Stella T. Lartey et al.

Evaluation of Unintended Consequences of COVID-19 Pandemic Restrictions and Obesity Prevalence Among Youths

JAMA, July 2023; doi:10.1001/jamanetworkopen.2023.23596

Abstract

Childhood obesity is linked to adulthood obesity and to childhood and adulthood noncommunicable diseases.1,2 Pandemic restrictions imposed in early 2020 contributed to decreased physical activity, reduced access to healthy foods, and increased stress, screen time, and consumption of processed foods and sugary drinks among youths.3-5 Recent studies provide limited insight on longer-term associations of COVID-19 restrictions with childhood obesity prevalence. Thus, this study aimed to evaluate whether pandemic-related body mass index (BMI) changes, if any, among children persisted after restriction removal and to identify associated factors.

Methods

This cohort study was conducted using data for Monroe County, Indiana, which encompasses 2 municipalities, 2 public school systems, and extensive agrarian and forested areas and had a 2020 population of approximately 148 000 (including 22 000 youths aged 2-19 years).6 Weight and height measurements were obtained from electronic health record data for children aged 2 to 19 years in repeated cross-sections (2016-2021; annual average n = 14 595) and for longitudinal cohorts aged 5 to 11 years in 2019 (cohort 1, 2017-2019; n = 8647) and 2021 (cohort 2, 2019-2021; n = 7816). The BMI categories (underweight, healthy weight, overweight, obesity, and severe obesity) were based on the US Centers for Disease Control and Prevention growth charts for age and sex1,2 (details in the Figure). Binomial logistic regression was used to establish trends in BMI prevalence and associated factors, including age, sex, residence (zip code group), and health insurance type (race and ethnicity data were not available). Pearson χ2 was used to compare transition trends (upward, downward, or stable) between BMI categories for both cohorts by longitudinally tracking individuals with complete responses for 3 consecutive years. The Indiana University Health Bloomington Hospital and Indiana University Bloomington institutional review boards approved this study and waived informed consent because deidentified patient data were used. The study followed the STROBE reporting guideline.

Data analysis was performed between April 2021 and April 2022. Results are presented as percentages or odds ratios (ORs) with 95% CIs. P < .05 (2-tailed) was statistically significant. All analyses were performed in Stata, version 17 (StataCorp).

Results

This study included 27 093 participants (13 497 girls [49.8%] and 13 596 boys [50.2%]; mean [SD] age, 9.8 [5.3] years). Overall severe obesity prevalence was higher in 2020 (5.9% [5.5%-6.4%]; P = .009) and 2021 (6.3% [5.8%-6.7%]; P < .001) compared with 2019 (5.1% [4.6%-5.5%]) (Figure and Table).

We observed the greatest increase in obesity prevalence among children aged 5 to 11 years (vs 2-4 and 12-19 years). Although healthy weight was significantly lower for this population in 2020 and 2021, their prevalence of both obesity and severe obesity was significantly higher in 2020, persisting into 2021 (11.5% [10.5%-12.5%]; P = .007 and 4.9% [4.2%-5.5%]; P = .004), compared with 2019 (9.8% [9.0%-10.6%] and 3.7% [3.2%-4.2%]). Their total unhealthy BMI prevalence (ie, overweight, obesity, and severe obesity) was also higher in 2020 (33.6% [32.7%-34.6%]) and 2021 (32.9% [32.0%-33.8%]) compared with 2019 (31.9% [31.0%-32.8%]). In addition, 2021 trends observed for these children were confirmed via longitudinal transition trend analysis, which suggested that cohort 2 experienced a significant upward BMI transition (18.1% [16.9%-19.3%]) compared with cohort 1 (14.0% [13.0%-15.0%]) (P < .001).

Finally, we observed that in 2020 and 2021 compared with 2019, female sex (OR, 1.28 [95% CI, 1.07-1.54]; P = .008 and OR, 1.32 [95% CI, 1.09-1.59]; P = .004), public insurance (OR, 1.24 [95% CI, 1.04-1.48]; P = .02 and OR, 1.36 [95% CI, 1.14-1.62]; P = .001), and residence in southeast Monroe County, a relatively high-income area (OR, 1.41 [95% CI, 1.10-1.80]; P = .006 and OR, 1.49 [95% CI, 1.17-1.91]; P = .001) were associated with higher odds of severe obesity.

