Research

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12 pages, 992 KiB

Open AccessArticle

Antibiotic Prescription and In-Hospital Mortality in COVID-19: A Prospective Multicentre Cohort Study

by Larisa Pinte, Alexandr Ceasovschih, Cristian-Mihail Niculae, Laura Elena Stoichitoiu, Razvan Adrian Ionescu, Marius Ioan Balea, Roxana Carmen Cernat, Nicoleta Vlad, Vlad Padureanu, Adrian Purcarea, Camelia Badea, Adriana Hristea, Laurenţiu Sorodoc and Cristian Baicus

J. Pers. Med. 2022, 12(6), 877; https://doi.org/10.3390/jpm12060877 - 26 May 2022

Cited by 12 | Viewed by 3644

Abstract

Background: Since the beginning of the COVID-19 pandemic, empiric antibiotics (ATBs) have been prescribed on a large scale in both in- and outpatients. We aimed to assess the impact of antibiotic treatment on the outcomes of hospitalised patients with moderate and severe coronavirus [...] Read more.

Background: Since the beginning of the COVID-19 pandemic, empiric antibiotics (ATBs) have been prescribed on a large scale in both in- and outpatients. We aimed to assess the impact of antibiotic treatment on the outcomes of hospitalised patients with moderate and severe coronavirus disease 2019 (COVID-19). Methods: We conducted a prospective multicentre cohort study in six clinical hospitals, between January 2021 and May 2021. Results: We included 553 hospitalised COVID-19 patients, of whom 58% (311/553) were prescribed antibiotics, while bacteriological tests were performed in 57% (178/311) of them. Death was the outcome in 48 patients—39 from the ATBs group and 9 from the non-ATBs group. The patients who received antibiotics during hospitalisation had a higher mortality (RR = 3.37, CI 95%: 1.7–6.8), and this association was stronger in the subgroup of patients without reasons for antimicrobial treatment (RR = 6.1, CI 95%: 1.9–19.1), while in the subgroup with reasons for antimicrobial therapy the association was not statistically significant (OR = 2.33, CI 95%: 0.76–7.17). After adjusting for the confounders, receiving antibiotics remained associated with a higher mortality only in the subgroup of patients without criteria for antibiotic prescription (OR = 10.3, CI 95%: 2–52). Conclusions: In our study, antibiotic treatment did not decrease the risk of death in the patients with mild and severe COVID-19, but was associated with a higher risk of death in the subgroup of patients without reasons for it. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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11 pages, 1207 KiB

Open AccessArticle

A Single Session of Virtual Reality Improved Tiredness, Shortness of Breath, Anxiety, Depression and Well-Being in Hospitalized Individuals with COVID-19: A Randomized Clinical Trial

by Isabele Moraes Rodrigues, Adriana Gomes Lima, Ana Evelyn dos Santos, Anne Carolline Almeida Santos, Luciana Silva do Nascimento, Maria Veronica Cavalcanti Lins Serra, Terezinha de Jesus Santos Pereira, Felipe Douglas Silva Barbosa, Valquiria Martins Seixas, Katia Monte-Silva, Kelly Regina Dias da Silva Scipioni, Daniel Marinho Cezar da Cruz, Daniele Piscitelli, Michela Goffredo, Miburge Bolivar Gois-Junior and Aristela de Freitas Zanona

J. Pers. Med. 2022, 12(5), 829; https://doi.org/10.3390/jpm12050829 - 19 May 2022

Cited by 9 | Viewed by 3015

Abstract

Background: In 2020, the world was surprised by the spread and mass contamination of the new Coronavirus (COVID-19). COVID-19 produces symptoms ranging from a common cold to severe symptoms that can lead to death. Several strategies have been implemented to improve the well-being [...] Read more.

Background: In 2020, the world was surprised by the spread and mass contamination of the new Coronavirus (COVID-19). COVID-19 produces symptoms ranging from a common cold to severe symptoms that can lead to death. Several strategies have been implemented to improve the well-being of patients during their hospitalization, and virtual reality (VR) has been used. However, whether patients hospitalized for COVID-19 can benefit from this intervention remains unclear. Therefore, this study aimed to investigate whether VR contributes to the control of pain symptoms, the sensation of dyspnea, perception of well-being, anxiety, and depression in patients hospitalized with COVID-19. Methods: A randomized, double-blind clinical trial was designed. Patients underwent a single session of VR and usual care. The experimental group (n = 22) received VR content to promote relaxation, distraction, and stress relief, whereas the control group (n = 22) received non-specific VR content. Results: The experimental group reported a significant decrease in tiredness, shortness of breath, anxiety, and an increase in the feeling of well-being, whereas the control group showed improvement only in the tiredness and anxiety. Conclusions: VR is a resource that may improve the symptoms of tiredness, shortness of breath, anxiety, and depression in patients hospitalized with COVID-19. Future studies should investigate the effect of multiple VR sessions on individuals with COVID-19. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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15 pages, 771 KiB

