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1.
PLoS One ; 15(10): e0240394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031467

RESUMO

BACKGROUND: The SARS-CoV-2 pandemic compounds Mexico's pre-existing challenges: very high levels of both non-communicable diseases (NCD) and social inequity. METHODS AND FINDINGS: Using data from national reporting of SARS-CoV-2 tested individuals, we estimated odds of hospitalization, intubation, and death based on pre-existing non-communicable diseases and socioeconomic indicators. We found that obesity, diabetes, and hypertension are positively associated with the three outcomes in a synergistic manner. The municipal poverty level is also positively associated with hospitalization and death. CONCLUSIONS: Mexico's response to COVID-19 is complicated by a synergistic double challenge: raging NCDs and extreme social inequity. The response to the current pandemic must take both into account both to be effective and to ensure that the burden of COVID-19 not falls disproportionately on those who are already disadvantaged.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Betacoronavirus/fisiologia , Comorbidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Complicações do Diabetes , Diabetes Mellitus/fisiopatologia , Feminino , Hospitalização , Humanos , Hipertensão/fisiopatologia , Intubação , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pobreza , Fatores Sexuais , Fatores Socioeconômicos
2.
Fluids Barriers CNS ; 17(1): 55, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912226

RESUMO

Human coronaviruses are highly pathogenic viruses that pose a serious threat to human health. Examples include the severe acute respiratory syndrome outbreak of 2003 (SARS-CoV-1), the Middle East Respiratory Syndrome (MERS-CoV) outbreak of 2012, and the current SARS-CoV-2 (COVID-19) pandemic. Herein, we review the neurological manifestations of coronaviruses and discuss the potential pathogenic role of blood-brain barrier dysfunction. We present the hypothesis that pre-existing vascular damage (due to aging, cardiovascular disease, diabetes, hypertension or other conditions) facilitates infiltration of the virus into the central nervous system (CNS), increasing neuro-inflammation and the likelihood of neurological symptoms. We also discuss the role of a neuroinflammatory cytokine profile in both blood-brain barrier dysfunction and macrovascular disease (e.g. ischemic stroke and thromboembolism). Future studies are needed to better understand the involvement of the microvasculature in coronavirus neuropathology, and to test the diagnostic potential of minimally-invasive screening tools (e.g. serum biomarkers, fluorescein retinal angiography and dynamic-contrast MRI).


Assuntos
Barreira Hematoencefálica/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Inflamação/fisiopatologia , Microvasos/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Pneumonia Viral/fisiopatologia , Betacoronavirus , Barreira Hematoencefálica/imunologia , Barreira Hematoencefálica/virologia , Doenças Cardiovasculares/fisiopatologia , Infecções por Coronavirus/imunologia , Citocinas/imunologia , Diabetes Mellitus/fisiopatologia , Encefalite/imunologia , Encefalite/fisiopatologia , Humanos , Inflamação/imunologia , Microvasos/imunologia , Doenças do Sistema Nervoso/imunologia , Pandemias , Pneumonia Viral/imunologia , Convulsões/imunologia , Convulsões/fisiopatologia , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/fisiopatologia , Tromboembolia/imunologia , Tromboembolia/fisiopatologia
3.
Orv Hetil ; 161(38): 1637-1645, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32924968