Discussion

The findings of this cohort study suggest that childhood obesity, especially among US children aged 5 to 11 years, was significantly higher after COVID-19 restrictions were imposed and persisted for multiple reasons3-5 after restriction removal in 2021. The sampling method used may have potentially introduced selection bias, and the narrow data coverage (1 US county) limits the generalizability of these findings. Obesity prevention efforts should focus on elementary school–aged youths to prevent high prevalence of unhealthy BMI.

AyaKatasako et al.

Changes in neurological outcomes of out-of-hospital cardiac arrest during the COVID-19 pandemic in Japan: a population-based nationwide observational study

The Lancet, May 2023; doi.org/10.1016/j.lanwpc.2023.100771

Abstract

There is growing interest in the indirect negative effects of coronavirus disease 2019 (COVID-19) on mortality. We aimed to assess its indirect effect on out-of-hospital cardiac arrest (OHCA) outcomes.

Methods

We analysed a prospective nationwide registry of 506,935 patients with OHCA between 2017 and 2020. The primary outcome was favourable neurological outcome (Cerebral Performance Category 1 or 2) at 30 days. The secondary outcomes were public access defibrillation (PAD) and bystander-initiated chest compression. We performed an interrupted time series (ITS) analysis to assess changes in the trends of these outcomes around the declaration of a state of emergency (April 7 – May 25, 2020). We also performed a subgroup analysis stratified by infection spread status.

Findings

We identified 21,868 patients with OHCA witnessed by a bystander who had an initial shockable heart rhythm. ITS analysis showed a drastic decline in PAD use (relative risk [RR], 0.60; 95% confidence interval [CI], 0.49–0.72; p < 0.0001) and a reduction in favourable neurological outcomes (RR, 0.79; 95% CI, 0.68–0.91; p = 0.0032) all over Japan after the state of emergency was declared when compared with the equivalent time period in previous years. The decline in favourable neurological outcomes was more pronounced in areas with COVID-19 spread than in areas without spread (RR, 0.70; 95% CI, 0.58–0.86 vs. RR, 0.87; 95% CI, 0.72–1.03; p for effect modification = 0.019).

Interpretation

COVID-19 is associated with worse neurological outcomes and less PAD use in patients with OHCA.

G. Camelia Adams et al.

Physicians’ mental health and coping during the COVID-19 pandemic: One year exploration

Cell, May 2023; doi.org/10.1016/j.heliyon.2023.e15762

Numerous cross-sectional studies have examined physicians' health and coping during the COVID-19 pandemic, while longitudinal studies are lacking. This study explores the progression over one year of physicians' physical and mental health symptoms, their strategies used to cope and discusses coping strategies in relation to physical and mental health symptoms. Two surveys, one year apart, exploring physicians' physical, mental health symptoms and employed coping strategies were sent to all physicians practicing in the province of Saskatchewan, Canada. A total of 117 physicians participated in Round I (RI) (November 2020–January 2021) and 158 participated in Round II (RII) (October 2021–February 2022). Physicians' physical and mental health symptoms remained high, irrespective of their specialty or COVID-19 exposure. COVID-related Post-Traumatic Stress Disorder increased by five times at RII (p = 0.02). In RI anxiety was most prevalent in middle-aged females. In RII depression was most prevalent in physicians with no children. Most coping was adaptive (90%) and included Behavioural, Relational, Cognitive, Spiritual, and Interventional strategies. After one-year, Spiritual coping decreased, while Interventional coping increased by eight times (p = 0.01). Despite efforts to employ adaptive coping, physicians' rates of psychological and physical health difficulties remained high or worsened over one year, offering insight into the protracted health care crisis, and the need for solutions. Our observation of physicians’ needs for additional supports, camaraderie and appreciation as well as the shift in coping strategies as the pandemic progressed, offer targets for interventions meant to promote recovery.

Fabio Medas et al.

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

The Lancet, April 2023; doi.org/10.1016/S2213-8587(23)00094-3

Abstract

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.

Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.