Open AccessArticle

Do the Successive Waves of SARS-CoV-2, Vaccination Status and Place of Infection Influence the Clinical Picture and COVID-19 Severity among Patients with Persistent Clinical Symptoms? The Retrospective Study of Patients from the STOP-COVID Registry of the PoLoCOV-Study

by Michał Chudzik, Mateusz Babicki, Joanna Kapusta, Damian Kołat, Żaneta Kałuzińska, Agnieszka Mastalerz-Migas and Piotr Jankowski

J. Pers. Med. 2022, 12(5), 706; https://doi.org/10.3390/jpm12050706 - 28 Apr 2022

Cited by 9 | Viewed by 2232

Abstract

The severity of ailments caused by SARS-CoV-2 varies and the clinical picture has already evolved during the pandemic, complicating diagnostics. In Poland, no study has been performed to assess the clinical picture of patients across the successive pandemic waves. The aim of the [...] Read more.

The severity of ailments caused by SARS-CoV-2 varies and the clinical picture has already evolved during the pandemic, complicating diagnostics. In Poland, no study has been performed to assess the clinical picture of patients across the successive pandemic waves. The aim of the study was to present the characteristics of patients who present to medical center because of persistent symptoms after COVID-19, and to study differences between hospitalized/non-hospitalized, vaccinated/non-vaccinated individuals and between different waves in Poland. This is a retrospective study evaluating the clinical presentation of COVID-19 patients from the STOP-COVID registry of the PoLoCOV-Study. This registry includes patients who present to the medical center because of persistent clinical symptoms after the isolation. The patients’ data were obtained from individuals who suffered from COVID-19 between September 2020 and December 2021.The patients were divided into groups according to the infection rate increase pattern (II/III/IV pandemic wave), status of vaccination and place of isolation. Regardless of the pandemic wave, the patients’ most commonly reported weaknesses were a cough and a headache. The arterial hypertension and hyperlipidemia were the most frequent concomitant chronic conditions. Hospitalized patients more often reported weakness or a cough while home-isolated patients were more likely to have rhinitis or a headache. Patients who completed the vaccination course showed a shorter duration of clinical symptoms and a lower mean number of symptoms. Additionally, vaccinated individuals reported less taste and/or olfactory dysfunction than unvaccinated individuals. To conclude, the persistence of the pandemic has resulted in significant changes observed in the clinical picture. Successive waves caused deterioration in the subjective assessment of the disease severity. A cough seemed to occur more frequently in the later pandemic waves. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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11 pages, 712 KiB

Open AccessArticle

Depression, Insomnia and Post-Traumatic Stress Disorder in COVID-19 Survivors: Role of Gender and Impact on Quality of Life

by Sofia Pappa, Zafeiria Barmparessou, Nikolaos Athanasiou, Elpitha Sakka, Kostas Eleftheriou, Stavros Patrinos, Nikolaos Sakkas, Apostolis Pappas, Ioannis Kalomenidis and Paraskevi Katsaounou

J. Pers. Med. 2022, 12(3), 486; https://doi.org/10.3390/jpm12030486 - 17 Mar 2022

Cited by 22 | Viewed by 3679

Abstract

Evidence to date suggests that a significant proportion of COVID-19 patients experience adverse psychological outcomes and neuropsychiatric complications. The aim of this study was to evaluate the effect of SARS-CoV-2 infection and subsequent hospitalization on the mental health, sleep, and quality of life [...] Read more.

Evidence to date suggests that a significant proportion of COVID-19 patients experience adverse psychological outcomes and neuropsychiatric complications. The aim of this study was to evaluate the effect of SARS-CoV-2 infection and subsequent hospitalization on the mental health, sleep, and quality of life of COVID-19 survivors. Patients were assessed 1–2 months after hospital discharge using standardized screening tools for depression and anxiety (HADS), post-traumatic stress disorder (IES-R), insomnia (AIS), and quality of life (EQ-5D-5L). Sociodemographic factors, comorbidities, disease severity and type of hospitalization were also collected. Amongst the 143 patients included, mental health symptoms were common (depression—19%; anxiety—27%; traumatic stress—39%; insomnia—33%) and more frequently reported in female than in male patients. Age, smoking status, comorbidities and illness severity were not found to significantly correlate with the presence of mood, sleep, or stress disorders. Finally, quality of life was worse for patients requiring ICU (p = 0.0057) or a longer hospital stay (p < 0.001) but was unaffected by factors such as sex and other measured outcomes. These findings highlight the need for appropriate intervention to properly manage the immediate and enduring mental health complications of COVID-19. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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14 pages, 1384 KiB

Open AccessArticle

Fever, Tachypnea, and Monocyte Distribution Width Predicts Length of Stay for Patients with COVID-19: A Pioneer Study

by Sheng-Feng Lin, Hui-An Lin, Han-Chuan Chuang, Hung-Wei Tsai, Ning Kuo, Shao-Chun Chen and Sen-Kuang Hou

J. Pers. Med. 2022, 12(3), 449; https://doi.org/10.3390/jpm12030449 - 12 Mar 2022

Cited by 5 | Viewed by 2186

Abstract

(1) Background: Our study investigated whether monocyte distribution width (MDW) could be used in emergency department (ED) settings as a predictor of prolonged length of stay (LOS) for patients with COVID-19. (2) Methods: A retrospective cohort study was conducted; patients presenting to the [...] Read more.

