Risk Factor For Severe COVID-19 Research Articles

A reasoned approach towards administering COVID-19 vaccines to pregnant women.

There are over 50 SARS‐CoV‐2 candidate vaccines undergoing Phase II and III clinical trials. Several vaccines have been approved by regulatory authorities and rolled out for use in different countries. Due to concerns of potential teratogenicity or adverse effect on maternal physiology, pregnancy has been a specific exclusion criterion for most vaccine trials with only two trials not excluding pregnant women. Thus, other than limited animal studies, gradually emerging development and reproductive toxicity data, and observational data from vaccine registries, there is a paucity of reliable information to guide recommendations for the safe vaccination of pregnant women. Pregnancy is a risk factor for severe COVID‐19, especially in women with comorbidities, resulting in increased rates of preterm birth and maternal morbidity. We discuss the major SARS‐CoV‐2 vaccines, their mechanisms of action, efficacy, safety profile and possible benefits to the maternal‐fetal dyad to create a rational approach towards maternal vaccination while anticipating and mitigating vaccine‐related complications. Pregnant women with high exposure risks or co‐morbidities predisposing to severe COVID‐19 infection should be prioritised for vaccination. Those with risk factors for adverse effects should be counselled accordingly. It is essential to support patient autonomy by shared decision‐making involving a risk‐benefit discussion with the pregnant woman.

Psychiatric patient profiling during the COVID-19 pandemic – should schizophrenia be assigned among risk factors?

Objective. While the identification of vulnerable groups is critical in any pandemic, scarce information has been published on COVID-19 patients with underlying psychiatric comorbidities. The present study aimed to assess whether a preexisting diagnosis of schizophrenia represents an independent risk factor for severe COVID-19 and whether patients with schizophrenia have poorer outcomes of COVID-19 compared to patients with any other premorbid mental illness. Methods. The present data derives from the medical records of 242 patients admitted to “Prof. Dr. Alexandru Obregia” Clinical Psychiatry Hospital (Bucharest, Romania), Department 9, with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result between October 2020 and May 2021. Results. 128 (52.9%) of the patients were diagnosed with a schizophrenia spectrum disorder. Psychiatric patients who developed a severe form of infection were older and more likely to have relevant somatic comorbidities for COVID-19, compared to the rest of the patients in the study sample (p<0.001). We did not identify a significant association between a particular psychiatric diagnosis and a severe form of infection (p>0.005), with only a small proportion (12.5%) of patients with a diagnosis of schizophrenia spectrum disorder having developed a severe form of infection. Conclusion. Although a pre-existing diagnosis of schizophrenia spectrum disorder was not associated with severe forms of COVID-19, patients with schizophrenia spectrum disorders represented more than half of the population in our study, a finding that supports the higher risk of infection for this group and suggests that these patients should be considered a vulnerable population.

Characteristics and outcomes of COVID-19 infection in 45 patients with breast cancer: A multi-center retrospective study in Hubei, China

BackgroundThe COVID-19 pandemic is a significant worldwide health crisis. Breast cancer patients with COVID-19 are fragile and require particular clinical care. This study aimed to identify the clinical characteristics of breast cancer patients with COVID-19 and the risks associated with anti-cancer treatment. MethodsThe medical records of breast cancer patients with laboratory-confirmed COVID-19 were collected among 9559 COVID-19 patients from seven designated hospitals from 13th January to 18th March 2020 in Hubei, China. Univariate and multivariate analyses were performed to assess risk factors for COVID-19 severity. ResultsOf the 45 breast cancer patients with COVID-19, 33 (73.3%) developed non-severe COVID-19, while 12 (26.7%) developed severe COVID-19, of which 3 (6.7%) patients died. The median age was 62 years, and 3 (6.7%) patients had stage IV breast cancer. Univariate analysis showed that age over 75 and the Eastern Cooperative Oncology Group (ECOG) score were associated with COVID-19 disease severity (P < 0.05). Multivariate analysis showed that patients who received chemotherapy within 7 days had a significantly higher risk for severe COVID-19 (logistic regression model: RR = 13.886, 95% CI 1.014–190.243, P = 0.049; Cox proportional hazards model: HR = 13.909, 95% CI 1.086–178.150, P = 0.043), with more pronounced neutropenia and higher LDH, CRP and procalcitonin levels than other patients (P < 0.05). ConclusionsIn our breast cancer cohort, the severity of COVID-19 could be associated with baseline factors such as age over 75 and ECOG scores. Chemotherapy within 7 days before symptom onset could be a risk factor for severe COVID-19, reflected by neutropenia and elevated LDH, CRP and procalcitonin levels.

