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1.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3962861.v1

ABSTRACT

Background: Streptococcus pneumoniae is the most common bacterial cause of community acquired pneumonia and the acute respiratory distress syndrome (ARDS). Some clinical trials have demonstrated a beneficial effect of corticosteroid therapy in community acquired pneumonia, COVID-19, and ARDS, but the mechanisms of this benefit remain unclear. The objective of this study was to investigate the effects of corticosteroids on the pulmonary biology of pneumococcal pneumonia in an observational cohort of mechanically ventilated patients and in a mouse model of bacterial pneumonia with Streptococcus pneumoniae. Methods: We studied gene expression with lower respiratory tract transcriptomes from a cohort of mechanically ventilated patients and in mice. We also carried out comprehensive physiologic, biochemical, and histological analyses in mice to identify the mechanisms of lung injury in Streptococcus pneumoniae with and without adjunctive steroid therapy. Results: Transcriptomic analysis identified pleiotropic effects of steroid therapy on the lower respiratory tract in critically ill patients with pneumococcal pneumonia, findings that were reproducible in mice. In mice with pneumonia, dexamethasone in combination with ceftriaxone reduced (1) pulmonary edema formation, (2) alveolar protein permeability, (3) proinflammatory cytokine release, (4) histopathologic lung injury score, and (5) hypoxemia but did not increase bacterial burden. Conclusions: The gene expression studies in patients and in the mice support the clinical relevance of the mouse studies, which replicate several features of pneumococcal pneumonia and steroid therapy in humans. In combination with appropriate antibiotic therapy in mice, treatment of pneumococcal pneumonia with steroid therapy reduced hypoxemia, pulmonary edema, lung permeability, and histologic criteria of lung injury, and also altered inflammatory responses at the protein and gene expression level. The results from these studies provide evidence for the mechanisms that may explain the beneficial effects of glucocorticoid therapy in patients with community acquired pneumonia from Streptococcus Pneumoniae.


Subject(s)
COVID-19 , Pulmonary Edema , Respiratory Distress Syndrome , Lung Diseases , Pneumonia, Pneumococcal , Pneumonia, Bacterial , Critical Illness , Adenocarcinoma, Bronchiolo-Alveolar , Hypoxia , Pneumonia
2.
medrxiv; 2024.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2024.02.13.24302773

ABSTRACT

Background: Human rhinoviruses (RV) primarily cause the common cold, but infection outcomes vary from subclinical to severe cases, including asthma exacerbations and fatal pneumonia in immunocompromised individuals. To date, therapeutic strategies have been hindered by the high diversity of serotypes. Global surveillance efforts have traditionally focused on sequencing VP1 or VP2/VP4 genetic regions, leaving gaps in understanding RV true genomic diversity. Methods: We sequenced 1,003 RV genomes from nasal swabs of symptomatic and asymptomatic individuals to explore viral evolution during two epidemiologically distinct periods in Washington State: when the COVID 19 pandemic affected the circulation of other seasonal respiratory viruses except for RV (from February to July 2021), and when the seasonal viruses reemerged with the severe RSV and influenza outbreak (November and December 2022). We constructed maximum likelihood and BEAST phylodynamic trees to characterize intra-genotype evolution. Results: We detected 100 of 168 known genotypes, identified two new genotypes (A111 and C59), and observed inter-genotypic recombination and genotype cluster swapping from 2021 to 2022. We found a significant association between the presence of symptoms and viral load, but not with RV species or genotype. Phylodynamic trees, polyprotein selection pressure, and Shannon diversity revealed co-circulation of divergent clades within genotypes with high amino acid constraints throughout polyprotein. Discussion: Our study underscores the dynamic nature of RV genomic epidemiology within a localized geographic region, as more than 20% of existing genotypes within each RV species co-circulated each month. Our findings also emphasize the importance of investigating correlations between rhinovirus genotypes and serotypes to understand long-term immunity and cross-protection.