RESUMO

INTRODUCTION: Intermittent claudication has a significant negative impact on the patients' quality of life. Revascularization procedures and noninvasive medical therapies can improve walking capacity. Cilostazol has IA recommendation for the treatment of intermittent claudication. AIM: The aim of this study was to evaluate the effect of a three-month cilostazol treatment on the health-related quality of life and on the lower-limb functional capacity in diabetic (DM) and non-diabetic patients (NDM) with intermittent claudication in the clinical practice. METHOD: The study was a multicenter, non-interventional trial; 812 patients with peripheral artery disease (Fontaine II stage, mean age: 67.17 years, male/female: 58.25/41.75%, 318 diabetics) were enrolled, who received cilostazol (50 or 100 mg twice a day) for 3 months. The quality of life was evaluated with the EQ-5D-3L questionnaire, the functional capacity with the WELCH questionnaire. Walking distances, ankle-brachial index were measured at baseline and after 3 months. RESULTS: Upon conclusion of the study, the EQ-5D index improved both in non-diabetic and diabetic patients (baseline: NDM -0.45 ± 0.22, DM -0.48 ± 0.23, 3rd month: -0,24 ± 0.18, -0,27 ± 0.19; respectively; p<0.0001) and there was a significant increase in the WELCH score as well (baseline: NDM 20 ± 14, DM 18 ± 14; 3rd month: 33 ± 19, 29 ± 16, respectively; p<0.0001). Both pain-free and maximal walking distance increased by 59.2% (median: 50.0%), 46.58 (median: 40.51%) in NDM and 42.85% (median: 43.33%), 41.61% (median: 34.68%) in DM patients, respectively (p<0.001). CONCLUSIONS: Three months of cilostazol treatment improved the quality of life and lower-limb functional capacity in diabetic and non-diabetic claudicant patients. The WELCH questionnaire is a useful tool in clinical practice for the evaluation of intermittent claudication treatment. Orv Hetil. 2020; 161(38): 1637-1645.


Assuntos
Cilostazol/uso terapêutico , Diabetes Mellitus/fisiopatologia , Claudicação Intermitente/tratamento farmacológico , Doença Arterial Periférica/complicações , Qualidade de Vida/psicologia , Tetrazóis/uso terapêutico , Vasodilatadores/uso terapêutico , Idoso , Estudos de Casos e Controles , Complicações do Diabetes , Feminino , Humanos , Claudicação Intermitente/psicologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/tratamento farmacológico , Resultado do Tratamento , Caminhada
4.
Pan Afr Med J ; 36: 158, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874422

RESUMO

Diabetes mellitus is a non-infectious disease and has affected about 425 million adults globally and nearly 15.9 million of them reside in Africa. Moreover, the prevalence of undiagnosed diabetes mellitus is very high in Africa and approximates to around 62%. Nearly 75% of the total deaths due to diabetes are in individuals lesser than 60 years of age. The multifaceted disease of diabetes mellitus produces chronic complications such as, neuropathy, nephropathy, retinopathy, microangiopathy etc. These patients of diabetes mellitus are more susceptible to infections due to compromised immune system. Hence these patients of diabetes mellitus and undiagnosed diabetes mellitus are at greater risk of contracting COVID-19 infections. The dual impact of pathophysiology of COVID-19 infections in diabetes mellitus may increase morbidity and mortality in these patients. Hence there is need of health awareness in diabetics as well in the high-risk group for diabetes such as persons with hypertension and obesity. The scarcity of health resources, shortage of trained medical personnel and disease burden of infectious and non-infectious diseases has laid a heavy impact on the economy in Africa and this has been further strained due to the COVID-19 pandemic. The practice of preventive measures by the risk group of Undiagnosed Diabetes Mellitus patients will prevent them from getting infected by COVID-19 and at the same time decrease mortality rates and hence the undiscovered group that is the patients of undiagnosed diabetes mellitus needs to be vigilant regarding safe preventive practices.


Assuntos
Infecções por Coronavirus/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , África/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Prevalência , Fatores de Risco
5.
Geriatr Gerontol Int ; 20(10): 980-987, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32886834

RESUMO

AIMS: Sarcopenia is a serious problem because of its poor prognosis. Growth differentiation factor 15 (GDF15) is associated with mitochondrial dysfunction, inflammation, insulin resistance and oxidative stress, which may play crucial roles for the development of sarcopenia. We aimed to examine whether serum GDF15 level is associated with muscle mass, strength and lower extremity function in older patients with cardiometabolic disease. METHODS: Serum GDF15 levels were measured in 257 patients with cardiometabolic diseases (including 133 patients with diabetes) who had visited the frailty clinic, using a latex turbidimetric immunoassay. Appendicular skeletal muscle index, handgrip strength, timed-up-and-go test and gait speed were evaluated. Power, speed, balance and total scores based on the sit-to-stand test were calculated to assess lower extremity function. RESULTS: The highest tertile of serum GDF15 was independently associated with low handgrip strength, low gait speed, long timed-up-and-go time and scores of lower extremity function but not an appendicular skeletal muscle index in multiple logistic regression analyses after adjustment for covariates. Patients in the highest tertile of GDF15 were at the risk of having three to nine times lower grip strength, three times lower gait speed, five to six times lower mobility and five to 11 times reduction in lower extremity function as compared with those in the lowest GDF15 tertile dependent on the models. CONCLUSIONS: Elevated serum GDF15 level was independently associated with low muscle strength and lower extremity function in older patients with cardiometabolic disease. Serum GDF15 could be one of the biomarkers for muscle weakness and low physical performance. Geriatr Gerontol Int 2020; 20: 980-987.