Hyperactivated RAGE in Comorbidities as a Risk Factor for Severe COVID-19-The Role of RAGE-RAS Crosstalk.

The receptor for advanced glycation-end products (RAGE) is a multiligand receptor with a role in inflammatory and pulmonary pathologies. Hyperactivation of RAGE by its ligands has been reported to sustain inflammation and oxidative stress in common comorbidities of severe COVID-19. RAGE is essential to the deleterious effects of the renin–angiotensin system (RAS), which participates in infection and multiorgan injury in COVID-19 patients. Thus, RAGE might be a major player in severe COVID-19, and appears to be a useful therapeutic molecular target in infections by SARS-CoV-2. The role of RAGE gene polymorphisms in predisposing patients to severe COVID-19 is discussed.

The major genetic risk factor for severe COVID-19 does not show any association among South Asian populations

With the growing evidence on the variable human susceptibility against COVID-19, it is evident that some genetic loci modulate the severity of the infection. Recent studies have identified several loci associated with greater severity. More recently, a study has identified a 50 kb genomic segment introgressed from Neanderthal adding a risk for COVID-19, and this genomic segment is present among 16% and 50% people of European and South Asian descent, respectively. Our studies on ACE2 identified a haplotype present among 20% and 60% of European and South Asian populations, respectively, which appears to be responsible for the low case fatality rate among South Asian populations. This result was also consistent with the real-time infection rate and case fatality rate among various states of India. We readdressed this issue using both of the contrasting datasets and compared them with the real-time infection rates and case fatality rate in India. We found that the polymorphism present in the 50 kb introgressed genomic segment (rs10490770) did not show any significant correlation with the infection and case fatality rate in India.

Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services-Longitudinal Data from the Swedish Sleep Apnea Registry.

The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment.

Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults.

Context Diabetes is reported as a risk factor for severe COVID-19, but whether this risk is similar in all categories of age remains unclear.Objective To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories.Design Setting and ParticipantsWe conducted a retrospective observational cohort study of 6,314 consecutive patients hospitalized for COVID-19 between February and June 30 2020, and follow-up recorded until 30 September 2020, in the Paris metropolitan area, France.Main Outcome Measure(s)The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories.Results Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (HR 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, p<0.001), but adjusted HR for diabetes was significant only in patients under 50 (HR 1.81 [1.14-2.87]).Conclusions Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.

976-P: Cardiovascular Risk Predicts Severe Respiratory Failure in Patients Hospitalized with COVID-19

