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Menéndez R, Méndez R, Latorre A, González-Jiménez P, Peces-Barba G, Molina-Molina M, España PP, García E, Consuegra-Vanegas A, García-Clemente MM, Panadero C, Figueira-Gonçalves JM, De la Rosa-Carrillo D, Sibila O, Martínez-Pitarch MD, Toledo-Pons N, López-Ramírez C, Almonte-Batista W, Macías-Paredes A, Villamon M, Domínguez-Álvarez M, Pérez-Rodas EN, Lázaro J, Quirós S, Cordovilla R, Cano-Pumarega I, Torres A. Clustering patients with COVID-19 according to respiratory support requirements, and its impact on short- and long-term outcome (RECOVID study). Pulmonology 2025; 31:2442175. [PMID: 39750717 DOI: 10.1080/25310429.2024.2442175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/19/2024] [Indexed: 01/04/2025] Open
Abstract
INTRODUCTION The Spanish Society of Pulmonology and Thoracic Surgery created a registry for hospitalised patients with COVID-19 and the different types of respiratory support used (RECOVID). Objectives. To describe the profile of hospitalised patients with COVID-19, comorbidities, respiratory support treatments and setting. In addition, we aimed to identify varying profiles of patients according to outcomes and the complexity of respiratory support needed. METHODS Multicentre, observational study in 49 Spanish hospitals. A protocol collected demographic data, comorbidities, respiratory support, treatment setting and 1-year follow-up. Patients were described using either frequency and percentages or median and interquartile range, as appropriate. A cluster analysis made it possible to identify different types of profile among the patients. RESULTS In total, 2148 of 2454 hospitalised patients (87.5%) received care in the conventional ward, whilst 126 in IRCU and 180 in ICU. In IRCU, 30% required high-flow nasal oxygen whilst 25%, non-invasive mechanical ventilation and 17%, mechanical ventilation. Four clusters of patients were identified. Two clusters were more likely to require IRCU/ICU admission, although primarily Cluster 2: Cluster (C) 1 consisted of patients without comorbidities and C2, those with comorbidities. Both presented higher inflammatory levels and lower lymphocyte count and SpO2/FiO2; however, C2 showed worse values. Two different clusters identified patients requiring less complex respiratory support. C3 presented higher comorbidities and elevated lymphocyte count, SpO2/FiO2 and low C-reactive protein (CRP). C4 included those without comorbidities except for arterial hypertension, lymphopenia and an intermediate CRP. In-hospital mortality and subsequent 1-year mortality were greater for C2 (28.6% and 7.1%) and C1 (11.1%, 8.3%) than for C4 (3.3%, 1.8%) and C3 (0%, 0%). CONCLUSIONS The cluster analysis identified four clinical phenotypes requiring distinct types of respiratory support, with great differences present per characteristics and outcomes.
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Affiliation(s)
- Rosario Menéndez
- Pneumology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory Infections, Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Raúl Méndez
- Pneumology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory Infections, Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Ana Latorre
- Respiratory Infections, Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Paula González-Jiménez
- Pneumology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory Infections, Research Institute La Fe (IISLAFE), Valencia, Spain
| | | | - María Molina-Molina
- ILD Unit, Pneumology Service, Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Hospitalet de Llobregat, Spain
| | | | - Estela García
- Pneumology Service, Hospital de Cabueñes, Gijón, Spain
| | | | | | | | | | | | - Oriol Sibila
- Pneumology Service, Hospital Clínic, Barcelona, Spain
| | | | - Nuria Toledo-Pons
- Pneumology Service, Hospital Son Espases-Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | | | | | | | | | | | | | - Javier Lázaro
- Pneumology Service, Hospital Royo Villanova, Zaragoza, Spain
| | - Sarai Quirós
- Pneumology Service, Hospital Basurto, Bilbao, Spain
| | | | - Irene Cano-Pumarega
- Sleep Unit, Pneumology Service, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Antoni Torres
- Pneumology Service, Hospital Clínic, Barcelona, Spain
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Zhong X, Wang X, Feng X, Yu H, Chen Z, Chen X. The blood urea nitrogen-to-creatinine ratio is associated with acute kidney injury among COVID-19 patients. Ren Fail 2025; 47:2442049. [PMID: 40033758 PMCID: PMC11881656 DOI: 10.1080/0886022x.2024.2442049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 11/05/2024] [Accepted: 12/02/2024] [Indexed: 03/05/2025] Open
Abstract
INTRODUCTION To explore the associations between the blood urea nitrogen-to-creatinine ratio (BCR), acute kidney injury (AKI), and in-hospital mortality in coronavirus disease 2019 (COVID-19) patients. METHODS COVID-19 patients from Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine were enrolled in this study. Clinical data and laboratory parameters were collected. AKI was defined using two serum creatinine tests according to KDIGO guidelines. Cox regression and receiver operating characteristic (ROC) curve analyses were performed. RESULTS Five hundred and sixty-seven COVID-19 patients were enrolled, 44.1% of whom were male. The mean age was 75 years. Among all patients, 17 patients developed AKI, and 30 patients died during hospitalization. Compared to non-AKI patients, the BCR in AKI patients was significantly greater. BCR was significantly associated with AKI (unadjusted HR 1.04, 95% CI: 1.02-1.05, p < 0.001; adjusted HR 1.06, 95% CI 1.02-1.10, p = 0.001). BCR was also a risk factor of in-hospital mortality (unadjusted HR 1.03, 95% CI: 1.02-1.05, p < 0.001; adjusted HR 1.04, 95% CI: 1.01-1.08, p = 0.019). The BCR threshold was 38.9, with 70.6% sensitivity and 87.1% specificity for predicting AKI, while a threshold of 33.0 predicted mortality. Subgroup analysis revealed that BCR could predict AKI and mortality in different subgroups according to sex, age, diabetes mellitus, and estimated glomerular filtration rate. CONCLUSIONS The BCR, a simple index, is associated with AKI onset and mortality in COVID-19 patients. The BCR possesses certain specificity for AKI screening, which indicates an effective clinical indicator for screening patients at high risk of AKI.
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Affiliation(s)
- Xiaoli Zhong
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuejie Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobei Feng
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijin Yu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijin Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mohamed AA, Alanazi AT, Ahmed HH, Elfiky S, Abdel Ghafar MT, Maher I, Taha SA, AbuRahma MZA, Elagawy W, Mohareb DA, Rawy AM, Abostate HM, Youssef AA, Elsayed DS, Abdel-Hamid RM. FokI polymorphism of the vitamin D receptor gene: Linking COVID-19 risk to genetic susceptibility in children. Cytokine 2025; 191:156958. [PMID: 40367829 DOI: 10.1016/j.cyto.2025.156958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 04/24/2025] [Accepted: 05/05/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Vitamin D receptor (VDR), influenced by gene polymorphisms like FokI, may affect susceptibility to infections, including coronavirus disease 2019 (COVID-19). Since studies in children are limited, we aimed to analyze the correlation between the VDR FokI variant and both the incidence and severity of COVID-19 in Egyptian children. METHODS Seventy-seven COVID-19-positive and 107 COVID-19-negative pediatric patients were included. Participants' serum 25(OH)D levels, inflammatory biomarkers, and demographics were evaluated. Real-time polymerase chain reaction (PCR) was used for genotyping the VDR FokI (rs2228570) polymorphism. RESULTS Absolute lymphocyte count (ALC) was significantly lower in COVID-19 patients than in controls, while interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, and D-dimer were significantly higher (all p < 0.001). Vitamin D insufficiency was significantly more common in COVID-19 cases (18.2 % versus 3.7 %, p = 0.002). Male sex, increased tumor necrosis factor-alpha (TNF-α), and CRP were significantly associated with severe COVID-19 (p = 0.032, 0.029, < 0.001, respectively). The FokI TT genotype in codominant and recessive models and the T allele in the multiplicative model were significantly correlated with 2.4, 3.0, and 1.8 folds increased COVID-19 risk (p = 0.043, < 0.001, and 0.004, respectively). However, VDR FokI variants did not significantly associate with severe COVID-19. CONCLUSION The T allele and TT genotype of the FokI variant in the VDR gene increase susceptibility to COVID-19 but not its severity in Egyptian children. Additional research is required to validate the potential role of vitamin D and its receptor polymorphism in COVID-19.
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Affiliation(s)
- Amal Ahmed Mohamed
- Biochemistry Department, National Hepatology and Tropical Medicine Research Institute, GOTHI, Cairo 11511, Egypt,.
| | - Abdullah Taher Alanazi
- Immunology Laboratory, College of Medical Sciences, MOH-Eradah and Mental Health Complex, Madinah 42311, Saudi Arabia,.
| | - Hoda H Ahmed
- Pediatric Department, Medical Research and Clinical Studies Institute, National Research Centre, Cairo 11511, Egypt.
| | - Samar Elfiky
- Pediatric and Neonatology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt.
| | | | - Ingy Maher
- Biotechnology Department, Modern Sciences and Arts University, Giza 12451, Egypt.
| | - Sherin A Taha
- Pediatric Department, Faculty of Medicine, Suez University, Suez, 43221, Egypt.
| | | | - Waleed Elagawy
- Department of Tropical Medicine, Faculty of Medicine, Port Said University, Port Fouad, 42526, Egypt.
| | - Dina A Mohareb
- Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
| | - Abeer M Rawy
- Chest Diseases Department, Faculty of Medicine, Benha University, Benha 13511, Egypt.
| | - Heba M Abostate
- Microbiology and Immunology Department, Faculty of Pharmacy, Egyptian Russian University, Cairo 11511, Egypt.
| | - Amira AlSayed Youssef
- Microbiology Lab Department, Egyptian (CDC) Center of Disease Control at the National Institute of Liver, Digestive and Infectious Diseases, Giza, 12311, Egypt.
| | | | - Rasha M Abdel-Hamid
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, 11562, Egypt.
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Shaffer A, Meyerowitz EA. Clinical Manifestations of SARS-CoV-2 Infection in Immunocompetent Adults in the Era of Widespread Population Immunity and Omicron Sublineage Viruses. Infect Dis Clin North Am 2025; 39:233-251. [PMID: 40068975 DOI: 10.1016/j.idc.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
While most SARS-CoV-2 infections and reinfections in the era of widespread population immunity with omicron subsub-lineage variants are mild for immunocompetent individuals, any manifestation previously seen during the pandemic phase is still possible. COVID-19 may affect any organ system. Previous infections and prior vaccines protect against symptomatic future SARS-CoV-2 infections, though this protection wanes over time.
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Affiliation(s)
- Alexander Shaffer
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric A Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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Tejero-Mas M, Palmerín-Donoso A, Buitrago-Ramírez F, Pérez-Caballero FL, Morales-Gabardino JA. [Clinical and sociodemographic characteristics and progression of SARS-CoV-2 patients in two health areas of Extremadura during the first six months of the pandemic]. Aten Primaria 2025; 57:103155. [PMID: 39689623 PMCID: PMC11719368 DOI: 10.1016/j.aprim.2024.103155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 11/04/2024] [Accepted: 11/11/2024] [Indexed: 12/19/2024] Open
Abstract
OBJECTIVE To describe clinical and sociodemographic characteristics as well as the outcome of patients infected with SARS-CoV-2 in first six months of the pandemic. DESIGN Observational and ambispective study. SITE: Primary Care (two Health Areas in Extremadura). PARTICIPANTS A total of 1,422 patients were included (mean age 45.6 years; 53.2% women) who had the ICPC-2 diagnostic code for "confirmed SARS-CoV-2 infection" recorded in their clinical history during the first six months of the pandemic. INTERVENTIONS Not necessary. MAIN MEASUREMENTS Clinical and sociodemographic characteristics as well as outcome of patients (hospital visits, admissions and mortality). RESULTS The mean age (50.8 vs. 42.3 years, p<0.001), and prevalence of most of the comorbidities, dependent patients (13.8% vs. 4.0%), and residents in social care institutions (15.4% vs. 3.1%) were higher in the Don Benito-Villanueva area than in Badajoz. The predominant age group was 19-49 years (44.4%). 41.4% of patients were actively employed, mainly in National Classification of Occupations groups 2, 5, and 9, while 16.5% were social healthcare professionals. 16.5% of patients visited the hospital, 13.4% required hospitalization. Among those who consulted in hospital emergency departments independently, 46.2% were hospitalized, compared to 78.8% of those referred from primary care (p=0.000). The overall mortality rate was 2.0% (3.1% in Don Benito-Villanueva versus 1.3% in Badajoz; p=0.016) increasing to 8.9% among hospitalized patients. CONCLUSIONS Sociodemographic and clinical differences were noted between the two health areas. Most infections were managed in primary care, while those referred to the hospital had a higher hospitalization rate.
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Affiliation(s)
- Manuel Tejero-Mas
- Consultorio Local de Trujillanos, Centro de Salud Mérida Norte (Mérida), Badajoz, España.
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Siciliani L, Cappa G, Zattera C, Albi G, Mondelli MU, Marzi L. Altered liver hemodynamics in patients with COVID-19: a cross sectional study. J Ultrasound 2025; 28:437-445. [PMID: 40172816 PMCID: PMC12145364 DOI: 10.1007/s40477-025-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Accepted: 03/16/2025] [Indexed: 04/04/2025] Open
Abstract
AIMS Abnormalities in liver biochemistry are common in COVID-19 patients. Hepatic vein Doppler waveform, typically triphasic, may become biphasic or monophasic in cirrhosis, correlating with liver dysfunction, fibrosis, inflammation, and portal hypertension. This study investigates liver ultrasound (US) features in COVID-19 patients, correlating hepatic vein Doppler waveform and portal vein velocity (PVV) with inflammatory indexes and clinical outcomes. METHODS Fifty-seven patients with SARS-CoV-2 infection participated in a crosssectional study. Bedside upper abdomen US evaluations, including B-mode and Doppler, were conducted using a convex probe. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic, and the hepatic vein waveform index (HVWI) was calculated. PVV was measured over three cardiac cycles. Tracings were blindly analyzed by three operators to ensure consistency. RESULTS Low HVWI and high PVV correlated with elevated LDH, ALT, D-dimer, and ferritin (p < 0.05). HVWI showed significant negative correlations with ferritin, D-dimer, and ALT (p < 0.05). D-Dimer and ferritin were higher in patients with biphasic/monophasic waveforms (p < 0.05). High PVV and larger spleen diameters predicted worse respiratory outcomes, including CPAP and tracheal intubation (p < 0.05). Optimal cut-off values for PVV (21.7 cm/s) and spleen diameter (9.84 cm) maximized sensitivity and specificity for predicting these outcomes. FIB-4 scores did not correlate with respiratory outcomes or hepatic hemodynamics (p > 0.05). Hemodynamic alterations were not significantly influenced by the presence of SLD (Steatotic Liver Disease). CONCLUSIONS COVID-19 patients exhibit altered intrahepatic hemodynamics, with hepatic vein waveform abnormalities potentially reflecting liver inflammation and fibrosis. PVV and spleen diameter may serve as non-invasive predictors of respiratory outcomes.
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Affiliation(s)
- Luisa Siciliani
- Division of Clinical Immunology and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Giovanni Cappa
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo University Hospital, University of Pavia, Pavia, Italy
| | - Caterina Zattera
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo University Hospital, University of Pavia, Pavia, Italy
| | - Giuseppe Albi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Mario Umberto Mondelli
- Division of Clinical Immunology and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Marzi
- Gastroenterology Department, Bolzano Regional Hospital, 39100, Bolzano, Italy
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Meredith LS, Tobin JN, Cassells A, Howell K, Hernandez HG, Gidengil C, Williamson S, Dong L, Timmins G, Alvarado G, Holder T, Cortez Lainez J, Lin TJ, Lara M. Boost your health (Refuerza tu Salud): Design of a randomized controlled trial of a community health worker intervention to reduce inequities in COVID-19 and influenza vaccinations. Contemp Clin Trials 2025; 153:107848. [PMID: 39965727 DOI: 10.1016/j.cct.2025.107848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 01/30/2025] [Accepted: 02/14/2025] [Indexed: 02/20/2025]
Abstract
INTRODUCTION Low-income and underserved populations, especially racial and ethnic minorities, experience health disparities linked to social determinants. The COVID-19 pandemic amplified these disparities, necessitating effective strategies to address structural racism and related factors. Vaccination, crucial for mitigating infectious diseases, including COVID-19 and influenza, remains challenging among underserved populations. Community health worker (CHW) interventions show promise in addressing these disparities but have not undergone rigorous evaluation with a randomized controlled trial to increase vaccination uptake among underserved populations. This study develops and evaluates a CHW vaccination behavior (CHW-VB) intervention to increase COVID-19 and influenza vaccination among adult patients in primary care settings. METHODS Tailoring of the Boost Your Health (Refuerza tu Salud) intervention is grounded in behavior change theory and integrates input from a Community Advisory Board. The study employs a patient randomized controlled trial design to test the effectiveness the CHW-VB intervention compared with usual care across six Federally Qualified Health Centers (FQHCs) in New York. Patients are being screened for eligibility (vaccinated but not up to date with the COVID-19 vaccine and have at least one of seven common chronic illnesses) and 800 are assessed at baseline and three months. Outcomes include COVID-19 vaccine (primary) and influenza vaccine (secondary) uptake. The study also evaluates intervention implementation using the RE-AIM model. CONCLUSION Boost Your Health aims to increase COVID-19 and influenza vaccination among racially/ethnically diverse, underserved populations with chronic illness through the CHW-VB intervention, targeting critical gaps in vaccination uptake to reduce health disparities and increase health equity. TRIAL REGISTRATION (ClinicalTrials.govNCT06156254).
