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1.
Cochrane Database Syst Rev ; 6: CD013333, 2020 06 20.
Article in English | MEDLINE | ID: covidwho-1453528

ABSTRACT

BACKGROUND: Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prevalence of Demodex blepharitis among adults, and it affects both men and women equally. While Demodex mites are commonly treated with tea tree oil, the effectiveness of tea tree oil for treating Demodex blepharitis is not well documented. OBJECTIVES: To evaluate the effects of tea tree oil on ocular Demodex infestation in people with Demodex blepharitis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; LILACS; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions in the electronic search for trials. We last searched the databases on 18 June 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared treatment with tea tree oil (or its components) versus another treatment or no treatment for people with Demodex blepharitis. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the titles and abstracts and then full text of records to determine their eligibility. The review authors independently extracted data and assessed risk of bias using Covidence. A third review author resolved any conflicts at all stages. MAIN RESULTS: We included six RCTs (1124 eyes of 562 participants; 17 to 281 participants per study) from the US, Korea, China, Australia, Ireland, and Turkey. The RCTs compared some formulation of tea tree oil to another treatment or no treatment. Included participants were both men and women, ranging from 39 to 55 years of age. All RCTs were assessed at unclear or high risk of bias in one or more domains. We also identified two RCTs that are ongoing or awaiting publications. Data from three RCTs that reported a short-term mean change in the number of Demodex mites per eight eyelashes contributed to a meta-analysis. We are uncertain about the mean reduction for the groups that received the tea tree oil intervention (mean difference [MD] 0.70, 95% confidence interval [CI] 0.24 to 1.16) at four to six weeks as compared to other interventions. Only one RCT reported data for long-term changes, which found that the group that received intense pulse light as the treatment had complete eradication of Demodex mites at three months. We graded the certainty of the evidence for this outcome as very low. Three RCTs reported no evidence of a difference for participant reported symptoms measured on the Ocular Surface Disease Index (OSDI) between the tea tree oil group and the group receiving other forms of intervention. Mean differences in these studies ranged from -10.54 (95% CI - 24.19, 3.11) to 3.40 (95% CI -0.70 7.50). We did not conduct a meta-analysis for this outcome given substantial statistical heterogeneity and graded the certainty of the evidence as low. One RCT provided information concerning visual acuity but did not provide sufficient data for between-group comparisons. The authors noted that mean habitual LogMAR visual acuity for all study participants improved post-treatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). We graded the certainty of evidence for this outcome as low. No RCTs provided data on mean change in number of cylindrical dandruff or the proportion of participants experiencing conjunctival injection or experiencing meibomian gland dysfunction. Three RCTs provided information on adverse events. One reported no adverse events. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with re-educating the patient on application techniques and continuing use of the tea tree oil. We graded the certainty of the evidence for this outcome as very low. AUTHORS' CONCLUSIONS: The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the short-term treatment of Demodex blepharitis; however, if used, lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. Future studies should be better controlled, assess outcomes at long term (e.g. 10 to 12 weeks or beyond), account for patient compliance, and study the effects of different tea tree oil concentrations.


Subject(s)
Anti-Infective Agents, Local/therapeutic use , Blepharitis/drug therapy , Mite Infestations/drug therapy , Tea Tree Oil/therapeutic use , Adult , Blepharitis/parasitology , Female , Humans , Male , Middle Aged , Mite Infestations/complications , Randomized Controlled Trials as Topic
2.
Int J Mol Sci ; 22(5)2021 Mar 04.
Article in English | MEDLINE | ID: covidwho-1389392

ABSTRACT

Alveolar type II (ATII) cells are a key structure of the distal lung epithelium, where they exert their innate immune response and serve as progenitors of alveolar type I (ATI) cells, contributing to alveolar epithelial repair and regeneration. In the healthy lung, ATII cells coordinate the host defense mechanisms, not only generating a restrictive alveolar epithelial barrier, but also orchestrating host defense mechanisms and secreting surfactant proteins, which are important in lung protection against pathogen exposure. Moreover, surfactant proteins help to maintain homeostasis in the distal lung and reduce surface tension at the pulmonary air-liquid interface, thereby preventing atelectasis and reducing the work of breathing. ATII cells may also contribute to the fibroproliferative reaction by secreting growth factors and proinflammatory molecules after damage. Indeed, various acute and chronic diseases are associated with intensive inflammation. These include oedema, acute respiratory distress syndrome, fibrosis and numerous interstitial lung diseases, and are characterized by hyperplastic ATII cells which are considered an essential part of the epithelialization process and, consequently, wound healing. The aim of this review is that of revising the physiologic and pathologic role ATII cells play in pulmonary diseases, as, despite what has been learnt in the last few decades of research, the origin, phenotypic regulation and crosstalk of these cells still remain, in part, a mystery.


