Severe Forms Of Coronavirus Disease 2019 Research Articles

Association Between Obesity and COVID-19 Disease Severity in Saudi Population.

BackgroundThe persistent coronavirus disease 2019 (COVID-19) outbreak has placed a significant burden on the scientific and medical professions. The study examined the association between body mass index (BMI), stratified by category, and severe form of COVID-19, and to explore the influence of demographic characteristics and other known risk factors.MethodsThis was a retrospective analysis based on COVID-19 data from the Saudi Arabian Ministry of Health. Data were collected for all patients admitted to three main hospitals in Riyadh region between March 1st and July 30, 2020. The effects of BMI, demographic characteristics, clinical presentation, and comorbidities on infection severity were investigated.ResultsA total of 950 patients were included in the study (70% male, 85% aged younger than 60 years old). A total of 55 (5.8%) patients were underweight, 263 (27.7%) were normal weight, 351 (37%) were overweight, 161 (17%) were obese class I, 76 (8%) were obese class II, and 44 (4.6%) were obese class III. Cough, fever, and shortness of breath were the most common symptoms among overweight patients. According to the findings of a bivariate logistic regression study, class III obesity was significantly associated with a more severe form of COVID-19 (odds ratio, 2.874; 95% confidence interval, 1.344–6.149).ConclusionThis study revealed that patients with a BMI ≥40 kg/m2 had a higher risk of severe COVID-19 than those with normal weight. This suggests that obesity is a risk factor for severe COVID-19 and influences disease presentation.

Treatment and comorbidities of patients with erectile dysfunction before and during COVID-19 in the United States: A real-world data analysis

IntroductionErectile dysfunction (ED) is usually a symptom of another medical condition. People with poor overall health are more likely to develop severe form of coronavirus disease 2019 (COVID-19) and may have unwanted symptoms such as ED. COVID-19-related stress, anxiety, and depression can also impact sexual health and possibly lead to ED. There are various treatment options for patients with ED. However, real-world evidence of the impact of COVID-19 on the treatment and comorbidities of patients with ED is limited.ObjectivesTo estimate the impact of COVID-19 on the treatment and comorbidities of patients with ED in the United States.MethodsThis retrospective real-world data (RWD) analysis used the IQVIA PharMetrics® Plus claims database, which is a patient-Centric, closed claims database of fully adjudicated pharmacy, hospital and medical claims anonymized at the patient level, that captures the complete patient journey for all services billed to and covered by the patient's health plan. We compared the ED treatment and comorbidities in adult males aged 18+ years with ED in the same 3-month periods before (01March - 31May, 2019) and during (01March – 31May, 2020) the COVID-19 pandemic. ED treatment included any ED-related claims, prescriptions of any and individual phosphodiesterase-5 inhibitor (PDE5i) medications (avanafil, sildenafil, tadalafil and vardenafil).ResultsSee the table below for number of patients having ED-related claims, having any and individual PDE5i prescriptions, number of patients with COVID-19 diagnosis, and percentage of patients with each of the top 10 comorbidities, in the 3-month periods before and during COVID-19.ConclusionsRWD showed that ED-related claims significantly decreased during the COVID-19 pandemic, reflecting the pandemic's impact on ED patients’ health. However, the use of PDE5i medications remained stable during the pandemic. Key comorbidities including hypertension, hyperlipidemia, type 2 diabetes mellitus, benign prostatic hyperplasia with lower urinary tract symptoms, testicular hypofunction, and malignant neoplasm of the prostate, during the pandemic, compared with pre-pandemic period, highlighted the impact of the pandemic on ED patients’ health and need for managing their other comorbid chronic diseases.DisclosureWork supported by industry: yes, by Viatris. A consultant, employee (part time or full time) or shareholder is among the authors (Viatris).