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Affiliation(s)
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, United States of America; The Rockefeller University Center for Clinical and Translational Science, New York, NY, United States of America
| | - Andrea Cassells
- Clinical Directors Network (CDN), New York, NY, United States of America
| | | | | | | | | | - Lu Dong
- RAND, Santa Monica, CA, United States of America
| | | | | | - Tameir Holder
- Clinical Directors Network (CDN), New York, NY, United States of America
| | | | - T J Lin
- Clinical Directors Network (CDN), New York, NY, United States of America
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Salvo PF, Iannone V, Lombardi F, Ciccullo A, Lamanna F, Passerotto RA, Baldin G, Steiner RJ, Carbone A, Massaroni V, Di Giambenedetto S, Borghetti A. Estimating risk of acquiring SARS-COV2 infection in treatment-experienced PLWH: A case-control study. GLOBAL EPIDEMIOLOGY 2025; 9:100198. [PMID: 40225776 PMCID: PMC11987658 DOI: 10.1016/j.gloepi.2025.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/18/2025] [Accepted: 03/21/2025] [Indexed: 04/15/2025] Open
Abstract
Background Risk factors for acquiring SARS-CoV-2 infection in people living with HIV (PLWH) and the true relationship between HIV and SARS CoV-2, are still not fully understood. Objectives The aim of this study was to identify the independent risk factors for SARS-CoV-2 acquisition in treatment experienced PLWH, shedding light on potential risk factors associated with SARS CoV-2 infection in PLWH undergoing treatment. Study design PLWH were recruited from the Infectious Diseases Outpatient Clinic of Fondazione Policlinico Universitario A.Gemelli IRCCS in Italy and randomly interviewed via a questionnaire during their follow-up visits to determine if they had experienced a SARS-CoV-2 infection between March 2020 and June 2022.For each participant with reported history of SARS-CoV-2 (cases), two PLWH with no declared COVID-19 infection were selected (controls); PLWH had a similar potential exposure time to SARS-CoV-2. A total 220 PLWH were selected: 72 cases and 148 controls. None developed severe Covid-19 disease and only one participant required hospitalization. Results Overall, 220 PLWH were enrolled: 72 cases and 148 controls. Characteristics of cases and controls were similar, except for the ART regimen used and the last HIV-RNA concentration before the enrollment date. By an adjusted multivariable logistic regression, the estimated odds of SARS-CoV-2 infection was higher in more recent years (2022 versus 2020 aOR 20.74, 95 % CI 5.26-81.8) and in PLWH with last HIV-RNA >50 cp/mL before enrollment date (versus <50 aOR 4.56, 95 % CI 1.01-20.46). A reduced odds was correlated with >3 vaccine doses (versus <3 or not vaccinated aOR 0.08, 95 % CI 0.02-0.24). Conclusion In this cohort, the odds of SARS-CoV-2 acquisition increased over time, probably due to change in lock-down measures and in SARS-CoV-2 circulating variants.Detectable viral load was associated with increased risk of infection, highlighting the importance of HIV-RNA monitoring during pandemics.
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Affiliation(s)
- Pierluigi Francesco Salvo
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
| | - Valentina Iannone
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
| | - Francesca Lombardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Italia- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, 00168 Roma, Italy
| | - Arturo Ciccullo
- Ospedale San Salvatore, Dipartimento di Malattie Infettive L'Aquila, 67100, Italy
| | - Francesco Lamanna
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
| | - Rosa Anna Passerotto
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
| | - Gianmaria Baldin
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Italia- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, 00168 Roma, Italy
| | - Rebecca Jo Steiner
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
| | - Andrea Carbone
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
| | - Valentina Massaroni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Italia- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, 00168 Roma, Italy
| | - Simona Di Giambenedetto
- Università Cattolica del Sacro Cuore, Roma Italia- Dipartimento di Sicurezza e Bioetica sezione Malattie Infettive, 00168 Roma, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Italia- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, 00168 Roma, Italy
| | - Alberto Borghetti
- Dipartimento di Medicina Clinica e Sperimentale, Unità di Malattie Infettive, Università di Pisa, 56124, Pisa, Italy
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Hu Z, Yau YK, Quan J, Grépin KA, Mak IL, Lau GKK, Wong ICK, Chao DVK, Ko WWK, Lau CS, Lam CLK, Wan EYF. Indirect effect of the COVID-19 pandemic on cardiovascular diseases incidence, mortality, and healthcare use among patients with hypertension but without SARS-CoV-2 infection in Hong Kong: an interrupted time series analysis. Hypertens Res 2025:10.1038/s41440-025-02230-y. [PMID: 40410292 DOI: 10.1038/s41440-025-02230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 04/12/2025] [Accepted: 04/18/2025] [Indexed: 05/25/2025]
Abstract
This study investigated the effects of the COVID-19 pandemic on cardiovascular disease (CVD) incidence among hypertensive patients without SARS-CoV-2 infection by changes in CVD incidence, all-cause mortality, blood pressure (BP) control, and healthcare utilization rates among this population from Hong Kong. Individuals diagnosed with hypertension from January 2010 to January 2020 were followed up until death, SARS-CoV infection, or April 2022. Interrupted time series analyses on 1,318,907 patients with hypertension, comparing outcomes across four periods: pre-pandemic (January 2012-January 2020), early pandemic (February 2020-February 2021), interwave (March-December 2021), and Omicron outbreak (January-April 2022). A significant increase in out-of-hospital mortality was found when the early pandemic started. Overall all-cause mortality increased progressively during the interwave period. CVD incidence decreased immediately in the early pandemic period, followed by a progressive increase, and surpassed the pre-pandemic level at the beginning of the interwave period. The proportion of patients with office-measured BP ≤ 140/90 mmHg remained below pre-pandemic levels across the pandemic periods. Healthcare utilization declined immediately in February 2020, while most utilization rebounded to the pre-pandemic level after March 2021 and declined again during the Omicron outbreak. Healthcare disruptions during the early pandemic likely delayed CVD diagnosis and treatment, driving an immediate rise in out-of-hospital mortality. When healthcare services gradually recovered in the interwave period, CVD incidence rebounded and both in and out-of-hospital all-cause mortality increased with a lag, possibly related to delayed treatment.
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Affiliation(s)
- Zhuoran Hu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuk Kam Yau
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jianchao Quan
- Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Business School, The University of Hong Kong, Hong Kong, China
| | - Karen Ann Grépin
- Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gary Kui Kai Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Advanced Data Analytics for Medical Science Limited, Hong Kong, China
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital, Kowloon East Cluster, Hospital Authority, Hong Kong, China
| | - Welchie Wai Kit Ko
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong, China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- Advanced Data Analytics for Medical Science Limited, Hong Kong, China.
- The Institute of Cardiovascular Science and Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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10
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Partouche N, Maumy M, Chamaraux-Tran TN, Bertrand F, Schneider F, Meyer N, Solis M, Fafi-Kremer S, Noll E, Pottecher J. Does the IL-6/KL-6 ratio distinguish different phenotypes in COVID-19 Acute Respiratory Distress Syndrome? An observational study stemmed from prospectively derived clinical, biological, and computed tomographic data. PLoS One 2025; 20:e0321533. [PMID: 40397955 DOI: 10.1371/journal.pone.0321533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 03/07/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND As new SARS-CoV-2 variants emerge and as treatment of COVID-19 ARDS remains exclusively supportive, there is an unmet need to better characterize its different phenotypes to tailor personalized treatments. Clinical, biological, spirometric and CT data hardly allow deciphering of Heavy (H), Intermediate (I) and Light (L) phenotypes of COVID-19 ARDS and the implementation of tailored specific strategies (prone positioning, PEEP settings, recruitment maneuvers). We hypothesized that the ratio of two pivotal COVID-19 biomarkers (interleukin 6 [IL-6] and Krebs von den Lungen 6 [KL-6], related to inflammation and pneumocyte repair, respectively) would provide a biologic insight into the disease timeline allowing 1) to differentiate H, I and L phenotypes, 2) to predict outcome and 3) to reflect some of CT findings. METHODS AND FINDINGS This was a retrospective analysis of prospectively acquired data (COVID HUS cohort). Inclusion concerned any patient with severe COVID-19 pneumonia admitted to two intensive care units between March 1st and May 1st, 2020, in a high-density cluster of the first epidemic wave (Strasbourg University Hospital, France). Demographic, clinical, biological (standard, IL-6 [new generation ELISA], KL-6 [CLEIA technique]), spirometric (driving pressure, respiratory system compliance) and CT data were collected longitudinally. CT analysis included semi-automatic and automatic lung measurements and allowed segmentation of lung volumes into 4 (poorly aerated, non-aerated, overinflated and normally aerated) and 3 (ground-glass, restricted normally aerated, and overinflated) zones, respectively. The primary outcome was to challenge the IL-6/KL-6 ratio capacity to decipher the three COVID-19 ARDS phenotypes (H, I and L) defined on clinical, spirometric and radiologic grounds. Secondary outcomes were the analysis of the prognostic value of the IL-6/KL-6 ratio and its correlates with CT-acquired data. Multivariate analysis was based on principal component analysis. One hundred and forty-eight ventilated COVID-19 ICU patients from the COVID HUS cohort were assessed for eligibility and 77 were included in the full analysis. Most were male, all were under invasive mechanical ventilation and vasopressor therapy and displayed high severity scores (SAPSII: 48 [42-56]; SOFA: 8 [7-10]). The L, I and H COVID ARDS phenotypes were identified in 11, 15 and 48 patients, respectively. In three patients, the phenotype could not be defined precisely. Thirty patients (39%) died in the ICU and the number of ventilator-free days was 2 [0-2] days. The IL-6/KL-6 ratio was not significantly different between the L, I and H phenotypes and evolved according to similar patterns over time. Surviving and deceased patients displayed an inverse kinetic of KL-6. IL-6 and the IL-6/KL-6 ratio were linearly associated with ground-glass volume on semi-automatic and automatic CT lung measurements. CONCLUSIONS In our population of severe ventilated COVID ARDS patients, the IL-6/KL-6 ratio was not clue to differentiate the H, I and L phenotypes and tailor a personalized ventilatory approach. There was an interesting correlation between IL-6/KL-6 ratio and ground-glass volume as determined by automated lung CT analysis. Such correlation deserves more in-depth pathophysiological study, at best gathered from a prospective cohort with a larger sample size and histological analysis. TRIAL REGISTRATION COVID HUS Trial registration number: NCT04405726.
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Affiliation(s)
- Nicolas Partouche
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, UR3072, FMTS, FHU Omicare, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, Strasbourg, France
| | - Myriam Maumy
- LIST3N, University of Technology of Troyes, Troyes, France
| | - Thien-Nga Chamaraux-Tran
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS UMR7104, INSERM U1258, Université de Strasbourg, 1 Rue Laurent Fries, Illkirch-Graffenstaden, France
| | | | - Francis Schneider
- Service de Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Service de santé Publique, GMRC, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Morgane Solis
- Faculté de Médecine, Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France - INSERM, UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Samira Fafi-Kremer
- Faculté de Médecine, Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France - INSERM, UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Eric Noll
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, UR3072, FMTS, FHU Omicare, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, Strasbourg, France
| | - Julien Pottecher
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, UR3072, FMTS, FHU Omicare, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, Strasbourg, France
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11
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Hermann M, Filipsky R, Bukowski N, Gerger G, Hermann A, Krenn K, Teufel A, Kimberger O, Laxar D, Maleczek M, Schaden E, Wiegele M, Willschke H, Tiboldi A. Long-Term Health-Related Quality of Life Following Survival of Acute Respiratory Distress Syndrome and Extracorporeal Membrane Oxygenation Due to COVID-19. J Clin Med 2025; 14:3358. [PMID: 40429356 PMCID: PMC12112094 DOI: 10.3390/jcm14103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 05/06/2025] [Accepted: 05/09/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Patients suffering from severe COVID-19 often develop acute respiratory distress syndrome (ARDS), necessitating intensive care unit (ICU) and extracorporeal membrane oxygenation (ECMO). Survivors frequently experience negative impacts on their health-related quality of life. These individuals may experience a range of symptoms and may require extended hospitalization and rehabilitation. The objective of this prospective cohort study was to assess the long-term health-related quality of life in intensive care survivors of COVID-19-related ARDS who received ECMO therapy, >18 months after their ICU discharge. Methods: The health-related quality of life of COVID-19 survivors who had received extracorporeal membrane oxygenation was evaluated using an augmented version of the Short-Form Health Survey-36, >18 months after their ICU discharge. The outcomes were compared to preexisting data from a meta-analysis analyzing patients with non-COVID-19 ARDS and ECMO therapy. Results: Of the 43 eligible patients (mean age 52 ± 9.5 years), 18 patients (46.2%) responded to the written invitation and were included in this study. The four subscales of the Short-Form Health Survey-36 survey, performed via telephone interview, that showed the most severe limitations (points) were role limitation due to physical problems (37.5), emotional problems (47.9), social functioning (38.1), and general health (49.2). The general health, energy/fatigue (vitality), and physical functioning significantly correlated with higher age (p = 0.004, p = 0.003, and p = 0.05, respectively). A longer duration of extracorporeal membrane oxygenation was positively associated with an improved energy/fatigue ratio (vitality) and emotional well-being (p = 0.04 and p = 0.02, respectively). Compared to survivors of non-COVID-19 ARDS treated with ECMO, the survivors in our cohort scored significantly lower on social functioning, physical functioning, and general health (p < 0.01, p = 0.02, p < 0.01). Conclusions: Patients who have recovered from intensive care treatment for COVID-19-related ARDS and have received ECMO therapy continue to experience more severe impairments in their physical, mental, and cognitive health-related quality of life. A longer ECMO duration may improve outcomes in this selected patient population.
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Affiliation(s)
- Martina Hermann
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Rebecca Filipsky
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Nils Bukowski
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Gernot Gerger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Alexander Hermann
- Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Krenn
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Anna Teufel
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Oliver Kimberger
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Daniel Laxar
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Mathias Maleczek
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva Schaden
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Marion Wiegele
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
| | - Akos Tiboldi
- Department of Anaesthesia, Clinical Division of General Anaesthesia and Intensive Care Medicine, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, 1180 Vienna, Austria
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Tang PF, Bao SS, Xie WF, Xiao ZX, Wu XM, Ge HL. Development and application of a UHPLC-MS/MS method for the simultaneous determination of firmonertinib and its main metabolite AST-5902 in rat plasma: a study on the in vivo drug interaction between firmonertinib and paxlovid. Front Pharmacol 2025; 16:1570206. [PMID: 40421224 PMCID: PMC12104055 DOI: 10.3389/fphar.2025.1570206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/28/2025] [Indexed: 05/28/2025] Open
Abstract
Due to the potential occurrence of drug interactions, the combined application of firmonertinib and paxlovid carries a relatively high risk. Nevertheless, as of now, there has been no comprehensive research on the interaction between firmonertinib and paxlovid. Our aim was to establish and validate an accurate, stable, rapid and simple UPLC-MS/MS method for the simultaneous determination of firmonertinib and its metabolite AST-5902 in rat plasma, which was applied to the study of the in vivo interaction between firmonertinib and paxlovid. Gefitinib was selected as the internal standard. After protein precipitation of the plasma samples with acetonitrile, the separation was carried out on a Shimadzu LC-20AT UHPLC. The chromatographic column was a Shim-pack Volex PFPP column (50 mm × 2.1 mm, 1.8 μm), and the mobile phase was composed of 0.1% formic acid - water and 0.1% formic acid - methanol. Mass spectrometry detection was performed using a Shimadzu 8,040 mass spectrometer in ESI+ and MRM mode. The precision, accuracy, recovery and matrix effect of this method were detected. The linearity of the method and the stability of the samples were assessed. Subsequently, the method was applied to the study of the interaction between firmonertinib and paxlovid. The parent ions and typical fragment ions of firmonertinib, AST-5902 and IS are respectively m/z 569.25 → 72.15, m/z 555.50 → 498.10 and m/z 447.25→ 128.20. The selectivity, specificity, linearity, recovery, matrix effect, accuracy and precision of the method and the stability of the samples were all adequately verified. The results of drug interaction showed that when firmonertinib was combined with paxlovid, the AUC and Cmax of firmonertinib were significantly increased, while the AUC, Tmax, and Cmax of AST-5902 were significantly decreased. The established UHPLC-MS/MS detection method is accurate, stable, rapid and simple. Paxlovid exhibit a significant inhibitory effect on the metabolism of firmonertinib in rats.
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Affiliation(s)
- Peng-Fei Tang
- Department of Clinical Pharmacy Room, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Su-Su Bao
- Department of Clinical Pharmacy Room, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei-Fei Xie
- Department of Hematology and Chemotherapy, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhong-Xiang Xiao
- Department of Clinical Pharmacy Room, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xue-Meng Wu
- Department of General Department, Market Supervision Administration of Yueqing City, Wenzhou, Zhejiang, China
| | - Hong-Lei Ge
- Department of Clinical Pharmacy Room, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Valencia-Blancas T, Pérez-Orozco LH, Durán-Gómez V, García-Barboza E, López-Anguiano RR. [Atypical clinical and mortality in older adults hospitalized with COVID-19 pneumonia]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2025; 63:e6350. [PMID: 40332445 PMCID: PMC12122060 DOI: 10.5281/zenodo.15178449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 02/05/2025] [Indexed: 05/08/2025]
Abstract
Background Pneumonia caused by SARS-CoV-2 is a public health problem. Older adults are vulnerable and the atypical presentation delays diagnosis and increases mortality. In this group the atypical clinical manifestations are more frequent. Objective To identify the clinical manifestations and mortality of COVID-19 pneumonia in hospitalized older adults. Material and methods A comparative cross-sectional observational study was carried out, from July 1, 2020, to December 31, 2021, in a general hospital of Mexico City. Patients aged 60 years or more who were hospitalized with a diagnosis of COVID-19 were included. Results 267 older adults participated; 53.9% were men, with a median age of 74 years. The most frequent comorbidities in this population were type 2 diabetes mellitus (T2DM), hypertension and chronic obstructive pulmonary disease (COPD). 41.2% showed atypical presentation of the disease; mortality in the studied population was 53.5%. Conclusions The atypical presentation of COVID-19 pneumonia is common in adults over 60 years of age and it increases significantly as they become older. The absence of typical symptoms of pneumonia and the ignorance of the most common signs could delay diagnosis and timely care in this age group, which may increase complications and mortality.
