Development Of Severe Illness Research Articles

Evaluation of hematological parameters alterations in different waves of COVID-19 pandemic: A cross-sectional study.

The occurrence of variations in routine hematological parameters is closely associated with disease progression, the development of severe illness, and the mortality rate among COVID-19 patients. This study aimed to investigate hematological parameters in COVID-19 hospitalized patients from the 1st to the 5th waves of the current pandemic. This cross-sectional study included a total of 1501 hospitalized patients with laboratory-confirmed COVID-19 based on WHO criteria, who were admitted to Shahid Sadoughi Hospital (SSH) in Yazd, Iran, from February 2020 to September 2021. Throughout, we encountered five COVID-19 surge waves. In each wave, we randomly selected approximately 300 patients and categorized them based on infection severity during their hospitalization, including partial recovery, full recovery, and death. Finally, hematological parameters were compared based on age, gender, pandemic waves, and outcomes using the Mann-Whitney U and Kruskal-Wallis tests. The mean age of patients (n = 1501) was 61.1±21.88, with 816 (54.3%) of them being men. The highest mortality in this study was related to the third wave of COVID-19 with 21.3%. There was a significant difference in all of the hematological parameters, except PDW, PLT, and RDW-CV, among pandemic waves of COVID-19 in our population. The highest rise in the levels of MCV and RDW-CV occurred in the 1st wave, in the 2nd wave for lymphocyte count, MCHC, PLT count, and RDW-SD, in the 3rd wave for WBC, RBC, neutrophil count, MCH, and PDW, and in the 4th wave for Hb, Hct, and ESR (p < 0.01). The median level of Hct, Hb, RBC, and ESR parameters were significantly higher, while the mean level of lymphocyte and were lower in men than in women (p < 0.001). Also, the mean neutrophil in deceased patients significantly was higher than in those with full recovered or partial recovery (p < 0.001). The findings of our study unveiled notable variations in hematological parameters across different pandemic waves, gender, and clinical outcomes. These findings indicate that the behavior of different strains of the COVID-19 may differ across various stages of the pandemic.

Identification of ferroptosis-related molecular clusters and genes for diabetic osteoporosis based on the machine learning.

Diabetic osteoporosis exhibits heterogeneity at the molecular level. Ferroptosis, a controlled form of cell death brought on by a buildup of lipid peroxidation, contributes to the onset and development of several illnesses. The aim was to explore the molecular subtypes associated with ferroptosis in diabetic osteoporosis at the molecular level and to further elucidate the potential molecular mechanisms. Integrating the CTD, GeneCards, FerrDb databases, and the microarray data of GSE35958, we identified ferroptosis-related genes (FRGs) associated with diabetic osteoporosis. We applied unsupervised cluster analysis to divide the 42 osteoporosis samples from the GSE56814 microarray data into different subclusters based on FRGs. Subsequently, FRGs associated with two ferroptosis subclusters were obtained by combining database genes, module-related genes of WGCNA, and differentially expressed genes (DEGs). Eventually, the key genes from FRGs associated with diabetic osteoporosis were identified using the least absolute shrinkage and selection operator (LASSO), Boruta, support vector machine recursive feature elimination (SVM - RFE), and extreme gradient boosting (XGBoost) machine learning algorithms. Based on ROC curves of external datasets (GSE56815), the model's efficiency was examined. We identified 15 differentially expressed FRGs associated with diabetic osteoporosis. In osteoporosis, two distinct molecular clusters related to ferroptosis were found. The expression results and GSVA analysis indicated that 15 FRGs exhibited significantly different biological functions and pathway activities in the two ferroptosis subclusters. Therefore, we further identified 17 FRGs associated with diabetic osteoporosis between the two subclusters. The results of the comprehensive analysis of 17 FRGs demonstrated that these genes were heterogeneous and had a specific interaction between the two subclusters. Ultimately, the prediction model had a strong foundation and excellent AUC values (0.84 for LASSO, 0.84 for SVM - RFE, 0.82 for Boruta, and 0.81 for XGBoost). IDH1 is a common gene to all four algorithms thus being identified as a key gene with a high AUC value (AUC = 0.698). As a ferroptosis regulator, IDH1 is able to distinguish between distinct molecular subtypes of diabetic osteoporosis, which may offer fresh perspectives on the pathogenesis of the disease's clinical symptoms and prognostic heterogeneity.