(1) Background: Our study investigated whether monocyte distribution width (MDW) could be used in emergency department (ED) settings as a predictor of prolonged length of stay (LOS) for patients with COVID-19. (2) Methods: A retrospective cohort study was conducted; patients presenting to the ED of an academic hospital with confirmed COVID-19 were enrolled. Multivariable logistic regression models were used to obtain the odds ratios (ORs) for predictors of an LOS of >14 days. A validation study for the association between MDW and cycle of threshold (Ct) value was performed. (3) Results: Fever > 38 °C (OR: 2.82, 95% CI, 1.13–7.02, p = 0.0259), tachypnea (OR: 4.76, 95% CI, 1.67–13.55, p = 0.0034), and MDW ≥ 21 (OR: 5.67, 95% CI, 1.19–27.10, p = 0.0269) were robust significant predictors of an LOS of >14 days. We developed a new scoring system in which patients were assigned 1 point for fever > 38 °C, 2 points for tachypnea > 20 breath/min, and 3 points for MDW ≥ 21. The optimal cutoff was a score of ≥2. MDW was negatively associated with Ct value (β: −0.32 per day, standard error = 0.12, p = 0.0099). (4) Conclusions: Elevated MDW was associated with a prolonged LOS. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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13 pages, 1877 KiB

Open AccessArticle

High Angiotensin-Converting Enzyme and Low Carboxypeptidase N Serum Activity Correlate with Disease Severity in COVID-19 Patients

by Phil-Robin Tepasse, Richard Vollenberg, Nico Steinebrey and Simone König

J. Pers. Med. 2022, 12(3), 406; https://doi.org/10.3390/jpm12030406 - 05 Mar 2022

Cited by 7 | Viewed by 1808

Abstract

(1) Background: Angiotensin-converting enzyme 2 (ACE2) is a functional receptor of SARS-CoV-2 and counter-balances ACE in the renin–angiotensin system (RAS). An imbalance of the RAS could be associated with severe COVID-19 progression. (2) Methods: Activities of serum proteases angiotensin-converting enzyme (ACE) and carboxypeptidase [...] Read more.

(1) Background: Angiotensin-converting enzyme 2 (ACE2) is a functional receptor of SARS-CoV-2 and counter-balances ACE in the renin–angiotensin system (RAS). An imbalance of the RAS could be associated with severe COVID-19 progression. (2) Methods: Activities of serum proteases angiotensin-converting enzyme (ACE) and carboxypeptidase N (CPN) for 45 hospitalized and 26 convalescent COVID-19 patients were investigated vs. healthy controls using labeled bradykinin (DBK) degradation with and without inhibition by captopril as a read-out. Data were correlated to clinical parameters. (3) Results: DBK degradation and CPN activity were significantly reduced gender-independently in COVID-19 and returned to normal during convalescence. ACE activity was over-active in severe disease progression; product DBK1-5 was significantly increased in critically ill patients and strongly correlated with clinical heart and liver parameters. ACE inhibitors seemed to be protective, as DBK1-5 levels were normal in moderately ill patients in contrast to critically ill patients. (4) Conclusions: CPN and ACE serum activity correlated with disease severity. The RAS is affected in COVID-19, and ACE could be a therapeutic target. Further proof from dedicated studies is needed. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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12 pages, 669 KiB

Open AccessArticle

A Machine Learning Approach to Predict the Rehabilitation Outcome in Convalescent COVID-19 Patients

by Sarah Adamo, Pasquale Ambrosino, Carlo Ricciardi, Mariasofia Accardo, Marco Mosella, Mario Cesarelli, Giovanni d’Addio and Mauro Maniscalco

J. Pers. Med. 2022, 12(3), 328; https://doi.org/10.3390/jpm12030328 - 22 Feb 2022

Cited by 5 | Viewed by 2056

Abstract

Background: After the acute disease, convalescent coronavirus disease 2019 (COVID-19) patients may experience several persistent manifestations that require multidisciplinary pulmonary rehabilitation (PR). By using a machine learning (ML) approach, we aimed to evaluate the clinical characteristics predicting the effectiveness of PR, expressed by [...] Read more.

