Journal of Clinical Medicine

Editorial

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2 pages, 162 KiB

Open AccessEditorial

Editorial: Unusual Clinical Presentation of COVID-19

by Pierpaolo Di Micco

J. Clin. Med. 2022, 11(11), 2953; https://doi.org/10.3390/jcm11112953 - 24 May 2022

Cited by 1 | Viewed by 1682

Abstract

Nearly two years ago, the SARS-CoV2 outbreak began, and our lives have changed significantly since then [...] Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

Research

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10 pages, 677 KiB

Open AccessArticle

The Impact of the COVID-19 Outbreak on Patients’ Adherence to PCSK9 Inhibitors Therapy

by Valentina Maria Caso, Simona Sperlongano, Biagio Liccardo, Emanuele Romeo, Sergio Padula, Fortunato Arenga, Antonello D’Andrea, Pio Caso, Paolo Golino, Gerardo Nigro and Vincenzo Russo

J. Clin. Med. 2022, 11(3), 475; https://doi.org/10.3390/jcm11030475 - 18 Jan 2022

Cited by 10 | Viewed by 2173

Abstract

PCSK9 inhibitors (PCSK9i) are monoclonal antibodies that have been shown to be effective in reducing both LDL cholesterol (LDL-C) values and major cardiovascular events in patients at high cardiovascular risk. Adherence to PCSK9i is critical for the success of the treatment. The aim [...] Read more.

PCSK9 inhibitors (PCSK9i) are monoclonal antibodies that have been shown to be effective in reducing both LDL cholesterol (LDL-C) values and major cardiovascular events in patients at high cardiovascular risk. Adherence to PCSK9i is critical for the success of the treatment. The aim of the present study is to evaluate patients’ adherence to PCSK9i during the COVID-19 pandemic. Patients referred to the Cardiac Diagnostic Unit of the University of Campania “Luigi Vanvitelli” Naples, taking PCSK9i, and who missed the cardiological follow-up visit during the first national COVID-19 lockdown (9 March–17 May 2020), were included. Each patient underwent medical teleconsultation to collect current clinical conditions, adherence to drug treatments, and lipid profile laboratory tests. Among 151 eligible patients, 20 were excluded for missing or untraceable telephone numbers and one for refusing to join the interview. The selected study population consisted of 130 patients (64 ± 9 years, 68% males), of whom 11 (8.5%) reported a temporary interruption of the PCSK-9 therapy for a mean period of 65 ± 1.5 days. The non-adherent patients showed a marked increase in LDL-C than in the pre-pandemic period (90.8 ± 6.0 vs. 54.4 ± 7.7 mg/dL, p < 0.0001), and 82% of patients moved out of the LDL-C therapeutic range. The non-adherent group was more likely to have a very high cardiovascular risk compared to the adherent group (81.8 vs. 33.6%, p < 0.001). Causes of interruption included drug prescription failure (63.6%) due to temporary interruption of the non-urgent outpatient visits and failure in drug withdrawal (36.4%) due to patients’ fear of becoming infected during the pandemic. The COVID-19 lockdown caused a remarkable lack of adherence to PCSK9i therapy, risking negative implications for the health status of patients at high cardiovascular risk. Facilitating patients’ access to PCSK9i and enhancing telemedicine seem to be effective strategies to ensure the continuity of care and appropriate management of these patients. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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13 pages, 1321 KiB

Open AccessArticle

Machine Learning to Calculate Heparin Dose in COVID-19 Patients with Active Cancer

by Egidio Imbalzano, Luana Orlando, Angela Sciacqua, Giuseppe Nato, Francesco Dentali, Veronica Nassisi, Vincenzo Russo, Giuseppe Camporese, Gianluca Bagnato, Arrigo F. G. Cicero, Giuseppe Dattilo, Marco Vatrano, Antonio Giovanni Versace, Giovanni Squadrito and Pierpaolo Di Micco

J. Clin. Med. 2022, 11(1), 219; https://doi.org/10.3390/jcm11010219 - 31 Dec 2021

Cited by 7 | Viewed by 2719

Abstract

To realize a machine learning (ML) model to estimate the dose of low molecular weight heparin to be administered, preventing thromboembolism events in COVID-19 patients with active cancer. Methods: We used a dataset comprising 131 patients with active cancer and COVID-19. We considered [...] Read more.

