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1.
MEDICC Rev ; 24(3-4): 57-60, 2022 Oct 31.
Article Dans Anglais | MEDLINE | ID: covidwho-2218182

Résumé

INTRODUCTION: Polyserositis is described as inflammation with effusion of more than one serous membrane. There is very little published literature linking it to COVID-19 as a late complication. OBJECTIVE: Present and describe a case of post-COVID-19 polyserositis. METHODS: Data were collected from the medical record of a female patient admitted for fainting spells and marked weakness. The patient underwent a clinical evaluation, additional hematology, imaging and histopathology tests, and a surgical procedure. The new index, called the abdominal adipose deposit index, was obtained by multiplying the subcutaneous fat thickness by visceral fat thickness, both measured by ultrasound. A cutoff point was established that facilitated discernment of an unhealthy phenotype: normal weight but metabolically obese, a cardiometabolic risk factor. RESULTS: We present the case of a 57-year-old female patient admitted to hospital for fainting spells and marked weakness, four months after COVID-19 infection. She also had a history of obesity, asthma, type 2 diabetes mellitus and a cholecystectomy in December 1992 for gallstones. Clinical assessment revealed pericardial effusion and bilateral pleural effusion, in addition to a tumor-like lesion outside the pericardium, proximal to the right ventricular wall. A surgical procedure and findings from additional tests led to diagnoses of thymic remnants and polyserositis. CONCLUSIONS: This is a case of polyserositis in a post-COVID-19 patient. After other causes of polyserositis were ruled out, and since there is a likely physiological and pathogenic mechanism operating between the two diseases, the polyserositis was determined to be a late complication of COVID-19. To date, it is the second case reported in the world and the first reported in Cuba.


Sujets)
, Diabète de type 2 , Femelle , Humains , /complications , Diabète de type 2/complications , Cuba , Inflammation , Obésité/complications , Maladie chronique , Syncope
2.
Br J Gen Pract ; 72(720): e456-e463, 2022 07.
Article Dans Anglais | MEDLINE | ID: covidwho-2217131

Résumé

BACKGROUND: Early evidence has shown that anticoagulant reduces the risk of thrombotic events in those infected with COVID-19. However, evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited. AIM: To investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2. DESIGN AND SETTING: On behalf of NHS England, a population-based cohort study was conducted. METHOD: The study used primary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England. Cox regression was used to estimate hazard ratios (HRs) for COVID-19 outcomes comparing people with current OAC use versus non-use, accounting for age, sex, comorbidities, other medications, deprivation, and general practice. RESULTS: Of 71 103 people with atrial fibrillation and a CHA2DS2-VASc score of 2, there were 52 832 current OAC users and 18 271 non-users. No difference in risk of being tested for SARS-CoV-2 was associated with current use (adjusted HR [aHR] 0.99, 95% confidence interval [CI] = 0.95 to 1.04) versus non-use. A lower risk of testing positive for SARS-CoV-2 (aHR 0.77, 95% CI = 0.63 to 0.95) and a marginally lower risk of COVID-19-related death (aHR, 0.74, 95% CI = 0.53 to 1.04) were associated with current use versus non-use. CONCLUSION: Among those at low baseline stroke risk, people receiving OACs had a lower risk of testing positive for SARS-CoV-2 and severe COVID-19 outcomes than non-users; this might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or unmeasured confounding, including more cautious behaviours leading to reduced infection risk.


Sujets)
Fibrillation auriculaire , , Accident vasculaire cérébral , Administration par voie orale , Anticoagulants/usage thérapeutique , Fibrillation auriculaire/complications , Fibrillation auriculaire/traitement médicamenteux , Fibrillation auriculaire/épidémiologie , /épidémiologie , Études de cohortes , Humains , SARS-CoV-2 , Accident vasculaire cérébral/traitement médicamenteux , Accident vasculaire cérébral/épidémiologie , Accident vasculaire cérébral/prévention et contrôle
3.
BMC Nephrol ; 23(1): 91, 2022 03 05.
Article Dans Anglais | MEDLINE | ID: covidwho-2214547

Résumé

BACKGROUND: Antibody-mediated rejection (AMR) was described in kidney transplant patients after viral infections, such as the cytomegalovirus. Very few cases were recently reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, probably in the context of lowering of immunosuppressive therapy. To date, no direct immunological link was proved to explain a connection between the coronavirus disease 19 (COVID-19) infection and antibody-mediated rejection (AMR) if it exists. CASE PRESENTATION: Here we try to find this association by presenting the case of a low immunological risk patient who presented, six years post-transplant, with c4d negative antibody mediated rejection due to an anti-HLA-C17 de novo donor specific antibody (DSA) after contracting the coronavirus disease 19. The HLA-Cw17 activated the antibody-dependent cell-mediated cytotoxicity via the KIR2DS1 positive NK cells. DISCUSSION AND CONCLUSIONS: This case report may prove a direct role for COVID-19 infection in AMRs in the kidney transplant recipients, leading us to closely monitor kidney transplant recipients, especially if they have "at-risk" donor antigens.


