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1.
Gene ; 766: 145145, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-32941953

RESUMEN

COVID-19, a novel coronavirus-related illness, has spread worldwide. Patients with apparently mild/moderate symptoms can suddenly develop severe pneumonia. Therefore, almost all COVID-19 patients require hospitalization, which can reduce limited medical resources in addition to overwhelming medical facilities. To identify predictive markers for the development of severe pneumonia, a comprehensive analysis of serum chemokines and cytokines was conducted using serial serum samples from COVID-19 patients. The expression profiles were analyzed along the time axis. Serum samples of common diseases were enrolled from a BioBank to confirm the usefulness of predictive markers. Five factors, IFN-λ3, IL-6, IP-10, CXCL9, and CCL17, were identified as predicting the onset of severe/critical symptoms. The factors were classified into two categories. Category A included IFN-λ3, IL-6, IP-10, and CXCL9, and their values surged and decreased rapidly before the onset of severe pneumonia. Category B included CCL17, which provided complete separation between the mild/moderate and the severe/critical groups at an early phase of SARS-CoV-2 infection. The five markers provided a high predictive value (area under the receiver operating characteristic curve (AUROC): 0.9-1.0, p < 0.001). Low expression of CCL17 was specifically observed in pre-severe COVID-19 patients compared with other common diseases, and the predictive ability of CCL17 was confirmed in validation samples of COVID-19. The factors identified could be promising prognostic markers to distinguish between mild/moderate and severe/critical patients, enabling triage at an early phase of infection, thus avoiding overwhelming medical facilities.


Asunto(s)
Biomarcadores/sangre , Quimiocina CCL17/sangre , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/sangre , Neumonía Viral/fisiopatología , Betacoronavirus/fisiología , Citocinas/sangre , Hospitalización , Humanos , Pandemias , Índice de Severidad de la Enfermedad
2.
BMC Cardiovasc Disord ; 20(1): 479, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167876

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic. Studies showed COVID-19 affected not only the lung but also other organs. In this study, we aimed to explore the cardiac damage in patients with COVID-19. METHODS: We collected data of 100 patients diagnosed as severe type of COVID-19 from February 8 to April 10, 2020, including demographics, illness history, physical examination, laboratory test, and treatment. In-hospital mortality were observed. Cardiac damage was defined as plasma hypersensitive troponin I (hsTnI) over 34.2 pg/ml and/or N-terminal-pro brain natriuretic peptide (NTproBNP) above 450 pg/ml at the age < 50, above 900 pg/ml at the age < 75, or above 1800 pg/ml at the age ≥ 75. RESULTS: The median age of the patients was 62.0 years old. 69 (69.0%) had comorbidities, mainly presenting hypertension, diabetes, and cardiovascular disease. Fever (69 [69.0%]), cough (63 [63.0%]), chest distress (13 [13.0%]), and fatigue (12 [12.0%]) were the common initial symptoms. Cardiac damage occurred in 25 patients. In the subgroups, hsTnI was significantly higher in elder patients (≥ 60 years) than in the young (median [IQR], 5.2 [2.2-12.8] vs. 1.9 [1.9-6.2], p = 0.018) and was higher in men than in women (4.2 [1.9-12.8] vs. 2.9 [1.9-7.4], p = 0.018). The prevalence of increased NTproBNP was significantly higher in men than in women (32.1% vs. 9.1%, p = 0.006), but was similar between the elder and young patients (20.0% vs. 25.0%, p = 0.554). After multivariable analysis, male and hypertension were the risk factors of cardiac damage. The mortality was 4.0%. CONCLUSIONS: Cardiac damage exists in patients with the severe type of COVID-19, especially in male patients with hypertension. Clinicians should pay more attention to cardiac damage.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Cardiopatías/etiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Neumonía Viral/complicaciones , Factores de Edad , Anciano , Biomarcadores/sangre , China , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Troponina I/sangre
4.
Clin Lab ; 66(11)2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-33180449