Esther Diana Rossi, Liron Pantanowitz

Effect of COVID-19 restrictions on thyroid cytopathology: delay in the diagnosis of indeterminate lesions

The Lancet, April 2023; doi.org/10.1016/S2213-8587(23)00089-X

Abstract

The COVID-19 pandemic has resulted in disastrous effects globally.1, 2 After the initial outbreak of SARS-CoV-2 in December, 2019, in Wuhan, China, the rapid spread of the virus to other countries forced large-scale social and economic shutdowns. In February, 2020, WHO formally named the disease COVID-19, and confirmed that the virus was a variant of the coronavirus (SARS-CoV) that had previously caused a serious and lethal acute respiratory syndrome (severe acute respiratory virus, known as SARS) in 2002–03.1 In March, 2020, WHO declared COVID-19 to be a global pandemic, which has been one of the most dramatic public health emergencies in the last century. The pandemic has had profound effects on health care, including disrupted access to patient care (eg, postponed in-person visits), disruption of particular services (eg, screening), economic stress, and workforce and supply shortages. The pandemic also diverted resources away from non-urgent and elective surgical procedures. In particular, this resulted in diagnostic and treatment delays for procedures such as fine needle aspiration cytology (FNAC), which is typically used in the evaluation of thyroid lesions.3, 4, 5, 6 In a multi-institutional study including 23 countries, Vigliar and colleagues4 found that 4 weeks of COVID-19 lockdowns (in the period between March 1 and April 30, 2020) led to a substantial reduction (by 45·3%) in the number of cytology samples, regardless of anatomic site or specimen type, compared with the corresponding periods in 2019. They also found a modest concomitant increase (5·6%) in the rate of non-gynaecological malignancies.4

In The Lancet Diabetes & Endocrinology, Fabio Medas and colleagues present a multicentre, retrospective study quantifying the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic between 2019 and 2021. As expected, the results presented by Medas and colleagues show that the number of surgeries for indeterminate thyroid nodules significantly decreased during the peak of the pandemic, compared with the prepandemic period. Furthermore, in the decreasing phase of the pandemic, there were significant increases in the occurrence of thyroid tumours larger than 10 mm, lymph node metastases, and risk of recurrence, compared with the prepandemic period.

In conclusion, the study by Medas and colleagues7 highlights the increased occurrence of aggressive thyroid cancers in patients with an FNAC-based diagnosis of indeterminate thyroid nodules in many regions of the world after the COVID-19 pandemic, which was likely to be due to reduced surgical activity for thyroid nodules during the pandemic. The lesson learned is that in the event of a new pandemic or another escalation of SARS-CoV-2 infections, surgical procedures for indeterminate thyroid nodules or even suspicious or malignant thyroid lesions should not be postponed, in order to avoid tumour progression and the development of more aggressive cancers.

Kim R. Chiok et al.

Mycobacterium tuberculosis and SARS-CoV-2 co-infections: the knowns and unknowns

Cell, April 2023; doi.org/10.1016/j.isci.2023.106629

Abstract

Health impacts of Mycobacterium tuberculosis (Mtb) and SARS-CoV-2 co-infections are not fully understood. Both pathogens modulate host responses and induce immunopathology with extensive lung damage. With a quarter of the world’s population harboring latent TB, exploring the relationship between SARS-CoV-2 infection and its effect on the transition of Mtb from latent to active form is paramount to control this pathogen. The effects of active Mtb infection on establishment and severity of COVID-19 are also unknown, despite the ability of TB to orchestrate profound long-lasting immunopathologies in the lungs. Absence of mechanistic studies and co-infection models hinder the development of effective interventions to reduce the health impacts of SARS-CoV-2 and Mtb co-infection. Here, we highlight dysregulated immune responses induced by SARS-CoV-2 and Mtb, their potential interplay, and implications for co-infection in the lungs. As both pathogens master immunomodulation, we discuss relevant converging and diverging immune-related pathways underlying SARS-CoV-2 and Mtb co-infections.

Jonathan S Schultz et al.

Return to Travel in the Coronavirus Disease 2019 Pandemic Recovery Period and Implications for Imported Malaria: Reinforcing Prevention, Early Diagnosis, and Appropriate Treatment of Malaria

CID, April 2023; doi.org/10.1093/cid/ciad061

Abstract

Return to international travel in the COVID-19 pandemic recovery period is expected to increase the number of patients with imported malaria in the United States (US). Malaria prevention in travelers and preparedness for timely diagnosis and appropriate treatment are key to minimize imported malaria morbidity and mortality. Intravenous artesunate (IVAS) is now available from commercial distributors in the US for the treatment of severe malaria. Hospitals and pharmacists should have a plan for malaria treatment, including stocking artemether-lumefantrine for uncomplicated malaria, and stocking or planning for rapid procurement of IVAS for the treatment of severe malaria.

