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1.
Int J Mol Sci ; 23(4)2022 Feb 16.
Article in English | MEDLINE | ID: covidwho-1701642

ABSTRACT

Several diseases (such as diabetes, cancer, and neurodegenerative disorders) affect the morpho-functional aspects of red blood cells, sometimes altering their normal metabolism. In this review, the hematological changes are evaluated, with particular focus on the morphology and metabolic aspects of erythrocytes. Changes in the functionality of such cells may, in fact, help provide important information about disease severity and progression. The viral infection causes significant damage to the blood cells that are altered in size, rigidity, and distribution width. Lower levels of hemoglobin and anemia have been reported in several studies, and an alteration in the concentration of antioxidant enzymes has been shown to promote a dangerous state of oxidative stress in red blood cells. Patients with severe COVID-19 showed an increase in hematological changes, indicating a progressive worsening as COVID-19 severity progressed. Therefore, monitored hematological alterations in patients with COVID-19 may play an important role in the management of the disease and prevent the risk of a severe course of the disease. Finally, monitored changes in erythrocytes and blood, in general, may be one of the causes of the condition known as Long COVID.


Subject(s)
COVID-19/blood , COVID-19/diet therapy , Erythrocytes/virology , Anemia/virology , Antiviral Agents/pharmacology , COVID-19/complications , COVID-19/etiology , COVID-19/metabolism , Erythrocytes/metabolism , Erythrocytes/pathology , Hemoglobins/metabolism , Hemolysis , Humans , Oxidative Stress
2.
Immunopharmacol Immunotoxicol ; 43(6): 644-650, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1545788

ABSTRACT

BACKGROUND: The current outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread throughout the world. During treatment, we found that the majority of patients had a decrease in hemoglobin (Hb). Interferon-α2b (IFN-α2b) was the primary suspected drug that was related to Hb reduction. Thus, the study aimed to investigate whether IFN-α2b could induce Hb reduction in severe patients with COVID-19 and its potential mechanism. MATERIAL AND METHODS: A total of 50 patients who were admitted to the First Affiliated Hospital of Harbin Medical University with severe COVID-19 infection were enrolled from February 12th to 24th, 2020. The demographics, baseline characteristics, clinical data, and therapeutic regimen were collected retrospectively. The patients were divided into two groups according to the declined use of IFN-α2b on day 14. The Hb levels on admission, day 7, day14, and day 21 were collected and analyzed. The primary endpoint was the level of Hb on day 21. RESULTS: A total of 31 patients in the IFN-stop group and 19 patients in the non-IFN-stop group were reviewed. The age, gender, comorbidities, clinical symptoms, nutritional status, disease severity, complications, and other factors of the patients were compared, no difference was found between the IFN-stop group and the non-IFN-stop group. The Hb levels of all patients significantly decreased on day 7 compared with that on admission (p < .0001). In the IFN-stop group, the Hb level was increased in 7 days after IFN-α2b was stopped (p = .0008), whereas no difference was found between day 14 and day 21 in the non-IFN-stop group (p = .3152). CONCLUSIONS: IFN-α2b was associated with Hb reduction in the treatment of severe patients of COVID-19. Clinicians should be aware of the high incidence of Hb reduction for patients treated by IFN-α2b.


Subject(s)
Anemia/chemically induced , Antiviral Agents/adverse effects , COVID-19/drug therapy , Interferon alpha-2/adverse effects , SARS-CoV-2/drug effects , Administration, Inhalation , Adult , Aged , Aged, 80 and over , Anemia/blood , Anemia/diagnosis , Antiviral Agents/administration & dosage , Biomarkers/blood , COVID-19/diagnosis , COVID-19/immunology , COVID-19/virology , China , Female , Hemoglobins/metabolism , Host-Pathogen Interactions , Humans , Interferon alpha-2/administration & dosage , Male , Middle Aged , Nebulizers and Vaporizers , Retrospective Studies , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Severity of Illness Index , Time Factors , Treatment Outcome , Young Adult
3.
Pak J Biol Sci ; 24(9): 920-927, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1431004

ABSTRACT

<b>Background and Objective:</b> COVID-19 is a fast-spreading worldwide pandemic caused by SARS-CoV-2. The World Health Organization recommended wearing face masks. Masks have become an urgent necessity throughout the pandemic, the study's goal was to track the impact of wearing masks on immunological responses. <b>Materials and Methods:</b> This study was conducted on 40 healthy people who were working in health care at Nineveh Governorate Hospitals from September-December, 2020. They wore face masks at work for more than 8 months for an average of 6 hrs a day. The control sample included 40 healthy individuals, who wore masks for very short periods. All samples underwent immunological and physiological tests to research the effects of wearing masks for extended periods within these parameters. <b>Results:</b> The results showed a significant decrease in total White Blood Count and the absolute number of neutrophils, lymphocytes, monocytes and phagocytic activity. However, there was a significant increase in the absolute number of eosinophils in participants compared with the control. The results also suggested there were no significant differences in IgE, haemoglobin concentration and blood O<sub>2 </sub>saturation in participants who wore masks for more than 6 hrs compared to the control group. The results showed a significant increase in pulse rate in participants who wore masks for more than 6 hrs compared to the control group. The results also showed a strong correlation coefficient between the time of wearing masks and some immunological, haematological parameters. <b>Conclusion:</b> Wearing masks for long periods alters immunological parameters that initiate the immune response, making the body weaker in its resistance to infectious agents.