Cardiometabolic disease is associated with mortality and requirement for ventilation in COVID-19. Symptomatic atherosclerotic cardiovascular disease (CVD) implies the presence of significant endothelial dysfunction and is a risk factor for severe COVID-19. However, many patients with no history of CVD exhibit severe COVID-19. We hypothesised that CVD risk calculators could serve as a proxy for significant endothelial dysfunction and predict COVID-19 outcomes in those without symptomatic CVD. We reviewed 230 patients aged 35 to 65 years, hospitalized with COVID-19 at our institution. 190 patients with no history of symptomatic CVD were included. 23% developed severe respiratory failure (RF, requiring mechanical or non-invasive ventilation), while 4% (7/164) of those without prior end-stage renal disease required renal replacement therapy (RRT). In univariate analysis, age (β = 0.057 ± 0.02, p= 0.02), BMI (β = 0.05 ± 0.03, p = 0.049) and T2DM (β = 0.81 ± 0.41, p = 0.048) predicted RF. In keeping with a link between insulin resistance and severe COVID-19, an association was observed between triglycerides and RF (β = 0.26 ± 0.14, P = 0.058). CVD risk indices QRISK3 (0.07 ± 0.02, P &amp;lt;0.001), a CVD Risk Algorithm that predicts the risk of a CV event in next 10 years, and CHADS2VASC (0.53 ± 0.20, P=0.01) were both associated with RF. Age and QRISK3 were associated with a requirement for RRT and length of stay. We observed a threshold effect for QRISK3: when 10 year risk of a CV event was &amp;gt; 5% the risk of RF markedly increased (OR: 6.86 (95% CI: 2.30 - 20.5, P&amp;lt;0.001). The risk of RF was similar across all strata of QRISK3 &amp;gt;5%. A similar trend was observed when analysis was limited to those with T2DM (Ventilatory support in T2DM: QRISK&amp;lt;5% - 0/8, QRISK&amp;gt;5%: 11/30). All cases of RRT occurred in those with QRISK &amp;gt;5%. CVD risk calculators predict severe COVID-19, supporting a role for subclinical CVD in severe COVID-19. Patients hospitalized with QRISK3 &amp;gt;5% may be candidates for early intervention and enhanced monitoring. Disclosure S. Lockhart: None. A. Sheikh: None. H. Griffiths: None. J. Calvo latorre: None. A. B. Daly: None. L. Sibal: None. Funding National Institute for Health Research

Multiple sclerosis and COVID-19: The Swedish experience.

The COVID‐19 pandemic has brought challenges for healthcare management of patients with multiple sclerosis (MS). Concerns regarding vulnerability to infections and disease‐modifying therapies (DMTs) and their complications have been raised. Recent published guidelines on the use of DMTs in relation to COVID‐19 in MS patients have been diverse between countries with lack of evidence‐based facts. In Sweden, there exists a particular interest in anti‐CD20 therapy as a possible risk factor for severe COVID‐19 due to the large number of rituximab‐treated patients off‐label in the country. Rapid responses from the Swedish MS Association (SMSS) and the Swedish MS registry (SMSreg) have resulted in national guidelines on DMT use for MS patients and implementation of a COVID‐19 module in the SMSreg. Recently updated guidelines also included recommendations on COVID‐19 vaccination with regard to the different DMTs. Social distancing policies forced implementation of telemedicine consultation to replace in‐person consultations as part of regular MS health care. Patient‐reported outcome measures (PROMs) in SMSreg have been useful in this respect. This paper reports our experiences on the progress of national MS health care during the COVID‐19 pandemic, in addition to offering an overview of the present scientific context.

Retrospective study for the characterization of COVID-19 in renal cancer (COVID-REN) patients treated with antiangiogenics or immunotherapy and outcome comparison with non-infected cases.

4577 Background: Cancer is recognized as a major risk factor for severe COVID19. However little is known about the impact of oncologic treatments in the evolution of the disease. On the other hand, the influence of SARS-CoV2 in cancer response remains to be established. We aim to determine both aspects in renal cancer patients receiving different therapeutic options. Methods: We designed a retrospective case-control study to compare the outcome of patients with advanced renal cancer who developed COVID19 under antiangiogenic treatment (cohort A [ChA]) vs immunotherapy (alone or in combination: cohort B [ChB]) vs matched controls (cohort C [ChC]). Controls were renal cancer patients who were not infected during the period of study. One control per case was selected regarding age, gender, kidney cancer histology and type of treatment. Results: From May 20 to Feb 21, 80 patients were recruited. We present the first 55 patients included (15 ChA, 16 ChB and 20 ChC, 4 patients were screening failure) from 13 centers in Spain. Median age was 62 (range 25 to 88) overall and 62 (range 44 to 88) in Ch A, 64,5 (range 42 to 83) in ChB and 61 (range 41 to 77) in ChC. 38 patients were male and 13 were female. Overall 45 cases were clear cell carcinoma (13 ChA, 14 ChB and 18 ChC), 4 papillary (1 ChA, 2 ChB and 1 ChC), 1 chromophobe (ChA) and 1 unclassified (ChC). Median number of prior lines of treatment was 2 (range 1 to 6) overall, (1 [range 1 to 4] in ChA, 2 [range 1 to 4] in ChB and 2 [range 1 to 6] in ChC). 25 patients required treatment interruptions (8 in ChA [32%], 14 in ChB [56%] and 3 [12%] in ChC). 9 patients were hospitalized (4 in Ch A, 5 in ChB and none in ChC) for a median of 10 days (range 4 to 16) overall (7 [range 4 to 14] in ChA and 12 [range 5 to 16] in ChB). No patient required ICU admission. Best tumor response was complete or partial (CR+PR) in 25 patients (5 [20%] in ChA, 9 [36%] in ChB and 11 [44%] in ChC). Clinical benefit (CR+PR+stable disease) was observed in 38 patients (11 [28,9%] in ChA, 10 [26,3%] in ChB and 17 [44,7%] in ChC). One patient in ChB died (due to COVID19). Updated results will be presented. Conclusions: Patients with renal cancer who developed COVID19 held treatment more frequently and presented lower clinical benefit rates than non infected cases. Patients receiving immunotherapy required more frequent dose interruptions and longer hospitalizations than cases on antiangiogenics. These results point to an impact of SARS-CoV2 in renal cancer outcome. Therapies administered to treat renal cancer, could play a role in the evolution of COVID19.