Assuntos
Doenças Cardiovasculares/sangue , Diabetes Mellitus/sangue , Fator 15 de Diferenciação de Crescimento/sangue , Extremidade Inferior/fisiopatologia , Força Muscular/fisiologia , Sarcopenia/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus/fisiopatologia , Feminino , Fragilidade , Força da Mão , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Sarcopenia/fisiopatologia , Estudos de Tempo e Movimento , Velocidade de Caminhada/fisiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-32760350

RESUMO

Aims: This study aimed to investigate the clinical courses and outcomes of diabetes mellitus patients with coronavirus disease 2019 (COVID-19) in Wuhan. Methods: This study enrolled 1,880 consecutive patients with confirmed COVID-19 in Leishenshan Hospital. We collected and analyzed their data, including demographic data, history of comorbidity, clinical symptoms, laboratory tests, chest computed tomography (CT) images, treatment options, and survival. Results: The percentages of patients with diabetes among the severe and critical COVID-19 cases were higher than those among the mild or general cases (89.2%, 10.8 vs. 0%, p = 0.001). However, patients with and without diabetes showed no difference in the follow-up period (p = 0.993). The mortality rate in patients with or without diabetes was 2.9% (n = 4) and 1.1% (n = 9), respectively (p = 0.114). Univariate and multivariate Cox regression analyses and the Kaplan-Meier curves did not show any statistically significant differences between patients with and without diabetes (all p > 0.05). Conclusions: Our study results suggested that diabetes had no effect on the prognosis of COVID-19 patients but had a negative association with their clinical courses. These results may be useful for clinicians in the management of diabetic patients with COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus/fisiopatologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Adulto , China/epidemiologia , Comorbidade , Infecções por Coronavirus/complicações , Complicações do Diabetes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Prognóstico , Estudos Retrospectivos , Fatores de Risco
8.
Medicine (Baltimore) ; 99(30): e21289, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791710

RESUMO

This study investigated the impacts of renin-angiotensin system inhibitors (RASIs) on 2-year clinical outcomes in diabetes and dyslipidemic acute myocardial infarction (AMI) patients after a successful percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DESs).A total of 16,997 AMI patients were enrolled, and divided into four groups based on the presence or absence of diabetes and dyslipidemia as follows: diabetes -/dyslipidemia -(group A, 11,132 patients), diabetes +/dyslipidemia - (group B, 3,860 patients), diabetes -/dyslipidemia + (group C, 1,328 patients), and diabetes +/dyslipidemia + (group D, 677 patients). The clinical endpoint was the occurrence of major adverse cardiac events (MACEs), the composite of total death, recurrent myocardial infarction (re-MI), and any repeat revascularization, including target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (non-TVR).After RASIs therapy, the cumulative incidences of MACEs (adjusted hazard ratio [aHR], 1.330; 95% confidence interval [CI], 1.022-1.732; P = .034), any repeat revascularization (aHR, 1.584; 95% CI, 1.092-2.298; P = .015), TLR, and TVR were significantly higher in group B than group C. However, the cumulative incidences of all-cause death, cardiac death, re-MI, and non-TVR were similar in groups B and C.In this study, under the newer-generation DESs era, repeat revascularization rate reduction benefit of RASIs therapy in diabetic AMI patients was lesser than that in dyslipidemic AMI patients. However, larger randomized controlled studies are needed to confirm these results in the future.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Stents Farmacológicos , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/fisiopatologia , Dislipidemias/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Sistema de Registros , República da Coreia
9.
Artigo em Inglês | MEDLINE | ID: mdl-32754119