Subject(s)
COVID-19/prevention & control , Inhalation Exposure/prevention & control , Leukocytes/immunology , Masks , Occupational Exposure/prevention & control , Phagocytes/immunology , SARS-CoV-2/pathogenicity , Adult , Biomarkers/blood , COVID-19/transmission , Case-Control Studies , Female , Heart Rate , Hemoglobins/metabolism , Humans , Immunoglobulin E/blood , Inhalation Exposure/adverse effects , Leukocyte Count , Male , Masks/adverse effects , Middle Aged , Occupational Exposure/adverse effects , Occupational Health , Oxygen/blood , Personnel, Hospital , Phagocytosis , Time Factors
4.
Int J Mol Sci ; 22(16)2021 Aug 22.
Article in English | MEDLINE | ID: covidwho-1367850

ABSTRACT

SARS-CoV-2 primarily infects epithelial airway cells that express the host entry receptor angiotensin-converting enzyme 2 (ACE2), which binds to the S1 spike protein on the surface of the virus. To delineate the impact of S1 spike protein interaction with the ACE2 receptor, we incubated the S1 spike protein with human pulmonary arterial endothelial cells (HPAEC). HPAEC treatment with the S1 spike protein caused disruption of endothelial barrier function, increased levels of numerous inflammatory molecules (VCAM-1, ICAM-1, IL-1ß, CCL5, CXCL10), elevated mitochondrial reactive oxygen species (ROS), and a mild rise in glycolytic reserve capacity. Because low oxygen tension (hypoxia) is associated with severe cases of COVID-19, we also evaluated treatment with hemoglobin (HbA) as a potential countermeasure in hypoxic and normal oxygen environments in analyses with the S1 spike protein. We found hypoxia downregulated the expression of the ACE2 receptor and increased the critical oxygen homeostatic signaling protein, hypoxia-inducible factor (HIF-1α); however, treatment of the cells with HbA yielded no apparent change in the levels of ACE2 or HIF-1α. Use of quantitative proteomics revealed that S1 spike protein-treated cells have few differentially regulated proteins in hypoxic conditions, consistent with the finding that ACE2 serves as the host viral receptor and is reduced in hypoxia. However, in normoxic conditions, we found perturbed abundance of proteins in signaling pathways related to lysosomes, extracellular matrix receptor interaction, focal adhesion, and pyrimidine metabolism. We conclude that the spike protein alone without the rest of the viral components is sufficient to elicit cell signaling in HPAEC, and that treatment with HbA failed to reverse the vast majority of these spike protein-induced changes.


Subject(s)
Angiotensin-Converting Enzyme 2/metabolism , COVID-19/pathology , Endothelial Cells/metabolism , Hemoglobins/metabolism , Spike Glycoprotein, Coronavirus/metabolism , COVID-19/virology , Cell Hypoxia , Cell Survival , Cells, Cultured , Endothelial Cells/virology , Endothelium, Vascular/cytology , Endothelium, Vascular/pathology , Humans , Protein Subunits/metabolism , Pulmonary Artery/cytology , Pulmonary Artery/pathology , Reactive Oxygen Species/metabolism , Recombinant Proteins/metabolism , SARS-CoV-2/metabolism , SARS-CoV-2/pathogenicity
5.
Int J Mol Sci ; 22(16)2021 Aug 21.
Article in English | MEDLINE | ID: covidwho-1367849

ABSTRACT

(1) Background: coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been linked to hematological dysfunctions, but there are little experimental data that explain this. Spike (S) and Nucleoprotein (N) proteins have been putatively associated with these dysfunctions. In this work, we analyzed the recruitment of hemoglobin (Hb) and other metabolites (hemin and protoporphyrin IX-PpIX) by SARS-Cov2 proteins using different approaches. (2) Methods: shotgun proteomics (LC-MS/MS) after affinity column adsorption identified hemin-binding SARS-CoV-2 proteins. The parallel synthesis of the peptides technique was used to study the interaction of the receptor bind domain (RBD) and N-terminal domain (NTD) of the S protein with Hb and in silico analysis to identify the binding motifs of the N protein. The plaque assay was used to investigate the inhibitory effect of Hb and the metabolites hemin and PpIX on virus adsorption and replication in Vero cells. (3) Results: the proteomic analysis by LC-MS/MS identified the S, N, M, Nsp3, and Nsp7 as putative hemin-binding proteins. Six short sequences in the RBD and 11 in the NTD of the spike were identified by microarray of peptides to interact with Hb and tree motifs in the N protein by in silico analysis to bind with heme. An inhibitory effect in vitro of Hb, hemin, and PpIX at different levels was observed. Strikingly, free Hb at 1mM suppressed viral replication (99%), and its interaction with SARS-CoV-2 was localized into the RBD region of the spike protein. (4) Conclusions: in this study, we identified that (at least) five proteins (S, N, M, Nsp3, and Nsp7) of SARS-CoV-2 recruit Hb/metabolites. The motifs of the RDB of SARS-CoV-2 spike, which binds Hb, and the sites of the heme bind-N protein were disclosed. In addition, these compounds and PpIX block the virus's adsorption and replication. Furthermore, we also identified heme-binding motifs and interaction with hemin in N protein and other structural (S and M) and non-structural (Nsp3 and Nsp7) proteins.