Subject(s)
Alveolar Epithelial Cells/pathology , Alveolar Epithelial Cells/physiology , Lung Diseases/physiopathology , Lung/physiology , Alveolar Epithelial Cells/cytology , Animals , COVID-19/physiopathology , Humans , Immunity, Innate , Ions/metabolism , Lung/anatomy & histology , Lung Diseases/etiology , Lung Diseases/pathology , Pulmonary Surfactant-Associated Proteins/metabolism , Regeneration
3.
Mol Genet Genomic Med ; 9(7): e1726, 2021 07.
Article in English | MEDLINE | ID: covidwho-1361220

ABSTRACT

BACKGROUND: Primary ciliary dyskinesia (PCD) is a mostly autosomal recessive, genetic disease of abnormal motile cilia function, resulting in bronchiectasis, infertility, organ laterality defects, and chronic otolaryngology disease. Though motile, ependymal cilia influencing cerebrospinal fluid flow in the central nervous system share many aspects of structure and function with motile cilia in the respiratory tract, hydrocephalus is rarely associated with PCD. Recently, pathogenic variants in FOXJ1 (Chr 17q25.1) were identified causing PCD associated with hydrocephalus, reduced respiratory cilia number, axonemal microtubule disorganization, and occurring in a de novo, autosomal dominant inheritance pattern. METHOD: Two patients with chronic oto-sino-pulmonary disease and hydrocephalus underwent candidate testing of FOXJ1. Coding region and splice junctions were sequenced and analyzed under the auspices of Genetic Disorders of Mucociliary Clearance Consortium. RESULTS: Upon sequencing of the entire coding region and splice-junctions, heterozygous, pathogenic variants in FOXJ1 were discovered in exon 3 of two patients: an 11-month-old female with situs inversus totalis (NM_001454.4: c.945delC (p.Phe315Leufs*18)) and a 51 year-old male, post-double lung transplantation (NM_001454.4: c.929_932delACTG (p.Asp310Glyfs*22)). FOXJ1 variants were not detected in the available parents and the siblings of these probands. CONCLUSION: FOXJ1 pathogenic variants cause PCD in a de novo, autosomal dominant inheritance pattern, and are associated with hydrocephalus. Physicians treating patients with hydrocephalus and chronic oto-sino-pulmonary disease should be aware of this PCD association and test for FOXJ1 variants.


Subject(s)
Ciliary Motility Disorders/genetics , Forkhead Transcription Factors/genetics , Hydrocephalus/genetics , Ciliary Motility Disorders/pathology , Female , Genes, Dominant , Humans , Hydrocephalus/pathology , Infant , Male , Middle Aged , Mutation , Phenotype
4.
Thorax ; 76(7): 726-728, 2021 07.
Article in English | MEDLINE | ID: covidwho-1270899

ABSTRACT

Acute admission to hospital for an exacerbation of chronic respiratory disease (CRD) may impair skeletal muscle mass and function. We measured quadriceps thickness (Qthick), as a surrogate marker of muscle mass, at hospital admission, discharge, 6 weeks and 3 months in 55 patients with CRD. Qthick fell by 8.3% during the period of hospitalisation, which was sustained at 6 weeks, and only partially recovered at 3 months. Sustained loss was most marked in patients readmitted during the follow-up period. Acute reduction in quadriceps muscle mass occurs during hospitalisation, with prolonged and variable recovery, which is prevented with subsequent hospital readmission.


Subject(s)
Patient Admission/statistics & numerical data , Quadriceps Muscle/physiopathology , Respiration Disorders/complications , Sarcopenia/etiology , Aged , Chronic Disease , Disease Progression , Female , Follow-Up Studies , Humans , Male , Prognosis , Quality of Life , Respiration Disorders/physiopathology , Retrospective Studies , Risk Factors , Sarcopenia/physiopathology
5.
Hypertens Res ; 44(9): 1047-1053, 2021 09.
Article in English | MEDLINE | ID: covidwho-1260939

ABSTRACT

There is currently a respiratory disease outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After rapid development, RNA vaccines and adenoviral vector vaccines were approved within a year, which has demonstrated the strong impact of preventing infectious diseases using gene therapy technology. Furthermore, intensive immunological analysis has been performed to evaluate the efficiency and safety of these vaccines, potentially allowing for rapid progress in vaccine technology. After the coronavirus disease 2019 (COVID-19) era, the novel vaccine technology developed will expand to other vaccines. We have been developing vaccines for chronic diseases, such as hypertension, for >10 years. Regarding the development of vaccines against self-antigens (i.e., angiotensin II), the vaccine should efficiently induce a blocking antibody response against the self-antigen without activating cytotoxic T cells. Therefore, the epitope vaccine approach has been proposed to induce antibody production in response to a combination of a B cell epitope and exogenous T cell epitopes through major histocompatibility complex molecules. When these vaccines are established as therapeutic options for hypertension, their administration regimen, which might be a few times per year, will replace daily medication use. Thus, therapeutic vaccines for hypertension may be a novel option to control the progression of cerebrovascular diseases. Hopefully, the accumulation of immunological findings and vaccine technology advances due to COVID-19 will provide a novel concept for vaccines for chronic diseases.


