Editor's Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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Article
Prediction of Vaccine Response and Development of a Personalized Anti-SARS-CoV-2 Vaccination Strategy in Kidney Transplant Recipients: Results from a Large Single-Center Study
J. Pers. Med. 2022, 12(7), 1107; https://doi.org/10.3390/jpm12071107 - 05 Jul 2022
Cited by 1 | Viewed by 960
Abstract
Kidney transplant recipients (KTRs) displays marked inter-individual variations in magnitude of immune responses to anti-SARS-CoV-2 vaccination. The aim of this large single-center study was to identify the predictive factors for serological response to the mRNA-1273 vaccine in KTRs. We also devised a score [...] Read more.
Kidney transplant recipients (KTRs) displays marked inter-individual variations in magnitude of immune responses to anti-SARS-CoV-2 vaccination. The aim of this large single-center study was to identify the predictive factors for serological response to the mRNA-1273 vaccine in KTRs. We also devised a score to optimize prediction with the goal of implementing a personalized vaccination strategy. The study population consisted of 564 KTRs who received at least two doses of the mRNA-1273 vaccine. Anti-RBD IgG titers were quantified one month after each vaccine dose and until six months thereafter. A third dose vaccine was given when the antibody titer after the second dose was <143 BAU/mL. A score to optimize prediction of vaccine response was devised using the independent predictors identified in multivariate analysis. The seropositivity rate after the second dose was 46.6% and 22.2% of participants were classified as good responders (titers ≥ 143 BAU/mL). On analyzing the 477 patients for whom serology testing was available after the second or third dose, the global seropositivity rate was 69% (good responders: 46.3%). Immunosuppressive drugs, graft function, age, interval from transplantation, body mass index, and sex were associated with vaccine response. The devised score was strongly associated with the seropositivity rate (AUC = 0.752, p < 0.0001) and the occurrence of a good antibody response (AUC = 0.785, p < 0.0001). Notably, antibody titers declined over time both after the second and third vaccine doses. In summary, a high burden of comorbidities and immunosuppression was correlated with a weaker antibody response. A fourth vaccine dose and/or pre-exposure prophylaxis with monoclonal antibodies should be considered for KTRs who remain unprotected. Full article
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Article
Does COVID-19 Clinical Status Associate with Outcome Severity? An Unsupervised Machine Learning Approach for Knowledge Extraction
J. Pers. Med. 2021, 11(12), 1380; https://doi.org/10.3390/jpm11121380 - 17 Dec 2021
Cited by 2 | Viewed by 1681
Abstract
Since the beginning of the COVID-19 pandemic, 195 million people have been infected and 4.2 million have died from the disease or its side effects. Physicians, healthcare scientists and medical staff continuously try to deal with overloaded hospital admissions, while in parallel, they [...] Read more.
Since the beginning of the COVID-19 pandemic, 195 million people have been infected and 4.2 million have died from the disease or its side effects. Physicians, healthcare scientists and medical staff continuously try to deal with overloaded hospital admissions, while in parallel, they try to identify meaningful correlations between the severity of infected patients with their symptoms, comorbidities and biomarkers. Artificial intelligence (AI) and machine learning (ML) have been used recently in many areas related to COVID-19 healthcare. The main goal is to manage effectively the wide variety of issues related to COVID-19 and its consequences. The existing applications of ML to COVID-19 healthcare are based on supervised classifications which require a labeled training dataset, serving as reference point for learning, as well as predefined classes. However, the existing knowledge about COVID-19 and its consequences is still not solid and the points of common agreement among different scientific communities are still unclear. Therefore, this study aimed to follow an unsupervised clustering approach, where prior knowledge is not required (tabula rasa). More specifically, 268 hospitalized patients at the First Propaedeutic Department of Internal Medicine of AHEPA University Hospital of Thessaloniki were assessed in terms of 40 clinical variables (numerical and categorical), leading to a high-dimensionality dataset. Dimensionality reduction was performed by applying a principal component analysis (PCA) on the numerical part of the dataset and a multiple correspondence analysis (MCA) on the categorical part of the dataset. Then, the Bayesian information criterion (BIC) was applied to Gaussian mixture models (GMM) in order to identify the optimal number of clusters under which the best grouping of patients occurs. The proposed methodology identified four clusters of patients with similar clinical characteristics. The analysis revealed a cluster of asymptomatic patients that resulted in death at a rate of 23.8%. This striking result forces us to reconsider the relationship between the severity of COVID-19 clinical symptoms and the patient’s mortality. Full article
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Article
Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study
J. Pers. Med. 2021, 11(12), 1359; https://doi.org/10.3390/jpm11121359 - 13 Dec 2021
Viewed by 1254
Abstract
(1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was [...] Read more.
(1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was to determine survival according to corticosteroid initiation setting. (2) Methods: We conducted a cohort study including all successive critically ill COVID-19 patients treated with corticosteroids and managed in our ICU. We compared survival, whether corticosteroids were initiated before (Cb-group) or after ICU admission (Ca-group), using a propensity score matching. (3) Results: Overall, 228 patients (67 years (56–74); 168M/60F; invasive mechanical ventilation on admission, 17%) were included with 63 patients in the Cb-group and 165 patients in the Ca-group. Survival to hospital discharge was 43% versus 69%, respectively (p = 0.001). In a multivariable analysis, factors associated with death were age (odds ratio, 1.07; 95%-confidence interval, (1.04–1.11); p < 0.0001), the sequential organ failure assessment (SOFA) score on ICU admission (1.30 (1.14–1.50); p = 0.0001) and corticosteroid initiation before ICU admission (2.64 (1.30–5.43); p = 0.007). No significant differences in outcome related to corticosteroid regimen were found. (4) Conclusions: Critically ill COVID-19 patients transferred to the ICU with deterioration despite corticosteroids initiated before admission have a less favorable outcome than patients receiving corticosteroids initiated after ICU admission. Full article
(This article belongs to the Special Issue Recent Advances on Coronavirus Disease 2019 (COVID-19))
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Article
Early Response of CD8+ T Cells in COVID-19 Patients
J. Pers. Med. 2021, 11(12), 1291; https://doi.org/10.3390/jpm11121291 - 03 Dec 2021
Cited by 4 | Viewed by 1177
Abstract
Healthy and controlled immune response in COVID-19 is crucial for mild forms of the disease. Although CD8+ T cells play important role in this response, there is still a lack of studies showing the gene expression profiles in those cells at the beginning [...] Read more.