Background: After the acute disease, convalescent coronavirus disease 2019 (COVID-19) patients may experience several persistent manifestations that require multidisciplinary pulmonary rehabilitation (PR). By using a machine learning (ML) approach, we aimed to evaluate the clinical characteristics predicting the effectiveness of PR, expressed by an improved performance at the 6-min walking test (6MWT). Methods: Convalescent COVID-19 patients referring to a Pulmonary Rehabilitation Unit were consecutively screened. The 6MWT performance was partitioned into three classes, corresponding to different degrees of improvement (low, medium, and high) following PR. A multiclass supervised classification learning was performed with random forest (RF), adaptive boosting (ADA-B), and gradient boosting (GB), as well as tree-based and k-nearest neighbors (KNN) as instance-based algorithms. Results: To train and validate our model, we included 189 convalescent COVID-19 patients (74.1% males, mean age 59.7 years). RF obtained the best results in terms of accuracy (83.7%), sensitivity (84.0%), and area under the ROC curve (94.5%), while ADA-B reached the highest specificity (92.7%). Conclusions: Our model enables a good performance in predicting the rehabilitation outcome in convalescent COVID-19 patients. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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8 pages, 697 KiB

Open AccessCommunication

Evaluating the Role of the Interleukin-23/17 Axis in Critically Ill COVID-19 Patients

by Edison Jahaj, Alice G. Vassiliou, Chrysi Keskinidou, Parisis Gallos, Charikleia S. Vrettou, Stamatios Tsipilis, Zafeiria Mastora, Stylianos E. Orfanos, Ioanna Dimopoulou and Anastasia Kotanidou

J. Pers. Med. 2021, 11(9), 891; https://doi.org/10.3390/jpm11090891 - 07 Sep 2021

Cited by 4 | Viewed by 2035

Abstract

Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured [...] Read more.

Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured on admission to the intensive care unit (ICU) in critically ill COVID-19 (N = 38) and critically ill non-COVID-19 (N = 34) patients with an equal critical illness severity. Critically ill non-COVID-19 patients did not have sepsis or septic shock on ICU admission. None of the enrolled patients had previously received corticosteroids. In our study, circulating IL-17 levels were higher in the COVID-19 patients. More specifically, critically ill COVID-19 patients had levels of 0.78 (0.05–1.8) pg/mL compared to 0.11 (0.05–0.9) pg/mL in the critically ill non-COVID-19 patients (p = 0.04). In contrast, IL-23 levels were comparable between groups. A group of patients hospitalized in the specialized COVID-19 clinic (N = 16) was also used to evaluate IL-17 and IL-23 levels with respect to COVID-19 severity. Non-critically ill COVID-19 patients had undetectable levels of both cytokines. Our results support the notion of inhibiting IL-17 in critical COVID-19 infection. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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13 pages, 1004 KiB

Open AccessFeature PaperArticle

Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic

by Yolanda Cuñarro-López, Pilar Pintado-Recarte, Concepción Hernández-Martín, Pilar Paya-Martínez, Rocío López-Pérez, Ignacio Cueto-Hernández, Javier Ruiz-Labarta, Óscar Cano-Valderrama, Óscar Martínez-Pérez, Coral Bravo-Arribas, Miguel A. Ortega and Juan Antonio De León-Luis

J. Pers. Med. 2021, 11(7), 599; https://doi.org/10.3390/jpm11070599 - 25 Jun 2021

Cited by 4 | Viewed by 2791

Abstract

During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We [...] Read more.

During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We conducted an observational, analytical, ambispective cohort study with longitudinal follow-up of mothers with confirmed SARV-CoV-2 infection from different hospitals in our country between March–November 2020. We recruited 1295 pregnant women with SARS-CoV2 infection from 78 hospitals, 846 (65.3%) of whom were diagnosed during the first wave and 449 (34.7%) during the second wave. Our results show that patients developing COVID-19 during the first wave had more symptoms at triage, early in pregnancy with greater rates of COVID-19-related maternal morbidity; caesarean section and preterm birth in the first wave. We register two cases of maternal mortality and only during the first wave. Maternal morbidity events showed a strong link to perinatal mortality events in the first wave compared to the second wave, in which maternal morbidity was more associated with pneumonia. Likewise, maternal morbidity showed a strong correlation with perinatal morbidity events in both waves. We describe the differences between the patients’ profiles and management between the two waves and related to maternal and perinatal outcomes. Differences were also observed in the management of pregnant women with COVID-19. Thus, there were fewer caesarean sections, and maternal and perinatal morbidity events were reduced in the second wave, while the impacts of respiratory symptoms and their severity, including a greater need for maternal treatment, were greater in this last period. Identifying the impact that changes in the profile as well as in the treatment have on maternal–perinatal morbidity and mortality will help improve the well-being of our patients and their newborns. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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7 pages, 490 KiB

Open AccessCommunication

Antibody Response Following a Two-Dose mRNA Vaccination Regimen, in Health Care Workers of a Tertiary Hospital in Athens, Greece

by Elissavet Kontou, Kyriaki Ranellou, Dimitrios Zoulas, Anastasia Bletsa, Eirini Rompola, Evangelia-Theophano Piperaki, Nikolaos Athanasiou, Kleio Ampelakiotou, Maria Pratikaki, Christina Stergiopoulou, Athina Argyropoulou, Androula Alevra, Aggeliki Megalou and Alexandra Tsirogianni

J. Pers. Med. 2021, 11(6), 576; https://doi.org/10.3390/jpm11060576 - 19 Jun 2021

Cited by 15 | Viewed by 3178

Abstract

We analyzed the antibody responses of 564 hospital workers in Athens, Greece, after vaccination with two doses of the BNT162b2 (Comirnaty^®; BioNTech and Pfizer) mRNA COVID-19 vaccine. A greater antibody increase was observed in women, younger age groups, previously infected individuals [...] Read more.