AB0656 SARS-CoV-2 INFECTION IN PATIENTS WITH RHEUMATIC DISEASE: A TERTIARY SINGLE-CENTER EXPERIENCE

Background:In the context of the coronavirus (SARS-CoV-2) pandemic, several studies looked at the relation between rheumatic disease and SARS-CoV-2. It remains unclear whether these patients are at increased risk of developing more severe cases of coronavirus disease (COVID-19) or not.Objectives:The objective of this descriptive study is to report the characteristics and outcomes of rheumatic patients that had a history of confirmed SARS-CoV-2 infection. Findings have also been compared to some of the existing publications on COVID-19 in these patients.Methods:Between November 17, 2020 and January 18, 2021, a single-centre observational study was conducted in the rheumatology department of the Emergency Clinical County Hospital and the University of Medicine and Pharmacy “Iuliu Hatieganu” in Cluj-Napoca, Romania. The sample consisted of 62 rheumatic patients with a positive polymerase chain reaction test from nasopharyngeal/oral swab. Data on both systemic autoimmune disease and COVID-19 was collected using a survey, by means of telephone or in the outpatient clinic setting. Data on the patient rheumatologic condition was also collected from the electronic health records available within our departmentResults:62 patients were included, with 85.48% females and 14.51% males, and a median age of 52 years (SD +/- 14).The most frequent comorbidities were high blood pressure (HBP) 46.77%, dyslipidaemia 19.35%, liver disease 17.74%, and interstitial lung disease (ILD) 12.90%. Recurrent COVID-19 symptoms included: cough (62%), fever (46,77%), anosmia (46.77%), ageusia (30.64%), headache (29.03%), gastrointestinal symptoms (27.41%) and myalgia (25.80%).Out of the entire 62 sample, 41 patients had an inflammatory arthritis (IA) diagnosis, with the most frequent being rheumatoid arthritis (RA) - 68.29%, followed by ankylosing spondylitis - 21.95%, psoriatic arthritis - 7.31% and 2.43% with Still disease. Only 10 patients suffered from connective tissue disease (CTD): 3 systemic lupus erythematosus, 2 poli/dermatomyositis, 2 Sjogren syndrome (SjS), 2 mixed connective tissue disease, 1 systemic sclerosis (SSc). Another 10 patients had overlapping syndromes with the most frequent (40%) overlap between RA and SSc. One patient had osteoarthritis.49 patients followed a treatment with conventional synthetic disease-modifying anti-rheumatic drugs with 51.2% of them being treated with Methotrexate.14 of our patients received glucocorticoids (GC), but no relation between the GC dose and COVID-19 severity could be observed. Only 3 patients with doses greater than 10mg/day were present in the cohort and 2 developed mild while 1 developed an asymptomatic COVID-19 course.22 patients had received biological treatment. Anti TNF alpha medication was administered to 13 of these, and mostly consisted of Adalimumab, Etanercept and Golimumab. The anti TNF alpha patients were asymptomatic or had mild forms of COVID-19 (93.30%).8 cases had ILD: 3 RA patients, 3 overlapping syndromes, 1 SSc and 1 SjS. The median age was 59,5 years (SD +/- 10). 25% exhibited severe, 37,5% moderate, 25% mild and 12.5% asymptomatic COVID-19.The COVID-19 severity in our sample was as follows: 12.90% of the patients were asymptomatic, 59.67% exhibited a mild form, 19.35% a moderate one, and out of the 8.06% with a severe case of COVID-19, 1 patient died. The median age in the severe cases of COVID-19 was 66 years (SD +/- 12) and HBP was the most common comorbidity.Conclusion:Most patients in this sample were either asymptomatic or had a mild COVID-19 evolution. Although the research design has multiple limitations, rheumatic pathology does not seem to be a higher risk factor for severe COVID-19 than other associated comorbidities. With that in mind, ILD patients should be closely monitored as even in on our limited sample size a worse evolution of COVID-19 has been observed. Biological treatments, especially anti TNF alpha might help in reducing the severity of COVID-19, but this outcome could have been associated in our sample with other factors like lower median age and less comorbidities.Disclosure of Interests:None declared.

