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Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

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... It is widely accepted that patients with comorbidities are more likely to become infected with SARS-CoV-2 and acquire severe disease. The most prevalent comorbidity among COVID-19 patients is hypertension, which is associated with an increased risk of infection as well as poorer outcomes and prognosis [22][23][24][25][26][27]. The fact that hypertension is the most common comorbidity in COVID-19 patients is not surprising given that the illness is more common and severe in the elderly, and hypertension is common in the elderly, hence hypertension can be seen in many COVID-19 cases. ...
... A meta-analysis found that patients with underlying cardiovascular disease, such as hypertension, are more susceptible to MERS-CoV infection [28], and some studies have found that patients with cardiovascular disease, particularly hypertension, are more likely to become infected with COVID-19 and develop more severe disease, but more research is needed in this area [29]. Although hypertension is the most prevalent comorbidity among COVID-19 patients, and some studies have linked it to poorer outcomes [22][23][24][25]27], there is little data on prognostic variables among COVID-19 patients with underlying hypertension to predict probable outcomes. So, in this study, we aimed to compare the epidemiologic, clinical, and laboratory differences between COVID-19 patients with and without underlying hypertension, and we identified some prognostic factors to predict disease severity and other possible outcomes in patients with pre-existing hypertension. ...
... As a result, most studies have limits based on geographical consideration, parameters evaluated, and the predictive significance of altered variables. For example, Bangladesh is a highly populated country with a sizable elderly population [24,25] where 7.7% of the entire population is over the age of 60, and 53.8 percent of older persons have comorbidities such as blood diseases, hypertension, diabetes, COPD, and so on [26][27][28][29][30][31]. Indeed, an insufficient number of health care service professionals and limited healthcare facilities exacerbate the situation [31]. ...
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Background: Alteration in haematological parameters is identified as critical early indicators of COVID-19. Hypertension (HTN) has been linked to an increased severity of COVID-19. The goal of this study is to investigate the numerous haematological factors in COVID-19 positive hypertensive patients in order to intervene early and improve patient outcomes. Methods: In this retrospective cohort analysis, the medical e-records of 54 COVID-19 patients with HTN were evaluated. These patients’ demographic and analytical data were analysed. Results: Of the 54 hypertensive patients, 37.04 percent were asymptomatic at the time of presentation. Anaemia was observed in 20.37 percent of the patients across the haematological parameters. 63 percent had a high red-blood-cell count, and 25.93 percent had a high red-blood-cell-distribution-width RDW). There was14.81percent thrombocytosis and 7.41 percent thrombocytopenia. 44.44 percent had a large platelet distribution width (PDW) and 57.41 percent had a large mean platelet volume (MPV). Neutropenia affected 14.81 percent of the population, whereas lymphocytopenia affected 16.67 percent. Conclusion: Hypertensive COVID-19 positive individuals have been shown to have substantial hemopoietic-system signs with varying haematological profiles. Recognizing the significance of these variables early in primary care can assist physicians in making clinical decision and directing early referral to secondary-care facilities, which can help improve prognosis.
... The first observational studies of the current pandemic showed a negative prognostic correlation between severe coronavirus disease 2019 (COVID- 19) infection and a range of cardiovascular diseases in which RAAS inhibitors are commonly used [3][4][5]. Subsequently, hypotheses emerged that the use of medications that interfere with the RAAS axis have an implication on the morbidity, mortality and disease severity by increasing the circulating levels of ACE2 [6,7]. Conflicting evidence from early observational studies contributed to the confusion of the general population and the scientific community as to whether the clinical course of the COVID-19 infection is truly affected by the potential chronic upregulation of the ACE2 receptors and how the administration of the RAAS inhibitors may impact and alter the disease process. ...
... It is a key counter-regulatory component of angiotensin metabolism that was identified approximately twenty years ago [8,9]. One of its main metabolic actions includes the breakdown of angiotensin II to ang- [1][2][3][4][5][6][7] (Fig. 1) [10, 11•]. Angiotensin II has a major impact on blood pressure and cardiac remodelling [12]. ...
... By breaking down angiotensin II, ACE2 has therefore a protective role of paramount importance in cardiovascular homeostasis. Ang- [1][2][3][4][5][6][7] acts through the Mas receptor and promotes vasodilation, sodium and water excretion as well as attenuation of inflammation and fibrosis, counter-acting in this way the effects of angiotensin II signalling [6]. ...
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Purpose of Review This review summarises the literature data and provides an overview of the role and impact of the use of renin–angiotensin–aldosterone system (RAAS) inhibitors in patients with coronavirus disease 2019 (COVID-19) infection. Recent Findings The angiotensin-converting enzyme 2 (ACE2) has a key role in the regulation of the RAAS pathway, downregulating angiotensin II and attenuating inflammation, vasoconstriction and oxidative stress. Additionally, it plays an instrumental part in COVID-19 infection as it facilitates the cell entry of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enables its replication. The use and role of RAAS inhibitors therefore during the COVID-19 pandemic have been intensively investigated. Summary Although it was initially assumed that RAAS inhibitors may relate to worse clinical outcomes and severe disease, data from large studies and meta-analyses demonstrated that they do not have an adverse impact on clinical outcomes or prognosis. On the contrary, some experimental and retrospective observational cohort studies showed a potential protective mechanism, although this effect remains to be seen in large clinical trials.
... Therefore, ACE inhibition has become one of the prime drug targets for disease treatment. However, patients with cardiac disease, hypertension, or diabetes, and on treatments (e.g., ACE1 inhibitors) that increase ACE2 expression are at a higher risk for severe SARS-CoV-2 infection [5]. Recent transcriptomic data suggests low level of the ACE1, ACE2, and TMPRSS2 in human endometrial cells at the transcripts level [6]. ...
... An earlier study suggested that ACE1 inhibitor reduces Ang II formation and Ang-(1− 7) metabolism due to increased Ang II metabolism by ACE2 [12]. A recent report also suggested that patients receiving ACE1 inhibitors for the treatment of chronic disease were at risk of SARS-CoV-2 infection, partly due to the elevated expression of ACE2 receptor [5]. ...
Article
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells via receptor angiotensin-converting enzyme 2 (ACE2) and co-receptor transmembrane serine protease 2 (TMPRSS2). However, patients with SARS-CoV-2 infection receiving ACE1 inhibitors had higher ACE2 expression and were prone to poorer prognostic outcomes. Until now, information on the expression of ACE1, ACE2, and TMPRSS2 in human endometrial tissues, and the effects of ACE inhibitors on embryo implantation are limited. We found human endometria expressed ACE1, ACE2, and TMPRSS2 transcripts and proteins. Lower ACE1, but higher ACE2 transcripts were found at the secretory than in the proliferative endometria. ACE1 proteins were weakly expressed in endometrial epithelial and stromal cells, whereas ACE2 and TMPRSS2 proteins were highly expressed in luminal and glandular epithelial cells. However, ACE1 and TMPRSS4 were highly expressed in receptive human endometrial epithelial (Ishikawa and RL95–2) cells, but not in non-receptive AN3CA and HEC1-B cells. Treatment of human endometrial epithelial cells with ACE1 (Captopril, Enalaprilat, and Zofenopril) or ACE2 (DX600) inhibitors did not significantly alter the expression of ACE1, ACE2 and TMPRSS2 transcripts and spheroid (blastocyst surrogate) attachment onto Ishikawa cells in vitro. Taken together, our data suggest that higher ACE2 expression was found in mid-secretory endometrium and the use of ACE inhibitors did not alter endometrial receptivity for embryo implantation.
... SARS CoV-2 infection is particularly dangerous for people who have pre-existing cardiovascular disease and frequently receive drugs that interfere with the RAAS system. Some studies suggest that ARBs and ACEIs could cause ACE2 compensatory upregulation in the cardiovascular system [11,12]. Given that ACE2 is the main host receptor for SARS CoV-2 infection, the effects of RAAS blocking agents such as ARBs and ACE inhibitors on ACE2 expression gained huge interest [13][14][15][16]. ...