Yang Yiyue et al.

Effects of sleep quality on suicide risk in COVID-19 patients: The chain mediating of anxiety and depressive symptoms

Cell, March 2023; doi.org/10.1016/j.heliyon.2023.e15051

Abstract

Although current studies have identified sleep disorders as an independent risk factor for suicide, the relationship between sleep disorders and suicide risk has not been well established. This study explored whether anxiety and depressive symptoms are used as mediators to participate in the impact of sleep quality on suicide risk.

Methods

This is a cross-sectional study. We administered a psychological questionnaire to the participants, using a combination of self-assessment and psychiatrist assessment.Sleep quality, suicide risk, level of anxiety and depressive symptoms were assessed by PSQI, NGASR, SAS and SDS.The study subjects were 391 hospitalized COVID-19 patients from Wuhan hospitals. We used model 6 in the PROCESS (version 3.5) plug-in of SPSS software to conduct mediation test with sleep quality as the independent variable, suicide risk as the dependent variable, level of anxiety and depressive symptoms as intermediate variables.

Results

The severity of anxiety and depressive symptoms and the risk of suicide in the sleep disorder group (63.15 ± 13.71, 59.85 ± 13.38, 6.52 ± 3.67) were higher than those in the non-sleep disorder group (49.83 ± 13.14, 44.87 ± 10.19, 2.87 ± 3.26) (P < 0.001). The mediation model works well, The total indirect effect was 0.22 (95%CI = [0.17, 0.28]), and the direct effect was 0.16 (95%CI = [0.08, 0.24]).

Limitations

This study used a self-assessment scale.

Conclusions

Anxiety and depressive symptoms played a chain mediating role between sleep quality and suicide risk.

Huwen Wang et al.

Relationship between antidepressants and severity of SARS-CoV-2 Omicron infection: a retrospective cohort study using real-world data

The Lancet, February 2023; doi.org/10.1016/j.lanwpc.2023.100716

Abstract

Few studies have used real-world data to evaluate the impact of antidepressant use on the risk of developing severe outcomes after SARS-CoV-2 Omicron infection.

Methods

This is a retrospective cohort study using propensity-score matching to examine the relationship between antidepressant use and COVID-19 severity. Inpatient and medication records of all adult COVID-19 patients in Hong Kong during the Omicron-predominated period were obtained. Severe clinical outcomes including intensive care unit admission and inpatient death after the first positive results of reverse transcription polymerase chain reaction as well as a composite outcome of both were studied. Cox proportional hazard models were applied to estimate the crude and adjusted hazard ratios (HR).

Interpretation

Antidepressant use was associated with a lower risk of severe COVID-19. The findings support the continuation of antidepressants in patients with COVID-19, and provide evidence for the treatment potential of antidepressants for severe COVID-19.

Dan Lewer et al.

Opioid injection-associated bacterial infections in England, 2002-2021: a time series analysis of seasonal variation and the impact of COVID-19

CID, March 2023; doi.org/10.1093/cid/ciad144

Abstract

Background

Bacterial infections cause substantial pain and disability among people who inject drugs. We described time trends in hospital admissions for injecting-related infections in England.

Methods

We analysed hospital admissions in England between January 2002 and December 2021. We included patients with infections commonly caused by drug injection, including cutaneous abscesses, cellulitis, endocarditis, or osteomyelitis, and a diagnosis of opioid use disorder. We used Poisson regression to estimate seasonal variation and changes associated with COVID-19 response.

Results

There were 92,303 hospital admissions for injection-associated infections between 2002 and 2021. 87% were skin, soft-tissue or vascular infections; 72% of patients were male; and the median age increased from 31 years in 2002 to 42 years in 2021. The rate of admissions reduced from 13.97 per day (95% CI 13.59-14.36) in 2003 to 8.94 (95% CI 8.64-9.25) in 2011, then increased to 18.91 (95% CI 18.46-19.36) in 2019. At the introduction of COVID-19 response in March 2020, the rate of injection-associated infections reduced by 35.3% (95% CI 32.1%-38.4%). Injection-associated infections were also seasonal; the rate was 1.21 (95% CI 1.18-1.24) times higher in July than in February.