Children with SARS-CoV-2 infection during the novel coronaviral disease (COVID-19) outbreak in Iran: an alarming concern for severity and mortality of the disease

BackgroundThe rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections led to public health crises globally and the number of pediatric patients with Coronavirus Disease 2019 (COVID-19) is still rising. The aim of this study was to describe the epidemiological, clinical, laboratory, and imaging features of hospitalized patients with COVID-19 at an Iranian referral pediatrics hospital and to compare these parameters between hospitalized patients with and without severe disease, multisystem inflammatory syndrome in children (MIS-C) and children with acute COVID-19, as well as deceased and discharged cases.MethodsThis study included hospitalized children and adolescents (≤ 18 years) with suspected COVID-19 who had positive results for SARS-CoV-2.ResultsAmong the 262 patients with suspected COVID-19, 142 confirmed COVID-19 cases were included in the study. A total of 11 children were diagnosed as MIS-C. The majority of the cases with MIS-C were male, (n = 9, 82%) which is significantly higher than children (n = 61, 47%) with acute COVID-19 (P = 0.03). Fifty patients (35%) were shown to have a more severe form of COVID-19. Ninety percent of the cases (n = 45) with severe COVID-19 had comorbidities that was significantly higher than cases with non-severe or mild disease (n = 41, 45%; P < 0.0001). A mortality rate of 10% was reported (n = 14). Ninety-three percent of the deceased cases (n = 13) had comorbidities that were significantly higher than discharged patients (n = 73, 57%; P = 0.009).ConclusionThe increasing number of children with severe COVID-19 is cause for great concern. Underlying diseases, mainly cardiovascular diseases, cancer, and malignancies, are associated with greater risk of development of severe COVID-19 and even death in children. On the other hand, pediatric patients with MIS-C usually develop a milder form of the disease. However, evaluation specific immunological responses in children to explore the delayed inflammatory syndrome are highly recommended.

Effect of Hyperglycemia on COVID-19 Outcomes: Vaccination Efficacy, Disease Severity, and Molecular Mechanisms.

Background/Aims: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a positive-stranded single-stranded RNA virus, a member of the subgenus Sarbecovirus (beta-CoV lineage B) and responsible for the coronavirus disease 2019 (COVID-19). COVID-19 encompasses a large range of disease severity, from mild symptoms to severe forms with Intensive Care Unit admission and eventually death. The severe forms of COVID-19 are usually observed in high-risk patients, such as those with type two diabetes mellitus. Here, we review the available evidence linking acute and chronic hyperglycemia to COVID-19 outcomes, describing also the putative mediators of such interactions. Findings/Conclusions: Acute hyperglycemia at hospital admission represents a risk factor for poor COVID-19 prognosis in patients with and without diabetes. Acute and chronic glycemic control are both emerging as major determinants of vaccination efficacy, disease severity and mortality rate in COVID-19 patients. Mechanistically, it has been proposed that hyperglycemia might be a disease-modifier for COVID-19 through multiple mechanisms: (a) induction of glycation and oligomerization of ACE2, the main receptor of SARS-CoV-2; (b) increased expression of the serine protease TMPRSS2, responsible for S protein priming; (c) impairment of the function of innate and adaptive immunity despite the induction of higher pro-inflammatory responses, both local and systemic. Consistently, managing acute hyperglycemia through insulin infusion has been suggested to improve clinical outcomes, while implementing chronic glycemic control positively affects immune response following vaccination. Although more research is warranted to better disentangle the relationship between hyperglycemia and COVID-19, it might be worth considering glycemic control as a potential route to optimize disease prevention and management.

Vaccination and COVID-19 Dynamics in Dialysis Patients.

Dialysis patients have a high mortality risk after coronavirus disease 2019 (COVID-19) and an altered immunologic response to vaccines, but vaccine clinical effectiveness remains unknown in this population. Using Bayesian multivariable spatiotemporal models, we estimated the association between vaccine exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) severe infections (with hospital admission) in dialysis patients from simultaneous incidence in the general population. For dialysis patients, cases were reported within the French end-stage kidney disease REIN registry from March 11, 2020, to April 29, 2021, and vaccine exposure (first dose) was reported in weekly national surveys since January 2021. Cases in the general population were obtained from the national exhaustive inpatient surveillance system (SI-VIC database), and vaccination coverage (first dose) was obtained from the national surveillance system (VAC-SI database). During the first wave, incidence in dialysis patients was approximately proportional to the general population. However, we showed a lower relative incidence for dialysis patients during the second wave (compared with that observed in nondialysis patients), suggesting an effect of prevention measures. Moreover, from the beginning of the vaccination rollout, incidence in dialysis patients was lower compared with predictions based on the first and second waves. Adding vaccination coverages in dialysis and nondialysis patients as predictors allowed the reported cases to be fit correctly (3685 predicted cases, 95% confidence interval, 3552 to 3816, versus 3620 reported). Incidence rate ratios were 0.37 (95% confidence interval, 0.18 to 0.71) for vaccine exposure in dialysis patients and 0.50 (95% confidence interval, 0.40 to 0.61) per 10% higher in vaccination coverage in the same-age general population, meaning that vaccine exposure in dialysis patients and the general population was independently associated with lower hospitalization rate of dialysis patients. Our findings suggest that vaccination may yield a protective effect against severe forms of COVID-19 in dialysis patients, despite altered immunologic vaccine responses.