We analyzed the antibody responses of 564 hospital workers in Athens, Greece, after vaccination with two doses of the BNT162b2 (Comirnaty^®; BioNTech and Pfizer) mRNA COVID-19 vaccine. A greater antibody increase was observed in women, younger age groups, previously infected individuals and personnel working in COVID-19 clinics. Notably, individuals with a prior COVID-19 infection mounted a significantly higher antibody titer following the first dose than the rest of the population; the same was true for those working in COVID-19 clinics, even without history of previous infection. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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8 pages, 243 KiB

Open AccessArticle

Evolution of a Cohort of COVID-19 Infection Suspects Followed-Up from Primary Health Care

by Valle Coronado-Vázquez, Maria del Valle Ramírez-Durán, Juan Gómez-Salgado, María Silvia Dorado-Rabaneda, Elena Benito-Alonso, Marina Holgado-Juan and Cristina Bronchalo-González

J. Pers. Med. 2021, 11(6), 459; https://doi.org/10.3390/jpm11060459 - 24 May 2021

Cited by 8 | Viewed by 2116

Abstract

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose [...] Read more.

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p < 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

Review

Jump to: Research

36 pages, 4079 KiB

Open AccessReview

Nucleic Acid-Based COVID-19 Therapy Targeting Cytokine Storms: Strategies to Quell the Storm

by Mai Abdel Haleem Abusalah, Moad Khalifa, Mohammad A. I. Al-Hatamleh, Mu’taman Jarrar, Rohimah Mohamud and Yean Yean Chan

J. Pers. Med. 2022, 12(3), 386; https://doi.org/10.3390/jpm12030386 - 03 Mar 2022

Cited by 4 | Viewed by 4481

Abstract

Coronavirus disease 2019 (COVID-19) has shaken the world and triggered drastic changes in our lifestyle to control it. Despite the non-typical efforts, COVID-19 still thrives and plagues humanity worldwide. The unparalleled degree of infection has been met with an exceptional degree of research [...] Read more.

Coronavirus disease 2019 (COVID-19) has shaken the world and triggered drastic changes in our lifestyle to control it. Despite the non-typical efforts, COVID-19 still thrives and plagues humanity worldwide. The unparalleled degree of infection has been met with an exceptional degree of research to counteract it. Many drugs and therapeutic technologies have been repurposed and discovered, but no groundbreaking antiviral agent has been introduced yet to eradicate COVID-19 and restore normalcy. As lethality is directly correlated with the severity of disease, hospitalized severe cases are of the greatest importance to reduce, especially the cytokine storm phenomenon. This severe inflammatory phenomenon characterized by elevated levels of inflammatory mediators can be targeted to relieve symptoms and save the infected patients. One of the promising therapeutic strategies to combat COVID-19 is nucleic acid-based therapeutic approaches, including microRNAs (miRNAs). This work is an up-to-date review aimed to comprehensively discuss the current nucleic acid-based therapeutics against COVID-19 and their mechanisms of action, taking into consideration the emerging SARS-CoV-2 variants of concern, as well as providing potential future directions. miRNAs can be used to run interference with the expression of viral proteins, while endogenous miRNAs can be targeted as well, offering a versatile platform to control SARS-CoV-2 infection. By targeting these miRNAs, the COVID-19-induced cytokine storm can be suppressed. Therefore, nucleic acid-based therapeutics (miRNAs included) have a latent ability to break the COVID-19 infection in general and quell the cytokine storm in particular. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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18 pages, 323 KiB

Open AccessReview

Sleep Dysfunction in COVID-19 Patients: Prevalence, Risk Factors, Mechanisms, and Management

by Athanasia Pataka, Seraphim Kotoulas, Elpitha Sakka, Paraskevi Katsaounou and Sofia Pappa

J. Pers. Med. 2021, 11(11), 1203; https://doi.org/10.3390/jpm11111203 - 14 Nov 2021

Cited by 22 | Viewed by 4795

Abstract

During the COVID-19 pandemic, the need to establish the prevalence of sleep dysfunction and psychological distress, identify predisposing and protective factors, and explore effective management strategies remains an important priority. Evidence to date suggests that a considerable proportion of COVID-19 patients experience significant [...] Read more.

