Asymptomatic State Research Articles

Chlamydia in wild Australian rodents: a cross-sectional study to inform disease risks for a conservation translocation

Context Chlamydia species impose major global burdens on both human and animal health. However, chlamydial infections of wild rodents have been understudied, posing limitations on assessments of disease risks for rodent conservation translocations. This is particularly true when there is evidence of infection in proposed source populations, as occurred for the Shark Bay mouse (Pseudomys gouldii) translocations to Dirk Hartog Island. Aims The aim of this study was to reduce uncertainty surrounding the risks posed by Chlamydia for these translocations by: (1) determining the presence, prevalence and diversity of Chlamydia in rodent populations in the Shark Bay region of Western Australia; (2) identifying associations with health parameters; and (3) assessing for evidence of cross-species transmission. Methods Swab, faecal and tissue samples from 110 wild-caught individuals (comprising five rodent and two marsupial species) were collected across four islands in Western Australia. These samples were analysed by a Chlamydiaceae 23s rRNA qPCR in a 14-month cross-sectional study conducted between 2020 and 2021. Key results In total, 20% of all individuals (22/110; 95%CI 13.6–28.4) from five species, including 19% (19/100; 95% CI 12.5–27.8) of rodents, were positive by the Chlamydiaceae qPCR, although in low loads. Further attempts at species identification of the Chlamydiaceae were unsuccessful. Our results found no detectable adverse health associations, or significant associated pathological findings, with low molecular loads supporting an asymptomatic infection state. Additionally, there were no disease associations in Shark Bay bandicoots (Perameles bougainville) despite the presence of an ocular disease syndrome previously linked to chlamydial infection in this species. Conclusions and implications Our findings suggest that sub-clinical chlamydial infections in wild Australian rodents may be widespread, but for the Dirk Hartog Island translocations, the risks of Chlamydia associated with movement of Shark Bay mice are likely low. The results highlight how current knowledge gaps pertaining to wildlife health can be addressed through collaborative approaches to translocation planning and implementation.

Prognostic Significance of the Coagulation and Complement Systems in Critical COVID-19 Infection.

Infection with the SARS-CoV-2 virus (COVID-19 disease) can cause a wide range of clinical situations - from an asymptomatic state to fatal outcomes. In cases of serious clinical manifestations, the underlying mechanisms involve a number of immune cells and stromal cells as well as their products such as pro-inflammatory interleukin-6 and tumour necrosis factor-alpha that ultimately cause the cytokine storm. The situation of overproduction of pro-inflammatory cytokines is somewhat similar to, though in a mild form, health conditions in obesity and related metabolic disorders like type-2 diabetes, which are also considered important risk factors for severe illness in COVID-19. Interestingly, neutrophils perhaps play a significant role in this pathogenesis. On the other hand, it is thought that COVID-19-related critical illness is associated with pathological hyperactivity of the complement system and coagulopathy. Although the precise molecular interactions between the complement and coagulation systems are not clear, we observe an intimate cross-talk between these two systems in critically ill COVID-19 patients. It is believed that both of these biological systems are connected with the cytokine storm in severe COVID-19 disease and actively participate in this vicious cycle. In order to hinder the pathological progression of COVID-19, a number of anticoagulation agents and complement inhibitors have been used with varying success. Among these drugs, low molecular weight heparin enoxaparin, factor Xa inhibitor apixaban, and complement C5 inhibitor eculizumab have been commonly used in patients with COVID-19. Our overall experience might help us in the future to tackle any such conditions.

Investigating Longitudinal Continuity of Persistent White Matter Alterations in Sport-related Concussion Using Individualized Analyses