To realize a machine learning (ML) model to estimate the dose of low molecular weight heparin to be administered, preventing thromboembolism events in COVID-19 patients with active cancer. Methods: We used a dataset comprising 131 patients with active cancer and COVID-19. We considered five ML models: logistic regression, decision tree, random forest, support vector machine and Gaussian naive Bayes. We decided to implement the logistic regression model for our study. A model with 19 variables was analyzed. Data were randomly split into training (70%) and testing (30%) sets. Model performance was assessed by confusion matrix metrics on the testing data for each model as positive predictive value, sensitivity and F1-score. Results: We showed that the five selected models outperformed classical statistical methods of predictive validity and logistic regression was the most effective, being able to classify with an accuracy of 81%. The most relevant result was finding a patient-proof where python function was able to obtain the exact dose of low weight molecular heparin to be administered and thereby to prevent the occurrence of VTE. Conclusions: The world of machine learning and artificial intelligence is constantly developing. The identification of a specific LMWH dose for preventing VTE in very high-risk populations, such as the COVID-19 and active cancer population, might improve with the use of new training ML-based algorithms. Larger studies are needed to confirm our exploratory results. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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7 pages, 1774 KiB

Open AccessArticle

Efficacy of Prolonged-Release Melatonin 2 mg (PRM 2 mg) Prescribed for Insomnia in Hospitalized Patients for COVID-19: A Retrospective Observational Study

by Carolina Bologna, Pasquale Madonna and Eduardo Pone

J. Clin. Med. 2021, 10(24), 5857; https://doi.org/10.3390/jcm10245857 - 14 Dec 2021

Cited by 16 | Viewed by 4282

Abstract

Background: we have observed the effect of insomnia treatment in clinical and prognostic differences of patients admitted for COVID-19 pneumonia in respiratory sub-intensive units that were administered a prolonged-release melatonin 2 mg (PRM 2 mg) therapy versus a group of patients out of [...] Read more.

Background: we have observed the effect of insomnia treatment in clinical and prognostic differences of patients admitted for COVID-19 pneumonia in respiratory sub-intensive units that were administered a prolonged-release melatonin 2 mg (PRM 2 mg) therapy versus a group of patients out of therapy. Materials and Methods: We evaluated 40 patients on prolonged-release melatonin 2 mg (PRM 2 mg) therapy versus a control group of 40 patients out of therapy. Results: patients in the PRM 2 mg group had a shorter duration of therapy with non-invasive ventilation (5.2 ± 3.0 vs. 12.5 ± 4.2; p < 0.001), with a shorter stay in sub-intensive care (12.3 ± 3.2 vs. 20.1 ± 6.1; p < 0.001), and, therefore, a shorter overall duration of hospitalization (31.3 ± 6.8 vs. 34.3 ± 6.9 p = 0.03). In addition, a lower incidence of delirium was found (2.2 ± 1.1 vs. 3.3 ± 1.3; p < 0.001). Conclusions: A significant increase in sleep hours and a reduction in delirium episodes occurs in hospitalized insomniac patients treated with PRM 2 mg, compared to untreated patients. Based on these preliminary results, we can assume that there are benefits of prolonged-release melatonin 2 mg in COVID-19 therapy. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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7 pages, 375 KiB

Open AccessArticle

SARS-CoV-2 in Urine May Predict a Severe Evolution of COVID-19

by Alessandro Perrella, Mario Brita, Francesco Coletta, Simona Cotena, GiamPaola De Marco, Adele Longobardi, Crescenzo Sala, Dania Sannino, Antonio Tomasello, Marco Perrella, Giuseppe Russo, Marina Tarsitano, Massimo Chetta, Matteo Della Monica, Valentina Orlando, Enrico Coscioni and Romolo Villani

J. Clin. Med. 2021, 10(18), 4061; https://doi.org/10.3390/jcm10184061 - 8 Sep 2021

Cited by 8 | Viewed by 2761

Abstract

We hypothesized that the spread of SARS-CoV-2 in urine during a severe COVID-19 infection may be the expression of the worsening disease evolution. Therefore, the aim of this study was to verify if the COVID-19 disease severity is related to the viral presence [...] Read more.