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Affiliation(s)
- Tlalnelli Valencia-Blancas
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 2, Servicio de Geriatría. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Lucía Herlinda Pérez-Orozco
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 27, Servicio de Geriatría. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Verónica Durán-Gómez
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 27, Servicio de Geriatría. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Evelín García-Barboza
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 27, Servicio de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Roberto Rivelino López-Anguiano
- Instituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada Ciudad de México Norte, Coordinación Auxiliar Médica de Investigación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Hachimi A, El-Mansoury B, Merzouki M. Incidence, pathophysiology, risk factors, histopathology, and outcomes of COVID-19-induced acute kidney injury: A narrative review. Microb Pathog 2025; 202:107360. [PMID: 39894232 DOI: 10.1016/j.micpath.2025.107360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 01/28/2025] [Accepted: 01/30/2025] [Indexed: 02/04/2025]
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to a significant burden on global healthcare systems. COVID-19-induced acute kidney injury (AKI) is among one of the complications, that has emerged as a critical and frequent condition in COVID-19 patients. This AKI among COVID-19 patients is associated with poor outcomes, and high mortality rates, especially in those with severe AKI or requiring renal replacement therapy. COVID-19-induced AKI represents a significant complication with complex pathophysiology and multifactorial risk factors. Indeed, several pathophysiological mechanisms, including direct viral invasion of renal cells, systemic inflammation, endothelial and thrombotic abnormalities as well as nephrotoxic drugs and rhabdomyolysis are believed to underlie this condition. Moreover, histopathological and immunohistopathological findings commonly observed in postmortem studies include acute tubular necrosis, glomerular injury, and the presence of viral particles within renal tissue and urine. Identified risk factors for developing AKI vary among studies, depending on regions, underlying conditions, and the severity of the disease. Moreover, histopathological and immunohistopathological findings commonly observed in postmortem studies include show acute tubular necrosis, glomerular injury, and viral particles within renal tissue and urine. While, identified risk factors for developing AKI vary among studies, according to regions, underlying conditions, and the gravity of the disease. This narrative review aims to synthesize current knowledge on the incidence, pathophysiology, risk factors, histopathology, and outcomes of AKI induced by COVID-19.
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Affiliation(s)
- Abdelhamid Hachimi
- Medical ICU, Mohammed VI(th) University Hospital of Marrakech, Marrakech, Morocco; Morpho-Science Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco; Life Sciences Department, Bioengineering Laboratory, Faculty of Sciences and Technics, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Bilal El-Mansoury
- Nutritional Physiopathologies, Neuroscience and Toxicology Team, Laboratory of Anthropogenic, Biotechnology and Health, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco
| | - Mohamed Merzouki
- Life Sciences Department, Bioengineering Laboratory, Faculty of Sciences and Technics, Sultan Moulay Slimane University, Beni Mellal, Morocco.
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Vidal N, Climent MÁ, Pérez S, Méndez-Vidal MJ, Anguera G, Martínez Salas I, Gallardo E, Cuéllar-Rivas MA, Molina-Cerrillo J, Martín A, Rodriguez-Vida A, Almagro Casado E, Gonzalez M, Domènech M, Martínez Kareaga M, Fernández Calvo O, Villa Guzmán JC, Vázquez Estévez S, González-Del-Alba A, Puente J. Impact of COVID-19 infection on genitourinary cancer management. SOGUG-COVID-19: A spanish, multicenter, observational study. Clin Transl Oncol 2025; 27:2220-2231. [PMID: 39369361 DOI: 10.1007/s12094-024-03744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/21/2024] [Indexed: 10/07/2024]
Abstract
INTRODUCTION The COVID-19 pandemic is a great burden worldwide, but its impact on patients with genitourinary cancer (GUC) is poorly characterized. This study aimed to characterize the clinical features and evolution of GUC patients affected by COVID-19 in Spain. PATIENTS AND METHODS SOGUG-COVID-19 was an observational ambispective non-interventional study that recruited patients with SARS-CoV-2 infection who had been treated for GUC in 32 Spanish hospitals. Data were collected from patients' medical records in a short period of time, coinciding with the first waves of COVID-19, when the mortality was also higher in the general population. RESULTS From November 2020 to April 2021, 408 patients were enrolled in the study. The median age was 70 years, and 357 patients (87.5%) were male. Most frequent Cancer Origin was: prostate (40.7%), urothelial (31.4%) and kidney (22.1%). Most patients (71.3%) were diagnosed at the metastatic stage, and 33.3% had poorly differentiated histology. Anticancer treatment during the infection was reported in 58.3% of patients, and 21.3% had received immunotherapy prior to or concurrent with the infection. The most frequent COVID-19 symptoms were pyrexia (49.0%), cough (38.2%) and dyspnea (31.9%). Median age was higher for patients with pneumonia (p < 0.001), patchy infiltrates (p = 0.005), ICU admission (p < 0.001) and death (p < 0.001). Tumor stage was associated with complications (p = 0.006). The fatality rate was 19.9% and the 6-month COVID-19-specific survival rate was 79.7%. CONCLUSION Patients with genitourinary cancers seem exceptionally vulnerable to COVID-19 regardless of tumor type or anticancer therapy. Age and tumor stage were the only identified risk factors for severe COVID-19.
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Affiliation(s)
- Natalia Vidal
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | | | - Sara Pérez
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María José Méndez-Vidal
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC) Hospital Universitario Reina Sofía, Medical Oncology Department, Córdoba, Spain
| | - Georgia Anguera
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Enrique Gallardo
- Medical Oncology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Miler Andrés Cuéllar-Rivas
- Medical Oncology Department, Institut Català d'Oncologia (ICO) L'Hospitalet del Llobregat, Barcelona, Spain
| | | | - Almudena Martín
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, IMIM Research Institute, CIBERONC, Barcelona, Spain
| | - Elena Almagro Casado
- Medical Oncology Department, Hospital Universitario Quirón Salud Madrid, Pozuelo de Alarcón, Spain
| | - Macarena Gonzalez
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | | | | | - Ovidio Fernández Calvo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | - Aránzazu González-Del-Alba
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, C/Joaquin Rodrigo 2, Majadahonda, 28222, Madrid, Spain.
| | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
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Kamran F, Tjandra D, Valley TS, Prescott HC, Shah NH, Liu VX, Horvitz E, Wiens J. Reformulating patient stratification for targeting interventions by accounting for severity of downstream outcomes resulting from disease onset: a case study in sepsis. J Am Med Inform Assoc 2025; 32:905-913. [PMID: 40127468 PMCID: PMC12012354 DOI: 10.1093/jamia/ocaf036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 01/20/2025] [Accepted: 02/12/2025] [Indexed: 03/26/2025] Open
Abstract
OBJECTIVES To quantify differences between (1) stratifying patients by predicted disease onset risk alone and (2) stratifying by predicted disease onset risk and severity of downstream outcomes. We perform a case study of predicting sepsis. MATERIALS AND METHODS We performed a retrospective analysis using observational data from Michigan Medicine at the University of Michigan (U-M) between 2016 and 2020 and the Beth Israel Deaconess Medical Center (BIDMC) between 2008 and 2012. We measured the correlation between the estimated sepsis risk and the estimated effect of sepsis on mortality using Spearman's correlation. We compared patients stratified by sepsis risk with patients stratified by sepsis risk and effect of sepsis on mortality. RESULTS The U-M and BIDMC cohorts included 7282 and 5942 ICU visits; 7.9% and 8.1% developed sepsis, respectively. Among visits with sepsis, 21.9% and 26.3% experienced mortality at U-M and BIDMC. The effect of sepsis on mortality was weakly correlated with sepsis risk (U-M: 0.35 [95% CI: 0.33-0.37], BIDMC: 0.31 [95% CI: 0.28-0.34]). High-risk patients identified by both stratification approaches overlapped by 66.8% and 52.8% at U-M and BIDMC, respectively. Accounting for risk of mortality identified an older population (U-M: age = 66.0 [interquartile range-IQR: 55.0-74.0] vs age = 63.0 [IQR: 51.0-72.0], BIDMC: age = 74.0 [IQR: 61.0-83.0] vs age = 68.0 [IQR: 59.0-78.0]). DISCUSSION Predictive models that guide selective interventions ignore the effect of disease on downstream outcomes. Reformulating patient stratification to account for the estimated effect of disease on downstream outcomes identifies a different population compared to stratification on disease risk alone. CONCLUSION Models that predict the risk of disease and ignore the effects of disease on downstream outcomes could be suboptimal for stratification.
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Affiliation(s)
- Fahad Kamran
- Division of Computer Science and Engineering, Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, United States
| | - Donna Tjandra
- Division of Computer Science and Engineering, Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, United States
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
- VA Center for Clinical Management Research, Ann Arbor, MI 48105, United States
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
- VA Center for Clinical Management Research, Ann Arbor, MI 48105, United States
| | - Nigam H Shah
- Department of Medicine—Center for Biomedical Informatics Research, Clinical Excellence Research Center, Stanford University, Stanford, CA 94305, United States
| | - Vincent X Liu
- Division of Research, Kaiser Permanente, Oakland, CA 94611, United States
| | - Eric Horvitz
- Office of the Chief Scientific Officer, Microsoft, Redmond, WA 14820, United States
| | - Jenna Wiens
- Division of Computer Science and Engineering, Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, United States
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17
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Apalama ML, Begue F, Tanaka S, Cournot M, Couret D, Meilhac O, Pokeerbux MR. High-density lipoproteins and COVID-19: preparing the next pandemic. J Lipid Res 2025; 66:100779. [PMID: 40090619 PMCID: PMC12141899 DOI: 10.1016/j.jlr.2025.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 02/18/2025] [Accepted: 03/10/2025] [Indexed: 03/18/2025] Open
Abstract
High-density lipoproteins (HDLs) are heterogeneous particles with pleiotropic functions including anti-inflammatory and anti-infectious effects. In clinical studies, lower HDL-associated cholesterol (HDL-C) concentration has been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, severity, and mortality. A reduction in the number of HDL particles, particularly small ones has been observed with alterations in their protein and lipid composition impairing their functions. These observations have supported HDL supplementation with promising results in small preliminary studies. This review summarizes available evidence to better understand the two-way interaction between HDLs and Coronavirus disease 2019 (COVID-19) and guide future HDL-based therapies for preparing for the next pandemic.
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Affiliation(s)
- Marie Laurine Apalama
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France
| | - Floran Begue
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France; USMD, Délégation de la Recherche Clinique et de l'Innovation, CHU de La Réunion, Saint-Pierre, France
| | - Sébastien Tanaka
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France; AP-HP, Service d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, Paris, France
| | - Maxime Cournot
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France; Clinique Les Orchidées, Groupe de santé Clinifutur, Le Port, France
| | - David Couret
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France; Service de Neuroréanimation, CHU de la Réunion, Saint-Pierre, France
| | - Olivier Meilhac
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France; INSERM CIC1410, Plateforme de Recherche Clinique et Translationnelle, CHU de La Réunion, Saint-Pierre, France.
| | - Mohammad Ryadh Pokeerbux
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, France; Service de Médecine Interne et Polyvalente, CHU de la Réunion, Saint-Pierre, France
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18
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Wang J, Xiong Y, Song Z, Li Y, Zhang L, Qin C. Progress in research on osteoporosis secondary to SARS-CoV-2 infection. Animal Model Exp Med 2025; 8:829-841. [PMID: 40029778 DOI: 10.1002/ame2.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/13/2025] [Indexed: 05/28/2025] Open
Abstract
The World Health Organization has declared that COVID-19 no longer constitutes a "public health emergency of international concern," yet the long-term impact of SARS-CoV-2 infection on bone health continues to pose new challenges for global public health. In recent years, numerous animal model and clinical studies have revealed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to secondary osteoporosis. The mechanisms involved are related to the virus's direct effects on bone tissue, dysregulation of the body's inflammatory response, hypoxia, noncoding RNA imbalance, and metabolic abnormalities. Although these studies have unveiled the connection between SARS-CoV-2 infection and osteoporosis, current research is not comprehensive and in depth. Future studies are needed to evaluate the long-term effects of SARS-CoV-2 on bone density and metabolism, elucidate the specific mechanisms of pathogenesis, and explore potential interventions. This review aims to collate existing research literature on SARS-CoV-2 infection-induced secondary osteoporosis, summarize the underlying mechanisms, and provide direction for future research.
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Affiliation(s)
- Jinlong Wang
- Institute of Laboratory Animal Sciences, CAMS and Comparative Medicine Center, PUMC, Beijing, China
- Changping National Laboratory (CPNL), Beijing, China
| | - Yibai Xiong
- Institute of Laboratory Animal Sciences, CAMS and Comparative Medicine Center, PUMC, Beijing, China
| | - Zhiqi Song
- Institute of Laboratory Animal Sciences, CAMS and Comparative Medicine Center, PUMC, Beijing, China
| | - Yanhong Li
- Institute of Laboratory Animal Sciences, CAMS and Comparative Medicine Center, PUMC, Beijing, China
| | - Ling Zhang
- Institute of Laboratory Animal Sciences, CAMS and Comparative Medicine Center, PUMC, Beijing, China
| | - Chuan Qin
- Institute of Laboratory Animal Sciences, CAMS and Comparative Medicine Center, PUMC, Beijing, China
- Changping National Laboratory (CPNL), Beijing, China
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19
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Dichter JR, Brown D, Zamorano C, Cohen J, Miller EA, Niccum DE, LeClaire M, De Jong CB, Diebold D, Lyons J, Reilkoff R, Erickson HL, Martinelli J, Fischer JA, Mairose K, Kallestad J, Chell C, Shadiow A, Stoen S, Hick JL, Petersen-Kroeber C, Seaberg J, McLachlan E, Waterman AT, James WY, MacDonell S, Risser J, Klemond T, DeMartino ES, Wu J, DeBruin D, Wolf SM, Sederstrom NO, Baum KD, Greenlee K, Strike H, Kettler PA, Boehland A, Goodman KA, Maslonka KK, Wolf JM, Schoenecker J, Kesler SM. The Minnesota Critical Care Working Group 1: Monitoring and Coordinating Statewide Critical Care Surge Response in the COVID-19 Pandemic, March 2020 Through July 1, 2021. Chest 2025; 167:1356-1370. [PMID: 39622470 DOI: 10.1016/j.chest.2024.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 01/21/2025] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic and as part of the statewide health care coalition response, the Minnesota Critical Care Working Group (CCWG), composed of interprofessional leaders from the state's 9 largest health systems, was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July 1, 2021. RESEARCH QUESTION Can a statewide CCWG develop contingency and crisis-level surge strategies and indicators in response to the COVID-19 pandemic while evolving into a highly collaborative team? STUDY DESIGN AND METHODS CCWG members (intensivists, ethicists, nurses, Minnesota Department of Health and Minnesota Hospital Association leaders) met by audio video conferencing as often as daily assessing COVID-19 and non-COVID-19 hospitalization data, developed surge evidence reflecting contingency vs crisis conditions, and planned responses collaboratively. A foundation of collaboration and teamwork developed which facilitated an effective statewide response. RESULTS Pandemic surge health care system strategies included use of surge ICU beds, adapted staffing models, restriction of nonemergency procedures, augmentation of tele-ICU care, ability to recognize increasing staff shortages, use of PICU beds for younger adults, and use of noninvasive ventilation in non-ICU settings. CCWG supported development of the Minnesota Medical Operations Coordination Center, which was instrumental in load balancing and mitigating crisis conditions. Minnesota surge strategies are compared with published prepandemic and pandemic experiences regarding staff, space, supplies and medications/equipment, and system strategies. Adopted severe surge best practices included use of adapted staffing models and noninvasive ventilation in non-ICU settings. CCWG effectively developed shared strategies and facilitated ICU load balancing, which supported a regionally consistent standard of care. INTERPRETATION The CCWG developed statewide critical care surge strategies assisting health care organization response to COVID-19 surges, providing a platform for clinical and operational activities. Collaboration, trust, and teamwork between CCWG leaders and health care organizations was essential to success and serves as a model for future events.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shawn Stoen
- Central and West Central Healthcare Coalitions, St. Cloud, MN
| | - John L Hick
- University of Minnesota, Minneapolis, MN; Hennepin Healthcare, Minneapolis, MN
| | | | | | | | | | | | | | | | | | | | - Joel Wu
- University of Minnesota, Minneapolis, MN
| | | | | | | | | | | | | | | | | | | | - Ken K Maslonka
- Children's Minnesota Hospital Minneapolis, Minneapolis, MN
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20
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Kesler SM, De Jong CB, Chell C, DeBruin D, Erickson HL, Goodman KA, James WY, Kallestad J, Klemond T, McLachlan E, Petersen-Kroeber C, Risser J, DeMartino ES, Waterman AT, Wolf SM, Wu J, Zamorano C, Baum KD, Brown D, Cohen J, Diebold D, Fischer JA, Greenlee K, Hick JL, Kettler PA, LeClaire M, Lyons J, MacDonell S, Mairose K, Boehland A, Martinelli J, Miller EA, Niccum DE, Reilkoff R, Seaberg J, Sederstrom NO, Shadiow A, Stoen S, Strike H, Maslonka KK, Wolf JM, Schoenecker J, Dichter JR. The Minnesota Critical Care Working Group 2: Crisis Conditions During the COVID-19 Pandemic, July 2021 through March 2022. Chest 2025; 167:1371-1387. [PMID: 39613148 DOI: 10.1016/j.chest.2024.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 10/25/2024] [Accepted: 11/03/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND The Minnesota State Healthcare Coordination Center requested that the Minnesota Critical Care Working Group (CCWG) and Ethics Working Group (EWG), comprising interprofessional leaders from Minnesota's 9 largest health systems, plan and coordinate critical care operations during the COVID-19 pandemic, including the fall 2021 surge. RESEARCH QUESTION Can a statewide working group collaboratively analyze real-time evidence to identify crisis conditions and to engage state leadership to implement care processes? STUDY DESIGN AND METHODS The CCWG and EWG met via videoconferencing during the severe surge of fall 2021 to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions: group consensus on operating conditions, federal teletracking data, the Medical Operations Coordination Center (MOCC) patient placement data, and 2 surveys created and distributed to hospitals and health care professionals. The group developed and recommended processes to mitigate the conditions and engaged statewide leadership for support. RESULTS Evidence of crisis conditions included rising numbers of patients with COVID-19, tertiary care centers with difficulty accepting transfers (including emergencies), severe emergency department crowding, activation of ICU allocation teams, and low patient placement rate at the Minnesota MOCC. A statewide hospital survey demonstrated numerous staffing adaptations, expansion of telemedicine, and delay of nonemergent procedures. A survey of health care professionals revealed instances of poor patient outcomes, bedside rationing, implicit triage, and moral distress. Leadership engagement resulted in public messaging, although no change in how ICU care was allocated, nor were transfers managed. INTERPRETATION The CCWG collected and analyzed evidence demonstrating crisis conditions and health care professional moral distress during the fall 2021 COVID-19 surge. However, the group had a limited impact on care processes. This article analyzes the group's efforts. It includes recommendations for researchers and policy makers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joel Wu
- University of Minnesota, Minneapolis, MN
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shawn Stoen
- Central and West Central Healthcare Coalitions, St. Cloud, MN
| | | | - Ken K Maslonka
- Children's Minnesota Hospital Minneapolis, Minneapolis, MN
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21
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He Y, Zheng Q, Zhifang Z, Xiaofeng N, Shenggen W, Xue M, Zheng C, Liu Z. When COVID-19 meets diabetes: A bibliometric analysis. Diabetes Res Clin Pract 2025; 223:112118. [PMID: 40132732 DOI: 10.1016/j.diabres.2025.112118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 03/13/2025] [Accepted: 03/19/2025] [Indexed: 03/27/2025]
Abstract
Coronavirus disease 2019 (COVID-19) survivors are concerned about the likelihood of developing further diseases. This study examines the global trends in scientific research on diabetes associated with COVID-19 from several perspectives. Bibliometric analyses are used to undertake a scientific review of the literature. The Web of Science Core Collection (WoSCC) database was used to acquire bibliographic information on diabetes related to COVID-19 from Jan 2020 to Dec. 2023. The visual map was built via advanced CiteSpace 6.2.R6. 7,348 papers were found. Khunti Kamlesh and Rizzo-Manfredi are the most well-known high-yield authors in this area, and the top ten authors collaborate extensively. Most of these papers came from universities. Harvard Medical School has the most publications, followed by Wuhan University and Huazhong University of Science and Technology. China and the United States are the countries with the most publications. Angiotensin-converting enzymes, chronic disease, intensive care unit, viral infection, and gestational diabetes mellitus were scored 0-11, 2, 3, and 4, respectively. Zhou et al.'s work on this topic, which appeared in the prominent medical journal The Lancet, was cited 1,366 times, highlighting its importance. "clinical characteristics," "diabetes mellitus," "metabolic syndrome," and "angiotensin-converting enzyme" were used as keywords for reference co-citation and clustering data identify. Over the last four years, related investigations have focused primarily on observing clinical aspects. This report is important for developing treatment strategies, directing future research, and guiding clinical practice.