... The controversial hypotheses and evidence regarding the relationship between RAAS blockade and ACE2 expression and COVID-19 linked outcomes lead to a surge of studies on evaluating the safety and effectiveness of administration of ACEIs/ARBs during COVID-19 [40,41]. Some studies showed that RAAS blockade upregulated the ACE2 expression in patients with comorbidities, which potentially predisposed patients on these medications to severe infection of SARS-CoV-2 [11,42]. However, some studies support that ACEIs/ARBs have no effect on ACE2 concentration, activity or expression, [43,16,44]. ...
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Introduction: The angiotensin-converting enzyme 2 (ACE2) as well as the transmembrane protease serine type 2 (TMPRSS2) have been found to play roles in cell entry for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19). SARS-CoV-2 infection risk and severity of COVID-19 might be indicated by the expression of ACE2 and TMPRSS2 in the lung. Methods: A high salt diet rat model and RAAS blockade were used to test whether these factors affect ACE2 and TMPRSS2 expression of the lung. A normal (0.3% NaCl), a medium (2% NaCl), or a high (8% NaCl) salt diet was fed to rats for 12 weeks, along with enalapril or telmisartan, before examining the lung for histopathological alteration. Using immunofluorescence and qRT-PCR, the localization as well as mRNA expression of ACE2 and TMPRSS2 were investigated. Results: The findings provide evidence that both TMPRSS2 and ACE2 are highly expressed in bronchial epithelial cells as well as ACE2 was also expressed in alveolar type2 (AT2) cells. High salt diet exposure in rats leads to elevated ACE2 expression on protein level. Treatment with RAAS blockers had no effect on lung tissue expression of ACE2 and TMPRSS2. Conclusions: These findings offer biological support regarding the safety of these drugs that are often prescribed to COVID-19 patients with cardiovascular co-morbidity. High salt intake on the other hand might adversely affect COVID-19 outcome. Our preclinical data should stimulate clinical studies addressing this point of concern.
... It is necessary to note that the SARS-COV2 infection is associated with several stresses including the respiratory distress, hypoxia and sepsis that require IV insulin with fluid therapy for the infected diabetic individuals to control hyperglycemia and its metabolic complications [151]. However, IV insulin treatment of DKA contributing hyperglycemia may lead to hypokalemia [151,152].Remarkably, ACE2 is enormously expressed in many body tissues including the pancreatic tissues including the beta-cells leading to hyperglycemia besides, multiple organs damage/failure [83,152,[153][154][155][156], thus, SARS-COV2 infection to these cells causing a decline of insulin secretion as well as due to the damage of these cells to precipitate DKA [83,157,158], in addition to the development of new onset diabetes mellitus due to the tropism of this tissue [38,[159][160][161][162]. Moreover, the SARS-COV2 infection also induces NHE activation involved in insulin secretion that aggravate the insulin secreting tissue leading to a permanent damage [158] via activation of disintegrin and metalloprotease 17(ADAM17) that is associated with ACE2 expression decline along with increasing NHE activation [148,163] which is also with shedding of ACE2 from the endothelial cells of blood vessels to the blood circulation. ...
... However, it seems that age plays a significant role in DKA caused mortality as reported by (Alkundi, et al., 2020) who exploited that older diabetic patient even without the development of DKA have greater mortality rate than young diabetic patients even when they develop DKA [176] which comes in agreement with the reported lower mortality rates/disease severity of this infections among pediatric diabetic individuals [200][201][202].Although it is believed that DKA is also developed in cases of SARS-COV2 infections even among non-diabetic infected individuals [152,173], thus, glycemic control state as well as anion gap monitoring is required [203]. Ultimately, SARS-COV2 infection is bounded to ACE2 receptor expressed in the pancreatic tissue beta-cells causing the receptor deficiency [204,205,206] that inclines the level of Ang II [83,207]that impede the insulin secretion leading to insulin resistance related hyperglycemia [58,161] as well as developing a new-onset type I DM, that deteriorate disease condition besides triggering ketoacidosis [38,152,153,157,175,177,208] via enhancement of lipolysis [173,209] due to the decline of the insulin dependent antilipolytic effect developing DKA and HHS [210,211,212] as encountered with SARS-COV1 infection [213].Thus, during SARS-COV2 infection the insulin deficiency related decline of antilipolytic influence besides the steroids anti-inflammatory therapy related adverse metabolic behavior enhanced the insulin resistance related DKA among both diabetic and non-diabetic individuals as well as new-onset diabetes development [210]. In this context, in a multicenter study from United States 64 SARS-COV2 infected patients have exhibited hyperglycemia DKA complication [214]. ...
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A huge number of studies have demonstrated the significance correlation between diabetic ketoacidosis as well as other type of ketosis/hyperosmolar metabolic state deterioration conditions and the SARS-COV2 infection. It is investigated in various infected age group, geneders, and countries. It is reported to be correlated to the two types of diabetes (type I DM and type II DM) available as pre-existing co-morbidity, infection related new-onset developed diabetes of both types or even due to hyperinflammation related acute pancreatitis. In fact, although most of the studies have reported greater survival, however, small single center retrospective studies have reported the association of diabetic ketoacidosis with elevated mortality rate that approaches 50%. Mechanistically, the DKA caused metabolic state deterioration due to the glucose metabolism fluctuation is attributed to the bidirectional sophisticated SARS-COV2 infection and different reasons hyperglycemia disease-disease interaction. Nevertheless, exaggerated inflammatory/immune response may also worsen the glycemic state that brings about ketosis. Remarakably, DKA can be developed even in cases of approximately normoglycemic conditions of the SARS-COV2 infection which is fewly reported, yet, it is attributed to SGLT2 inhibitors therapy. The SARS-COV2 infection related DKA complication among diabetic individuals have been treated with the same therapeutic protocol of non-infectious conditions including insulin and IV replenishment therapy however, with significantly greater dosing regimen. It is worthy to note that the infused replenishment fluids should be carefully calculated along with monitoring the lung function besides careful monitoring the potassium and some other electrolytes level particularly while insulin is intravenously infused. Thus, in order to explore the significance of correlation of this metabolic complication with the virus infection poor prognosis as well as higher mortality rate this survey reports the development of DKA as well as the ketosis related metabolic abnormailities while the course of SARS-COV2 infection among individuals with pre-exisitng and new onset diabetes.
... Hypertension, heart failure (HF) and ischemic heart disease are often treated with renin-angiotensin-aldosterone system (RAAS) blockers such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The use of ACE inhibitors/ARBs in patients with COVID-19 or at risk of infection with the virus is currently a subject of intense debate (14,15), due to the evidence that SARS-CoV-2 uses the ACE2 receptor for entry into target cells (16). ACE2 and its related axis are an endogenous counterregulatory system, with effects opposite to those of the ACE axis (17,18). ...
... Prior therapy with ACE inhibitors/ARBs was not related to worse prognosis in this cohort. The use of ACE inhibitors and ARB in patients with COVID-19 has been called into question by some (14), due to the evidence that SARS-CoV-2 uses the ACE2 receptor for entry into target cells (16). On the other hand, it has been recently shown that treatment with ACE inhibitors and ARBs does not increase ACE2 plasma levels in patients with heart failure (23). ...
Article
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Background: Italy has one of the world's oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertension medications may increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown. Methods: Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site. Results: A large proportion of participating inpatients were ≥65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [ adj OR = 1.35 (1.2, 1.5) p < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death. Polverino et al. Italian NationWide COVID-19 Cohort Study Conclusions: This Italian nationwide observational study of COVID-19 inpatients, the majority of which ≥65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide.
