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1.
medrxiv; 2024.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2024.02.21.24303099

ABSTRACT

Long-term COVID-19 complications are a globally pervasive threat, but their plausible social drivers are often not prioritized. Here, we use data from a multinational consortium to quantify the relative contributions of social and clinical factors to differences in quality of life among participants experiencing long COVID and measure the extent to which social variables impacts can be attributed to clinical intermediates, across diverse contexts. In addition to age, neuropsychological and rheumatological comorbidities, educational attainment, employment status, and female sex were identified as important predictors of long COVID-associated quality of life days (long COVID QALDs). Furthermore, a great majority of their impacts on long COVID QALDs could not be tied to key long COVID-predicting comorbidities, such as asthma, diabetes, hypertension, psychological disorder, and obesity. In Norway, 90% (95% CI: 77%, 100%) of the effect of belonging to the highest versus lowest educational attainment quintile was not attributed to intermediate comorbidity impacts. The same was true for 86% (73%, 100%) of the protective effects of full-time employment versus all other employment status categories (excluding retirement) in the UK and 74% (46%,100%) of the protective effects of full-time employment versus all other employment status categories in a cohort of four middle-income countries (MIC). Of the effects of female sex on long COVID QALDs in Norway, UK, and the MIC cohort, 77% (46%,100%), 73% (52%, 94%), and 84% (62%, 100%) were unexplained by the clinical mediators, respectively. Our findings highlight that socio-economic proxies and sex may be as predictive of long COVID QALDs as commonly emphasized comorbidities and that broader structural determinants likely drive their impacts. Importantly, we outline a multi-method, adaptable causal machine learning approach for evaluating the isolated contributions of social disparities to long COVID quality of life experiences.


Subject(s)
Diabetes Mellitus , Obesity , Sexual Dysfunctions, Psychological , COVID-19 , Asthma , Hypertension
2.
preprints.org; 2024.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202402.0870.v1

ABSTRACT

Background: While the clinical factors of the post-COVID-19 condition (PCC) are becoming clearer, the economic implications remain uncertain, posing a challenge to healthcare professionals in terms of understanding and managing this emerging phenomenon. This article aims to investigate the demographic and clinical characteristics of PCC patients and quantify the economic impact of their healthcare resource utilisation. Methods: A retrospective and case-control observational study was conducted, comparing the case group of PCC population before and after diagnosis with a control group. Demographic and clinical variables were analysed with the objective of describing the population. Economic analysis was performed to evaluate the resource costs in procedures and primary, secondary (both outpatient and inpatient) and emergency care. Findings: PCC patients (N=341) exhibited older age and elevated cardiovascular risk factors compared to controls (N=49,078). There were differences in the socio-economic distribution between male and female patients in the PCC patients. Hypertension and diabetes mellitus type 2 were the most common chronic diseases observed among the case patients. Economic analysis revealed that PCC patients were approximately four times as costly as control patients, with increased utilisation of healthcare resources. However, post-diagnosis PCC patients showed a reduction in costs, primarily driven by decreased primary care visits and hospitalisations. Conclusion: Coordinated care management for PCC patients is associated with reduced costs and improved healthcare resource utilisation. Further research is warranted to investigate long-term health outcomes and establish causal relationships between COVID-19 sequelae and healthcare resource utilisation.


Subject(s)
Diabetes Mellitus, Type 2 , COVID-19 , Hypertension
3.
medrxiv; 2024.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2024.02.14.24302808

ABSTRACT

Background: The COVID-19 pandemic's global impact was mitigated through rapid vaccine development, leading to a mix of natural and vaccination-derived immunity. Immunological profile in hybrid immunity remains less studies, especially in regions where non-mRNA vaccines were used. This study focuses on the immunological profiles and predictors of immune response in one such population. Methods: This was a cross-sectional study to assess their humoral and cellular immune responses based on vaccination and infection history. Immunological assays were performed to measure anti-spike protein and neutralizing antibodies as well as interferon-γ release assay. Multivariable linear regression model was used to estimate predictors of immune response. Results: The study revealed significant differences in immune response among participants based on their hybrid immunity status, vaccination, and infection history. Higher antibody titres and cellular responses were observed in individuals with hybrid immunity, especially those with dual pre-Omicron and Omicron infections (3326 BAU/ml, IQR: 770.25-5678.25 and 4.92 IU of IFN-γ/mL, IQR:3.74-16.98 respectively, p <0.001). Age and comorbidities such as diabetes and hypertension were associated with lower antibody levels and cellular response, while vaccination and hybrid immunity correlated with higher immune responses. Conclusion: The prevalence of hybrid immunity was high, yet a substantial portion of the population lacks it, indicating the necessity for targeted immunization strategies. The findings underscore the importance of prioritizing high-risk individuals, such as elderly and individuals with comorbidities, for booster vaccinations to enhance community-level protection against COVID-19.


