BioMed, Volume 2, Issue 1 (March 2022) – 14 articles

Opportunistic invasive fungal infections (IFI) have been described in severe SARS-CoV-2 infection. COVID-19-related cytokine storm, immune dysregulation and lymphopenia may increase IFI susceptibility in comorbid patients. We described the case of a 64-year-old man with respiratory failure due to SARS-CoV-2 infection complicated with disseminated cryptococosis. We analyzed the role played by the SARS-CoV-2-associated lymphopenia and the cumulative risk factors that lead to secondary infection by Cryptococcus neoformans, and its part in the dysregulation of the immunity response. Full article

There were worries that the COVID-19 pandemic could result in a shortage of supplies of some drugs. We aimed to analyze if the COVID-19 pandemic resulted in the availability drop of different cardiodiabetological medicaments. Special attention was put to combined therapies and to investigate the general availability of these drugs. Data were obtained from the Polish startup company GdziePoLek regarding the availability of 121 cardiodiabetolocigal drugs divided into 23 separate categories in Polish pharmacies. The period of the analysis was limited from 1 January 2019 to 31 December 2020. The threshold of a 20% decrease of median availability was set to found drugs with the most severe drop in availability during the COVID-19 pandemic. We also identified medicaments with a median availability of less than 50%. We identified two drugs with the most severe drop in availability level during COVID-19 pandemics: acenocoumarol (decrease by 52.0%) and nitrendipine (decrease by 98.3%). In 2019 and 2020, 27 of 121 drugs had a median availability lower than 50%. The limited availability concerned the most novel agents and polypills, mostly non-insulin antidiabetic drugs. The decrease in drug availability in Poland was not as severe as expected. Accessibility to some novel non-refunded medicaments is limited. Full article

Background: Recent studies have highlighted the relationship between EDs and COVID-19 and have shown how the change in daily dynamics and lifestyle together with the forced isolation regime have worked as psychopathological risk factors. Prolonged isolation, as an effect of the lockdown, has generated anxieties and fears related to the loss of control, increasing food restrictions. Aim: The aim of this study was to evaluate the impact of COVID-19 on symptoms, body image and the relationship between the onset of symptoms and the second block of the pandemic period. Methods: A total of 14 female patients (mean age = 18.71; SD = 5.59) with anorexia nervosa in treatment before the COVID-19 outbreak contributed to this study. The evaluation included the EDI-3, BUT and Disgust Scale-R questionnaires for general psychopathology, personality and ED severity indexes. Results: A total of 30% of patients reported increased symptoms during lockdown, and 88.2% passed the clinical cut-off on the general psychological maladaptation scale (EDI-3–GPMC > 26p), showing widespread dissatisfaction with body image and increased diet-related stress. Conclusions: Preliminary data on these specific vulnerability factors combined with stressful situations—in our case, the isolation due to the COVID-19 pandemic—can help in the design of personalized preventive and therapeutic approaches. Full article

The definition of the word “pain” has recently been changed by the International agency for the studies of pain (IASP), to include also non-verbal and pre-verbal people. During the COVID pandemic, we have seen a new category of people who cannot speak: in many countries, anxiety and isolation and the cuts to home-assistance and to many hospital services, have brought to de-crease the explicit request for healthcare. This is a problem to be solved and an important alert about what is still an unsatisfactory response given by the national healthcare systems: the care of those who are most frail and voiceless. In this article, this scenario is described, and proposals for a future improvement of pain treatment for those who cannot speak are described. The first is to create a “Medicine of Abundance”: it is possible to avoid wastes in healthcare, and with these funds, a better welcoming of people in hospitals, a better stay, and more motivated personnel can be provided. Abundance is a right of the poorest and sickest even more than the general population; when people are at their ease, they can express better their wishes and their sufferings. The hospital should become a place of hospitality, its walls should be the first care for the sick: now in too many cases it is a cold hub/container of services. The second proposal is having caregivers always measure the pain level in hospitalized patients before taking decisions on implementing or withdrawing medical treatments, in particular those that can accelerate their end-of-life; this is called the “pain principle”. Full article

Multimorbid patients represent a special population of vulnerable individuals who suffer from two or more long-term conditions. They are a very prevalent group with an increased risk of death from COVID-19. The present study aimed to identify the sociodemographic and clinical determinants of multimorbidity of underlying conditions that increase the risk of severe COVID-19 in chronic adult individuals by analyzing data from the Portuguese National Health Survey 2019. The inclusion sample consisted of 7859 adult residents in Portugal who had at least one chronic condition. The health conditions considered for multimorbidity were CKD, COPD, heart conditions, diabetes mellitus, obesity, and smoking. In Portugal, approximately 6 out of every 10 individuals with chronic diseases suffer from one or more conditions that are on the list of those at increased risk of severe COVID-19 disease, and approximately 2 out of every 10 individuals have multimorbidity. Obesity and diabetes are the most frequent risk factors. Timely interventions (e.g., regular medical follow-up for preventive health services and health information) targeting multimorbidity in males and individuals with low educational levels, a poor health status, and low functionality may help to reduce the risk of severe COVID-19 and post-COVID-19 sequelae, and to improve health in a large proportion of the population. Full article