Healthy and controlled immune response in COVID-19 is crucial for mild forms of the disease. Although CD8+ T cells play important role in this response, there is still a lack of studies showing the gene expression profiles in those cells at the beginning of the disease as potential predictors of more severe forms after the first week. We investigated a proportion of different subpopulations of CD8+ T cells and their gene expression patterns for cytotoxic proteins (perforin-1 (PRF1), granulysin (GNLY), granzyme B (GZMB), granzyme A (GZMA), granzyme K (GZMK)), cytokine interferon-γ (IFN-γ), and apoptotic protein Fas ligand (FASL) in CD8+ T cells from peripheral blood in first weeks of SARS-CoV-2 infection. Sixteen COVID-19 patients and nine healthy controls were included. The absolute counts of total lymphocytes (p = 0.007), CD3+ (p = 0.05), and CD8+ T cells (p = 0.01) in COVID-19 patients were significantly decreased compared to healthy controls. In COVID-19 patients in CD8+ T cell compartment, we observed lower frequency effector memory 1 (EM1) (p = 0.06) and effector memory 4 (EM4) (p < 0.001) CD8+ T cells. Higher mRNA expression of PRF1 (p = 0.05) and lower mRNA expression of FASL (p = 0.05) at the fifth day of the disease were found in COVID-19 patients compared to healthy controls. mRNA expression of PRF1 (p < 0.001) and IFN-γ (p < 0.001) was significantly downregulated in the first week of disease in COVID-19 patients who progressed to moderate and severe forms after the first week, compared to patients with mild symptoms during the entire disease course. GZMK (p < 0.01) and FASL (p < 0.01) mRNA expression was downregulated in all COVID-19 patients compared to healthy controls. Our results can lead to a better understanding of the inappropriate immune response of CD8+ T cells in SARS-CoV2 with the faster progression of the disease. Full article
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COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases
J. Pers. Med. 2021, 11(12), 1283; https://doi.org/10.3390/jpm11121283 - 02 Dec 2021
Cited by 5 | Viewed by 2634
Abstract
Background: Reports describing post-vaccine autoimmune phenomena, in previously healthy individuals, increased the concerns regarding the risk of disease flare-ups in patients with immune diseases. We aimed to assess the potential risk of disease flare-up, after receiving the COVID-19 (Coronavirus disease 2019) vaccine, during [...] Read more.
Background: Reports describing post-vaccine autoimmune phenomena, in previously healthy individuals, increased the concerns regarding the risk of disease flare-ups in patients with immune diseases. We aimed to assess the potential risk of disease flare-up, after receiving the COVID-19 (Coronavirus disease 2019) vaccine, during a follow-up period of 6 months. Methods: We performed a prospective cohort study, enrolling the patients with autoimmune- and immune-mediated diseases who voluntarily completed our questionnaire, both online and during hospital evaluations. Based on their decision to receive the vaccine, the patients were divided into two groups (vaccinated and non-vaccinated). Participants who chose not to receive the vaccine served as a control group in terms of flare-ups. Results: A total of 623 patients, 416 vaccinated and 207 non-vaccinated, were included in the study during hospital evaluations (222/623) and after online (401/623) enrolment. There was no difference concerning the risk of flare-up between vaccinated and non-vaccinated patients (1.16, versus 1.72 flare-ups/100 patients-months, p = 0.245). The flare-ups were associated with having more than one immune disease, and with a previous flare-up during the past year. Conclusions: We did not find an increased risk of flare-up following COVID-19 vaccination in patients with autoimmune-/immune-mediated diseases, after a median follow-up of 5.9 months. According to our results, there should not be an obvious reason for vaccine hesitancy among this category of patients. Full article
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Article
Cirrhosis-Associated RAS-Inflammation-Coagulation Axis Anomalies: Parallels to Severe COVID-19
J. Pers. Med. 2021, 11(12), 1264; https://doi.org/10.3390/jpm11121264 - 01 Dec 2021
Cited by 7 | Viewed by 1321
Abstract
(1) Background: Cirrhotic patients have an increased risk for severe COVID-19. We investigated the renin-angiotensin-aldosterone system (RAS), parameters of endothelial dysfunction, inflammation, and coagulation/fibrinolysis in cirrhotic patients and in COVID-19 patients. (2) Methods: 127 prospectively characterized cirrhotic patients (CIRR), along with nine patients [...] Read more.
(1) Background: Cirrhotic patients have an increased risk for severe COVID-19. We investigated the renin-angiotensin-aldosterone system (RAS), parameters of endothelial dysfunction, inflammation, and coagulation/fibrinolysis in cirrhotic patients and in COVID-19 patients. (2) Methods: 127 prospectively characterized cirrhotic patients (CIRR), along with nine patients with mild COVID-19 (mild-COVID), 11 patients with COVID-19 acute respiratory distress syndrome (ARDS; ARDS-COVID), and 10 healthy subjects (HS) were included in the study. Portal hypertension (PH) in cirrhotic patients was characterized by hepatic venous pressure gradient (HVPG). (3) Results: With increased liver disease severity (Child−Pugh stage A vs. B vs. C) and compared to HS, CIRR patients exhibited higher RAS activity (angiotensin-converting enzyme (ACE), renin, aldosterone), endothelial dysfunction (von Willebrand-factor (VWF) antigen), inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)), and a disturbed coagulation/fibrinolysis profile (prothrombin fragment F1,2, D-dimer, plasminogen activity, antiplasmin activity). Increased RAS activity (renin), endothelial dysfunction (vWF), coagulation parameters (D-dimer, prothrombin fragment F1,2) and inflammation (CRP, IL-6) were significantly altered in COVID patients and followed similar trends from mild-COVID to ARDS-COVID. In CIRR patients, ACE activity was linked to IL-6 (ρ = 0.26; p = 0.003), independently correlated with VWF antigen (aB: 0.10; p = 0.001), and was inversely associated with prothrombin fragment F1,2 (aB: −0.03; p = 0.023) and antiplasmin activity (aB: −0.58; p = 0.006), after adjusting for liver disease severity. (4) Conclusions: The considerable upregulation of the RAS in Child−Pugh B/C cirrhosis is linked to systemic inflammation, endothelial dysfunction, and abnormal coagulation profile. The cirrhosis-associated abnormalities of ACE, IL-6, VWF antigen, and antiplasmin parallel those observed in severe COVID-19. Full article
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Comparison of Clinical Characteristics and Outcomes of Younger and Elderly Patients with Severe COVID-19 in Korea: A Retrospective Multicenter Study
J. Pers. Med. 2021, 11(12), 1258; https://doi.org/10.3390/jpm11121258 - 29 Nov 2021
Cited by 2 | Viewed by 1035
Abstract
Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary [...] Read more.
Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary care centers in South Korea. This retrospective multicenter study included patients with severe COVID-19 who were admitted at seven hospitals in South Korea from 2 February 2020 to 28 February 2021. The Cox regression analyses were performed to assess factors associated with the in-hospital mortality. Of 488 patients with severe COVID-19, 318 (65.2%) were elderly (≥65 years). The older patient group had more underlying diseases and a higher severity score than the younger patient group. The older patient group had a higher in-hospital mortality rate than the younger patient group (25.5% versus 4.7%, p-value < 0.001). The in-hospital mortality risk factors among patients with severe COVID-19 included age, acute physiology and chronic health evaluation II score, presence of diabetes and chronic obstructive lung disease, high white blood cell count, low neutrophil-lymphocyte ratio and platelet count, do-not-resuscitate order, and treatment with invasive mechanical ventilation. In addition to old age, disease severity and examination results must be considered in treatment decision-making. Full article
(This article belongs to the Special Issue Personalized Medicine and Management of COVID-19)
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Prognostic Implications of Right Ventricular Function and Pulmonary Pressures Assessed by Echocardiography in Hospitalized Patients with COVID-19
J. Pers. Med. 2021, 11(12), 1245; https://doi.org/10.3390/jpm11121245 - 24 Nov 2021
Cited by 2 | Viewed by 1060
Abstract
Aims: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. [...] Read more.
