Vitamin D deficiency and COVID-19 severity - plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis
Journal of Internal Medicine. 2022;289(1):97-115
Background: SARS-CoV-2 coronavirus infection ranges from asymptomatic through to fatal COVID-19 characterized by a 'cytokine storm' and lung failure Vitamin D deficiency has been postulated as a determinant of severity Objectives: To review the evidence relevant to vitamin D and COVID-19
Evaluation of the efficacy and safety of recombinant erythropoietin on the improvement of hospitalised COVID-19 patients: A structured summary of a study protocol for a randomised controlled trial
OBJECTIVES To evaluate the effect of recombinant erythropoietin on hospitalised COVID-19 patients. TRIAL DESIGN Concealed, randomized, single-blinded, phase 2 controlled clinical trial with two arm parallel-group design of 20 patients allocated with 1:1 ratio and using the placebo in the control group. PARTICIPANTS This study will be performed at Shahid Mohammadi Hospital in Bandar Abbas, Hormozgan in Iran. All positive (PCR confirmed) COVID-19 patients ≤65 years old who have Hb≤9 and at least one of the severe COVID-19 symptoms (tachypnea (breathing rate> 30 beats per minute), hypoxemia (O2 ≤93 saturation, the partial pressure ratio of arterial oxygen <300), Lung infiltration (> 50% of lung field within 24 to 48 hours), progressive lymphopenia, LDH>245 U/I, CRP>100) and are willing to cooperate in this project will be included in the study. Patients with a history of coronary heart disease, thrombosis, deep vein thrombosis, chronic lung disease, diabetes mellitus, weakened immune system, end-stage renal disease, liver disease, and patients with a history of taking oral contraceptive pills, systolic blood pressure more than 160 mm Hg, diastolic blood pressure more than 90 mm Hg and age over 65 and erythropoietin above 500 are excluded. INTERVENTION AND COMPARATOR Patients will receive the standard of care (SOC) based on the treatment protocols of the Iranian National Committee of COVID-19 and recombinant erythropoietin (EPREX Manufactured by Johnson and Johnson Pharmaceutical Company) 300 units / Kg or 4000IU as subcutaneous (SQ) injection three times a day for 5 days and simultaneously Enoxaparin 1 mg/kg SQ daily is also taken to prevent thrombosis in the intervention group. Patients' blood pressure, along with other vital signs, are checked regularly and at regular intervals. In the control group, patients received SOC and the placebo (distilled water) is given as a subcutaneous injection three times a day for 5 days. We use sterile water for injection (EXIRpharmaceutical company) as the placebo. To the same appearance of the placebo and the recombinant erythropoietin, they are taken in a separate room in the same size syringes and cover with labels before injection. MAIN OUTCOMES The main outcome for this study is a composite endpoint for Patient clinical symptoms (Respiratory rate, Oxygen saturation state and arterial oxygen partial pressure ratio, Lung infiltration status, blood pressure), Laboratory tests (LDH, CRP, Lymphocyte count, Endogenous erythropoietin, and Haemoglobin level). All of these will be assessed at the beginning of the study (before the intervention) and day 5 after the intervention. The study will also evaluate side effects and how to manage them. RANDOMISATION Eligible participants (20) will be randomized in two arms in the ratio of 1: 1 (10 per arm) by permuted block randomization method using online web-based tools. BLINDING (MASKING): Patients participating in the study will not be aware of the assignment to the intervention or control group. The principal investigator, health care personnel, data collectors, and those evaluating the outcome are aware of patient grouping. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 20 patients will participate in this study, who are randomly allocated to the 2 arms with a 1:1 ratio; 10 patients in the intervention group will receive SOC and recombinant erythropoietin, and 10 patients in the control group will receive SOC and placebo. TRIAL STATUS The protocol version is 3.0, approved by the Deputy of Research and Technology and the ethics committee of Hormozgan University of Medical Sciences on 6(th) June 2020, with the local grant number of 990108. The expected recruitment end date was on 21(th) December 2020 but since we had a wide and careful exclusion criteria because of the adverse reactions of the medication, the recruitment (for both cases and controls) was not so easy and did not finish on the expected date and we are still recruiting now. Recruitment began on 17(th) August 2020 and the updated expected recruitment end date is 1(st) August 2021. TRIAL REGISTRATION The protocol was registered before starting subject recruitment under the title: Evaluation of the effect of recombinant erythropoietin on the improvement of COVID-19 patients, IRCT20200509047364N1, at Iranian Registry of clinical trials ( https://en.irct.ir/trial/49282 ) on 2020/08/09. FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