We hypothesized that the spread of SARS-CoV-2 in urine during a severe COVID-19 infection may be the expression of the worsening disease evolution. Therefore, the aim of this study was to verify if the COVID-19 disease severity is related to the viral presence in urine samples. We evaluated the clinical evolution in acute COVID-19 patients admitted in the sub-intensive care and intensive care units between 28 of December 2020 and 15th of February 2021 and being positive for SARS-CoV-2 RNA in the respiratory tract, including repeated endotracheal aspirates (ETA), sputum, nasopharyngeal swabs (NPS) and urine. We found that those subjects with SARS-COV-2 in the urine at admittance (8 out of 60 eligible patients) had a more severe disease than those with negative SARS-CoV-2 in urine. Further, they showed an increase in fibrinogen and (C-reactive Protein) CRP serum levels, requiring mechanic ventilation. Of those with positive SARS-CoV-2 in the urine, 50% died. According to our preliminary results, it seems that the presence of SARS-CoV-2 in the urine characterizes patients with a more severe disease and is also related to a higher death rate. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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8 pages, 712 KiB

Open AccessArticle

Arterial Hypertension and Diabetes Mellitus in COVID-19 Patients: What Is Known by Gender Differences?

by Tiziana Ciarambino, Filippina Ciaburri, Venere Delli Paoli, Giuseppe Caruso, Mauro Giordano and Maria D’Avino

J. Clin. Med. 2021, 10(16), 3740; https://doi.org/10.3390/jcm10163740 - 23 Aug 2021

Cited by 6 | Viewed by 3226

Abstract

Background. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected >160 million people around the world. Hypertension (HT), chronic heart disease (CHD), and diabetes mellitus (DM) increase susceptibility to SARS-CoV-2 infection. Aims. We designed this retrospective study to assess the gender differences in hypertensive [...] Read more.

Background. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected >160 million people around the world. Hypertension (HT), chronic heart disease (CHD), and diabetes mellitus (DM) increase susceptibility to SARS-CoV-2 infection. Aims. We designed this retrospective study to assess the gender differences in hypertensive diabetic SARS-CoV-2 patients. We reported data, by gender differences, on the inflammatory status, on the hospital stays, intensive care unit (ICU) admission, Rx and CT report, and therapy. Methods. We enrolled 1014 patients with confirmed COVID-19 admitted into different Hospitals of Campania from 26 March to 30 June, 2020. All patients were allocated into two groups: diabetic-hypertensive group (DM-HT group) that includes 556 patients affected by diabetes mellitus and arterial hypertension and the non-diabetic- non-hypertensive group (non-DM, non-HT group) comprising 458 patients. The clinical outcomes (i.e., discharges, mortality, length of stay, therapy, and admission to intensive care) were monitored up to June 30, 2020. Results. We described, in the DM-HT group, higher proportion of cardiopathy ischemic (CHD) (47.5% vs. 14.8%, respectively; p < 0.0001) and lung diseases in females compared to male subjects (34.8% vs. 18.5%, respectively; p < 0.0001). In male subjects, we observed higher proportion of kidney diseases (CKD) (11% vs. 0.01%, respectively; p < 0.0001), a higher hospital stay compared to female subjects (22 days vs. 17 days, respectively, p < 0.0001), a higher admission in ICU (66.9% vs. 12.8%, respectively, p < 0.0001), and higher death rate (17.3% vs. 10.7%, respectively, p < 0.0001). Conclusion. These data confirm that male subjects, compared to female subjects, have a higher hospital stay, a higher admission to ICU, and higher death rate. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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Review

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28 pages, 382 KiB

Open AccessReview

How Does SARS-CoV-2 Affect Our Eyes—What Have We Learnt So Far about the Ophthalmic Manifestations of COVID-19?

by Jacek Baj, Alicja Forma, Barbara Teresińska, Magdalena Tyczyńska, Julita Zembala, Jacek Januszewski, Jolanta Flieger, Grzegorz Buszewicz and Grzegorz Teresiński

J. Clin. Med. 2022, 11(12), 3379; https://doi.org/10.3390/jcm11123379 - 13 Jun 2022

Cited by 4 | Viewed by 2482

Abstract

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has become a worldwide threat resulting in a pandemic in 2020. SARS-CoV-2 infection manifests itself as coronavirus disease 2019 (COVID-19) that is evidenced in a vast number of either specific or nonspecific symptoms. Except for [...] Read more.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has become a worldwide threat resulting in a pandemic in 2020. SARS-CoV-2 infection manifests itself as coronavirus disease 2019 (COVID-19) that is evidenced in a vast number of either specific or nonspecific symptoms. Except for typical (but nonspecific) symptoms such as fever, dry cough, or muscle weakness, the infected patients might also present atypical symptoms including neurological, dermatological, or ophthalmic manifestations. This paper summarizes the current state of knowledge regarding the onset, progression, and types of ophthalmic symptoms induced by SARS-CoV-2 infection recognized amongst the infected patients. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

15 pages, 3229 KiB

Open AccessReview

Prognostic Factors for Post-COVID-19 Syndrome: A Systematic Review and Meta-Analysis

by Giuseppe Maglietta, Francesca Diodati, Matteo Puntoni, Silvia Lazzarelli, Barbara Marcomini, Laura Patrizi and Caterina Caminiti

J. Clin. Med. 2022, 11(6), 1541; https://doi.org/10.3390/jcm11061541 - 11 Mar 2022

Cited by 117 | Viewed by 9547

Abstract

Evidence shows that a substantial proportion of patients with COVID-19 experiences long-term consequences of the disease, but the predisposing factors are poorly understood. We conducted a systematic review and meta-analysis to identify factors present during COVID-19 hospitalization associated with an increased risk of [...] Read more.