Aims: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. Methods and results: This is a multicenter Italian study, including consecutive patients hospitalized for COVID-19. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. The study included 227 (16.1%) subjects (mean age 68 ± 13 years); intensive care unit (ICU) admission was reported in 32.2%. At competing risk analysis, after stratifying the population into tertiles, according to TAPSE, PAPS, and TAPSE/PAPS ratio values, patients in the lower TAPSE and TAPSE/PAPS tertiles, as well as those in the higher PAPS tertiles, showed a significantly higher incidence of death vs. the probability to be discharged during the hospitalization. At univariable logistic regression analysis, TAPSE, PAPS, and TAPSE/PAPS were significantly associated with a higher risk of death and PE, both in patients who were and were not admitted to ICU. At adjusted multivariable regression analysis, TAPSE, PAPS, and TAPSE/PAPS resulted in independently associated risk of in-hospital death (TAPSE: OR 0.85, CI 0.74–0.97; PAPS: OR 1.08, CI 1.03–1.13; TAPSE/PAPS: OR 0.02, CI 0.02 × 10−1–0.2) and PE (TAPSE: OR 0.7, CI 0.6–0.82; PAPS: OR 1.1, CI 1.05–1.14; TAPSE/PAPS: OR 0.02 × 10−1, CI 0.01 × 10−2–0.04). Conclusions: Echocardiographic evidence of RV systolic dysfunction, increased PAPS, and poor RV-arterial coupling may help to identify COVID-19 patients at higher risk of mortality and PE during hospitalization. Full article
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Article
Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
J. Pers. Med. 2021, 11(11), 1238; https://doi.org/10.3390/jpm11111238 - 22 Nov 2021
Cited by 2 | Viewed by 1183
Abstract
(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course [...] Read more.
(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. (2) Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (ECMO-after group) and before the end of the 10-day dexamethasone course (ECMO-before group). (3) Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the ECMO-before and 12 (30%) in the ECMO-after group. In the ECMO-before group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the ECMO-after group (p < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the ECMO-before group tended to be younger (57 years (51–59) versus 62 years (57–67), p = 0.053). In the ECMO-after group, no patient (0%) survived while 12 patients (43%) survived in the ECMO-before group (p = 0.007). (4) Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required. Full article
(This article belongs to the Special Issue Recent Advances on Coronavirus Disease 2019 (COVID-19))
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Intensive Care Patients from the First COVID-19 Wave: One-Year Survival after Tocilizumab Treatment
J. Pers. Med. 2021, 11(11), 1234; https://doi.org/10.3390/jpm11111234 - 21 Nov 2021
Cited by 1 | Viewed by 1305
Abstract
Introduction: An infection by COVID-19 triggers a dangerous cytokine storm, so tocilizumab has been introduced in Italy as an agent blocking the cytokine storm. This paper aims to describe the one-year survival of ICU patients treated with tocilizumab. Methods: This observational study enrolled [...] Read more.
Introduction: An infection by COVID-19 triggers a dangerous cytokine storm, so tocilizumab has been introduced in Italy as an agent blocking the cytokine storm. This paper aims to describe the one-year survival of ICU patients treated with tocilizumab. Methods: This observational study enrolled all patients confirmed to be infected by COVID-19 who were admitted to the ICU in our center. We offered tocilizumab to all non-septic patients if they did not present any contraindications. Results: We enrolled 68 ICU patients in our center on 72 occasions during the enrollment period; we excluded four patients due to study criteria. The one-year mortality hazard ratio of treated patients was 0.64, with a confidence interval of 0.31 to 1.19, with p = 0.169. Among the survivors, 32 of 35 patients answered the phone interview (14 patients in the treated group and 18 in the untreated group); overall, the effect of COVID-19 on quality of life was 58.14%. These effects were lower in the tocilizumab group, with p = 0.016 *. Conclusions: Our observational data follow the most relevant largest trial. Patients treated with tocilizumab had lower rates of new-onset symptoms later COVID-19 ICU hospitalizations. As reported by recent medical literature, the presence of these symptoms suggests that a follow-up program for these types of patients could be useful. Full article
(This article belongs to the Special Issue Recent Advances on Coronavirus Disease 2019 (COVID-19))
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Unmanaged Pharmacogenomic and Drug Interaction Risk Associations with Hospital Length of Stay among Medicare Advantage Members with COVID-19: A Retrospective Cohort Study
J. Pers. Med. 2021, 11(11), 1192; https://doi.org/10.3390/jpm11111192 - 12 Nov 2021
Cited by 2 | Viewed by 1884
Abstract
Unmanaged pharmacogenomic and drug interaction risk can lengthen hospitalization and may have influenced the severe health outcomes seen in some COVID-19 patients. To determine if unmanaged pharmacogenomic and drug interaction risks were associated with longer lengths of stay (LOS) among patients hospitalized with [...] Read more.
Unmanaged pharmacogenomic and drug interaction risk can lengthen hospitalization and may have influenced the severe health outcomes seen in some COVID-19 patients. To determine if unmanaged pharmacogenomic and drug interaction risks were associated with longer lengths of stay (LOS) among patients hospitalized with COVID-19, we retrospectively reviewed medical and pharmacy claims from 6025 Medicare Advantage members hospitalized with COVID-19. Patients with a moderate or high pharmacogenetic interaction probability (PIP), which indicates the likelihood that testing would identify one or more clinically actionable gene–drug or gene–drug–drug interactions, were hospitalized for 9% (CI: 4–15%; p < 0.001) and 16% longer (CI: 8–24%; p < 0.001), respectively, compared to those with low PIP. Risk adjustment factor (RAF) score, a commonly used measure of disease burden, was not associated with LOS. High PIP was significantly associated with 12–22% longer LOS compared to low PIP in patients with hypertension, hyperlipidemia, diabetes, or chronic obstructive pulmonary disease (COPD). A greater drug–drug interaction risk was associated with 10% longer LOS among patients with two or three chronic conditions. Thus, unmanaged pharmacogenomic risk was associated with longer LOS in these patients and managing this risk has the potential to reduce LOS in severely ill patients, especially those with chronic conditions. Full article
(This article belongs to the Special Issue Pharmacogenetic Testing in Primary Care and Prevention)
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MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity
J. Pers. Med. 2021, 11(11), 1166; https://doi.org/10.3390/jpm11111166 - 09 Nov 2021
Cited by 5 | Viewed by 1700
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19) pandemic. Besides virus intrinsic characteristics, the host genetic makeup is predicted to account for the extreme clinical heterogeneity of the disease, which is characterized, among other [...] Read more.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19) pandemic. Besides virus intrinsic characteristics, the host genetic makeup is predicted to account for the extreme clinical heterogeneity of the disease, which is characterized, among other manifestations, by a derangement of hemostasis associated with thromboembolic events. To date, large-scale studies confirmed that genetic predisposition plays a role in COVID-19 severity, pinpointing several susceptibility genes, often characterized by immunologic functions. With these premises, we performed an association study of common variants in 32 hemostatic genes with COVID-19 severity. We investigated 49,845 single-nucleotide polymorphism in a cohort of 332 Italian severe COVID-19 patients and 1668 controls from the general population. The study was conducted engaging a class of students attending the second year of the MEDTEC school (a six-year program, held in collaboration between Humanitas University and the Politecnico of Milan, allowing students to gain an MD in Medicine and a Bachelor’s Degree in Biomedical Engineering). Thanks to their willingness to participate in the fight against the pandemic, we evidenced several suggestive hits (p < 0.001), involving the PROC, MTHFR, MTR, ADAMTS13, and THBS2 genes (top signal in PROC: chr2:127192625:G:A, OR = 2.23, 95%CI = 1.50–3.34, p = 8.77 × 10−5). The top signals in PROC, MTHFR, MTR, ADAMTS13 were instrumental for the construction of a polygenic risk score, whose distribution was significantly different between cases and controls (p = 1.62 × 10−8 for difference in median levels). Finally, a meta-analysis performed using data from the Regeneron database confirmed the contribution of the MTHFR variant chr1:11753033:G:A to the predisposition to severe COVID-19 (pooled OR = 1.21, 95%CI = 1.09–1.33, p = 4.34 × 10−14 in the weighted analysis). Full article
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Results of the Second Phase of the GER-e-TEC Experiment concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes
J. Pers. Med. 2021, 11(11), 1117; https://doi.org/10.3390/jpm11111117 - 29 Oct 2021
Cited by 1 | Viewed by 1202
Abstract
Background: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized [...] Read more.