Subject(s)
COVID-19/etiology , Hemoglobins/metabolism , SARS-CoV-2/metabolism , Viral Nonstructural Proteins/metabolism , Viral Structural Proteins/metabolism , COVID-19/blood , Hemin/metabolism , Hemoglobins/ultrastructure , Humans , Molecular Docking Simulation , Protein Binding , Protein Domains , Proteomics , Protoporphyrins/metabolism , SARS-CoV-2/pathogenicity , Viral Nonstructural Proteins/ultrastructure , Viral Structural Proteins/ultrastructure , Virus Attachment , Virus Replication
6.
J Med Virol ; 93(9): 5438-5445, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1363683

ABSTRACT

Adequate maternal selenium level is essential for immune response and healthy pregnancy. This study aimed to shed light on the selenium status of pregnant women with COVID-19 and the effects of potential deficiency in serum selenium levels. Totally 141 pregnant women, 71 of them were COVID-19 patients, in different trimesters were included in the study. Maternal serum selenium levels, demographic and clinical parameters were determined. Serum selenium levels of pregnant women in the second (p: .0003) and third (p: .001) trimesters with COVID-19 were significantly lower than in the healthy group. Maternal selenium level was found to be negatively correlated with gestational week (p < .0001, r: -.541), D-dimer (p: .0002, r: -.363) and interleukin-6 (IL-6) level (p: .02, r: -.243). In the second trimester, serum selenium level positively correlated with white blood cell (p: .002, r: .424), neutrophil (p: .006, r: .39), lymphocyte (p: .004, r: .410) count and hemoglobin (p: .02, r: .323), hematocrit (p: .008, r: .38) status. In the third trimester, it was found that maternal selenium level positively correlated with monocyte (p: .04, r: .353) and negatively correlated with C-reactive protein level (p: .03, r: -.384). Serum selenium level was gradually decreased during the pregnancy period, however, this natural decrease was enhanced together with COVID-19 infection. The reason might be increased selenium needs depended on the immune response against infection. The decrease in maternal selenium level was found to be related to IL-6 and D-dimer levels, which indicate selenium's role in disease progression.


Subject(s)
COVID-19/blood , COVID-19/immunology , Pregnancy Trimesters/blood , SARS-CoV-2/pathogenicity , Selenium/blood , Adult , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19/virology , Case-Control Studies , Female , Fibrin Fibrinogen Degradation Products/metabolism , Hematocrit , Hemoglobins/metabolism , Humans , Interleukin-6/blood , Lymphocytes/immunology , Lymphocytes/virology , Monocytes/immunology , Monocytes/virology , Neutrophils/immunology , Neutrophils/virology , Pregnancy , Pregnancy Trimesters/immunology , Severity of Illness Index
8.
Respir Physiol Neurobiol ; 292: 103709, 2021 10.
Article in English | MEDLINE | ID: covidwho-1253545

ABSTRACT

Previous studies suggested that erythropoietin (EPO) may protect against severe COVID-19-induced injuries, ultimately preventing mortality. This hypothesis is based on the fact that, in addition to promoting the increase in red blood cells, EPO is an anti-inflammatory, anti-apoptotic and protective factor in several non-erythropoietic tissues. Furthermore, EPO promotes nitric oxide production in the hypoxic lung and stimulates ventilation by interacting with the respiratory centers of the brainstem. Given that EPO in the blood is increased at high-altitude, we evaluated the serum levels of EPO in critical patients with COVID-19 at "Hospital Agramont" in the city of El Alto (4150 masl) in Bolivia. A total of 16 patients, 15 men, one woman, with a mean age of 55.8 ± 8.49 years, admitted to the Intensive Care Unit were studied. All patients were permanent residents of El Alto, with no travel history below 3000 masl for at least one year. Blood samples were collected upon admission to the ICU. Serum EPO concentration was assessed using an ELISA kit, and a standard technique determined hemoglobin concentration. Only half of the observed patients survived the disease. Remarkably, fatal cases showed 2.5 times lower serum EPO than survivors (2.78 ± 0.8643 mU/mL vs 7.06 ± 2.713 mU/mL; p = 0.0096), and 1.24 times lower hemoglobin levels (13.96 ± 2.56 g/dL vs 17.41 ± 1.61 g/dL; p = 0.0159). While the number of cases evaluated in this work is low, our findings strongly warrant further investigation of EPO levels in COVID-19 patients at high and low altitudes. Our results also support the hypothesis that exogenous EPO administration could help critically ill COVID-19 patients overcome the disease.