Evidence shows that a substantial proportion of patients with COVID-19 experiences long-term consequences of the disease, but the predisposing factors are poorly understood. We conducted a systematic review and meta-analysis to identify factors present during COVID-19 hospitalization associated with an increased risk of exhibiting new or persisting symptoms (Post-COVID-19 Syndrome, PCS). MedLine and WebOfScience were last searched on 30 September 2021. We included English language clinical trials and observational studies investigating prognostic factors for PCS in adults previously hospitalized for COVID-19, reporting at least one individual prospective follow-up of minimum 12 weeks. Two authors independently assessed risk of bias, which was judged generally moderate. Risk factors were included in the analysis if their association with PCS was investigated by at least two studies. To summarize the prognostic effect of each factor (or group of factors), odds ratios were estimated using raw data. Overall, 20 articles met the inclusion criteria, involving 13,340 patients. Associations were statistically significant for two factors: female sex with any symptoms (OR 1.52; 95% CI 1.27–1.82), with mental health symptoms (OR 1.67, 95% CI 1.21–2.29) and with fatigue (OR 1.54, 95% CI 1.32–1.79); acute disease severity with respiratory symptoms (OR 1.66, 95% CI 1.03–2.68). The I² statistics tests were calculated to quantify the degree of study heterogeneity. This is the first meta-analysis measuring the association between factors present during COVID-19 hospitalization and long-term sequelae. The role of female sex and acute disease severity as independent prognostic factors must be confirmed in robust longitudinal studies with longer follow-up. Identifying populations at greatest risk for PCS can enable the development of targeted prevention and management strategies. Systematic review registration: PROSPERO CRD42021253467. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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8 pages, 233 KiB

Open AccessReview

Movement Disorders Induced by SARS-CoV-2 Infection: Protocol for a Scoping Review

by Elena Cecilia Rosca, Zsolt Vastag, Onanong Phokaewvarangkul and Jirada Sringean

J. Clin. Med. 2022, 11(4), 923; https://doi.org/10.3390/jcm11040923 - 10 Feb 2022

Cited by 4 | Viewed by 2621

Abstract

Infections are a significant cause of movement disorders. The clinical manifestations of SARS-CoV-2 infection are variable, with up to one-third of patients developing neurologic complications, including movement disorders. This scoping review will lay out a comprehensive understanding of movement disorders induced by SARS-CoV-2 [...] Read more.

Infections are a significant cause of movement disorders. The clinical manifestations of SARS-CoV-2 infection are variable, with up to one-third of patients developing neurologic complications, including movement disorders. This scoping review will lay out a comprehensive understanding of movement disorders induced by SARS-CoV-2 infection. We aim to investigate the epidemiology, clinical and paraclinical features, interventions, and diagnostic challenges in patients with different types of movement disorders in the context of SARS-CoV-2 infection. We will search three databases applying appropriate search terms. Inclusion and exclusion criteria are pre-defined; the data of eligible studies will be extracted in standardized forms. We will report the results following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will present information for clinicians and other healthcare professionals, policymakers, and public health researchers. In addition, the results of the present review may assist in the development and confirmation of inclusion criteria and research questions for further systematic review or meta-analysis, with more precise, narrower questions. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

Other

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15 pages, 6928 KiB

Open AccessCase Report

Association between Severe SARS-CoV-2 Infection and Severe Acute Pancreatitis in Pregnancy and Postpartum

by Mihaela Mocan, Robert Szabo, Cătălin Constantinescu, Ciprian Cucoreanu and Romeo Ioan Chira

J. Clin. Med. 2022, 11(9), 2554; https://doi.org/10.3390/jcm11092554 - 2 May 2022

Cited by 2 | Viewed by 3275

Abstract

Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited to it. The gastrointestinal symptoms are polymorphic, including diarrhea, vomiting, abdominal pain, and even acute pancreatitis (AP). Pregnant women are more vulnerable to SARS-CoV-2 infection and have a higher risk of [...] Read more.

Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited to it. The gastrointestinal symptoms are polymorphic, including diarrhea, vomiting, abdominal pain, and even acute pancreatitis (AP). Pregnant women are more vulnerable to SARS-CoV-2 infection and have a higher risk of severe outcomes of COVID-19. Case report: We present a case report of a 31-year-old primigravid patient at 30 weeks of gestation, unvaccinated, with a medical history of thrombophilia, chronic nephropathy of unknown origin, hypertension, and optic neuropathy with left eye hemianopsia. She was diagnosed with moderate-to-severe COVID-19 and respiratory failure, with indication for cesarean section. Postpartum, she developed severe acute pancreatitis, complicated by peripancreatic and supradiaphragmatic abscesses. After 3 months of hospitalization and eight surgical interventions, the patient was discharged. A short mini-review of the literature is introduced. Conclusion: Pregnant women with cardiovascular comorbidities are prone to severe complications of SARS-CoV-2 infection. Clinicians should be aware of the association of SARS-CoV-2 and AP in pregnant women. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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23 pages, 3030 KiB

Open AccessSystematic Review

Oral Manifestations in SARS-CoV-2 Positive Patients: A Systematic Review

by Kacper Nijakowski, Sylvia Wyzga, Nisha Singh, Filip Podgórski and Anna Surdacka

J. Clin. Med. 2022, 11(8), 2202; https://doi.org/10.3390/jcm11082202 - 14 Apr 2022

Cited by 14 | Viewed by 3184

Abstract

The COVID-19 pandemic has severely affected the human population by revealing many health problems, including within the oral cavity. This systematic review was designed to answer the question “Is there a relationship between oral manifestations and SARS-CoV-2 infection?”. Following the inclusion and exclusion [...] Read more.

The COVID-19 pandemic has severely affected the human population by revealing many health problems, including within the oral cavity. This systematic review was designed to answer the question “Is there a relationship between oral manifestations and SARS-CoV-2 infection?”. Following the inclusion and exclusion criteria, twenty-seven studies were included (according to PRISMA statement guidelines). Based on the meta-analysis, nearly two-thirds of the SARS-CoV-2 positive patients reported oral symptoms, in particular taste alterations, xerostomia and ulcerations (54.73% [95% CI: 46.28–63.04%], 37.58% [95% CI: 26.35–49.53%], and 21.43% [95% CI: 13.17–31.06%], respectively). In conclusion, despite the conducted systematic review, the increased prevalence of oral manifestations in SARS-CoV-2 infection cannot be clearly established due to the possible association of other factors, e.g., individual or environmental factors. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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7 pages, 242 KiB

Open AccessBrief Report

Clinical Differences between COVID-19 and a COVID-Like Syndrome

by Pierpaolo Di Micco, Giuseppe Camporese, Vincenzo Russo, Giuseppe Cardillo, Egidio Imbalzano, Antonella Tufano, Enrico Bernardi and Andrea Fontanella

J. Clin. Med. 2021, 10(11), 2519; https://doi.org/10.3390/jcm10112519 - 7 Jun 2021

Cited by 5 | Viewed by 3045 | Correction

Abstract

COVID-19 is an infection due to SARS-CoV-2; this virus has been identified as the cause of the present pandemic. Several typical characteristics are present in this infection, in particular pneumonia with possible lung failure, but atypical clinical presentations are being described daily by [...] Read more.

COVID-19 is an infection due to SARS-CoV-2; this virus has been identified as the cause of the present pandemic. Several typical characteristics are present in this infection, in particular pneumonia with possible lung failure, but atypical clinical presentations are being described daily by physicians around the world. Ground-glass opacities with pneumonia are the most common and dangerous presentations of the COVID-19 disease, and they are usually associated with positive nasopharyngeal swab (NPS) tests with detectable SARS-CoV-2 viral RNA. Compared to the general population, hospital workers have been at a greater risk of infection ever since the first patients were hospitalized. However, hospital workers have also been reported as having COVID-like symptoms despite repeated negative swab tests but having tested positive for SARS-CoV-2 antibodies with serological tests. We can postulate that a COVID-like syndrome is possible, in particular in hospital workers, that is characterized by symptoms similar to those of COVID-19, but with repeated negative nasopharyngeal swabs. These repeated negative NSPs make the difference in daily clinical management with people that experienced a single false negative nasopharyngeal swab; furthermore, a clear clinical differentiation of these situations is still lacking in the literature. For this reason, here, we report our main findings from a cohort of patients with a COVID-like syndrome compared to a similar group affected by typical COVID-19. Full article

(This article belongs to the Special Issue Unusual Clinical Presentation of COVID-19)

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