... Nifedipine may be explored as an option in the case of tocolysis 74 . b. Betamethasone/Dexamethasone use should be limited after 34 weeks of gestation as there is an increased risk of COVID-19 related mortality associated with the use of steroids 73,80 . c. Magnesium sulfate: may be used as indicated in patients with mild to moderate respiratory symptoms and in those with delivery before 32 weeks of gestation or preeclampsia 81 . ...
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It is of greatest concern how COVID-19 is affecting pregnancy, mothers, and babies. Scientists are studying the impact of COVID-19 on pregnant women and babies and are understanding a little more every day. Reports show that there is an increased risk in pregnant women compared to nonpregnant women to get more serious illness due to COVID-19. Researchers are also investigating COVID-19 and its potential impact on a fetus. There are exceedingly rare cases of COVID-19 transmission to the fetus, and newborns can pick up COVID-19 when exposed. Vaccines are proved to be safe for pregnant women and help prevent both mother and the fetus from getting COVID-19 and are also highly effective to prevent COVID-19 infection, critical sickness, and fatalities in general. There are specific guidelines for labor and delivery during the COVID-19 pandemic which are to be imposed and followed to achieve safer and healthier childbirth. In this article, the overall influence of COVID-19 in pregnancy, its pathophysiology, effects on placenta and neonates, maternal and perinatal features and outcomes, the role of vaccination, available treatment options, and the guidelines to be followed during the pandemic are discussed based on the available scientific evidence.
... The elevation of ACE2-by-ACE2 antagonists, ACE II receptor blockers, and ibuprofen supports the immediate need to employ and/or find alternate ACE2 blockers. As a result, medicinal plant-derived product lines or NPs that selectively hinder the ACE2 protein without hindering enzyme action could be effective at preventing and treating SARSCoV-2 transmission in humans without raising ACE2 representation inpatient role and thus raising the hazard of COVID-19 infection [41]. ...
Article
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Despite the fact that various therapeutic compounds are being investigated, there is still a scarcity of effective and reliable therapeutic regimens to treat COVID-19. Ever since the COVID-19 pandemic, a diversity of traditional herbal treatments has been investigated to cure infected people, either alone or in conjunction with mainstream pharmaceuticals, with encouraging outcomes. In this article, we look at the latest research on the usage of natural products to alleviate the severity of COVID-19. To determine the activity of the natural products, act against SARS-CoV-2 to various targets like Mpro, ACE-II, papain-like, chymotrypsin-like proteases, and some antiviral targets. The processes underlying this preventative or therapeutic action are also examined. We used PubMed, Scopus, Google Scholar, and the WHO site to perform our review. The anti-SARS-CoV-2 impacts of various herbal extracts and purified compounds may be mediated via direct prevention of viral replication or entrance. Interestingly, certain items might avert SARS-CoV-2 from infecting human cells by blocking the ACE-2 protein or the serine protease TMPRRS2. Natural products have also been stated to suppress proteins intricate in the virus life cycle, like papain-like and chymotrypsin-like proteases. To conclude, natural products can be used alone or in combination as remedies or treatments for COVID-19. In addition, their compositions may provide insight into the development of effective and reliable antiviral drugs.
... To cite a few, a published clinical trial describing the successful use of hydroxychloroquine in COVID-19 patients (Gautret et al., 2020) was actively promoted by the Trump administration (Baker et al., 2020) despite multiple concerns regarding the quality of its study design (Fauci et al., 2020;Servick, 2020;Voss, 2020). Another study, a letter published in the Lancet Respiratory Medicine journal early in the pandemic raising concerns about the use of ibuprofen to treat COVID-19 symptoms (Fang et al., 2020), was initially supported by WHO (Moffitt, 2020) and led doctors to advise against treating COVID-19 fever with nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Day, 2020), and the French Health Ministry to completely ban NSAIDs (DGS-urgent, 2020); all these actions being swiftly reversed once data insufficiency became apparent (Drake et al., 2021). These disputes demonstrate the pressure that the peer-review system and the entire scientific community experienced during the early coronavirus pandemic (Chirico et al., 2020). ...
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This study explores the evolution of publication practices associated with the SARS‐CoV‐2 research papers, namely, peer‐reviewed journal and review articles indexed in PubMed and their associated preprints posted on bioRxiv and medRxiv servers: a total of 4,031 journal article‐preprint pairs. Our assessment of various publication delays during the January 2020 to March 2021 period revealed the early bird effect that lies beyond the involvement of any publisher policy action and is directly linked to the emerging nature of new and ‘hot’ scientific topics. We found that when the early bird effect and data incompleteness are taken into account, COVID‐19 related research papers show only a moderately expedited speed of dissemination as compared with the pre‐pandemic era. Medians for peer‐review and production stage delays were 66 and 15 days, respectively, and the entire conversion process from a preprint to its peer‐reviewed journal article version took 109.5 days. The early bird effect produced an ephemeral perception of a global rush in scientific publishing during the early days of the coronavirus pandemic. We emphasize the importance of considering the early bird effect in interpreting publication data collected at the outset of a newly emerging event.
... One of these services was routine clinical and neuropsychological assessments related to cognitive impairment (CD), given their nature in terms of the interpersonal contact involved 2 . Unfortunately, during quarantine, there was evidence that medical conditions such as diabetes and hypertension 3 , considered risk factors for CD 4 , worsened and that neuropsychiatric symptoms and the risk of CD increased among the elderly 5 . Therefore, the field of neuropsychology had to quickly evolve and adapt, by incorporating telehealth or teleneuropsychology (TNP) assessments to continue providing cognitive assessment and monitoring services to the elderly 6,7 . ...
Article
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The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27–28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases
... One of these services was routine clinical and neuropsychological assessments related to cognitive impairment (CD), given their nature in terms of the interpersonal contact involved 2 . Unfortunately, during quarantine, there was evidence that medical conditions such as diabetes and hypertension 3 , considered risk factors for CD 4 , worsened and that neuropsychiatric symptoms and the risk of CD increased among the elderly 5 . Therefore, the field of neuropsychology had to quickly evolve and adapt, by incorporating telehealth or teleneuropsychology (TNP) assessments to continue providing cognitive assessment and monitoring services to the elderly 6,7 . ...
Article
Full-text available
The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.
... Ha habido evidencia reciente contradictoria con respecto al uso de los antiinflamatorios no esteroideos (AINES) en los pacientes con COVID-19, debido a que se evidenció que este virus se une a la células por medio del receptor convertidor de angiotensina -2, por lo que se postulaba que los AINES, aumentan la expresión de estos receptores, podrían empeorar la enfermedad. 20 Sin embargo esto no ha logrado demostrarse, razón por la cual múltiples organizaciones internacionales incluidas la OMS y la FDA han expresado que no debería haber una restricción con el uso de estos medicamentos. En el contexto clínico de tocólisis, una opción alternativa a la indometacina a considerar es la nifedipina. ...
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Resumen El embarazo es considerado como un estado de inmunosupresión parcial que asociado a los cambios fisiológicos y mecánicos hace susceptible a la mujer a distintas infecciones virales, por lo tanto la pandemia por COVID-19 puede tener implicaciones serias en esta población. La mujer embarazada y su feto representan una población vulnerable durante cualquier brote de una enfermedad infecciosa, razón por la cual es importante contar con información actualizada y confiable para la toma de decisiones clínicas. Se presenta a continuación una revisión de literatura reciente incluyendo aspectos inmunológicos, implicaciones clínicas de la enfermedad en pacientes embarazadas, manejo en este grupo específico de pacientes y recomendaciones con respecto al uso de medicamentos, seguimiento y manejo intraparto, para poder abordar oportunamente a la paciente embarazada con COVID-19, con el objetivo de salvaguardar tanto la vida materna como la fetal ante esta enfermedad que hasta hace poco no conocíamos. Abstract Pregnancy is considered a state of partial immunosuppression, adding to the physiological and mechanical adaptations that take place during pregnancy, pregnant women are more susceptible to viral infections, and the current COVID-19 pandemic is no exception. These women and their fetuses are a highly vulnerable population during any infectious disease outbreak, this is the main reason why the clinician needs access to reliable sources and current information to guide its clinical performance. This review focuses on issues regarding pregnancy and COVID-19, a disease caused by the new coronavirus SARS-CoV-2, and it is intended as a guide in clinical care to help safeguard the mother and the unborn child. Introducción El 11 de marzo del presente año la OMS (Organización Mundial de la Salud) calificó como una Pandemia la enfermedad causada por un virus, hasta hace poco desconocido y en cuestión de meses con una diseminación sin precedentes en la historia moderna este virus alcanza todas las regiones del mundo, lo que sumado a la ausencia de terapia específica contra el virus ha afectado la vida de las personas en una forma inimaginable. La enfermedad conocida como COVID-19 (coronavirus disease 2019) es causada por el virus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), identificado por primera vez en diciembre del 2019 en Wuhan, China.