Sujets)
Anticorps/immunologie , /complications , Rejet du greffon/étiologie , Rejet du greffon/immunologie , Transplantation rénale , Humains , Mâle , Adulte d'âge moyen , Facteurs temps
4.
BMC Infect Dis ; 22(1): 682, 2022 Aug 09.
Article Dans Anglais | MEDLINE | ID: covidwho-2214535

Résumé

BACKGROUND: Immunization against the coronavirus disease 2019 (COVID-19) began in January 2021 in Iran; nonetheless, due to a lack of vaccination among children under 12, this age group is still at risk of SARS-CoV-2 infection and its complications. CASE PRESENTATION: SARS-CoV-2 infection was diagnosed in a 6-year-old girl who had previously been healthy but had developed a fever and pancytopenia. The bone marrow aspiration/biopsy demonstrated just hypocellular marrow without signs of leukemia. She was worked up for primary and secondary causes of pancytopenia. Except for a repeated reactive HIV antibody/Ag P24 assay, all test results were inconclusive. After a thorough diagnostic investigation, the cross-reactivity of the HIV antibody/Ag P24 test with SARS-CoV-2 antibodies was confirmed. The patient did not develop any COVID-19-related signs and symptoms, but she did get a severe invasive fungal infection and neutropenic enterocolitis. She died as a result of disseminated intravascular coagulopathy. CONCLUSION: It is critical to recognize children infected with SARS-CoV-2 who exhibit atypical clinical manifestations of COVID-19, such as persistent pancytopenia. SARS-CoV-2 infection can cause severe and deadly consequences in children; thus, pediatricians should be aware of COVID-19's unusual signs and symptoms mimicking other conditions such as aplastic anemia.


Sujets)
Anémie aplasique , , Entérocolite du patient neutropénique , Infections à VIH , Infections fongiques invasives , Pancytopénie , Anémie aplasique/étiologie , Moelle osseuse/anatomopathologie , /complications , Enfant , Entérocolite du patient neutropénique/complications , Femelle , Infections à VIH/complications , Humains , Infections fongiques invasives/complications , Pancytopénie/diagnostic , Pancytopénie/étiologie , SARS-CoV-2
5.
Ann Hematol ; 101(9): 1887-1895, 2022 Sep.
Article Dans Anglais | MEDLINE | ID: covidwho-2209317

Résumé

COVID-19 is a global pandemic triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 entry point involves the interaction with angiotensin-converting enzyme 2 (ACE2) receptor, CD147, and erythrocyte Band3 protein. Hemolytic anemia has been linked to COVID-19 through induction of autoimmune hemolytic anemia (AIHA) caused by the formation of autoantibodies (auto-Abs) or directly through CD147 or erythrocyte Band3 protein-mediated erythrocyte injury. Here, we aim to provide a comprehensive view of the potential mechanisms contributing to hemolytic anemia during the SARS-CoV-2 infection. Taken together, data discussed here highlight that SARS-CoV-2 infection may lead to hemolytic anemia directly through cytopathic injury or indirectly through induction of auto-Abs. Thus, as SARS-CoV-2-induced hemolytic anemia is increasingly associated with COVID-19, early detection and management of this condition may prevent the poor prognostic outcomes in COVID-19 patients. Moreover, since hemolytic exacerbations may occur upon medicines for COVID-19 treatment and anti-SARS-CoV-2 vaccination, continued monitoring for complications is also required. Given that, intelligent nanosystems offer tools for broad-spectrum testing and early diagnosis of the infection, even at point-of-care sites.


Sujets)
Anémie hémolytique , , Anémie hémolytique/étiologie , /complications , /traitement médicamenteux , Humains , Peptidyl-Dipeptidase A/métabolisme , SARS-CoV-2
6.
Muscle Nerve ; 62(2): 254-258, 2020 08.
Article Dans Anglais | MEDLINE | ID: covidwho-2209145

Résumé

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic, but little is known about its potential impact on patients with myasthenia gravis (MG). METHODS: We studied the clinical course of COVID-19 in five hospitalized patients with autoimmune MG (four with acetylcholine receptor antibodies, one with muscle-specific tyrosine kinase antibodies) between April 1, 2020-April 30-2020. RESULTS: Two patients required intubation for hypoxemic respiratory failure, whereas one required significant supplemental oxygen. One patient with previously stable MG had myasthenic exacerbation. One patient treated with tocilizumab for COVID-19 was successfully extubated. Two patients were treated for MG with intravenous immunoglobulin without thromboembolic complications. DISCUSSION: Our findings suggest that the clinical course and outcomes in patients with MG and COVID-19 are highly variable. Further large studies are needed to define best practices and determinants of outcomes in this unique population.