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Affiliation(s)
- Yingli He
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Qingcong Zheng
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhang Zhifang
- Fujian Center for Disease Control and Prevention, Fuzhou 350012, China
| | | | - Wu Shenggen
- Fujian Center for Disease Control and Prevention, Fuzhou 350012, China
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Chunfu Zheng
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
| | - Zhijun Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, China.
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22
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Volandes AE, Chang Y, Lakin JR, Paasche-Orlow MK, Lindvall C, Zupanc SN, Martins-Welch D, Carney MT, Burns EA, Itty J, Emmert-Tangredi K, Martin NJ, Sanghani S, Tilburt J, Pollak KI, Davis AD, Garde C, Barry MJ, El-Jawahri A, Quintiliani L, Sciacca K, Goldman J, Tulsky JA. An Intervention to Increase Advance Care Planning Among Older Adults With Advanced Cancer: A Randomized Clinical Trial. JAMA Netw Open 2025; 8:e259150. [PMID: 40343696 PMCID: PMC12065034 DOI: 10.1001/jamanetworkopen.2025.9150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 03/06/2025] [Indexed: 05/11/2025] Open
Abstract
Importance Many older adults with advanced cancer never communicate goals of care or treatment preferences to their clinicians, raising the risk that care received will not match their values. Scalable models of care may help surmount this barrier. Objective To test whether a combined patient and clinician intervention increased the rate of advance care planning (ACP) documentation in large health care systems. Design, Setting, and Participants This stepped-wedge cluster randomized clinical trial using an open cohort design included patients aged 65 years or older with advanced cancer seen at oncology clinics in 3 health care systems located in the US South, Midwest, and Mid-Atlantic regions from April 1, 2020, to November 30, 2022. Data collection ended in 2024. Intervention The intervention involved delivering brief evidence-based patient-facing video decision aids available in 25 languages as well as goals-of-care communication training to oncology clinicians. Patients in the control period received usual care. Main Outcomes and Measures The primary outcome was ACP documentation, which included any electronic health record documentation of a goals-of-care conversation, palliative care, hospice, or limitation of life-sustaining treatments, identified via a validated natural language processing program. Analysis was performed on an intention-to-treat basis. Results Twenty-nine practices, comprising 13 800 unique eligible patients with a total of 29 357 repeated measurements, were included (mean [SD] age, 74.5 [6.6] years; 52.3% men [15 344 of 29 357 measurements]). The proportion of patients with ACP documentation was greater in the intervention phase compared with the usual care phase (adjusted rate difference, 6.8% [95% CI, 2.8%-10.8%]; P < .001). ACP documentation in the intervention phase occurred among 3980 of 15 754 patients (25.3%) (goals-of-care conversation, 21.4% [3377 of 15 754]; palliative care, 9.6% [1517 of 15 754]; hospice, 5.4% [847 of 15 754]; and limitation of life-sustaining treatments, 7.2% [1128 of 15 754]). In comparison, ACP documentation in the usual care phase occurred among 2834 of 13 603 patients (20.8%) (goals-of-care conversation, 16.8% [2281 of 13 603]; palliative care, 9.5% [1287 of 13 603]; hospice, 5.3% [724 of 13 603]; and limitation of life-sustaining treatments, 8.4% [1149 of 13 603]). Conclusions and Relevance In this stepped-wedge cluster randomized clinical trial for older adults with advanced cancer, a bundled evidence-based decision aid and communication training intervention increased the proportion of older patients with ACP documentation. This approach offers an innovative paradigm with a clinically meaningful increase in ACP documentation, a widely used quality metric that reflects high-quality patient-centered care delivery. Trial Registration ClinicalTrials.gov Identifier: NCT03609177.
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Affiliation(s)
- Angelo E. Volandes
- Department of Medicine, Dartmouth Health, Lebanon, New Hampshire
- Geisel School of Medicine, Hanover, New Hampshire
- Department of Medicine, Massachusetts General Hospital, Boston
- ACP Decisions, Waban, Massachusetts
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Joshua R. Lakin
- Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michael K. Paasche-Orlow
- Department of Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Charlotta Lindvall
- Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Seth N. Zupanc
- Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- School of Medicine, University of California San Francisco, San Francisco
| | - Diana Martins-Welch
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hofstra/Northwell, New Hyde Park, New York
| | - Maria T. Carney
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hofstra/Northwell, New Hyde Park, New York
| | - Edith A. Burns
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hofstra/Northwell, New Hyde Park, New York
| | - Jennifer Itty
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Kaitlin Emmert-Tangredi
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Narda J. Martin
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Shreya Sanghani
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Jon Tilburt
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine and Duke Cancer Institute, Durham, North Carolina
| | | | | | - Michael J. Barry
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Lisa Quintiliani
- Department of Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Kate Sciacca
- Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Julie Goldman
- Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - James A. Tulsky
- Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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23
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Salimi M, Javidnia J, Moslemi A, Abastabar M, Mobayen MR, Rahimzadeh G, Tirabadi NM, Nouranibaladezaei S, Asghari H, Sobouti B, Dahmardehei M, Seyedmousavi S, Shokohi T. Characterization of COVID-19-Associated Candidemia Among Burn Patients. J Clin Lab Anal 2025; 39:e70031. [PMID: 40197603 PMCID: PMC12089798 DOI: 10.1002/jcla.70031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 02/27/2025] [Accepted: 03/28/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND The emergence of COVID-19 has led to a significant public health crisis, and an increase in fungal infections, including candidemia. Candida species are frequently found in intensive care units (ICUs), and it is a common cause of death in many patients. The isolates were identified using polymerase chain reaction-restriction. In this study, We investigated the factors linked to Candida infections in COVID-19 burn patients in the ICU and assessed the antifungal susceptibility of the isolates in vitro. METHODS Out of 335 burn patients admitted to the ICU, fifty-six with concurrent COVID-19 were included in this study. A total of 133 yeast isolates were obtained from burn wounds, 29 from blood cultures, and 36 from urine cultures. The isolates were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS Out of fifty-six patients, twenty-nine had infections and forty-eight had colonization, with Candida parapsilosis being the most common species. Twenty-one patients died during their ICU stay, with mortality rates of 43.8% among colonized patients and 69.0% among infected patients. Fluconazole and itraconazole exhibited the highest minimum inhibitory concentrations, while luliconazole and amphotericin B were identified as the most effective antifungal agents. CONCLUSION Our findings indicate that colonization may act as an important prognostic factor prior to the onset of candidemia. In addition, prolonged hospitalization, catheter use, and concurrent COVID-19 infection were identified as key risk factors for candidemia in this patient group. Notably, the rising drug resistance in non-albicans Candida species is a major public health concern.
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Affiliation(s)
- Maryam Salimi
- Student Research CommitteeSchool of Medicine, Mazandaran University of Medical SciencesSariIran
- Invasive Fungi Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Javad Javidnia
- Invasive Fungi Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
- Department of Medical MycologySchool of Medicine, Mazandaran University of Medical SciencesSariIran
| | - Azam Moslemi
- Student Research CommitteeSchool of Medicine, Mazandaran University of Medical SciencesSariIran
- Invasive Fungi Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Mahdi Abastabar
- Invasive Fungi Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
- Department of Medical MycologySchool of Medicine, Mazandaran University of Medical SciencesSariIran
| | - Mohammad Reza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical ScienceRashtIran
| | - Golnar Rahimzadeh
- Pediatric Infectious Diseases Research CenterCommunicable Diseases Institute Mazandaran University of Medical SciencesSariIran
| | - Nahid Mirzaei Tirabadi
- Department of Infectious Disease and Tropical MedicineShahid Motahari Burns Hospital, Iran University of Medical SciencesTehranIran
| | | | - Hassan Asghari
- Burn CenterZare Hospital, Mazandaran University of Medical SciencesSariIRIran
| | - Behnam Sobouti
- Infectious Disease Research CenterAli‐Asghar Children Hospital, Iran University of Medical SciencesTehranIran
| | - Mostafa Dahmardehei
- Department of Plastic and Reconstructive SurgeryBurn Research Center, Iran University of Medical SciencesTehranIran
| | - Seyedmojtaba Seyedmousavi
- Microbiology ServiceDepartment of Laboratory Medicine, Clinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Tahereh Shokohi
- Invasive Fungi Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
- Department of Medical MycologySchool of Medicine, Mazandaran University of Medical SciencesSariIran
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Meseldžić N, Prnjavorac B, Dujić T, Malenica M, Prnjavorac L, Bedak O, Imamović-Kadrić S, Marjanović D, Bego T. Insights into biochemical, hematological, and coagulation parameters and their association with COVID-19 severity within four patients cohort from Bosnia and Herzegovina. Technol Health Care 2025:9287329251327481. [PMID: 40302487 DOI: 10.1177/09287329251327481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
IntroductionCOVID-19, caused by the SARS-CoV-2 virus, has resulted in a global public health crisis with a wide spectrum of clinical manifestations, ranging from asymptomatic infections to severe pneumonia. This study explores the association between various biomarkers and COVID-19 progression, aiming to identify early indicators of disease severity and enhance patient management.Materials and MethodsThe study included 750 confirmed COVID-19 patients categorized into four groups based on disease severity. Patients were recruited at the General Hospital in Tešanj, Bosnia and Herzegovina. All biochemical, hematological and coagulation parameters were analyzed using standard IFCC protocols.ResultsThe study identified significant differences in biochemical, hematological, and coagulation biomarkers across varying COVID-19 severities. Key markers such as C-reactive protein (CRP), D-dimer, lymphocyte count, erythrocyte sedimentation rate (ESR), and platelet count were analyzed. Elevated CRP and D-dimer were strongly linked to severe cases, while decreased lymphocyte count, elevated ESR, and platelet abnormalities were also associated with increased disease severity.ConclusionsOur study highlights the vital role of specific biochemical, hematological and coagulation parameters in predicting COVID-19 severity. Integrating these findings into clinical practice could enhance timely risk stratification, early intervention, and improved outcomes for affected individuals.
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Affiliation(s)
- Neven Meseldžić
- Department of Pharmaceutical biochemistry and laboratory diagnostics, University of Sarajevo, Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
| | | | - Tanja Dujić
- Department of Pharmaceutical biochemistry and laboratory diagnostics, University of Sarajevo, Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
| | - Maja Malenica
- Department of Pharmaceutical biochemistry and laboratory diagnostics, University of Sarajevo, Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
| | | | - Omer Bedak
- General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
| | - Selma Imamović-Kadrić
- Department of Pharmaceutical biochemistry and laboratory diagnostics, University of Sarajevo, Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
| | - Damir Marjanović
- Institute for Anthropological Research, Zagreb, Croatia
- Department of Genetics and Bioengineering, International Burch University, Sarajevo, Bosnia and Herzegovina
- Faculty of Biotechnology and Drug Development, University of Rijeka, Rijeka, Croatia
| | - Tamer Bego
- Department of Pharmaceutical biochemistry and laboratory diagnostics, University of Sarajevo, Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
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25
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Schaefer CM, Krause TM, Delclos GL, Greenberg RS. Risk of post-acute symptoms among adults: A comparison study of severe COVID-19, pneumonia, and influenza. PLoS One 2025; 20:e0322020. [PMID: 40299849 PMCID: PMC12040114 DOI: 10.1371/journal.pone.0322020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 03/16/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND A retrospective cohort study was undertaken to assess the relationship between initial disease severity of COVID-19 and the risk of post-acute symptoms. The COVID-19 cohort was compared against influenza and pneumonia cohorts to assess whether risk of post-acute symptoms differed. METHODS Administrative health claims data were obtained for commercially insured and Medicare Advantage covered adults (≥ 18 years) with symptomatic laboratory-confirmed COVID-19 diagnosed in 2020 (n=121,205), and similar cohorts of influenza (n=20,844) and pneumonia (n=29,052) patients diagnosed prior to the pandemic. Post-acute symptoms were assessed at four weeks, three and six months following initial diagnosis. RESULTS Among the patients with COVID-19, the likelihood of any post-acute symptom increased with initial disease severity, and was also influenced by the presence of comorbidities, especially rheumatoid arthritis, ischemic heart disease and asthma. The specific post-acute symptoms varied by age, with increased risks of anxiety and headache among the young, whereas the elderly experienced increased brain fog and fatigue. When compared against the influenza and pneumonia cohorts, all three groups experienced post-acute symptoms, with a strong relationship to disease severity, and only partial resolution over the six-month observation period. Those with influenza were less likely than those with COVID-19 to experience post-acute symptoms while those with pneumonia were more likely to have post-acute illness than those with COVID-19. CONCLUSIONS Using a large national dataset, we found that COVID-19 symptomology could not be described by previously seen influenza or pneumonia symptomology and differences exist in the prevalence of symptoms as well as time to resolution, better characterizing "long COVID" and identifying that these differences are unique to COVID-19.