... It is worth noting that the investigations have revealed that the nonsurviving hypertensive patients were frequently treated with angiotensin converting enzyme (ACE) inhibitors [3]. ...
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The recent elevation of cases infected from novel COVID-19 has placed the human life in trepidation mode, especially for those suffering from comorbidities. Most of the studies in the last few months have undeniably raised concerns for hypertensive patients that face greater risk of fatality from COVID-19. Furthermore, one of the recent WHO reports has estimated a total of 1.13 billion people are at a risk of hypertension of which two-thirds live in low and middle income countries. The gradual escalation of the hypertension problem andthe sudden rise of COVID-19 cases have placed an increasingly higher number of human lives at risk in low and middle income countries. To lower the risk of hypertension, most physicians recommend drugs that have angiotensin-converting enzyme (ACE) inhibitors. However, prolonged use of such drugs is not recommended due to metabolic risks and the increase in the expression of ACE-II which could facilitate COVID-19 infection. In contrast, the intake of optimal macronutrients is one of the possible alternatives to naturally control hypertension. In the present study, a nontrivial feature selection and machine learning algorithm is adopted to intelligently predict the food-derived antihypertensive peptide. The proposed idea of the paper lies in reducing the computational power while retaining the performance of the support vector machine (SVM) by estimating the dominant pattern in the features space through feature filtering. The proposed feature filtering algorithm has reported a trade-off performance by reducing the chances of Type I error, which is desirable when recommending a dietary food to patients suffering from hypertension. The maximum achievable accuracy of the best performing SVM models through feature selection are 86.17% and 85.61%, respectively.
... The severity of coronavirus disease based on the type of underlying disease has not been reported previously, but a number of studies have shown that the most common diseases associated with coronavirus are hypertension, diabetes, and coronary heart disease [21,22]. Fang and his colleagues also showed that the severity of coronavirus disease was higher in people with underlying hypertension, diabetes mellitus, coronary heart disease, and cerebrovascular disease [23]. In addition to underlying diseases mentioned in Table 1, AIDS, acute kidney disease, surgical history, malignant tumors, and epilepsy were examined in this study. ...
Article
Background The SARS-CoV-2 can cause severe pneumonia and highly impact general health. We aimed to investigate different clinical features and CT scan findings of patients with COVID-19 based on disease severity to have a better understanding of this disease. Methods Ninety patients with coronavirus were divided into three categories based on the severity of the disease: mild/moderate, severe, and very severe. Clinical, laboratory, and CT scan findings of the patients were examined retrospectively. Any association between these features and disease severity was assessed. Results The mean age and duration of hospitalization of patients increased with increasing the severity of the disease. The most common clinical symptoms were shortness of breath, cough, and fever. As the severity of the disease increased from mild/moderate to very severe, there was an increase in neutrophil counts and a decrease in lymphocytes and white blood cells (WBC) showing excessive inflammation associated with severe forms of COVID-19. Subpleural changes (81%) and ground-glass opacification/opacity (GGO) lesions (73%) of the lung were the most common features in CT images of COVID-19 patients, and interlobular septal thickening (10%) was the lowest CT feature among patients. Regarding the affected parts of the lung in COVID-19 patients, bilateral, peripheral, and multiple lesions had the highest prevalence. Conclusions It has been shown that clinical, laboratory, and CT scan findings varied in COVID-19 patients based on disease severity, which need to be considered carefully in timely diagnosis and treatment of this illness.
... SARS-CoV-2 binds to target cells via ACE2, which is present in the epithelial cells of the lungs, kidneys, intestines, and blood vessels (25). Once SARS-CoV-2 enters target cells, the virus can trigger an innate or adaptive immune response. ...
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The severity of coronavirus disease 2019 (COVID-19) is determined not only by viral damage to cells but also by the immune reaction in the host. In addition to therapeutic interventions that target the viral infection, immunoregulation may be helpful in the management of COVID-19. Vitamin D exerts effects on both innate and adaptive immunity and subsequently modulates immune responses to bacteria and viruses. Patients with chronic kidney disease (CKD) frequently have vitamin D deficiency and increased susceptibility to infection, suggesting a potential role of vitamin D in this vulnerable population. In this paper, we review the alterations of the immune system, the risk of COVID-19 infections and mechanisms of vitamin D action in the pathogenesis of COVID-19 in CKD patients. Previous studies have shown that vitamin D deficiency can affect the outcomes of COVID-19. Supplementing vitamin D during treatment may be protective against COVID-19. Future studies, including randomized control trials, are warranted to determine the effect of vitamin D supplementation on the recovery from COVID-19 in CKD patients.
... SARS of Corona Virus 2 joins directly to (ACE2) receptor that can be invasion of epithelial cell of many organ such( lung, blood vessel ,kidney and intestine) , which can be stated by epithelial cells of numerous organs(blood vessels, lung, kidney and intestine) (Fang et al.,2020). Though SARS-CoV-2chieflycreates respiratory illness, it may affect renal deficiency in addition to multi-organ failure (MOF) in sober conditions elevated ACE2 appearance identifies equally in bladderurothelial cells and renal proximal tubular cells (Zou et al.,2020). ...
Article
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Coronavirus disease (COVID-19) is a life-threatening and highly infectious disease. It impacts several body organs for example the lungs, kidneys, blood texture and contents, digestive cannel, and heart. The first case emerged in China and rapidly spreading and affirmed a global pandemic. COVID-19 is a major threat and a pandemic all over the world. Severe Acute Respiratory Syndrome Corona Virus2, the cause of coronavirus disease 19, connects to its target cells utilizing (ACE2), Angiotensin Converting Enzyme 2which can be stated via epithelial cells of numerous organs. Corona Virus can basis reasonable or harsh kidney damage with signs involving proteinuria, hematuria, eminent urea nitrogen, and creatinine. The kidney cell contain ACE2 receptors that allow to Corona Virus 2 to join it , attack , duplicate and potentially destroy all tissue
... Most important risk factors for developing COVID-19 in our cohort were older age, male sex smoking, underlying comorbidities such as DM, HTN and pre-existent lung disease. Early on in this pandemic, it was understood that DM and HTN form the major risk for COVID-19 [28,29]. Bhandari et al. reported HTN and DM to be the major underlying conditions from Jaipur, India in 522 COVID-19 patients [30]. ...
... Most important risk factors for developing COVID-19 in our cohort were older age, male sex smoking, underlying comorbidities such as DM, HTN and pre-existent lung disease. Early on in this pandemic, it was understood that DM and HTN form the major risk for COVID-19 [28,29]. Bhandari et al. reported HTN and DM to be the major underlying conditions from Jaipur, India in 522 COVID-19 patients [30]. ...
Article
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Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine (HCQ), glucocorticoids and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited and followed up longitudinally to assess parameters contributing to development of COVID-19 and its outcome. Results COVID-19 occurred in 314 (3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129, 219) days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19. Glucocorticoids in moderate dose (7.5–20 mg/day) conferred higher risk (RR = 1.72) of infection. Among the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence (17.5 vs 5.3 per 1 lakh (Karnataka) and 25.3 vs 7.9 per 1 lakh (Kerala)) and case fatality (4.1% vs 1.3% (Karnataka) and 4.3% vs 0.4% (Kerala)) rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the corresponding geographic region. Conclusions Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients. Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk. The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general population.