Sujets)
Anticorps monoclonaux humanisés/usage thérapeutique , Infections à coronavirus/thérapie , Hypoxie/thérapie , Immunoglobulines par voie veineuse/usage thérapeutique , Facteurs immunologiques/usage thérapeutique , Myasthénie/thérapie , Pneumopathie virale/thérapie , Insuffisance respiratoire/thérapie , Adulte , Sujet âgé de 80 ans ou plus , Betacoronavirus , , Infections à coronavirus/complications , Infections à coronavirus/traitement médicamenteux , Évolution de la maladie , Femelle , Humains , Hypoxie/étiologie , Immunosuppresseurs/usage thérapeutique , Intubation trachéale , Mâle , Adulte d'âge moyen , Myasthénie/complications , Myasthénie/immunologie , Oxygénothérapie , Pandémies , Pneumopathie virale/complications , Récepteurs à activité tyrosine kinase/immunologie , Récepteurs cholinergiques/immunologie , Ventilation artificielle , Insuffisance respiratoire/étiologie , SARS-CoV-2
7.
J Ayub Med Coll Abbottabad ; 34(3): 410-416, 2022.
Article Dans Anglais | MEDLINE | ID: covidwho-2207193

Résumé

BACKGROUND: Many cytokines propose to play a role in the pathogenesis of Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) associated COVID-19 disease. High interleukin-6 (IL-6) levels are associated with mortality and other poor clinical outcomes in COVID-19. METHODS: In this retrospective study, the correlation of IL-6 level with clinical and other inflammatory parameters, its role in treatment change and its relationship with mortality in COVID-19 patients developing acute respiratory distress syndrome (ARDS) were investigated. RESULTS: Totally 76 patients were included in the study; Thirty-four (44.7%) patients were female and 42 (55.3%) patients were male. All patients had IL-6 levels above the upper reference value (>5.9 pg/mL). Overall, 48 patients (63.1%) had a severe clinical presentation (tachypnoea, tachycardia, fever) that was clinically compatible with IL-6 values, and medical treatment was changed for COVID-19 in this group. A positive correlation was detected between IL-6 and CRP on the day of the change in treatment (p=0.035, r=0.76). There was no decrement observed in IL-6 level on the 3rd day in patients that was clinically thought to have cytokine storm and whose treatment was changed. Mortality was higher in the group whose treatment was changed. CONCLUSIONS: We believe that IL-6 level alone is insufficient to decide on a change in treatment, and correlation of IL-6 with the patient's clinical status is more significant in such decision.


Sujets)
, , Femelle , Humains , Mâle , /complications , Interleukine-6 , /étiologie , /thérapie , Études rétrospectives , SARS-CoV-2
8.
J Ayub Med Coll Abbottabad ; 34(3): 557-562, 2022.
Article Dans Anglais | MEDLINE | ID: covidwho-2207192

Résumé

BACKGROUND: Coronavirus disease 19 (COVID-19) is a viral disease caused by SARS-CoV-2. There is an increased incidence of a thromboembolic phenomenon in patients with COVID-19 infection. Pulmonary embolism is the most common thrombotic presentation in COVID-19 patients. Extra-pulmonary thrombosis is an unusual thrombotic complication of COVID-19 disease. METHODS: This study was conducted at The Aga Khan University Hospital from June-July'2021. Patients clinical and laboratory findings, treatment, and outcomes were recorded. RESULTS: We report three cases with the diagnosis of COVID-19 pneumonia associated with extra-pulmonary thrombosis from June to July 2021. The mean age of the patients were 66.3 and two of them (66.6%) were male. The diagnosis of COVID-19 was confirmed by real-time reverse transcriptase-polymerase chain reaction analysis in all the three patients. Extra-pulmonary thrombosis was identified in the celiac artery and splenic veins in case 1, left common iliac artery in case 2, and left ventricular apical thrombus in case 3. All the patients were treated with anticoagulation. In total, two patients were discharged home after total recovery, while the third patient died. CONCLUSIONS: The take-home message is that COVID-19 infection is a pro-thrombotic condition that can provoke arterial and venous thrombosis. Extra-pulmonary thrombosis is increasingly identified with COVID-19 infection. It is important to remember that the patient might have no potential risk factor for thromboses, as COVID-19 infection per se is a risk to induce thrombosis.