Creating the Hematology/Oncology/Stem Cell Transplant Advancing Resiliency Team: A Nurse-Led Support Program for Hematology/Oncology/Stem Cell Transplant Staff
Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses. 2021;:10434542211011046
Background: Burnout, moral distress, compassion fatigue, and posttraumatic stress disorder are concerns for health-care staff. Due to the high mental, physical, and emotional demands of the pediatric hematology/oncology profession, workplace supports should be in place to address the needs of the staff. A nurse-led support program is one strategy to enhance staff well-being. Methods: The Hematology/Oncology/Stem Cell Transplant Advancing Resiliency Team (HART) is a nurse-led peer-to-peer on-site support program for multidisciplinary staff caring for hematology/oncology patients. HART coaches, working 8-hour shifts, covering both day and night shift hours, are present 3 days a week on the unit. HART offers a confidential space for one on one or group interactions, educational sessions, assistance with work related, patient-care based, or personal concerns, and various forms of integrative therapies. Results: There have been over 1,100 coach consults and 98 HART shifts worked. The most commonly reported changes since HART began include staff feeling more supported by leadership and staff making time for breaks during the work shift. A 25.6% increase in staff reporting to be extremely satisfied with unit support was found. Discussion: Cultivating a culture of staff support is important. Due to COVID-19, physical HART coach presence was put on hold for 4 weeks and virtual interventions were trialed. Since its return, coach consult numbers have been steadily rising. Having a support program led by coaches with direct experience understanding the emotional toll of caring for the pediatric hematology/oncology patient population was found to be well utilized, feasible through donor funding, and measurable via staff report.
Safety of full-dose anticoagulation in a ventilated predominantly black population with COVID-19
Critical Care Medicine. 2021;49(1 SUPPL 1):104-104
INTRODUCTION Coronavirus disease 2019 (COVID-19) can be associated with coagulopathy and a high incidence of thromboembolic events These events were associated with worse clinical outcomes, especially in critically ill patients Our study investigated the safety of full dose anticoagulation (AC), in ventilated, predominantly Black patients with COVID-19 infection METHODS This is a retrospective observational study based on a chart review of patients admitted to the University Hospital of Brooklyn in New York City from March 23rd through April 23rd, 2020 Inclusion criteria included age ≥ 18 years, confirmed COVID-19 infection, and need for mechanical ventilation The variables collected included demographics, comorbidities, laboratory results, type of anticoagulation, and Sepsis- Induced Coagulopathy (SIC) score RESULTS A total of 48 hospitalized patients met the inclusion criteria 41 (85 4%) were Black, 26 (54%) were males, 22 (46%) were females, and the average age was 68 years Average days on mechanical ventilation was 13 6 days D-Dimer was elevated in all patients, with an average of 5 8 mcg/ml Almost all patients (47/48) had elevated SIC score, defined as SIC score of 2 or above AC agent used was Heparin in 13 patients (27 1%), low molecular weight heparin (LMWH) in 12 (25%), direct oral anticoagulants (DOAC) in 8 (16 7%), and multiple AC agents in 15 (31 3%) AC was stopped because of major bleed in 5 patients Overall mortality was 62 5% AC discontinuation was not associated with increased overall mortality (Pearson Chi-Square= 0 228;p=0 633) CONCLUSIONS Our study showed that full dose anticoagulation was administered in high risk ICU patients with COVID-19 infection, and significantly elevated D-Dimer level and SIC score Most patients received heparin or LMWH, or a combination of heparin products with transition to DOAC However only 5 patients had a major bleed, that was not a significant contributor to overall mortality Based on our results, administration of full dose anticoagulation in ventilated predominantly black patients with COVID-19 infection, was overall safe and well tolerated
Blood Group A Epitopes do not Facilitate Entry of SARS-CoV-2
Journal of Internal Medicine. 2021
Information on the impact of ABO blood group (BG) on SARS-CoV-2 infections is conflicting (1-4). To identify risk factors for severe COVID-19 courses we performed a cross-sectional study in volunteers between 18 and 61 years of age registered with DKMS for stem cell donation approved by the Institutional Review Board of the Technische Universität Dresden. All participants provided explicit consent that COVID-19 specific data were linked to genotype data in the donor registry file.