ÇOCUKLARDA SARS-COV-2 ENFEKSİYONUNDA İMMÜNOGLOBULİNLER HASTALIK ŞİDDETİ VE HASTANEDE YATIŞ SÜRESİNE ETKİLİ MİYDİ ?

OBJECTIVE: We investigated whether immunoglobulin levels on admission are associated with disease severity, time to negativization of SARS-CoV-2 RT-PCR test, and length of hospital stay in children with severe illness requiring hospitalization. MATERIAL AND METHODS: Forty-four pediatric patients hospitalized and treated for COVID-19 were included. The patients were divided into two groups as those with mild-to-moderate (n=35) and those with severe disease (n=9) for ease of evaluation. The relationship of immunoglobulin levels with disease severity, time to SARS-CoV-2 RT-PCR test negativization and length of hospital stay was examined. RESULTS: The study population had a median (min-max) age of 13 (1-18) years and consisted of 25 (56.8%) girls and 19 (43.2%) boys. IgG levels were normal in 89.2% (n=33) and elevated in 5.7% (n=2) of the children with mild-to-moderate disease. Among patients with severe disease, IgG levels were normal in 44.4% (n=4) and elevated in 55.6% (n=5). A significant difference was found between the groups in terms of IgG levels (p=0.002). When the relationship of IgG level with length of hospital stay and time to SARS-CoV-2 RT-PCR test negativization was investigated, no significant correlation was observed between time to SARS-CoV-2 RT-PCR test negativization and Ig G level (p=0.096, z=1.667). However, the length of hospital stay was significantly longer in patients with elevated IgG levels (p=0.096, p=0.002). CONCLUSIONS: Higher-than-normal endogenous IgG levels may be independently associated with the development of severe illness and prolonged hospital stay in children hospitalized for COVID-19.

Co-morbidity associated with development of severe COVID-19 before vaccine availability: a retrospective cohort study in the first pandemic year among the middle-aged and elderly in Jönköping county, Sweden

BackgroundIn preparation of future pandemics, it is important to recognise population-level determinants associated with development of severe illness before efficient vaccines and evidence-based therapeutic measures are available. The aim of this study was to identify pre-pandemic diagnoses recorded in a middle-aged and elderly population that were associated with development of severe COVID-19 during the first pandemic year.MethodsA cohort study design was used. Severe COVID-19 was defined as a course of illness that resulted in hospital admission or death. A retrospective analysis was performed that comprised all individuals aged 39 years and older (N = 189,951) living in Jönköping County, Sweden. All diagnosed morbidity recorded in contacts with health care during the pre-pandemic year 2019 was used to identify which diagnoses that were associated with development of severe COVID-19 in the first pandemic year 2020. The analyses were performed separately for each diagnosis using binary logistic regression with adjustment for sex and age.ResultsSevere COVID-19 was suffered by 0.67% (N = 1,280) of the middle-aged and elderly population in the first pandemic year. Individuals previously diagnosed with dementia, cerebral palsy, kidney failure, type 2 diabetes mellitus, hypertension, and obesity were at higher risk of developing severe COVID-19. For patients with Type 2 diabetes mellitus, the odds ratio (OR) was 2.18 (95% confidence interval, 1.92–2.48). Type 1 diabetes mellitus was not associated with increased risk.ConclusionDiagnoses suggesting service provision at long-term healthcare facilities and co-morbidity with components of the metabolic syndrome were associated with an increased risk of developing severe COVID-19 in a middle-aged and elderly population before vaccines were available.

Influence of Cigarettes and Alcohol on the Severity and Death of COVID-19: A Multicenter Retrospective Study in Wuhan, China.

BackgroundThe recent emergence and rapid global spread of coronavirus disease 2019 (COVID-19) is leading to public health crises worldwide. Alcohol consumption and cigarette smoking (CS) are two known risk factors in many diseases including respiratory infections.MethodsWe performed a multi-center study in the four largest hospitals designated for COVID-19 patients in Wuhan. There are totally 1547 patients diagnosed with COVID-19 enrolled in the study, alcohol consumption and CS history were evaluated among these patients. The epidemiology, laboratory findings and outcomes of patients contracted COVID-19 were further studied.ResultsOur findings indicated that COVID-19 patients with a history of CS tend to have more severe outcomes than non-smoking patients. However, alcohol consumption did not reveal significant effects on neither development of severe illness nor death rates in COVID-19 patients.ConclusionCS is a risk factor for developing severe illness and increasing mortality during the SARS-CoV-2 infection. We believe that our findings will provide a better understanding on the effects of alcohol intake and CS exposure in COVID-19 patients.