RESUMEN

BACKGROUND: To investigate the clinical value of multi-index combined detection in the diagnosis of new coronavirus disease 2019 (COVID-19). METHODS: A total of 63 laboratory confirmed patients treated in our hospital were selected as the COVID-19 group, including 28 severe patients and 35 non-severe patients. Another 50 healthy subjects undergoing physical examination simultaneously were selected as the healthy group. Here we performed a study on the laboratory characteristics and explored their efficacy for diagnosis of the disease. RESULTS: Compared with healthy people, the abnormal indicators of patients with COVID-19 are low levels of lymphocytes (LYM), red blood cells (RBC), hemoglobin (HGB), platelets (PLT), total protein (TP), and albumin (ALB), and high levels of monocytes (MON), aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), and C-reactive protein (CRP). The level of MON and CRP in severe patients were significantly increased compared with non-severe pneumonia patients, and indicators such as LYM and ALB were significantly reduced (p < 0.05). The sensitivity and specificity of the combined detection of LYM, MON, RBC, HGB, PLT, TP, ALB, AST, GGT, and CRP was 97.7% and 91.7%, which was higher than the single item (p < 0.05). The sensitivity and specificity of combined detection of LYM, MON, ALB, and CRP to predict the severity of COVID-19 were 96.4% and 73.0%, which were higher than those of separate detections (p < 0.05). CONCLUSIONS: The index of LYM, MON, RBC, HGB, PLT, TP, ALB, AST, GGT, and CRP can be used for the diagnosis of new COVID-19, and the indicators of LYM, MON, ALB, and CRP may be predictors of severe pneumonia. The combined detection of the laboratory indexes can diagnose COVID-19 and predict the severity more effectively and accurately.


Asunto(s)
Biomarcadores/sangre , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/sangre , Neumonía Viral/sangre , Adulto , Anciano , Estudios de Casos y Controles , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pandemias
5.
J Coll Physicians Surg Pak ; 30(10): 1026-1029, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33143821

RESUMEN

OBJECTIVE: To determine clinical features and biochemical markers in COVID-19 patients at a tertiary care hospital, in Multan. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Pathology, Combined Military Hospital, Multan, Pakistan, from March to June 2020. METHODOLOGY: Sixty-three cases of all ages admitted in Isolation ward, Combined Military Hospital, Multan with COVID-19 were included. Clinical features like fever, cough and shortness of breath were recorded. Blood sample was collected in plain tube for biochemical features like serum albumin, ferritin, AST, LDH, CRP and urea, which were analysed in Pathology Department of the Hospital. Association of the clinical features and these biochemical markers were determined. RESULTS: In 63 patients, only one (1.6%) patient was between 1 to 12 years, 42 (66.7 %) belonged to 13 to 45 years while 20 (31.7%) patients were between 46 to 95 years. Mean age was 41.39+15.68 years. Forty-eight (76.2%) patients were males and 15 (23.8%) females. Thirteen (20.6%) patients presented with fever, 14 (22.2%) had productive cough and only 3 (4.8%) patients were aware of known history of contact. Median (IQR) value of serum ferritin, LDH, albumin, AST, CRP and urea were 176.5 (252) ng/ml, 284 (96) IU/L, 42 (7) g/L, 28 (22) U/L, 3.9 (11) mg/L and 4.25 (1.6) mmol/L, respectively. CONCLUSION: Pakistani patients with COVID-19 disease showed variable pattern of clinical features. Specific biochemical markers, particularly serum ferritin, may help in diagnosis. Key Words: Covid-19, Clinical features, Biochemical features, Multan, Pakistan.


Asunto(s)
Betacoronavirus , Biomarcadores/sangre , Infecciones por Coronavirus/sangre , Pandemias , Neumonía Viral/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
6.
JAMA ; 324(17): 1765-1776, 2020 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-33141212

RESUMEN

Importance: Incidence rates for lower extremity deep vein thrombosis (DVT) range from 88 to 112 per 100 000 person-years and increase with age. Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event. Observations: PubMed and Cochrane databases were searched for English-language studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies. Risk factors for venous thromboembolism (VTE), such as older age, malignancy (cumulative incidence of 7.4% after a median of 19 months), inflammatory disorders (VTE risk is 4.7% in patients with rheumatoid arthritis and 2.5% in those without), and inherited thrombophilia (factor V Leiden carriers with a 10-year cumulative incidence of 10.9%), are associated with higher risk of VTE. Patients with signs or symptoms of lower extremity DVT, such as swelling (71%) or a cramping or pulling discomfort in the thigh or calf (53%), should undergo assessment of pretest probability followed by D-dimer testing and imaging with venous ultrasonography. A normal D-dimer level (ie, D-dimer <500 ng/mL) excludes acute VTE when combined with a low pretest probability (ie, Wells DVT score ≤1). In patients with a high pretest probability, the negative predictive value of a D-dimer less than 500 ng/mL is 92%. Consequently, D-dimer cannot be used to exclude DVT without an assessment of pretest probability. Postthrombotic syndrome, defined as persistent symptoms, signs of chronic venous insufficiency, or both, occurs in 25% to 50% of patients 3 to 6 months after DVT diagnosis. Catheter-directed fibrinolysis with or without mechanical thrombectomy is appropriate in those with iliofemoral obstruction, severe symptoms, and a low risk of bleeding. The efficacy of direct oral anticoagulants-rivaroxaban, apixaban, dabigatran, and edoxaban-is noninferior to warfarin (absolute rate of recurrent VTE or VTE-related death, 2.0% vs 2.2%). Major bleeding occurs in 1.1% of patients treated with direct oral anticoagulants vs 1.8% treated with warfarin. Conclusions and Relevance: Greater recognition of VTE risk factors and advances in anticoagulation have facilitated the clinical evaluation and treatment of patients with DVT. Direct oral anticoagulants are noninferior to warfarin with regard to efficacy and are associated with lower rates of bleeding, but costs limit use for some patients.