Subject(s)
Diabetes Mellitus , COVID-19 , Hypertension
4.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3937538.v1

ABSTRACT

Hypertension is a leading cause of death and morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests to analyse medical claims data from Ghana’s National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019- February 2020) relative to the target/pandemic period (March 2020 - February 2021). We observed significant changes in health services use for hypertension during the pandemic. While there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant (a 17.6% increase (95% CI. 15.0% – 20.3%; p = 0.031)). There was also an 18.64% or $22.88 (95% CI:$12 – $25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.


Subject(s)
Death , COVID-19 , Hypertension
5.
medrxiv; 2024.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2024.02.05.24302369

ABSTRACT

The novel coronavirus (COVID-19) is known to be the fifth pandemic causing massive deaths worldwide. This virus has not only been deeply associated with acute respiratory distress, but also acute kidney injury (AKI). This study describes the baseline characteristics and various outcomes of AKI based on the KDIGO 2012 Clinical Practice Guidelines in patients hospitalized with COVID-19 at a Philippine tertiary hospital. A total of 195 patient records were retrospectively reviewed for the study. Of the 195 patients, 81(42%) patients developed AKI. Significant baseline characteristics included older age (56.28 + 14.12), presence of hypertension (p=0.004), diabetes mellitus (p=0.002), and cardiovascular disease (p=0.003). Also, the use of diuretics, inotropes and antibiotics were more prevalent in patients who developed AKI. Most of the patients who had AKI were categorized as stage 1 (49.38%).  Mechanical ventilation was significantly (p<0.001) more prevalent in patients with AKI (20.99%) compared to patients without AKI (5.26%). There was significantly higher rates (p<0.001) of renal replacement therapy in patients with AKI (30.86%). Lastly, higher mortality rates were observed in patients with AKI (50.62%) versus patients without AKI (12.28%). Our study demonstrated that patients with COVID-19 can develop AKI and tend to have a poorer prognosis.


Subject(s)
Diabetes Mellitus , Kidney Diseases , COVID-19 , Cardiovascular Diseases , Acute Kidney Injury , Hypertension
6.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667918.82784506.v1

ABSTRACT

Background: Coronavirus disease-2019 (COVID-19) can cause asymptomatic, mild upper respiratory tract symptoms, pneumonia in young persons. How the disease will progress in each patient is still unknown. Therefore, we aimed to investigate the prognostic markers of the development of pneumonia and the clinical characteristics of patients under 65 years with COVID-19 confirmed by a positive reverse transcriptase polymerase chain reaction (RT-PCR) test. Method: In this retrospective study, a total of 271 patients admitted in our unit were included. The patients were divided into two groups, those who did or did not develop pneumonia. Their clinical features, treatment protocols and laboratory parameters were recorded retrospectively. Results: Pneumonia developed in 67.9% (n = 184) of the cases. Age in the pneumonia group was higher than in the non-pneumonia group (p < 0.001). In the logistic regression analysis, when symptom and comorbidity status were examined according to the presence of pneumonia; HT (OR: 4,525 95% CL: 1,494–13,708) were the most important risk factor for pneumonia. When age and laboratory values were examined according to the presence of pneumonia, advanced age (OR: 1.042 95% CL: 1.01–1.073), low albumin (OR: 0.917 95% CL: 0.854–0.986) and high troponin (OR: 1.291 95% CL: 1.044–1.596) were identified as risk factors for pneumonia. Conclusion: HT, older age, low albumin, high troponin were important factors for predicting COVID-19 pneumonia in patients under 65 years of age. Young patients with these predictive factors should be more carefully evaluated by further diagnostic procedures, such as thoracic CT. Key Words: COVID-19, pneumonia, young adults


Subject(s)
Pneumonia , COVID-19 , Hypertension
7.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170670243.38938793.v1

ABSTRACT

Cardiovascular diseases (CVDs) remain the cause of millions of deaths in the world annually. Despite the great progress in therapies, which are available for patients with CVDs, some limitations including drug complications still exist. Hence, the endocannabinoid system (ECS) was proposed as a new avenue for CVDs treatment. The cardiovascular action of cannabinoids is complex as they not only affect vasculature and myocardium directly via specific receptors but also exert indirect effects through the central and peripheral nervous system. The growing interest in phytocannabinoid studies has been broadened the knowledge about their molecular targets as well as therapeutical properties, nonetheless, some areas of their actions are not yet fully recognized. The purpose of this review is to summarize and update the cardiovascular actions of the most potent phytocannabinoids and the potential therapeutic role of ECS in CVDs, including ischemic reperfusion injury, arrhythmia, heart failure, hypertension as well as cardiac complications associated with the novel coronavirus SARS-CoV-2 infections.


