Phenotyping COVID-19 inpatients prognosis at admission based upon serum biomarkers: a retrospective monocentric study

Background: Prompt recognition of COVID-19 prognosis could improve the care of inpatients admitted to Internal Medicine wards. Aim. To evaluate the impact of serum biomarkers at admission on COVID-19 prognosis. Methods: Two hundred eighteen COVID-19 patients referred to the Internal Medicine Baccelli, University of Bari were consecutively analyzed (September 2020 - June 2021) in a retrospective, monocentric study. A complete medical history, physical examination, blood count, renal function, inflammatory biomarkers, and total serum calcium were obtained. Results: Low serum calcium was found on average (8.4 mg/dl) but it normalized after correction for albuminemia (8.9 mg/dL). Patients transferred to the intensive care unit showed a statistically significant lower serum calcium (8.1 vs 8.4 mg/dL, p<0.01) compared to those not transferred to the intensive care even if relation vanished after albumin correction. Older age (81 vs 63y, p <0.001), higher C reactive protein (114 vs 38.5 mg/dL, p <0.001), d-dimer (2543 vs 641 ng/mL, p <0.001), lactic dehydrogenase (301 vs 236 UI/L, p <0.001), neutrophil-to-lymphocyte ratio (9.9 vs 4.5, p <0.001), interleukin- 6 (118 vs 21.6 pg/mL, p <0.001), creatinine (1.17 vs 0.88 mg/dL, p <0.001), and corrected calcium (9.2 vs 8.4 mg/dL, p<0.001) predicted death. Conclusions: Low total serum calcium might anticipate patients' transfer to the intensive care unit. This phenomenon may be driven by hypoalbuminemia. Advanced age, higher inflammatory biomarkers and creatinine, and higher serum calcium corrected for albumin may predict death.

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects.

BACKGROUND: Thyroid dysfunction has been observed in patients with COVID-19, and endocrinologists are requested to understand this clinical issue. Pandemic-related restrictions and reorganization of healthcare services may affect thyroid disease management. OBJECTIVE AND METHODS: To analyze and discuss the relationship between COVID-19 and thyroid diseases from several perspectives. PubMed/MEDLINE, Google Scholar, Scopus, ClinicalTrial.gov were searched for this purpose by using free text words and medical subject headings as follows: "sars cov 2", "covid 19", "subacute thyroiditis", "atypical thyroiditis", "chronic thyroiditis", "hashimoto's thyroiditis", "graves' disease", "thyroid nodule", "differentiated thyroid cancer", "medullary thyroid cancer", "methimazole", "levothyroxine", "multikinase inhibitor", "remdesivir", "tocilizumab". Data were collected, analyzed, and discussed to answer the following clinical questions: "What evidence suggests that COVID-19 may induce detrimental consequences on thyroid function?"; "Could previous or concomitant thyroid diseases deteriorate the prognosis of COVID-19 once the infection has occurred?"; "Could medical management of thyroid diseases influence the clinical course of COVID-19?"; "Does medical management of COVID-19 interfere with thyroid function?"; "Are there defined strategies to better manage endocrine diseases despite restrictive measures and in-hospital and ambulatory activities reorganizations?". RESULTS: SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis. Patients with baseline thyroid diseases are not at higher risk of contracting or transmitting SARS-CoV-2, and baseline thyroid dysfunction does not foster a worse progression of COVID-19. However, it is unclear whether low levels of free triiodothyronine, observed in seriously ill patients with COVID-19, may worsen the disease's clinical progression and, consequently, if triiodothyronine supplementation could be a tool for reducing this burden. Glucocorticoids and heparin may affect thyroid hormone secretion and measurement, respectively, leading to possible misdiagnosis of thyroid dysfunction in severe cases of COVID-19. High-risk thyroid nodules require a fine-needle aspiration without relevant delay, whereas other non-urgent diagnostic procedures and therapeutic interventions should be postponed. DISCUSSION: Currently, we know that SARS-CoV-2 could lead to short-term and reversible thyroid dysfunction, but thyroid diseases seem not to affect the progression of COVID-19. Adequate management of patients with thyroid diseases remains essential during the pandemic, but it could be compromised because of healthcare service restrictions. Endocrine care centers should continuously recognize and classify priority cases for in-person visits and therapeutic procedures. Telemedicine may be a useful tool for managing patients not requiring in-person visits.

Preliminary trajectories in dietary behaviors during the COVID-19 pandemic: a public health call to action to face obesity

The world is currently struggling to face the coronavirus pandemic (COVID-19), and many countries have imposed lockdowns and recommended quarantine to limit both the spread of the virus and overwhelming demands for medical care. Direct implications include the disruption of work routines, boredom, depression, increased calorie consumption, and other similar harmful effects. The present narrative review article briefly analyzes the preliminary effects of the quarantine lifestyle from the standpoint of dietary habits. In six different databases, we searched for original articles up to 10 August 2020, assessing eating habits among populations during the COVID-19 pandemic, and recorded any change in the intake of major food categories, as well as changes in body weight. The research strategy yielded 364 articles, from which we selected 12 articles that fitted our goal. Our preliminary findings revealed a sharp rise of carbohydrates sources consumption, especially those with a high glycemic index (i.e., homemade pizza, bread, cake, and pastries), as well as more frequent snacks. A high consumption of fruits and vegetables, and protein sources, particularly pulses, was also recorded, although there was no clear peak of increase in the latter. Data concerning the consumption of junk foods lacked consistency, while there was a decreased alcohol intake and fresh fish/seafood consumption. As a possible connection, people gained body weight. Therefore, in the realistic perspective of a continuing global health emergency situation, timely preventive measures are needed to counteract obesity-related behaviors in the long-term, so as to prevent further health complications.