A Cell's Fate: An Overview of the Molecular Biology and Genetics of Apoptosis.

Apoptosis is one of the main types of regulated cell death, a complex process that can be triggered by external or internal stimuli, which activate the extrinsic or the intrinsic pathway, respectively. Among various factors involved in apoptosis, several genes and their interactive networks are crucial regulators of the outcomes of each apoptotic phase. Furthermore, mitochondria are key players in determining the way by which cells will react to internal stress stimuli, thus being the main contributor of the intrinsic pathway, in addition to providing energy for the whole process. Other factors that have been reported as important players of this intricate molecular network are miRNAs, which regulate the genes involved in the apoptotic process. Imbalance in any of these mechanisms can lead to the development of several illnesses, hence, an overall understanding of these processes is essential for the comprehension of such situations. Although apoptosis has been widely studied, the current literature lacks an updated and more general overview on this subject. Therefore, here, we review and discuss the mechanisms of apoptosis, highlighting the roles of genes, miRNAs, and mitochondria involved in this type of cell death.

Cytokines Induced During Influenza Virus Infection.

Influenza A virus is one of the major human pathogens. The influenza infection can pass out without any subclinical symptoms or infestation can appear in upper respiratory tract as well as in lower respiratory tract where it can result in lethal outcome. Both innate and adaptive immune responses are activated shortly after infection providing protection against infection. Many activities of the cells of innate and adaptive immunity are coordinated by cytokines. However, inordinate or disbalanced immune response may result in overproduction of cytokines as well as chemokines which can lead to severe inflammation, including excessive recruitment of neutrophils and mononuclear cells at the site of infection. These may damage lung tissue, reduce respiratory capacity, and cause severe disease and mortality. Recently, the role of cytokines induced by virus infection has been reevaluated. While moderate inflammatory response protects against development of severe illness, the hyper-inflammatory response can elevate the disease progression. In this mini-review, we summarized the data on cytokines and chemokines induced in the sera of hospitalized patients infected with human and avian influenza viruses and define their possible role in pathogenesis. Interleukin IL-6 and chemokines CCL-2/MCP-1, CCL-4/MIP-1β, CXCL-8/IL-8, CXCL-9/MIG, and CXCL-10/IP-10 are associated with pathogenicity of both avian (H5N1 and H7N9) and human (pdmH1N1 and H3N2) viruses. Chemokines CCL-2/MCP-1, CXCL-8/IL-8, CXCL-9/MIG, and CXCL-10/IP-10 are also related with mortality. These cytokines may be used as targets for new, more complex therapy in the extenuation of unfavorable effects of hyper inflammatory response.

Characteristic findings of pediatric inpatients with pandemic (H1N1) 2009 virus infection among severe and nonsevere illnesses

We analyzed the clinical features of inpatients at a Japanese pediatric department who were infected with pandemic (H1N1) 2009 virus. Study participants included 46 children hospitalized from July 2009 to January 2010. Infection with the virus was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR). The epidemic month was October 2009; 34 patients were boys, and median age was 7 years. Pandemic influenza-associated respiratory diseases included pneumonia (n = 42), bronchitis (n = 3), and pharyngitis (n = 1). The median time from onset to admission was 3 days. Children were divided into those with severe (n = 32) versus nonsevere illnesses (n = 14) according to Japanese guidelines. Significant features in the severe group were younger age, previous asthmatic attack, exacerbation of asthma, decreased oxygen saturation, elevated white blood cell/neutrophil counts and serum lactate dehydrogenase, and longer times from admission to being afebrile and discharged. Both groups showed lymphopenia at admission. Additional infection with Streptococcus pneumoniae was frequent in the severe group. Whereas 44 patients received antiviral therapy (median times from onset to initiation 2 days), 32 received antibiotics (median duration 7 days). All children recovered, with a median hospital stay of 8 days. Our observations suggest that history of asthma and preschool age might be risk factors for severe illness. Prompt initiation of antiviral and antibiotic treatments should be considered to prevent development of severe illness.