During the COVID-19 pandemic, the need to establish the prevalence of sleep dysfunction and psychological distress, identify predisposing and protective factors, and explore effective management strategies remains an important priority. Evidence to date suggests that a considerable proportion of COVID-19 patients experience significant sleep disturbances (estimated to afflict up to 50–75%) as well as psychological distress such as depression, anxiety, and traumatic stress. Duration of hospitalization, pre-existing mental health concerns, lower absolute lymphocyte count, and increased neutrophil-to-lymphocyte ratio have been all associated with a greater risk of sleep dysfunction in infected and hospitalized patients. Furthermore, in this review, we discuss the link between sleep deprivation, susceptibility to viral infections, and psychosocial wellbeing in relevance to COVID-19 and summarize the existing evidence regarding the presence and role of sleep apnea in infected individuals. Finally, we highlight the importance of suitable interventions in order to prevent and manage sleep dysfunction and avoid long-term physical and psychological implications. Future research should aim to provide high-quality information including in high risk, underserved, or difficult to reach populations and on the long-term consequences and effectiveness of applied interventions. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

18 pages, 353 KiB

Open AccessReview

COVID-19 ARDS: Points to Be Considered in Mechanical Ventilation and Weaning

by Eumorfia Kondili, Demosthenes Makris, Dimitrios Georgopoulos, Nikoletta Rovina, Anastasia Kotanidou and Antonia Koutsoukou

J. Pers. Med. 2021, 11(11), 1109; https://doi.org/10.3390/jpm11111109 - 28 Oct 2021

Cited by 13 | Viewed by 3371

Abstract

The COVID-19 disease can cause hypoxemic respiratory failure due to ARDS, requiring invasive mechanical ventilation. Although early studies reported that COVID-19-associated ARDS has distinctive features from ARDS of other causes, recent observational studies have demonstrated that ARDS related to COVID-19 shares common clinical [...] Read more.

The COVID-19 disease can cause hypoxemic respiratory failure due to ARDS, requiring invasive mechanical ventilation. Although early studies reported that COVID-19-associated ARDS has distinctive features from ARDS of other causes, recent observational studies have demonstrated that ARDS related to COVID-19 shares common clinical characteristics and respiratory system mechanics with ARDS of other origins. Therefore, mechanical ventilation in these patients should be based on strategies aiming to mitigate ventilator-induced lung injury. Assisted mechanical ventilation should be applied early in the course of mechanical ventilation by considering evaluation and minimizing factors associated with patient-inflicted lung injury. Extracorporeal membrane oxygenation should be considered in selected patients with refractory hypoxia not responding to conventional ventilation strategies. This review highlights the current and evolving practice in managing mechanically ventilated patients with ARDS related to COVID-19. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

16 pages, 324 KiB

Open AccessReview

COVID-19 Advanced Care

by Evangelia Fouka, Ioannis Kalomenidis, Niki Gianniou, Sofia Gida and Paschalis Steiropoulos

J. Pers. Med. 2021, 11(11), 1082; https://doi.org/10.3390/jpm11111082 - 25 Oct 2021

Cited by 1 | Viewed by 1890

Abstract

The coronavirus disease 2019 (COVID-19) pandemic, related to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial burden in public health due to an enormous increase in hospitalizations for pneumonia with the multiorgan disease. Treatment for [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic, related to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial burden in public health due to an enormous increase in hospitalizations for pneumonia with the multiorgan disease. Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care, and ongoing trials are testing the efficacy of antiviral therapies, immune modulators and anticoagulants in the prevention of disease progression and complications, while monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies. Consensus suggestions can standardize care, thereby improving outcomes and facilitating future research. This review discusses current evidence regarding the pharmacotherapy of COVID-19. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

18 pages, 1752 KiB

Open AccessReview

Direct and Indirect Effects of COVID-19 in Frail Elderly: Interventions and Recommendations

by María Guadalupe Pizano-Escalante, Luis Miguel Anaya-Esparza, Karla Nuño, José de Jesús Rodríguez-Romero, Sughey Gonzalez-Torres, David A. López-de la Mora and Zuamí Villagrán

J. Pers. Med. 2021, 11(10), 999; https://doi.org/10.3390/jpm11100999 - 02 Oct 2021

Cited by 13 | Viewed by 4004

Abstract

Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to [...] Read more.

Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to describe frailty as a physiological vulnerability agent during the COVID-19 pandemic in elderly patients, summarizing the direct and indirect effects caused by the SARS-COV-2 infection and its prognosis in frail individuals, as well as the interventions and recommendations to reduce their effects. Cohort studies have shown that patients with a Clinical Frailty Scale higher than five have a higher risk of mortality and use of mechanical ventilation after COVID-19; nonetheless, other scales have also associated frailty with longer hospital stays and more severe forms of the disease. Additionally, the indirect effects caused by the pandemic have a negative impact on the health status of older people. Due to the above, a holistic intervention is proposed based on a comprehensive geriatric assessment for frail patients (preventive or post-infection) with emphasis on physical activity and nutritional recommendations, which could be a potential preventive intervention in viral infections by COVID-19. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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18 pages, 478 KiB

Open AccessReview

Management of COVID-19 Patients in the Emergency Department

by Ioannis Pantazopoulos, Stamatoula Tsikrika, Stavroula Kolokytha, Emmanouil Manos and Konstantinos Porpodis

J. Pers. Med. 2021, 11(10), 961; https://doi.org/10.3390/jpm11100961 - 27 Sep 2021

Cited by 8 | Viewed by 2386

Abstract

COVID-19 is an emerging disease of global public health concern. As the pandemic overwhelmed emergency departments (EDs), a restructuring of emergency care delivery became necessary in many hospitals. Furthermore, with more than 2000 papers being published each week, keeping up with ever-changing information [...] Read more.