... Scientists are becoming interested in ACE2 single nucleotide polymorphisms (SNPs). [10][11][12] Several databases found 298 protein-altering variations in human ACE2 (hACE2). 13 COVID-19 symptoms are acute respiratory distress syndrome (ARDS) and death. ...
Article
It has been a busy year for coronaviruses, with the most recent one causing severe coronavirus illness in 2019 (COVID-19). It is broadly distributed in many human tissues and organs as the potential SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2). ACE2 provides homeostatic modulation of circulation angiotensin II levels by acting as a physiological counterbalance to ACE. They have been linked to COVID-19 disease acquisition, progression, and severity. As a result, we investigated how ACE2 variations and epigenetic variables affect SARS-CoV-2 infection susceptibility and infection outcomes in terms of age, gender, and ethnicity. Debates raged over the etiology of this occurrence. It is important to note that further research is required to demonstrate the efficacy of human recombinant ACE2 and ACE2-derived peptides in fighting SARSCoV-2 variants. Better recognition of a host genetic, as well as the function of the properties of ACE2 variations, would assist in explaining clinical disparities of infection between individuals and contribute to the development of remedies and managing future SARS-CoV-2 epidemics, an essential function for ACE2 in essential hypertension (EH). We wanted to see how ACE2 gene polymorphisms and enzyme activity correlated with COVID-19 incidence in the Iraqi province of Al-Diwaniya. A total of 63 COVID-19 patients and 70 (NT) controls were genotyped using Sequenom Mass-ARRAY RS1000 for ACE2. Participants' ACE2 rs1514283 SNP was linked to COVID-19.
... Hydroxychloroquine, in combination with azithromycin, was one striking example of this, showing no beneficial effects in several randomized clinical trials [10,11], but increased the likelihood of serious side effects [12]. In parallel, concerns related to the intake of certain commonly used medications, including non-steroidal antiinflammatory drugs (NSAIDs) [13] and renin-angiotensin system medications [14], and a subsequent increased risk of severe COVID-19 have also been raised but have not been confirmed. This plethora of new and constantly changing information during the pandemic may have affected the behaviour of prescribers and patients regarding medication use. ...
Preprint
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Information on medication utilization among pregnant and postpartum women during the pandemic is lacking. We described the prevalence and patterns of self-reported medication use among pregnant and postpartum women during the third wave of the pandemic (June–August 2021). An online questionnaire was distributed in five European countries between June–August 2021. Pregnant women or women who had delivered in the three preceding months, and ≥18 years old, could participate. The prevalence of overall medication use, self-medication, and changes in chronic medication use were determined. A total of 2158 women out of 5210 participants (41.4%) used at least one medication. Analgesics (paracetamol), systemic antihistamines (cetirizine), and drugs for gastric disorders (omeprazole) were the three most used classes. Anti-infectives were less prevalent than during pre-pandemic times. Antidepressants and anxiety related medication use remained similar, despite a higher prevalence of these symptoms. Self-medication was reported in 19.4% of women, and 4.1% of chronic medication users reported that they changed a chronic medication on personal initiative due to the pandemic. In conclusion, medication use patterns in our cohort were mostly similar to those of the first COVID-19 wave and the pre-pandemic period. More studies are needed to explore factors associated with self-medication and changes in chronic medication use due to the pandemic in this perinatal population.
... Cardiopulmonary imaging plays an essential role in the diagnosis of SARS-CoV-2 infection and its complications. Imaging can assess the extent of disease, prognosis, and evaluation of therapeutic interventions [1][2][3][4][5][6][7]. Imaging services resources (ISR) such as electrocardiogram (ECG) [8,9], chest X-ray (cX-ray) [10], echocardiogram (cEcho) [11][12][13][14], lung ultrasound (LUS) [15,16], and chest computed tomography (cCT) [17,18] have been at the front line of the pandemic. ...
Article
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Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM.
... Furthermore, the ACE inhibitors and AT1R blockers augment ACE2 expression, which controls hypertension and inflammation resulting from elevated Ang II in hypertensive and diabetic patients. These patients could be in high-risk groups susceptible to infection with SARS-CoV-2 due to higher ACE2 levels that facilitate virus entrance [21]. It has also been well documented that these high-risk groups have a dysbiotic gut microbiota, and this could be considered as another possible explanation for increased susceptibility to COVID-19 infection because of elevated ACE2 and viral entrance. ...
... Adipose tissue could function as a deposit for a wider viral spread with increased immune activation and cytokine amplification in patients associated with abnormal cytokine profiles [114]. SARS-CoV-2 infection depends on its binding to target cells facilitated by ACE2, which is expressed in various human tissue [115], particularly in the lungs, bowels, kidneys, and blood vessels [116]. ...
Article
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Ageing is associated with changes in body composition, such as low muscle mass (sarcopenia), decreased grip strength or physical function (dynapenia), and accumulation of fat mass. When the accumulation of fat mass synergistically accompanies low muscle mass or reduced grip strength, it results in sarcopenic obesity and dynapenic obesity, respectively. These types of obesity contribute to the increased risk of cardiovascular disease and mortality in the elderly, which could increase the damage caused by COVID-19. In this review, we associated factors that could generate a higher risk of COVID-19 complications in dynapenic obesity and sarcopenic obesity. For example, skeletal muscle regulates the expression of inflammatory cytokines and supports metabolic stress in pulmonary disease; hence, the presence of dynapenic obesity or sarcopenic obesity could be related to a poor prognosis in COVID-19 patients.
... This 'miracle drug' could be an essential ally during the COVID-19 pandemic (Amini et al., 2021). The NCDs' list, heart problems, hypertension, diabetes, and problems arising from obesity, are diseases identified as comorbidities in death cases of those affected by the coronavirus (Amini et al., 2021;D'Antiga, 2020;Fang et al., 2020;Hamer et al., 2020). ...
Conference Paper
This paper aims to infer the importance of gyms and health clubs in the fight against non-communicable chronic diseases (NCDs) and the fight against obesity and physical inactivity amid a global pandemic. Neither scholars nor health associations present a clear indicator of devices dealing with physical inactivity, unlike what was done with hospital beds. In this gap lies this article’s purpose: in light of upstream social marketing, to propose that the number of gyms per 100,000 inhabitants, with the physical activity penetration rate, combined in a synthetic variable is an indicator in the fight against physical inactivity and obesity. We strive to offer a synthetic variable, namely Gym Access. We proposed a Gym Access ranking amongst the 61 countries utilizing the new variable. We analyzed secondary data from 61 countries using Confirmatory and Exploratory Factorial Analyses, Linear and Multiple Regression, Process Mediation Analysis, and One-way ANOVA. The latent variable positively impacts the country’s life expectancy, and NCDs absolute risk rate mediates the impact of Gym Access on the country’s life expectancy. Finland ranks first in the Gym Access ranking, and Indonesia ranks last. There is a significant statistical difference between OECD countries compared to other countries.
... Previous studies suggested that COVID-19 patients with underlying medical comorbidities such as hypertension, obesity, chronic cardiac and pulmonary disease, chronic kidney disease, and cancer are at greater risk of mortality and developing severe disease [4][5]. However, hypertension is known to be the most common comorbid condition in COVID-19 patients, which is associated with worse outcomes and prognosis [6]. In one study, hypertension was the most common concomitant condition in 20,982 COVID-19 patients, accounting for 12.6%, while the overall proportion of hypertension was 39.75% in the 406 COVID-19 patients who died [7]. ...