RESUMO

Background: Diabetes correlates with poor prognosis in patients with COVID-19, but very few studies have evaluated whether impaired fasting glucose (IFG) is also a risk factor for the poor outcomes of patients with COVID-19. Here we aimed to examine the associations between IFG and diabetes at admission with risks of complications and mortality among patients with COVID-19. Methods: In this multicenter retrospective cohort study, we enrolled 312 hospitalized patients with COVID-19 from 5 hospitals in Wuhan from Jan 1 to Mar 17, 2020. Clinical information, laboratory findings, complications, treatment regimens, and mortality status were collected. The associations between hyperglycemia and diabetes status at admission with primary composite end-point events (including mechanical ventilation, admission to intensive care unit, or death) were analyzed by Cox proportional hazards regression models. Results: The median age of the patients was 57 years (interquartile range 38-66), and 172 (55%) were women. At the time of hospital admission, 84 (27%) had diabetes (and 36 were new-diagnosed), 62 (20%) had IFG, and 166 (53%) had normal fasting glucose (NFG) levels. Compared to patients with NFG, patients with IFG and diabetes developed more primary composite end-point events (9 [5%], 11 [18%], 26 [31%]), including receiving mechanical ventilation (5 [3%], 6 [10%], 21 [25%]), and death (4 [2%], 9 [15%], 20 [24%]). Multivariable Cox regression analyses showed diabetes was associated increased risks of primary composite end-point events (hazard ratio 3.53; 95% confidence interval 1.48-8.40) and mortality (6.25; 1.91-20.45), and IFG was associated with an increased risk of mortality (4.11; 1.15-14.74), after adjusting for age, sex, hospitals and comorbidities. Conclusion: IFG and diabetes at admission were associated with higher risks of adverse outcomes among patients with COVID-19.


Assuntos
Glicemia/metabolismo , Infecções por Coronavirus/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus/fisiopatologia , Intolerância à Glucose/complicações , Hiperglicemia/complicações , Pneumonia Viral/mortalidade , Adulto , Idoso , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/virologia , Diabetes Mellitus/virologia , Jejum , Feminino , Seguimentos , Intolerância à Glucose/virologia , Mortalidade Hospitalar , Hospitalização , Humanos , Hiperglicemia/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida
10.
Pharmazie ; 75(8): 375-380, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32758336

RESUMO

Diabetes mellitus (DM) is one of the major risk factors for COVID-19 complications as it is one of the chronic immune-compromising conditions especially if patients have uncontrolled diabetes, poor HbA1c and/or irregular blood glucose levels. Diabetic patients' mortality rates with COVID-19 are higher than those of cardiovascular or cancer patients. Recently, Bacillus Calmette-Guérin (BCG) vaccine has shown successful results in reversing diabetes in both rats and clinical trials based on different mechanisms from aerobic glycolysis to beta cells regeneration. BCG is a multi-face vaccine that has been used extensively in protection from tuberculosis (TB) and leprosy and has been repositioned for treatment of bladder cancer, diabetes and multiple sclerosis. Recently, COVID-19 epidemiological studies confirmed that universal BCG vaccination reduced morbidity and mortality in certain geographical areas. Countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies that have shown low numbers of reported COVID-19 cases. Some countries have started clinical trials that included a single dose BCG vaccine as prophylaxis from COVID-19 or an attempt to minimize its side effects. This proposed research aims to use BCG vaccine as a double-edged weapon countering both COVID-19 and diabetes, not only as protection but also as therapeutic vaccination. The work includes a case study of regenerated pancreatic beta cells based on improved C-peptide and PCPRI laboratory findings after BCG vaccination for a 9 year old patient. The patient was re-vaccinated based on a negative tuberculin test and no scar at the site of injection of the 1st BCG vaccination at birth. The authors suggest and invite the scientific community to take into consideration the concept of direct BCG re-vaccination (after 4 weeks) because of the reported gene expressions and exaggerated innate immunity consequently. As the diabetic MODY-5 patient (mutation of HNF1B, Val2Leu) was on low dose Riomet® while eliminating insulin gradually, a simple analytical method for metformin assay was recommended to ensure its concentration before use as it is not approved yet by the Egyptian QC labs.