Subject(s)
Autoantigens/immunology , COVID-19 Vaccines/immunology , COVID-19/prevention & control , Hypertension/therapy , SARS-CoV-2/immunology , Vaccines/therapeutic use , Chronic Disease , Humans
6.
Healthcare (Basel) ; 9(5)2021 May 07.
Article in English | MEDLINE | ID: covidwho-1256477

ABSTRACT

BACKGROUND: Psoriasis is a chronic dermatological condition characterized by lesions on extensor surfaces, hands, feet, and genital areas. Chronic renal failure is often associated with metabolic syndrome and inflammatory conditions, such as psoriasis. CASE REPORT: In this paper, we report a patient with stage-three chronic renal failure that improved his renal condition after treatment with ixekizumab, an anti-IL17A drug used in the treatment of various cutaneous and rheumatological conditions. CONCLUSIONS: IL17A blockage may help to treat various autoimmune and inflammatory conditions, such as psoriasis, that may lead to renal impairment. Further investigation is necessary in order to prove the effectiveness of this drug in renal conditions.

7.
BMC Public Health ; 21(1): 1068, 2021 06 05.
Article in English | MEDLINE | ID: covidwho-1255924

ABSTRACT

BACKGROUND: Since early 2020, the Covid-19 pandemic has engulfed the world. Amidst the growing number of infections and deaths, there has been an emphasis of patients with non-communicable diseases as they are particularly susceptible to the virus. The objective of this literature review is to systematize the available evidence on the link between non-communicable diseases and Covid-19. METHODS: We have conducted a systematic review of the literature on Covid-19 and non-communicable diseases from December, 2019 until 15th of November, 2020. The search was done in PubMed and in doing so we used a variety of searching terms in order to isolate the final set of papers. At the end of the selection process, 45 papers were selected for inclusion in the literature review. RESULTS: The results from the review indicate that patients with certain chronic illnesses such as diabetes, hypertension (and other cardiovascular diseases), chronic respiratory illnesses, chronic kidney and liver conditions are more likely to be affected by Covid-19. More importantly, once they do get infected by the virus, patients with chronic illnesses have a much higher likelihood of having worse clinical outcomes (developing a more severe form of the disease or dying) than an average patient. There are two hypothesized channels that explain this strong link between the chronic illnesses enumerated above and Covid 19: (i) increased ACE2 (angiotensin-converting enzyme 2) receptor expressions, which facilitates the entry of the virus into the host body; and (ii) hyperinflammatory response, referred to as "cytokine storm". Finally, the literature review does not find any evidence that diabetes or hypertension related medications exacerbate the overall Covid-19 condition in chronic illness patients. CONCLUSIONS: Thus, the evidence points out to 'business as usual' disease management model, although with greater supervision. However, given the ongoing Covid-19 vulnerabilities among people with NCDs, prioritizing them for the vaccination process should also figure high on the agenda on health authorities.


Subject(s)
COVID-19 , Hypertension , Noncommunicable Diseases , Humans , Hypertension/epidemiology , Noncommunicable Diseases/epidemiology , Pandemics , SARS-CoV-2
8.
Stud Health Technol Inform ; 281: 392-396, 2021 May 27.
Article in English | MEDLINE | ID: covidwho-1247793

ABSTRACT

This paper proposes an automated knowledge synthesis and discovery framework to analyze published literature to identify and represent underlying mechanistic associations that aggravate chronic conditions due to COVID-19. We present a literature-based discovery approach that integrates text mining, knowledge graphs and ontologies to discover semantic associations between COVID-19 and chronic disease concepts that were represented as a complex disease knowledge network that can be queried to extract plausible mechanisms by which COVID-19 may be exacerbated by underlying chronic conditions.