Asunto(s)
Extremidad Inferior/irrigación sanguínea , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Factores de Edad , Biomarcadores/sangre , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Estilo de Vida , Ilustración Médica , Síndrome Postrombótico/etiología , Valor Predictivo de las Pruebas , Factores de Riesgo , Factores Sexuales , Evaluación de Síntomas , Trombectomía/métodos , Trombofilia/complicaciones , Trombofilia/genética , Ultrasonografía , Filtros de Vena Cava , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiología , Warfarina/uso terapéutico
7.
Front Immunol ; 11: 585647, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33133104

RESUMEN

Cytokine storm resulting from SARS-CoV-2 infection is one of the leading causes of acute respiratory distress syndrome (ARDS) and lung fibrosis. We investigated the effect of inflammatory molecules to identify any marker that is related to lung fibrosis in coronavirus disease 2019 (COVID-19). Seventy-six COVID-19 patients who were admitted to Youan Hospital between January 21 and March 20, 2020 and recovered were recruited for this study. Pulmonary fibrosis, represented as fibrotic volume on chest CT images, was computed by an artificial intelligence (AI)-assisted program. Plasma samples were collected from the participants shortly after admission, to measure the basal inflammatory molecules levels. At discharge, fibrosis was present in 46 (60.5%) patients whose plasma interferon-γ (IFN-γ) levels were twofold lower than those without fibrosis (p > 0.05). The multivariate-adjusted logistic regression analysis demonstrated the inverse association risk of having lung fibrosis and basal circulating IFN-γ levels with an estimate of 0.43 (p = 0.02). Per the 1-SD increase of basal IFN-γ level in circulation, the fibrosis volume decreased by 0.070% (p = 0.04) at the discharge of participants. The basal circulating IFN-γ levels were comparable with c-reactive protein in the discrimination of the occurrence of lung fibrosis among COVID-19 patients at discharge, unlike circulating IL-6 levels. In conclusion, these data indicate that decreased circulating IFN-γ is a risk factor of lung fibrosis in COVID-19.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Interferón gamma/sangre , Neumonía Viral/complicaciones , Fibrosis Pulmonar/etiología , Anciano , Inteligencia Artificial , Biomarcadores/sangre , Estudios de Cohortes , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/inmunología , Estudios Transversales , Femenino , Humanos , Inflamación/inmunología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/inmunología , Fibrosis Pulmonar/sangre , Fibrosis Pulmonar/diagnóstico por imagen , Factores de Riesgo , Tomografía Computarizada por Rayos X
8.
Cephalalgia ; 40(13): 1410-1421, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33146036

RESUMEN

OBJECTIVE: To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. METHODS: This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. RESULTS: Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). CONCLUSIONS: Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Cefalea/virología , Neumonía Viral/complicaciones , Adulto , Anciano , Betacoronavirus , Biomarcadores/sangre , Infecciones por Coronavirus/inmunología , Femenino , Cefalea/epidemiología , Humanos , Inflamación/sangre , Inflamación/virología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/inmunología , Síntomas Prodrómicos , Estudios Prospectivos
9.
Trials ; 21(1): 882, 2020 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-33106171