Subject(s)
Altitude , COVID-19/blood , Erythropoietin/blood , Lung/diagnostic imaging , Aged , Bolivia , COVID-19/diagnostic imaging , COVID-19/mortality , Female , Hemoglobins/metabolism , Humans , Intensive Care Units , Male , Middle Aged , Prognosis , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Tomography, X-Ray Computed
9.
Clin Nutr ESPEN ; 43: 223-229, 2021 06.
Article in English | MEDLINE | ID: covidwho-1240255

ABSTRACT

BACKGROUND AND AIMS: Several factors that worsen the prognosis of the new coronavirus SARS-CoV-2 have been identified, such as obesity or diabetes. However, despite that nutrition may change in a lockdown situation, little is known about the influence of malnutrition among subjects hospitalized due to COVID-19. Our study aimed to assess whether the presence of malnutrition among patients admitted due to COVID-19 had any impact on clinical outcomes compared with patients with the same condition but well nourished. METHODS: 75 patients admitted to hospital due to COVID-19 were analyzed cross-sectionally. Subjective Global Assessment (SGA) was completed by phone interview. Clinical parameters included were extracted from the electronic medical record. RESULTS: According to the SGA, 27 admitted due to a COVID-19 infection had malnutrition. Patients not well nourished were older than patients with a SGA grade A (65 ± 14.1 vs 49 ± 15.1 years; p < 0.0001). Length of hospital stay among poorly nourished patients was significantly higher (18.4 ± 15.6 vs 8.5 ± 7.7 days; p = 0.001). Mortality rates and admission to ICU were greater among subjects with any degree of malnutrition compared with well-nourished patients (7.4% vs 0%; p = 0.05 and 44.4% vs 6.3%; p < 0.0001). CRP (120.9 ± 106.2 vs 60.8 ± 62.9 mg/l; p = 0.03), D-dimer (1516.9 ± 1466.9 vs 461.1 ± 353.7 ng/mL; p < 0.0001) and ferritin (847.8 ± 741.1 vs 617.8 ± 598.7mcg/l; p = 0.03) were higher in the group with malnutrition. Haemoglobin (11.6 ± 2.1 vs 13.6 ± 1.5 g/dl; p < 0.0001) and albumin 3.2 ± 0.7 vs 4.1 ± 0.5 g/dl; p < 0.0001) were lower in patients with any degree of malnutrition. CONCLUSIONS: The presence of a poor nutritional status is related to a longer stay in hospital, a greater admission in the ICU and a higher mortality.


Subject(s)
COVID-19 , Hospital Mortality , Hospitalization , Intensive Care Units , Length of Stay , Malnutrition/complications , Nutritional Status , Adult , Albumins/metabolism , C-Reactive Protein/metabolism , COVID-19/mortality , Communicable Disease Control/methods , Cross-Sectional Studies , Female , Ferritins/blood , Hemoglobins/metabolism , Humans , Male , Malnutrition/mortality , Malnutrition/therapy , Middle Aged , Nutrition Assessment , Pandemics , Prognosis , SARS-CoV-2 , Severity of Illness Index
10.
Med Hypotheses ; 146: 110421, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1233540

ABSTRACT

BACKGROUND: Infection with SARS-CoV-2 is responsible for the COVID-19 crisis affecting the whole world. This virus can provoke acute respiratory distress syndrome (ARDS) leading to overcrowed the intensive care unit (ICU). Over the last months, worldwide experience demonstrated that the ARDS in COVID-19 patients are in many ways "atypical". The mortality rate in ventilated patients is high despite the application of the gold standard treatment (protective ventilation, curare, prone position, inhaled NO). Several studies suggested that the SARS-CoV-2 could interact negatively on red blood cell homeostasis. Furthermore, SarsCov2 creates Reactive Oxygen Species (ROS), which are toxic and generate endothelial dysfunction. Hypothesis/objective(s) We hypothesis that HEMO2Life® administrated intravenously is safe and could help symptomatically the patient condition. It would increase arterial oxygen content despite lung failure and allow better tissue oxygenation control. The use of HEMO2Life® is also interesting due to its anti-oxidative effect preventing cytokine storm induced by the SARS-CoV-2. Evaluation of the hypothesis: Hemarina is based on the properties of the hemoglobin of the Arenicola marina sea-worm (HEMO2Life®). This extracellular hemoglobin has an oxygen capacity 40 times greater than the hemoglobin of vertebrates. Furthermore, the size of this molecule is 250 times smaller than a human red blood cell, allowing it to diffuse in all areas of the microcirculation, without diffusing outside the vascular sector. It possesses an antioxidative property du a Superoxide Dismutase Activity. This technology has been the subject of numerous publications and HEMO2Life® was found to be well-tolerated and did not induce toxicity. It was administered intravenously to hamsters and rats, and showed no acute effect on heart rate and blood pressure and did not cause microvascular vasoconstriction. In preclinical in vivo models (mice, rats, and dogs), HEMO2Life® has enabled better tissue oxygenation, especially in the brain. This molecule has already been used in humans in organ preservation solutions and the patients showed no abnormal clinical signs. CONSEQUENCES OF THE HYPOTHESIS: The expected benefits of HEMO2Life® for COVID-19 patients are improved survival, avoidance of tracheal intubation, shorter oxygen supplementation, and the possibility of treating a larger number of patients as molecular respirator without to use an invasive machine.