Subject(s)
COVID-19 , Diabetes Mellitus , Kidney Diseases , Data Mining , Humans , Pattern Recognition, Automated , SARS-CoV-2
9.
Int J Environ Res Public Health ; 18(10)2021 05 16.
Article in English | MEDLINE | ID: covidwho-1234717

ABSTRACT

BACKGROUND: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. OBJECTIVE: To explore the prevalence of some behavioral health risk factors, intermediate risk factors, and chronic diseases at different timepoints during 2020 using the data available from a currently used surveillance system in Saudi Arabia. METHODS: This study undertook a secondary analysis of data from the Sharik Health Indicators Surveillance System (SHISS). The SHISS employs short cross-sectional phone interviews, conducted in all 13 administrative regions of Saudi Arabia on a quarterly basis. Each interview lasts approximately 4 min and is conducted by a trained data collector. The SHISS collects demographic data, as well as data on the major behavioral and intermediate chronic disease risk factors and the major chronic diseases, including diabetes, heart disease, stroke, cancer, and chronic respiratory diseases. RESULTS: Of the 44,782 potential participants contacted in 2020, 30,134 completed the interview, with a response rate of 67.29%. Out of the total participants, 51.2% were female. The mean age was 36.5. The behavioral risk factors in this period exhibited significant changes compared to those in the first quarter (Q1) of 2020, when there were no significant restrictions on daily activities. These significant changes are related to reductions in fruit and vegetable intake (adjusted odds ratio (AOR), 0.23) and physical activity (AOR, 0.483), and a significant increase in e-cigarette use (AOR 1.531). In terms of the intermediate risk factors observed in the SHISS, significant increases in hypercholesterolemia (AOR, 1.225) and hypertension (AOR, 1.190) were observed. Finally, heart disease (AOR, 1.279) and diabetes (AOR, 1.138) displayed significant increases compared to Q1. CONCLUSIONS: This study shows some evidence of the impact of responses to COVID-19 on the health of the population in Saudi Arabia. Significant reductions in fruit and vegetable intake and physical activity, and significant increases in e-cigarette use, hypertension, and hypercholesterolemia may increase the burden of chronic diseases in Saudi Arabia in the near future. Thus, continuous monitoring of the health risk factors within the population, and early interventions, are recommended to prevent future increases in chronic diseases.


Subject(s)
COVID-19 , Electronic Nicotine Delivery Systems , Population Health , Adult , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , Saudi Arabia/epidemiology
10.
Public Health Pract (Oxf) ; 2: 100141, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1233591

ABSTRACT

OBJECTIVES: Socioeconomic factors such as elevated incidence of chronic disease, overcrowding, and increased occupational exposure result in higher risk of infectious disease. The COVID-19 pandemic has appeared to disproportionately affect communities affected by deprivation and discrimination, who also appear to be at greater risk of severe disease. Our aim was to investigate the evolution of the socioeconomic groups affected by COVID-19 over the course of the first wave of the pandemic by examining patients presenting to an acute NHS trust. STUDY DESIGN: and methods: A retrospective study using the postcodes of patients presenting to the Brighton and Sussex University Hospitals NHS Trust who tested PCR-positive for COVID-19 were used to determine average house price and index of multiple deprivation. These were used as markers of affluence to examine the trend in the socioeconomic status of affected patients from February to May 2020. RESULTS: 384 cases were included. The postcodes of those individuals who were initially infected had higher average house prices and index of multiple deprivation, both of which followed downward trends as the outbreak progressed. CONCLUSION: Our data shows that the outbreak spread from higher to lower affluence groups through the course of the pandemic. We hypothesise that this was due to wealthier individuals initially transmitting the virus from abroad. Therefore, an earlier and more effective quarantine could have reduced spread to members of the community at greater risk of infection and harm. We suggest that hospitals systematically record the socioeconomic status of affected individuals in order to monitor trends, identify those who may be at risk of severe disease, and to push for more equitable public health policy.

11.
J Asthma ; : 1-7, 2021 Jun 02.
Article in English | MEDLINE | ID: covidwho-1232110

ABSTRACT

OBJECTIVE: There is limited information in literature on how coronavirus disease-2019 (COVID-19) pandemic period affects people with asthma. This study aimed to compare levels of physical activity, stress, and fear and quality of life and sleep quality between patients with asthma and healthy individuals during the pandemic. METHODS: Twenty-two patients with asthma and 22 healthy individuals aged between 18 and 65 years were included. Physical activity level using "International Physical Activity Questionnaire"; stress level, using "Perceived Stress Scale-14"; fear level, using "Fear of COVID-19 Scale"; sleep quality, using "Pittsburgh Sleep Quality Index"; and quality of life, using "World Health Organization Quality of Life" were evaluated. RESULTS: Total physical activity level, vigorous physical activity level, and walking score of patients with asthma were lower than healthy individuals (p < .05). Sitting time of patients with asthma was higher than healthy individuals (p < .05). Subjective sleep quality, latency, duration, efficiency, sleeping medication use, and daytime dysfunction of both were similar (p > .05). Only sleep disturbance score of patients with asthma were higher than healthy individuals (p < .05). Quality of life, stress, and fear levels of both were similar (p > .05). CONCLUSION: During pandemic, patients with asthma are more inactive than healthy individuals regardless of the presence of a chronic disease; pandemic negatively affected stress, fear levels, sleep, and quality of life. To minimize the effects of restrictions and psychological burden caused by pandemic and to encourage patients with asthma to perform physical activities, conducting studies to control stress levels and increasing quality of life and sleep of all individuals are important.