Sujets)
, Thrombose , Thrombose veineuse , Humains , Mâle , Femelle , /complications , SARS-CoV-2 , Anticoagulants/usage thérapeutique , Thrombose veineuse/étiologie , Thrombose/étiologie
10.
Probl Endokrinol (Mosk) ; 68(5): 14-23, 2022 Jul 20.
Article Dans Russe | MEDLINE | ID: covidwho-2203930

Résumé

A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread around the world since was first scientifically described in December 2019. At present approximately 400 million people have suffered from the disease, almost 6 million people have died.SARS-CoV-2 uses the angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 for S protein priming. ACE2 and TMPRSS2 are expressed in several endocrine glands, including the pituitary, pancreas, thyroid, ovaries, and testes. Thus, the endocrine glands may be a direct target for SARS-CoV-2. The main risk factors for severity of the COVID-19 are obesity, arterial hypertension, diabetes mellitus (DM), vertebral fractures, which potentially predisposes patients to a severe course of COVID-19.In this review, we present current data on the course of COVID-19 in patients with hypothalamic-pituitary diseases, and also discuss treatment for endocrinopathies during to COVID-19.


Sujets)
, Maladies de l'hypophyse , Humains , , /complications , SARS-CoV-2 , Peptidyl-Dipeptidase A/métabolisme
11.
Probl Endokrinol (Mosk) ; 68(4): 111-116, 2022 Apr 17.
Article Dans Russe | MEDLINE | ID: covidwho-2203928

Résumé

BACKGROUND: COVID-19 is a disease that has a negative systemic effect on the human body, including the male gonads. Therefore, the androgenic status in men with COVID-19 needs to be studied. AIM: To evaluate the levels of total testosterone, sex hormone binding globulin (SHBG) and free testosterone in men in the acute phase of COVID-19 and during convalescence. MATERIALS AND METHODS: A continuous dynamic prospective study of 70 men with moderate to severe COVID-19 at the age of 50[44; 64] years. During the study, the levels of total testosterone, SHBG were determined with further calculation of the level of free testosterone by Vermeullen. The data were collected twice - at the patient's hospitalization and at his discharge. The differences between the groups were considered statistically significant at p <0.05. RESULTS: At the time of hospitalization for COVID-19, hypogonadism syndrome was observed in 61 people - 87%. Patients with hypogonadism did not statistically significant differ in age and severity of COVID-19 disease compared to men without hypogonadism. Inpatient treatment lasting 12[10;14] days resulted in a statistically significant increase in the levels of total testosterone from 4,7[2,96;8,48] to 12,85[8,62;19,2] nmol/l, p<0,001; SHBG from 27,87[20,78;36,57] to 33,76[26,27;52,60] nmol/l, p<0,001 and free testosterone from 107[65;174] to 235[162;337] pmol/l, p<0,001. This led to the elimination of hypogonadism in 28 patients - 40%. Patients with persistent hypogonadism were statistically significantly older than men with normalized testosterone, there were no statistically significant differences in the initial levels of total testosterone, SHBG and free testosterone, and there were also no differences in the prevalence of severe COVID-19 (3,97[2,86;7,46] vs 4,26[2,93;5,96] nmol/l, p=0,100; 28,76[20,78;48,59] vs 24,63[18,85;31,70] nmol/l, р=0,994; 100[58;118] vs 96[64;143] pmol/l, p=0,522; 24 против 18%, p=0,754, respectively). CONCLUSION: COVID-19 has a pronounced negative effect on the production of testosterone in men, leading to the development of laboratoric hypogonadism, which is potentially reversible. The reversibility of laboratoric hypogonadism is typical for younger patients.


Sujets)
, Hypogonadisme , Androgènes , /épidémiologie , Humains , Hypogonadisme/complications , Hypogonadisme/épidémiologie , Mâle , Adulte d'âge moyen , Études prospectives , Testostérone
12.
Probl Endokrinol (Mosk) ; 68(3): 50-56, 2022 03 24.
Article Dans Russe | MEDLINE | ID: covidwho-2203927

Résumé

AIM: To present a clinical case of reversible hypopituitarism due to hypophysitis developed after COVID-19 infection. MATERIALS AND METHODS: A patient with residual clinical manifestations of hypopituitarism underwent clinical evaluation at the time of symptoms of hypopituitarism and in follow-up. Morning serum cortisol (171-536 nmol/l) was measured by electrochemiluminescence immunoassay. Morning ACTH (7.2-63.3 pg/ml), prolactin (66-436 mU/l), TSH (0.25-3.5 mIU/L), fT4 (9-19 pmol/l) and fT3 (2.6-5.7 pmol/l) were measured by chemiluminescence immunoassay. Data were analyzed throughout the course of the disease. RESULTS: A 35-year-old female developed clinical symptoms of hypopituitarism two months after recovery from a confirmed COVID-19 infection. Laboratory investigation confirmed hypocorticism, hypothyroidism, hypogonadism and the patient was prescribed appropriate hormonal therapy in January 2021. Four months later the symptoms were alleviated (April 2021) and there were signs of recovery shown by imaging and hormonal: morning serum cortisol 227 nmol/l, morning ACTH 33.96 pg/ml, prolactin 68.3 mU/l, TSH 2.626 mIU/L, fT4 10.75 pmol/l, fT3 3.96 pmol/l. Thyroid hormone was discontinued, but hypogonadism and hypocorticism persisted with estradiol - 51.48 pmol/l, 24h urine cortisol level - 41.8 nmol/day. MRI results showed that the signs of hypophysitis were alleviated in comparison with MRI from January 2021. Full recovery of pituitary axis was reported in October 2021, with recovery of normal menstrual cycle. Furthermore, hormonal profile was likewise normal. CONCLUSION: This report provides evidence of delayed damage to the pituitary gland after infection with the COVID-19, with recovery of its function and structure. To date, the mechanisms of such an impact are not entirely clear; further collection of data on such cases and analysis is required.