Subject(s)
COVID-19/complications , COVID-19/therapy , Hemoglobins/therapeutic use , Hypoxia/etiology , Hypoxia/therapy , Models, Biological , Oxygen/administration & dosage , Animals , COVID-19/physiopathology , Cricetinae , Dogs , Hemoglobins/administration & dosage , Hemoglobins/metabolism , Humans , Hypoxia/physiopathology , Injections, Intravenous , Mice , Oxidative Stress/drug effects , Oxygen/metabolism , Pandemics , Rats , SARS-CoV-2
11.
J Med Virol ; 93(9): 5438-5445, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1230212

ABSTRACT

Adequate maternal selenium level is essential for immune response and healthy pregnancy. This study aimed to shed light on the selenium status of pregnant women with COVID-19 and the effects of potential deficiency in serum selenium levels. Totally 141 pregnant women, 71 of them were COVID-19 patients, in different trimesters were included in the study. Maternal serum selenium levels, demographic and clinical parameters were determined. Serum selenium levels of pregnant women in the second (p: .0003) and third (p: .001) trimesters with COVID-19 were significantly lower than in the healthy group. Maternal selenium level was found to be negatively correlated with gestational week (p < .0001, r: -.541), D-dimer (p: .0002, r: -.363) and interleukin-6 (IL-6) level (p: .02, r: -.243). In the second trimester, serum selenium level positively correlated with white blood cell (p: .002, r: .424), neutrophil (p: .006, r: .39), lymphocyte (p: .004, r: .410) count and hemoglobin (p: .02, r: .323), hematocrit (p: .008, r: .38) status. In the third trimester, it was found that maternal selenium level positively correlated with monocyte (p: .04, r: .353) and negatively correlated with C-reactive protein level (p: .03, r: -.384). Serum selenium level was gradually decreased during the pregnancy period, however, this natural decrease was enhanced together with COVID-19 infection. The reason might be increased selenium needs depended on the immune response against infection. The decrease in maternal selenium level was found to be related to IL-6 and D-dimer levels, which indicate selenium's role in disease progression.


Subject(s)
COVID-19/blood , COVID-19/immunology , Pregnancy Trimesters/blood , SARS-CoV-2/pathogenicity , Selenium/blood , Adult , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19/virology , Case-Control Studies , Female , Fibrin Fibrinogen Degradation Products/metabolism , Hematocrit , Hemoglobins/metabolism , Humans , Interleukin-6/blood , Lymphocytes/immunology , Lymphocytes/virology , Monocytes/immunology , Monocytes/virology , Neutrophils/immunology , Neutrophils/virology , Pregnancy , Pregnancy Trimesters/immunology , Severity of Illness Index
12.
Acta Haematol ; 144(6): 678-682, 2021.
Article in English | MEDLINE | ID: covidwho-1199822

ABSTRACT

SARS-CoV-2 has been reported as a possible triggering factor for the development of several autoimmune diseases and inflammatory dysregulation. Here, we present a case report of a woman with a history of systemic lupus erythematosus and antiphospholipid syndrome, presenting with concurrent COVID-19 infection and immune thrombotic thrombocytopenic purpura (TTP). The patient was treated with plasma exchange, steroids, and caplacizumab with initial good response to therapy. The course of both TTP and COVID-19 disease was mild. However, after ADAMTS-13 activity was normalized, the patient experienced an early unexpected TTP relapse manifested by intravascular hemolysis with stable platelet counts requiring further treatment. Only 3 cases of COVID-19 associated TTP were reported in the literature thus far. We summarize the literature and suggest that COVID-19 could act as a trigger for TTP, with good outcomes if recognized and treated early.