Efeitos da COVID-19 entre gestantes pretas e pardas: Revisão integrativa da literatura

Objetivo: identificar e analisar a produção científica sobre a evolução da COVID-19 em gestantes/puérperas segundo cor da pele/raça. Metodologia: trata-se de Revisão Integrativa da Literatura (RIL), com busca nas bases de dados EMBASE, LILACS, portal PUBMED/MEDLINE e Web of Science realizada em fevereiro de 2021. A partir da estratégia PICO foi construída a pergunta de pesquisa: Há evidências que gestantes/puérperas pretas com COVID-19, tratadas em ambiente hospitalar, quando comparadas às gestantes brancas, evoluem com mais gravidade (necessidade de internação em Unidade de Terapia Intensiva/Óbito)? Foram utilizados os termos indexados no vocabulário estruturado dos Descritores em Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH terms): “COVID-19” OR “2019-nCoV” AND “Gestante” OR “Cuidado pré-natal” OR “gravidez” AND “Raça” OR “Grupos Raciais” OR “Racismo” OR “Iniquidades Sociais” OR “Afro-americano” AND “Hospitalização” OR “Unidade de Internação” AND “Morte” OR “Causas de Morte” OR “Morte Materna” OR “Unidades de Terapia Intensiva”. Resultados: foram identificados seis estudos, realizados nos Estados Unidos da América (três estudos), Reino Unido (um estudo) e Brasil (dois estudos) e apenas um deles foi classificado com nível de evidência 4, sendo os demais de nível 6. Todos os estudos eram observacionais, muitas vezes com amostras pequenas e grupos étnicos variados, não permitindo conclusões efetivas. Dois estudos brasileiros que utilizaram banco de dados secundários e de base populacional encontraram a raça/cor preta como fator de risco para COVID-19 grave. Conclusão: com os estudos analisados, não foi possível estabelecer clara relação entre raça/cor e desfechos negativos (necessidade de internação em Unidade de Terapia Intensiva/óbito) da COVID-19 entre gestantes/puérperas.