Subject(s)
Ischemia , COVID-19 , Cardiovascular Diseases , Coronavirus Infections , Heart Failure , Arrhythmias, Cardiac , Hypertension
8.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3903857.v1

ABSTRACT

The ongoing COVID-19 pandemic necessitates the identification of effective biomarkers to gauge disease severity. C-reactive protein (CRP), D-Dimer, and White Blood Cell counts (WBCs) have emerged as potential indicators of COVID-19 severity and prognosis. This research, conducted at Qalla Hospital, enrolled 112 confirmed COVID-19 patients and 35 healthy controls, employing comprehensive clinical and laboratory evaluations that included CRP, D-Dimer, and WBC measurements. The diagnosis of COVID-19 adhered to established clinical criteria and was confirmed through SARS-CoV-2 testing, with stringent assessments to ensure precise participant classification. The results unveiled significantly elevated CRP (p-value=0.0001), D-Dimer (p-value=0.0001), and WBCs in COVID-19 patients compared to healthy controls. Elevated CRP levels, indicative of inflammation, increased D-Dimer levels associated with coagulation abnormalities, and raised WBCs within the CRP level (0.943), indicative of an immune response, were prevalent in COVID-19 patients. Gender distribution was balanced, while comorbidities such as diabetes mellitus (25%), hypertension (34.8%), kidney disease (6.2%), and multiple concurrent diseases (34%) were prevalent in the COVID-19 cohort. The discussion underscores the substantial differences in CRP, D-Dimer, and WBCs, emphasizing their potential as valuable biomarkers for diagnosing and monitoring COVID-19 severity. These biomarkers could serve as critical tools in evaluating disease progression, predicting complications, and guiding tailored therapeutic interventions. In conclusion, CRP, D-Dimer, and WBCs exhibited marked disparities between healthy individuals and COVID-19 patients, indicating their potential as diagnostic and prognostic indicators. Continued investigation into the utility of these biomarkers may refine risk stratification and treatment strategies, ultimately enhancing patient outcomes in COVID-19 management. A deeper understanding of the clinical implications of CRP, D-Dimer, and WBC levels could profoundly impact disease management and patient care strategies.


Subject(s)
Diabetes Mellitus , Inflammation , Kidney Diseases , COVID-19 , Coagulation Protein Disorders , Hypertension
9.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3875469.v1

ABSTRACT

Background Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the elderly in Jiangsu, China is relatively lacking. Methods We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patternsin old adults. Results The mean age of these patients was 72.0±8.7 years, and the male-to-female ratio was 1:1.53. These patients during the COVID-19 period(from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases(I10-I15)", "Other forms of heart disease(I30-I52)", "Diabetes mellitus(E10-E14)", "lschaemic heart diseases(I20-I25)" and "Cerebrovascular diseases(I60-I69)". The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by Diabetes mellitus, Other forms of heart disease, and lschaemic heart diseases(I20-I25). Conclusion In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in gerontal patients. More efforts to improve the understanding of multimorbidity patterns would help us develop new clinical and family care models.


Subject(s)
Chronic Disease , Diabetes Mellitus , Cerebrovascular Disorders , Heart Diseases , COVID-19 , Hypertension
10.
medrxiv; 2024.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2024.01.17.24301326