Sujets)
, Hypogonadisme , Hypophysite , Hypopituitarisme , Hormone corticotrope , Adulte , /complications , Femelle , Humains , Hydrocortisone/usage thérapeutique , Hypopituitarisme/complications , Prolactine , Thyréostimuline
13.
Probl Endokrinol (Mosk) ; 68(2): 56-65, 2022 02 22.
Article Dans Russe | MEDLINE | ID: covidwho-2203926

Résumé

BACKGROUND: There is a lack of data on the features of dysglycemia in hospitalized patients with COVID-19 and concomitant diabetes mellitus (DM) confirmed by continuous glucose monitoring (CGM). AIM: to study the glycemic profile in hospitalized patients with COVID-19 and type 2 diabetes mellitus by continuous glucose monitoring and the role of steroid therapy in dysglycemiadevelopment. MATERIALS AND METHODS: We examined 21 patients with COVID-19 and DM 2 and 21 patients with DM 2 without COVID-19 (control group) using a professional 4-7-day CGM. We also compared two subgroups of patients with COVID-19 and DM 2: 1) patients received systemic glucocorticosteroids (GCS) during CGM and 2) patients in whomCGMwas performed after discontinuation of GCS. RESULTS: Compared with controls, patients with COVID-19 and DM2 had lesser values of glycemic «time in range¼ (32.7 ± 20.40 vs 48.0 ± 15.60%, p = 0.026) andhigher parameters of mean glycemia (p <0.05) but similar proportion of patients with episodes of hypoglycemia (33.3% vs 38.1%, p = 0.75). Patients who received dexamethasone during CGM were characterized by higher hyperglycemia and the absence of episodes of hypoglycemia. In patients who hadCGM after dexamethasone discontinuation, hyperglycemia was less pronounced, but 60% of them had episodes of hypoglycemia, often nocturnal, clinically significant and not detected by routine methods. CONCLUSION: Patients with COVID-19 and DM 2had severe and persistent hyperglycemia but a third of them hadalso episodes of hypoglycemia. During therapy with dexamethasone, they had the most pronounced hyperglycemia without episodes of hypoglycemia. In patients who underwent CGM after discontinuation of dexamethasone, hyperglycemia was less pronounced but 60% of them have episodes of hypoglycemia, often nocturnal, clinically significant and not diagnosed by routine methods. It would be advisable to recommend at least a 5-6-fold study of the blood glucose level (with its obligatory assessment at night) even for stable patients with COVID-19 and DM 2after the end of GCS treatment.


Sujets)
, Diabète de type 2 , Hyperglycémie , Hypoglycémie , Glycémie , Autosurveillance glycémique , /complications , /traitement médicamenteux , Dexaméthasone/effets indésirables , Diabète de type 2/complications , Diabète de type 2/traitement médicamenteux , Humains , Hyperglycémie/traitement médicamenteux , Hypoglycémie/induit chimiquement , Stéroïdes
14.
Am J Case Rep ; 23: e936096, 2022 Apr 14.
Article Dans Anglais | MEDLINE | ID: covidwho-2203692

Résumé

BACKGROUND Waterhouse-Friderichsen syndrome, also known as acute adrenal insufficiency due to adrenal gland hemorrhage, is an uncommon and frequently fatal condition classically presenting with fever, shock, rash, and coagulopathy. Although most often associated with Meningococcemia, many other etiologies have been implicated, including reports of Staphylococcus aureus infection on autopsy examinations. This report details an adult intravenous drug user with adrenal hemorrhage associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. CASE REPORT A 58-year-old man with a history of intravenous drug use presented to the hospital with weakness. Vitals were initially normal and exam findings were notable for decreased right-sided motor strength. Magnetic resonance imaging (MRI) revealed a cervical epidural abscess with spinal cord compression. Despite initiation of broad-spectrum antibiotics and intravenous fluids, the patient progressed to shock, requiring vasopressor administration, and his blood cultures later grew MRSA. Further imaging of the abdomen/pelvis was completed, revealing bilateral adrenal hemorrhage. Random cortisol at that time was 5.6 µg/dL, confirming a diagnosis of critical illness-related corticosteroid insufficiency in addition to likely septic and spinal shock. The patient was initiated on hydrocortisone with improvement in his hypotension. He was transitioned to prednisone and fludrocortisone in addition to 8 weeks of antibiotics after achieving clinical stability. CONCLUSIONS This report brings to attention the risk of adrenal hemorrhage and acute adrenal insufficiency as a sequela of the relatively common illness of Staphylococcus aureus bacteremia. As symptoms of adrenal insufficiency can overlap with septic shock related to the primary condition, this diagnosis requires a high index of suspicion in the critically ill patient.