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Affiliation(s)
- Caroline M. Schaefer
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas United States of America
| | - Trudy Millard Krause
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas United States of America
| | - George L. Delclos
- Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas United States of America
| | - Raymond S. Greenberg
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas United States of America
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26
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Wang F, Zhu L, Chen Y, Li L. Clinical manifestations of SARS-CoV-2 Omicron infection is associated with the stage of liver cirrhosis. BMC Infect Dis 2025; 25:630. [PMID: 40301739 PMCID: PMC12042577 DOI: 10.1186/s12879-025-11040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 04/24/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND & AIM The impact of Omicron variants on cirrhosis was largely unknown. Herein, we aimed to evaluate the impact of SARS-CoV-2 omicron variants infection on the clinical course and mortality of patients with liver cirrhosis. METHODS Between 26 December 2022, and 27 January 2023, eighty-two hospitalized patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled. The clinical and pulmonary CT imaging features were retrospectively collected. A gender and age-matched cohort of 51 non-cirrhotic patients with COVID-19 were also included. RESULTS Our results indicated the symptom heterogeneity in patients with cirrhosis infected with omicron variants. Patients with more severe liver disease tended to have less severe respiratory symptoms and less pulmonary lesions. SARS-CoV-2 omicron did not cause obvious perturbation of liver function or cirrhosis decompensation. In comparison with hospitalized COVID-19 patients without liver cirrhosis, cirrhotic patients showed more severe pulmonary lesions and higher levels of inflammatory cytokine IL-6, but no significant increase in mortality. Multivariate analysis identified lung lesions proportion, MELD ≥ 15 score, and APTT as independent predictors for 28-day-mortality in these patients. CONCLUSION SARS-CoV-2 omicron variants caused a more severe inflammatory response in cirrhotic patients than in non-cirrhotic patients, but no further deterioration of liver function. Instead, patients with advanced stage of liver cirrhosis showed milder respiratory symptoms and pulmonary lesions. These results underscore the intricate relationship between Omicron infection and cirrhosis, highlighting the necessity for personalized clinical approaches in managing this specific patient group.
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Affiliation(s)
- Fengjiao Wang
- Shandong First Medical University, Jinan City, 250022, China
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan City, 250022, China
| | - Lingxiao Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Yanfei Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, 310003, China.
| | - Lanjuan Li
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan City, 250022, China.
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, 310003, China.
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27
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Al Rahmoun M, Sabaté-Elabbadi A, Guillemot D, Brun-Buisson C, Watier L. Impacts of the COVID-19 pandemic on sepsis incidence, etiology and hospitalization costs in France: a retrospective observational study. BMC Infect Dis 2025; 25:627. [PMID: 40301806 PMCID: PMC12038952 DOI: 10.1186/s12879-025-11000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Accepted: 04/17/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND Sepsis is a serious medical condition that causes long-term morbidity and high mortality, annually affecting millions of people worldwide. The COVID-19 pandemic may have impacted its burden. This study aimed to estimate the impact of the COVID-19 pandemic on sepsis incidence, etiology and associated hospitalization costs in metropolitan France. METHODS This retrospective observational study used data drawn from a cohort of hospitalized sepsis patients in France's national healthcare database. Sepsis was identified through both explicit International Classification of Diseases 10th revision (ICD-10) codes (E-sepsis) and implicit codes (I-sepsis). Participants included all patients aged 15 years or older hospitalized with E-sepsis or I-sepsis in metropolitan France between January 1, 2018, and December 31, 2022. Patient and hospital stay characteristics were described by sepsis type (E-sepsis, I-sepsis) and overall. The distribution of sepsis etiology was estimated for each year. Annual incidence rates were estimated overall and by sepsis type and etiology. Total and median per-stay hospitalization costs were calculated. RESULTS The total age- and sex-standardized sepsis incidence rate per 100,000 increased slightly from 2018 (446, 95% CI 444.2 to 447.7) to 2020 (457, 95% CI 455.1 to 458.6) and then decreased in 2022 (382, 95% CI 380.2 to 383.7) (p <.0001). Incidence rates decreased for both E-sepsis and bacterial sepsis during the pandemic period, whereas I-sepsis incidence increased in 2020 and 2021, associated with a marked increase in viral sepsis and co-infections (p <.0001 for E- and I-sepsis). Viral sepsis represented about 10% of all sepsis cases during the pandemic, but only about 1% prior to the pandemic. Total sepsis-associated hospitalization costs and extra medication costs increased during the pandemic. Characteristics of patients and their hospital stays were overall stable over the five-year study period. CONCLUSIONS The COVID-19 pandemic led to a higher burden of sepsis in French hospitals and an increase in hospital stay costs. Critically, our study highlights the need for introducing more explicit viral sepsis codes within the ICD classification system and for achieving a consensus on its definition in order to robustly estimate sepsis incidence.
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Affiliation(s)
- Marie Al Rahmoun
- Université Paris-Saclay, Université de Versailles St Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM) 1018, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Anti-infective evasion and pharmacoepidemiology Research Team, Montigny-Le-Bretonneux, France.
- Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antimicrobials Evasion (EMAE), Paris, France.
| | - Alexandre Sabaté-Elabbadi
- Université Paris-Saclay, Université de Versailles St Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM) 1018, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Anti-infective evasion and pharmacoepidemiology Research Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antimicrobials Evasion (EMAE), Paris, France
| | - Didier Guillemot
- Université Paris-Saclay, Université de Versailles St Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM) 1018, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Anti-infective evasion and pharmacoepidemiology Research Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antimicrobials Evasion (EMAE), Paris, France
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Christian Brun-Buisson
- Université Paris-Saclay, Université de Versailles St Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM) 1018, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Anti-infective evasion and pharmacoepidemiology Research Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antimicrobials Evasion (EMAE), Paris, France
| | - Laurence Watier
- Université Paris-Saclay, Université de Versailles St Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM) 1018, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Anti-infective evasion and pharmacoepidemiology Research Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antimicrobials Evasion (EMAE), Paris, France
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Arribas-Leal JM, Rivera-Caravaca JM, Vicente-Andreu C, Verdú-Verdú A, Sornichero Á, Pérez-Martínez D, Blanco-Morillo J, Gutiérrez F, Simón-Páez M, Jara R, Canovas-Lopez SJ, Albacete-Moreno C. Experience with ECMO therapy for acute respiratory distress syndrome treatment throughout the COVID-19 pandemic. Med Intensiva 2025:502207. [PMID: 40300975 DOI: 10.1016/j.medine.2025.502207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 02/14/2025] [Accepted: 03/13/2025] [Indexed: 05/01/2025]
Abstract
OBJECTIVE To analyze our experience with extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS) treatment during the COVID-19 pandemic. DESIGN Retrospective, observational, single center study. SETTING Third-level hospital in Spain. PATIENTS Adult patients with COVID-19 ARDS treated with an ECMO system in our center between March 2020 and March 2023. INTERVENTIONS Retrospective collection of variables during hospital admission and follow-up. MAIN VARIABLES OF INTEREST Demographic variables, clinical history, variables related to ECMO therapy, COVID-19 wave number, in-hospital mortality, adverse events, ICU and hospital length of stay, and functional status at follow-up were collected. RESULTS Eighty-one patients were included. Of these, 61 patients (75%) died during hospitalization. Patients who died were older and had more comorbidities. During the second, third, and sixth waves, mortality was higher. In the multivariate analysis, the only independent predictor of mortality was age (OR 1.24 95% CI (1.027-1.5, P = 0.025). After discharge, 40% of patients had difficulties returning to normal life due to respiratory failure requiring oxygen and arthropathies. CONCLUSION In-hospital mortality increased during the pandemic. Older age was the only independent predictor of mortality. After discharge, no deaths were recorded during the first 18 months of follow-up, although 40% of surviving patients had respiratory and motor sequelae making it difficult for them to return to a normal life.
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Affiliation(s)
- José María Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
| | - José Miguel Rivera-Caravaca
- Faculty of Nursing, University of Murcia, Murcia, Spain; Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Claudia Vicente-Andreu
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Alicia Verdú-Verdú
- Perfusion Service and Extracorporeal Therapies, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ángel Sornichero
- Perfusion Service and Extracorporeal Therapies, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Daniel Pérez-Martínez
- Department of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan Blanco-Morillo
- Perfusion Service and Extracorporeal Therapies, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Gutiérrez
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Marina Simón-Páez
- Department of Microbiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Rubén Jara
- Department of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Sergio J Canovas-Lopez
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Carlos Albacete-Moreno
- Department of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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29
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Shiraseb F, Mirzababaei A, Mehri Hajmir M, Ebrahimi S, Hosseini S, Zarrinvafa Z, Sadid M, Aali Y, Mohamadi A, Mirzaei K. The association between dietary fat quality and quantity and hospitalization duration in COVID-19 in Iranian patients: a cross-sectional study. Front Nutr 2025; 12:1551760. [PMID: 40331093 PMCID: PMC12052533 DOI: 10.3389/fnut.2025.1551760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 03/24/2025] [Indexed: 05/08/2025] Open
Abstract
Background The global impact of Coronavirus Disease 2019 (COVID-19 (has highlighted the necessity of understanding factors influencing its severity and hospitalization duration. While a balanced diet is crucial for immune support, the role of dietary fats in this context has not been well understood. This study explored associations between the quality and quantity of fatty acids and severity and the length of hospitalization in COVID-19 patients in 2022. Method This cross-sectional study included 107 COVID-19 patients aged 20-60 years who were hospitalized at Amir Alam Hospital in Tehran, Iran. Dietary fat intake was assessed using 24 h food recall. Data on symptoms were collected using a demographic questionnaire and verified against their hospital records. Linear and binary logistic regressions were employed for statistical analysis. Result A higher omega 6/omega 3(N6/N3) ratio was linked to increased odds of respiratory distress syndrome (RDS) and elevated D-dimer levels, while correlating with lower odds of fever. While RDS odds increased over Vit E/polyunsaturated fatty acid (PUFA) ratio tertiles, chills decreased. [PUFA + monounsaturated fatty acid (MUFA)]/saturated fatty acid (SFA) ratio was associated with reduced odds of chest pain, duration of hospitalization (DH) time, c-reactive protein (CRP), and D-dimer levels. Furthermore, PUFA intake was negatively associated with odds of poor appetite, RDS, and headaches, whereas SFA intake was positively associated with odds of fever. Additionally, there was a positive correlation between cholesterol-saturated index (CSI) levels and DH time (P < 0.7). Conclusion Our findings indicate that higher N6/N3 and VitE/PUFA ratios were associated with increased RDS and D-dimer levels, while the VitE/PUFA ratio was linked to reduced chills. Higher (PUFA + MUFA)/SFA ratios were associated with lower chest pain, DH, CRP, and D-dimer levels. While higher PUFA intake was related to reduced poor appetite, RDS, and headache, higher SFA intake was linked to increased fever. Additionally, there was a positive association between CSI levels and DH. Current findings indicate that the quality and balance of dietary fats may play a crucial role in modulating inflammatory responses and clinical outcomes.
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Affiliation(s)
- Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahya Mehri Hajmir
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Sara Ebrahimi
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Shabnam Hosseini
- Faculty of Agricultural and Environmental Sciences, School of Human Nutrition, McGill University, Montreal, QC, Canada
| | - Zeinab Zarrinvafa
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mahnaz Sadid
- Amir Alam Hospital, Internal Department, Tehran University Medical of Science, Tehran, Iran
| | - Yasaman Aali
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azam Mohamadi
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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30
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Bian H, Chen L, Zhang Z, Wen AD, Zheng ZH, Song LQ, Yao MY, Liu YX, Zhang XJ, Dong HL, Lian JQ, Pan L, Liu Y, Gu X, Zhao H, Wang JW, Wang QY, Zhang K, Jia JF, Xie RH, Luo X, Fu XH, Jia YY, Hou JN, Tan QY, Chen XX, Yang LQ, Lin YL, Wang XX, Zhang L, Zeng QJ, Li WJ, Wang RX, Zhang Y, Sun XX, Wang B, Yang X, Jiang JL, Li L, Wu J, Yang XM, Zhang H, Shi Y, Chen XC, Tang H, Shi HW, Liu SS, Yang Y, Yang TY, Wei D, Chen ZN, Zhu P. Meplazumab, a CD147 antibody, for severe COVID-19: a double-blind, randomized, placebo-controlled, phase 3 clinical trial. Signal Transduct Target Ther 2025; 10:119. [PMID: 40222976 PMCID: PMC11994814 DOI: 10.1038/s41392-025-02208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 02/17/2025] [Accepted: 03/13/2025] [Indexed: 04/15/2025] Open
Abstract
Meplazumab, a humanized CD147 antibody, showed favorable safety and clinical benefits in phase 1 and phase 2/3 seamless clinical studies. Further evaluation of its therapeutic efficacy in patients with severe COVID-19 is needed. In this phase 3 add-on study, we randomized patients with severe COVID-19 in a 1:1 ratio to receive 0.2 mg/kg meplazumab or placebo via intravenous injection, and evaluated efficacy and safety within 56 days. Between February 2023 and November 2023, 108 patients with severe COVID-19 were randomized to two groups, with their baseline characteristics generally balanced. The primary endpoint, 28-day all-cause mortality was 1.96% in the meplazumab group vs 7.69% in the placebo group (P = 0.1703). Supplementary analysis using composite strategy indicated a significant reduction of 28-day all-cause mortality in meplazumab compared to placebo (3.92% vs 15.38%, P = 0.044). Meplazumab also significantly reduced the mortality in smoking subjects on day 28 (P = 0.047) compared to placebo in supplementary analysis. The secondary endpoint, 56-day all-cause mortality, was 1.96% in the meplazumab group and 11.54% in the placebo group (P = 0.048), which was 3.92% and 15.38%, respectively (P = 0.044) by supplementary analysis. Additional secondary endpoints showed potential benefits, including increased hospital discharge rates, improved clinical outcomes, and improved viral nucleotide conversion rate. Meplazumab demonstrated good safety and tolerability, with no grade ≥ 3 TEAEs observed. These promising results indicate that meplazumab reduces mortality and enhances clinical benefits in severe COVID-19 patients with a good safety profile, providing effective and specific therapeutics for severe COVID-19 (the trial was registered at ClinicalTrials.gov (NCT05679479)).
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Affiliation(s)
- Huijie Bian
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China.
| | - Liang Chen
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
- School of Medicine, Shanghai University, Shanghai, China
| | - Zheng Zhang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Ai-Dong Wen
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhao-Hui Zheng
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Li-Qiang Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Meng-Ying Yao
- Department of Pulmonary, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Xia Liu
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Xi-Jing Zhang
- Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hong-Lin Dong
- Department of Vascular Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Qi Lian
- The Center for Diagnosis and Treatment of Infectious Diseases, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lei Pan
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yu Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xing Gu
- Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, Xi'an, China
| | - Hui Zhao
- Department of Vascular Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing-Wen Wang
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Qing-Yi Wang
- School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Kui Zhang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Jun-Feng Jia
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Rong-Hua Xie
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Xing Luo
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Xiang-Hui Fu
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Yan-Yan Jia
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jun-Na Hou
- Department of Pulmonary, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiu-Yue Tan
- Department of Pulmonary, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Xia Chen
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Liu-Qing Yang
- Department of Liver Disease, Shenzhen Third People's Hospital, Shenzhen, China
| | - Yuan-Long Lin
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Xiao-Xia Wang
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qin-Jing Zeng
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wen-Jie Li
- Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, Xi'an, China
| | - Rui-Xuan Wang
- Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, Xi'an, China
| | - Yang Zhang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Xiu-Xuan Sun
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Bin Wang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Xu Yang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Jian-Li Jiang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Ling Li
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Jiao Wu
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Xiang-Min Yang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Hai Zhang
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Ying Shi
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China
| | - Xiao-Chun Chen
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Hao Tang
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Hong-Wei Shi
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Shuang-Shuang Liu
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Yong Yang
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Tian-Yi Yang
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Ding Wei
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China.
| | - Zhi-Nan Chen
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China.
| | - Ping Zhu
- Department of Cell Biology of National Translational Science Center for Molecular Medicine and Department of Clinical Immunology of Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Xi'an, China.
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Mtenga SM, Mashasi I, Kisia L, Binyaruka P, Masanja H, Mohamed SF, Sanya RE, Mhalu G, Magembe G, Ramaiya K, Asiki G, Mair F, Bunn C, Gray CM. Socio-structural and direct health challenges related to illness management among patients with type 2 diabetes in Kenya and Tanzania during the COVID-19 pandemic: A qualitative inquiry. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0003876. [PMID: 40202987 PMCID: PMC11981119 DOI: 10.1371/journal.pgph.0003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 01/26/2025] [Indexed: 04/11/2025]
Abstract
During COVID-19, people with type 2 diabetes (T2D) experienced increased vulnerability, including severe COVID-19 complications, disruptions in diabetes management, and social isolation. These aspects were heightened in many sub-Saharan African countries, such as Kenya and Tanzania, where healthcare systems already face critical challenges in coping with increasing non-communicable diseases (NCDs). Little is known about how people with T2D in these countries managed their diabetes or how the different approaches to COVID-19 control (Kenya imposed lockdown and curfew, whereas Tanzania adopted less strict measures) impacted their T2D management. This qualitative study aimed to compare the accounts of T2D patients in both countries to examine similarities and differences in the illness management challenges they faced during the COVID-19 pandemic.Semi-structured interviews were conducted with 52 patients (Kenya, n=22; Tanzania, n=30), and the transcripts were analyzed thematically. Despite different COVID-19 control measures, patients in both countries faced similar direct health challenges, such as difficulties accessing diabetic consultations and treatment, but they also experienced distinct socio-structural challenges. Direct health challenges included difficulties in accessing diabetic consultations and treatment, limited availability of diabetic medicine at health facilities and mental health distress. These were exacerbated by socio-structural challenges, many of which pre-dated COVID-19 but intensified during the pandemic. These included closure of diabetic clinics in Dar es Salaam, business instability, financial difficulties, health insurance challenges, higher food prices impacting patients' adherence to T2D dietary recommendations (in both countries), and price inflation of diabetic medicine and test kits (in Kenya). Together, these challenges led to patients practicing self-medication, missing doses and resulted in poor blood sugar control. People with T2D in Kenya and Tanzania have described similar illness management challenges. In both countries, future contingency planning is essential to ensure adequate routine management of T2D and to improve access to care in emergency situations. Affordable comprehensive health insurance, economic support, and psychosocial services are required to increase patient resilience and support the health and wellbeing of people with T2D.