Subject(s)
Pneumonia
3.
preprints.org; 2024.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202402.0739.v1

ABSTRACT

Given the various clinical manifestations that characterize COVID-19, the scientific community is constantly searching for biomarkers with prognostic value. SP-A and SP-D collectins play a crucial role in ensuring proper alveolar function and an alteration of their serum levels have been reported in several pulmonary diseases characterized by ARDS and pulmonary fibrosis. Considering that such clinical manifestations can also occur during SARS-CoV-2 infection, we wondered if these collectins could act as prognostic markers. In this regard, serum levels of SP-A and SP-D were measured by enzyme immunoassay in patients with SARS-CoV-2 infection (n=51) at admission (T0) and after 7 days (T1) and compared with healthy donors (n=11). SP-D increased in COVID-19 patients compared to healthy controls during the early phases of infection, while a significant reduction was observed at T1. Stratifying SARS-CoV-2 patients according to disease severity, increased serum SP-D levels were observed in severe compared to mild patients. In the light of these results SP-D, but not SP-A, seems to be an eligible marker of COVID-19 pneumonia and the early detection of SP-D serum levels could be crucial for a preventive clinical management


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Lung Diseases , Pulmonary Fibrosis , Adenocarcinoma, Bronchiolo-Alveolar , Pneumonia
4.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3952351.v1

ABSTRACT

Background: Pulmonary fibrosis persists long after recovering from coronavirus disease 2019 (COVID-19) infection, thereby reducing quality of life and lung function. We aimed to evaluate the prevalence and risk factors for pulmonary fibrosis in patients with severe COVID-19 pneumonia requiring mechanical ventilation, a high-risk group for developing pulmonary fibrosis. Methods: Clinical data and chest computed tomography (CT) scans of patients with severe COVID-19 pneumonia requiring mechanical ventilation were retrospectively collected from nine hospitals in South Korea. Fibrotic-like changes on chest CT were visually assessed. Results: We included 125 patients with a mean age of 68.5 years, 60.8% men and 7.2% having underlying lung disease. Based on follow-up chest CT (the median interval: 38.0 days, interquartile range: 24.0–68.0 days), 94 (75.2%) patients exhibited fibrotic-like changes, with traction bronchiectasis and/or bronchiolectasis being the most common change (60.8%). Adjusted Cox regression analysis revealed as association between hemoglobin levels ≤9 g/dL and an increased risk of pulmonary fibrosis development (HR: 3.182, 95% Cl: 1.203–8.415, P=0.025). Among all patients, 17.6% died during hospitalization and 71.2% experienced complications, including intubation-related airway injury (12.8%), ventilator-associated pneumonia (44.8%), lung injury (11.2%), and hemodynamic disturbance (33.4%). In-hospital mortality (16.1% vs. 18.1%) and complications (67.7% vs. 72.3%) were similar between patients with and without fibrotic-like changes. Conclusion: Our study demonstrated that in patients with severe COVID-19 pneumonia requiring mechanical ventilation, chest CT revealed fibrotic-like changes in approximately three-fourths of patients. Low hemoglobin levels might be associated with pulmonary fibrosis in severe COVID-19 pneumonia.


Subject(s)
COVID-19 , Lung Diseases , Pulmonary Fibrosis , Critical Illness , Pneumonia
5.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3939729.v1