COVID-19 is an emerging disease of global public health concern. As the pandemic overwhelmed emergency departments (EDs), a restructuring of emergency care delivery became necessary in many hospitals. Furthermore, with more than 2000 papers being published each week, keeping up with ever-changing information has proven to be difficult for emergency physicians. The aim of the present review is to provide emergency physician with a summary of the current literature regarding the management of COVID-19 patients in the emergency department. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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21 pages, 403 KiB

Open AccessReview

COVID Mortality Prediction with Machine Learning Methods: A Systematic Review and Critical Appraisal

by Francesca Bottino, Emanuela Tagliente, Luca Pasquini, Alberto Di Napoli, Martina Lucignani, Lorenzo Figà-Talamanca and Antonio Napolitano

J. Pers. Med. 2021, 11(9), 893; https://doi.org/10.3390/jpm11090893 - 07 Sep 2021

Cited by 36 | Viewed by 4347

Abstract

More than a year has passed since the report of the first case of coronavirus disease 2019 (COVID), and increasing deaths continue to occur. Minimizing the time required for resource allocation and clinical decision making, such as triage, choice of ventilation modes and [...] Read more.

More than a year has passed since the report of the first case of coronavirus disease 2019 (COVID), and increasing deaths continue to occur. Minimizing the time required for resource allocation and clinical decision making, such as triage, choice of ventilation modes and admission to the intensive care unit is important. Machine learning techniques are acquiring an increasingly sought-after role in predicting the outcome of COVID patients. Particularly, the use of baseline machine learning techniques is rapidly developing in COVID mortality prediction, since a mortality prediction model could rapidly and effectively help clinical decision-making for COVID patients at imminent risk of death. Recent studies reviewed predictive models for SARS-CoV-2 diagnosis, severity, length of hospital stay, intensive care unit admission or mechanical ventilation modes outcomes; however, systematic reviews focused on prediction of COVID mortality outcome with machine learning methods are lacking in the literature. The present review looked into the studies that implemented machine learning, including deep learning, methods in COVID mortality prediction thus trying to present the existing published literature and to provide possible explanations of the best results that the studies obtained. The study also discussed challenging aspects of current studies, providing suggestions for future developments. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

19 pages, 1105 KiB

Open AccessReview

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

by Evangelia Akoumianaki, Eleni Ischaki, Konstantinos Karagiannis, Ioanna Sigala and Spyros Zakyn-thinos

J. Pers. Med. 2021, 11(9), 884; https://doi.org/10.3390/jpm11090884 - 03 Sep 2021

Cited by 9 | Viewed by 3799

Abstract

Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation [...] Read more.

Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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13 pages, 285 KiB

Open AccessReview

Long COVID-19 Pulmonary Sequelae and Management Considerations

by Afroditi K. Boutou, Andreas Asimakos, Eleni Kortianou, Ioannis Vogiatzis and Argyris Tzouvelekis

J. Pers. Med. 2021, 11(9), 838; https://doi.org/10.3390/jpm11090838 - 26 Aug 2021

Cited by 33 | Viewed by 5508

Abstract

The human coronavirus 2019 disease (COVID-19) and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst global health crisis of the last century. Similarly, to previous coronaviruses leading to past pandemics, including severe acute respiratory syndrome (SARS) and middle east [...] Read more.

The human coronavirus 2019 disease (COVID-19) and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst global health crisis of the last century. Similarly, to previous coronaviruses leading to past pandemics, including severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), a growing body of evidence support that a substantial minority of patients surviving the acute phase of the disease present with long-term sequelae lasting for up to 6 months following acute infection. The clinical spectrum of these manifestations is widespread across multiple organs and consists of the long-COVID-19 syndrome. The aim of the current review is to summarize the current state of knowledge on the pulmonary manifestations of the long COVID-19 syndrome including clinical symptoms, parenchymal, and functional abnormalities, as well as highlight epidemiology, risk factors, and follow-up strategies for early identification and timely therapeutic interventions. The literature data on management considerations including the role of corticosteroids and antifibrotic treatment, as well as the therapeutic potential of a structured and personalized pulmonary rehabilitation program are detailed and discussed. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

15 pages, 308 KiB

Open AccessReview

Outpatient Management of COVID-19 Disease: A Holistic Patient-Centered Proposal Based on the Greek Experience

by Adamantia Liapikou, Eleni Tzortzaki, Georgios Hillas, Miltiadis Markatos, Ilias C. Papanikolaou and Konstantinos Kostikas

J. Pers. Med. 2021, 11(8), 709; https://doi.org/10.3390/jpm11080709 - 23 Jul 2021

Cited by 1 | Viewed by 3249

Abstract

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic and affected more than 227 countries or territories, resulting in more than 179 million cases with over 3.890.00 deaths, [...] Read more.