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Affiliation(s)
- Sally Mmanyi Mtenga
- Health System Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Irene Mashasi
- Health System Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Lyagamula Kisia
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi Kenya
| | - Peter Binyaruka
- Health System Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Honorati Masanja
- Health System Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shukri F. Mohamed
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi Kenya
| | - Richard E. Sanya
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi Kenya
| | - Grace Mhalu
- Health System Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | - Gershim Asiki
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi Kenya
| | - Frances Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
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32
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Gacouin A, Maamar A, Terzi N, Tadié JM. Association of obesity on short- and long-term survival in patients with moderate to severe pneumonia-related ARDS: a retrospective cohort study. BMC Pulm Med 2025; 25:153. [PMID: 40181311 PMCID: PMC11969934 DOI: 10.1186/s12890-025-03614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 03/20/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND The incidence of obesity among patients admitted to the intensive care unit (ICU) is increasing, and pneumonia remains the leading cause of acute respiratory distress syndrome (ARDS). The association of obesity on both short- and long-term outcomes in patients with pneumonia-induced ARDS has been the subject of only limited research. METHODS We conducted a retrospective analysis of a prospective cohort consisting of ARDS patients who had microbiologically confirmed pneumonia and a PaO2/FiO2 ratio ≤ 150 mmHg. Patients were assessed for mortality at 28 days, 90 days, and at 1 year from the diagnosis of ARDS and compared between obese defined by a body mass index (BMI) ≥ 30 kg.m2 and non-obese patients. Models were adjusted for age, sex, COPD, coronary artery disease, immunodepression, severity score and acute kidney injury on admission to the ICU, severity of ARDS (PaO2/FiO2 ratio ≤ 100 mmHg), severe hypercapnia (PaCO2 ≥ 50 mmHg), ventilatory ratio and plateau pressure the first day of ARDS, influenza, COVID-19, pneumocystosis, and bacteria involved in pneumonia. We also investigated the continuous spectrum of BMI on the risk of mortality. RESULTS Of 603 patients, 227 patients (37.6%) were obese. Obesity was associated with female gender (p = 0.009), hypertension (p < 0.001), diabetes mellitus (p < 0.001), COVID-19 pneumonia (p = 0.008), and PaO2/FiO2 ratio ≤ 100 mmHg (p = 0.006). Obesity was independently associated with lower mortality at 28 days (adjusted Odds Ratio (OR) 0.55, 95% confident interval (CI) 0.33-0.90, p = 0.02) but not at 90 days (adjusted OR 0.70, 95% CI 0.45-1.09, p = 0.11) nor at 1 year from the diagnosis of ARDS (adjusted OR 0.73, 95% CI 0.47-1.13, p = 0.16). Mortality at 28 days was significantly lower in obese patients than in non-obese patients when propensity score matching was used (15.2% versus 22%, p = 0.04). BMI was also independently associated with lower mortality at 28 days (p = 0.038) but not with mortality at 90 days (p = 0.12) and 1 year (p = 0.12). CONCLUSION Our results suggest that in patients with pneumonia-related ARDS, obesity is independently associated with better survival at 28 days but not at 90 days and 1 year from the diagnosis of ARDS.
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Affiliation(s)
- Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France.
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France.
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, 35033, Rennes, France.
| | - Adel Maamar
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France
| | - Nicolas Terzi
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, 35033, Rennes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, 35033, Rennes, France
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33
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Neves CAM, Dorneles GP, Teixeira PC, Santana Filho PC, Peres A, Boeck CR, Rotta LN, Thompson CE, Romão PRT. Neuroinflammation in Severe COVID-19: The Dynamics of Inflammatory and Brain Injury Markers During Hospitalization. Mol Neurobiol 2025; 62:4264-4273. [PMID: 39433647 DOI: 10.1007/s12035-024-04551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 10/11/2024] [Indexed: 10/23/2024]
Abstract
Patients with COVID-19 can develop excessive inflammation in the brain and consequent neurological complications. The aim of this study was to evaluate the inflammatory, endothelial and brain injury markers in hospitalized COVID-19 patients and compare those with or without neurological symptoms. A total of 30 intensive care unit (ICU) COVID-19 patients were allocated into COVID-19 (without neurological symptoms) or neuro-COVID-19 (with neurological symptoms) groups. Patients with respiratory infection symptoms but negative for COVID-19 were included as a control group. Peripheral blood samples were collected at hospital admission (T1) (controls and ICU patients) and during hospitalization (T2: last 72 h before hospital discharge or in-hospital death) (ICU COVID-19 patients) to analyze inflammatory markers. Higher ICAM-1, CCL26 and VEGF at T1 were identified in both COVID-19 groups compared with control. Neuro-COVID-19 patients presented lower systemic BDNF levels compared with the control group and increased S100B compared with the control and COVID-19 groups. BDNF levels in survivors were lower in the neuro-COVID-19 group compared to the COVID-19 group, while S100B were higher, regardless of the outcome. In addition, all COVID-19 patients presented increased ICAM-1 and CCL26 levels over the hospitalization period (T2 > T1). Furthermore, S100B, ICAM-1, CCL26 and VEGF levels increased in relation to T1 in neuro-COVID-19 patients, with S100B and CCL26 being significantly higher in relation to the COVID-19 group. In conclusion, high levels of brain injury biomarkers were found in patients with neuro-COVID-19, indicating neuroinflammatory and consequent brain injury in the last 72 h of hospitalization.
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Affiliation(s)
- Carla Andretta Moreira Neves
- Laboratory of Cellular and Molecular Immunology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Gilson P Dorneles
- Laboratory of Cellular and Molecular Immunology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil.
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
| | - Paula C Teixeira
- Laboratory of Cellular and Molecular Immunology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Paulo C Santana Filho
- Laboratory of Cellular and Molecular Immunology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Alessandra Peres
- Laboratory of Cellular and Molecular Immunology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil
- Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Liane N Rotta
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Claudia E Thompson
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Pedro R T Romão
- Laboratory of Cellular and Molecular Immunology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil.
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
- Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
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Dey P, Mal N, Sinha R, Kumar A, Kumar P, Saroj U, Chaudhuri PK, Sinha MBK, Guria R, Mishra B, Prasad ML, Kumar D, Kumar S, Prasad MK. Neutrophil gelatinase-associated lipocalin as a predictive biomarker of acute kidney injury in COVID-19 infection: A systematic review and meta-analysis. J Family Med Prim Care 2025; 14:1194-1206. [PMID: 40396107 PMCID: PMC12088576 DOI: 10.4103/jfmpc.jfmpc_1513_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 10/08/2024] [Accepted: 10/13/2024] [Indexed: 05/22/2025] Open
Abstract
Background Coronavirus 2019 (COVID-19) is an infectious disease caused by a novel coronavirus, SARS-CoV-2. Acute kidney injury (AKI) affects approximately 20-40% of patients with COVID-19 admitted to the intensive care unit (ICU), and it is a complication that has been linked to increased morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury. Methods Articles were searched from databases such as PubMed, Google Scholar, and Cochrane Library till June 2023. Pooled sensitivity, specificity, area under the curve (AUC), diagnostic odds ratio (DOR), and summery receiver operating curve (SROC) were calculated with 95% confidence interval. I2 statistics and Chi-square test were used to look for the heterogeneity in between studies. Meta-regression was conducted to look for the source of heterogeneity and GRADE analysis was performed to look for the certainty of evidence. Results Altogether, eight studies were selected (4 serum/5 urine), out of which one study had both serum and urine NGAL data. The total sample size was 1,067 (349 serum/718 urine). For serum and urine NGAL, the pooled sensitivity was 0.79 (95% CI: 0.72-0.84) and 0.75 (95% CI: 0.68-0.80), pooled specificity was 0.87 (95% CI: 0.81-0.91) and 0.85 (95% CI: 0.77-0.91), DOR was 24 (95% CI: 14-43), and 17 (95% CI: 9-32) and AUC was 0.90 (95% CI: 0.87-0.92) and 0.80 (95% CI: 0.76-0.83), respectively. Conclusion Both serum and urine NGAL have favourable pooled sensitivity, specificity, DOR and AUC for the diagnosis of AKI in COVID-19 infection, however, with low certainty of evidence.
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Affiliation(s)
- Puja Dey
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Nilanjan Mal
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Rashmi Sinha
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Pramod Kumar
- Department of Biochemistry, Hi-Tech Medical College and Hospital, Rourkela, Odisha, India
| | - Usha Saroj
- Department of Blood Centre and Transfusion Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Partha Kumar Chaudhuri
- Department of Paediatrics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | | | - Rishi Guria
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Brajesh Mishra
- Department of TB and Chest, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Manohar Lal Prasad
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Divakar Kumar
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Satish Kumar
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Manoj Kumar Prasad
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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35
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Boldt K, Rose N, Ware S, Dinh MM, Paul KK, Ho Y, Muscatello DJ. Characteristics and predictors of severe outcomes of COVID-19 cases presenting to the emergency department of a major Australian referral hospital: A record linkage study. Emerg Med Australas 2025; 37:e70040. [PMID: 40207594 PMCID: PMC11983665 DOI: 10.1111/1742-6723.70040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 03/12/2025] [Accepted: 03/20/2025] [Indexed: 04/11/2025]
Abstract
OBJECTIVE To describe the characteristics, outcomes and predictors of a severe outcome of patients presenting with a SARS-CoV-2 infection to the ED of a major urban referral hospital in New South Wales, Australia, from January 2020 through February 2022. METHODS Linked healthcare and death registration records were used and included any person assigned a diagnosis potentially related to an acute respiratory infection in the ED and that had a linked positive COVID-19 detection. Logistic regression was used to determine predictors of a severe outcome (ICU admission or death) within 28 days. RESULTS Of 2081 included COVID-19 patients, 238 (11.4%) had a severe outcome within 28 days of arrival at the ED. Among adults, the odds of a severe outcome increased with age, although the rate of increase in odds within age groups was statistically significant only in 30-64-year-olds (4% per year of age; confidence interval [CI] 2-6). Ambulance arrival (odds ratio [OR] 2.85; CI 1.76-4.78), higher triage urgency (category 1 or 2 compared with 4 or 5: OR 8.63; CI 4.41-18.12), and presentation during the pre-Delta (OR 6.18; CI 3.59-10.66) and Delta (OR 3.64; 95% CI 2.49-5.35) variant periods (compared with Omicron) were independently associated with increased risk of a severe outcome. CONCLUSION Age, ambulance arrival, higher triaged urgency, and presentation earlier in the pandemic were predictors of a severe COVID-19 outcome. Aged care measures and prioritising vaccination of older persons and aged care workers may have reduced severe outcomes in the elderly.
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Affiliation(s)
- Katrina Boldt
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nectarios Rose
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Sandra Ware
- Greater Sydney Helicopter Emergency Medical ServiceNSW AmbulanceSydneyNew South WalesAustralia
| | - Michael M Dinh
- Emergency Department, RPA Green Light InstituteRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Kishor Kumar Paul
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Yvonne Ho
- NSW Biostatistics Training ProgramNSW Ministry of HealthSydneyNew South WalesAustralia
| | - David J Muscatello
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
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36
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van Buchem‐Post NF, Ouwerkerk W, Stalman EW, van Dam KPJ, Wieske L, Bekkenk MW, Wolkerstorfer A, Spuls P, Musters AH, Bosma AL, Hijnen D, Eftimov F, Luiten RM, T2B! immunity against SARS‐CoV‐2 study group, van Kempen ZLE, Stalman EW, Steenhuis M, Kummer LYL, van Dam KPJ, Ten Brinke A, van Ham SM, Kuijpers T, Rispens T, Eftimov F, Wieske L, Killestein J, Kooi AJV, Raaphorst J, Zwinderman AHK, Löwenberg M, Volkers AG, D'Haens GRAM, Takkenberg RB, Tas SW, Hilhorst ML, Vegting Y, Bemelman FJ, Verstegen NJM, Fernandez L, Keijzer S, Keijser JBD, Cristianawati O, Voskuyl AE, Broens B, Sanchez AP, Nejentsev S, Mirfazeli ES, Wolbink GJ, Boekel L, Rutgers BA, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart R, Teng Y, Busch MH, Brusse E, van Doorn PA, Baars M, Schreurs C, van der Pol WL, Goedee HS, van Els CACM, de Wit J. Impact of COVID-19 disease and vaccination on dermatological immune-mediated inflammatory diseases atopic dermatitis, psoriasis, and vitiligo: a Target2B! substudy. J Dermatol 2025; 52:624-633. [PMID: 39950702 PMCID: PMC11975183 DOI: 10.1111/1346-8138.17664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/20/2025] [Accepted: 01/25/2025] [Indexed: 04/08/2025]
Abstract
During the COVID-19 pandemic, the daily life of many patients with dermatological immune-mediated inflammatory diseases (DIMIDs), such as atopic dermatitis (AD), psoriasis, and vitiligo, was impacted by social restrictions caused by (fear of) morbidity, mortality associated with COVID-19, and vaccine hesitancy. This prospective observational, multicenter, multidisciplinary cohort study explored the impact of COVID-19 disease and vaccination on DIMIDs, specifically AD, psoriasis, and vitiligo. Data from patients with DIMIDs were collected as part of the Target2B! study (between February 2021 and October 2022). We analyzed the differences in baseline characteristics, risk of developing COVID-19, proportion of DIMIDs in patients reaching seroconversion upon vaccination per DIMID, and self-reported increase in DIMID activity by multivariable logistic regression and sensitivity analyses. A total of 424 patients with DIMID were included. COVID-19 disease commonly occurred in patients with vitiligo (51.1%), AD (42.0%), and psoriasis (34.3%) (p = 0.038). COVID-19 was not associated with the use of immunosuppressive therapy. Three patients (two with AD and one with vitiligo) were hospitalized due to COVID-19. Nearly all patients with DIMIDs exhibited effective seroconversion after regular vaccination regimens (vitiligo 100%, psoriasis 97.9%, AD 96.5%). Increased DIMID activity after COVID-19 (6.6%) or severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) vaccination (12.26%) was reported in a minority of patients, with baseline progressive disease (disease activity 3 months preceding baseline survey) being the only associated risk factor (COVID-19: odds ratio [OR], 4.27 [p = 0.02]; vaccination OR, 3.45 [p = 0.002]). In conclusion, no alarming signs were shown in this study regarding (severe) COVID-19 in patients with AD, psoriasis, or vitiligo. Vaccination against COVID-19 is advised in patients with DIMIDs. Moreover, patients with DIMIDs can safely continue their immunosuppressant therapy, since this does not increase the risk of COVID-19, while vaccination-induced humoral responses are adequate. In only a minority of patients, increased DIMID activity after COVID-19 or SARS-CoV-2 vaccination occurred.
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Affiliation(s)
- Nicoline F. van Buchem‐Post
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
| | - Wouter Ouwerkerk
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
- National Heart Centre SingaporeSingaporeSingapore
| | - Eileen W. Stalman
- Department of Neurology, Amsterdam NeuroscienceAmsterdam UMCAmsterdamNetherlands
| | - Koos P. J. van Dam
- Department of Neurology, Amsterdam NeuroscienceAmsterdam UMCAmsterdamNetherlands
| | - Luuk Wieske
- Department of Neurology, Amsterdam NeuroscienceAmsterdam UMCAmsterdamNetherlands
| | - Marcel W. Bekkenk
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, VU University, Amsterdam Institute for Infection and ImmunityRotterdamNetherlands
| | - Albert Wolkerstorfer
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
| | - Phyllis Spuls
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
| | - Annelie H. Musters
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
| | - Angela L. Bosma
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
| | - Dirk‐Jan Hijnen
- Department of DermatologyErasmus University RotterdamRotterdamNetherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam NeuroscienceAmsterdam UMCAmsterdamNetherlands
| | - Rosalie M. Luiten
- Department of DermatologyNetherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Immunology & Infectious DiseasesAmsterdamNetherlands
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Laazaazia O, Ouladlahsen A, Aqillouch S, Altawalah H, Bouddahab O, Noureddine R, Pineau P, Lkhider M, Ezzikouri S. Association of TNFRSF13B Gene Polymorphisms With SARS-CoV-2 Infection, Severity, and Humoral Immune Response in a Moroccan Population. Int J Immunogenet 2025; 52:75-87. [PMID: 40025551 DOI: 10.1111/iji.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/17/2025] [Accepted: 02/23/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND AND AIMS Genetic factors, including polymorphisms in the TNFRSF13B gene, which regulates humoral immunity, can influence susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to investigate the association between two polymorphisms, rs12603708 and rs3751987, and SARS-CoV-2 susceptibility, disease severity, and humoral immune responses in a Moroccan population. MATERIALS AND METHODS A total of 303 unvaccinated COVID-19 patients (151 severe cases and 152 asymptomatic/moderate cases) and 150 individuals from a SARS-CoV-2-negative group were included in the analysis. Genotyping was performed using TaqMan SNP assays. SARS-CoV-2 antibodies targeting the nucleocapsid protein and IgG antibodies specific to the receptor-binding domain (RBD) were quantified using chemiluminescence microparticles immunoassay. Complete blood counts and C-reactive protein levels were evaluated using an automated platform. RESULTS Our analysis revealed that the A/A genotype of rs12603708 significantly increased the risk of SARS-CoV-2 infection in both codominant (p = 0.0055; OR = 3.74; adjusted p value = 0.022) and recessive (p = 0.0049; OR = 3.17; adjusted p value = 0.022) models, as well as the risk of severe disease (p = 0.014; OR = 3.43; adjusted p value = 0.049). For rs3751987, the G/G genotype was linked to higher susceptibility to infection (p = 0.0011; OR = 2.91; adjusted p value = 0.008), while the G/A genotype appeared protective (p = 0.0007; OR = 0.45; adjusted p value = 0.008). No association was found between rs3751987 and disease severity. Analysis of IgG anti-N and anti-RBD levels revealed no significant associations with either polymorphism (p > 0.05). CONCLUSION These findings highlight the role of TNFRSF13B polymorphisms in SARS-CoV-2 susceptibility and severity, while their impact on humoral immune responses appears limited.