A COVID-19 smoker’s paradox was identified during the early days of the COVID-19 pandemic—many studies reported that smokers appeared to be protected against SARS-CoV-2 infections. Conversely, other studies added to the smoker’s paradox controversy with findings of increased risk for COVID-19 in heavy smokers. Ciliary beat frequency (CBF) within the ciliated epithelium of the nasal tract can be stimulated to a higher frequency and provide increased protection against transient exposure to airway irritants. Smokers as well as non-smokers exposed to secondhand tobacco smoke were found to have higher CBFs. However, with extended exposure to irritants, persistent upregulated CBF can damage and remodel the epithelial layer with fewer protective cilia. Additionally, mucociliary clearance (MCC), the innate defense mechanism of the respiratory system, traps particles and pathogens within the mucous layer of the epithelium and propels them out of the airways through ciliary activity. However, this mechanism becomes defective as disease progresses, increasing susceptibility to viral respiratory infections. This paper proposes that a smoker’s paradox associated with SARS-CoV-2 infection in COVID-19 patients may be mediated by upregulated ciliary beating frequency and mucociliary clearance with transient exposure to tobacco smoke, and downregulated CBF and MCC with extended exposure to tobacco smoke. Full article

COVID-19 remains a major world health problem, and its clinical manifestations can vary from an oligosymptomatic form to severe pulmonary infection, which can require invasive ventilation and is strictly related to death. Identifying risk factors for adverse outcomes is essential for performing adequate care and contrasting high mortality. Chronic kidney disease (CKD) is a widespread comorbidity and is a known risk factor for death during SARS-CoV-2 infection. The present study evaluates the death risk assessment during the COVID-19 pandemic in (CKD) patients, considering the baseline value of an estimated glomerular filtration rate (eGFR) and other possible risk factors. We retrospectively assessed the mortality risk in 150 patients with COVID-19 between 1 October and 31 December 2020. We evaluated eGFR, haemoglobin, albumin, uric acid, cholesterol, triglycerides, and significant risk factors, such as diabetes mellitus and cardiovascular disease in every patient. We had 53 deaths (35.3%) during the observational period, significantly related to age, eGFR, albumin, and baseline nephropathy. In the multivariable analysis, only baseline eGFR and age were independent predictors of death during SARS-CoV-2 infection, with an OR equal to 0.96 and 1.067, respectively. In conclusion, by our analysis, age, and the baseline eGFR were the only reliable predictors of death during COVID-19 in CKD patients. Full article

The outbreak of the COVID-19 epidemic has focused enormous attention on the genetics of viral infection and related disease. Since the beginning of the pandemic, we focused on the collection and integration of SARS-CoV-2 databases, which contain information on the structure of the virus and on its ability to spread, mutate, and evolve; data are made available from several open-source databases. In the past, we gathered experience on human genomics data by building models and integrated databases of genomic datasets (representing, e.g., mutations, gene expression profiles, epigenetic signals). We also coordinated the development of a data dictionary describing the clinical phenotype of the COVID19 disease, in the context of a very large consortium. The main objective of this paper is to describe the content of the data dictionary and the process of data collection and organization. We also argue that—in the context of the COVID-19 disease—interoperability between the three domains of viral genomics, clinical phenotype, and human host genomics is essential for empowering important analysis processes and results. We call for actions that could be performed to link these data. Full article

The pandemic caused by the new coronavirus in 2019, now called SARS-CoV-2 or COVID-19 disease, has become a major public health problem worldwide. The main method of diagnosing SARS-CoV-2 infection is RT-PCR, but medical imaging brings important quantitative and qualitative information that complements the data for diagnosis and prediction of the clinical course of the disease, even if chest X-rays and CT scans are not routinely recommended for screening and diagnosis of COVID-19 infections. Identifying characteristics of medical images, such as GGO, crazy paving, and consolidation as those of COVID-19 can guide the diagnosis, and can help clinicians in decisions in patient treatment if an RT-PCR result is not available rapidly. Chest radiographs and CT also bring information about the severity and unfavorable evolution potential of the disease. Radiomics, a new research subdomain of A.I. based on the extraction and analysis of shape and texture characteristics from medical images, along with deep learning, another A.I. method that uses neural networks, can offer new horizons in the development of models with diagnostic and predictive value for COVID-19 disease management. Standardizing the methods and creating multivariable models that include etiological, biological, and clinical data may increase the value and impact of using radiomics in routine COVID-19 evaluation. Recently, proposed complex models that may include radiological features or clinical variables have appeared to add value to the accuracy of CT diagnosis by radiomix and are likely to underlie the routine use of radiomic in COVID-19 management. Full article