Assuntos
Vacina BCG/administração & dosagem , Infecções por Coronavirus/imunologia , Diabetes Mellitus/imunologia , Células Secretoras de Insulina/citologia , Pneumonia Viral/imunologia , Animais , Vacina BCG/imunologia , Criança , Infecções por Coronavirus/complicações , Diabetes Mellitus/fisiopatologia , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Ratos , Regeneração/imunologia , Fatores de Risco , Vacinação/métodos
11.
Diabetes Res Clin Pract ; 166: 108346, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32710998

RESUMO

AIMS: Diabetes mellitus has been reported to be one of the most prevalent comorbidity in patients with Coronavirus Disease 2019 (COVID-19). We aimed to assess the association of comorbid diabetes with COVID-19 severity or mortality in China. METHODS: We performed a systematic literature search from six electronic databases on diabetes and COVID-19. The outcome of interest was disease severity or mortality. Heterogeneity among the studies was assessed by the Cochran Q test and the I2 statistic. A random effects model was applied to calculate the pooled risk ratio (RR) with 95% confidence interval (CI). RESULTS: Nine studies from different provinces/cities were identified according to the predefined inclusion and exclusion criteria. There were a total of 1070 patients with diabetes, out of the 8807 COVID-19 cases. The majority of the cases were derived from Hubei Province. A low degree of heterogeneity in the risk estimates was observed in the included studies. Meta-analysis showed that there was a significant association of preexisting diabetes with disease severity or death. The pooled RR was 2.96 (95% CI: 2.31-3.79; p < 0.001). Sensitivity analysis demonstrated no significant changes in the pooled estimates. CONCLUSIONS: Comorbid diabetes was associated with an increased risk of disease severity or death in Chinese COVID-19 patients.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus/mortalidade , Pneumonia Viral/mortalidade , China/epidemiologia , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Complicações do Diabetes/fisiopatologia , Complicações do Diabetes/virologia , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/virologia , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , Índice de Gravidade de Doença , Taxa de Sobrevida
12.
Diabetes Res Clin Pract ; 166: 108347, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32711003

RESUMO

BACKGROUND: COVID-19 pneumonia is a newly recognized illness that is spreading rapidly around the world and causes many disability and deaths. Some diseases, for instance diabetes, is continuously suggested as a risk factor which contributes to the severity and mortality of COVID-19. However, to date, there are no comprehensive studies aiming to explain the exact relationship between diabetes and COVID-19. Thus, this study aims to summarize the evidence about diabetes and COVID-19 outbreak through a systematic review and meta-analysis approach. METHOD: A literature review was implemented within databases of Scopus, PubMed, Science direct, and Web of science. Observational reviews, case-report, and case-series studies that assessed the diabetes in COVID-19 patients, were included. Data extraction and assessment were guided by PRISMA checklist. FINDINGS: Some studies suggest that there were no significant differences in symptoms between patients who suffered from both diabetes and COVID-19 and those who only suffered COVID-19. In the subsequent meta-analysis 14.5% of the subjects were diabetic patient. These clients have poor ARDS prognosis, severe symptoms, and the death rate is higher among COVID-19 patients. In addition, it is suggested the diabetic patients will be treated with antibiotics, antivirals, and HCQ. CONCLUSION: The results of this study show that diabetes is a risk factor - and contributes to the severity and mortality of patients with COVID-19. This paper also provides recommendations and guidelines for which could be useful for prevention and treatment of diabetic patients affected by COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Diabetes Mellitus/fisiopatologia , Pneumonia Viral/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus/virologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Fatores de Risco
13.
Diabetes Metab Syndr ; 14(5): 1017-1025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634716

RESUMO

BACKGROUND AND AIMS: Currently there is limited knowledge on medical comorbidities and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of various morbidities on serious events in COVID 19. METHODS: PubMed, Cochrane Central Register of Clinical Trials were searched on April 28, 2020, to extract published articles that reported the outcomes of COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics". ICU admission, mechanical ventilation, ARDS, Pneumonia, death was considered serious events. The comorbidities assessed in the study were Hypertension (HTN), Diabetes mellitus (DM), Cardiovascular diseases (CVD), Chronic obstructive pulmonary disease (COPD) and Chronic Kidney disease (CKD). Subsequently, comparisons between comorbidity patient group and the non-comorbidity patient groups, in terms of serious events were made using the pooled estimates of odd's ratio (OR) RESULTS: We identified 688 published results and 16 studies with 3994 patients were included in the systematic review. Serious events were seen in 526(13.16%) patients. Presence of hypertension with OR 2.95, diabetes mellitus with OR 3.07, Cardio vascular disease with OR 4.58, COPD with OR 6.66 and Chronic kidney disease with OR 5.32 had significant association in patients with COVID 19 on having serious events. Presence of diabetes mellitus (OR 2.78)) had a significant impact on death in COVID 19 patients with a p-value 0.004. CONCLUSIONS: Presence of medical comorbidities in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical intubation and mortality. The presence of Diabetes mellitus has a significant impact on mortality rate in COVID-19 patients.