Background: Sport-related concussion (SRC) has been shown to lead to acute and long-term alterations in white matter (WM) organization. The Centers for Disease Control estimates around 283,000 children each year seek medical attention for SRC/recreation-related traumatic brain injury. However, literature on subject-specific longitudinal WM abnormalities in SRC is limited.Purpose: Given the heterogeneous nature of SRC on WM microstructure, the goal of this study is to investigate the longitudinal continuity of persistent white matter alterations using a subject-specific approach.
 Methods: MRI is a non-invasive imaging modality suitable for detecting neuropathophysiological changes after SRC. Compared to conventional anatomical MRI, using diffusion MRI to probe WM microarchitecture may provide additional sensitivity.The diffusion MRI data from 50 participants were obtained from the CARE consortium, a prospective multisite study examining the natural history of concussion. Each concussed athlete underwent MRI scan at three time points: (1) 24-48 hours after concussion, (2) asymptomatic state, and (3) 7-days after returned to play. Diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) metrics were computed and Z-scored based on a normal distribution template created from non-contact sport controls. Potential WM alterations indicated by extreme deviations of Z-score maps were calculated for all diffusion metrics in each concussed participant and time point.
 Results: WM alterations persistent across all three timepoints manifested in 76%, 62%, and 82% of the participants as quantified by increases of mean, axial, and radial diffusivity, respectively. 58% of the participants had fractional anisotropy decreases. For NODDI metrics, 82% and 86% of the participants showed increases of isotropic volume fraction and orientation dispersion index, respectively.
 Conclusion: This study demonstrated that by applying subject-specific analysis, extreme Z-score voxels can be identified across time in the same or spatially proximal brain regions suggesting persistent WM abnormalities beyond apparent clinical recovery.

Asymptomatic versus symptomatic SARS-CoV-2 infection: a cross-sectional seroprevalence study

BackgroundAlthough symptomatic SARS-CoV-2 infection predisposes patients to develop complications, the asymptomatic SARS-CoV-2 infection state is of public health importance being a hidden source of infection. Moreover, the asymptomatic state may camouflage the actual burden of the disease.MethodsData of 1434 seropositive participants for SARS-CoV-2 spike (anti-S) and/or nucleocapsid antibodies (anti-N) were retrieved from a larger cross-sectional survey on COVID-19. Relevant data were retrieved from records including socio-demographic, medical, and behavioral characteristics of seropositive participants as well as history of COVID-19 symptoms during the last 6 months. Symptomatic/asymptomatic SARS-CoV-2 infection was categorized based on the history of the presence or absence of COVID-19 symptoms.ResultsThe rate of asymptomatic SARS-CoV-2 infection was 34.9%. There was a statistically significant difference between symptomatic and asymptomatic participants regarding age, residence, medical conditions, habits, and infection control measures. The number of symptoms was positively correlated with anti-S titer and both were positively correlated with adult body mass index. Slum areas residence, client-facing occupation or being a healthcare worker, having lung disease, having blood group type A, never practicing exercise or social distancing, never using soap for hand washing, and minimal engagement in online working/studying were independent factors associated with the symptomatic state. Patients having less than three symptoms were less likely to be diagnosed by any means.ConclusionsOne-third of SARS-CoV-2 infections in our study were asymptomatic. This mandates applying proper measures to prevent transmission even from apparently healthy individuals. Modifiable factors associated with symptomatic infection should be controlled to reduce the risk of COVID-19 complications.

Acute myocarditis masquerading as anterior wall myocardial infarction: A case report

Myocarditis is the inflammation of the myocardium. The clinical presentation of myocarditis ranges from asymptomatic state to acute heart failure which may mimic acute coronary events. Because of the similar presentation of chest pain, elevated cardiac enzymes, and electrocardiographic (ECG) changes, acute myocarditis may rarely masquerade as acute myocardial infarction (AMI). High suspicion is often necessary for treating such patients, keeping in mind the different treatment protocols required for managing each pathology. SCARE 2020 Guidelines. We report a case of a young female presenting with sudden onset chest pain with ECG changes suggestive of acute anterior wall myocardial infarction (AWMI). Further investigations ruled out AWMI, and she was diagnosed with acute myocarditis. She was treated for myocarditis and showed a prompt recovery. Acute myocarditis may present clinically similarly to ACS; hence a high level of suspicion is required to differentiate the two entities. The absence of significant cardiovascular risk factors for atherosclerotic coronary artery disease, absence of RWMA, and normal coronary angiogram are further suggestive of myocarditis.