12.
EPMA J ; : 1-14, 2021 Mar 03.
Article in English | MEDLINE | ID: covidwho-1227926

ABSTRACT

Chronic liver disease management is a comprehensive approach requiring multi-professional expertise and well-orchestrated healthcare measures thoroughly organized by responsible medical units. Contextually, the corresponding multi-faceted chain of healthcare events is likely to be severely disturbed or even temporarily broken under the force majeure conditions such as global pandemics. Consequently, the chronic liver disease is highly representative for the management of any severe chronic disorder under lasting pandemics with unprecedented numbers of acutely diseased persons who, together with the chronically sick patient cohorts, have to be treated using the given capacity of healthcare systems with their limited resources. Current study aimed at exploring potentially negative impacts of the SARS CoV-2 outbreak on the quality of the advanced chronic liver disease (ACLD) management considering two well-classified parameters, namely, (1) the continuity of the patient registrations and (2) the level of mortality rates, comparing pre-COVID-19 statistics with these under the current pandemic in Slovak Republic. Altogether 1091 registrations to cirrhosis registry (with 60.8% versus 39.2% males to females ratio) were included with a median age of 57 years for patients under consideration. Already within the very first 3 months of the pandemic outbreak in Slovakia (lockdown declared from March 16, 2020, until May 20, 2020), the continuity of the patient registrations has been broken followed by significantly increased ACLD-related death rates. During this period of time, the total number of new registrations decreased by about 60% (15 registrations in 2020 versus 38 in 2018 and 38 in 2019). Corresponding mortality increased by about 52% (23 deaths in 2020 versus 10 in 2018 and 12 in 2019). Based on these results and in line with the framework of 3PM guidelines, the pandemic priority pathways (PPP) are strongly recommended for maintaining tertiary care uninterrupted. For the evidence-based implementation of PPP, creation of predictive algorithms and individualized care strategy tailored to the patient is essential. Resulting classification of measures is summarized as follows:The Green PPP Line is reserved for prioritized (urgent and comprehensive) treatment of patients at highest risk to die from ACLD (tertiary care) as compared to the risk from possible COVID-19 infection.The Orange PPP Line considers patients at middle risk of adverse outcomes from ACLD with re-addressing them to the secondary care. As further deterioration of ACLD is still probable, pro-active management is ascertained with tertiary center serving as the 24/7 telemedicine consultation hub for a secondary facility (on a physician-physician level).The Red PPP Line is related to the patients at low risk to die from ACLD, re-addressing them to the primary care. Since patients with stable chronic liver diseases without advanced fibrosis are at trivial inherent risk, they should be kept out of the healthcare setting as far as possible by the telemedical (patient-nurse or patient- physician) measurements. The assigned priority has to be monitored and re-evaluated individually-in intervals based on the baseline prognostic score such as MELD. The approach is conform with principles of predictive, preventive and personalized medicine (PPPM / 3PM) and demonstrates a potential of great clinical utility for an optimal management of any severe chronic disorder (cardiovascular, neurological and cancer) under lasting pandemics.

13.
Aging (Albany NY) ; 13(9): 12301-12307, 2021 05 06.
Article in English | MEDLINE | ID: covidwho-1220256

ABSTRACT

Patients with pre-existing chronic diseases are more susceptible to coronavirus disease 2019 (COVID-19), yet the underlying causes of increased risk are of infection remain unclear. Angiotensin-converting- enzyme 2 (ACE2), the cell surface receptor that recognizes the coronavirus spike protein has protective effects against inflammation and chronic hyperglycemia in animal models. The roles of ACE2 in severe SARS-CoV-2 infections remains ambiguous due to contradictory findings. In this study, we aimed to investigate the relationship between human plasma ACE2 levels in diabetics and the high risk of severe SARS-CoV-2 infection. First, the medical records of 245 patients with SARS-CoV-2-positive who have chronic diseases were analyzed. We also recruited 404 elderly subjects with comorbid chronic diseases such as diabetes mellitus, coronary heart disease, cerebrovascular disease, hypertension and obesity, and investigated the ACE2 plasma levels. Plasma concentrations of ACE2 were much lower (2973.83±2196.79 pg/mL) in diabetics with chronic disease than in healthy controls (4308.21±2352.42 pg/ml), and the use of hypoglycemia drugs was associated with lower circulating concentrations of ACE2 (P=1.49E-08). Diabetics with lower plasma levels of ACE2 may be susceptible to severe COVID-19. Our findings suggest that the poor prognosis in patients with diabetes infected with SARS-CoV-2 may be due to low circulating ACE2 levels.