Background: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the “GER-e-TEC COVID study”. Methods: This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. Results: 30 elderly patients affected by COVID-19 disease were monitored remotely; the mean age was 85.9 years and a male/female ratio of 1.5 to 1.11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. Conclusions: The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes. Full article
(This article belongs to the Section Methodology, Drug and Device Discovery)
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Myocarditis and Pericarditis following COVID-19 Vaccination: Inequalities in Age and Vaccine Types
J. Pers. Med. 2021, 11(11), 1106; https://doi.org/10.3390/jpm11111106 - 28 Oct 2021
Cited by 29 | Viewed by 16812
Abstract
An increasing number of myocarditis/pericarditis incidences has been reported after coronavirus disease-19 (COVID-19) vaccination in adolescents and young adults. This study was designed to investigate the incidence rate of—and risk for—myocarditis and pericarditis following COVID-19 vaccination in the United States according to age [...] Read more.
An increasing number of myocarditis/pericarditis incidences has been reported after coronavirus disease-19 (COVID-19) vaccination in adolescents and young adults. This study was designed to investigate the incidence rate of—and risk for—myocarditis and pericarditis following COVID-19 vaccination in the United States according to age and vaccine type. This study used the Vaccine Adverse Events Reporting System (VAERS) from 11 December 2020 to 13 August 2021. A population-based data mining approach was performed based on the reporting odds ratio (ROR). Adverse events of myocarditis and pericarditis following COVID-19 vaccination were rare, with an incidence rate of 5.98 (95% CI = 5.73–6.24) cases per million doses administered. The incidence rate was higher in adolescents and after the administration of the second dose of messenger RNA (mRNA) vaccines. Overall, two mRNA vaccines were significantly associated with increased risks for myocarditis/pericarditis (mRNA-1273 (Moderna): ROR = 2.91, 95% CI = 2.21–3.83; BNT162b2 (Pfizer–BioNTech): ROR = 5.37, 95% CI = 4.10–7.04) compared to all other vaccines from VAERS. The viral vector vaccine of Ad26.COV2.S (Janssen) was not associated with signals of myocarditis/pericarditis (ROR = 1.39; 95% CI = 0.99–1.97). This study found increased risks for myocarditis/pericarditis following mRNA COVID-19 vaccines. For patients at high risk for myocarditis/pericarditis or with myocardial injuries, the viral vector vaccine may be an alternative for consideration. Full article
(This article belongs to the Special Issue Personalized Medicine and Management of COVID-19)
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Quantitative Analysis of Residual COVID-19 Lung CT Features: Consistency among Two Commercial Software
J. Pers. Med. 2021, 11(11), 1103; https://doi.org/10.3390/jpm11111103 - 28 Oct 2021
Cited by 3 | Viewed by 1113
Abstract
Objective: To investigate two commercial software and their efficacy in the assessment of chest CT sequelae in patients affected by COVID-19 pneumonia, comparing the consistency of tools. Materials and Methods: Included in the study group were 120 COVID-19 patients (56 women and 104 [...] Read more.
Objective: To investigate two commercial software and their efficacy in the assessment of chest CT sequelae in patients affected by COVID-19 pneumonia, comparing the consistency of tools. Materials and Methods: Included in the study group were 120 COVID-19 patients (56 women and 104 men; 61 years of median age; range: 21–93 years) who underwent chest CT examinations at discharge between 5 March 2020 and 15 March 2021 and again at a follow-up time (3 months; range 30–237 days). A qualitative assessment by expert radiologists in the infectious disease field (experience of at least 5 years) was performed, and a quantitative evaluation using thoracic VCAR software (GE Healthcare, Chicago, Illinois, United States) and a pneumonia module of ANKE ASG-340 CT workstation (HTS Med & Anke, Naples, Italy) was performed. The qualitative evaluation included the presence of ground glass opacities (GGOs) consolidation, interlobular septal thickening, fibrotic-like changes (reticular pattern and/or honeycombing), bronchiectasis, air bronchogram, bronchial wall thickening, pulmonary nodules surrounded by GGOs, pleural and pericardial effusion, lymphadenopathy, and emphysema. A quantitative evaluation included the measurements of GGOs, consolidations, emphysema, residual healthy parenchyma, and total lung volumes for the right and left lung. A chi-square test and non-parametric test were utilized to verify the differences between groups. Correlation coefficients were used to analyze the correlation and variability among quantitative measurements by different computer tools. A receiver operating characteristic (ROC) analysis was performed. Results: The correlation coefficients showed great variability among the quantitative measurements by different tools when calculated on baseline CT scans and considering all patients. Instead, a good correlation (≥0.6) was obtained for the quantitative GGO, as well as the consolidation volumes obtained by two tools when calculated on baseline CT scans, considering the control group. An excellent correlation (≥0.75) was obtained for the quantitative residual healthy lung parenchyma volume, GGO, consolidation volumes obtained by two tools when calculated on follow-up CT scans, and for residual healthy lung parenchyma and GGO quantification when the percentage change of these volumes were calculated between a baseline and follow-up scan. The highest value of accuracy to identify patients with RT-PCR positive compared to the control group was obtained by a GGO total volume quantification by thoracic VCAR (accuracy = 0.75). Conclusions: Computer aided quantification could be an easy and feasible way to assess chest CT sequelae due to COVID-19 pneumonia; however, a great variability among measurements provided by different tools should be considered. Full article
(This article belongs to the Special Issue Cancer Challenges during COVID-19 Pandemic)
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Strong Association of Angiotensin Converting Enzyme-2 Gene Insertion/Deletion Polymorphism with Susceptibility to SARS-CoV-2, Hypertension, Coronary Artery Disease and COVID-19 Disease Mortality
J. Pers. Med. 2021, 11(11), 1098; https://doi.org/10.3390/jpm11111098 - 27 Oct 2021
Cited by 14 | Viewed by 1665
Abstract
Background: The ongoing outbreak of SARS-CoV-2 represents a significant challenge to international health. Several reports have highlighted the importance of ACE2 on the pathogenesis of COVID-19. The spike protein of SARS-CoV-2 efficiently binds to the angiotensin-converting enzyme 2 (ACE2) receptors and facilitates virus [...] Read more.