Conclusions

This incidence of opioid injection-associated infections varies within years and reduced following COVID-19 response measures. This suggest that social and structural factors such as housing and the degree of social mixing may contribute to the risk of infection, supporting investment in improved social conditions for this population as a means to reduce the burden of injecting-related infections.

BiboZhu et al.

Inhibition of the mitochondrial pyruvate carrier simultaneously mitigates hyperinflammation and hyperglycemia in COVID-19

Science, February 2023; doi/10.1126/sciimmunol.adf0348

Abstract

The relationship between diabetes and COVID-19 is bi-directional: while individuals with diabetes and high blood glucose (hyperglycemia) are predisposed to severe COVID-19, SARS-CoV-2 infection can also cause hyperglycemia and exacerbate underlying metabolic syndrome. Therefore, interventions capable of breaking the network of SARS-CoV-2 infection, hyperglycemia, and hyper-inflammation, all factors that drive COVID-19 pathophysiology, are urgently needed. Here, we show that genetic ablation or pharmacological inhibition of mitochondrial pyruvate carrier (MPC) attenuates severe disease following influenza or SARS-CoV-2 pneumonia. MPC inhibition using a second-generation insulin sensitizer, MSDC-0602 K (MSDC), dampened pulmonary inflammation and promoted lung recovery, while concurrently reducing blood glucose levels and hyperlipidemia following viral pneumonia in obese mice. Mechanistically, MPC inhibition enhanced mitochondrial fitness and destabilized HIF-1α, leading to dampened virus-induced inflammatory responses in both murine and human lung macrophages. We further showed that MSDC enhanced responses to nirmatrelvir (the antiviral component of Paxlovid) to provide high levels of protection against severe host disease development following SARS-CoV-2 infection and suppressed cellular inflammation in human COVID-19 lung autopsies, demonstrating its translational potential for treating severe COVID-19. Collectively, we uncover a metabolic pathway that simultaneously modulates pulmonary inflammation, tissue recovery, and host metabolic health, presenting a synergistic therapeutic strategy to treat severe COVID-19, particularly in patients with underlying metabolic disease.

Alan C. Kwan et al.

Association of COVID-19 Vaccination With Risk for Incident Diabetes After COVID-19 Infection

Jamanetwork, February 2023; doi:10.1001/jamanetworkopen.2022.55965

Abstract

Introduction

In early phases of the COVID-19 pandemic, persons who recovered from infection had increased risks for new-onset cardiometabolic diseases, including diabetes, hypertension, and hyperlipidemia.1-3 In the current pandemic phase, which is dominated by less virulent Omicron variants,4 it remains unclear whether risks of cardiometabolic disease after COVID-19 infection persist or have become attenuated and whether vaccination status is associated with these risks.

Discussion

In this cohort study, COVID-19 infection was associated with increased risk of diabetes, consistent findings of a meta-analysis.1 Our results suggest that this risk persisted as the Omicron variant became predominant, and the association remained even after accounting for temporal confounders. Diabetes risk after COVID-19 infection was higher in unvaccinated than vaccinated patients, suggesting a benefit of vaccination. Mechanisms contributing to postinfection diabetes risk remain unclear, although persistent inflammation contributing to insulin resistance is a proposed pathway. Study limitations include reliance on diagnostic coding, unaccounted confounders (infection severity indices), and insufficient sample size and statistical power for testing multiple interactions. Additional studies are needed to understand cardiometabolic sequelae of COVID-19 and whether COVID-19 vaccination attenuates risk of cardiometabolic disease.

Ruth H. Ja et al.

Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study

The Lancet, February 2023; doi.org/10.1016/j.eclinm.2023.101857

Abstract

Background

Since the onset of the coronavirus (COVID-19) pandemic, clinicians have reported an increase in presentations of sudden and new onset tics particularly affecting teenage girls. This population-based study aimed to describe and compare the incidence of tics in children and young people in primary care before and during the COVID-19 pandemic in England.

Interpretation

The incidence of tics in children and young people increased across all age and sex groups during the COVID-19 pandemic, with a differentially large effect in teenage girls (a greater than four-fold increase). Furthermore, in those with tic symptoms, proportions with mental health disorders including anxiety increased during the pandemic. Further research is required on the social and contextual factors underpinning this rise in onset of tics in teenage girls.

Olaker VR et al.