Cardiovascular complications associated with acromegaly. A state-of-the-art

Acromegaly is a rare disease, mainly caused by a pituitary tumor secreting growth hormone. It is characterized by slow progression and is associated with a multisystemic involvement, being the cardiovascular system, one of the most involved, even reaching, more than 10 years ago, to represent the main cause of death. Cardiovascular complications develop as a result of elevated blood concentrations of growth hormone and insulin-like growth factor 1, which exert direct and indirect effects on the endothelium, large vessels, kidney and cardiomyocytes; causing arterial hypertension, valve disease, cardiac arrhythmia and a specific heart disease called acromegalic cardiomyopathy. After the literature overview related to the pathophysiology, clinical manifestations, diagnosis and treatment of cardiovascular involvement, we found that from a cardiovascular point of view, patients with acromegaly can range from an asymptomatic state to severe cardiac dysfunction, being the biochemical markers and imaging studies diagnostic tools that allow assessment the degree of cardiovascular disease in order to provide individualized treatment. The normalization of growth hormone and insulin-like growth factor 1 levels improves cardiovascular parameters, and therefore its prognosis.

Vitamin B12 (Cobalamin): Its Fate from Ingestion to Metabolism with Particular Emphasis on Diagnostic Approaches of Acquired Neonatal/Infantile Deficiency Detected by Newborn Screening.

Acquired vitamin B12 (vB12) deficiency (vB12D) of newborns is relatively frequent as compared with the incidence of inherited diseases included in newborn screening (NBS) of different countries across the globe. Infants may present signs of vB12D before 6 months of age with anemia and/or neurologic symptoms when not diagnosed in asymptomatic state. The possibility of identifying vitamin deficient mothers after their pregnancy during the breastfeeding period could be an additional benefit of the newborn screening. Vitamin supplementation is widely available and easy to administer. However, in many laboratories, vB12D is not included in the national screening program. Optimized screening requires either second-tier testing or analysis of new urine and blood samples combined with multiple clinical and laboratory follow ups. Our scope was to review the physiologic fate of vB12 and the pathobiochemical consequences of vB12D in the human body. Particular emphasis was put on the latest approaches for diagnosis and treatment of vB12D in NBS.

Public Action for Prevention of Iatrogenic Transmission Of CJD

Creutzfeldt-Jakob Disease (CJD) is a rare and a rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein. The disease develops in very different ways, such as sporadic, familial, and iatrogenic. Although there is no means to prevent sporadic and familial CJD outbreaks, iatrogenic CJD can be prevented since the iatrogenic transmission pathway to human is mostly identified. However, despite its public health importance, there is no practical laboratory method for diagnosing this disease in an asymptomatic state. Therefore, it is very important to track the infection route one by one and act public preventive measure. However, there are no manual for prevention of iatrogenic transmission of this disease in Korea. Accordingly, this review summarizes on how to evaluate and act on surgical incidents that occurred in patients with CJD or high-risk patients. However, this is not an easy task for public health management teams as this field continues to require new scientific or specialized clinical knowledge. Therefore, a group or organization of expert panels is needed to manage and make decisions in general. Finally, this review was made with reference to the management regulations of countries with widespread exposure to CJD, including variant CJD. In other words, it is a very conservative and strict safety-oriented guideline. However, since the surveillance of diseases must take into each national medical situation and economic burden, some readjustments are necessary to the situation of the Republic of Korea.

Three-Country Snapshot of Ornithine Transcarbamylase Deficiency.

X-linked ornithine transcarbamylase deficiency (OTCD) is the most common urea cycle defect. The disease severity ranges from asymptomatic carrier state to severe neonatal presentation with hyperammonaemic encephalopathy. We audited the diagnosis and management of OTCD, using an online 12-question-survey that was sent to 75 metabolic centres in Turkey, France and the UK. Thirty-nine centres responded and 495 patients were reported in total. A total of 208 French patients were reported, including 71 (34%) males, 86 (41%) symptomatic and 51 (25%) asymptomatic females. Eighty-five Turkish patients included 32 (38%) males, 39 (46%) symptomatic and 14 (16%) asymptomatic females. Out of the 202 UK patients, 66 (33%) were male, 83 (41%) asymptomatic and 53 (26%) symptomatic females. A total of 19%, 12% and 7% of the patients presented with a neonatal-onset phenotype in France, Turkey and the UK, respectively. Vomiting, altered mental status and encephalopathy were the most common initial symptoms in all three countries. While 69% in France and 79% in Turkey were receiving protein restriction, 42% were on a protein-restricted diet in the UK. A total of 76%, 47% and 33% of patients were treated with ammonia scavengers in Turkey, France and the UK, respectively. The findings of our audit emphasize the differences and similarities in manifestations and management practices in three countries.