Hypothesis for renin-angiotensin inhibitor mitigation of COVID-19

Preexisting hypertension is a known risk factor for severe COVID-19. Abnormal activation of RAS upregulates angiotensin II (Ang-II) and contributes to severe manifestations of COVID-19. Although RAS inhibitors (RASi) are a mainstay of antihypertensive therapy, they have been associated (in some animal studies) with an increase in angiotensin converting enzyme 2 (ACE2) receptors that facilitate cellular entry of the SARS-CoV-2 virus. Nonetheless, current medical practice does not recommend curtailing RASi to protect hypertensive patients from COVID. On the contrary, there is clinical evidence to support a beneficial effect of RASi for hypertensive patients in the midst of a COVID-19 pandemic, although the precise mechanism for this is unclear. In this paper, we hypothesize that RASi reduces the severity of COVID-19 by promoting ACE2-AT1R complex formation at the cell surface, where AT1R mediates the major vasopressor effects of Ang-II. Furthermore, we propose that the interaction between ACE2 and AT1R impedes binding of SARS-CoV-2 to ACE2, thereby allowing ACE2 to convert Ang-II to the more beneficial Ang(1–7), that has vasodilator and anti-inflammatory activity. Evidence for ACE2-AT1R complex formation during reduced Ang-II comes from receptor colocalization studies in isolated HEK293 cells, but this has not been confirmed in cells having endogenous expression of ACE2 and AT1R. Since the SARS-CoV-2 virus attacks the kidney, as well as the heart and lung, our hypothesis for the effect of RASi on COVID-19 could be tested in vitro using human proximal tubule cells (HK-2), having ACE2 and AT1 receptors. Specifically, colocalization of fluorescent labelled: SARS-CoV-2 spike protein, ACE2, and AT1R in HK-2 cells can be used to clarify the mechanism of RASi action in renal and lung epithelia, which could lead to protocols for reducing the severity of COVID-19 in both hypertensive and normotensive patients.

COVID-19 and the pituitary.

BackgroundDespite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions.AimTo review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination.ConclusionsOur review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients.There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

Proportion of Patients With HbA1c Corresponding to Prediabetes and Diabetes Ranges Without Previous Diagnosis in a Covid-19 Unit in Mexico City

Mexico has been one of the most affected countries by COVID-19, with case rate of 1195.32 per 100,000 patients and one of the highest mortality rates worldwide. Diabetes has been found a major risk factor for severe COVID-19. Mexico has a high prevalence of diabetes, estimated around 10.3%. On top of this, recent estimates suggest that 4.1% of the population has diabetes but does not have a proper diagnosis. We conducted a retrospective study in patients hospitalized for COVID-19 in tertiary private hospital in Mexico City from March 15th to July 10th, 2020. We classified patients as having diabetes or prediabetes if it was registered in the electronical medical record. Patients were classified as newly diagnosed diabetes if they had an HbA1c on admission greater or equal than 6.5%. A total of 144 measurements of HbA1c were done on non-diabetic patients. Eighteen patients (12.5%) had a level of HbA1c equal or higher than 6.5%, while 70 (48.6%) patients had a level between 5.7% and 6.5%. Of the patients with HbA1c levels suggesting prior diabetes, 9 (50%) of them did not have hyperglycemia (>140 mg/dl) on admission. Our findings suggest that Mexican patients with COVID-19 might need HbA1c measurements regardless of glucose levels on admission since unknown diabetes is frequent and might modify in-hospital glucose management and discharge follow up and treatment.

Asthma may not be a risk factor for severe COVID-19 in children

To the best of our knowledge, no studies to date have identified any risk factors for developing a severe form of COVID-19 in children, except young age.1 However, worries remain regarding children with asthma, for whom more severe forms of COVID-19 are expected. However, data about whether asthma could be a risk factor for a severe form of COVID-19, or whether COVID-19 could worsen control of asthma, remain scarce.2

Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review.

Emerging data suggest that obesity is a major risk factor for the progression of major complications such as acute respiratory distress syndrome (ARDS), cytokine storm and coagulopathy in COVID-19. Understanding the mechanisms underlying the link between obesity and disease severity as a result of SARS-CoV-2 infection is crucial for the development of new therapeutic interventions and preventive measures in this high-risk group. We propose that multiple features of obesity contribute to the prevalence of severe COVID-19 and complications. First, viral entry can be facilitated by the upregulation of viral entry receptors, like angiotensin-converting enzyme 2 (ACE2), among others. Second, obesity-induced chronic inflammation and disruptions of insulin and leptin signaling can result in impaired viral clearance and a disproportionate or hyper-inflammatory response, which together with elevated ferritin levels can be a direct cause for ARDS and cytokine storm. Third, the negative consequences of obesity on blood coagulation can contribute to the progression of thrombus formation and hemorrhage. In this review we first summarize clinical findings on the relationship between obesity and COVID-19 disease severity and then further discuss potential mechanisms that could explain the risk for major complications in patients suffering from obesity.