Association of Recent SARS-CoV-2 Infection With New-Onset Alcohol Use Disorder, January 2020 Through January 2022

JAMA, february 2023; doi:10.1001/jamanetworkopen.2022.55496

Abstract

Importance  The COVID-19 pandemic affects many diseases, including alcohol use disorders (AUDs). As the pandemic evolves, understanding the association of a new diagnosis of AUD with COVID-19 over time is required to mitigate negative consequences.

Objective  To examine the association of COVID-19 infection with new diagnosis of AUD over time from January 2020 through January 2022.

Design, Setting, and Participants  In this retrospective cohort study of electronic health records of US patients 12 years of age or older, new diagnoses of AUD were compared between patients with COVID-19 and patients with other respiratory infections who had never had COVID-19 by 3-month intervals from January 20, 2020, through January 27, 2022.

Exposures  SARS-CoV-2 infection or non–SARS-CoV-2 respiratory infection.

Main Outcomes and Measures  New diagnoses of AUD were compared in COVID-19 and propensity score–matched control cohorts by hazard ratios (HRs) and 95% CIs from either 14 days to 3 months or 3 to 6 months after the index event.

Results  This study comprised 1 201 082 patients with COVID-19 (56.9% female patients; 65.7% White; mean [SD] age at index, 46.2 [18.9] years) and 1 620 100 patients with other respiratory infections who had never had COVID-19 (60.4% female patients; 71.1% White; mean [SD] age at index, 44.5 [20.6] years). There was a significantly increased risk of a new diagnosis of AUD in the 3 months after COVID-19 was contracted during the first 3 months of the pandemic (block 1) compared with control cohorts (HR, 2.53 [95% CI, 1.82-3.51]), but the risk decreased to nonsignificance in the next 3 time blocks (April 2020 to January 2021). The risk for AUD diagnosis increased after infection in January to April 2021 (HR, 1.30 [95% CI, 1.08-1.56]) and April to July 2021 (HR, 1.80 [95% CI, 1.47-2.21]). The result became nonsignificant again in blocks 7 and 8 (COVID-19 diagnosis between July 2021 and January 2022). A similar temporal pattern was seen for new diagnosis of AUD 3 to 6 months after infection with COVID-19 vs control index events.

Conclusions and Relevance  Elevated risk for AUD after COVID-19 infection compared with non–COVID-19 respiratory infections during some time frames may suggest an association of SARS-CoV-2 infection with the pandemic-associated increase in AUD. However, the lack of excess hazard in most time blocks makes it likely that the circumstances surrounding the pandemic and the fear and anxiety they created also were important factors associated with new diagnoses of AUD.

Zheng Zhu et al.

Association of Glucose-Lowering Drugs With Outcomes in Patients With Diabetes Before Hospitalization for COVID-19 - A Systematic Review and Network Meta-analysis

JAMA, December 2022; doi:10.1001/jamanetworkopen.2022.44652

Abstract

Importance Patients with COVID-19 have a high prevalence of diabetes, and diabetes and blood glucose control are determinants of intensive care unit admission and mortality. Objective To evaluate the association between COVID-19–related adverse outcomes and 8 antihyperglycemic drugs in patients with diabetes who were subsequently diagnosed and hospitalized with COVID-19.

Conclusions and Relevance

These findings suggest that the use of an SGLT-2i before COVID19 infection is associated with lower COVID-19–related adverse outcomes. In addition to SGLT-2is, glucagon-like peptide-1 receptor agonists and metformin were also associated with relatively low risk of adverse outcomes.

Chaturved R. et al.

Profiles of host immune impairment in Plasmodium and SARS-CoV-2 infections

Cell, November 2022; doi.org/10.1016/j.heliyon.2022.e11744

Abstract

Over the past two decades, many countries that have reported a steady decline in reported cases of malaria and a few countries like China have been declared malaria-free by the World Health Organization. In 2020, global total malaria cases 108 malaria-endemic countries as in 2000, while the number of deaths from malaria has declined since 2000. COVID-19 pandemic has adversely affected overall public health efforts and thus it is feasible that there might be resurgence of malaria. COVID-19 and malaria share some similarities in the immune responses of the patient and these two diseases also share overlapping early symptoms such as fever, headache, nausea, and muscle pain/fatigue. In the absence of early diagnostics there can be a misdiagnosis of the infection(s) that can pose additional challenges due to delayed treatment. In both SARS-CoV-2 and Plasmodium infections there is a rapid release of cytokines/chemokines that play a key role in disease pathophysiology. In this review, we have discussed the cytokine/chemokine storm observed during COVID-19 and malaria. We observe that: (1) Severity in malaria and COVID-19 is likely a consequence primarily of an uncontrolled ‘cytokine storm’; (2) five pro-inflammatory cytokines (IL-6, IL-10, TNF-α, type I IFN and IFN-γ) are significantly increased in severe/critically ill patients in both diseases; (3) Plasmodium and SARS-CoV-2 share some similar clinical manifestations and thus may result in fatal consequences if misdiagnosed during onset.