Like a Game of Chess, Every Move Matters: The Role of Antibodies in the Myasthenia Gravis Treatment Landscape.

Symptoms and disease pathophysiology of myasthenia gravis (MG) vary considerably with each patient, and their individual preferences and priorities add to the need for individualized treatment of this autoimmune disease. Research in MG has grown substantially in recent years. New treatments have the potential of being both effective and well tolerated, addressing the trade-off of choosing either efficacy or tolerability when selecting treatments. Promising investigational treatments that may become available in the future may allow more patients than ever before to achieve an asymptomatic state, with the ultimate goal being to turn off abnormal antibody production.

Localized Elevation of Wall Shear Stress Is Linked to Recent Symptoms in Patients with Carotid Stenosis

Background: Estimation of symptomatic and asymptomatic carotid atherosclerosis differences can be the basis for prevention and management of carotid artery stenosis disease. In clinical practice, carotid plaque vulnerability is assessed only on the basis of luminal stenosis. However, the evolution of carotid plaque from an asymptomatic state to a symptomatic one is a complex process and the underlying hemodynamic mechanisms are unknown. We aimed to investigate the differences in hemodynamic parameters between patients with recently symptomatic carotid stenosis and asymptomatic ones. Methods: Hemodynamic simulations were performed on 26 carotid plaques from 25 patients with carotid artery stenosis ≥50%, 16 of whom had recent cerebrovascular ischemic events. Using human-specific flow parameters and 3D reconstruction of carotid computed tomography angiography images, we assessed hemodynamic characteristics such as wall shear stress (WSS), time-averaged WSS (TAWSS), oscillatory shear index, and relative residence time (RRT) during the cardiac cycle in patients with and without symptoms. Results: We found that symptomatic carotid stenosis patients had greater local TAWSS (99.59 ± 26.29 vs. 60.40 ± 20.46 dyn/cm², p = 0.0007) and maximal WSS (116.65 ± 39.11 vs. 68.28 ± 23.67 dyn/cm², p = 0.003), but lower RRT (0.019 ± 0.006 vs. 0.013 ± 0.069 s, p = 0.049), than asymptomatic patients, but this hemodynamic difference was not associated with carotid stenosis severity (p = 0.70). Patients with transient ischemic attack (TIA) or stroke had higher local TAWSS and WSSmax than patients with asymptomatic stenosis (p < 0.05). Subgroup analysis showed that there was no statistical difference in local hemodynamic variables between TIA and stroke patients with carotid artery stenosis. Conclusions: Patients with carotid artery stenosis are more likely to experience acute ischemic cerebrovascular accidents if they have higher WSS. Simultaneous assessment with hemodynamic parameters like WSS along with stenosis severity may aid risk stratification in patients with asymptomatic carotid artery stenosis.

S141 Long-Term Risk of Colorectal Cancer in Patients With Prediabetes : A Systematic Review and Meta-Analysis

Introduction: Prediabetes is often underdiagnosed and underreported due to its asymptomatic state in over 80% of individuals. Considering its role in promoting cancer incidence and limited evidence linking prediabetes and colorectal cancer (CRC), we conducted a meta-analysis to evaluate the incidence of colorectal cancer in people with prediabetes. (Figure) Methods: A comprehensive search through PubMed/Medline, Embase, Scopus, and Google Scholar was performed until June 1, 2022, to screen for studies reporting colorectal cancer incidence/risk in prediabetics. Binary random-effects models were used to perform meta-analysis and subgroup analyses. Sensitivity analysis was done using leave-one-out method. Results: Seven prospective and one retrospective study comprising 15 cohorts and a pooled number of 854876 cases and 2190511 controls were included in the analysis (2 Japan, 2 Korea, 1 Sweden, 1 UK, 1 China, and 1 USA). After combining all the studies the forest plots for adjusted analysis shows a significant increase in odds of having CRC with prediabetes - (OR 1.16; 1.08–1.25, p< 0.01) (fig 1b) and unadjusted analysis also shows a significant increase in odds of having CRC with prediabetes (OR 1.62; 1.35–1.95, p< 0.01) (fig 1a). Sensitivity analysis using the Leave-one-out method did confirm equivalent results (fig 1c). Heterogeneity analysis for adjusted OR had moderate heterogeneity with an overall I^2 of 56.06% with a p value < 0.01 and for unadjusted OR had considerable heterogeneity with an overall I^2 of 85.72% with a p value less than 0.01. Subgroup analysis based on type of study, the odds of developing colorectal cancer was higher in prospective studies (OR 1.175; 1.065-1.298)(p 0.001) than retrospective studies(OR 1.162; 1.033- 1.306)(p 0.012) .The odds of developing cancer was not significantly higher in ages >60(OR 1.446; 0.887-2.356)(p 0.139) compared to less than 60 years. The strongest association b/w Prediabetes and CRC was found on a median 5-10 years(aOR 1.257; 1.029-1.534)(p 0.025) follow-up compared to < 5 years and 10 years and higher. Conclusion: This study showed nearly 16% higher long-term risk of colorectal cancer in patients with prediabetes. Lifestyle modifications like weight loss, proper diet, and exercise are essential to control prediabetes. This study further warrants a specific prediabetes screening for patients already at high risk of colorectal cancer with other risk factors. These strides would help subsequently lower the disease burden, and associated morbidity/mortality.Figure 1.: Forest Plot: Long-term Risk of Colorectal Cancer in Patients with Prediabetes vs Normoglycemia