ABSTRACT

Background The COVID-19 pandemic has posed a major challenge to healthcare systems globally. Millions of people have been infected, and millions of deaths have been reported worldwide. Glucocorticoids have attracted worldwide attention for their potential efficacy in the treatment of COVID-19. Various glucocorticoids with different dosages and treatment durations have been studied in patients with different severities, with a suitable dosage and treatment duration not yet defined. This study aimed to investigate whether in-hospital survival differs between critically ill patients treated with low-dose glucocorticoids, high-dose glucocorticoids or no glucocorticoids.Methods All critically ill patients admitted to the intensive care unit of the Charité Hospital - Universitätsmedizin Berlin between February 2020 and December 2021 with COVID-19 pneumonia were eligible to participate in this multicenter real-world data study. Patients were retrospectively assigned to one of three groups: the high corticosteroid dose (HighC) group (receiving 6 mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), the low corticosteroid dose (LowC) group (receiving less than 6 mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), or the no corticosteroid (NoC) group. Overall survival and risk effects were compared among groups within the total observation period, as well as at 35 days after the onset of COVID-19 symptoms. Adjusted multivariable Cox proportional hazard regression analysis was performed to compare the risk of death between the treatment groups.Results Out of 1561 critically ill COVID-19 patients, 1014 were included in the baseline analysis. In the survival study, 1009 patients were assigned to the NoC (n = 346), HighC (n = 552), or LowC group (n = 111). The baseline characteristics were balanced between groups, except for age, BMI, APACHE II score, SOFA and SAPS II. While the 35-day survival did not show any differences, a landmark analysis of the patients surviving beyond 35 days revealed differences between groups. The restricted mean survival time was 112 days in the LowC group [95% CI: 97–128], 133 days in the HighC group [95% CI: 124–141] and 144 days in the NoC group [95% CI: 121–167]. The multivariable-adjusted Cox proportional hazard analysis indicated that, regardless of age, sex, health status or invasive oxygenation, a low-dose treatment increased the hazard of death of critically ill COVID-19 patients by a factor of 2.09 ([95% CI: 0.99, 4.4], p = 0.05) and a high-dose corticosteroid treatment increased the risk by a factor of 1.07 ([95% CI: 0.53, 2.15], p = 0.85) compared to no treatment with glucocorticoids.Conclusion The analysis reveals that corticosteroid treatment does not influence the survival of critically ill COVID-19 patients in the intensive care unit within 35 days. Our evaluations further suggest that regardless of ventilation status, the decision-making process for administering corticosteroid therapy should account for the individual severity of the illness. Notably, in non-severely ill patients in the intensive care unit, corticosteroid treatment seems to offer no benefits. In contrast, severely critically ill patients demonstrate the advantages of a high dosage of glucocorticoids.


Subject(s)
COVID-19 , Critical Illness , Pneumonia
6.
researchsquare; 2024.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3931620.v1

ABSTRACT

Objective This retrospective cohort study aimed to assess the clinical characteristics, treatment outcomes, and short-term prognosis of kidney transplant recipients (KTRs) with concurrent coronavirus disease 2019 (COVID-19) pneumonia.Methods KTRs with COVID-19 pneumonia who were admitted to our hospital from December 28, 2022, to March 28, 2023 were included in the study, and their clinical symptoms, response to antiviral medications, and short-term prognosis were analyzed.Results A total of 64 KTRs with initial diagnosis of COVID-19 pneumonia were included in this study. The primary symptoms were fever, cough, and myalgia, with an incidence of 79.7%, 89.1%, and 46.9%, respectively. The administration of antiviral drugs (paxlovid or molnupiravir) within 1–5 days and for over 5 days demonstrated a statistically significant reduction in viral shedding time compared to the group without antiviral medication (P = 0.002). Both the paxlovid and molnupiravir treatment groups exhibited a significantly shorter duration of viral shedding time in comparison to the group without antiviral drugs (P = 0.002). After 6 months of recovery, there was no significantly negative impact on transplant kidney function (P = 0.294).Conclusion Fever, cough, and myalgia remain common initial symptoms of concurrent COVID-19 pneumonia in KTRs. The earlier use of antiviral drugs (the paxlovid or molnupiravir) is associated with better therapeutic outcomes. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had limited impact on short-term renal function of the KTRs with concurrent moderate or severe COVID-19 pneumonia.


Subject(s)
COVID-19 , Cough , Fever , Myalgia , Severe Acute Respiratory Syndrome , Pneumonia
7.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667000.08057435.v1