Subject(s)
COVID-19/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , ADAMTS13 Protein/metabolism , COVID-19/pathology , COVID-19/virology , Female , Hemoglobins/metabolism , Humans , Middle Aged , Plasma Exchange , Platelet Count , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/therapy , Recurrence , SARS-CoV-2/isolation & purification , Single-Domain Antibodies/therapeutic use
13.
Int Immunopharmacol ; 97: 107697, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1193340

ABSTRACT

BACKGROUND: Toward the end of December 2019, a novel type of coronavirus (2019-nCoV) broke out in Wuhan, China. Here, the hematological characteristics of patients with severe and critical 2019-nCoV pneumonia in intensive care unit (ICU) were investigated, which may provide the necessary basis for its diagnosis and treatment. METHODS: We collected data on patients with confirmed 2019-nCoV pneumonia in the ICU of Leishenshan Hospital in Wuhan from February 25 to April 2, 2020. Real-time reverse-transcription polymerase chain reaction was used to confirm the presence of 2019-nCoV, and various hematological characteristics were analyzed. RESULTS: All patients tested positive for 2019-nCoV using nasopharyngeal swabs or sputum after admission, and interstitial pneumonia findings were noted on chest computed tomography. Sex, age and comorbidities were not significantly different between the severe and critical groups. In terms of prognosis, the survival rate of patients in the severe group reached 100%, whereas that of patients in the critical group was only 13.33% after positive treatment. Furthermore, lymphocyte percentage, blood urea nitrogen, calcium, D-dimer, myohemoglobin, procalcitonin, and IL-6 levels were high-risk factors for disease progression in critical patients. Finally, lymphocyte percentage and blood urea nitrogen, calcium, myohemoglobin, and IL-6 levels were closely associated with patient prognosis. CONCLUSIONS: 2019-nCoV pneumonia should be considered a systemic disease. Patients with more complications were more likely to develop critical disease. Lymphocyte percentage and blood urea nitrogen, calcium, myohemoglobin, and IL-6 levels can be monitored to prevent progression critical disease.


Subject(s)
COVID-19/blood , COVID-19/diagnosis , Intensive Care Units , Adult , Aged , Blood Urea Nitrogen , COVID-19/mortality , Calcium/blood , Female , Fibrin Fibrinogen Degradation Products/metabolism , Hemoglobins/metabolism , Humans , Interleukin-6/blood , Logistic Models , Lymphocytes/metabolism , Male , Middle Aged , Procalcitonin/blood , Prognosis , Retrospective Studies , Risk Factors
14.
J Endocrinol Invest ; 44(12): 2601-2607, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1169067

ABSTRACT

PURPOSE: The aim of the study was to investigate the association between serum 25-hydroxyvitamin D status within the last 6 months prior to COVID-19 infection and parameters of immune function and clinical outcomes. METHODS: Fifty-six patients, who were admitted to the emergency clinic and diagnosed with COVID-19 infection, were included in the study. Data on clinical characteristics, inflammatory parameters and vitamin D status were recorded for each patient. All the participants had data on 25-hydroxyvitamin D status within the last 6 months prior to COVID-19 infection. RESULTS: The patients were stratified as those with vitamin D status less than 20 ng/mL and higher than 20 ng/mL. A group with vitamin D status less than 20 ng/mL had lower lymphocyte counts and lower haemoglobin levels that was statistically significant (respectively; p = 0.021, p = 0.035). Higher C-reactive protein (CRP) levels were seen in the vitamin D-deficient group (p = 0.013). It was observed that vitamin D status of the patients who required oxygen therapy were lower than those who did not require oxygen therapy, not statistically significant (p = 0.05). Patients who did not use vitamin D supplementation within 6 months prior to COVID-19 infection had more likely to be diagnosed with pneumonia (p = 0.004). CONCLUSION: Cases with lower vitamin D status had increased inflammatory markers and worse clinical outcomes than patients with higher vitamin D status. This study suggests that vitamin D status can be used as a prognostic factor in COVID-19 patients, and vitamin D supplementation can be recommended to improve the clinical outcomes in COVID-19 infection.


Subject(s)
COVID-19/blood , Nutritional Status , Vitamin D Deficiency/blood , Vitamin D/analogs & derivatives , Vitamin D/blood , Adult , Aged , C-Reactive Protein/analysis , COVID-19/complications , COVID-19/immunology , Comorbidity , Dietary Supplements , Female , Hemoglobins/metabolism , Humans , Lymphocyte Count , Male , Middle Aged , Oxygen Inhalation Therapy , Pneumonia/complications , Pneumonia/epidemiology , Retrospective Studies , Treatment Outcome , Vitamin D/immunology , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/immunology
15.
Eur J Gastroenterol Hepatol ; 33(5): 691-694, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1159992