ABSTRACT

ObjectiveTo explore the reasons for not getting vaccinated against COVID-19. Material and methodsIn October 2021, a nationwide structured telephone survey (disproportionate stratified sampling) was conducted regarding COVID-19 pandemics, including vaccination experience. To examine associations between inoculation and other characteristics, the chi-square test and logistic regression analysis were applied. ResultsOut of 3 126 adults, 68% reported complete vaccination and 21% only the first dose, while 11% remained unvaccinated. Non-vaccination was associated with being younger, male, without a partner, low socioeconomic level, and no previous diagnosis of hypertension, obesity or diabetes. Furthermore, the non-vaccinated were less likely to have tested for COVID-19, and more likely to consider COVID-19 as low severe and not real compared with the vaccinated. Using logistic regression models: place of residence, marital status, educational level, age, BMI, testing for COVID-19, and the perception of COVID-19 (severe and real) were significant predictors of non-vaccination. The predominant reasons for not getting vaccinated were: 63% "external barriers" (e.g., not being able to attend an appointment), and 37% "internal motives" (e.g., "vaccine does not work"). ConclusionsThe causes of non-vaccination against COVID-19 are related to both social and geographical determinants. Addressing external barriers is necessary in order to promote equity in vaccination. Reviewing the results in the context of earlier studies on the willingness to vaccinate, the gap between intention and vaccination is notable.


Subject(s)
Obesity , Diabetes Mellitus , COVID-19 , Hypertension
11.
medrxiv; 2024.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2024.01.11.24301106

ABSTRACT

Adverse effects of COVID-19 on perinatal health have been documented, however there is a lack of research that separates individual disease from other changing risks during the pandemic period. We linked California statewide birth and hospital discharge data for 2019-2020, and compared health indicators among 3 groups of pregnancies: [a] 2020 delivery with COVID-19, [b] 2020 delivery with no documented COVID-19, and [c] 2019 pre-pandemic delivery. We aimed to quantify the links between COVID-19 and perinatal health, separating individual COVID-19 disease (a vs b) from the pandemic period (b vs c). We examined the following health indicators: preterm birth, hypertensive disorders of pregnancy, gestational diabetes mellitus and severe maternal morbidity. We applied model based standardization to estimate "average effect of treatment on the treated" risk differences (RD), and adjusted for individual and community-level confounders. Among pregnancies in 2020, those with COVID-19 disease had higher burdens of preterm birth (RD[95% confidence interval (CI)]=2.8%[2.1,3.5]), hypertension (RD[95% CI]=3.3%[2.4,4.1]), and severe maternal morbidity (RD[95% CI]=2.3%[1.9,2.7]) compared with pregnancies without COVID-19 (a vs b) adjusted for confounders. Pregnancies in 2020 without COVID-19 had a lower burden of preterm birth (RD[95% CI]=-0.4%[-0.6,-0.3]), particularly spontaneous preterm, and a higher burden of hypertension (RD[95% CI]=1.0%[0.9,1.2]) and diabetes RD[95%CI]=0.9%[0.8,1.1] compared with pregnancies in 2019 (b vs c) adjusted for confounders. Protective associations of the pandemic period for spontaneous preterm birth may be explained by socioenvironmental and behavioral modifications, while increased maternal conditions may be due to stress and other behavioral changes. To our knowledge, our study is the first to distinguish between individual COVID-19 disease and the pandemic period in connection with perinatal outcomes.


Subject(s)
Diabetes, Gestational , COVID-19 , Hypertension , Diabetes Mellitus
12.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.12.22.23300474

ABSTRACT

In sub-Saharan Africa, reported COVID-19 numbers have been lower than anticipated, even when considering populations younger age. The extent to which risk factors, established in industrialised countries, impact the risk of infection and of disease in populations in sub-Saharan Africa, remains unclear. We estimated the incidence of mild and moderate COVID-19 in urban Mozambique and analysed factors associated with infection and disease in a population-based surveillance study. During December 2020-March 2022, households of a population cohort in Polana Canico, Maputo, Mozambique, were contacted biweekly. Residents reporting any respiratory sign, anosmia, or ageusia, were asked to self-administer a nasal swab, for SARS-CoV-2 PCR testing. Of a subset of 1400 participants, dried blood spots were repeatedly collected three-monthly from finger pricks at home. Antibodies against SARS-CoV-2 spike glycoprotein and nucleocapsid protein were detected using an in-house developed multiplex antibody assay. We estimated the incidence of respiratory illness and COVID-19, and SARS-CoV-2 seroprevalence. We used Cox regression models, adjusting for age and sex, to identify factors associated with first symptomatic COVID-19 and with SARS-CoV-2 sero-conversion in the first six months. During 11925 household visits in 1561 households, covering 6049 participants (median 21 years, 54.8% female, 7.3% disclosed HIV positive), 1895.9 person-years were followed up. Per 1000 person-years, 364.5 (95%CI 352.8-376.1) respiratory illness episodes of which 72.2 (95%CI 60.6-83.9) COVID-19 confirmed, were reported. Of 1412 participants, 2185 blood samples were tested (median 30.6 years, 55.2% female). Sero-prevalence rose from 4.8% (95%CI 1.1-8.6%) in December 2020 to 34.7% (95%CI 20.2-49.3%) in June 2021, when 3.0% were vaccinated. Increasing age (strong gradient in hazard ratio, HR, up to 15.70 in [≥]70 year olds, 95%CI 3.74-65.97), leukaemia, chronic lung disease, hypertension, and overweight increased risk of COVID-19. We found no increased risk of COVID-19 in people with HIV or tuberculosis. Risk of COVID-19 was lower among residents in the lowest socio-economic quintile (HR 0.16, 95%CI 0.04-0.64), with no or limited handwashing facilities, and who shared bedrooms (HR 0.42, 95%CI 0.25-0.72). Older age also increased the risk of SARS-CoV-2 seroconversion (HR 1.57 in 60-69 year olds, 95%CI 1.03-2.39). We found no associations between SARS-CoV-2 infection risk and socio-economic, behavioural factors and comorbidities. Active surveillance in an urban population cohort confirmed frequent COVID-19 underreporting, yet indicated that the large majority of cases were mild and non-febrile. In contrast to industrialised countries, deprivation did not increase the risk of infection nor disease.