Challenges in diagnosis and management of acquired factor V inhibitors

Inhibitors to factor V is a rare phenomenon with varied clinical presentation ranging from asymptomatic states to life-threatening bleeds. They are known to be associated with exposure to bovine thrombin, drugs, autoimmune diseases and malignancies. Establishing the diagnosis of FV inhibitors is challenging and the presence of lupus-like properties of the inhibitor can further complicate the diagnosis. Here we document an unusual case of an asymptomatic elderly female posted for pacemaker implantation and incidentally, the laboratory workup revealed a disproportionately abnormal coagulation screen. The intricacies in the diagnosis and management are discussed along with a brief review of the literature. An awareness of the diverse manifestations of this underrecognized disorder and difficulties in management is essential for medical practitioners, particularly in patients with idiopathic severe bleeding diathesis.

Prevalence of Prediabetes and Associated Risk Factor Assessment Among Adults Attending Primary Healthcare Centers in Al Bahah, Saudi Arabia: A Cross-Sectional Study.

BackgroundPrediabetes is an asymptomatic intermediate state of hyperglycemia with a major risk of developing type 2 diabetes (T2D). It is a progressive condition; it can take a few years for patients to become diabetic from a prediabetes state.ObjectivesThis study aimed to detect the prevalence rate of prediabetes among the adult population and to assess the association of the risk factors to prediabetes in both the male and female genders.MethodsA cross-sectional study was carried out in primary healthcare centers (PHC) in the city of Al Bahah, Saudi Arabia. A total of 378 study participants of both sexes from two central PHCs were eligible to participate in the study, which was conducted from January to February 2018. Data were collected through anthropometric measurements, laboratory investigations, and a predesigned questionnaire interview to identify demographic, lifestyle, and medical variables. Two blood tests were used to diagnose prediabetes: fasting plasma glucose (FBG) and hemoglobin A1c (HbA1C).ResultsThe overall prevalence of prediabetes among all participants was 20% (around 21% in males and 19% in females of all ages). There was a statistically significant association between prediabetes and obesity (central obesity), hypertension, and a family history of diabetes mellitus (FHDM).ConclusionThe prediabetic state is highly prevalent among adults attending PHC in Al Bahah city (20%). It is associated with obesity (especially central), hypertension, and FHDM. We highly recommend that public health professionals implement strategies for effective screening, diagnosis, and management of prediabetes.

The evolution of immune dysfunction in multiple myeloma.

This review discusses the role of immune dysfunction at the different stages of multiple myeloma (MM). Narrative review. MM is a complex disease and immune dysfunction has been known to play an important role in disease pathogenesis, progression, and drug resistance. MM is known to be preceded by asymptomatic precursor states and progression from the precursor states to MM is likely related to a progressive impairment of the immune system. An understanding of the role of the immune system in the progression of MM is important to guide the development of immunotherapeutic strategies for this disease.