RESUMEN

OBJECTIVES: We will evaluate the efficacy and safety of Melatonin, compared to the standard therapeutic regimen on clinical symptoms and serum inflammatory parameters in patients with confirmed COVID-19, who are moderately ill. TRIAL DESIGN: This is a single-center, randomized, double-blind, placebo-controlled clinical trial with a parallel-group design conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran. PARTICIPANTS: All patients admitted to Severe Acute Respiratory Syndrome Departments of Shahid Mohammadi Hospital, Bandar Abbas, Iran will be screened for the following criteria. INCLUSION CRITERIA: 1. Age ≥20 years 2. Confirmed SARS-CoV-2 diagnosis (positive polymerase chain reaction). 3. Moderate COVID-19 pneumonia (via computed tomography and or X-ray imaging), requiring hospitalization. 4. Hospitalized ≤48 hours. 5. Signing informed consent and willingness of the participant to accept randomization to any assigned treatment arm. EXCLUSION CRITERIA: 1. Underlying diseases, including chronic hypertension, diabetes mellitus, seizure, depression, chronic hepatitis, cirrhosis, and cholestatic liver diseases. 2. Severe and critical COVID-19 pneumonia. 3. Use of warfarin, corticosteroids, hormonal drugs, alcohol, other antiviral and investigational medicines, and illegal drugs (during the last 30 days). 4. History of known allergy to Melatonin. 5. Pregnancy and breastfeeding. INTERVENTION AND COMPARATOR: Intervention group: The standard treatment regimen for COVID-19, according to the Iranian Ministry of Health and Medical Education's protocol, along with Melatonin capsules at a dose of 50 mg daily for a period of seven days. CONTROL GROUP: The standard therapeutic regimen for COVID-19 along with Melatonin-like placebo capsules at a dose of one capsule daily for a period of seven days. Both Melatonin and placebo capsules were prepared at the Faculty of Pharmacy and Pharmaceutical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. MAIN OUTCOMES: The primary outcomes are the recovery rate of clinical symptoms and oxygen saturation as well as improvement of serum inflammatory parameters, including C-reactive protein, tumor necrosis factor-alpha (TNF-ɑ), interleukin-1ß (IL-1ß), and IL-6 within seven days of randomization. The secondary outcomes are the time to improve clinical and paraclinical features along with the incidence of serious adverse drug reactions within seven days of randomization. RANDOMIZATION: Included patients will be allocated to one of the study arms using block randomization in a 1:1 ratio (each block consists of 10 patients). This randomization method ensures a balanced allocation between the arms during the study. A web-based system will generate random numbers for the allocation sequence and concealment of participants. Each number relates to one of the study arms. BLINDING (MASKING): All study participants, clinicians, nurses, research coordinators, and those analyzing the data are blinded to the group assignment. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): A total of 60 patients randomized into two groups (30 in each group). TRIAL STATUS: The trial protocol is Version 1.0, August 14, 2020. Recruitment began August 22, 2020, and is anticipated to be completed by November 30, 2020. TRIAL REGISTRATION: The trial protocol has been registered in the Iranian Registry of Clinical Trials (IRCT). The registration number is " IRCT20200506047323N5 ". The registration date was 14 August 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Betacoronavirus/efectos de los fármacos , Depresores del Sistema Nervioso Central/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Melatonina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Adulto , Betacoronavirus/genética , Biomarcadores/sangre , Estudios de Casos y Controles , Depresores del Sistema Nervioso Central/administración & dosificación , Depresores del Sistema Nervioso Central/efectos adversos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Método Doble Ciego , Hospitalización , Humanos , Irán/epidemiología , Melatonina/administración & dosificación , Melatonina/efectos adversos , Oxígeno/sangre , Pandemias , Placebos/administración & dosificación , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Seguridad , Factores de Tiempo , Resultado del Tratamiento
10.
BMC Infect Dis ; 20(1): 758, 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33059627