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Affiliation(s)
- Oumaima Laazaazia
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
- Laboratory of Virology, Microbiology, Quality and Biotechnology/Ecotoxicology and Biodiversity, Hassan II University, Faculté des Sciences et Techniques, Mohammedia, Morocco
| | - Ahd Ouladlahsen
- Service des maladies Infectieuses, CHU Ibn Rochd, Casablanca, Morocco
| | - Safaa Aqillouch
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Haya Altawalah
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Virology Unit, Yacoub Behbehani Center, Sabah Hospital, Ministry of Health, Shuwaikh, Kuwait
| | - Oumaima Bouddahab
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Rachid Noureddine
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Pascal Pineau
- Institut Pasteur, Université Paris Cité, Unité « Organisation Nucléaire et Oncogenèse», INSERM U993, Paris, France
| | - Mustapha Lkhider
- Laboratory of Virology, Microbiology, Quality and Biotechnology/Ecotoxicology and Biodiversity, Hassan II University, Faculté des Sciences et Techniques, Mohammedia, Morocco
| | - Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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Fantechi L, Barbarossa F, Cecchini S, Zoppi L, Amabili G, Di Rosa M, Paci E, Fornarelli D, Bonfigli AR, Lattanzio F, Maranesi E, Bevilacqua R. Predicting Hospitalization Length in Geriatric Patients Using Artificial Intelligence and Radiomics. Bioengineering (Basel) 2025; 12:368. [PMID: 40281728 PMCID: PMC12024832 DOI: 10.3390/bioengineering12040368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Revised: 03/17/2025] [Accepted: 03/28/2025] [Indexed: 04/29/2025] Open
Abstract
(1) Background: Predicting hospitalization length for COVID-19 patients is crucial for optimizing resource allocation and patient management. Radiomics, combined with machine learning (ML), offers a promising approach by extracting quantitative imaging features from CT scans. The aim of the present study is to use and adapt machine learning (ML) architectures, exploiting CT radiomics information, and analyze algorithms' capability to predict hospitalization at the time of patient admission. (2) Methods: The original CT lung images of 168 COVID-19 patients underwent two segmentations, isolating the ground glass area of the lung parenchyma. After an isotropic voxel resampling and wavelet and Laplacian of Gaussian filtering, 92 intensity and texture radiomics features were extracted. Feature reduction was conducted by applying a last absolute shrinkage and selection operator (LASSO) to the radiomic features set. Three ML classification algorithms, linear support vector machine (LSVM), medium neural network (MNN), and ensemble subspace discriminant (ESD), were trained and validated through a 5-fold cross-validation technique. Model performance was assessed using accuracy, sensitivity, specificity, precision, F1-score, and the area under the receiver operating characteristic curve (AUC-ROC). (3) Results: The LSVM classifier achieved the highest predictive performance, with an accuracy of 86.0% and an AUC of 0.93. However, reliable outcomes are also registered when MNN and ESD architecture are used. (4) Conclusions: The study shows that radiomic features can be used to build a machine learning framework for predicting patient hospitalization duration. The findings suggest that radiomics-based ML models can accurately predict COVID-19 hospitalization length.
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Affiliation(s)
- Lorenzo Fantechi
- Unit of Nuclear Medicine, IRCCS INRCA, 60127 Ancona, Italy; (L.F.); (D.F.)
| | - Federico Barbarossa
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (F.B.); (G.A.); (A.R.B.); (F.L.); (R.B.)
| | - Sara Cecchini
- Unit of Radiology, IRCCS INRCA, 60127 Ancona, Italy; (S.C.); (L.Z.); (E.P.)
| | - Lorenzo Zoppi
- Unit of Radiology, IRCCS INRCA, 60127 Ancona, Italy; (S.C.); (L.Z.); (E.P.)
| | - Giulio Amabili
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (F.B.); (G.A.); (A.R.B.); (F.L.); (R.B.)
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, 60127 Ancona, Italy;
| | - Enrico Paci
- Unit of Radiology, IRCCS INRCA, 60127 Ancona, Italy; (S.C.); (L.Z.); (E.P.)
| | - Daniela Fornarelli
- Unit of Nuclear Medicine, IRCCS INRCA, 60127 Ancona, Italy; (L.F.); (D.F.)
| | - Anna Rita Bonfigli
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (F.B.); (G.A.); (A.R.B.); (F.L.); (R.B.)
| | - Fabrizia Lattanzio
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (F.B.); (G.A.); (A.R.B.); (F.L.); (R.B.)
| | - Elvira Maranesi
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (F.B.); (G.A.); (A.R.B.); (F.L.); (R.B.)
| | - Roberta Bevilacqua
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (F.B.); (G.A.); (A.R.B.); (F.L.); (R.B.)
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Whittemore R, Jeon S, Akyirem S, Chen HNC, Lipson J, Minchala M, Wagner J. Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study. JMIR Form Res 2025; 9:e67293. [PMID: 40131327 PMCID: PMC11979536 DOI: 10.2196/67293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 02/20/2025] [Accepted: 02/21/2025] [Indexed: 03/26/2025] Open
Abstract
BACKGROUND Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. OBJECTIVE This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. METHODS A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. RESULTS In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% CONCLUSIONS MAP shows promise for improving health equity in portal use for T2D. Larger, controlled studies are needed to determine how best to implement MAP in complex clinical settings and to evaluate efficacy over time. TRIAL REGISTRATION ClinicalTrials.gov NCT05180721; https://clinicaltrials.gov/study/NCT05180721.
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Affiliation(s)
| | - Sangchoon Jeon
- School of Nursing, Yale University, Orange, CT, United States
| | - Samuel Akyirem
- School of Nursing, Yale University, Orange, CT, United States
| | - Helen N C Chen
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Joanna Lipson
- School of Nursing, Yale University, Orange, CT, United States
| | - Maritza Minchala
- School of Public Health, Yale University, New Haven, CT, United States
| | - Julie Wagner
- Department of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington, CT, United States
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Lai CH, Chen CH, Chiu YW, Huang FW, Wu SY, Shih HM, Hsueh PR. Efficacy of monocyte distribution width in predicting critical illness in patients with COVID-19 pneumonia: a retrospective cohort study. BMC Infect Dis 2025; 25:400. [PMID: 40128650 PMCID: PMC11934797 DOI: 10.1186/s12879-024-10391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 12/23/2024] [Indexed: 03/26/2025] Open
Abstract
BACKGROUND Identifying patients at a risk of severe COVID-19 is crucial for prompt intervention and mortality risk mitigation. The monocyte distribution width (MDW) is an effective accurate predictor of sepsis in emergency settings, facilitating timely patient management. However, few reliable laboratory parameters are available for predicting the severity and prognosis of COVID-19. Thus, this study was conducted to investigate whether MDW can accurately predict the severity and progression of COVID-19 pneumonia. METHODS This retrospective cohort study included patients with COVID-19 pneumonia who had been admitted to our hospital between January 1, 2022, and September 31, 2022. The primary outcome was the development of critical illness, which was assessed in terms of intensive care unit (ICU) admission, need for mechanical ventilation (MV), or mortality. The secondary outcomes were durations of ICU stay, MV, and hospital stay. Multivariate logistic regression was performed to estimate the risks of critical illness and mortality. RESULTS Data from 878 patients with COVID-19 were analyzed. Of these, 258 (29.4%) developed critical illness. The high-MDW group (MDW > 22) showed a higher rate of critical illness (155/452, 34.29%) compared to the low-MDW group (103/426, 24.18%). Mortality was also higher in the high-MDW group (95/452, 21.02%) than in the low-MDW group (37/426, 8.69%). Patients with MDW > 22 exhibited a significantly higher risk of developing critical illness (adjusted odds ratio [aOR]: 1.48; 95% confidence interval [CI]: 1.08-2.04) and mortality (aOR: 2.46; 95% CI: 1.63-3.74) compared to those with MDW ≤ 22. CONCLUSION Our findings suggest that an elevated MDW value at presentation may serve as a promising predictor of severe outcomes in patients with COVID-19 pneumonia. This underscores the need for further research to validate the utility of MDW in predicting critical illness among patients with viral pneumonia.
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Affiliation(s)
- Chia-Hung Lai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Hung Chen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Wei Chiu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fen-Wei Huang
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Yun Wu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Mo Shih
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Loboda D, Golba KS, Gurowiec P, Bredelytė A, Razbadauskas A, Sarecka-Hujar B. Variability in Arterial Stiffness and Vascular Endothelial Function After COVID-19 During 1.5 Years of Follow-Up-Systematic Review and Meta-Analysis. Life (Basel) 2025; 15:520. [PMID: 40283075 PMCID: PMC12028431 DOI: 10.3390/life15040520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/18/2025] [Accepted: 03/20/2025] [Indexed: 04/29/2025] Open
Abstract
Increasing long-term observations suggest that coronavirus disease 2019 (COVID-19) vasculopathy may persist even 1.5 years after the acute phase, potentially accelerating the development of atherosclerotic cardiovascular diseases. This study systematically reviewed the variability of brachial flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (cfPWV) from the acute phase of COVID-19 through 16 months of follow-up (F/U). Databases including PubMed, Web of Science, MEDLINE, and Embase were screened for a meta-analysis without language or date restrictions (PROSPERO reference CRD42025642888, last search conducted on 1 February 2025). The quality of the included studies was assessed using the Newcastle-Ottawa Quality Scale. We considered all studies (interventional pre-post studies, prospective observational studies, prospective randomized, and non-randomized trials) that assessed FMD or cfPWV in adults (aged ≥ 18 years) with or after laboratory-confirmed COVID-19 compared with non-COVID-19 controls or that assessed changes in these parameters during the F/U. Twenty-one studies reported differences in FMD, and 18 studies examined cfPWV between COVID-19 patients and control groups during various stages: acute/subacute COVID-19 (≤30 days from disease onset), early (>30-90 days), mid-term (>90-180 days), late (>180-270 days), and very late (>270 days) post-COVID-19 recovery. Six studies assessed variability in FMD, while nine did so for cfPWV during the F/U. Data from 14 FMD studies (627 cases and 694 controls) and 15 cfPWV studies (578 cases and 703 controls) were included in our meta-analysis. FMD showed a significant decrease compared to controls during the acute/subacute phase (standardized mean difference [SMD]= -2.02, p < 0.001), with partial improvements noted from the acute/subacute phase to early recovery (SMD = 0.95, p < 0.001) and from early to mid-term recovery (SMD = 0.92, p = 0.006). Normalization compared to controls was observed in late recovery (SMD = 0.12, p = 0.69). In contrast, cfPWV values, which were higher than controls in the acute/subacute phase (SMD = 1.27, p < 0.001), remained elevated throughout the F/U, with no significant changes except for a decrease from mid-term to very late recovery (SMD= -0.39, p < 0.001). In the very late recovery, cfPWV values remained higher than those of controls (SMD = 0.45, p = 0.010). In the manuscript, we discuss how various factors, including the severity of acute COVID-19, the persistence of long-term COVID-19 syndrome, and the patient's initial vascular age, depending on metrics age and cardiovascular risk factors, influenced the time and degree of FMD and cfPWV improvement.
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Affiliation(s)
- Danuta Loboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland; (K.S.G.); (P.G.)
| | - Krzysztof S. Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland; (K.S.G.); (P.G.)
| | - Piotr Gurowiec
- Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland; (K.S.G.); (P.G.)
| | - Aelita Bredelytė
- Faculty of Health Sciences, Klaipėda University, LT-92294 Klaipeda, Lithuania; (A.B.); (A.R.)
| | - Artūras Razbadauskas
- Faculty of Health Sciences, Klaipėda University, LT-92294 Klaipeda, Lithuania; (A.B.); (A.R.)
- Chemotherapy Unit, Department of Oncology, Klaipeda University Hospital, LT-92288 Klaipeda, Lithuania
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland;
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Sun S, Ding Y, Yang D, Shen J, Zhang T, Song G, Chen X, Lin Y, Chen R. Identification of potential hub genes and drugs in septic kidney injury: a bioinformatic analysis with preliminary experimental validation. Front Med (Lausanne) 2025; 12:1502189. [PMID: 40166075 PMCID: PMC11955678 DOI: 10.3389/fmed.2025.1502189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 02/13/2025] [Indexed: 04/02/2025] Open
Abstract
Background Sepsis-associated kidney injury (SAKI) is a prevalent complication in intensive care unit (ICU) patients with sepsis. Diagnosis currently relies on clinical assessment, urine output, and serum creatinine levels, yet effective clinical treatments remain scarce. Our objectives are to explore prospective, targeted medications for the treatment of septic kidney injury and to employ bioinformatics to identify key genes and pathways that may be implicated in the pathogenesis of SAKI. Methods We utilized the GEO database for differential gene screening. Related genes of septic kidney injury were identified through Pubmed2Ensembl, followed by annotation and visualization of gene ontology biological processes and KEGG pathways using DAVID. Protein-protein interactions were analyzed with the STRING database, and hub genes were identified using Cytoscape software. Candidate genes were further validated through Metascape. The CTD database was employed to uncover the relationship between hub genes and acute kidney injury (AKI). CIBERSORT was applied to evaluate the infiltration of immune cells and their association with hub genes. Hub genes were experimentally verified through qPCR detection. Lastly, the Drug-Gene Interaction Database (DGIdb) was utilized to identify drug-gene interactions. Results Six genes, including TNF, CXCL8, IL-6, IL-1β, IL-2, and IL-10, were associated with three major signaling pathways: the COVID-19 adverse outcome pathway, an overview of pro-inflammatory and pro-fibrotic mediators, and the interleukin-10 signaling pathway. Additionally, 12 targeted drugs were identified as potential therapeutic agents.
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Affiliation(s)
- Shujun Sun
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
- Department of Pain, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Ding
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Dong Yang
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
- Department of Pain, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiwei Shen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Guobin Song
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Yun Lin
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Rui Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, China
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Narin Çopur E, Ergün D, Ergün R, Atik S, Türk Dağı H, Körez MK. Risk Factors Affecting the Severity, Mortality, and Intensive Care Unit Admission of COVID-19 Patients: A Series of 1075 Cases. Viruses 2025; 17:429. [PMID: 40143356 PMCID: PMC11946003 DOI: 10.3390/v17030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 03/11/2025] [Accepted: 03/15/2025] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is broad; it can range from asymptomatic cases to mild upper respiratory tract illness, respiratory failure, and severe multiorgan failure resulting in death. Therefore, it is important to identify the clinical course of the disease and the factors associated with mortality. OBJECTIVE The aim of this study is to identify the risk factors associated with the severity of the disease, intensive care unit admission, and mortality in COVID-19 patients. METHODS A total of 1075 patients with clinical and radiological findings compatible with COVID-19 pneumonia and positive SARS-CoV-2 PCR were selected and retrospectively screened. All included patients were classified according to the 7th edition of the 2019 Coronavirus Disease Guidelines published by the National Health Commission of China. RESULTS It was observed that elevated white blood count (WBC) increased the severity of COVID-19 by 3.26 times and the risk of intensive care unit (ICU) admission by 3.47 times. Patients with high D-dimer levels had a 91% increased risk, and those with high fibrinogen levels had a 2.08 times higher risk of severe disease. High C-reactive protein (CRP) values were found to increase disease severity by 6.89 times, mortality by 12.84 times, and ICU admission by 3.37 times. CONCLUSIONS Identifying the factors associated with disease severity, ICU admission, and mortality in COVID-19 patients could help reduce disability and mortality rates in pandemics.