Article
Despite the lack of direct evidence that hypertension increases the likelihood of new infections, hypertension is known to be the most common comorbid condition in COVID-19 patients and also a major risk factor for severe COVID-19 infection. The literature review suggests that data is heterogeneous in terms of the association of hypertension with mortality. Hence, it remains a topic of interest whether hypertension is associated with COVID-19 disease severity and mortality. Herein, we perform a multicenter retrospective analysis to study hypertension as an independent risk for in-hospital mortality in hospitalized COVID-19 patients. This multicenter retrospective analysis included 515 COVID-19 patients hospitalized from March 1, 2020 to May 31, 2020. Patients were divided into two groups: hypertensive and normotensive. Demographic characteristics and laboratory data were collected, and in-hospital mortality was calculated in both groups. The overall mortality of the study population was 25.3% (130 of 514 patients) with 96 (73.8%) being hypertensive and 34 (26.2%) being normotensive (p-value of 0.01, statistically non-significant association). The mortality rate among the hypertensive was higher as compared to non-hypertensive; however, hypertensive patients were more likely to be old and have underlying comorbidities including obesity, diabetes mellitus, coronary artery disease, congestive heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and cancer. Therefore, multivariable logistic regression failed to show any significant association between hypertension and COVID-19 mortality. To our knowledge, few studies have shown an association between hypertension and COVID-19 mortality after adjusting confounding variables. Our study provides further evidence that hypertension is not an independent risk factor for in-hospital mortality when adjusted for other comorbidities in hospitalized COVID-19 patients.
... Cardiopulmonary imaging plays an essential role in the diagnosis of SARS-CoV-2 infection and its complications. Imaging can assess the extent of disease, prognosis, and evaluation of therapeutic interventions [1][2][3][4][5][6][7]. Imaging services resources (ISR) such as electrocardiogram (ECG) [8,9], chest X-ray (cX-ray) [10], echocardiogram (cEcho) [11][12][13][14], lung ultrasound (LUS) [15,16], and chest computed tomography (cCT) [17,18] have been at the front line of the pandemic. ...
Article
Full-text available
Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM.
... On a clinical basis, it should be remembered that individuals with reduced organ ACE-2 expression like diabetic, hypertensive patients, and the elderly, represent setting of subjects proven to be more prone to higher mortality following SARS-CoV-2 infection [28]. On one hand, high levels of ACE-2 favor the entry of the virus into the host cells, on the other hand, low levels of the ACE-2 receptor would be translated into adverse consequences for the host in terms of the progression of the disease. ...
Article
Background: A more severe course of COVID-19 was associated with low levels of Vitamin D (VitD). Moreover in vitro data showed that VitD up-regulates the mRNA of the Angiotensin Converting Enzyme 2 (ACE-2), the SARS-COV-2 receptor in different type of cells. ACE-2 is expressed in several type of tissues including thyroid cells, on which its mRNA was shown to be up-regulated by interferon-gamma (IFN-γ). The aim of the present study was to investigate if treatment with VitD alone or in combination with IFN-γ would increase ACE-2 both at mRNA and protein levels in primary cultures of human thyrocytes. Materials and methods: Primary thyroid cell cultures were treated with VitD and IFN-γ alone or in combination for 24 h. ACE-2 mRNA levels were measured by Real-time Polymerase Chain Reaction (RT-PCR). The presence of ACE-2 on thyroid cell membrane was assessed by immunocytochemistry basally and after the previous mentioned treatments. Results: ACE-2 mRNA levels increased after treatment with VitD and IFN-γ alone. The combination treatment (VitD + IFN-γ) showed an additive increase of ACE-2-mRNA. Immunocytochemistry experiments showed ACE-2 protein on thyroid cells membrane. ACE-2 expression increased after treatment with VitD and IFN-γ alone and further increased by the combination treatment with VitD + IFN-γ. Conclusions: VitD would defend the body by SARS-COV2 both by regulating the host immune defense and by up-regulating of the expression of the ACE-2 receptor. The existence of a co-operation between VitD and IFN-γ demonstrated in other systems is supported also for ACE-2 up-regulation. These observations lead to an increased interest for the potential therapeutic benefits of VitD supplementation in COVID-19.
... Estradiol, a major female sex hormone, presumably regulates ACE2 expression in airway epithelial cells, kidneys, cardiac, and adipose tissues (Stelzig et al., 2020;Gupte et al., 2012;Dalpiaz et al., 2015). The polymorphism of the ACE2 gene correlates with diabetes mellitus, cerebral stroke, and hypertension-a plausible reason these patients carry elevated risk due to COVID-19 (Fang et al., 2020). Other than the ACE2 receptor, SARS-CoV-2 requires another serine protease, transmembrane serine protease 2 (TMPRSS2), to enter the airway epithelial cells [52]. ...
Article
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Multiple lines of evidence indicate that the male sex is a significant risk factor for severe disease and mortality due to coronavirus disease 2019 (COVID-19). However, the precise explanation for the discrepancy is currently unclear. Immunologically, the female-biased protection against COVID-19 could presumably be due to a more rapid and robust immune response to viruses exhibited by males. The female hormones, e.g., estrogens and progesterone, may have protective roles against viral infections. In contrast, male hormones, e.g., testosterone, can act oppositely. Besides, the expression of the ACE-2 receptor in the lung and airway lining, which the SARS-CoV-2 uses to enter cells, is more pronounced in males. Estrogen potentially plays a role in downregulating the expression of ACE-2, which could be a plausible biological explanation for the reduced severity of COVID-19 in females. Comorbidities, e.g., cardiovascular diseases, diabetes, and kidney disorders, are considered significant risk factors for severe outcomes in COVID-19. Age-adjusted data shows that males are statistically more predisposed to these morbidities—amplifying risks for males with COVID-19. In addition, many sociocultural factors and gender-constructed behavior of men and women impact exposure to infections and outcomes. In many parts of the world, women are more likely to abide by health regulations, e.g., mask-wearing and handwashing, than men. In contrast, men, in general, are more involved with high-risk behaviors, e.g., smoking and alcohol consumption, and high-risk jobs that require admixing with people, which increases their risk of exposure to the infection. Overall, males and females suffer differently from COVID-19 due to a complex interplay between many biological and sociocultural factors.
... It is also claimed that the use of ACEi and ARBs can enhance the high expression of ACE2 leading to the accelerated entry of SARS-CoV-2 and so, they recommended cessation of such drugs (Fang et al., 2020a;Fang et al., 2020b;Kuster et al., 2020;Yilmaz et al., 2020). They also claimed that the people who take thiazolidinediones and ibuprofen are over-expressive to this disease as it increases ease expression of ACE2 (Fang et al., 2020a;Kuster et al., 2020, Yilmaz et al., 2020. ...
Article
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COVID-19 is a pandemic malady caused by SARS-CoV-2, a novel coronavirus. It is a global threat that has affected 223 countries and territories all over the world. According to the WHO report as of April 06, 2022 coronavirus has affected 492,189,439 people globally with 6,159,474 confirmed deaths. The pandemic of COVID-19 has badly affected Bangladesh likewise many other countries of the world. According to Worldometer report on 06 April 2022 the number of confirmed cases of COVID-19 were 1,951,903 with 29,123 deaths, and 1,886,036 COVID-19 recoveries in Bangladesh. After originating from China, this notorious virus has been spread to almost all the countries of the world. Its spike protein aids in binding with the ACE2 receptors of the cell membrane resulting in cell entry, replication, and induction of inflammatory and pro-inflammatory responses leading to the pathogenic condition. The novel COVID-19 virus has structural and genetic similarity with its predecessors specially SARS-CoV and MERS-CoV. This review presents the existing literature on COVID-19 and discusses different aspects of COVID-19 including virology, etiology, epidemiology, pathogenesis, diagnosis, transmission and susceptibility and preventive measures of COVID-19.
... Multiple such predictors are still under investigation. These predictors of progression to severe disease and mortality can also aid in the selection of patients who require early intensive care unit (ICU) care [3][4][5][6]. ...