Assuntos
Betacoronavirus/isolamento & purificação , Doenças Cardiovasculares/mortalidade , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/mortalidade , Hipertensão/mortalidade , Pneumonia Viral/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Insuficiência Renal Crônica/mortalidade , Doenças Cardiovasculares/fisiopatologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/fisiopatologia , Incidência , Índia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Taxa de Sobrevida
14.
Diabetes Metab Syndr ; 14(5): 1133-1142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663789

RESUMO

BACKGROUND AND AIMS: To undertake a review and critical appraisal of published/preprint reports that offer methods of determining the effects of hypertension, diabetes, stroke, cancer, kidney issues, and high-cholesterol on COVID-19 disease severity. METHODS: A search was conducted by two authors independently on the freely available COVID-19 Open Research Dataset (CORD-19). We developed an automated search engine to screen a total of 59,000 articles in a few seconds. Filtering of the articles was then undertaken using keywords and questions, e.g. "Effects of diabetes on COVID/normal coronavirus/SARS-CoV-2/nCoV/COVID-19 disease severity, mortality?". The search terms were repeated for all the comorbidities considered in this paper. Additional articles were retrieved by searching via Google Scholar and PubMed. FINDINGS: A total of 54 articles were considered for a full review. It was observed that diabetes, hypertension, and cholesterol levels possess an apparent relation to COVID-19 severity. Other comorbidities, such as cancer, kidney disease, and stroke, must be further evaluated to determine a strong relationship to the virus. CONCLUSION: Reports associating cancer, kidney disease, and stroke with COVID-19 should be carefully interpreted, not only because of the size of the samples, but also because patients could be old, have a history of smoking, or have any other clinical condition suggesting that these factors might be associated with the poor COVID-19 outcomes rather than the comorbidity itself. Further research regarding this relationship and its clinical management is warranted.


Assuntos
Betacoronavirus/isolamento & purificação , Colesterol/metabolismo , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/fisiopatologia , Hipertensão/fisiopatologia , Nefropatias/fisiopatologia , Pneumonia Viral/mortalidade , Índice de Gravidade de Doença , Acidente Vascular Cerebral/fisiopatologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus/virologia , Humanos , Hipertensão/virologia , Nefropatias/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Acidente Vascular Cerebral/virologia , Taxa de Sobrevida
15.
Biosci Rep ; 40(8)2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32725148

RESUMO

The new 2019 coronavirus disease (COVID-19), according to the World Health Organization (WHO), has been characterized as a pandemic. As more is being discovered about this virus, we aim to report findings of the complete blood count (CBC) of COVID-19 patients. This would serve in providing physicians with important knowledge on the changes that can be expected from the CBC of mild and normal COVID-19 patients. A total of 208 mild and common patients were admitted at the Dongnan Hospital located in the city of Xiaogan, Hubei, China. The CBCs of these patients, following a confirmed diagnosis of COVID-19, were retrospectively analyzed and a significant P<0.05 was found after a full statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS). CBC analysis revealed changes in the levels of red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), and C-reactive protein (CRP). Clinicians should expect similar findings when dealing with the new COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Doença das Coronárias/diagnóstico , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Hipertensão/diagnóstico , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Idoso , Doenças Assintomáticas , Contagem de Células Sanguíneas , Proteína C-Reativa/metabolismo , China/epidemiologia , Comorbidade , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Índices de Eritrócitos , Eritrócitos/patologia , Eritrócitos/virologia , Feminino , Hematócrito , Hemoglobinas/metabolismo , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Insuficiência Respiratória/sangue , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença
16.
J Drug Target ; 28(7-8): 683-699, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32700580

