics of patients with COVID-19 in Saudi Arabia in various severity groups. Methods: Data for 485 patients were extracted from the medical records from the infectious disease center of Prince Mohammed bin Abdul Aziz Hospital in Riyadh. Patients' basic information, laboratory test results, signs and symptoms, medication prescribed, other comorbidities, and outcome data were collected and analyzed. Descriptive data were reported to examine the distribution of study variables between the severe and not severe groups. Results: Of 458 included patients, 411 (89.7%) were classified as not severe, 47 (10.3%) as severe. Most (59.1%) patients were aged between 20 and 39 years. Patients with severe conditions were non-Saudi, with a chronic condition history, and tended to have more chronic conditions compared with those without severe disease. Diabetes, hypertension, and thyroid disease were significantly higher in patients with severe disease. Death was reported in only 4.26% of severe patients. Only 16 (34.04%) patients remained in the hospital in the severe group. Conclusions: Severe cases were more likely to have more comorbidities, diabetes, hypertension, and thyroid disorders were most common compared with non-severe cases.


Subject(s)
COVID-19/epidemiology , COVID-19/physiopathology , Comorbidity , Diabetes Mellitus/physiopathology , Hypertension/physiopathology , Severity of Illness Index , Thyroid Diseases/physiopathology , Adult , Age Factors , Aged , Aged, 80 and over , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2 , Saudi Arabia/epidemiology , Thyroid Diseases/epidemiology , Young Adult
19.
Clin Investig Arterioscler ; 33(3): 151-157, 2021.
Article in English, Spanish | MEDLINE | ID: covidwho-972455

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Diabetes is one of the most frequent comorbidities in people with COVID-19 with a prevalence that varies between 7 and 30%. Diabetics infected with SARS-CoV-2 have a higher rate of hospital admission, severe pneumonia, and higher mortality compared to non-diabetic subjects. Chronic hyperglycemia can compromise innate and humoral immunity. Furthermore, diabetes is associated with a low-grade chronic inflammatory state that favors the development of an exaggerated inflammatory response and therefore the appearance of acute respiratory distress syndrome. Recent evidence has shown that SARS-CoV-2 is also capable of causing direct damage to the pancreas that could worsen hyperglycemia and even induce the onset of diabetes in previously non-diabetic subjects. Therapeutic strategies should be aimed at facilitating patient access to the healthcare system. Control of blood glucose and comorbidities must be individualized in order to reduce the incidence of complications and decrease the burden on health systems. In this article we will review the pathophysiological mechanisms that explain the bidirectional relationship between COVID-19 and diabetes mellitus, its implication in the prognosis and management of hyperglycemia in this group of patients.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hyperglycemia/complications , Blood Glucose/metabolism , COVID-19/physiopathology , COVID-19/virology , Diabetes Mellitus/physiopathology , Hospitalization/statistics & numerical data , Humans , Hyperglycemia/physiopathology , Prognosis , SARS-CoV-2/isolation & purification
20.
J Med Virol ; 92(10): 2055-2066, 2020 10.
Article in English | MEDLINE | ID: covidwho-969528

ABSTRACT

Clinical and laboratory data on patients with coronavirus disease 2019 (COVID-19) in Beijing, China, remain extremely limited. In this study, we summarized the clinical characteristics of patients with COVID-19 from a designated hospital in Beijing. In total, 55 patients with laboratory-confirmed SARS-CoV-2 infection in Beijing 302 Hospital were enrolled in this study. Demographic data, symptoms, comorbidities, laboratory values, treatments, and clinical outcomes were all collected and retrospectively analyzed. A total of 15 (27.3%) patients had severe symptoms, the mean age was 44.0 years (interquartile range [IQR], 34.0-56.0), and the median incubation period was 7.5 days (IQR, 5.0-11.8). A total of 26 (47.3%) patients had exposure history in Wuhan of less than 2 weeks, whereas 20 (36.4%) patients were associated with familial clusters. Also, eighteen (32.7%) patients had underlying comorbidities including hypertension. The most common symptom of illness was fever (45; 81.8%); 51 (92.7%) patients had abnormal findings on chest computed tomography. Laboratory findings showed that neutrophil count, percentage of lymphocyte, percentage of eosinophil, eosinophil count, erythrocyte sedimentation rate, albumin, and serum ferritin are potential risk factors for patients with a poor prognosis. A total of 26 patients (47.3%) were still hospitalized, whereas 29 (52.7%) patients had been discharged. Compared with patients in Wuhan, China, the symptoms of patients in Beijing are relatively mild. Older age, more comorbidities, and more abnormal prominent laboratory markers were associated with a severe condition. On the basis of antiviral drugs, it is observed that antibiotics treatment, appropriate dosage of corticosteroid, and gamma globulin therapy significantly improve patients' outcomes. Early identification and timely medical treatment are important to reduce the severity of patients with COVID-19.


Subject(s)
COVID-19/physiopathology , Coronary Disease/physiopathology , Diabetes Mellitus/physiopathology , Hypertension/physiopathology , Kidney Failure, Chronic/physiopathology , Adrenal Cortex Hormones/therapeutic use , Adult , Age Factors , Antiviral Agents/therapeutic use , COVID-19/diagnostic imaging , COVID-19/therapy , COVID-19/virology , China , Comorbidity , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Coronary Disease/virology , Diabetes Mellitus/diagnostic imaging , Diabetes Mellitus/therapy , Diabetes Mellitus/virology , Eosinophils/pathology , Eosinophils/virology , Female , Ferritins/blood , Fever/physiopathology , Hospitalization , Hospitals , Humans , Hypertension/diagnostic imaging , Hypertension/therapy , Hypertension/virology , Immunoglobulins, Intravenous/therapeutic use , Infectious Disease Incubation Period , Kidney Failure, Chronic/diagnostic imaging , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/virology , Leukocyte Count , Lymphocytes/pathology , Lymphocytes/virology , Male , Middle Aged , Neutrophils/pathology , Neutrophils/virology , Retrospective Studies , Risk Factors , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Severity of Illness Index , Tomography, X-Ray Computed
SELECTION OF CITATIONS
SEARCH DETAIL
...