Sujets)
Maladies des surrénales , Insuffisance surrénale , Bactériémie , Staphylococcus aureus résistant à la méticilline , Infections à staphylocoques , Toxicomanie intraveineuse , Syndrome de Waterhouse-Friderichsen , Maladies des surrénales/complications , Maladies des surrénales/traitement médicamenteux , Insuffisance surrénale/complications , Adulte , Antibactériens/usage thérapeutique , Bactériémie/complications , Bactériémie/traitement médicamenteux , Hémorragie/traitement médicamenteux , Humains , Mâle , Adulte d'âge moyen , Infections à staphylocoques/complications , Infections à staphylocoques/traitement médicamenteux , Toxicomanie intraveineuse/complications , Syndrome de Waterhouse-Friderichsen/complications , Syndrome de Waterhouse-Friderichsen/diagnostic , Syndrome de Waterhouse-Friderichsen/traitement médicamenteux
15.
Theranostics ; 12(10): 4779-4790, 2022.
Article Dans Anglais | MEDLINE | ID: covidwho-2203050

Résumé

New variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are continuing to spread globally, contributing to the persistence of the COVID-19 pandemic. Increasing resources have been focused on developing vaccines and therapeutics that target the Spike glycoprotein of SARS-CoV-2. Recent advances in microfluidics have the potential to recapitulate viral infection in the organ-specific platforms, known as organ-on-a-chip (OoC), in which binding of SARS-CoV-2 Spike protein to the angiotensin-converting enzyme 2 (ACE2) of the host cells occurs. As the COVID-19 pandemic lingers, there remains an unmet need to screen emerging mutations, to predict viral transmissibility and pathogenicity, and to assess the strength of neutralizing antibodies following vaccination or reinfection. Conventional detection of SARS-CoV-2 variants relies on two-dimensional (2-D) cell culture methods, whereas simulating the micro-environment requires three-dimensional (3-D) systems. To this end, analyzing SARS-CoV-2-mediated pathogenicity via microfluidic platforms minimizes the experimental cost, duration, and optimization needed for animal studies, and obviates the ethical concerns associated with the use of primates. In this context, this review highlights the state-of-the-art strategy to engineer the nano-liposomes that can be conjugated with SARS-CoV-2 Spike mutations or genomic sequences in the microfluidic platforms; thereby, allowing for screening the rising SARS-CoV-2 variants and predicting COVID-19-associated coagulation. Furthermore, introducing viral genomics to the patient-specific blood accelerates the discovery of therapeutic targets in the face of evolving viral variants, including B1.1.7 (Alpha), B.1.351 (Beta), B.1.617.2 (Delta), c.37 (Lambda), and B.1.1.529 (Omicron). Thus, engineering nano-liposomes to encapsulate SARS-CoV-2 viral genomic sequences enables rapid detection of SARS-CoV-2 variants in the long COVID-19 era.


Sujets)
, Infections à coronavirus , Pneumopathie virale , Animaux , Anticorps neutralisants , Anticorps antiviraux , /complications , /diagnostic , Infections à coronavirus/prévention et contrôle , Génomique , Humains , Liposomes , Microfluidique , Mutation , Pandémies/prévention et contrôle , Peptidyl-Dipeptidase A/métabolisme , SARS-CoV-2/génétique , Glycoprotéine de spicule des coronavirus
16.
Swiss Med Wkly ; 152: w30212, 2022 08 29.
Article Dans Anglais | MEDLINE | ID: covidwho-2202462