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Affiliation(s)
- Ecem Narin Çopur
- Department of Pulmonary Medicine, Dr. Yaşar Eryılmaz Doğubeyazıt State Hospital, Ağrı 04402, Turkey
| | - Dilek Ergün
- Department of Pulmonary Medicine, Faculty of Medicine, Selcuk University, Konya 42130, Turkey;
| | - Recai Ergün
- Department of Pulmonary Medicine, Faculty of Medicine, Selcuk University, Konya 42130, Turkey;
| | - Serap Atik
- Department of Pulmonary Medicine, Iğdır Dr. Nevruz Erez State Hospital, Iğdır 76000, Turkey;
| | - Hatice Türk Dağı
- Department of Medical Microbiology, Faculty of Medicine, Selcuk University, Konya 42130, Turkey;
| | - Muslu Kazım Körez
- Department of Biostatistics, Faculty of Medicine, Selcuk University, Konya 42130, Turkey;
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Gutzler C, Höhne K, Bani D, Kayser G, Fähndrich S, Ambros M, Hug MJ, Rieg S, Falcone V, Müller-Quernheim J, Zissel G, Frye BC. Vasoactive Intestinal Peptide (VIP) in COVID-19 Therapy-Shedding of ACE2 and TMPRSS2 via ADAM10. Int J Mol Sci 2025; 26:2666. [PMID: 40141308 PMCID: PMC11942504 DOI: 10.3390/ijms26062666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 03/07/2025] [Accepted: 03/14/2025] [Indexed: 03/28/2025] Open
Abstract
Patients infected with SARS-CoV-2 may develop mild respiratory symptoms but also Acute Respiratory Distress Syndrome (ARDS). Additionally, severe systemic inflammation contributes to morbidity and mortality. The SARS-CoV-2 virus enters the cell by binding to the angiotensin-converting enzyme 2 (ACE2) receptor, followed by cleavage by transmembrane serine protease 2 (TMPRSS2). Vasoactive intestinal peptide (VIP) is known for its immune-modulating effects by suppressing the release of pro-inflammatory cytokines and enhancing regulatory T-cells. Furthermore, it has been tested in SARS-CoV-2-related clinical trials. We set out to investigate its role in the setting of SARS-CoV-2 infection in vitro. Epithelial cells (CaCo-2) were stimulated with SARS-CoV-2 spike protein, treated with native VIP and analyzed to investigate the mRNA and surface expression of ACE2 and TMPRSS2, the enzyme activity of TMPRSS2 and the infection rate by a SARS-CoV-2 pseudovirus. VIP downregulated ACE2 and TMPRSS2 mRNA and surface expression. Beyond these direct effects, VIP mediates the shedding of surface-expressed ACE2 and TMPRSS2 via upregulation of a sheddase protease (ADAM10). Functionally, these dual mechanisms of VIP-mediated downregulation of proteins involved in SARS-CoV-2 cell entry resulted in a reduced infection rate by the SARS-CoV-2 pseudovirus. These data imply that VIP hampers viral entry mechanisms based on SARS-CoV-2 and the linkage to ADAM10 may stimulate research in other indications beyond SARS-CoV-2.
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Affiliation(s)
- Charlotte Gutzler
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
- Department of Internal Medicine IV, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Kerstin Höhne
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Daniele Bani
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, Imaging Platform, University of Florence, 50134 Florence, Italy
| | - Gian Kayser
- Institute of Pathology Naehrig Mattern Kayser, Boetzinger Strasse 60, 79111 Freiburg, Germany
| | - Sebastian Fähndrich
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Michael Ambros
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Martin J. Hug
- Pharmacy, Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Siegbert Rieg
- Department of Internal Medicine II, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Valeria Falcone
- Institute of Virology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Joachim Müller-Quernheim
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Gernot Zissel
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
| | - Björn C. Frye
- Department for Pneumology, University Medical Center, Faculty of Medicine–University of Freiburg, 79106 Freiburg, Germany
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Alqahtani SA, Alshammari TM, Alzahrani EM, Alaohali AA, Alqahtani JS, Alzahrani YA, Alrawashdeh AA, Williams B, Aljumaan MA, Alsulaibikh AH, Alghamdi MA, Almulhim MA, Alqahtani SY, Al-Ahmadi S, Alshahrani MS. Outcomes of COVID-19 During the First Wave in Saudi Arabia: An Observational Study of ICU Cases from a Single Hospital. J Clin Med 2025; 14:1915. [PMID: 40142722 PMCID: PMC11942682 DOI: 10.3390/jcm14061915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 03/08/2025] [Accepted: 03/11/2025] [Indexed: 03/28/2025] Open
Abstract
Background/Objectives: Mortality from COVID-19 in intensive care units (ICUs) was not clearly reported in many regions during the first wave. We aimed to assess the characteristics and outcomes of ICU patients with COVID-19 in Saudi Arabia. Methods: This was a secondary data analysis of the Convalescent Plasma Trial. All patients who were recruited from King Fahad Hospital of the University (KFHU) in the Eastern Region of Saudi Arabia between 13 March 2020 and 13 September 2020 were included. Characteristics and outcomes, differences in characteristics and outcomes between Saudi and non-Saudi populations, and predictors of mortality were assessed. Results: The KFHU recruited 185 ICU patients with COVID-19. Of those, 90 (48.6%) were Saudi, and 95 (51.4%) were non-Saudi. The overall mean age was 56.7 years, and 71.9% were males. Compared with Saudis, non-Saudis were younger, with a mean age of 54.4 years, were more likely to be males (81.1%), and had a higher median respiratory rate (28.0 breaths/min vs. 24.0), a lower percentage of blood-oxygen saturation (86.0% vs. 91.0%), and higher median levels of ferritin per µg/L (820 vs. 550). The overall mortality rate was 33.0% (n = 61). The mortality rate in non-Saudis (42.1%) was higher than that in Saudis (23.3%). The variables associated with increased mortality included non-Saudi status (odds ratio [OR] 2.66; 95% CI: 1.05, 6.72), ferritin (OR 1.01; 95% CI: 1.00, 1.02), and intubation (OR 8.55; 95% CI: 2.92, 24.97). Conclusions: Since the mortality rate in non-Saudis was greater than that in Saudis, more efforts should be made to improve social determinants of health across non-Saudis in our region.
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Affiliation(s)
- Saeed A. Alqahtani
- Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Dhahran 34313, Saudi Arabia (J.S.A.)
| | - Talal M. Alshammari
- Department of Emergency Medical Care, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Eidan M. Alzahrani
- Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Dhahran 34313, Saudi Arabia (J.S.A.)
| | - Abeer A. Alaohali
- Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Dhahran 34313, Saudi Arabia (J.S.A.)
| | - Jaber S. Alqahtani
- Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Dhahran 34313, Saudi Arabia (J.S.A.)
| | - Yahya A. Alzahrani
- Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Dhahran 34313, Saudi Arabia (J.S.A.)
| | - Ahmad A. Alrawashdeh
- Department of Paramedics, Faculty of Allied Medical Sciences, Jordan University of Science and Technology, Ar-Ramtha 3030, Jordan
| | - Brett Williams
- Department of Paramedicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Mohammed A. Aljumaan
- Department of Emergency Medical Care, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.A.)
| | - Amal H. Alsulaibikh
- Department of Intensive Care, King Fahad Hospital of the University of Imam Abdulrahman bin Faisal, Dammam 34212, Saudi Arabia
| | - Mohannad A. Alghamdi
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.A.)
| | - Mohammed A. Almulhim
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.A.)
| | - Shaya Y. Alqahtani
- Department of Internal and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Sarah Al-Ahmadi
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.A.)
| | - Mohammed S. Alshahrani
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia; (M.A.A.)
- Department of Intensive Care, King Fahad Hospital of the University of Imam Abdulrahman bin Faisal, Dammam 34212, Saudi Arabia
- Department of Internal and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Wang Z, Zhao L, Xie K. Development and validation of a nomogram to assess the occurrence of liver dysfunction in patients with COVID-19 pneumonia in the ICU. BMC Infect Dis 2025; 25:332. [PMID: 40065225 PMCID: PMC11892215 DOI: 10.1186/s12879-025-10684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/18/2025] [Indexed: 03/14/2025] Open
Abstract
The global pandemic of novel coronavirus pneumonia (COVID-19) has resulted in millions of deaths over the past three years. As one of the most commonly affected extra-pulmonary organs, numerous studies have reported varying degrees of liver injury in a significant proportion of patients with COVID-19, particularly in severe and critically ill patients. Early prediction of liver dysfunction in hospitalized patients would facilitate the clinical management of COVID-19 and improve clinical prognosis, but reliable and valid predictive models are still lacking.MethodsWe collected data from 286 patients with RT-PCR confirmed COVID-19 admitted to various ICUs from the case system. These patients were randomly divided into a training cohort (50%) and a validation cohort (50%). In the training cohort, we first used ROC curves to measure the predictive efficiency of each of the variables for the development of liver damage during hospitalization in patients with COVID-19, followed by LASSO regression analysis to screen the variables for predictive models and logistic regression analysis to identify relevant risk factors. A nomogram based on these variables was created following the above model. Finally, the efficiency of the prediction models in the training and validation cohorts was assessed using AUC, consistency index (C index), calibration curves and Decision Curve Analysis.ResultsOut of a total of 80 parameters for COVID-19 patients admitted to the ICUs, 10 were determined to be significantly associated with the occurrence of liver dysfunction during hospitalization. Based on these predictors, further prediction models were used to construct and develop a nomogram that was offered for practical clinical application. The C-index of the column line graphs for the training and validation cohorts was 0.956 and 0.844 respectively. in addition, the calibration curves for the model showed a high degree of agreement between the predicted and actual incidence of liver dysfunction in patients with COVID-19.ConclusionBy developing a predictive model and associated nomogram, we predicted the incidence of liver dysfunction during hospitalization in patients with COVID-19 in the ICU. The model's predictive performance was determined in both the training and validation cohorts, contributing to the clinical management of COVID-19.
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Affiliation(s)
- Zhiwei Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Lina Zhao
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.
- Laboratory of Anesthesia and Critical Care Medicine in Colleges and Universities of Shandong Province, School of Anesthesiology, Shandong Second Medical University, Weifangaq, Weifang, Shandong, 261053, China.
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Thieulent CJ, Balasuriya UBR, Tseng A, Crossland NA, Stephens JM, Dittmar W, Staszkiewicz J, Richt JA, Carossino M. Diabetes exacerbates SARS-CoV-2 replication through ineffective pulmonary interferon responses, delayed cell-mediated immunity, and disruption of leptin signaling. Front Cell Infect Microbiol 2025; 15:1513687. [PMID: 40125513 PMCID: PMC11925909 DOI: 10.3389/fcimb.2025.1513687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/06/2025] [Indexed: 03/25/2025] Open
Abstract
Comorbidities, including obesity and type 2 diabetes mellitus (T2DM), are associated with increased disease severity and mortality following SARS-CoV-2 infection. Here, we investigated virus-host interactions under the effects of these comorbidities in diet-induced obesity (DIO) and leptin receptor-deficient (T2DM) mice following infection with SARS-CoV-2. DIO mice, as well as their lean counterparts, showed limited susceptibility to SARS-CoV-2 infection. In contrast, T2DM mice showed exacerbated pulmonary SARS-CoV-2 replication and delayed viral clearance associated with down-regulation of innate and adaptative immune gene signatures, ineffective type I interferon response, and delayed SARS-CoV-2-specific cell-mediated immune responses. While T2DM mice showed higher and prolonged SARS-CoV-2-specific immunoglobulin isotype responses compared to their lean counterparts, neutralizing antibody levels were equivalent. By silencing the leptin receptor in vitro using a human alveolar epithelial cell line, we observed an increase in SARS-CoV-2 replication and type I interferons. Altogether, our data provides for the first time evidence that disruption of leptin receptor signaling leading to obesity and T2DM induces altered type I interferon and cell-mediated responses against SARS-CoV-2, mediating increased viral replication and delayed clearance. These data shed light on the alteration of the innate immune pathway in the lung using in-depth transcriptomic analysis and on adaptive immune responses to SARS-CoV-2 under T2DM conditions. Finally, this study provides further insight into this risk factor aggravating SARS-CoV-2 infection and understanding the underlying cellular mechanisms that could help identify potential intervention points for this at-risk population.
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MESH Headings
- Animals
- SARS-CoV-2/physiology
- SARS-CoV-2/immunology
- Mice
- COVID-19/immunology
- COVID-19/virology
- Virus Replication
- Receptors, Leptin/genetics
- Receptors, Leptin/metabolism
- Obesity/immunology
- Obesity/complications
- Signal Transduction
- Humans
- Diabetes Mellitus, Type 2/immunology
- Diabetes Mellitus, Type 2/complications
- Leptin/metabolism
- Interferon Type I/immunology
- Interferon Type I/metabolism
- Lung/immunology
- Lung/virology
- Immunity, Cellular
- Mice, Inbred C57BL
- Immunity, Innate
- Male
- Disease Models, Animal
- Antibodies, Neutralizing/blood
- Interferons
- Mice, Knockout
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Affiliation(s)
- Côme J. Thieulent
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
- Louisiana Animal Disease Diagnostic Laboratory (LSU Diagnostics), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Udeni B. R. Balasuriya
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
- Louisiana Animal Disease Diagnostic Laboratory (LSU Diagnostics), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Anna Tseng
- Department of Virology, Immunology, and Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Nicholas A. Crossland
- Department of Virology, Immunology, and Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Pathology and Laboratory Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA, United States
| | - Jacqueline M. Stephens
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Wellesley Dittmar
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
- Louisiana Animal Disease Diagnostic Laboratory (LSU Diagnostics), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Jaroslaw Staszkiewicz
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Juergen A. Richt
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Mariano Carossino
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
- Louisiana Animal Disease Diagnostic Laboratory (LSU Diagnostics), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
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Kalibatas V, Kaseliene S, Kalediene R, Mesceriakova O, Sauliune S. Perceptions of healthcare access among Lithuanians aged 65 and over during the COVID-19 pandemic. Front Public Health 2025; 13:1504049. [PMID: 40104119 PMCID: PMC11913820 DOI: 10.3389/fpubh.2025.1504049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 02/12/2025] [Indexed: 03/20/2025] Open
Abstract
Aim This study investigates the perceived accessibility of healthcare services among older adults in Lithuania during the COVID-19 pandemic. The study is significant as it sheds light on geographical, organizational, and financial healthcare access issues encountered by the older population. Methods Conducted in January 2024, the study involved an anonymous questionnaire survey of 1,503 Lithuanian residents aged 65 and older. Results The most frequently utilized healthcare services were consultations with a general practitioner (75.4%) 22.0% of respondents reported not receiving any healthcare services. 53.5% respondents were satisfied with travel time to specialists. Common challenges included difficulties in getting appointments with specialists (53.9%) and dentists (36.2%). Financial barriers led to unmet healthcare needs: 12.6% of the respondents did not receive needed services, 12.8% did not undergo recommended tests, and 14.2% did not purchase prescribed medications. Healthcare services were less accessible to elders with lower education, lower incomes, and those who self-rated health poorly (p < 0.05). Conclusion Most respondents received the healthcare they needed during the pandemic and rated geographical access positively. However, some problems in organizational and financial access were disclosed. The observed social gradient indicates that socioeconomic factors significantly influence healthcare access, potentially increasing vulnerability among certain groups.
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Dagnaw GG, Paltiel O, Shafrir A. Long term outcomes after COVID-19 in patients with schizophrenia: a historical cohort study in a health maintenance organization. Soc Psychiatry Psychiatr Epidemiol 2025:10.1007/s00127-025-02860-0. [PMID: 40029403 DOI: 10.1007/s00127-025-02860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 02/13/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND Severe mental illness may affect health behaviors and outcomes during pandemics. Few studies have assessed whether people living with schizophrenia spectrum disorders (SSD) experienced adverse COVID-19 outcomes. METHODS In a population-based historical cohort study comprising members of a health maintenance organization, we included 1273 patients with SSD and 12,730 age- and sex-matched controls tested for SARS-CoV-2 between March 2020 and May 2022. We assessed the association between schizophrenia and hospitalization, hospital length-of-stay, 30-day, and one-year mortality, constructing multiple linear regression and logistic regression models adjusting for sociodemographic factors, BMI, smoking, number of comorbidities, and vaccinations. We also assessed whether vaccination modified the association between schizophrenia and mortality. RESULTS Among patients with SSD, 477 (37.5%) had a positive test, compared to 6203 (48.7%) in the comparison group. patients with SSD were at increased risk of hospitalization (adjusted odds ratio (ORadj) 3.44, 95% confidence interval (CI): 2.88-4.11, p < 0.001); longer length-of-stay (β = 1.20, p < 0.001); increased 30-day (ORadj 9.07, 95%CI 3.11-26.44); and one-year mortality (ORadj 6.27, 95%CI: 2.73-14.39). Further adjustment for vaccination altered the OR for 30-day mortality (ORadj 4.54, 95%CI: 1.54-13.38). Additionally, the association between schizophrenia and 30-day mortality was attenuated in strata of vaccinated (OR 4.79, 95%CI: 0.82-28.13, p = 0.082), vs. unvaccinated individuals (OR 7.53, 95%CI 2.19-25.92, p = 0.001), respectively. CONCLUSIONS In our cohort, patients with SSD experienced a significantly higher rate of hospitalization, length of stay, and mortality following a positive SARS-CoV-2 test, even after adjusting for important prognostic factors. COVID-19 vaccination modified these risks.
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Affiliation(s)
- Gashaw Getaneh Dagnaw
- College of Veterinary Medicine and Animal Sciences, Department of Epidemiology and Public Health, University of Gondar, Gondar, Ethiopia
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Jerusalem, Israel
- Department of Haematology, Faculty of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Asher Shafrir
- Department of Gastroenterology, Faculty of Medicine, Hadassah-Hebrew University, Jerusalem, Israel.
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Demir G, Seki Öz H. Psychological Experiences of Elderly Patients With Covid-19 Diagnosis in Intensive Care: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2025; 90:1701-1715. [PMID: 36069594 DOI: 10.1177/00302228221126212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the study, it was aimed to determine the experiences of elderly COVID-19 patients hospitalized in intensive care units. The study was conducted based on the phenomenological design, one of the qualitative research methods. In-depth interviews were conducted using a semi-structured interview form with 15 participants, who were determined by the homogeneous and criterion sampling methods, two of the purposive sampling methods. Data were analyzed using Colaizzi's seven-step method. After the interviews, four themes were determined: intensive care experiences, importance of nursing care, intensive care environment and coping mechanisms related to COVID-19 disease, and post-intensive care realizations. In addition, 13 sub-themes were determined. This study provided a better understanding of the psychological experiences of elderly individuals during the disease, who have been hospitalized in intensive care unit and survived COVID-19.
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Affiliation(s)
- Gökçe Demir
- Faculty of Health Sciences, Department of Nursing, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hilal Seki Öz
- Faculty of Health Sciences, Department of Nursing, Kırşehir Ahi Evran University, Kırşehir, Turkey
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