ABSTRACT

BACKGROUND: Infection due to severe acute respiratory syndrome coronavirus 2 is typically associated with a respiratory syndrome, but gastrointestinal symptoms have been described in early reports from China. However, data from European centres are scarce. OBJECTIVES: We aimed to characterise the gastrointestinal manifestations of patients with coronavirus disease 2019 (COVID-19) and their disease course. METHODS: Patients admitted at our centre between March and April 2020 with diagnosis of COVID-19 were included. Asymptomatic patients or those without symptom information were excluded. Clinical features, laboratory data and disease severity (mechanical ventilation, intensive care admission or death) were analysed. RESULTS: Two-hundred one patients were included (median age 71 years; 56.2% male). Digestive symptoms were reported by 60 (29.9%) patients during the disease course, being part of the disease presentation in 34 (16.9%). The most frequent were diarrhoea in 36 patients (17.9%). Patients with gastrointestinal symptoms were younger (P = 0.032), had higher haemoglobin levels (P = 0.002) and lower C-reactive protein (P = 0.045) and potassium levels (P = 0.004). Patients with digestive symptoms had less severe disease (28.3 vs. 44.0%; P = 0.038). Regarding liver damage, aspartate aminotransferase (AST) was elevated in 65.2% of patients and alanine aminotransferase (ALT) in 62.7%, but these patients did not present a more severe disease (elevated AST P = 0.062; elevated ALT P = 0.276). CONCLUSION: A significant portion of COVID-19 patients have digestive symptoms, mostly at presentation. This should be taken into account in order to keep a high level of suspicion to reach an early diagnosis and setup infection control measures to control the transmission rate. This subgroup of patients appears to have a less severe disease course.


Subject(s)
COVID-19/physiopathology , Diarrhea/physiopathology , Vomiting/physiopathology , Abdominal Pain/epidemiology , Abdominal Pain/metabolism , Abdominal Pain/physiopathology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/metabolism , Ageusia/physiopathology , Alanine Transaminase/metabolism , Aspartate Aminotransferases/metabolism , C-Reactive Protein/metabolism , COVID-19/metabolism , Diarrhea/epidemiology , Diarrhea/metabolism , Female , Hemoglobins/metabolism , Humans , Male , Middle Aged , Nausea/epidemiology , Nausea/metabolism , Nausea/physiopathology , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Vomiting/epidemiology , Vomiting/metabolism , Young Adult
16.
Am J Emerg Med ; 48: 140-147, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1157085

ABSTRACT

OBJECTIVES: We investigated the impact of anemia based on admission hemoglobin (Hb) level as a prognostic risk factor for severe outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: A single-center, retrospective cohort study was conducted from a random sample of 733 adult patients (age ≥ 18 years) obtained from a total of 4356 laboratory confirmed SARS-CoV-2 cases who presented to the Emergency Department of Montefiore Medical Center between March-June 2020. The primary outcome was a composite endpoint of in-hospital severe outcomes of COVID-19. A secondary outcome was in-hospital all-cause mortality. RESULTS: Among the 733 patients included in our final analysis, 438 patients (59.8%) presented with anemia. 105 patients (14.3%) had mild, and 333 patients (45.5%) had moderate-severe anemia. Overall, 437 patients (59.6%) had a composite endpoint of severe outcomes. On-admission anemia was an independent risk factor for all-cause mortality, (Odds Ratio 1.52, 95% CI [1.01-2.30], p = 0.046) but not for composite severe outcomes. However, moderate-severe anemia (Hb < 11 g/dL) on admission was independently associated with both severe outcomes (OR1.53, 95% CI [1.05-2.23], p = 0.028) and mortality (OR 1.67, 95% CI [1.09-2.56], p = 0.019) during hospitalization. CONCLUSION: Anemia on admission was independently associated with increased odds of all-cause mortality in patients hospitalized with COVID-19. Furthermore, moderate-severe anemia (Hb <11 g/dL) was an independent risk factor for severe COVID-19 outcomes. Moving forward, COVID-19 patient management and risk stratification may benefit from addressing anemia on admission.


Subject(s)
Acute Kidney Injury/epidemiology , Anemia/blood , COVID-19/blood , Hospital Mortality , Hypotension/epidemiology , Respiratory Insufficiency/epidemiology , Shock, Septic/epidemiology , Aged , Aged, 80 and over , Anemia/therapy , Blood Transfusion/statistics & numerical data , COVID-19/mortality , Cause of Death , Cohort Studies , Female , Hemoglobins/metabolism , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
17.
Turk J Med Sci ; 51(6): 2810-2821, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1138800

ABSTRACT

Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and nonsevere cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters. Materials and methods: In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio, neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (nonsevere or severe). Results: The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters. Conclusion: Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups.


Subject(s)
Biomarkers/blood , COVID-19/diagnosis , Emergency Service, Hospital/statistics & numerical data , Hematologic Tests/methods , Adult , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/epidemiology , COVID-19 Testing , Female , Hemoglobins/metabolism , Humans , Lymphocytes , Male , Middle Aged , Neutrophils , Predictive Value of Tests , Prognosis , Real-Time Polymerase Chain Reaction , Retrospective Studies , SARS-CoV-2/isolation & purification , Turkey/epidemiology
18.
J Med Case Rep ; 15(1): 104, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1112451

ABSTRACT

BACKGROUND: Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period. CASE PRESENTATION: This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection. CONCLUSION: This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection.