When and whom to scope in case of gastrointestinal bleeding in the COVID-19 era?
Minerva gastroenterology. 2021
Heparin-induced thrombocy-topenia and covid-19
Hematology Reports. 2021;13(1):21-23
Pulmonary Embolism Prophylaxis in Patients with COVID-19: An Emerging Issue
Heart, Lung and Circulation. 2021
Severe acute respiratory syndrome (SARS)-CoV-2 virus disease (coronavirus disease 2019;COVID-19) is associated with increased coagulation activity, resulting in an excessive risk of venous thromboembolism (VTE) and poor prognosis The most common manifestation of VTE is pulmonary embolism (PE), with approximately one in five hospitalised patients being at risk These reports led to the empirical use of prophylactic anticoagulation, even in the absence of established or clinically suspected disease This review summarises current aspects and recommendations regarding the use of thromboprophylaxis for PE in patients with COVID-19
Getting to the Heart of the Matter: Myocardial Injury, Coagulopathy, and Other Potential Cardiovascular Implications of COVID-19
International Journal of Vascular Medicine. 2021;:1-16
COVID-19 was primarily identified as a respiratory illness, but reports of patients presenting initially with cardiovascular complaints are rapidly emerging Many patients also develop cardiovascular complications during and after COVID-19 infection Underlying cardiovascular disease increases the severity of COVID-19 infection;however, it is unclear if COVID-19 increases the risk of or causes cardiovascular complications in patients without preexisting cardiovascular disease The review is aimed at informing the primary care physicians of the potential cardiovascular complications, especially in patients without underlying cardiovascular disease A comprehensive literature review was performed on cardiac and vascular complications of COVID-19 The primary cardiac and vascular complications include myocarditis, acute coronary syndrome, myocardial injury, arrhythmia, heart failure, shock, multisystem inflammatory syndrome, venous and arterial thrombotic events, stroke, and coagulopathy A detailed analysis of the pathogenesis revealed six possible mechanisms: direct cardiac damage, hypoxia-induced injury, inflammation, a dysfunctional endothelial response, coagulopathy, and the catecholamine stress response Autopsy reports from studies show cardiomegaly, hypertrophy, ventricular dilation, infarction, and fibrosis A wide range of cardiac and vascular complications should be considered when treating patients with confirmed or suspected COVID-19 infection Elevated troponin and natriuretic peptides indicate an early cardiac involvement in COVID-19 Continuous monitoring of coagulation by measuring serum D-dimer can potentially prevent vascular complications A long-term screening protocol to follow-up the patients in the primary care settings is needed to follow-up with the patients who recovered from COVID cardiovascular complications [ABSTRACT FROM AUTHOR] Copyright of International Journal of Vascular Medicine is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )
SARS-CoV-2 antibody seroprevalence follow-up in Malagasy blood donors during the 2020 COVID-19 Epidemic
BACKGROUND The incidence of the 2020 COVID-19 epidemic in Africa seems to be different from that of the rest of the world, however its true extent is probably underestimated. Conducting population based sero-surveys during the epidemic has moreover been extremely challenging, driving our group and others to study blood donor samples. METHODS We collected regional epidemiological COVID-19 surveillance data, and simultaneously monitored anti-SARS-CoV-2 antibody seroprevalences monthly throughout the epidemic in 5 major Region-associated Blood Transfusion Centres of Madagascar over a period of 9 months. FINDINGS Soon after attaining the first epidemic peaks between May and August 2020, both crude and population-weighted test-performance-adjusted seroprevalences of anti-SARS-CoV-2 antibodies was in Malagasy blood donors rapidly increased up to over 40% positivity. INTERPRETATION These findings suggest a high cumulative incidence of infection and seroconversion, which may have contributed to the observed deceleration of infection rates, but was not sufficient to prevent the second epidemic wave that struck Madagascar in Spring 2021. FUNDING This project was funded by the United States Agency for International Development.