Subject(s)
Hypertension , Respiratory Insufficiency , COVID-19 , Pulmonary Disease, Chronic Obstructive , Tuberculosis , Leukemia , Ageusia , Olfaction Disorders
13.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.12.18.23300150

ABSTRACT

Background: Chronic kidney disease (CKD) patients were susceptible to morbidity and mortality once they affected by COVID-19. These patients were more likely to develop severe disease, requiring dialysis, admission to intensive care unit. The aim of this study was to evaluate the presentations and outcomes of COVID-19 in stage 3-5 CKD patients not on dialysis. Methods This prospective observational study was conducted in the COVID-19 unit, at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2020 to August 2021. Hospitalized RT-PCR positive COVID-19 patients with pre-existing CKD having eGFR <60 ml/min/1.73 m 2 but not yet on dialysis were enrolled. Clinical and laboratory parameters were recorded. Outcomes were observed till discharge from the hospital and followed up after 3 months of survived patients. Results Out of 109 patients, the mean age was 58.1(SD: 15.4) years where 61.5% were male. Common co-morbid conditions were hypertension (89.0%), diabetes mellitus (58.7%) and ischemic heart disease (24.8%). Fever, cough, shortness of breath and fatigue were common presenting features. Most of the patients had moderate (41.3%) and severe (41.3%) COVID-19. Sixty-six patients (60.6%) developed AKI on CKD. Twenty patients (30.3%) required dialysis. Death occurred in 16 patients (14.7%) and 12 patients (11%) required ICU admission and 6 patients (9.1%) achieved baseline renal function at discharge. We identified risk factors like low haemoglobin, lymphopenia, high CRP, high procalcitonin, high LDH and low SpO 2 in patients who did not survive. Seventy-six patients were followed up at 3rd month where 17 patients were lost. Ten patients (27.0%) achieved baseline renal function who had persistent AKI at discharge and 34 patients (87.1%) remained stable who had stable renal function at discharge. Conclusion The stage 3-5 chronic kidney patients with COVID-19 are vulnerable to severe to critical morbidity and mortality with higher incidence of AKI which demands a special attention to this group of patients.


Subject(s)
Diabetes Mellitus , Fever , Dyspnea , Ischemia , Heart Diseases , COVID-19 , Renal Insufficiency, Chronic , Cough , Lymphopenia , Fatigue , Hypertension
14.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.12.17.23300072