Article
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Introduction: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them. Methodology: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors. Results: The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR) >4 was a common independent predictor of the need for oxygen (p<0.001), need for ICU transfer (p=0.04), and mortality (p=0.06). Clinical risk scores were developed (10*c-reactive protein (CRP) + 14.8*NLR + 12*urea), (10*aspartate transaminase (AST) + 15.7*NLR + 14.28*CRP), (10*NLR + 10.1*creatinine) which, if ≥14.8, ≥25.7, ≥10.1 predicted need for oxygenation, need for ICU transfer and mortality with a sensitivity and specificity (81.6%, 70%), (73.3%, 75.7%), (61.1%, 75%), respectively. Conclusion: The NLR, CRP, urea, creatinine, and AST are independent predictors in identifying patients with poor outcomes. An objective scoring system can be used at the bedside for appropriate triaging of patients and utilization of resources.
... Two further surveys, the last during the third wave due to the more infective omicron variant confirmed these findings with very few GS/BS patients infected and/or with very mild symptoms. This prompt us to investigate the role of angiotensin converting enzyme 2 (ACE2) given that, due to the role of ACE2 as entry point for the virus into the cell, patients under angiotensin receptors blockers or ACE inhibitors, that are held to increase ACE2 levels, might be more susceptible to the infection [55]. The increased levels of ACE2 are a characteristics of GS/BS patients [9,56] and it is also a very important pathway that drives Ang II to Ang 1-7 and to the counterregulatory axis of the RAAS [57]. ...
Article
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Background: Gitelman’s and Bartter’s syndromes (GS/BS) are rare genetic tubulopathies characterized by electrolyte imbalance and activation of the renin angiotensin aldosterone system (RAAS). These syndromes have intriguing biochemical and hormonal abnormalities that leads them to be protected from hypertension, cardiovascular and renal remodeling. Summary: In this review we explore the biochemical/molecular mechanisms induced by the activation of the RAAS and its counterregulatory arm which is particularly activated in GS/BS patients, in the context of blood pressure regulation. In addition, we report our findings in the context of COVID-19 pandemic where we observed GS/BS subjects being protected from infection. Key Messages: The intracellular pathways induced by Ang II starting from induction of oxidative stress and vasoconstriction, are crucial for the progression toward cardiovascular-renal remodeling and might be useful targets in order to reduce/halt the progression of Ang II/oxidative stress-induced cardiovascular-renal morbidity in several diseases.
Article
Background: COVID-19 entails a higher rate of complications in subjects with type 2 diabetes mellitus (T2DM). Likewise, COVID-19 infection can cause alterations in glucose metabolism that may lead to worse control. The aim of the study was to analyse the perceptions of a large group of Spanish physicians about the relationship between COVID-19 and T2DM, as well as the management, monitoring, and treatment of both diseases. Methods: A cross-sectional multicenter national project was conducted based on a survey which included opinion, attitude, and behavior (OAB) questions. Physicians specialised in internal medicine or endocrinology, whose usual clinical practices included the management of T2DM, responded to the survey between March and April 2021. Results: A total of 112 participants responded to the survey, from which 64.3% believed that COVID-19 entailed a higher risk of glycaemic decompensation irrespective of the presence of previously known T2DM. Obesity was considered a risk factor for poor control of T2DM by 57.7% and for a worse course of COVID-19 by 61.0%. Treatment intensification in not-on-target patients was considered by 57.1% in the presence of COVID-19 and by 73.2% in the absence of COVID-19. No participants considered the suspension of dipeptidyl peptidase 4 inhibitors (DPP-4i) in ambulatory patients, 85.7% declared that this therapeutic approach in hospitalized patients should be kept, and 88.4% supported the option of maintaining DPP-4i when corticosteroids were prescribed. Conclusion: The physicians involved in the management of T2DM and COVID-19 are aware of the bidirectional relationship between both conditions. However, the monitoring and therapeutic management of patients with T2DM who are infected by SARS-CoV-2 needs improvement through the following of the current recommendations and available evidence.
Article
Deviations in laboratory tests assessing liver function in patients with COVID-19 are frequently observed. Their importance and pathogenesis are still debated. In our retrospective study, we analyzed liver-related parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), albumin, comorbidities and other selected potential risk factors in patients admitted with SARS-CoV-2 infection to assess their prognostic value for intensive care unit admission, mechanical ventilation necessity and mortality. We compared the prognostic effectiveness of these parameters separately and in pairs to the neutrophil-to-lymphocyte ratio (NLR) as an independent risk factor of in-hospital mortality, using the Akaike Information Criterion (AIC). Data were collected from 2109 included patients. We created models using a sample with complete laboratory tests n = 401 and then applied them to the whole studied group excluding patients with missing singular variables. We estimated that albumin may be a better predictor of the COVID-19-severity course compared to NLR, irrespective of comorbidities (p < 0.001). Additionally, we determined that hypoalbuminemia in combination with AST (OR 1.003, p = 0.008) or TBIL (OR 1.657, p = 0.001) creates excellent prediction models for in-hospital mortality. In conclusion, the early evaluation of albumin levels and liver-related parameters may be indispensable tools for the early assessment of the clinical course of patients with COVID-19.
Article
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Background . The ongoing pandemic of a new coronavirus infection (COVID-19) determines the relevance of the analysis of epidemiological patterns of SARS-CoV-2 spread among the population of the Russian Federation. Aim — study of the manifestations of the epidemic process of COVID-19 in the Russian Federation in 2020–2022. Materials and methods. A retrospective epidemiological analysis of the incidence of COVID-19 in the Russian Federation was carried out from 03/30/2020 to 04/24/2022. The data from the Rospotrebnadzor report No. 970 “Information on cases of infectious diseases in persons with suspected new coronavirus infection”, information portal Stopcoronavirus.rf, etc. were used. The presence of SARS-CoV-2 RNA was confirmed by real-time RT-PCR. Results and discussion. The analysis of the manifestations of the epidemic process of COVID-19 in the Russian Federation in 2020–2022 showed the presence of two stages which differed depending on the influence of the biological factor and the ongoing anti-epidemic measures. There was a pronounced trend in the development of the epidemic process, starting from megacities (Moscow, Moscow region and St. Petersburg), which are major transport hubs and centers of migration activity of the population, to the regions of the Russian Federation. The SARS-CoV-2 pathogenicity has been shown to decrease with each subsequent cycle of the rise in the incidence of COVID-19 against the background of the increased contagiousness of the virus. Conclusion. As a result of the study, risk areas (megacities) and risk groups were identified.
Article
The SARS-CoV-2 pandemia had stimulated the numerous publications emergence on the α1-proteinase inhibitor (α1-PI, α1-antitrypsin), primarily when it was found that high mortality in some regions corresponded to the regions with deficient α1-PI alleles. By analogy with the last century's data, when the root cause of the α1-antitrypsin, genetic deficiency leading to the elastase activation in pulmonary emphysema, was proven. It is evident that proteolysis hyperactivation in COVID-19 may be associated with α1-PI impaired functions. The purpose of this review is to systematize scientific data, critical directions for translational studies on the role of α1-PI in SARS-CoV-2-induced proteolysis hyperactivation as a diagnostic marker and a target in therapy. This review describes the proteinase-dependent stages of a viral infection: the reception and virus penetration into the cell, the plasma aldosterone-angiotensin-renin, kinins, blood clotting systems imbalance. The ACE2, TMPRSS, ADAM17, furin, cathepsins, trypsin- and elastase-like serine proteinases role in the virus tropism, proteolytic cascades activation in blood, and the COVID-19-dependent complications is presented. The analysis of scientific reports on the α1-PI implementation in the SARS-CoV-2-induced inflammation, the links with the infection severity, and comorbidities were carried out. Particular attention is paid to the acquired α1-PI deficiency in assessing the patients with the proteolysis overactivation and chronic non-inflammatory diseases that are accompanied by the risk factors for the comorbidities progression, and the long-term consequences of COVID-19 initiation. Analyzed data on the search and proteases inhibitory drugs usage in the bronchopulmonary cardiovascular pathologies therapy are essential. It becomes evident the antiviral, anti-inflammatory, anticoagulant, anti-apoptotic effect of α1-PI. The prominent data and prospects for its application as a targeted drug in the SARS-CoV-2 acquired pneumonia and related disorders are presented.