Groß R & Kleger A.

COVID-19 and diabetes — where are we now?

Nature, November 2022; doi.org/10.1038/s42255-022-00691-w

Abstract

As emerging clinical analyses suggest an increased risk of new-onset diabetes following COVID-19, a causal link and underlying mechanisms are yet to be established. Persistence of hyperglycaemia after disease regression and the potential infection of non-pancreatic tissue are adding another layer of complexity to the relationship between COVID-19 and diabetes mellitus. Diabetes mellitus (DM) is a well-established risk factor for severe disease and mortality in COVID-19, but accumulating clinical and laboratory evidence on metabolic dysregulation after infection raises the question whether SARS-CoV-2 itself may trigger or expedite development of DM.

Balqis Okta Putry et al.

Can SARS-CoV-2 trigger new onset of autoimmune disease in adults? A case-based review

Cell, November 2022; doi.org/10.1016/j.heliyon.2022.e11328

Abstract

Introduction

Although it has been proposed that SARS-CoV-2 can cause autoimmunity by inducing a transient immunodeficiency of both innate and acquired immunity components in which the immune system fails to identify autoantigens adequately, the exact mechanism that causes this disease remains unknown. We aim to systematically review of existing case reports for evidence of new autoimmune diseases in adults caused by SARS-CoV-2 infection.

Methods

PRISMA-P 2020 method was used to search for literature in "PubMed" databases using the string "COVID-19 AND autoimmune disease AND complication". We used JBI Critical Appraisal Checklist to assess the articles' quality.

The new onset of autoimmune disease in adult triggered by SARS-CoV-2 included Guillain-Barré syndrome and Miller Fisher syndrome, systemic lupus erythematosus, immune thrombocytopenia, autoimmune haemolytic anemia, latent autoimmune diabetes in adults, myositis, acute demyelinating encephalomyelitis, autoimmune encephalitis, central nervous system vasculitis, and autoimmune thyroid diseases.

Conclusion

SARS-CoV-2 can trigger new onset of a variety of autoimmune diseases. Doctors who take care patients infected by COVID-19 must be aware of the complications of autoimmune diseases. Future cohort or cross-sectional studies on SARS-CoV-2-related autoimmune disease should be conducted.

R. Green et al.

SARS-CoV-2 infection increases the gene expression profile for Alzheimer’s disease risk

Molecular Therapy: Methods & Clinical Development, September 2022; doi.org/10.1016/j.omtm.2022.09.007

Abstract

The COVID-19 pandemic has caused over 600,000,000 infections globally. But there is a paucity of knowledge of molecular brain markers, and whether these can precipitate the onset of Alzheimer’s disease (AD). The authors report the brain gene expression profiles of severe COVID-19 patients showing increased expression of innate immune response genes and genes implicated in AD pathogenesis.

L. Simoni et al.

Ongoing Covid-19 pandemic effects on admissions and in-hospital outcomes in patients with st-elevation myocardial infarction (stemi): an albanian observational study

Cureus, July 2022; doi: 10.7759/cureus.26813

Abstract

Background Multiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period.

Methods A retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30^th, the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period.

Results The study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions (PCI) [1.09 (0.89-1.34)]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)].

Conclusions After the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.

S. Ahmar Shah et al.

Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database

The Lancet Regional Health - Europe, June 2022; doi.org/10.1016/j.lanepe.2022.100428

Abstract

Background

Several countries reported a substantial reduction in asthma exacerbations associated with COVID-19 pandemic-related restrictions. However, it is not known if these early reported declines were short-term and if these have rebounded to pre-pandemic levels following easing of lockdown restrictions.