ABSTRACT

AimsTo describe patterns of weight change amongst adults living in England with Type 2 Diabetes (T2D) and/or hypertension during the COVID-19 pandemic. Design and SettingWith the approval of NHS England, we conducted an observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP. MethodWe estimated individual rates of weight gain during the pandemic ({delta}). We then estimated associations between clinical and sociodemographic characteristics and rapid weight gain (>0.5kg/m2/year) using multivariable logistic regression. ResultsWe extracted data on adults with T2D (n=1,231,455, 44% female, 76% white British) or hypertension (n=3,558,405, 50% female, 84% white British). Adults with T2D lost weight overall (median {delta} = -0.1kg/m2/year [IQR: -0.7, 0.4]), however, rapid weight gain was common (20.7%) and associated with sex (male vs female: aOR 0.78[95%CI 0.77, 0.79]); age, older age reduced odds (e.g. 60-69-year-olds vs 18-29-year-olds: aOR 0.66[0.61, 0.71]); deprivation, (least-deprived-IMD vs most-deprived-IMD: aOR 0.87[0.85, 0.89]); white ethnicity (Black vs White: aOR 0.70[0.69, 0.71]); mental health conditions (e.g. depression: aOR 1.13 [1.12, 1.15]); and diabetes treatment (non-insulin treatment vs no pharmacological treatment: aOR 0.68[0.67, 0.69]). Adults with hypertension maintained stable weight overall (median {delta} = 0.0kg/m2/year [-0.6, 0.5]), however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D. ConclusionAmongst adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common amongst females, younger adults, those living in more deprived areas, and those with mental health conditions. How this fits inPrevious studies, in the general population, have reported female sex, deprivation and comorbid mental health conditions increased risk of unhealthy weight gain during the pandemic, but it is not clear whether people living with hypertensions and/or type 2 diabetes experienced the same trends. We found that, during the pandemic, adults with hypertension maintained a stable weight whilst those with type 2 diabetes lost weight overall. However, underlying these overall trends, rapid weight gain was common amongst people with type 2 diabetes (20.7%) or hypertension (24.7%)), with female sex, younger age, deprivation, and comorbid mental health conditions associated with an increased odds of rapid weight gain in both populations. We have identified clinical and sociodemographic characteristics of individuals with hypertension and/or type 2 diabetes who could benefit from primary care interventions on weight and health behaviours to combat health inequalities in patterns of weight gain that were exacerbated by the pandemic.


Subject(s)
Diabetes Mellitus, Type 2 , Diabetes Mellitus , Weight Gain , Depressive Disorder , COVID-19 , Hypertension
15.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.12.15.23298521

ABSTRACT

Introduction: Prior studies have identified various determinants of differential immune responses to COVID-19. This investigation delves into the Ig-G anti-RBD marker, scrutinizing its potential correlations with sex, vaccine type, body fat percentage, metabolic risk, perceived stress, and previous COVID-19 exposure. Methods. In this study, data were obtained from 116 participants from the ESFUERSO cohort, who completed questionnaires detailing their COVID-19 experiences and stress levels assessed through the SISCO scale. Quantification of Ig-G anti-RBD concentrations was executed using an ELISA assay developed by UNAM. Multiple regression analysis was adeptly employed to control for covariates, including sex, age, body fat percentage, BMI, and perceived stress. Results. This sample comprised young individuals (average age of 21.4 years), primarily consisting of females (70%), with a substantial proportion reporting a family history of diabetes, hypertension, or obesity. Most students had received the Moderna or Pfizer vaccines, and 91% displayed a positive anti-RBD response. A noteworthy finding was the interaction between body fat percentage and sex. In males, increased adiposity was associated with a decrease in Ig-G anti-RBD concentration, while in females, the response increased. Importantly, this trend was consistent regardless of the vaccine received. No significant associations were observed for variables such as dietary habits or perceived stress. Conclusions. In summation, this research reports the impact of both sex and body fat percentage on the immune response through Ig-G anti-RBD levels to COVID-19 vaccines. The implications of these findings offers a foundation for educational initiatives and the formulation of preventive policies aimed at mitigating health disparities.


Subject(s)
Obesity , Diabetes Mellitus , COVID-19 , Hypertension
16.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3722818.v1

ABSTRACT

Background COVID-19 survivors may develop long-term symptoms of fatigue, dyspnea, mental health issues, and functional limitations: a condition termed post-acute sequelae of COVID-19 (PASC). Pulmonary rehabilitation (PR) is a recommended treatment for PASC; however, there is a lack of data regarding PR’s effect on multiple health indices and the factors that influence patient outcomes.Methods We extracted patient demographic, comorbidity, and outcome data from Allegheny Health Network’s electronic medical records. Functionality test results were compared before and after PR, including 6-minute walk test (6MWT), chair rise repetitions (CR reps), timed up and go test (TUG), gait speed (Rehab gait), modified medical research council scale (MMRC), shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS) and chronic obstructive pulmonary disease assessment test (CAT) scores. Multiple regression analysis was done to evaluate the effect of comorbidities and patient factors on patient responses to PR.Results The 55 patients included in this study had a mean time of 3.8 months between the initial COVID-19 diagnosis and the subsequent PASC diagnosis. Post-PR, patients signficantly improved in 6MWT, CR reps, TUG, Rehab gait, MMRC, SOBQ, HADS, and CAT scores. However, hypertension, diabetes, chronic lung diseases, being an outpatient, and receiving pharmacologic treatments (decadron, decadron + remdesivir, and decadron + remdesivir + tocilizumab) were associated with a poor response to PR.Conclusion Our study supports PR as an integrated model of care for PASC patients to improve several physical and mental health indices. The long-term effects of PR on patients’ functional status should be investigated in the future.