Lipid profile changes in patients with COVID-19 referred to medical centers in Kermanshah, Iran; a case-control study.

ObjectiveTo evaluate blood lipid profiles in patients with coronavirus disease 2019 (COVID-19), and to explore the association with disease severity.MethodsThis case–control study included patients with COVID-19, referred to two medical centers in Kermanshah, Iran (between July 2020 and December 2020), and healthy controls. Lipid profiles were evaluated in patients who were grouped according to severe (intensive care unit [ICU]), or less severe (outpatient), forms of COVID-19, and in healthy controls, and were compared among the three groups.ResultsA total of 132 participants were included, comprising ICU (n = 49), outpatient (n = 48) and control (n = 35) groups. Mean cholesterol levels were lower in the patient groups than in controls; high-density lipoprotein cholesterol (HDL-C) levels were higher in the ICU group versus outpatients, and low-density lipoprotein cholesterol (LDL-C) levels were lower in the ICU group versus outpatients. The frequency of diabetes and hypertension was higher in the ICU group than in the outpatient group. Furthermore, LDL-C level was associated with disease severity (odds ratio 0.966, 95% confidence interval 0.944, 0.989).ConclusionLipid profiles differ between severe and less severe forms of COVID-19. LDL-C level may be a useful indicator of COVID-19 severity.

COVID-19 and Diabetes Outcomes: Rationale for and Updates from the CORONADO Study

Purpose of ReviewIn France, in order to describe the phenotypic characteristics of patients with diabetes hospitalized for coronavirus disease-2019 (COVID-19) and to identify the prognostic factors in this specific population, the CORONADO (CORONAvirus and Diabetes Outcomes) study was launched. This review will summarize the key findings from the CORONADO study and put them in perspectives with others studies published on the subject.Recent FindingsFor almost 2 years, the new SARS-CoV-2 (Severe Acute Respiratory Syndrome-CoronaVirus-2), which causes COVID-19, has spread all around the world leading to a pandemic. From the first epidemiological reports, diabetes mellitus has rapidly emerged as a major risk factor associated with severe forms of COVID-19 but few data were available about diabetes characteristics in hospitalized people with COVID-19.SummaryBetween March 10 and April 10, 2020, 2951 patients were included in 68 centers throughout the national territory, including overseas territories. In the CORONADO study, the primary outcome was a composite endpoint combining invasive mechanical ventilation (IMV) and/or death within day 7 (D7). Secondary outcomes included death, IMV, intensive care unit (ICU) admission, and hospital discharge, all considered within D7 and day 28 (D28). The primary outcome occurred in 29.0% participants within D7 following hospital admission. Within D28, the end of the follow-up period, the mortality rate was 20.6%, while 50.2% of patients were discharged. In multivariable analysis, advanced age, microvascular complications, treatment with insulin or statin prior to admission, dyspnea on admission, as well as biological markers reflecting the severity of the infection (high levels of transaminases, leukocytes and CRP, and low platelet levels) were associated with an increased risk of death. Several exploratory analyses were performed to clarify the influence of some parameters such as weight status, sex, type of diabetes, and some routine drugs, including metformin or statins.

Evaluation serum levels of Insulin Growth Factor-1 (IGF-1) and its association with clinical parameters in severe COVID-19.