Background: The ongoing outbreak of SARS-CoV-2 represents a significant challenge to international health. Several reports have highlighted the importance of ACE2 on the pathogenesis of COVID-19. The spike protein of SARS-CoV-2 efficiently binds to the angiotensin-converting enzyme 2 (ACE2) receptors and facilitates virus entry into the host cell. In the present study, we hypothesize that a functional insertion/deletion polymorphism-rs4646994 I/D and rs4240157 T > C in the ACE gene could be associated with SARS-CoV-2 infection and mortality. Methodology: This study included 117 consecutive COVID-19 patients and 150 age matched healthy controls (ACE2-rs4646994 I/D) and 100 age matched healthy controls with ACE2 rs4240157 T > C. We used Mutation specific PCR (MSP) for ACE2-rs4646994 I/D genotyping and amplification refractory mutation system (ARMS-PCR) for ACE2 rs4240157 T > C genotyping. Results: Results indicated that there were significant differences in the genotype distributions of ACE2-rs4646994 I/D polymorphisms (p < 0.030) and ACE2 rs4240157 T > C between COVID-19 patients and controls (p-values < 0.05). Higher frequency of DD genotype (48.71%) and D allele (0.67) was reported in COVID-19 patients than controls. Our results showed that the ACE2-DD genotype was strongly associated with increased COVID-19 severity (OR 2.37 (95%) CI = (1.19–4.70), RR = 1.39 (1.09–1.77), p < 0.013) and also a strong association was seen with ACE2-ID genotype with COVID-19 severity (OR 2.20 (95%) CI = (1.08–4.46), p < 0.020) in the codominant model. In allelic comparison, the D allele was strongly associated with COVID-19 severity (OR 1.58 (95% CI) (1.11–2.27), RR 1.21 (1.05–1.41) p < 0.010). A significant correlation of ACE2-I/D genotypes was reported with Age (p < 0.035), T2D (p < 0.0013), hypertension (p < 0.0031) and coronary artery disease (p < 0.0001). Our results indicated ACE2-DD genotype was strongly associated with increased COVID-19 mortality (OR 8.25 (95%) CI = (2.40 to 28.34), p < 0.008) and also ACE2-DD + DI genotype was strongly associated with increased COVID-19 mortality with OR 4.74 (95%) CI = (1.5214 to 14.7915), p < 0.007. A significant correlation was reported between COVID-19 patients and age matched controls (p < 0.0007). Higher frequency of heterozygosity TC (40%) followed by ACE2-CC genotype (24.78%) was reported among COVID-19 patients. Using multivariate analysis, ACE2–CT genotype was strong associated with SARS-CoV-2 severity with an OR 2.18 (95% CI) (1.92–3.99), p < 0.010 and also ACE2–CC genotype was linked with COVID-19 severity with an OR 2.66 (95% CI) (1.53–4.62), p < 0.005. A significant correlation of ACE2-T > C genotypes was reported with gender (p < 0.04), T2D (p < 0.035). ACE2-CC genotype was strongly associated with increased COVID-19 mortality OR 3.66 (95%) CI = (1.34 to 9.97), p < 0.011 and also ACE2-C allele was associated with COVID-19 mortality OR 2, 01 (1.1761–3.45), p < 0.010. Conclusions: It is concluded that ACE-DD genotype and D allele was strongly associated with increased COVID-19 patient severity. In addition, ACE I/D polymorphism were strongly associated with advanced age, diabetes and ischemic heart disease in COVID-19 patients whereas ACE-II genotype was a protective factor against the development of severe COVID-19. ACE2-DD genotype was strongly associated with increased COVID-19 mortality. Additionally, ACE2–CC and CT genotypes were strongly associated with COVID-19 severity. Therefore, our study might be useful for identifying the susceptible population groups for targeted interventions and for making relevant public health policy decisions. Full article
(This article belongs to the Section Mechanisms of Diseases)
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Article
TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma
J. Pers. Med. 2021, 11(10), 1041; https://doi.org/10.3390/jpm11101041 - 17 Oct 2021
Cited by 17 | Viewed by 1310
Abstract
The aim of the present study was to correlate laboratory data and postprocedural parameters after conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) with the radiological response. The study consisted of a retrospective analysis of prospectively collected data from 70 consecutive patients who [...] Read more.
The aim of the present study was to correlate laboratory data and postprocedural parameters after conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) with the radiological response. The study consisted of a retrospective analysis of prospectively collected data from 70 consecutive patients who underwent cTACE. Laboratory parameters were assessed daily after cTACE and compared to pretreatment values. Post-treatment radiological response was assessed using mRECIST at one month from cTACE, and factors associated with treatment response (complete and objective response) were assessed by logistic regression analysis. The optimal cutoff points in predicting the complete response of target lesions were a 52% ALT and a 46% AST increase after cTACE compared to the pre-treatment values. Using multivariate analyses, >46% AST and >52% ALT increases with respect to the pre-treatment value were significantly correlated with the objective response (p = 0.03 and p = 0.04, respectively) and the complete response (p = 0.02 and p = 0.02, respectively). No patients experienced liver function deterioration after cTACE, and no specific treatment was required. This study showed that post-treatment transient transaminase elevation was predictive of objective response to superselective cTACE in clinical practice, representing a simple tool to guide treatment strategy of HCC patients in a tailored approach. Full article
(This article belongs to the Special Issue The Present and Future of Personalized Medicine in Oncology)
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Domain-Adaptive Artificial Intelligence-Based Model for Personalized Diagnosis of Trivial Lesions Related to COVID-19 in Chest Computed Tomography Scans
J. Pers. Med. 2021, 11(10), 1008; https://doi.org/10.3390/jpm11101008 - 07 Oct 2021
Cited by 4 | Viewed by 1253
Abstract
Background: Early and accurate detection of COVID-19-related findings (such as well-aerated regions, ground-glass opacity, crazy paving and linear opacities, and consolidation in lung computed tomography (CT) scan) is crucial for preventive measures and treatment. However, the visual assessment of lung CT scans is [...] Read more.
Background: Early and accurate detection of COVID-19-related findings (such as well-aerated regions, ground-glass opacity, crazy paving and linear opacities, and consolidation in lung computed tomography (CT) scan) is crucial for preventive measures and treatment. However, the visual assessment of lung CT scans is a time-consuming process particularly in case of trivial lesions and requires medical specialists. Method: A recent breakthrough in deep learning methods has boosted the diagnostic capability of computer-aided diagnosis (CAD) systems and further aided health professionals in making effective diagnostic decisions. In this study, we propose a domain-adaptive CAD framework, namely the dilated aggregation-based lightweight network (DAL-Net), for effective recognition of trivial COVID-19 lesions in CT scans. Our network design achieves a fast execution speed (inference time is 43 ms on a single image) with optimal memory consumption (almost 9 MB). To evaluate the performances of the proposed and state-of-the-art models, we considered two publicly accessible datasets, namely COVID-19-CT-Seg (comprising a total of 3520 images of 20 different patients) and MosMed (including a total of 2049 images of 50 different patients). Results: Our method exhibits average area under the curve (AUC) up to 98.84%, 98.47%, and 95.51% for COVID-19-CT-Seg, MosMed, and cross-dataset, respectively, and outperforms various state-of-the-art methods. Conclusions: These results demonstrate that deep learning-based models are an effective tool for building a robust CAD solution based on CT data in response to present disaster of COVID-19. Full article
(This article belongs to the Special Issue Application of Artificial Intelligence in Personalized Medicine)
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Article
Impact of COVID-19 on the Mental Health of Medical Students in Portugal
J. Pers. Med. 2021, 11(10), 986; https://doi.org/10.3390/jpm11100986 - 30 Sep 2021
Cited by 5 | Viewed by 2001
Abstract
(1) Background: The purpose of this article is to assess the impact of the COVID-19 pandemic on the mental health of medical students in Portugal in the period after returning to face-to-face classes during the COVID-19 pandemic, in the 2020/2021 academic year. (2) [...] Read more.