Subject(s)
Diabetes Mellitus , Depressive Disorder , Hypertension , COVID-19 , Lung Diseases , Pulmonary Disease, Chronic Obstructive , Anxiety Disorders , Fatigue , Dyspnea
17.
biorxiv; 2023.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2023.09.20.558551

ABSTRACT

Tissue specific implications of SARS-CoV-2 encoded accessory proteins are not fully understood. SARS-CoV-2 infection can severely affect three major organs - the heart, lung, and brain. We analysed SARS-CoV-2 ORF3a interacting host proteins in these three major organs. Further we identified common and unique interacting host proteins, their targeting miRNAs (lung and brain), and delineated associated biological processes reanalysing RNA-seq data from the brain (COVID-19 infected/uninfected Choroid Plexus Organoids study), lung tissue from COVID-19 patients/healthy subjects, and cardiomyocyte cells based transcriptomics analyses. Our in silico studies showed ORF3a interacting proteins could vary depending upon tissues. Number of unique ORF3a interacting proteins in brain, lung and heart were 10, 7 and 1 respectively. Though common pathways influenced by SARS-CoV-2 infection were more, unique 21 brain and 7 heart pathways were found. One unique pathway for heart was negative regulation of calcium ion transport. Reported observations of COVID-19 patients with the history of hypertension taking calcium channel blockers (CCBs) or dihydorpyridine CCBs had elevated rate of intubation or increased rate of intubation/death respectively. Also likelihood of hospitalization of chronic CCB users with COVID-19 was more in comparison to long term Angiotensin Converting Enzyme inhibitors/Angiotensin Receptor Blockers users. Further studies are necessary to confirm this. miRNA analysis of ORF3a interacting proteins in brain and lung revealed, 2 of 37 brain miRNAs and 1 of 25 lung miRNAs with high degree and betweenness indicating their significance as hubs in the interaction network. Our study could help in identifying potential tissue specific COVID-19 drug/drug repurposing targets.


Subject(s)
COVID-19 , Papilloma, Choroid Plexus , Hypertension
18.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.09.21.23295669

ABSTRACT

BackgroundThe long-term impact of coronavirus disease 2019 (COVID-19) on many aspects of society emphasizes the necessity of vaccination and nucleic acid conversion time as markers of prevention and diagnosis. However, little research has been conducted on the immunological effects of vaccines and the influencing factors of virus clearance. Epidemiological characteristics and factors related to disease prognosis and nucleic acid conversion time need to be explored. Design and participantsWe reviewed published documentation to create an initial draft. The data were then statistically evaluated to determine their link. Given that a Chongqing shelter hospital is typical in terms of COVID-19 patients receiving hospital management and treatment effects, a retrospective analysis was conducted on 4,557 cases of COVID-19 infection in a shelter hospital in Chongqing in December 2022, which comprised 2,291 males and 2,266 females. The variables included age, medical history, nucleic acid conversion time, vaccination status, and clinical symptoms. ResultsUnivariate survival analysis using the Log-rank test (P < 0.05) showed that factors such as age significantly affected nucleic acid conversion time. COX regression analysis indicated a significant association between a history of hypertension and nucleic acid conversion time, which had a hazard ratio of 0.897 (95% CI: 0.811-0.992). A statistically significant difference was observed between vaccinated and unvaccinated infected individuals in terms of the presence of symptoms such as cough and sensory system manifestations (P < 0.05). ConclusionThe effect of vaccination against COVID-19 on symptoms such as coughing, nasal congestion, muscle aches, runny nose, and sensory system symptoms in COVID-19 patients was determined. Typical symptoms, such as runny nose, were generally higher in vaccinated than in unvaccinated ones; previous hypertension was an influential factor in nucleic acid conversion time in patients with COVID-19 infection. STRENGTHS AND LIMITATIONSThis study clarifies the advantages of vaccination by comparing the symptom development between patients who had received vaccinations and those who had not. This research suggests potential future study directions, such as investigating the impact of pre-existing diseases like hypertension on viral clearance time and assessing vaccine efficacy and safety in certain demographic groups. This work investigated data from 4,557 coronavirus disease 2019 patients admitted to a shelter hospital, which offered significant insights into patients clinical features and outcomes over a defined time span. This study has several flaws because a retrospective analysis method was used and not all confounding variables that might have affected the results were appropriately controlled. The overall research sample may not be representative of other communities because it was drawn from a shelter hospital in Chongqing, and the types of immunizations used were not disclosed. These factors might have had an impact on the precision and extent of the research findings.