BackgroundSevere coronavirus disease-2019 (COVID-19) is associated with dysregulated immune response and extreme inflammatory injury. Considering the role of insulin growth factor-1 (IGF-1) in immune-mediated and inflammatory reactions, this study was conducted to investigate the IGF-1 contribution to the pathogenesis of severe form of COVID-19.Material and methodsSixty-two patients with severe COVID-19 and 52 healthy subjects were enrolled in this study. The serum levels of IGF-1 were measured using a solid-phase enzyme-linked chemiluminescent immunoassay on an Immulite 2000 system (Siemens Healthcare Diagnostics.ResultThe serum levels of IGF-1 had no significant difference in COVID-19 patients compared to the healthy subjects (p = 0.359). There was a positive correlation between IGF-1 and age in the severe COVID-19 patients, while a negative correlation was observed for the serum levels of IGF-1 and age in the control group (r = 0.364, p = 0.036, r = − 0.536, p = 0.001, respectively). Moreover, IGF-1 was remarkably associated with hypertension, neurogenic disease, shock, and nausea in patients with the severe form of COVID-19 (p = 0.031, p = 0.044, p = 0.01, p = 0.03, respectively).ConclusionOur results pointed to the complex role of IGF-1 in the severe form of COVID-19, and its association with clinical parameters, and some risk factors in the severe form of COVID-19.

Effects of Cumulative Doses of Corticosteroids On the Recovery of Patients with Covid-19

Background: Corticosteroids suppress the immune system and have been proposed as a treatment for the severe form of coronavirus disease 2019 (COVID-19) due to their potential ability to inhibit the COVID-19- induced cytokine storm. We aimed to evaluate the effects of cumulative doses of corticosteroids on the recovery of COVID-19 patients. Patients and methods: In this descriptive cross-sectional study, we retrospectively evaluated patients with COVID-19 (confirmed by polymerase chain reaction [PCR]) receiving corticosteroids at Shahid Mohammadi Hospital, Bandar Abbas, Iran during June-October 2020. All patients had been admitted to the general wards and not the intensive care unit. COVID-19 was not severe in any of the patients. Beside corticosteroids, all patients had received similar standard COVID-19 treatment according to the National COVID-19 Committee protocols. In addition to the demographic features of the patients including age and gender, COVID-19 symptoms, respiratory rate (RR), lactate dehydrogenase (LDH) level, C-reactive protein (CRP) level, oxygen saturation (SpO2 ), lymphocyte percentage and count, and lung infiltration (in chest computed tomography) on admission and at the last evaluation before discharge were extracted from the patients’ medical files. Results: A total of 200 patients with confirmed COVID-19 were included in this study. The mean age of the patients was 51.65 ± 9.35 years and 117 (58.5%) were male. The administered corticosteroid was dexamethasone in 55%, methylprednisolone in 32.5%, and prednisolone in 12.5%. The mean administered cumulative corticosteroid dose was equal to 82.69 ± 59.40 mg prednisolone. All COVID-19 symptoms, including fever, cough, dyspnea, headache, body ache, and anosmia/ageusia, decreased in the patients. However, there was no significant difference between patients using &lt; 65 mg of corticosteroids and those using ≥ 65 mg of the medicine regarding the final status of symptoms. The increase in SpO2 was significantly higher in patients using &lt; 65 mg of corticosteroids (P = 0.008). Moreover, the proportion of patients with negative final CRP was significantly higher in this group (P &lt; 0.001). On the contrary, hospital length of stay was significantly shorter in patients using ≥ 65 mg of corticosteroids (P = 0.034). The two groups had no significant differences in terms of LDH levels, lymphocyte percentage and count, RR, and the final status of lung infiltration (P &gt; 0.05). Conclusions: While the cumulative dose of corticosteroids equal to &lt; 65 mg of prednisolone is associated with increased SpO2 and decreased CRP in COVID-19 patients, it leads to prolonged hospital stay compared to the ≥ 65 mg dose of corticosteroids.

An Insight on the Maternal-Fetal Outcomes of Critically Ill Pregnant Women During the Second Wave of COVID-19.