Can Statins Be Beneficial in COVID 19 Patients?

Covid-19 remains a novel pandemic with many controversies and variable clinical expression and severity. Diabetes and a pre-existing cardiovascular disease are the greatest risk factor for severe Covid-19. The overall case fatality rate of 2.3% in the general population increases to 7.3% in presence of diabetes and reaches 15% in presence of a pre-existing cardiovascular disease

Obesity and COVID-19

Background: Obesity is a recognized risk factor for severe COVID-19, possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens as well as to impaired lung function from excess weight. Obesity is a common metabolic disease; approximately two in three Iraqi adult participants were overweight/obese. Aim of Study: The aim of this study is to investigate the association between COVID-19 disease severity and obesity among sample of Iraqi patients. Patient and methods: A prospective observational study included 609 patients with confirmed Covid-19 infection carried out in Azadi and alShifaa14 hospitals and on outpatient cases in Kirkuk city from 1st November2020 to 30 April 2021 through which BMI was calculated for each patient and correlated with severity. Results: The study showed that majority of patients (77.9%) were overweight or obese., majority of patients (63.5%) were in sever condition, (24.5%) patients were in mild state, and only 2 patients were critical ill. The males gender were associated with more severe cases (p=0.018). The age was associated with more severity (p=0.0001). BMI showed an association with viral disease severity, in which over weight and obese categories were had more severe symptoms (p=0.0001). Conclusions: BMI showed an association with COVID-19 Disease status, in which overweight and obese categories were had more severe symptoms (p=0.0001). The study revealed that males gender were associated with more severe cases of COVID-19 disease status (p=0.018).

HYPERTENSION ASSOCIATED RISKS DURING THE COVID-19 PANDEMIC: THE PATIENTS’ PERCEPTION

Objective: Soon after the outbreak of the pandemic, uncontrolled hypertension was recognized as a risk factor for severe COVID-19 while concerns were raised that RAAS-i may increase the susceptibility and the severity of disease. The study aims to assess patients’ perception on risks associated with hypertension. Design and method: Hypertension patients visiting the emergency (non-COVID) department or the outpatient clinics of a tertiary hospital in Northern Greece were invited to participate by completing a short questionnaire. This observational study was conducted during the first and the much more forceful ongoing second wave. The Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to measure the frequency and severity of depression and anxiety. Results: 373 hypertensive patients (205 women, 55.0%) participated (mean age 63.6 ± 9.4 years), with 341 (91.4%) taking RAAS-i. About half (191, 51.2%) were taking RAAS-i for hypertension, while the rest for other indications. The vast majority (364, 97.6%) were alert that hypertension was a risk factor for COVID-19, although only 1 in 8 were informed that it mainly implied uncontrolled/untreated hypertension. Most of the patients (347, 93.0%) had heard that antihypertensive drugs might be harmful (mainly from TV reports), though only 199 (58.4%) of the patients taking RAAS-i knew they were taking such drugs. Moreover, 176 patients (47.2%), mostly during second wave, conducted their doctor and eventually 17 altered therapy. Participants during second wave reported higher chances of getting COVID-19, with the majority believing they are more susceptible and expecting more severe disease. The mean Beck's anxiety and depression score was 10.7 ± 7.1 and 12.2 ± 9.3 respectively, with the prevalence of significant anxiety (BAI&gt; = 10) or depression (BDI&gt; = 17) reaching 11% (41 patients) and 6.2% (23 patients), with as expected, higher scores for second wave patients. Disturbingly, only 20 patients (5.4%) had been informed of the position of major scientific. Conclusions: Greek patients are concerned of hypertension association with COVID-19 although not properly informed that it implies mainly uncontrolled/untreated hypertension. Hypertensive patients seem worried about the pandemic which is mirrored into anxiety and depression scores. Nevertheless they lack information from scientific societies.