Résumé

AIMS OF THE STUDY: Awake prone positioning (aPP) in non-intubated patients with severe SARS-CoV-2-related pneumonia improves oxygenation and reduces the intubation rate, but no early predictors for success or failure of the strategy have been described. The main objective of this study was to assess whether response to the first aPP in terms of PaO2/FiO2, alveolar-arterial gradient (Aa-O2), respiratory rate and PaCO2 could predict the need for intubation. As secondary objective, we assessed the effects of aPP on the same parameters for all the sessions considered together. METHODS: Retrospective analysis of consecutive SARS-CoV-2 pneumonia patients suffering from acute respiratory failure with moderate to severe hypoxaemia for whom aPP was performed for at least 45 minutes based on the prescription of the clinician in charge according to predefined criteria. Respiratory rate, blood gases and oxygenation parameters (PaO2/FiO2 and Aa-O2), before and after the first aPP were compared between patients who were subsequently intubated or not. Effects of all the aPP sessions together were also analysed. RESULTS: One hundred and sixty-six patients were admitted for SARS-CoV-2 pneumonia during the study period. Among them, 50 received aPP lasting at least 45 minutes. Because 17 denied consent for data analysis and 2 were excluded because of a "do not intubate order", 31 patients (for a total of 116 aPP sessions without any severe adverse events reported) were included. Among them, 10 (32.3%) were intubated. Mean age ± standard deviation (SD) was 60 ± 12 years. At ICU admission, respiratory rate was 26 ± 7/minute, median PaO2/FiO2 94 (interquartile range [IQR] 74-116) mm Hg and median Aa-O2 412 (IQR 286-427) mm Hg (markedly increased). Baseline characteristics did not statistically differ between patients who subsequently needed intubation or not. During the first aPP, PaO2/FiO2 increased and Aa-O2 decreased. When comparing patients who later where intubated or not, we observed, in the non intubated group only, a clinically significant decrease in median Aa-O2, from 294 (280-414) to 204 (107-281) mm Hg, corresponding to a 40% (26-56%) reduction, and a PaO2/FiO2 increase, from 103 (84-116) to 162 (138-195), corresponding to an increase of 48% (11-93%). The p value is <0.005 for both. When all the aPP sessions (n = 80) were considered together, aPP was associated with a significant increase in PaO2/FiO2 from 112 (80-132) to 156 (86-183) mm Hg (p <0.001) and Aa-O2 decrease from 304 (244-418) to 224 (148-361) mm Hg (p = 0.001). CONCLUSIONS: Awake pronation in spontaneously breathing patients is feasible, and improves PaO2/FiO2 and Aa-O2. Response to the first session seems to be associated with lower intubation rate.


Sujets)
, , Insuffisance respiratoire , /complications , /thérapie , Humains , Hypoxie/complications , Hypoxie/thérapie , Intubation trachéale/effets indésirables , Décubitus ventral , /thérapie , Insuffisance respiratoire/étiologie , Insuffisance respiratoire/thérapie , Études rétrospectives , SARS-CoV-2 , Vigilance
17.
Int J Mol Sci ; 23(17)2022 Aug 25.
Article Dans Anglais | MEDLINE | ID: covidwho-2200287

Résumé

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted millions of lives, despite several vaccine interventions and strict precautionary measures. The main causative organism of this disease is the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) which infects the host via two key players: the angiotensin-converting enzyme 2 (ACE2) and the transmembrane protease, serine 2 (TMPRSS2). Some reports revealed that patients with glycemic dysregulation could have increased susceptibility to developing COVID-19 and its related neurological complications. However, no previous studies have looked at the involvement of these key molecules within the hypothalamus, which is the central regulator of glucose in the brain. By exposing embryonic mouse hypothalamic neurons to varying glucose concentrations, we aimed to investigate the expression of ACE2 and TMPRSS2 using quantitative real time polymerase chain reaction and western blotting. A significant and time-dependent increase and decrease was observed on the viability of hypothalamic neurons with increasing and decreasing glucose concentrations, respectively (p < 0.01 and p < 0.001, respectively). Under the same increasing and decreasing glucose conditions, the expression of hypothalamic ACE2 also revealed a significant and time-dependent increase (p < 0.01). These findings suggest that SARS-CoV-2 invades the hypothalamic circuitry. In addition, it highlights the importance of strict glycemic control for COVID-19 in diabetic patients.


Sujets)
, /génétique , Animaux , /complications , Glucose , Hypothalamus/métabolisme , Souris , Peptidyl-Dipeptidase A/génétique , Peptidyl-Dipeptidase A/métabolisme , SARS-CoV-2
18.
Int J Mol Sci ; 23(7)2022 Mar 25.
Article Dans Anglais | MEDLINE | ID: covidwho-2200271

Résumé

The genomic activity of vitamin D is associated with metabolic effects, and the hormone has a strong impact on several physiological functions and, therefore, on health. Among its renowned functions, vitamin D is an immunomodulator and a molecule with an anti-inflammatory effect, and, recently, it has been much studied in relation to its response against viral infections, especially against COVID-19. This review aims to take stock of the correlation studies between vitamin D deficiency and increased risks of severe COVID-19 disease and, similarly, between vitamin D deficiency and acute respiratory distress syndrome. Based on this evidence, supplementation with vitamin D has been tested in clinical trials, and the results are discussed. Finally, this study includes a biochemical analysis on the effects of vitamin D in the body's defense mechanisms against viral infection. In particular, the antioxidant and anti-inflammatory functions are considered in relation to energy metabolism, and the potential, beneficial effect of vitamin D in COVID-19 is described, with discussion of its influence on different biochemical pathways. The proposed, broader view of vitamin D activity could support a better-integrated approach in supplementation strategies against severe COVID-19, which could be valuable in a near future of living with an infection becoming endemic.