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic and affected more than 227 countries or territories, resulting in more than 179 million cases with over 3.890.00 deaths, as of June 25, 2021. The Hellenic Thoracic Society (HTS) during the second wave of COVID-19 pandemic released a guidance document for the management of patients with COVID-19 in the community and in hospital setting. In this review, with guidance the HTS document, we are discussing the outpatient management of COVID-19 patients, including the preventive measures, the patients’ isolation and quarantine criteria of close contacts, the severity and risk stratification, including the decisions for advanced hospitalization, and the disease management at home in patients with mild disease and after hospital discharge for those with more severe disease. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

10 pages, 626 KiB

Open AccessFeature PaperReview

Plitidepsin: Mechanisms and Clinical Profile of a Promising Antiviral Agent against COVID-19

by Michail Papapanou, Eleni Papoutsi, Timoleon Giannakas and Paraskevi Katsaounou

J. Pers. Med. 2021, 11(7), 668; https://doi.org/10.3390/jpm11070668 - 16 Jul 2021

Cited by 17 | Viewed by 7199

Abstract

Current standard treatment of COVID-19 lacks in effective antiviral options. Plitidepsin, a cyclic depsipeptide authorized in Australia for patients with refractory multiple myeloma, has recently emerged as a candidate anti-SARS-CoV-2 agent. The aim of this review was to summarize current knowledge on plitidepsin’s [...] Read more.

Current standard treatment of COVID-19 lacks in effective antiviral options. Plitidepsin, a cyclic depsipeptide authorized in Australia for patients with refractory multiple myeloma, has recently emerged as a candidate anti-SARS-CoV-2 agent. The aim of this review was to summarize current knowledge on plitidepsin’s clinical profile, anti-tumour and anti-SARS-CoV-2 mechanisms and correlate this with available or anticipated, preclinical or clinical evidence on the drug’s potential for COVID-19 treatment.PubMed, Scopus, CENTRAL, clinicaltrials.gov, medRxiv and bioRxiv databases were searched.Plitidepsinexerts its anti-tumour and antiviral properties primarily through acting on isoforms of the host cell’s eukaryotic-translation-elongation-factor-1-alpha (eEF1A). Through inhibiting eEF1A and therefore translation of necessary viral proteins, it behaves as a “host-directed” anti-SARS-CoV-2 agent. In respect to its potent anti-SARS-CoV-2 properties, the drug has demonstrated superior ex vivo efficacy compared to other host-directed agents and remdesivir, and it might retain its antiviral effect against the more transmittable B.1.1.7 variant. Its well-studied safety profile, also in combination with dexamethasone, may accelerate its repurposing chances for COVID-19 treatment. Preliminary findings in hospitalized COVID-19 patients, have suggested potential safety and efficacy of plitidepsin, in terms of viral load reduction and clinical resolution. However, the still incomplete understanding of its exact integration into host cell–SARS-CoV-2 interactions, its intravenous administration exclusively purposing it for hospital settings the and precocity of clinical data are currently considered its chief deficits. A phase III trial is being planned to compare the plitidepsin–dexamethasone regimen to the current standard of care only in moderately affected hospitalized patients. Despite plitidepsin’s preclinical efficacy, current clinical evidence is inadequate for its registration in COVID-19 patients.Therefore, multicentre trials on the drug’s efficacy, potentially also studying populations of emerging SARS-CoV-2 lineages, are warranted. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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25 pages, 344 KiB

Open AccessReview

Dexamethasone in the Treatment of COVID-19: Primus Inter Pares?

by Vasiliki Romanou, Evangelia Koukaki, Vasiliki Chantziara, Panagiota Stamou, Alexandra Kote, Ioannis Vasileiadis, Antonia Koutsoukou and Nikoletta Rovina

J. Pers. Med. 2021, 11(6), 556; https://doi.org/10.3390/jpm11060556 - 15 Jun 2021

Cited by 14 | Viewed by 3576

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread globally, becoming a huge public health challenge. Even though the vast majority of patients are asymptomatic, some patients present with pneumonia, acute respiratory distress syndrome (ARDS), septic [...] Read more.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread globally, becoming a huge public health challenge. Even though the vast majority of patients are asymptomatic, some patients present with pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and death. It has been shown in several studies that the severity and clinical outcomes are related to dysregulated antiviral immunity and enhanced and persistent systemic inflammation. Corticosteroids have been used for the treatment of COVID-19 patients, as they are reported to elicit benefits by reducing lung inflammation and inflammation-induced lung injury. Dexamethasone has gained a major role in the therapeutic algorithm of patients with COVID-19 pneumonia requiring supplemental oxygen or on mechanical ventilation. Its wide anti-inflammatory action seems to form the basis for its beneficial action, taming the overwhelming “cytokine storm”. Amid a plethora of scientific research on therapeutic options for COVID-19, there are still unanswered questions about the right timing, right dosing, and right duration of the corticosteroid treatment. The aim of this review article was to summarize the data on the dexamethasone treatment in COVID-19 and outline the clinical considerations of corticosteroid therapy in these patients. Full article

(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)

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