Clinical Characteristics and Outcomes of 104 Pregnant Women with Coronavirus Disease 2019 during delta wave, single-center observational study

Background. Pregnancy is one of the risk factor associated with the severity of Coronavirus Disease 2019 (COVID-19). The perinatal complications also known to be increased when pregnant women become infected with COVID-19. However, there were not enough studies involving pregnant women with severe COVID-19, especially in Korea. The purpose of this study was to analyze the cases of pregnant women with COVID-19 infection with various severities, and to compare and describe the clinical course and the effects on pregnancy and perinatal prognosis according to severity. Methods. We retrospectively analyzed the medical records of adults 18 years of age or older who were PCR-confirmed COVID-19 and proved pregnancy, from February 1, 2020 to January 31, 2022. Through the epidemiological investigation report, the patient's medical history, obstetric history, date of diagnosis and variants of COVID-19, and vaccination history were collected. Clinical symptoms, oxygen demand, chest imagings, treatment, perinatal complications, fetal conditions, delivery results, and complications were collected through medical records. Results. A total of 104 pregnant women with PCR-confirmed COVID-19 were hospitalized. The age at the time of diagnosis was 33 +/-4.24 (Mean +/- SD) years, and 4 patients (3.8%) were vaccinated with the COVID-19 vaccine. During hospital stay, the most common complaints were cough (99 patients, 95.2%) and fever (85 patients, 81.7%). Oxygen was applied in 40 patients (38.5%), and in 19 patients (18.3%) in severe cases. Thirty-seven patients (35.6%) delivered during isolation treatment. Critical COVID-19 patients group has statisticaly significant higher rate of preterm delivery compared with mild COVID-19 patient group (31.6 % versus 6.3 %, p=0.009). One patient died from septic shock caused by multidrug-resistant Acinetobacter baumannii during treatment. A total of 39 babies were born, of which 4 received postnatal oxygen therapy. Conclusion. Pregnant women with COVID-19 had higher mortality rates, aggravation rates, and premature birth rates compared to non-pregnant patients of the same age. In a situation where effective and safe COVID-19 treatments for pregnant women are limited, it is necessary to increase the vaccination rate to prevent undesired outcomes in both mother and child.

Changes of neuropsychiatricsymptomsin patients with dementia during COVID-19 crisis: Telephone survey from the Yangcheon Dementia Reassurance Center

Objective: The purpose of this study was to investigate the changes in the neuropsychiatric symptoms of patients with dementia during the pandemic through the complete enumeration telephone survey in the caregivers of dementia patients who were registered at the database of Yangcheon Dementia Reassurance Center (YDRC) for Dementia. Background: It has been reported that the social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients. Design/Methods: There were a total of 2080 dementia patients on the database of YDRC who were registered as having dementia from 2008 ∼2020. From Mar to April in 2021, the telephone survey was conducted in all the caregivers with dementia on the database of YDRC. We asked whether the neuropsychiatric symptoms of patients were aggravated during COVID 19 and if they were, which neuropsychiatric symptoms were aggravated among the 12 symptoms of neuropsychiatric inventory (NPI): delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, disturbances of sleep, and disturbances of appetite/eating. Results: Among 2080 patients with dementia (mean age: 81.2 years, 66.8 % females), a total of 1038 caregivers of patients with dementia responded to the telephone survey. Among 1038 patients, 274 patients (26.4%) were reported to have at least one and more aggravating neuropsychiatric symptoms, especially depression/dysphoria (44.5 %), disturbances of sleep (9.5 %), and delusion (9.1 %). Conclusions: Given that patients'neuropsychiatric worsening is commonly associated with greater burden of the caregiver's, a more preemptive strategy to manage aggravating the neuropsychiatric symptoms from the Community Dementia Reassurance can help reduce difficulties of caregivers in this pandemic situation.

COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use. MATERIALS AND METHODS: We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). RESULTS: Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19. CONCLUSIONS: AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.

Suicide associated with COVID-19 infection: an immunological point of view.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide. MATERIALS AND METHODS: We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients. RESULTS: Patients infected with COVID-19 have high amounts of IL-1ß, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed. CONCLUSIONS: COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

Risk factors of COVID-19 mortality: a systematic review of current literature and lessons from recent retracted articles.

OBJECTIVE: Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight. MATERIALS AND METHODS: We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers. RESULTS: Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91). CONCLUSIONS: When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.

Clinical characteristics and mortality of patients with hematologic malignancies and COVID-19: a systematic review.

OBJECTIVE: Hematologic cancer patients with Coronavirus Disease 2019 (COVID-19) tend to have a more serious disease course than observed in the general population. Herein, we comprehensively reviewed existing literature and analyzed clinical characteristics and mortality of patients with hematologic malignancies and COVID-19. MATERIALS AND METHODS: Through searching PubMed until June 03, 2020, we identified 16 relevant case studies (33 cases) from a total of 45 studies that have reported on patients with COVID-19 and hematologic malignancies. We investigated the clinical and laboratory characteristics including type of hematologic malignancies, initial symptoms, laboratory findings, and clinical outcomes. Then, we compared those characteristics and outcomes of patients with hematologic malignancies and COVID-19 to the general population infected with COVID-19. RESULTS: The median age was 66-year-old. Chronic lymphocytic leukemia was the most common type of hematologic malignancy (39.4%). Fever was the most common symptom (75.9%). Most patients had normal leukocyte counts (55.6%), lymphocytosis (45.4%), and normal platelet counts (68.8%). In comparison to patients with COVID-19 without underlying hematologic malignancies, dyspnea was more prevalent (45.0 vs. 24.9%, p=0.025). Leukocytosis (38.9 vs. 9.8%, p=0.001), lymphocytosis (45.4 vs. 8.2%, p=0.001), and thrombocytopenia (31.3 vs. 11.4%, p=0.036) were significantly more prevalent and lymphopenia (18.2 vs. 57.4%, p=0.012) less prevalent in patients with hematologic malignancies. There were no clinical and laboratory characteristics predicting mortality in patients with hematologic malignancies. Mortality was much higher in patients with hematologic malignancies compared to those without this condition (40.0 vs. 3.6%, p<0.001). CONCLUSIONS: Co-occurrence of hematologic malignancies and COVID-19 is rare. However, due to the high mortality rate from COVID-19 in this vulnerable population, further investigation on tailored treatment and management is required.