Subject(s)
Pain , COVID-19 , Cough , Coronavirus Infections , Hypertension
19.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.09.10.23295323

ABSTRACT

Introduction: The association between COVID-19 infection and the development of new-onset diabetes and hypertension is an emerging area of research. However, a comprehensive understanding of the underlying molecular mechanisms is still lacking. Network analysis using bioinformatics tools can provide valuable insights into the complex molecular interactions involved in these conditions after COVID-19 infection. Objective: This study aims to use bioinformatics tools to analyze the network of molecular interactions related to new-onset diabetes and hypertension following COVID-19 infection. Methods: Data from publicly available databases were utilized, including gene expression profiles and protein-protein interaction information. Differential expression analysis was performed to identify genes that were differentially expressed in individuals with new-onset diabetes and hypertension after COVID-19 infection compared to healthy controls. A protein interaction network was constructed using bioinformatics tools to explore the functional relationships among the identified differentially expressed genes. Results: The network analysis revealed several key proteins and pathways related to the pathogenesis of new-onset diabetes and hypertension after COVID-19 infection. Notably, proteins involved in insulin signaling, glucose metabolism, inflammation, and blood pressure regulation were found to be prominently associated. The signaling pathway and the renin-angiotensin system were identified as key pathways in this context. Conclusion: This study provides insights by showing a network-based perspective on the molecular interactions involved in the development of new-onset diabetes and hypertension after COVID-19 infection. Keywords: COVID-19 infection, diabetes, hypertension, network analysis, bioinformatics.


Subject(s)
Diabetes Mellitus , Glucose Metabolism Disorders , Inflammation , COVID-19 , Hypertension
20.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.09.03.23294865

ABSTRACT

Introduction: Antivirals with differing mechanisms of action are needed for COVID 19 treatment; remdesivir is mainly used in hospitalized patients, but additional antivirals are needed in this setting. Ensitrelvir, a 3C like protease inhibitor, received emergency approval in Japan in November 2022, based on evidence of rapid symptom resolution in nonhospitalized patients, but confirmation of its efficacy in hospitalized patients is lacking. Case presentations: This case series reports outcomes for all patients who received ensitrelvir whilst hospitalized with SARS CoV 2 infection at Rinku General Medical Center, Japan (November 2022 to April 2023). Thirty two hospitalized patients received five days of ensitrelvir treatment (375/125 mg). Mean age was 73.5 years and most patients had mild COVID 19. Patients exhibited various underlying diseases, most commonly hypertension (78.1%) and chronic kidney disease (25.0%). Seven (21.9%) patients were on hemodialysis. The most common concomitant medications were antihypertensives (59.4%) and corticosteroids (31.2%); two (6.3%) patients were being treated with rituximab; 27 (84.4%) patients had viral persistence following pretreatment remdesivir failure. Following ensitrelvir treatment, all patients experienced clinical improvement as assessed by the investigator. No ICU admissions or deaths due to COVID 19 occurred. Viral clearance was recorded in 18 (56.3%) patients by day 5 and 25 (78.1%) patients at final measurement. No new safety signals were observed. Discussion: This case series represents ensitrelvir clinical efficacy in hospitalized patients with SARS CoV 2 in a real world setting. Most patients experienced persistent viral shedding despite pretreatment with antivirals, and most were considered high risk due to underlying conditions. Despite this, no patients experienced progression of COVID 19 to severe or critical disease, including those who failed prior remdesivir treatment. The antiviral activity of ensitrelvir demonstrated here indicates it is a viable treatment option for SARS CoV 2 infection in this setting. Conclusion: Ensitrelvir was associated with potent antiviral activity and positive clinical outcomes in high risk, hospitalized patients with various comorbidities. Trial Registration: UMIN000051300


Subject(s)
Renal Insufficiency, Chronic , Critical Illness , Severe Acute Respiratory Syndrome , Hypertension
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