RESUMEN

BACKGROUND: HIV infection exacerbates the prognosis of HCV infection, with a faster progression of hepatitis. Hepatic fibrosis is the major disruption of the hepatic tissue architecture characterized by anarchic deposition and excess of the extracellular matrix. The objective of this study was to evaluate hepatic fibrosis in HIV/HCV co-infected individuals as compared to HCV mono-infected. METHODS: A total of 97 participants (mean age 60.2 ± 14.3 years and 0.76 male/female sex ratio) was enrolled in a study conducted in Yaoundé, Cameroon from November 2018 to January 2019. Liver fibrosis was assessed by the APRI score (Aspartate Aminotransferase or AST/Platelet Ratio Index) which identifies the stage of fibrosis as classified by the Metavir system (F0 to F4). CD4 counts and plasmatic HIV viral load of HIV/HCV co-infected individuals were determined and the correlation between hepatic fibrosis and immuno-virological status established. Statistical analysis was done using Microsoft Excel 2016 and EpiInfo7 software. RESULTS: A high proportion (63.6%) of HIV/HCV co-infected participants had an abnormal AST level: 73.6 ± 45.8 IU/L as compared to 58.5 ± 39.3 IU/L (59.3%) among HCV mono-infected participants. The frequency of thrombocytopenia was 63.6% with a mean platelet count of 137 ± 50 ×  103 IU/L in HIV/HCV co-infected participants as compared to 176 ± 67 × 103 IU/L in HCV mono-infected participants (38.4%). The progression of hepatic fibrosis in participants with clinically significant fibrosis: F2, F3 and F4 was higher among HIV/HCV co-infected and the mean APRI score was 1.7 ± 1.4 versus 1 ± 0.8 among HCV mono-infected (26.7%). All participants (100%) with detectable HIV viral load had clinically significant fibrosis compared to 33.4% in those with undetectable HIV viral load (p = 0.55). Only 42.9% participants with CD4 >  500 cells/µL had clinically significant fibrosis (p = 0.72) while 100% participants with CD4 <  200 cells/µL had clinically significant fibrosis (p = 0.58). CONCLUSIONS: A high level of AST combined with thrombocytopenia (APRI score > 1.5) is an indicator of hepatic fibrosis in HIV/HCV co-infected individuals. Because of its non-invasive and less costly nature, the APRI score can be a suitable biomarker to monitor hepatic fibrosis in HIV/HCV co-infected individuals in resource constrained settings.


Asunto(s)
Aspartato Aminotransferasas/sangre , Coinfección/virología , Infecciones por VIH/sangre , Hepatitis C/sangre , Cirrosis Hepática/virología , Recuento de Plaquetas , Anciano , Biomarcadores/sangre , Recuento de Linfocito CD4 , Camerún , Estudios Transversales , Femenino , Fibrosis , Infecciones por VIH/virología , Hepatitis C/virología , Humanos , Cirrosis Hepática/sangre , Masculino , Persona de Mediana Edad , Trombocitopenia/virología , Carga Viral , Viremia/complicaciones , Viremia/patología
11.
J Toxicol Sci ; 45(10): 611-617, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33012729

RESUMEN

Acute paraquat poisoning (APP) is a serious public health problem with a high mortality rate and there is no specific antidote for APP in clinical. Early haemoperfusion (HP) treatment is effective in APP rescue. In this study, we compared the influence of routine HP and continuous HP on the survival rate and the treatment of pulmonary fibrosis in mild and moderate APP patients. Eighty-two cases of mild and moderate APP patients who were admitted to our hospital from January of 2017 to December of 2018 were selected. All patients were randomly divided into a routine haemoperfusion (HP) group (n = 40) and a continuous haemoperfusion (CHP) group (n = 42). Compared with the HP group, the 28-day survival rate of mild and moderate APP patients was elevated in the CHP group. Blood N-terminal procollagen Ш propeptide (PIIINP) levels in APP patients were positively related with paraquat (PQ) concentration (r = 0.309, P = 0.000). There were statistically significant differences in the levels of PIIINP, Collage TypeIV (CIV), transforming growth factor-beta 1 (TGF-ß1), malondialdehyde (MDA), superoxide dismutase (SOD) activity and sequential organ failure assessment (SOFA) score between the two groups both on the third and seventh days after treatment, and the treatment effect of the CHP group on pulmonary fibrosis in APP patients was better than that of the HP group. In conclusion, CHP treatment had a significant therapeutic effect on mild and moderate APP patients, which could effectively improve the survival rate and relieve pulmonary fibrosis.


Asunto(s)
Hemoperfusión/métodos , Paraquat/envenenamiento , Fibrosis Pulmonar/etiología , Fibrosis Pulmonar/terapia , Adolescente , Adulto , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Fibrosis Pulmonar/diagnóstico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto Joven
12.
Vasc Health Risk Manag ; 16: 403-418, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33116551