Subject(s)
Angiotensin-Converting Enzyme 2/blood , COVID-19/blood , Diabetes Mellitus/blood , Aged , COVID-19/enzymology , Diabetes Mellitus/enzymology , Female , Humans , Male , Middle Aged , SARS-CoV-2
14.
J Clin Endocrinol Metab ; 106(5): e2025-e2034, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1199961

ABSTRACT

PURPOSE: Comorbidities making up metabolic syndrome (MetS), such as obesity, type 2 diabetes, and chronic cardiovascular disease can lead to increased risk of coronavirus disease-2019 (COVID-19) with a higher morbidity and mortality. SARS-CoV-2 antibodies are higher in severely or critically ill COVID-19 patients, but studies have not focused on levels in convalescent patients with MetS, which this study aimed to assess. METHODS: This retrospective study focused on adult convalescent outpatients with SARS-CoV-2 positive serology during the COVID-19 pandemic at NewYork Presbyterian/Weill Cornell. Data collected for descriptive and correlative analysis included SARS-COV-2 immunoglobin G (IgG) levels and history of MetS comorbidities from April 17, 2020 to May 20, 2020. Additional data, including SARS-CoV-2 IgG levels, body mass index (BMI), hemoglobin A1c (HbA1c) and lipid levels were collected and analyzed for a second cohort from May 21, 2020 to June 21, 2020. SARS-CoV-2 neutralizing antibodies were measured in a subset of the study cohort. RESULTS: SARS-CoV-2 IgG levels were significantly higher in convalescent individuals with MetS comorbidities. When adjusted for age, sex, race, and time duration from symptom onset to testing, increased SARS-CoV-2 IgG levels remained significantly associated with obesity (P < 0.0001). SARS-CoV-2 IgG levels were significantly higher in patients with HbA1c ≥6.5% compared to those with HbA1c <5.7% (P = 0.0197) and remained significant on multivariable analysis (P = 0.0104). A positive correlation was noted between BMI and antibody levels [95% confidence interval: 0.37 (0.20-0.52) P < 0.0001]. Neutralizing antibody titers were higher in COVID-19 individuals with BMI ≥ 30 (P = 0.0055). CONCLUSION: Postconvalescent SARS-CoV-2 IgG and neutralizing antibodies are elevated in obese patients, and a positive correlation exists between BMI and antibody levels.


Subject(s)
Antibodies, Neutralizing/immunology , COVID-19/immunology , Immunoglobulin G/immunology , Metabolic Syndrome/immunology , Adult , Antibodies, Neutralizing/blood , COVID-19/blood , COVID-19/complications , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/immunology , Diabetes Mellitus, Type 2/virology , Female , Humans , Immunoglobulin G/blood , Male , Metabolic Syndrome/blood , Metabolic Syndrome/virology , Middle Aged , Obesity/blood , Obesity/immunology , Obesity/virology , Retrospective Studies
15.
Obes Surg ; 31(7): 3083-3089, 2021 07.
Article in English | MEDLINE | ID: covidwho-1176405

ABSTRACT

BACKGROUND: During the SARS-CoV-2 pandemic, in order to protect the patient and to save hospital beds, cancelation of elective surgeries has become a great challenge. Considering that obesity is a chronic disease and the possible effect imposed by quarantine on weight gain with worsening rates of obesity and metabolic comorbidities, the creation of a protocol for a safe return to bariatric surgery became essential. OBJECTIVE: The aim of this study was to identify the incidence of new-onset severe acute respiratory syndrome coronavirus (SARS-CoV-2) symptoms in patients who underwent bariatric procedures during the declining curve period. SETTING: Private practice METHODS: A prospective observational cohort study was conducted and included patients with indications for bariatric surgery during the decreasing curve period of the SARS-CoV-2 pandemic who underwent surgery under a hospital security protocol. Patients were asked to answer a questionnaire and had a swab PCR test for SARS-CoV-2 detection. The primary outcome measure was the presence of 14-day and 30-day postoperative symptoms associated with COVID-19. Mortality was also analyzed. RESULTS: Three hundred patients with negative RT-PCR were operated on from May to June 2020. Seventeen patients had their surgery postponed because of a positive RT-PCR test or close contact. None of the patients developed new-onset SARS-CoV-2 symptomatic infection after 30 days of observation. No deaths were reported. Eleven had complications not related to SARS-CoV-2. CONCLUSIONS: Even though this population may have a poorer outcome when infected with SARS-CoV-2, this security protocol has shown that the procedure can be safely performed during the outbreak.