Methods

We undertook a retrospective, cohort study of all asthma patients in a national primary care database of almost 10 million patients, Optimum Patient Care Database (OPCRD), identified from January 1, 2010, to December 31, 2015, using a previously validated algorithm. We subsequently followed the identified cohort of asthma patients from January 1, 2016, to October 3, 2021, and identified every asthma exacerbation episode with a validated algorithm. To quantify any pandemic-related change in exacerbations, we created a control time-series (mean of 2016-2019) and then compared the change in exacerbation rate in 2020-2021 over quarterly periods when compared with the control period (the pre-pandemic period). We undertook overall and stratified analyses by age group, sex, and English region.

Findings

We identified 100,362 asthma patients (502,669 patient-years) from across England who experienced at least one exacerbation episode (298,390 exacerbation episodes during the entire follow-up). Except for the first quarter of 2020, the exacerbation rates were substantially lower (>25%) during all quarters in 2020-2021 when compared with the rates during 2016-2019 (39.7% (95% Confidence Interval (CI): 34.6, 44.9) in quarter-2, 2020; 46.5% (95%CI: 36.7, 56.4) in quarter-3, 2020; 56.3% (95%CI: 48.7, 63.9) in quarter-4, 2020; 63.2% (95%CI: 53.9, 72.5) in quarter-1, 2021; 57.7% (95%CI: 52.9, 62.4) in quarter-2, 2021; 53.3% (95%CI: 43.8, 62.8) in quarter-3, 2021).

Interpretation

There was a substantial and persistent reduction in asthma exacerbations across England over the first 18 months after the first lockdown. This is unlikely to be adequately explained by changes in health-seeking behaviour, pandemic-related healthcare service disruption, or any air-quality improvements.

Editorial

COVID-19 pandemic disturbs respiratory virus dynamics

The Lancet Respiratory Medicine, July 2022; doi.org/10.1016/ S2213-2600(22)00255-7

Abstract

The winter months normally bring a higher number of respiratory viruses as people spend more time indoors together and the cold, dry air allows viruses to survive, and infect people, more easily. The last two winters, however, have been very different. During both the 2020–21 and 2021–22 winter seasons, rates of COVID-19 were high and people were physical distancing, and wearing masks. This meant that the rates of influenza, RSV, rhinovirus, and other respiratory viral infections were incredibly low compared with previous winters. But as we have entered the warmer summer months in 2022, when rates of respiratory viral infections would normally be very low or absent, some countries have seen unusual seasonal changes in the prevalence of RSV, influenza, and parainfluenza.

Publications Lancet Diabetes Endocrinol.

Prioritising COVID-19 over everything: the unintended harm

June 2022;  doi: 10.1016/S2213-8587(21)00147-9

No abstract available

Amass et al.

Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit With COVID-19

Jama Internal Medicine, April 2022; doi:10.1001/jamainternmed.2022.1118

Abstract

Importance  The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined.

Objective  To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission.

Design, Setting, and Participants  This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states.

Exposure  Having a family member in the ICU with COVID-19.

Main Outcomes and Measures  Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6).

Results  A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients’ child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners.

Conclusions and Relevance  In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.

Gatti et al

Clinical outcome in solid organ transplant recipients affected by COVID-19 compared to general population: a systematic review and meta-analysis

CMI, https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00116-1/fulltext

CONTENUTO E COMMENTO: Revisione sistematica e metanalisi degli outcome di pazienti con COVID-19 sottoposti a trapianto di organo solido, a confronto con la popolazione generale di trapiantati senza infezione : nessun eccesso di mortalità fra gli infetti, ma aumentato rischio di ricovero in Rianimazione e di insufficienza renale acuta.

Englum, B.R.; et al.

Impact of the COVID-19 pandemic on diagnosis of new cancers: A national multicenter study of the Veterans Affairs Healthcare System

Cancer, https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.34011

CONTENUTO E COMMENTO: Studio sugli effetti del COVID-19 sulla diagnostica delle 4 principali neoplasie negli stati uniti (prostata, polmone, vescica e colon-retto). Si evidenzia nel 2020 una riduzione del numero delle procedure, specialmente le colonscopie, ma anche altre procedure invasive come le biopsie prostatiche e le cistoscopie, necessarie per la diagnosi delle relative neoplasie. Insieme al calo del numero di procedure si osserva una riduzione del numero di diagnosi.

Le conseguenze di questo trend negativo e dunque il ritardo diagnostico potrebbe portare ad un incremento della mortalità.