Background: Coronavirus disease 2019 (COVID-19) and other respiratory infections have been attributed to causing severe disease and pneumonia in pregnant women because of physiological stress and alterations in the immune system during pregnancy. Pregnant women are prone to develop serious outcomes for both mother and child when infected by previous coronaviruses, but there is a paucity of data regarding clinical characteristics and maternal-fetal outcomes in COVID-19. Moreover, various laboratory and radiological parameters are scarcely studied in pregnant women in the third trimester who develop severe COVID-19. Therefore, we conducted this study to assess and compare the maternal-fetal outcomes of critically ill pregnant women with COVID-19 pneumonia who required admission to the intensive care unit (ICU).Materials and methods: We conducted this retrospective observational study at a tertiary care hospital affiliated with an academic center in the United Arab Emirates. A total of 123 patients in their third trimester were included in the study from December 1, 2020, to March 31, 2021, comprising 30 cases of severe or critical COVID-19 and 93 mild to moderate COVID-19 patients. We collected and analyzed maternal demographic data and radiological and biochemical profiles. We also compared maternal-fetal outcomes.Results: Thirty patients (24.3%) were admitted to the ICU, and eight required invasive ventilation. Severe COVID-19 pneumonia was significantly associated with higher mortality (20% vs. 0%; p < 0.001), postpartum complications (50% vs. 9.67%; p < 0.001), and increased overall hospital stay than mild to moderate COVID-19 (p < 0.001). In addition, the primary indication for intervention in severe cases was worsening of COVID-19 pneumonia, and pregnant patients had significantly greater chances of undergoing delivery by Cesarean section (80% vs. 40.8%; p = 0.01). Neonates born to severe COVID-19 patients had significantly higher chances of being born preterm (76.6% vs. 35.7%; p < 0.001) and had low birth weight (46.6% vs. 13.9%; p-value = 0.002). There were four stillbirth cases, two vertical transmission cases, and no neonatal deaths.Conclusions: This study assessed and compared maternal-fetal outcomes of critically ill pregnant women with COVID-19 pneumonia who required admission to the ICU because of the paucity of data in this patient demographic. Pregnant women with severe COVID-19 have high mortality, peripartum complications, increased hospital stay, and are more likely to undergo Cesarean section delivery because of COVID-19 progression than pregnant patients with less severe forms of COVID-19. The newborns born to such mothers may be premature and have low birth weights but have similar mortality to those born to mothers with mild to moderate COVID-19.

Proportion and risk factors of fatal outcomes among severely and critically ill COVID-19 patients: A hospital experience, Baghdad, Iraq 2021

Background: Severe forms of Coronavirus disease 2019 (COVID‐19) were found among 6 - 10% of all COVID-19 patients. Acute respiratory distress syndrome ARDS is non-cardiogenic pulmonary edema manifested by the rapid development of shortness of breath, tachypnea, and hypoxemia. Patients’ outcomes after critical care for COVID-19 have not been adequately documented in this low-resource environment, despite advocacy for prevention and response measures in low- and middle-income countries. Objectives: To highlight the rate of severe illness among COVID-19 patients and its associated factors in Al-Imam Ali Hospital, Baghdad-Iraq 2021. Patients and Methods: A descriptive cross-sectional study on cases with severe and critical COVID-19 illness (with ARDS) admitted to the isolation ward in Al-Imam Ali Hospital from 23 March to 23 May, 2021. All COVID-19 patients admitted in a severe or critical state were included. A data collection form was filled by the researcher. The P value of &lt; 0.05 was used to determine statistical significance. Ethical Approval was obtained. Results: A total of 504 severely ill COVID-19 patients were included in this study. There were 71 (14.1%) patients below 45 years of age. Males formed 40.9% of patients while that of females was 59.1%. Fever was the presenting symptom in 381 (75.6%) patients, 197 (39.1%) patients had anosmia, and 192 (38.1%) had ageusia. There were 358 (71.0%) survivors while 146 (29.0%) died. Patients aged 65 years or more had more possible risk for death than those below 65 years (OR=1.14, 95% CI =0.6-2.2). Female gender appeared to be protective compared to male gender (OR=0.52, 95% CI =0.35-0.77). Ex-smokers had a higher risk than non-smoker and current smokers (OR for ex-smoker=4.38, 95% CI 2.6-7.5), and (OR for current smoker=1.7, 95% CI 0.98-3). Renal disease was found to be a risk factor leading to death (OR=2.9; 95% CI=1.73-5.1). Diabetes Mellitus, respiratory diseases, and solid cancer showed a high risk for death, [OR=2.3, 95% CI=1.4-4; OR=1.7; 95% CI=1.1-2.9, OR=8, 95% CI=3.3-19 respectively]. Patients with three comorbidities had a higher mortality risk, OR=1.6, 95% CI=1.3-2. Conclusion: This study concluded that mortality of severely and critically ill COVID-19 patients was 29%, and males and older patients were risk factors for death. In addition to; ex-smoker, alcoholic, and patients with baseline comorbidities appeared to be risk factors for mortality. Finally; laboratory tests and Pao2/Fio2 ratio can be used to predict the outcome.