ABSTRACT

Aim: In this study we aimed to investigate diagnostic usefullness and optimal cut-off values of monocyte, mean platelet volume (MPV), eosinophil, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocye ratio (MLR), red blood cell distribution width (RDW) in laboratory confirmed Covid-19 cases with and without pneumonia who were totally healthy before being infected with Covid-19. Materials and Methods: Data of a total 10000 patients who were admitted to hospital with complaints apropriate with Covid-19 in six months (March–Agust 2020) interval and underwent SARS-CoV-2 Polymerase Chain Reaction (PCR) investigated. Out of 10000 patients we included only previosly healthy 174 patients with Covid-19 pneumonia, 144 SARS-CoV-2 positive but no pneumonia and SARS-CoV-2 PCR negative 156 healthy controls. The laboratory results and demographic findings were collected from patient files retrospectively before undergiong treatment for Covid-19. Results: We found wbc levels lower in Covid-19 patients with pneumonia (p <0.001 vs healthy), as well as neutrophil (p <0.001 vs healthy), Monocyte (p <0.001 vs healthy and Covid-19 without pneumonia), Eosinophil (p <0.001 vs healthy and Covid-19 without pneumonia) and Platelet count (p <0.001 vs healthy). MLR remained higher in patients without pneumonia (p <0.001 vs Covid-19 with pneumonia and healthy controls) as well as PLR (p <0.001 versus Healthy). Conclusion: In the light of the obtained results, decrease in wbc, neutrophil, monocyte and eosinophil levels support the diagnosis of Covid-19 pneumonia on the other hand increase in MLR and PLR may indicate Covid-19 without pneumonia. Keywords: Covid-19 pneumonia, esoinophil, monocyte


Subject(s)
COVID-19 , Pneumonia
8.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667121.18354854.v1

ABSTRACT

Aim: The purpose of this study was to determine the host risk factors associated with mortality in COVID-19 patients who are hospitalized for pneumonia, and also, to find a COVID-19 mortality score based on these. Methods: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalised in our Chest Diseases Education and Research Hospital between March 11, 2020 and October 1,2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. Results: Over 422 patients (n: 51 mortal, n: 371 survivors) univariate regression analysis showed that age, male gender, smoking, comorbidity, and using ACE inhibitor were prognostic host risk factors for COVID-19-related mortality. Using this analysis, a novel scoring model Co-AMSCA (Age, Male, Smoking history, Comorbidity, ACE inh)was established. The cut-off value of this scoring system (including only host risk factors), which determines the mortality risk in patients, was 3.5 points with 88.4% sensitivity and 65.5 % specificity (AUC = 0.761, 95% CI 0.697-0.826, P < .001) (Figure 1). The mortality risk in patients with a Co-AMSCA mortality score above 3.5 points was 7.8 times higher than patients with lower than 3.5 (OR= 7.8; P < .001).In multivariate logistic regression analysis, older age and smoking (smoker/ex-smoker) were found to be important risk factors for mortality (OR = 12.09; 95% CI 2,564-57,054 P =0.004 and OR = 3.1; 95% CI 1,381-7,295; P = 0.007,respectively). Counclusion:We created a simple mortality score, which is easily calculated and does not require laboratory and time.This study showed that by using Co-AMSCA mortality score that has only host risk factors achieved a prediction of mortality in COVID-19 patients who are hospitalized for pneumonia.


Subject(s)
COVID-19 , Chest Pain , Pneumonia
9.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667173.31690793.v1

ABSTRACT

On 31 December 2019, pneumonia of unknown cause was detected in Wuhan, China, and was first reported to the WHO Country Office in China. On 30 January 2020, the outbreak was declared a Public Health Emergency of International Concern. (1) It was an outbreak of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection that occurred in Wuhan, Hubei Province, China and got spread across China and beyond. WHO officially named the disease - Corona virus Disease 2019 (COVID-19) on February 12, 2020. (2) It has been spreading worldwide for a period of atleast a year & half (3) This review article addresses the current scenario caused by the SARS- Co V along with the treatment protocols and ongoing vaccines.


Subject(s)
COVID-19 , Severe Acute Respiratory Syndrome , Virus Diseases , Pneumonia
10.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667412.29359311.v1

ABSTRACT

Congenital Adrenal Hyperplasia (CAH) is managed with long-term corticosteroid and is suggested to higher dose, based on the general sick day principles. I presented a 5-year-old CAH case by pneumonia managed in our pediatrics department. Considering stress doses of cortisone in management of CAH patients with COVID19 should be considered.