(1) Background: The purpose of this article is to assess the impact of the COVID-19 pandemic on the mental health of medical students in Portugal in the period after returning to face-to-face classes during the COVID-19 pandemic, in the 2020/2021 academic year. (2) Methods: We conducted an observational, descriptive, and cross-sectional study, between December 2020 and February 2021 with a representative sample of Portuguese medical students (n = 649), applying an anonymous questionnaire which was composed by a sociodemographic characterization, The Brief Symptoms Inventory–18, The Fear of COVID-19 Scale and the Negative Impact Assessment Scale. For statistical processing, Statistical Package for Social Sciences (SPSS ©) was used. (3) Results: 65.3% of participants said that self-perceived relevant anxiety symptoms, and around 10% said that they had a physical or a mental illness diagnosis. Significant differences (p < 0.05) were found for Fear of COVID-19, Somatization, Anxiety and Overall Mental Health, indicating that women, students from the 1st and last years of training had higher scores. Age, year of training, Fear of COVID-19 and Negative Impact of COVID-19 were significant predictors of overall mental health. (4) Conclusion: In our sample of Portuguese medical students, age, year of training, but mostly fear of COVID-19 and the negative impact of COVID-19 contributed to mental health symptoms. Full article
Article
Late Failure of High-Flow Nasal Cannula May Be Associated with High Mortality in COVID-19 Patients: A Multicenter Retrospective Study in the Republic of Korea
J. Pers. Med. 2021, 11(10), 989; https://doi.org/10.3390/jpm11100989 - 30 Sep 2021
Cited by 1 | Viewed by 1424
Abstract
The aim of this study was to determine whether the late failure of high-flow nasal cannula (HFNC) is associated with mortality in patients with coronavirus disease 2019 (COVID-19). This multicenter study included seven university-affiliated hospitals in the Republic of Korea. We collected the [...] Read more.
The aim of this study was to determine whether the late failure of high-flow nasal cannula (HFNC) is associated with mortality in patients with coronavirus disease 2019 (COVID-19). This multicenter study included seven university-affiliated hospitals in the Republic of Korea. We collected the data of patients hospitalized with COVID-19 between 10 February 2020 and 28 February 2021. Failure of HFNC was defined as the need for mechanical ventilation despite HFNC application. According to the time of intubation, HFNC failure was divided into early failure (within 48 h) and late failure (after 48 h). During the study period, 157 patients received HFNC and 133 were eligible. Among them, 70 received mechanical ventilation. The median time from HFNC initiation to intubation of the early failure group was 4.1 h (interquartile range [IQR]: 1.1–13.5 h), and that of the late failure group was 70.9 h (IQR: 54.4–145.4 h). Although the ratio of pulse oximetry/fraction of inspired oxygen (ROX index) within 24 h of HFNC initiation tended to be lower in the early failure group than in the late failure group, the ROX index before two hours of intubation was significantly lower in the late failure group (odds ratio [OR], 5.74 [IQR: 4.58–6.98] vs. 4.80 [IQR: 3.67–5.97], p = 0.040). The late failure of HFNC may be associated with high mortality in COVID-19 patients with acute respiratory failure. Full article
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Article
Biomarkers Associated with Failure of Liberation from Oxygen Therapy in Severe COVID-19: A Pilot Study
J. Pers. Med. 2021, 11(10), 974; https://doi.org/10.3390/jpm11100974 - 29 Sep 2021
Cited by 1 | Viewed by 1175
Abstract
This study aimed to investigate whether clinical and laboratory biomarkers can identify patients with COVID-19 who are less likely to be liberated from oxygen therapy. This was a retrospective study comparing 18 patients in the weaning failure group with 38 patients in the [...] Read more.
This study aimed to investigate whether clinical and laboratory biomarkers can identify patients with COVID-19 who are less likely to be liberated from oxygen therapy. This was a retrospective study comparing 18 patients in the weaning failure group with 38 patients in the weaning success group. Weaning failure was defined as death or discharge with an oxygen device before day 28 after hospital admission or requiring oxygen support as of day 28. The median quick Sequential Organ Failure Assessment (qSOFA) score was significantly higher and the median SpO2/FiO2 was significantly lower in the weaning failure group. The laboratory biomarkers, procalcitonin (PCT) and D-dimer, were significantly higher in the weaning failure group, as were the biomarkers of endothelial injury, such as angiopoietin-2 (Ang-2) and Ang-2/Ang-1, and tumor necrosis factor-α (TNF-α). Patients’ qSOFA scores, SpO2/FiO2, and PCT, D-dimer, Ang-2, Ang-2/Ang-1, endocan (4-day and 7-day increases), and TNF-α levels predicted weaning failure; 7-day endocan levels were the best predictor of weaning failure with an AUC of 0.81 (95% CI, 0.67–0.94). We identified clinical and laboratory parameters, including plasma biomarkers of endothelial injury, that may be considered as biomarkers for predicting failure of liberation from oxygen therapy in patients with severe COVID-19. Full article
(This article belongs to the Special Issue Recent Advances on Coronavirus Disease 2019 (COVID-19))
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Article
Uncertainty, Anxiety and Isolation: Experiencing the COVID-19 Pandemic and Lockdown as a Woman with Polycystic Ovary Syndrome (PCOS)
J. Pers. Med. 2021, 11(10), 952; https://doi.org/10.3390/jpm11100952 - 25 Sep 2021
Cited by 2 | Viewed by 2638
Abstract
Background: The COVID-19 pandemic and the related lockdown measures presented a significant risk to physical and mental wellbeing in affected populations. Women with polycystic ovary syndrome (PCOS) are predisposed to several cardio-metabolic risk factors which increase the susceptibility to severe COVID-19 and also [...] Read more.
Background: The COVID-19 pandemic and the related lockdown measures presented a significant risk to physical and mental wellbeing in affected populations. Women with polycystic ovary syndrome (PCOS) are predisposed to several cardio-metabolic risk factors which increase the susceptibility to severe COVID-19 and also exhibit increased likelihood of impaired mental health wellbeing. Therefore, these women who usually receive care from multiple primary and specialist healthcare services may be disproportionately impacted by this pandemic and the related restrictions. This study aimed to explore the lived experience of the first UK national lockdown as a woman with PCOS. Methods: As part of a larger cross-sectional study, 12 women with PCOS living in the UK during the first national COVID-19 lockdown were recruited to a qualitative study. Telephone interviews were conducted in June/July of 2020, and data collected were subjected to thematic analysis. Results: Five themes were identified. “My PCOS Journey” describes participants’ experiences of diagnosis, treatment and ongoing management of their PCOS. “Living Through Lockdown” describes the overall experience and impact of the lockdown on all aspects of participants’ lives. “Self-care and Managing Symptoms” describe multiple challenges to living well with PCOS during the lockdown, including lack of access to supplies and services, and disruption to weight management. “Healthcare on Hold” describes the uncertainty and anxiety associated with delays in accessing specialised healthcare for a range of PCOS aspects, including fertility treatment. “Exacerbating Existing Issues” captures the worsening of pre-existing mental health issues, and an increase in health anxiety and feelings of isolation. Conclusion: For the women with PCOS in this study, the COVID-19 pandemic and the first national lockdown was mostly experienced as adding to the pre-existing challenges of living with their condition. The mental health impact experienced by the study participants was increased due to lack of access to their normal support strategies, limitations on healthcare services and uncertainty about their risk of COVID-19. Full article
(This article belongs to the Special Issue Chronic Disease Management in the Primary Care)
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Article
Graphical Trajectory Comparison to Identify Errors in Data of COVID-19: A Cross-Country Analysis
J. Pers. Med. 2021, 11(10), 955; https://doi.org/10.3390/jpm11100955 - 25 Sep 2021
Viewed by 768
Abstract
Data from the early stage of a novel infectious disease outbreak provide vital information in risk assessment, prediction, and precise disease management. Since the first reported case of COVID-19, the pattern of the novel coronavirus transmission in Wuhan has become the interest of [...] Read more.