Subject(s)
COVID-19/diagnosis , Plasmapheresis , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Infectious/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Stillbirth , Acute Kidney Injury/therapy , Amphetamine-Related Disorders , Antiviral Agents/therapeutic use , COVID-19/therapy , Drug Combinations , Erythrocyte Transfusion , Female , Hemoglobins/metabolism , Humans , Hydroxychloroquine/therapeutic use , Intensive Care Units , L-Lactate Dehydrogenase/metabolism , Lopinavir/therapeutic use , Methamphetamine , Pregnancy , Pregnancy Complications, Hematologic/metabolism , Pregnancy Complications, Hematologic/therapy , Pregnancy Complications, Infectious/metabolism , Pregnancy Complications, Infectious/therapy , Purpura, Thrombotic Thrombocytopenic/metabolism , Purpura, Thrombotic Thrombocytopenic/therapy , Renal Dialysis , Ritonavir/therapeutic use , SARS-CoV-2 , Tomography, X-Ray Computed , Young Adult
19.
Sci Rep ; 11(1): 4432, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1101681

ABSTRACT

Cardiac injury is a common complication of the coronavirus disease 2019 (COVID-19), and is associated with adverse clinical outcomes. In this study, we aimed to reveal the association of cardiac injury with coagulation dysfunction. We enrolled 181 consecutive patients who were hospitalized with COVID-19, and studied the clinical characteristics and outcome of these patients. Cardiac biomarkers high-sensitivity troponin I (hs-cTnI), myohemoglobin and creatine kinase-myocardial band (CK-MB) were assessed in all patients. The clinical outcomes were defined as hospital discharge or death. The median age of the study cohort was 55 (IQR, 46-65) years, and 102 (56.4%) were males. Forty-two of the 181 patients (23.2%) had cardiac injury. Old age, high leukocyte count, and high levels of aspartate transaminase (AST), D-dimer and serum ferritin were significantly associated with cardiac injury. Multivariate regression analysis revealed old age and elevated D-dimer levels as being strong risk predictors of in-hospital mortality. Interleukin 6 (IL6) levels were comparable in patients with or without cardiac injury. Serial observations of coagulation parameters demonstrated highly synchronous alterations of D-dimer along with progression to cardiac injury. Cardiac injury is a common complication of COVID-19 and is an independent risk factor for in-hospital mortality. Old age, high leukocyte count, and high levels of AST, D-dimer and serum ferritin are significantly associated with cardiac injury, whereas IL6 are not. Therefore, the pathogenesis of cardiac injury in COVID-19 may be primarily due to coagulation dysfunction along with microvascular injury.


Subject(s)
Blood Coagulation Disorders/virology , COVID-19/blood , Heart Injuries/virology , Aged , Biomarkers/blood , Blood Coagulation/physiology , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/epidemiology , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/virology , China/epidemiology , Cohort Studies , Creatine Kinase, MB Form/blood , Female , Fibrin Fibrinogen Degradation Products/analysis , Fibrin Fibrinogen Degradation Products/metabolism , Heart Injuries/blood , Heart Injuries/epidemiology , Heart Injuries/physiopathology , Hemoglobins/metabolism , Hospital Mortality , Humans , Male , Middle Aged , Risk Factors , SARS-CoV-2/isolation & purification , Troponin I/blood
20.
J Perinat Med ; 49(2): 148-152, 2021 Feb 23.
Article in English | MEDLINE | ID: covidwho-1076288

ABSTRACT

OBJECTIVES: Our aim was to evaluate the effect of standard surgical and N-95 respiratory mask use on maternal oxygen saturation, vital signs and result on non-stress tests in term pregnancies. METHODS: It is a prospective observational study. The study included healthy, not in labor, singleton pregnant women of 370/7-410/7 weeks who were applied to our hospital for routine obstetric control examination between March 1, 2020, and August 31, 2020. Patients were randomised by coin toss method. Oxygen saturation, systolic, and diastolic arterial blood pressure, pulse, respiratory rate, and temperature of pregnant women using surgical masks and respiratory masks were measured before and after the non-stress test. The tolerance of the masks was also evaluated. Student's t-test was used for variables showing parametric distribution and the Mann Whitney U-test was used for non-parametric tests. The categorical variables between the groups was analyzed by using the Chi square test or Fisher Exact test. The statistical significance level was taken as p<0.05 in all tests. RESULTS: A total of 297 pregnant women using masks were included in the study. The effect of mask type on oxygen saturation before and after the non-stress test was found to be significant (97.1±1.8 corresponds to 95.3±2.6 for the surgical mask, p=0.0001; 97.8±1.7 corresponds to 93.7±2.0 for the respiratory mask, p=0.0001). Mask tolerance of patients using respiratory masks was significantly higher than those using surgical masks (mean 8, 1-10, p=0.0001). CONCLUSIONS: Surgical mask and respiratory mask usage decreased significantly in oxygen saturation in term pregnancies.


Subject(s)
Hemoglobins/metabolism , Masks/adverse effects , Oxygen/metabolism , Pregnancy/metabolism , Vital Signs , Adult , COVID-19 , Female , Humans , Prospective Studies , Young Adult
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