A Severe Form of COVID-19 in an Infant with Underlining Undiagnosed Acute Myeloid Leukemia

The new global pandemic of coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019, in an outbreak of respiratory illness of unknown in China. The virus spread rapidly all over the world, and on March 11, 2020 the World Health Organization (WHO) declared COVID-19 a global pandemic. Although childhood COVID-19 cases appeared early in the outbreak, the disease burden in children is far less than in adults. The clinical presentation in adults ranges from mild illness to severe pneumonia, acute respiratory distress syndrome, acute cardiac failure, and thromboembolic complications. Children experience critical illness far less than adults with lesser degree of admission to the intensive care unit and mortality. Here is reported the case of an 8-month infant who was admitted for a severe form of COVID-19 and contemporaneously was discovered an underlining, unknown before, myelodysplastic disorder. Concerning a child with severe form of COVID-19, a high index of suspicion should be maintained towards underling diseases which compromise the immune system such as the case of acute myeloid leukemia.

How COVID-19 affects children: a review article

Coronavirus disease 2019 (COVID-19) has affected 550,369 confirmed cases, with 8,856 fatalities. COVID-19 was more common in adults over 15 during the early outbreak, and the proportion of confirmed cases among youngsters was relatively low. In addition, children with COVID-19 are asymptomatic or have mild clinical symptoms compared to adults. The present study reviewed the clinical features, signs, symptoms, and effect of COVID-19 in children. This review was performed through an electronic literature search for relevant studies identified using keywords on the MEDLINE database between 2020 and 2021, inclusive: COVID-19, COVID-19 in children, coronavirus, novel coronavirus in children, COVID-19 symptoms in children, COVID-19 effect in children. Similar keywords were used to peruse and identify relevant articles on Google Scholar. The articles were chosen based on defined inclusion criteria. The current review included papers published between 2020 and 2021. The review was written under specific titles in the discussion part. This review concluded that children of all ages are susceptible to getting COVID-19 due to human-to-human transmission. COVID-19 has a milder clinical course, quicker recovery, and a better prognosis in children than adults. Infants less than 1 year and children with underlying chronic disorders were at higher risk of having severe forms of COVID-19. Septic shock, toxic encephalopathy, multiple organ failure syndromes, disseminated intravascular coagulation, and status epilepticus were the most common consequences identified in children with severe forms of COVID-19. Infection prevention by isolation of diseased children is critical, as is thorough surveillance, early diagnosis of illness complications, and the ability to treat patients on time while preventing secondary dissemination.

PD-L1 Overexpression in the Lungs of Subjects Who Died from COVID-19: Are We on the Way to Understanding the Immune System Exhaustion Induced by SARS-CoV-2?

Knowledge of the pathogenic mechanisms of severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) is certainly a priority for the scientific community. Two main elements are involved in the biology of the most severe forms of coronavirus disease 2019 (COVID-19): the direct cytopathic effect of the virus against the host tissues, and a dysfunction of the immune system, characterized by the exhaustion of T lymphocytes. The exhaustion of T cells in COVID-19 is poorly understand, but some data could suggest a possible role of PD-1/PD-L1 axis. The aim of this study was to evaluate the possible role of PD-L1 expression in the pulmonary tissue in subjects affected by COVID-19. The presence of SARS-CoV-2 in the pulmonary tissue, and its exact location, was indagated by in situ hybridization; the expression of PD-L1 and CD8 in the same tissue was indagated by immunohistochemistry. Overall, PD-L1 resulted diffusely expressed in 70% of the cases, and an intense expression was observed in 43.5% of cases. Diffuse and intense presence of SARS-CoV-2 by in situ hybridization significantly correlated with an intense PD-L1 expression, and with expression of PD-L1 by pneumocytes. PD-L1 is overexpressed in the pulmonary tissue of subjects died from COVID-19, and mainly in subjects with a high viral load. These data suggest a possible role of PD-L1 in the immune system exhaustion at the basis of the severe forms of the disease.