Development of a prognostic model of COVID-19 severity: a population-based cohort study in Iceland

BackgroundThe severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis.MethodsAll SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed.ResultsThe prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke’s R2 was 23.4% (95%CI, 22.7–24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96–0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], Emax 0.014 [95%CI, 0.008–0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], Emax 0.018 [95%CI, 0.010–0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and Emax 0.027 [95%CI, 0.013–0.041]).ConclusionOur prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.

Data-driven approach in a compartmental epidemic model to assess undocumented infections

Nowcasting and forecasting of epidemic spreading rely on incidence series of reported cases to derive the fundamental epidemiological parameters for a given pathogen. Two relevant drawbacks for predictions are the unknown fractions of undocumented cases and levels of nonpharmacological interventions, which span highly heterogeneously across different places and times. We describe a simple data-driven approach using a compartmental model including asymptomatic and pre-symptomatic contagions that allows to estimate both the level of undocumented infections and the value of effective reproductive number Rt from time series of reported cases, deaths, and epidemiological parameters. The method was applied to epidemic series for COVID-19 across different municipalities in Brazil allowing to estimate the heterogeneity level of under-reporting across different places. The reproductive number derived within the current framework is little sensitive to both diagnosis and infection rates during the asymptomatic states. The methods described here can be extended to more general cases if data is available and adapted to other epidemiological approaches and surveillance data.

Recent Evidence on Acute Kidney Injury in COVID-19 Patients: A Narrative Review

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The clinical manifestation of COVID-19 is broad, ranging from an asymptomatic carrier state to severe disease leading to the death penalty. There is also emerging evidence that kidneys are affected early in COVID-19. Proteinuria and haematuria have been reported in 44% and 26.7% on admission, respectively. This literature review shows clinical manifestations of acute kidney injury (AKI) in a patient with COVID-19 infection. Literature reviews are carried out on various sources found on Google Scholar and Pubmed to search for articles, journal research, case reports, systematic reviews, meta-analyses, and textbooks. Various studies demonstrate the possibility of coronavirus infecting the kidney with several mechanisms such as cytokine storm syndrome (CSS), direct viral infection, and imbalance of renin-angiotensin-aldosterone (RAAS). Haematuria and proteinuria are associated with higher mortality and may signify aggressive disease early. Thus all patients should have a baseline urinalysis. There is a number of different causes of AKI in COVID-19, and some mechanisms by which COVID-19 affects kidneys remain unclear.

Is D-dimer a Useful Predictive Marker for COVID-19 Severity?

The 2019 coronavirus disease (COVID-19) presents with a large variety of clinical manifestations ranging from asymptomatic carrier state to severe respiratory distress, multiple organ dysfunction and death.

Circulating 1,5-Anhydroglucitol as a Biomarker of ß-cell Mass Independent of a Diabetes Phenotype in Human Subjects.

During an asymptomatic prediabetic state, the functional ß-cell mass decreases to a critical threshold, triggering diabetes and related symptoms. To date, there are no reliable readouts able to capture in vivo a potential drop of the ß-cell mass. Beside its use as a short-term marker of glycemic control, the deoxyhexose 1,5-anhydroglucitol was identified in rodents as a circulating biomarker of the functional ß-cell mass already in the asymptomatic prediabetic stage. The present study investigated the putative corresponding relevance of circulating 1,5-anhydroglucitol in different human cohorts. We analyzed clinical and blood parameters in patients with established type 2 diabetes and subjects considered at high risk of developing diabetes, as well as patients with no history of diabetes scheduled for pancreaticoduodenectomy. Circulating 1,5-anhydroglucitol was reduced in type 2 diabetic patients, negatively correlating with fasting plasma glucose (P < 0.0001) and hemoglobin A1c (P < 0.0001). In healthy subjects, 1,5-AG levels positively correlated with body mass index (P = 0.004) and Homeostatic Model Assessment of Insulin Resistance %S (P < 0.03) and was particularly high in nondiabetic obese individuals, potentially accounting for compensatory ß-cell expansion. Patients with no history of diabetes undergoing pancreaticoduodenectomy exhibited a 50% reduction of circulating 1,5-anhydroglucitol levels following surgery leading to an acute loss of their ß-cell mass (P = 0.002), regardless their glucose tolerance status. In summary, plasma concentration of 1,5-anhydroglucitol follows the ß-cell mass and its noninvasive monitoring may alert about the loss of ß cells in subjects at risk for diabetes, an event that cannot be captured by other clinical parameters of glycemic control.