RESUMO

The COVID-19 pandemic is caused by the severe acute-respiratory-syndrome-coronavirus-2 that uses ACE2 as its receptor. Drugs that raise serum/tissue ACE2 levels include ACE inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) that are commonly used in patients with hypertension, cardiovascular disease and/or diabetes. These comorbidities have adverse outcomes in COVID-19 patients that might result from pharmacotherapy. Increasing ACE2 could potentially increase the risk of infection, severity or mortality in COVID-19 or it might be protective as it forms angiotensin-(1-7) which exhibits anti-inflammatory/anti-oxidative effects and prevents diabetes- and/or hypertension-induced end-organ damage. Thus, there existed clinical uncertainty. Here, we review studies implicating 15 classes of drugs in increasing ACE2 levels in vivo and the available literature on the clinical safety of these drugs in COVID-19 patients. Further, in a re-analysis of clinical data from a meta-analysis of 9 studies, we show that ACEIs/ARBs usage was not associated with an increased risk of all-cause mortality. Literature suggests that ACEIs/ARBs usage generally appears to be clinically safe though their use in severe COVID-19 patients might increase the risk of acute renal injury. For definitive clarity, further clinical and mechanistic studies are needed in assessing the safety of all classes of ACE2 raising medications.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/tratamento farmacológico , Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Animais , Betacoronavirus/isolamento & purificação , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Humanos , Pandemias , Peptidil Dipeptidase A/efeitos dos fármacos , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Fatores de Risco
17.
Diabetes Res Clin Pract ; 166: 108299, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623030

RESUMO

AIMS: To investigate the clinical characteristics, laboratory findings and high- resolution CT (HRCT) features and to explore the risk factors for in-hospital death and complications of coronavirus disease 2019 (COVID-19) patients with diabetes. METHODS: From Dec 31, 2019, to Apr 5, 2020, a total of 132 laboratory-confirmed COVID-19 patients with diabetes from two hospitals were retrospectively included in our study. Clinical, laboratory and chest CT data were analyzed and compared between the two groups with an admission glucose level of ≤11 mmol/L (group 1) and >11 mmol/L (group 2). Logistic regression analyses were used to identify the risk factors associated with in-hospital death and complications. RESULTS: Of 132 patients, 15 died in hospital and 113 were discharged. Patients in group 2 were more likely to require intensive care unit care (21.4% vs. 9.2%), to develop acute respiratory distress syndrome (ARDS) (23.2% vs. 9.2%) and acute cardiac injury (12.5% vs. 1.3%), and had a higher death rate (19.6% vs. 5.3%) than group 1. In the multivariable analysis, patients with admission glucose of >11 mmol/l had an increased risk of death (OR: 7.629, 95%CI: 1.391-37.984) and in-hospital complications (OR: 3.232, 95%CI: 1.393-7.498). Admission d-dimer of ≥1.5 µg/mL (OR: 6.645, 95%CI: 1.212-36.444) and HRCT score of ≥10 (OR: 7.792, 95%CI: 2.195-28.958) were associated with increased odds of in-hospital death and complications, respectively. CONCLUSIONS: In COVID-19 patients with diabetes, poorly-controlled blood glucose (>11 mmol/L) may be associated with poor outcomes. Admission hyperglycemia, elevated d-dimer and high HRCT score are potential risk factors for adverse outcomes and death.


Assuntos
Betacoronavirus/isolamento & purificação , Glicemia/metabolismo , Infecções por Coronavirus/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus/fisiopatologia , Intolerância à Glucose/complicações , Hiperglicemia/complicações , Pneumonia Viral/mortalidade , Idoso , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/virologia , Diabetes Mellitus/virologia , Feminino , Intolerância à Glucose/virologia , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/virologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
18.
Diabetes Res Clin Pract ; 166: 108295, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623032