COMMON VARIABLE IMMUNODEFICIENCY: PREDISPOSING OR PROTECTIVE FACTOR FOR SEVERE COMPLICATIONS OF COVID-19?

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The usual presentation of the disease is a common cold-like illness but it can present with more severe and sometimes fatal manifestations. Immunocompromised patients such as those with common variable immunodeficiency (CVID) also are among the infected population. A limited number of reports have been published concerning CVID patients with COVID-19. The main reported symptoms were fever, cough, dyspnea and fatigue while the median duration of illness was 19 (interquartile range 14-26.5) days. Total recovery rate was 88.4%. It is still unknown whether primary immunodeficiency interacts as a predisposing or protective factor against the severe forms of COVID-19. Substitute immunoglobulin (IG) therapy is the only treatment option for CVID. Some reports suggest that early administration of intravenous IGs or convalescent plasma infusion may positively influence the outcome of COVID-19 in these patients.

Pregnancy, Preeclampsia, and COVID-19: Susceptibility and Mechanisms: A Review Study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through angiotensin converting enzyme 2 (ACE2), which expression of its gene increases during pregnancy that is resulted in an enhanced level of the ACE2 enzyme. It might enhance the risk of SARS-CoV-2 infection and its complications in the pregnant women. Although, pregnancy hypertensive disorders and severe infection with SARS-CoV-2 are correlated with high comorbidity, these two entities should be discriminated from each other. Also, there is a concern about the risk of preeclampsia and consequently severe coronavirus disease 2019 (COVID-19) development in the pregnant women. So, to answer these questions, in the present review the literature was surveyed. It seems there is higher severity of COVID-19 among pregnant women than non-pregnant women and more adverse pregnancy outcomes among pregnant women infected with SARS-CoV-2. In addition, an association between COVID-19 with preeclampsia and the role of preeclampsia and gestational hypertension as risk factors for SARS-CoV-2 infection and its complications is suggested. However, infection of the placenta and the SARS-CoV-2 vertical transmission is rare. Various mechanisms could explain the role of COVID-19 in the risk of preeclampsia and association between preeclampsia and COVID-19. Suggested mechanisms are included decreased ACE2 activity and imbalance between Ang II and Ang-(1-7) in preeclampsia, association of both of severe forms of COVID-19 and pregnancy hypertensive disorders with comorbidity, and interaction between immune system, inflammatory cytokines and the renin angiotensin aldosterone system and its contribution to the hypertension pathogenesis. It is concluded that preeclampsia and gestational hypertension might be risk factors for SARS-CoV-2 infection and its complications.

Effects of The Mitochondrial Genome on Germ Cell Fertility: A Review of The Literature.

Infertility is one of the major problems faced in medicine. There are numerous factors that play a role in infertility. For example, numerous studies mention the impact of the quantity and quality of mitochondria in sexual gametes. This is a narrative review of the effects of the mitochondrial genome on fertility. We searched the PubMed, Science Direct, SID, Google Scholar, and Scopus databases for articles related to “Fertility, Infertility, Miscarriage, Mitochondria, Sperm, mtDNA, Oocytes” and other synonymous keywords from 2000 to 2020. The mitochondrial genome affects infertility in both male and female gametes; in sperm, it mainly releases free radicals. In the oocyte, a mutation in this genome can affect the amount of energy required after fertilisation, leading to gestation failure. In both cases, infertile cells have substantially less mitochondrial DNA (mtDNA) copies. The effects of mtDNA on gamete fertility occur via changes in oxidative phosphorylation and cellular energy production. Also, a reduction in the number of mtDNA copies is directly associated with sex cell infertility. Therefore, evaluation of the mitochondrial genome can be an excellent diagnostic option for couples who have children with neonatal disorders, infertile couples who seek assisted reproductive treatment, and those in whom assisted reproductive techniques have failed.