RESUMEN

Cardiovascular (CV) disease remains the leading cause of morbidity and mortality worldwide and poses an ongoing challenge with the aging population. Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD), and the expert consensus is the use of statin therapy (if tolerated) as first line for LDL-C reduction. However, patients with ASCVD may experience recurrent ischemic events despite receiving maximally tolerated statin therapy, including those whose on-treatment LDL-C remains ≥70 mg/dL, patients with familial hypercholesterolemia, high-risk subgroups with comorbidities such as diabetes mellitus, and those who have an intolerance to statin therapy. Optimal therapeutic strategies for this unmet need should deploy aggressive lipid lowering to minimize the contribution of dyslipidemia to their CV risk, particularly for very high-risk populations with additional risk factors beyond hypercholesterolemia and established ASCVD. To understand the current clinical climate and guidelines regarding ASCVD, we primarily searched PubMed for articles published in English regarding lipid-lowering therapies and CV risk reduction, including emerging therapies, and CV outcomes trials with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. This review discusses the findings of recent clinical trial evidence for CV risk reduction with cholesterol-lowering therapies, with a focus on CV outcomes trials with PCSK9 inhibitors, and considers the impact of the study results for secondary prevention and future strategies in patients with hypercholesterolemia and CV risk despite maximally tolerated statin therapy.


Asunto(s)
Anticolesterolemiantes/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Proproteína Convertasa 9/antagonistas & inhibidores , Inhibidores de Serina Proteinasa/uso terapéutico , Anticolesterolemiantes/efectos adversos , Biomarcadores/sangre , Enfermedades Cardiovasculares/epidemiología , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/epidemiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Factores de Riesgo , Inhibidores de Serina Proteinasa/efectos adversos , Resultado del Tratamiento
13.
J Stroke Cerebrovasc Dis ; 29(11): 105202, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066924

RESUMEN

INTRODUCTION AND OBJECTIVES: Motor evoked potentials (MEPs) have been postulated to be useful in predicting recovery in patients with motor impairment. We aimed to investigate whether MEPs elicited by transcranial magnetic stimulation (TMS), serum brain derived neurotrophic factor (BDNF) and its genotype have prognostic value on stroke recovery in patients with hand paresis due to stroke. METHODS: This was an observational cohort study. Patients underwent TMS with MEPs from abductor digiti minimi evaluation between 2-14 (D0) and 30 days (D30) after stroke and their impact on motor function of the upper limb and general outcome was assessed after 3 months (D90). The presence of a BDNF gene polymorphism was determined and serum BDNF concentrations were measured at D0, D30 and D90. RESULTS: The presence of MEPs and their amplitude at rest and in effort significantly correlated with improvement of upper-limb paresis and general outcome after 3 months. Resting motor threshold did not have prognostic value. Central motor conduction time and MEP latency less consistently predicted stroke outcome or motor deficit improvement. Neither BDNF polymorphisms nor BDNF concentration at D0, D30 and D90 corresponded with the degree of paresis or the independence of patients 3 months after stroke. CONCLUSIONS: The presence of MEPs and their amplitude are useful predictors of upper-limb motor function recovery and general outcome after stroke. BDNF concentration and its genotype had no prognostic value. Further studies conducted on large cohorts are necessary to determine the usefulness of these methods in motor recovery and stroke outcome prediction.


Asunto(s)
Factor Neurotrófico Derivado del Encéfalo/sangre , Potenciales Evocados Motores , Mano/inervación , Paresia/terapia , Accidente Cerebrovascular/terapia , Estimulación Transcraneal de Corriente Directa , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Factor Neurotrófico Derivado del Encéfalo/genética , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Paresia/diagnóstico , Paresia/fisiopatología , Polimorfismo Genético , Valor Predictivo de las Pruebas , Tiempo de Reacción , Recuperación de la Función , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
14.
J Stroke Cerebrovasc Dis ; 29(11): 105198, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066946

RESUMEN

PURPOSE: Single subcortical infarction (SSI) in the middle cerebral artery (MCA) territory can be classified into proximal SSI (pSSI) and distal SSI (dSSI) based on the heterogeneous pathogenesis. It is hypothesized that pSSI is more relevant with atherosclerosis, as low-density lipoprotein cholesterol (LDL-C) is the major atherogenic lipoprotein, we conducted the present study to investigate the association between LDL-C levels and pSSI in comparison with dSSI. PATIENTS AND METHODS: This study is a subset of the Chinese Intracranial Atherosclerosis study. A total of 380 with SSI in the MCA territory classified as small artery occlusion stroke were enrolled in this study. 3.0-T magnetic resonance imaging (MRI) was performed to categorize the participants into two groups, pSSI (extending to the basal surface of MCA) and dSSI (not extending to the basal surface of MCA). RESULTS: Out of the 380 enrolled participants (273 men and 107 women), the proportion of pSSI and dSSI were 53.2% (202/380) versus 46.8% (178/380) based on MRI. The results of univariate and multivariate logistic regression were both at the borderline level of statistical significance. Further stratified analyses revealed that age is an interaction factor (P = 0.03), the association between LDL-C levels and the pSSI in participants aged over 65 had a significant positive relation (OR: 1.56; 95%CI: 1.14-2.12). CONCLUSION: LDL-C level is an independent risk factor for pSSI in patients aged over 65. Our result is in accordance with the hypothesis that pSSI is more relevant with atherosclerosis, thus appropriate treatment should be applied differently to pSSI and dSSI.