Subject(s)
Bariatric Surgery , COVID-19 , Obesity, Morbid , Humans , Obesity, Morbid/surgery , Observational Studies as Topic , Pandemics , Prospective Studies , SARS-CoV-2
16.
Nat Commun ; 12(1): 2133, 2021 04 09.
Article in English | MEDLINE | ID: covidwho-1174672

ABSTRACT

Our understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still developing. We perform an observational study to investigate seroprevalence and immune responses in subjects professionally exposed to SARS-CoV-2 and their family members (155 individuals; ages 5-79 years). Seropositivity for SARS-CoV-2 Spike glycoprotein aligns with PCR results that confirm the previous infection. Anti-Spike IgG/IgM titers remain high 60 days post-infection and do not strongly associate with symptoms, except for fever. We analyze PBMCs from a subset of seropositive and seronegative adults. TLR7 agonist-activation reveals an increased population of IL-6+TNF-IL-1ß+ monocytes, while SARS-CoV-2 peptide stimulation elicits IL-33, IL-6, IFNa2, and IL-23 expression in seropositive individuals. IL-33 correlates with CD4+ T cell activation in PBMCs from convalescent subjects and is likely due to T cell-mediated effects on IL-33-producing cells. IL-33 is associated with pulmonary infection and chronic diseases like asthma and COPD, but its role in COVID-19 is unknown. Analysis of published scRNAseq data of bronchoalveolar lavage fluid (BALF) from patients with mild to severe COVID-19 reveals a population of IL-33-producing cells that increases with the disease. Together these findings show that IL-33 production is linked to SARS-CoV-2 infection and warrant further investigation of IL-33 in COVID-19 pathogenesis and immunity.


Subject(s)
Antibodies, Viral/immunology , COVID-19/immunology , Immunoglobulin G/immunology , Interleukin-33/immunology , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , Adolescent , Adult , Aged , COVID-19/virology , Child , Child, Preschool , Female , Humans , Interleukin-33/metabolism , Male , Middle Aged , SARS-CoV-2/genetics , SARS-CoV-2/physiology , Seroepidemiologic Studies , Spike Glycoprotein, Coronavirus/genetics , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , Young Adult
17.
Prev Chronic Dis ; 18: E33, 2021 04 08.
Article in English | MEDLINE | ID: covidwho-1173046

ABSTRACT

The Centers for Disease Control and Prevention (CDC) define chronic diseases as conditions that last 1 year or more and that require ongoing medical attention or limit activities of daily living, or both (1). Chronic diseases may be influenced by a combination of genetics, lifestyle and social behaviors, health care system factors, community influences, and environmental determinants of health (2). These risk factors often coexist and interact with each other. Therefore, a better understanding of determinants of chronic diseases such as tobacco use, unhealthy eating, and physical inactivity stands to benefit from effective strategies for improving primary, secondary, and tertiary disease prevention and management in diverse global settings (3). Strategies to prevent and manage chronic disease outcomes such as diabetes and cardiovascular diseases (CVDs) have global commonalities (4-7). The impact of chronic diseases is disproportionately evident in Black and Brown communities (8,9). Chronic disease prevention and management typically focus on behavioral interventions such as healthy eating, increased physical activity, and cessation of unhealthy practices such as tobacco and alcohol use (10-15). In 2020, the COVID-19 pandemic added to the fact that chronic diseases disproportionately affect low-resource communities, where many Black and Brown populations live (16,17). COVID-19 demonstrated that chronic disease disparities actually present as preexisting conditions in Black and Brown communities, who are disproportionately affected by COVID-19 outcomes. Although most of the articles in this Preventing Chronic Disease (PCD) collection were published before the pandemic, the insights they present, combined with the racial and ethnic data on the burden of COVID-19 thus far, support this reality. Many researchers and public health practitioners often consider the need to sufficiently address the relationships between chronic diseases and social, behavioral, and community factors (18). Global lessons in the prevention and management of chronic diseases, therefore, can help researchers and practitioners benefit from the shared lessons and experience derived from research and interventions conducted in different parts of the world. There are more than 7 billion people worldwide, who speak diverse languages and who have different nationalities, identities, and health systems. Yet, if we share challenges and opportunities for chronic disease prevention and management, many of the global adversities to improving health and well-being can be ameliorated, which is the purpose of this collection. The authors in this collection share lessons that represent experiences in diverse contexts across countries and regions of the world.