Subject(s)
Adrenal Hyperplasia, Congenital , COVID-19 , Pneumonia
11.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667338.83766255.v1

ABSTRACT

Introduction: One of the most important risk factor for COVID-19 infection is malignancy especially hematologic ones. Focusing on the clinical, radiological and laboratory characteristics of COVID-19 infected cancer patients remain largely important. Materials and Methods: In this retrospective study, we analyzed the data of 194 patients with hematologic malignancy and COVID-19 pneumonia. We categorized patients based on the type of the hematologic malignancy and phase of the treatment. All associated and important laboratory data including complete blood count, pro-inflammatory markers, and computerized tomography scan findings were reported to assess the risk factors associated mortality. Results: From January 2020 to March 2021, a total of 194 COVID-19 infected patients with hematologic malignancies were included in different phase of treatments. Median age was 44 (15-81) years. 135 of the cases were male and 59 of the cases were female. Acute myeloid leukemia was the most frequent cancer type (43.8%). A total of 119 patients had severe COVID-19 and 61 patients were admitted to intensive care unit. A total of 92 deaths occurred among all cases for an overall case fatality rate of 47%. Male gender (P=0.03), pre-induction and induction phase of the treatment (P<0.001), Intensive care unit admission (P<0.001), low level of oxygen saturation at the onset of COVID-19 disease (P<0.001) and high level of fibrinogen (P=0.002) were associated with COVID-19 mortality among patients with hematologic malignancies. Conclusion: The results of this study showed male gender, pre-induction and induction phase of the treatment, Intensive care admission, low levels of oxygen saturation at the onset of COVID-19 disease, RH positivity and higher fibrinogen level were associated with the risk of death. Identification of factors potentially associated with mortality for cancer patients are important in assessment strategy in these high risk group.


Subject(s)
Hematologic Neoplasms , COVID-19 , Infections , Neoplasms , Leukemia, Myeloid , Death , Pneumonia
12.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667437.73023879.v1

ABSTRACT

COVID-19 has caused global pandemics since the emergent outbreak and resulted in a large number of deaths. IL-6, as an important autoimmune cytokine, had been suggested for the treatment of acute respiratory distress syndrome (ARDS) patients in COVID-19. A review of the relevant literature revealed more than one role for IL-6 in the lung infection because of its diverse biological effects. It may have a variety of different physiological functions in the development of lung infection. We have summarized its role in different progress of COVID-19, including lung infection, pneumonia, ALI, pulmonary fibrosis, and lung translation and even lung cancer. This will facilitate a deeper understanding of the role of IL-6 in the treatment of COVID-19.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Lung Diseases , Pulmonary Fibrosis , Lung Neoplasms , Pneumonia
13.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667602.23138802.v1

ABSTRACT

The first case of sever pneumonia caused by coronavirus (COVID-19) was detected in Wuhan, China in December 2019 and spread rapidly around the world. Pneumothorax has been reported as an uncommon complication following COVID-19 infection which caused by alveolar rupture, air leakage and interstitial emphysema after alveolar damages. Bilateral pneumothorax is also an uncommon life threatening complication induced by COVID-19 which has to be considered in patients present with late sudden dyspnea after Coronavirus infection. In this case report, we are presenting a patient with mild COVID-19 pneumonia with a left massive pneumothorax following a late sudden dyspnea in third week of the disease, during the hospitalization, in addition to aggravating the respiratory condition, right pneumothorax was also added.


Subject(s)
Dyspnea , COVID-19 , Emphysema , Coronavirus Infections , Adenocarcinoma, Bronchiolo-Alveolar , Pneumonia
14.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667979.90522820.v1