Sujets)
, Carence en vitamine D , /traitement médicamenteux , Humains , SARS-CoV-2 , Vitamine D/métabolisme , Carence en vitamine D/complications , Carence en vitamine D/traitement médicamenteux , Carence en vitamine D/épidémiologie , Vitamines/usage thérapeutique
19.
Front Cell Infect Microbiol ; 12: 726263, 2022.
Article Dans Anglais | MEDLINE | ID: covidwho-2198679

Résumé

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is resilient, highly pathogenic, and rapidly transmissible. COVID-19 patients have been reported to have underlying chronic liver abnormalities linked to hepatic dysfunction. Discussion: Viral RNAs are detectable in fecal samples by RT-PCR even after negative respiratory samples, which suggests that SARS-CoV-2 can affect the gastrointestinal tract and the liver. The case fatality rates are higher among the elderly and those with underlying comorbidities such as hypertension, diabetes, liver abnormality, and heart disease. There is insufficient research on signaling pathways. Identification of molecular mechanisms involved in SARS-CoV-2-induced damages to hepatocytes is challenging. Herein, we demonstrated the multifactorial effects of SARS-CoV-2 on liver injury such as psychological stress, immunopathogenesis, systemic inflammation, ischemia and hypoxia, drug toxicity, antibody-dependent enhancement (ADE) of infection, and several others which can significantly damage the liver. Conclusion: During the COVID-19 pandemic, it is necessary for clinicians across the globe to pay attention to SARS-CoV-2-mediated liver injury to manage the rising burden of hepatocellular carcinoma. To face the challenges during the resumption of clinical services for patients with pre-existing liver abnormalities and HCC, the impact of SARS-CoV-2 on hepatocytes should be investigated both in vitro and in vivo.


Sujets)
, Carcinome hépatocellulaire , Maladies gastro-intestinales , Tumeurs du foie , Sujet âgé , /complications , Humains , Foie/anatomopathologie , Tumeurs du foie/anatomopathologie , Pandémies , SARS-CoV-2
20.
Med Mycol J ; 63(3): 59-64, 2022.
Article Dans Anglais | MEDLINE | ID: covidwho-2198582

Résumé

Acute invasive fungal rhinosinusitis is a rare infection primarily affecting patients with co-morbidities like immunosuppression and poorly controlled diabetes. Mucormycosis is increasingly being reported in patients with SARS-CoV-2 (COVID-19). However, reports of coinfection of aspergillosis and mucormycosis involving nose, paranasal sinuses, orbit, and brain are rare in literature. We aimed to evaluate the patient demographics, clinical presentation, and management of cases presenting with mixed infection. We carried out retrospective analysis of 12 patients with confirmed diagnosis of mixed invasive fungal infections post-COVID-19 disease out of 70 cases of COVID-19-associated mucormycosis (CAM) presenting to a tertiary-level hospital in North India from May to June 2021. All patients had diabetes mellitus; the mean age was 48 years. The common presenting features were headache, nasal congestion, palatal ulcer, and vision loss accompanied by facial pain and swelling. Two patients developed cerebral abscess during the course of treatment; three patients had concurrent COVID-19 pneumonia. All patients received systemic liposomal amphotericin B and serial surgical debridements. The overall mortality rate was 16.7%. Our study demonstrates that mucormycosis and aspergillosis are angioinvasive mycoses that are clinically and radiologically identical. KOH direct mount of clinical sample showing septate hyphae should be extensively searched for aseptate hyphae after digestion and clearing of the tissue. A high index of suspicion of mixed infection post-COVID-19 and early initiation of liposomal amphotericin B followed by prompt surgical intervention can reduce the overall morbidity and mortality among patients with this condition.


Sujets)
Aspergillose , , Co-infection , Infections fongiques invasives , Mucormycose , Sinusite , Antifongiques/usage thérapeutique , Aspergillose/microbiologie , /complications , Co-infection/complications , Co-infection/traitement médicamenteux , Co-infection/microbiologie , Humains , Infections fongiques invasives/traitement médicamenteux , Adulte d'âge moyen , Mucormycose/complications , Mucormycose/diagnostic , Études rétrospectives , SARS-CoV-2 , Sinusite/complications , Sinusite/microbiologie , Centres de soins tertiaires
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