Article
In December 2019, a novel respiratory tract infection, from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was detected in China that rapidly spread around the world. This virus possesses spike (S) glycoproteins on the surface of mature virions, like other members of coronaviridae. The S glycoprotein is a crucial viral protein for binding, fusion, and entry into the target cells. Binding the receptor-binding domain (RBD) of S protein to angiotensin-converting enzyme 2 (ACE 2), a cell-surface receptor, mediates virus entry into cells; thus, understanding the basics of ACE2 and S protein, their interactions, and ACE2 targeting could be a potent priority for inhibition of virus infection. This review presents current knowledge of the SARS-CoV-2 basics and entry mechanism, structure and organ distribution of ACE2, and also its function in SARS-CoV-2 entry and pathogenesis. Furthermore, it highlights ACE2 targeting by recombinant ACE2 (rACE2), ACE2 activators, ACE inhibitor, and angiotensin II (Ang II) receptor blocker to control the SARS-CoV-2 infection.
Article
Objective To assess short- and long-term mortality and risk factors in nursing home patients with COVID-19 infection. Design Retrospective two-center cohort study. Setting and participants Dutch nursing home patients with clinically suspected COVID-19 infection confirmed by RT–PCR testing. Methods Data were gathered between March 2020 and November 2020 using electronic medical records, including demographic characteristics, comorbidities, medical management and symptoms on the first day of suspected COVID-19 infection. Mortality at thirty days and six months was assessed using multivariate logistic regression models and Kaplan–Meier analysis. At six months, a subgroup analysis was performed to estimate the mortality risk between COVID-negative patients and patients who survived COVID-19. Risk factors for mortality were assessed through multivariate logistic regression models. Results A total of 321 patients with suspected COVID-19 infection were included, of whom 134 tested positive. Sixty-two patients in the positive group died at thirty days, with a short-term mortality rate of 2.9 (95% CI 1.7–5.3). Risk factors were fatigue (OR 2.6, 95% CI 1.3–6.2) and deoxygenation (OR 2.9, 95% CI 1.3–7.6). At six months, the mortality risk was 2.1 (95% CI 1.3–3.7). Risk factors for six-month mortality were shortness of breath (OR 2.7, 95% CI 1.3–7.0), deoxygenation (OR 2.5, 95% CI 1.1–6.5) and medical management (OR 4.5, 95% CI 1.7–25.8). However, among patients who survived COVID-19 infection, the long-term mortality risk was not sustained (OR 1.0, 95% CI 0.4–2.7). Conclusions and Implications Overall, COVID-19 infection increases short- and long-term mortality risk among nursing home patients. However, this study shows that surviving COVID-19 infection does not lead to increased mortality in the long term within this population. Therefore advanced care planning should focus on quality of life among nursing home patients after COVID-19 infection.
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Background: Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) infection has been widely spread. We aim to investigate the clinical characteristic and allergy status of patients infected by SARS-CoV-2. Methods: Electronical medical records including demographics, clinical manifestation, comorbidities, laboratory data and radiological materials of 140 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection were extracted and analysed. Results: An approximately 1:1 ratio of male (50.7%) and female COVID-19 patients was found, with an overall median age of 57.0 years. All patients were community acquired cases. Fever (91.7%), cough (75.0%), fatigue (75.0%) and gastrointestinal symptoms (39.6%) were the most common clinical manifestations, whereas hypertension (30.0%) and diabetes mellitus (12.1%) were the most common comorbidities. Drug hypersensitivity (11.4%) and urticaria (1.4%) were self-reported by several patients. Asthma or other allergic diseases was not reported by any of the patients. Chronic obstructive pulmonary disease (COPD, 1.4%) and current smokers (1.4%) were rare. Bilateral ground glass or patchy opacity (89.6%) were the most common signs of radiological finding. Lymphopenia (75.4%) and eosinopenia (52.9%) were observed in most patients. Blood eosinophil counts correlate positively with lymphocyte counts in severe (r=0.486, p<0.001) and non-severe (r=0.469, p<0.001) patients after hospital admission. Significantly higher levels of D-dimer, C-reactive protein and procalcitonin were associated with severe patients compared to non-severe patients (all p<0.001). Conclusion: Detailed clinical investigation of 140 hospitalized COVID-19 cases suggest eosinopenia together with lymphopenia may be a potential indicator for diagnosis. Allergic diseases, asthma and COPD are not risk factors for SARS-CoV-2 infection. Elder age, high number of comorbidities and more prominent laboratory abnormalities were associated with severe patients.
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Background: An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods: In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings: Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3-11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation: The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1-2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding: None.
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The recent emergence of Wuhan coronavirus (2019-nCoV) puts the world on alert. 2019-nCoV is reminiscent of the SARS-CoV outbreak in 2002 to 2003. Our decade-long structural studies on the receptor recognition by SARS-CoV have identified key interactions between SARS-CoV spike protein and its host receptor angiotensin-converting enzyme 2 (ACE2), which regulate both the cross-species and human-to-human transmissions of SARS-CoV. One of the goals of SARS-CoV research was to build an atomic-level iterative framework of virus-receptor interactions to facilitate epidemic surveillance, predict species-specific receptor usage, and identify potential animal hosts and animal models of viruses. Based on the sequence of 2019-nCoV spike protein, we apply this predictive framework to provide novel insights into the receptor usage and likely host range of 2019-nCoV. This study provides a robust test of this reiterative framework, providing the basic, translational, and public health research communities with predictive insights that may help study and battle this novel 2019-nCoV.
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The renin-angiotensin system (RAS) is undisputedly one of the most prominent endocrine (tissue-to-tissue), paracrine (cell-to-cell) and intracrine (intracellular/nuclear) vasoactive systems in the physiological regulation of neural, cardiovascular, blood pressure, and kidney function. The importance of the RAS in the development and pathogenesis of cardiovascular, hypertensive and kidney diseases has now been firmly established in clinical trials and practice using renin inhibitors, angiotensin-converting enzyme (ACE) inhibitors, type 1 (AT1) angiotensin II (ANG II) receptor blockers (ARBs), or aldosterone receptor antagonists as major therapeutic drugs. The major mechanisms of actions for these RAS inhibitors or receptor blockers are mediated primarily by blocking the detrimental effects of the classic angiotensinogen/renin/ACE/ANG II/AT1/aldosterone axis. However, the RAS has expanded from this classic axis to include several other complex biochemical and physiological axes, which are derived from the metabolism of this classic axis. Currently, at least five axes of the RAS have been described, with each having its key substrate, enzyme, effector peptide, receptor, and/or downstream signaling pathways. These include the classic angiotensinogen/renin/ACE/ANG II/AT1 receptor, the ANG II/APA/ANG III/AT2/NO/cGMP, the ANG I/ANG II/ACE2/ANG (1-7)/Mas receptor, the prorenin/renin/prorenin receptor (PRR or Atp6ap2)/MAP kinases ERK1/2/V-ATPase, and the ANG III/APN/ANG IV/IRAP/AT4 receptor axes. Since the roles and therapeutic implications of the classic angiotensinogen/renin/ACE/ANG II/AT1 receptor axis have been extensively reviewed, this article will focus primarily on reviewing the roles and therapeutic implications of the vasoprotective axes of the RAS in cardiovascular, hypertensive and kidney diseases.
Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study
  • X Yang
  • Y Yu
  • J Xu
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; published online Feb 24. https://doi.org/10.1016/S2213-2600(20)30079-5.