RESUMO

AIM: The novel coronavirus infection (COVID-19), now a worldwide public health concern is associated with varied fatality. Patients with chronic underlying conditions like diabetes and hypertension have shown worst outcomes. The understanding of the association might be helpful in early vigilant monitoring and better management of COVID-19 patients at high risk. The aim of the meta-analysis was to assess the association of diabetes and hypertension with severity of disease. METHODS: A literature search was conducted using the databases PubMed and Cochrane until March 31, 2020. Seven studies were included in the meta- analysis, including 2018 COVID-19 patients. RESULTS: Diabetes was lower in the survivors (OR: 0.56; 95%CI: 0.35-0.90; p = 0.017; I2: 0.0%) and non-severe (OR: 1.66; 95%CI: 1.20-2.30; p = 0.002; I2: 0.0%) patients. No association of diabetes was found with ICU care. Hypertension was positively associated with death (OR: 0.49; 95%CI: 0.34-0.73; p<0.001; I2: 0.0%), ICU care (OR: 0.42; 95%CI: 0.22-0.81; p = 0.009; I2: 0.0%) and severity (OR: 2.69; 95%CI: 1.27-5.73; p = 0.01; I2: 52.4%). CONCLUSIONS: Our findings suggest that diabetes and hypertension have a negative effect on health status of COVID-19 patients. However, large prevalence studies demonstrating the consequences of comorbid diabetes and hypertension are urgently needed to understand the magnitude of these vexatious comorbidities.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Complicações do Diabetes , Diabetes Mellitus/fisiopatologia , Hipertensão/fisiopatologia , Pneumonia Viral/complicações , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Diabetes Mellitus/virologia , Humanos , Hipertensão/complicações , Hipertensão/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico
19.
Diabetes Res Clin Pract ; 166: 108301, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623036

RESUMO

AIMS: The present observational study aims to describe political actions in place to combat COVID-19 in the South and Central America region (SACA) while protecting individuals with diabetes. METHODS: A survey with 12 questions was shared with all IDF-SACA member organizations, in 18 countries. A descriptive analysis was performed and a multivariate cluster analysis technique pam (partitioning around medoids) was applied. RESULTS: Two groups of countries were identified. The first group, mostly countries with stricter measures to contain the spread of the virus, reported more difficulties (limitations in accessing basic or health needs) and fears (concerns regarding the impact of the pandemic); whereas most of the second group consisted of countries with less restrictive measures, and reported fewer difficulties. Only 37% responded that a policy was put into place to protect individuals with diabetes, either delivering their medicines and supplies at home (16%) or providing them at once enough for 2-3 months (21%). All respondents reported that one of the main fear was to "be infected and not to receive adequate treatment" and/or "getting infected if going to the hospital or medical appointments". CONCLUSION: Most of the SACA countries failed to implement timely measures to protect individuals with diabetes, which may severely impact individuals, health systems and economies.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Complicações do Diabetes , Diabetes Mellitus/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , América Central/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Diabetes Mellitus/terapia , Diabetes Mellitus/virologia , Humanos , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , América do Sul/epidemiologia , Inquéritos e Questionários
20.
Diabetes Res Clin Pract ; 166: 108303, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623038

RESUMO

The coronavirus disease-2019 (COVID-19) has been designated as a highly contagious infectious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) since December 2019, when an outbreak of pneumonia cases emerged in Wuhan, China. The COVID-19 pandemic has led to a global health crisis, devastating the social, economic and political aspects of life. Many clinicians, health professionals, scientists, organizations, and governments have actively defeated COVID-19 and shared their experiences of the SARS-CoV2. Diabetes is one of the major risk factors for fatal outcomes from COVID-19. Patients with diabetes are vulnerable to infection because of hyperglycemia; impaired immune function; vascular complications; and comorbidities such as hypertension, dyslipidemia, and cardiovascular disease. In addition, angiotensin-converting enzyme 2 (ACE2) is a receptor for SARS-CoV-2 in the human body. Hence, the use of angiotensin-directed medications in patients with diabetes requires attention. The severity and mortality from COVID-19 was significantly higher in patients with diabetes than in those without. Thus, the patients with diabetes should take precautions during the COVID-19 pandemic. Therefore, we review the current knowledge of COVID-19 including the global and regional epidemiology, virology, impact of diabetes on COVID-19, treatment of COVID-19, and standard of care in the management of diabetes during this critical period.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/fisiopatologia , Pneumonia Viral/epidemiologia , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/virologia , Saúde Global , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , República da Coreia/epidemiologia
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