ABSTRACT

Objective: To assess and compare the Maternal and fetal outcomes of critically ill pregnant women infected with COVID – 19 cases of pneumonia who required admission to the intensive care unit. Design: A retrospective observational study Settings: Tertiary care hospital settings affiliated with an academic center in UAE. Patients and Methods: A total of 123 patients in their third trimester were included from 1 December 2020 to 31 March 2021 in the study with 30 cases of severe or critical COVID and 93 mild to moderate pregnant COVID patients. The maternal demographic, radiological, and biochemical profile of mothers was noted. Maternal and fetal outcomes were compared. Main outcomes Measured: Maternal and fetal outcomes were compared in severe and mild COVID cases. Result: A total of 30 (24.3%) patients were admitted in ICU and eight required invasive ventilation meaning, Severe COVID was significantly associated with higher mortality (20% vs 0% p-value <0.001), postpartum complications (50% vs 9.67% p-value<0.001) and increased overall hospital stay (p-value<0.001). Neonates born to severe COVID patients had significant higher chances of being born preterm (76.6% vs 35.7% p-value<0.001) and have low birth weight (46.6% vs 13.9% p-value=0.002). There were four cases of stillbirth, two cases of vertical transmission, and no neonatal deaths. Conclusion: Pregnant females with severe COVID have high mortality, peripartum complications; and increased hospital stay. The newborns born to such mothers may be premature, have low birth weights but have comparable mortality


Subject(s)
COVID-19 , Critical Illness , Stillbirth , Pneumonia
15.
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)
Hypertension , COVID-19 , Pneumonia
16.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170668400.07102481.v1

ABSTRACT

The novel coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is a global pandemic which is primarily considered a respiratory illness. However, emerging reports show that the virus exhibits both pulmonary and extra-pulmonary manifestations in humans, with the kidney as a major extra-pulmonary target due to its abundant expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2, which facilitate entry of the virus into cells. Acute kidney injury has become prevalent in COVID-19 patients without prior any history of kidney dysfunction. In addition, the virus also worsens kidney conditions and increases mortality of COVID-19 patients with pre-existing chronic kidney disease, renal cancer, diabetic nephropathy, end-stage kidney disease as well as dialysis and kidney transplant patients. In the search for antiviral agents for the treatment of COVID-19, hydrogen sulfide (H2S), the third established member of gasotransmitter family, is emerging as a potential candidate, possessing important therapeutic properties including antiviral, anti-inflammatory, anti-thrombotic and antioxidant properties. A recent clinical study revealed higher serum H2S levels in survivors of COVID-19 pneumonia with reduced interleukin-6 levels compared to fatal cases. In this review, we summarize the global impact of COVID-19 on kidney conditions and discuss the emerging role of H2S as a potential COVID-19 therapy.


Subject(s)
Renal Insufficiency, Chronic , COVID-19 , Respiratory Insufficiency , Kidney Diseases , Kidney Neoplasms , Thrombosis , Acute Kidney Injury , Diabetic Nephropathies , Kidney Failure, Chronic , Pneumonia
17.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170668278.82813816.v1

ABSTRACT

Background: T wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short and long-term cardiovascular mortality in patients who have heart failure, anterior myocardial infarction, and receive hemodialysis for various reasons. The aim of this study was to investigate the relationship between T wave positivity in the lead aVR on superficial ECG and mortality from COVID-19 pneumonia. Methods: This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction (PCR) studied from an oropharyngeal swab Results: A total of 130 patients were included in this study. Patients were divided into 2 groups: survived and deceased. There were 55 patients (with a mean age of 64.76-14.93 years, 58.18% male, 41.12% female) in the survived group, while there were 75 patients (with a mean age of 65-15 years, 58.67% male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive TAVR (OR: 5.151, 95% CI: 1.001-26.504, p: 0.0012), lactate dehydrogenase (LDH) (OR: 1.006, 95% CI: 1.001-1.010, p: 0.012) and D-dimer (OR:1.436, 95% CI: 1.115-1.848, p: 0.005) were independent risk factors for mortality Conclusions: positive TAaVR is useful in risk stratification for COVID-19 pneumonia mortality. KEY WORLD:Electrocardıographıa, positive TAaVR, COVID-19 pneumonia, mortality


Subject(s)
COVID-19 , Ventricular Fibrillation , Heart Failure , Thoracic Diseases , Myocardial Infarction , Pneumonia
18.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170668498.88811116.v1