Asunto(s)
LDL-Colesterol/sangre , Dislipidemias/sangre , Infarto de la Arteria Cerebral Media/epidemiología , Factores de Edad , Anciano , Biomarcadores/sangre , Angiografía Cerebral , China/epidemiología , Imagen de Difusión por Resonancia Magnética , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Femenino , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Recurrencia , Medición de Riesgo , Factores de Riesgo
15.
J Am Coll Cardiol ; 76(17): 1965-1977, 2020 10 27.
Artículo en Inglés | MEDLINE | ID: mdl-33092732

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. OBJECTIVES: The purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification. METHODS: Consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data. RESULTS: In total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. CONCLUSIONS: Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Ecocardiografía , Corazón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Remodelación Ventricular , Anciano , Anciano de 80 o más Años , Betacoronavirus , Biomarcadores/sangre , Estudios de Cohortes , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Femenino , Corazón/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Medición de Riesgo
16.
Clin Appl Thromb Hemost ; 26: 1076029620964868, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33030047

RESUMEN

To discuss the coagulation dysfunction in COVID-19 patients and to find new biomarkers to separate severe COVID-19 patients from mild ones. We use a retrospective analysis of 88 COVID-19 patients, and compare the coagulation function between severe and mild groups. We found the prothrombin time (PT), thrombin time (TT), D-dimer were significantly higher in the severe group (P < 0.05), and the highest area under the curve (AUC) is 0.91 for D-dimer, while the AUC of PT and TT were 0.80 and 0.61 respectively. We identified that D-dimer has a better value in predicting patients who are likely to develop into severe cases, with the sensitivity and specificity were 84.4% and 88.8%, respectively. D-dimer may be a good biomarker to separate the severe COVID-19 patients from the mild ones.


Asunto(s)
Trastornos de la Coagulación Sanguínea/etiología , Pruebas de Coagulación Sanguínea/métodos , Infecciones por Coronavirus/complicaciones , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Neumonía Viral/complicaciones , Adulto , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/fisiopatología , China , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Valor Predictivo de las Pruebas , Tiempo de Protrombina , Curva ROC , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tiempo de Trombina
17.
Artículo en Inglés | MEDLINE | ID: mdl-33014893

RESUMEN

Objective: To explore the diagnostic value of serum severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) protein assay in the early stages of SARS-COV-2 infection. Methods: Serum N protein level in SARS-COV-2 infected patients and non-SARS-COV-2 infected population was measured by enzyme-linked immunosorbent assay (ELISA) double antibody sandwich assay. Colloidal gold immunochromatography assay was used to detect serum N protein antibodies in the above populations. Results: Fifty cases of SARS-CoV-2 nucleic acid-positive and SARS-CoV-2 antibody-negative patients had a serum N protein positivity rate of 76%. Thirty-seven patients who were positive for serum SARS-CoV-2 antibody after infection had a serum SARS-CoV-2 N protein positivity rate of 2.7%. Serum N protein test results of 633 non-SARS-COV-2 infected patients, including pregnant women, patients with other respiratory infections, and individuals with increased rheumatoid factor were all negative, with serum N protein concentration <10.00 pg/mL at 100% specificity. Using SPSS 19.0 to calculate the receiver operating characteristic curve, the area under the curve was determined to be 0.9756 (95% confidence interval 0.9485-1.000, p < 0.0001), and sensitivity and specificity were 92% (95% confidence interval 81.16-96.85%) and 96.84% (95% confidence interval 95.17-97.15%), respectively. The best CUT-OFF value was 1.850 pg/mL. Conclusion: The measurement of serum SARS-COV-2 N protein has a high diagnostic value for infected patients before the antibody appears and shortens the window period of serological diagnosis. It is recommended that the manufacturer establish two different CUT-OFF values according to the purpose of the application. One CUT-OFF value is used for the diagnosis of clinical SARS-COV-2 infection, and the other is used to screen out as many suspected cases as possible.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Proteínas de la Nucleocápside/sangre , Neumonía Viral/diagnóstico , Anticuerpos Antivirales/sangre , Betacoronavirus/aislamiento & purificación , Biomarcadores/sangre , Infecciones por Coronavirus/sangre , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/sangre , Embarazo , Sensibilidad y Especificidad
18.
Arq Bras Cardiol ; 115(4): 660-666, 2020 10.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33111866