Subject(s)
COVID-19/epidemiology , Chronic Disease , Global Health , Public Health , Social Determinants of Health , Causality , Chronic Disease/epidemiology , Chronic Disease/prevention & control , Chronic Disease/therapy , Health Services Accessibility , Healthcare Disparities , Humans , Information Dissemination , Life Style , Psychology , Public Health/standards , Public Health/trends , SARS-CoV-2 , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data
18.
J Cell Physiol ; 236(10): 7266-7289, 2021 10.
Article in English | MEDLINE | ID: covidwho-1168883

ABSTRACT

Mesenchymal stem cells (MSCs) are located in various tissues where these cells show niche-dependent multilineage differentiation and secrete immunomodulatory molecules to support numerous physiological processes. Due to their regenerative and reparative properties, MSCs are extremely valuable for cell-based therapy in tackling several pathological conditions including COVID-19. Iron is essential for MSC processes but iron-loading, which is common in several chronic conditions, hinders normal MSC functionality. This not only aggravates disease pathology but can also affect allogeneic and autologous MSC therapy. Thus, understanding MSCs from an iron perspective is of clinical significance. Accordingly, this review highlights the roles of iron and iron-related proteins in MSC physiology. It describes the contribution of iron and endogenous iron-related effectors like hepcidin, ferroportin, transferrin receptor, lactoferrin, lipocalin-2, bone morphogenetic proteins and hypoxia inducible factors in MSC biology. It summarises the excess-iron-induced alterations in MSC components, processes and discusses signalling pathways involving ROS, PI3K/AKT, MAPK, p53, AMPK/MFF/DRP1 and Wnt. Additionally, it evaluates the endogenous and exogenous saviours of MSCs against iron-toxicity. Lastly, it elaborates on the involvement of MSCs in the pathology of clinical conditions of iron-excess, namely, hereditary hemochromatosis, diabetes, ß-thalassaemia and myelodysplastic syndromes. This unique review integrates the distinct fields of iron regulation and MSC physiology. Through an iron-perspective, it describes both mechanistic and clinical aspects of MSCs and proposes an iron-linked MSC-contribution to physiology, pathology and therapeutics. It advances the understanding of MSC biology and may aid in identifying signalling pathways, molecular targets and compounds for formulating adjunctive iron-based therapies for excess-iron conditions, and thereby inform regenerative medicine.


Subject(s)
Iron/metabolism , Mesenchymal Stem Cells/metabolism , Animals , Cell Differentiation/physiology , Cell- and Tissue-Based Therapy/methods , Humans , Immunomodulation/physiology , Mesenchymal Stem Cell Transplantation/methods , Regenerative Medicine/methods , Signal Transduction/physiology
19.
Rev Cardiovasc Med ; 22(1): 105-114, 2021 03 30.
Article in English | MEDLINE | ID: covidwho-1168429

ABSTRACT

Heart Failure (HF), a common chronic disease, requires multidisciplinary care to optimise outcomes. The COVID-19 pandemic, its impact on people's movement and access to health services, introduced severe challenges to chronic disease management. The era that will evolve after this pandemic is likely to provide uncertainty and service model disruptions. HF treatment is based on guidelines derived from randomised clinical trial evidence. Translational shortfalls from trials into practice have been overcome with post-trial service improvement studies like OPTIMIZE-HF where a team using a process of care can translate evidence to the general population. However, gaps remain for vulnerable populations e.g. those with more severe HF, with multiple comorbid conditions, and certain demographic groups and/or residents in remote locations. Health technology has come with great promise, to fill some of these gaps. The COVID-19 pandemic provides an opportunity to observe, from Australian healthcare lens, HF management outside the traditional model of care. This narrative review describes relatively recent events with health technology as a solution to improve on service gaps.


Subject(s)
Biomedical Technology , COVID-19/epidemiology , Cardiology/organization & administration , Delivery of Health Care/organization & administration , Heart Failure/therapy , Australia , COVID-19/prevention & control , COVID-19/transmission , Humans , Telemedicine
20.
Int J Environ Res Public Health ; 18(5)2021 03 02.
Article in English | MEDLINE | ID: covidwho-1154368

ABSTRACT

The strong spread of COVID-19 and the significant number of deaths associated with it could be related to improper lifestyles, which lead to a low-grade inflammation (LGI) that not only increases the risk of chronic diseases, but also the risk of facing complications relating to infections and a greater susceptibility to infections themselves. Recently, scientific research has widely demonstrated that the microbiota plays a fundamental role in modulating metabolic responses in the immune system. There is, in fact, a two-way interaction between lifestyle, infection, and immunity. The immune response is compromised if nutrition is unbalanced or insufficient, because diet affects the intestinal flora predisposing people to infections and, at the same time, the nutritional state can be aggravated by the immune response itself to the infection. We evaluate the link between balanced diet, the efficiency of the immune system, and microbiota with the aim of providing some practical advice for individuals, with special attention to the elderly. A correct lifestyle that follows the Mediterranean model, which is especially rich in plant-based foods along with the use of extra-virgin olive oil, are the basis of preventing LGI and other chronic pathologies, directly influencing the intestinal microbiota and consequently the immune response.


Subject(s)
COVID-19 , Diet, Mediterranean , Virus Diseases , Aged , Diet , Humans , Immune System , Inflammation , Olive Oil , SARS-CoV-2
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