ABSTRACT

Background: Our knowledge about SARS-CoV2 infection is still evolving, its effects and complications on children and adolescents with cancer need to be studied more. The aim of this study is to present our experience with SARS-CoV2 infection in this population and to highlight specific complications and outcomes. Methods: This is a retrospective and prospective observational study, involved 21 cancer patients below the age of 18 years in north Jordan. Data regarding age, sex, cancer type, phase of treatment, duration between infection and chemotherapy and others were collected and reviewed. Results: A total of 21 patients with malignancy were included. Mean age of 8.5 years. Two patients (9.5%) had died; 4.7% is COVID related mortality and 4.7% related to cancer progression. Four patients had disease progression following SARS-CoV2 infection. Six cases developed hematological malignancy weeks to months after SARS-CoV2 infection and one patient was diagnosed with malignancy concomitantly with COVID-19 infection. Out of 15 patients with pre-existing malignancy, 1 patient (7%) developed pulmonary embolism, 4 (27%) patients were diagnosed with pneumonia and one patient was diagnosed with pericarditis (7%), 2 (13%) patients were admitted to pediatric intensive care unit. Regarding oxygen requirements; a total of 3 (20%) patients required some form of Oxygen supplementation. Conclusion: Diagnosis of COVID19 should not distract physicians from investigating new malignancy or relapse as they may come together or may be the result of COVID-19 infection. More studies and investigations are needed to identify the contribution of corona virus in pathogenesis of cancer.


Subject(s)
Hematologic Neoplasms , COVID-19 , Pericarditis , Neoplasms , Pulmonary Embolism , Severe Acute Respiratory Syndrome , Pneumonia
19.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170668577.76388463.v1

ABSTRACT

Pulmonary alveolar proteinosis (PAP) is a rare syndrome due to increased production or decreased clearance of surfactant in alveoli and terminal bronchi that cause hypoxemic respiratory insufficiency. Here we present a patient with past medical history of PAP whose disease was exacerbated by superimposed COVID-19 pneumonia. He underwent whole pulmonary lavage (WPL). Evaluation of the viral count of the first and the last lavage of the left lung showed viral load in the alveolar space dropped by approximately 10-folds, however the magnitude of the viral load was substantial in both lavage samples. Whole pulmonary lavage may be used as a treatment option on patients with COVID pneumonia superimposed on a pulmonary alveolar proteinosis (PAP) exacerbation.


Subject(s)
COVID-19 , Respiratory Insufficiency , Rare Diseases , Adenocarcinoma, Bronchiolo-Alveolar , Pulmonary Alveolar Proteinosis , Pneumonia
20.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170668786.68650928.v1

ABSTRACT

Background: Considering the role of higher blood urea nitrogen and lower serum albumin (SA) levels in deceased COVID-19 patients, increased blood urea nitrogen to SA (B/A) ratio may help to determine those at higher risk of becoming critically ill. This study evaluated the association of SA level and B/A ratio with disease severity and 30–day mortality and also their predictive value for disease severity in COVID–19 patients. Methods: 433 adult patients with COVID–19, admitted to a referral medical center in Tehran, Iran, from February to May 2020 were included. The laboratory markers were measured on admission. Disease severity was categorized into mild disease, severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and septic shock. The mortality was followed up for thirty days after admission. Results: Thirty–day mortality rate was 27.25%. The frequency of mild, severe pneumonia, ARDS, sepsis, and septic shock was 30.72%, 36.95%, 24.02%, 6.00%, and 2.31%, respectively. Mean B/A ratio was different among different disease severities. The odds of thirty-day mortality increased by 16% by each unit increase in B/A ratio and decreased by 57% by each unit increase in SA level. B/A ratio had the AUC of 0.45 for disease severity prediction with 71% sensitivity and 22% specificity. Conclusion: The results showed that B/A ratio and SA levels are associated with mortality in COVID–19 patient, while they had low predictive value for disease severity. High B/A ratio is, additionally, associated with disease severity. Therefore, we suggest to use this marker for clinical assessment of patients with COVID–19.


Subject(s)
Sepsis , COVID-19 , Respiratory Distress Syndrome , Shock, Septic , Pneumonia
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