Impact of cardiac and acute kidney injury on COVID-19 in-hospital mortality

Background and aimThe severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. Cardiac and acute kidney injury (AKI) are two complications commonly reported in severe forms of COVID-19. We aimed to investigate the effect of these tow complications on the COVID-19 in-hospital mortality.Materials and methodsThis is a prospective study, including 120 severe cases of COVID-19, admitted at the university hospital of Blida. Troponin was assessed by an immuno-fluoroassay method. AKI was defined according to the KDIGO-2012 guidelines. The association with in-hospital mortality was assessed using the Kaplan–Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve.ResultsCardiac and acute kidney injury were very common, occurring in 19% and 25% of patients. When analyzing survival, both were significantly associated with in-hospital mortality (pLogRank < 0.0001). A cutoff value of 9.6 ng/mL for troponin and 13.9 mg/L for creatinine could predict poor prognosis with a sensitivity of 73% and 67%, and a specificity of 62% and 64%, respectively. Hazard ratios were (HR = 3.5, 95% CI [1.7–7.3], P = 0.001 and HR = 3.14, 95% CI [1.6–6.1], P = 0.001) for troponin cutoff and AKI respectively.ConclusionThis study demonstrates the high frequency of cardiac and acute kidney injury in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis.

Mortality Predictors in Severe COVID-19 Patients from an East European Tertiary Center: A Never-Ending Challenge for a No Happy Ending Pandemic.

(1) Background: There are limited clinical data in patients from the Eastern European regions hospitalized for a severe form of Coronavirus disease 2019 (COVID-19). This study aims to identify risk factors associated with intra-hospital mortality in patients with COVID-19 severe pneumonia admitted to a tertiary center in Iasi, Romania. (2) Methods: The study is of a unicentric retrospective observational type and includes 150 patients with severe COVID-19 pneumonia divided into two subgroups, survivors and non-survivors. Demographic and clinical parameters, as well as comorbidities, laboratory and imaging investigations upon admission, treatments, and evolution during hospitalization were recorded. First, we sought to identify the risk factors associated with intra-hospital mortality using logistic regression. Secondly, we assessed the correlations between D-Dimer and C-reactive protein and predictors of poor prognosis. (3) Results: The predictors of in-hospital mortality identified in the study are D-dimers >0.5 mg/L (p = 0.002), C-reactive protein >5 mg/L (p = 0.001), and heart rate above 100 beats per minute (p = 0.001). The biomarkers were also significantly correlated the need for mechanical ventilation, admission to intensive care unit, or multiple organ dysfunction syndrome. By area under the curve (AUC) analysis, we noticed that both D-Dimer (AUC 0.741) and C-reactive protein (AUC 0.707) exhibit adequate performance in predicting a poor prognosis in patients with severe viral infection. (4) Conclusions: COVID-19′s outcome is significantly influenced by several laboratory and clinical factors. As mortality induced by severe COVID-19 pneumonia is considerable, the identification of risk factors associated with negative outcome coupled with an early therapeutic approach are of paramount importance, as they may significantly improve the outcome and survival rates.

Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review.

IntroductionObesity has been considered as one of the independent risk factors for a severe form of coronavirus disease-2019 (COVID-19) and relationship between obesity, critical illness, and infection is still poorly understood. We herein discuss clinical course and outcome of critically ill obese patients with COVID-19 admitted to critical care unit.Materials and methodsWe retrospectively analyzed data of critically ill obese patients hospitalized with COVID-19 over a span of 6 months. Management was guided according to the institutional protocol. Collected data included demographic parameters (age, sex, comorbidities, and body mass index (BMI)), complications, inflammatory markers (interleukin (IL)-6, Ferritin), length of mechanical ventilation, length of intensive care unit (ICU) stay, and inhospital death.ResultsThere was no appreciable difference in terms of demographics, inflammatory markers, predictors of mortality scores, and comorbidity indices between the survivors and nonsurvivors. Among outcome analysis, there was a statistically significant difference between ventilator days between survivors and nonsurvivors (p = 0.003**).ConclusionObesity itself is a significant risk factor for severe COVID-19 infection; however, if efficiently managed and in a protocol-determined manner, it can have a favorable outcome.How to cite this articleKaur M, Aggarwal R, Ganesh V, Kumar R, Patel N, Ayub A, et al. Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review. Indian J Crit Care Med 2021;25(12):1382–1386.