RESUMEN

BACKGROUND: COVID-19 causes severe pulmonary involvement, but the cardiovascular system can also be affected by myocarditis, heart failure and shock. The increase in cardiac biomarkers has been associated with a worse prognosis. OBJECTIVES: To evaluate the prognostic value of Troponin-T (TNT) and natriuretic peptide (BNP) in patients hospitalized for Covid-19. METHODS: This was a convenience sample of patients hospitalized for COVID-19. Data were collected from medical records to assess the association of TnT and BNP measured in the first 24 hours of hospital admission with the combined outcome (CO) of death or need for mechanical ventilation. Univariate analysis was used to compare the groups with and without the CO. Cox's multivariate model was used to determine independent predictors of the CO. RESULTS: We evaluated 183 patients (age = 66.8±17 years, 65.6% of which were males). The time of follow-up was 7 days (range 1 to 39 days). The CO occurred in 24% of the patients. The median troponin-T and BNP levels were 0.011 and 0.041ng/dL (p <0.001); 64 and 198 pg/dL (p <0.001), respectively, for the groups without and with the CO. In the univariate analysis, in addition to TnT and BNP, age, presence of coronary disease, oxygen saturation, lymphocytes, D-dimer, t-CRP and creatinine, were different between groups with and without outcomes. In the bootstrap multivariate analysis, only TnT (1.12 [95% CI 1.03-1.47]) and t-CRP (1.04 [95% CI 1.00-1.10]) were independent predictors of the CO. CONCLUSION: In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation. This finding further reinforces the clinical importance of cardiac involvement in COVID-19. (Arq Bras Cardiol. 2020; 115(4):660-666).


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Péptido Natriurético Encefálico/sangre , Neumonía Viral/diagnóstico , Troponina T/sangre , Anciano , Anciano de 80 o más Años , Betacoronavirus , Biomarcadores/sangre , Sistema Cardiovascular/fisiopatología , Sistema Cardiovascular/virología , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Pronóstico
20.
Medicine (Baltimore) ; 99(41): e22523, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031294

RESUMEN

There is scarce evidence that the erythrocyte sedimentation rate (ESR) could efficiently improve the prediction accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score in cases of ST-elevation myocardial infarction (STEMI).A cohort of 1094 STEMI patients undergoing primary percutaneous coronary intervention was retrospectively recruited. Patients were categorized based on the ESR values. Final endpoints included cardiovascular death and major adverse cardiovascular event (MACE) occurrence. The predictive value of combined models with the GRACE score and ESR was assessed by receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement.During the mean follow-up of 23 months, 34 patients died and 190 experienced MACEs, of which 23 patients died in the first year; both endpoints were more frequent in the higher group. The ESR and high-sensitivity C-reactive protein (hs-CRP) were independent risk factors of 1-year cardiovascular death, together with the GRACE score (ESR: hazard ratio = 1.03, P = .006 hs-CRP: hazard ratio = 1.00, P = .001; GRACE: 1.03, P = .012). Although no statistical improvement in the area under the ROC curve was observed in either the GRACE/ESR or the GRACE/hs-CRP model (GRACE/ESR models: 0. 8073 vs GRACE: 0.7714, P = .22; GRACE/ESR models: 0. 7815 vs GRACE: 0.7714, P = .61), the GRACE score and ESR together significantly improved the NRI (0.633; P< .001) compared with the GRACE alone. Regarding the mid-term mortality, adding the ESR to the GRACE score not only improved the NRI (0.8433; P < .001), but also increased the integrated discrimination improvement (0.0509; P = .04).The ESR is an independent risk factor of cardiovascular death and MACE in STEMI patients receiving primary percutaneous coronary intervention. The ESR comparatively enhanced the predictive values of the prognostic model, including the GRACE risk score.


Asunto(s)
Sedimentación Sanguínea , Infarto del Miocardio con Elevación del ST/sangre , Biomarcadores/sangre , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Sistema de Registros , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/cirugía
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