SARS-CoV-2 is one more virus that can affect the brain in one way or another. Now, we are only beginning to understand some mechanisms and the degree to which it can impact the nervous system. Considering the rapid accumulation of knowledge about multiple neurological and cognitive symptoms in COVID-19 patients, it seems useful to encourage the development of systematic approaches for the diagnosis, management and treatment of the cognitive aspects of COVID-19. From what is known at this time about the impact of COVID-19 on the brain, the presentation of long-term cognitive sequelae can be expected to be heterogeneous in nature and will depend at least in part on the severity of the disease at the stage acute COVID-19. The long-term essential characteristics of these sequelae will probably be related to a combination of causes and different neuropathological processes in the acute phase. The scope and severity of the current COVID-19 pandemic are unparalleled in modern society. The later implications for neurological function can be just as serious. Although the current focus is on the management of acute diseases, in the near future the focus should be on the long-term consequences of COVID-19 infection and its mitigation, hence the need for the development of systematic approaches for the management of the cognitive and neuropsychiatric aspects of COVID-19. Full article

Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (UK) witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to the conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights the contemporary necessity to equip and empower all maternity stakeholders to deliver the basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational Diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families, aiming to foster long term healthy lifestyle changes. The final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened the “diagnosis to first consultation” intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of GBP 66,384 a year. Full article

Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) is a positive-sense single-stranded RNA coronavirus capable of causing potentially lethal pneumonia-like infectious diseases in mammals and birds. The main mechanisms by which SARS-CoV-2 spreads include airborne transmission (aerosols and droplets) and the direct exposure of tissues (conjunctival, nasal, and oral mucosa) to contaminated fluids. The aerosol formation is universal in dentistry due to the use of rotary instruments (handpieces), ultrasonic scalers, and air–water syringes. Several layers of infection control should protect key stakeholders such as dentists, dental staff, and patients. These include the utilization of personal protective equipment, high-volume evacuation systems, pre-procedural mouthwashes, rubber dam, and more recently, antimicrobial photodynamic therapy and intra-oral visible light irradiation. These non-specific light-based approaches are relatively simple, inexpensive, and effective against viruses, bacteria, and fungi. Therefore, the present perspective review discusses the current efforts and limitations on utilizing biophotonic approaches as adjunct infection control methods to prevent the transmission of SARS-CoV-2 in dental settings. In addition, the present perspective review may positively impact subsequent developments in the field, as it offers relevant information regarding the intricacies and complexities of infection control in dental settings. Full article

We conducted a systematic survey of COVID-19 endpoint prediction literature to: (a) identify publications that include data that adhere to FAIR (findability, accessibility, interoperability, and reusability) principles and (b) develop and reuse mortality prediction models that best generalize to these datasets. The largest such cohort data we knew of was used for model development. The associated published prediction model was subjected to recursive feature elimination to find a minimal logistic regression model which had statistically and clinically indistinguishable predictive performance. This model could still not be applied to the four external validation sets that were identified, due to complete absence of needed model features in some external sets. Thus, a generalizable model (GM) was built which could be applied to all four external validation sets. An age-only model was used as a benchmark, as it is the simplest, effective, and robust predictor of mortality currently known in COVID-19 literature. While the GM surpassed the age-only model in three external cohorts, for the fourth external cohort, there was no statistically significant difference. This study underscores: (1) the paucity of FAIR data being shared by researchers despite the glut of COVID-19 prediction models and (2) the difficulty of creating any model that consistently outperforms an age-only model due to the cohort diversity of available datasets. Full article

Introduction: One of the most common chronic complications of diabetes mellitus is diabetic neuropathy. The aim of the study was to elucidate the association between selected markers of oxidative stress and markers of vascular stiffness and to contribute to the understanding of the pathophysiological links between oxidative stress and micro- and macrovascular complications of diabetes. Methods: We enrolled patients with type 2 DM (n = 49), with moderate to severe diabetic polyneuropathy of lower extremities, and a control group without microvascular complications (n = 29). The neuropathy group received alpha-lipoic acid infusion therapy. Sampling was performed before and after treatment to determine the level of oxidative markers (advanced glycation end-products—AGEs, glycation products of AOPP proteins, MDA malondialdehyde and oxidized LDL), parameters of metabolic control and parameters of vascular wall stiffness were measured by sphygmomanometry. Results: After the administration of alpha-lipoic acid, we demonstrated a significant reduction in the level of three selected oxidation markers (AOPP: p < 0.001, AGE: p < 0.001, oxLDL: p < 0.05). In contrast, the level of MDA did not change significantly (p = 0.83). Throughout the group, oxLDL was significantly correlated with central BP (SBP and DBP in the aorta, p < 0.05 and <0.01) and with the augmentation index (AiX/75 bpm, p < 0.01). AOPP significantly correlated with systolic BP in the aorta (p < 0.05). We did not find significant associations in the remaining oxidation markers. Conclusion: In our study, we demonstrated a reduction in the level of oxidative markers after alpha-lipoic acid administration and also an association between markers of oxidative damage to lipids and proteins (oxLDL and AOPP) and some parameters of vascular stiffness. Full article