Data from the early stage of a novel infectious disease outbreak provide vital information in risk assessment, prediction, and precise disease management. Since the first reported case of COVID-19, the pattern of the novel coronavirus transmission in Wuhan has become the interest of researchers in epidemiology and public health. To thoroughly map the mechanism of viral spreading, we used the patterns of data at the early onset of COVID-19 from seven countries to estimate the time lag between peak days of cases and deaths. This study compared these data with those of Wuhan and estimated the natural history of disease across the infected population and the time lag. The findings suggest that comparative analyses of data from different regions and countries reveal the differences between peaks of cases and deaths caused by COVID-19 and the incomplete and underestimated cases in Wuhan. Different countries may show different patterns of cases peak days, deaths peak days, and peak periods. Error in the early COVID-19 statistics in Brazil was identified. This study provides sound evidence for policymakers to understand the local circumstances in diagnosing the health of a population and propose precise and timely public health interventions to control and prevent infectious diseases. Full article
(This article belongs to the Special Issue Personalized Medicine and Management of COVID-19)
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Article
The Impact of the COVID-19 Pandemic on Nursing Care: A Cross-Sectional Survey-Based Study
J. Pers. Med. 2021, 11(10), 945; https://doi.org/10.3390/jpm11100945 - 23 Sep 2021
Cited by 6 | Viewed by 1840
Abstract
The COVID-19 pandemic has had a severe impact on nursing care. This cross-sectional survey-based study compared aspects of nursing care and nurses’ satisfaction with care provided before and during the first wave of the COVID-19 pandemic. A total of 936 registered nurses (RNs) [...] Read more.
The COVID-19 pandemic has had a severe impact on nursing care. This cross-sectional survey-based study compared aspects of nursing care and nurses’ satisfaction with care provided before and during the first wave of the COVID-19 pandemic. A total of 936 registered nurses (RNs) rated the frequency with which they performed fundamental care, nursing techniques, patient education, symptom management, and nurse–patient relationships before and during the pandemic. A recursive partitioning for ordered multivariate response in a conditional inference framework approach was applied. More frequent fundamental cares were associated with their frequency before the pandemic (p < 0.001), caring for COVID-19 patients (p < 0.001), and workplace reassignment (p = 0.004). Caring for COVID-19 patients (p < 0.001), workplace reassignment (p = 0.030), and caring for ≤7.4 COVID-19 patients (p = 0.014) increased nursing techniques. RNs in high-intensity COVID-19 units (p = 0.002) who educated patients before the pandemic, stopped this task. RNs caring for COVID-19 patients reported increased symptom management (p < 0.001), as did RNs caring for more non-COVID-19 patients (p = 0.037). Less frequent nurse–patient relationships before the pandemic and working in high-intensity COVID-19 units decreased nurse–patient relationships (p = 0.002). Despite enormous challenges, nurses continued to provide a high level of care. Ensuring the appropriate deployment and education of nurses is crucial to personalize care and to maintain nurses’ satisfaction with the care provided. Full article
(This article belongs to the Special Issue Personalized Nursing and Health Care)
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Quality of Life, Sleep Quality, Depression, Anxiety, Stress, Eating Habits, and Social Bounds in Nurses during the Coronavirus Disease 2019 Pandemic in Qatar (The PROTECTOR Study): A Cross-Sectional, Comparative Study
J. Pers. Med. 2021, 11(9), 918; https://doi.org/10.3390/jpm11090918 - 15 Sep 2021
Cited by 13 | Viewed by 3879
Abstract
There have been numerous concerns regarding the physical and mental health of nurses during the COVID-19 pandemic. Stress, sleep deprivation, anxiety, and depression potentiated nurses’ vulnerability to poor eating habits. Aims and Objectives: The purpose of this study was to explore the differences [...] Read more.
There have been numerous concerns regarding the physical and mental health of nurses during the COVID-19 pandemic. Stress, sleep deprivation, anxiety, and depression potentiated nurses’ vulnerability to poor eating habits. Aims and Objectives: The purpose of this study was to explore the differences between nurses’ characteristics with COVID-19 facility designation, and sleep quality, depression, anxiety, stress, eating habits, social bonds, and quality of life. Design: A cross-sectional, comparative study. Methods: An online survey was sent using the corporation’s email to nurses working in three hospitals in Qatar from September to December 2020. One of them is a designated COVID-19 facility. The sleep quality, depression, eating habits, social bonds, and quality of life were measured using The Insomnia Severity Index (ISI), Depression Anxiety and Stress Scale 21 (DASS-21), Emotional Eater Questionnaire (EEQ), Oslo Social Support Scale (OSSS-3), and the World Health Organization Quality of Life (WHOQOL-BREF), respectively. Results: A total of 200 nurses participated in the study (RR: 13.3%). No statistically significant association was found between designated facility (COVID-19 vs. not COVID-19) or nurses’ characteristics and ISI categories (OR 1.15; 95% CI 0.54, 2.44). Nurses working in COVID-19 facilities had increased odds of having higher EEQ categories by 2.62 times (95% CI 1.18, 5.83). Similarly, no statistically significant associations were found between any of the nurses’ characteristics and OSSS-3 categories. On the other hand, no statistically significant associations were found between any of the nurses’ characteristics and QOL domains except for the gender and social relationships’ domain. Conclusion: Overall, the quality of life of nurses in Qatar is on a positive level whether they are assigned to a COVID-19 facility or not. Although no significant difference was found with regard to the sleep quality, stress, anxiety, depression, and eating habits between nurses in a COVID-19 facility and in a non-COVID-19 facility, special interventions to diminish stressors need to be implemented and maintained. Full article
(This article belongs to the Special Issue Personalized Clinical and Community Nursing)
Article
COVID-19 Pandemic Outbreak in the Subcontinent: A Data Driven Analysis
J. Pers. Med. 2021, 11(9), 889; https://doi.org/10.3390/jpm11090889 - 07 Sep 2021
Cited by 4 | Viewed by 1153
Abstract
Human civilization is experiencing a critical situation that presents itself for a new coronavirus disease 2019 (COVID-19). This virus emerged in late December 2019 in Wuhan city, Hubei, China. The grim fact of COVID-19 is, it is highly contagious in nature, therefore, spreads [...] Read more.
Human civilization is experiencing a critical situation that presents itself for a new coronavirus disease 2019 (COVID-19). This virus emerged in late December 2019 in Wuhan city, Hubei, China. The grim fact of COVID-19 is, it is highly contagious in nature, therefore, spreads rapidly all over the world and causes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Responding to the severity of COVID-19 research community directs the attention to the analysis of COVID-19, to diminish its antagonistic impact towards society. Numerous studies claim that the subcontinent, i.e., Bangladesh, India, and Pakistan, could remain in the worst affected region by the COVID-19. In order to prevent the spread of COVID-19, it is important to predict the trend of COVID-19 beforehand the planning of effective control strategies. Fundamentally, the idea is to dependably estimate the reproduction number to judge the spread rate of COVID-19 in a particular region. Consequently, this paper uses publicly available epidemiological data of Bangladesh, India, and Pakistan to estimate the reproduction numbers. More specifically, we use various models (for example, susceptible infection recovery (SIR), exponential growth (EG), sequential Bayesian (SB), maximum likelihood (ML) and time dependent (TD)) to estimate the reproduction numbers and observe the model fitness in the corresponding data set. Experimental results show that the reproduction numbers produced by these models are greater than 1.2 (approximately) indicates that COVID-19 is gradually spreading in the subcontinent. Full article
(This article belongs to the Section Epidemiology)
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Communication
Evaluating the Role of the Interleukin-23/17 Axis in Critically Ill COVID-19 Patients
J. Pers. Med. 2021, 11(9), 891; https://doi.org/10.3390/jpm11090891 - 07 Sep 2021
Cited by 2 | Viewed by 1282
Abstract
Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured [...] Read more.
Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured on admission to the intensive care unit (ICU) in critically ill COVID-19 (N = 38) and critically ill non-COVID-19 (N = 34) patients with an equal critical illness severity. Critically ill non-COVID-19 patients did not have sepsis or septic shock on ICU admission. None of the enrolled patients had previously received corticosteroids. In our study, circulating IL-17 levels were higher in the COVID-19 patients. More specifically, critically ill COVID-19 patients had levels of 0.78 (0.05–1.8) pg/mL compared to 0.11 (0.05–0.9) pg/mL in the critically ill non-COVID-19 patients (p = 0.04). In contrast, IL-23 levels were comparable between groups. A group of patients hospitalized in the specialized COVID-19 clinic (N = 16) was also used to evaluate IL-17 and IL-23 levels with respect to COVID-19 severity. Non-critically ill COVID-19 patients had undetectable levels of both cytokines. Our results support the notion of inhibiting IL-17 in critical COVID-19 infection. Full article
(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)
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Effect of COVID-19-Related Lockdown οn Hospital Admissions for Asthma and COPD Exacerbations: Associations with Air Pollution and Patient Characteristics
J. Pers. Med. 2021, 11(9), 867; https://doi.org/10.3390/jpm11090867 - 30 Aug 2021
Cited by 4 | Viewed by 1598
Abstract
We conducted a retrospective observational study to assess the hospitalization rates for acute exacerbations of asthma and COPD (chronic obstructive pulmonary disease) during the first imposed lockdown in Athens, Greece. Patient characteristics and the concentration of eight air pollutants [namely, NO (nitrogen monoxide), [...] Read more.
We conducted a retrospective observational study to assess the hospitalization rates for acute exacerbations of asthma and COPD (chronic obstructive pulmonary disease) during the first imposed lockdown in Athens, Greece. Patient characteristics and the concentration of eight air pollutants [namely, NO (nitrogen monoxide), NO2 (nitrogen dioxide), CO (carbon monoxide), PM2.5 (particulate matter 2.5), PM10 (particulate matter 10), O3 (ozone), SO2 (sulfur dioxide) and benzene] were considered. A total of 153 consecutive hospital admissions were studied. Reduced admissions occurred in the Lockdown period compared to the Pre-lockdown 2020 (p < 0.001) or the Control 2019 (p = 0.007) period. Furthermore, the concentration of 6/8 air pollutants positively correlated with weekly hospital admissions in 2020 and significantly decreased during the lockdown. Finally, admitted patients for asthma exacerbation during the lockdown were younger (p = 0.046) and less frequently presented respiratory failure (p = 0.038), whereas patients with COPD presented higher blood eosinophil percentage (p = 0.017) and count (p = 0.012). Overall, admissions for asthma and COPD exacerbations decreased during the lockdown. This might be partially explained by reduction of air pollution during this period while medical care avoidance behavior, especially among elderly patients cannot be excluded. Our findings aid in understanding the untold impact of the pandemic on diseases beyond COVID-19, focusing on patients with obstructive diseases. Full article
(This article belongs to the Special Issue Personalized Medicine in Bronchial Asthma)
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The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity
J. Pers. Med. 2021, 11(8), 810; https://doi.org/10.3390/jpm11080810 - 19 Aug 2021
Cited by 20 | Viewed by 1846
Abstract
Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective [...] Read more.
Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity. Full article
(This article belongs to the Special Issue Personalized Care and Treatment Compliance in Chronic Conditions)
Article
Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE)
J. Pers. Med. 2021, 11(8), 762; https://doi.org/10.3390/jpm11080762 - 31 Jul 2021
Cited by 1 | Viewed by 1169
Abstract
Despite low rates of bacterial co-infections, most COVID-19 patients receive antibiotic therapy. We hypothesized that patients with positive pneumococcal urinary antigens (PUAs) would benefit from antibiotic therapy in terms of clinical outcomes (death, ICU admission, and length of stay). The San Matteo COVID-19 [...] Read more.
Despite low rates of bacterial co-infections, most COVID-19 patients receive antibiotic therapy. We hypothesized that patients with positive pneumococcal urinary antigens (PUAs) would benefit from antibiotic therapy in terms of clinical outcomes (death, ICU admission, and length of stay). The San Matteo COVID-19 Registry (SMACORE) prospectively enrolls patients admitted for COVID-19 pneumonia at IRCCS Policlinico San Matteo, Pavia. We retrospectively extracted the data of patients tested for PUA from October to December 2020. Demographic, clinical, and laboratory data were recorded. Of 469 patients, 42 tested positive for PUA (8.95%), while 427 (91.05%) tested negative. A positive PUA result had no significant impact on death (HR 0.53 CI [0.22–1.28] p-value 0.16) or ICU admission (HR 0.8; CI [0.25–2.54] p-value 0.70) in the Cox regression model, nor on length of stay in linear regression (estimate 1.71; SE 2.37; p-value 0.47). After adjusting for age, we found no significant correlation between urinary antigen positivity and variations in the WHO ordinal scale and laboratory markers at admission and after 14 days. We found that a positive PUA result was not frequent and had no impact on clinical outcomes or clinical improvement. Our results did not support the routine use of PUA tests to select COVID-19 patients who will benefit from antibiotic therapy. Full article
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Article
Role of Lung Ultrasound in Predicting Clinical Severity and Fatality in COVID-19 Pneumonia
J. Pers. Med. 2021, 11(8), 757; https://doi.org/10.3390/jpm11080757 - 30 Jul 2021
Cited by 7 | Viewed by 1680
Abstract
Background: Lung ultrasound (LUS) is a useful imaging method for identifying COVID-19 pneumonia. The aim of this study was to explore the role of LUS in predicting the severity of the disease and fatality in patients with COVID-19. Methods: This was a single-center, [...] Read more.
Background: Lung ultrasound (LUS) is a useful imaging method for identifying COVID-19 pneumonia. The aim of this study was to explore the role of LUS in predicting the severity of the disease and fatality in patients with COVID-19. Methods: This was a single-center, follow-up study, conducted from 1 November 2020, to 22 March 2021. The LUS protocol was based on the assessment of 14 lung zones with a total score up to 42, which was compared to the disease severity and fatality. Results: A total of 133 patients with COVID-19 pneumonia confirmed by RT-PCR were enrolled, with a median time from hospital admission to lung ultrasound of one day. The LUS score was correlated with clinical severity at hospital admission (Spearman’s rho 0.40, 95% CI 0.24 to 0.53, p < 0.001). Patients with higher LUS scores were experiencing greater disease severity; a high flow nasal cannula had an odds ratio of 1.43 (5% CI 1.17–1.74) in patients with LUS score > 29; the same score also predicted the need for mechanical ventilation (1.25, [1.07–1.48]). An LUS score > 30 (1.41 [1.18–1.68]) and age over 68 (1.26 [1.11–1.43]) were significant predictors of fatality. Conclusions: LUS at hospital admission is shown to have a high predictive power of the severity and fatality of COVID-19 pneumonia. Full article
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Article
Superiority of Mild Interventions against COVID-19 on Public Health and Economic Measures
J. Pers. Med. 2021, 11(8), 719; https://doi.org/10.3390/jpm11080719 - 26 Jul 2021
Cited by 3 | Viewed by 2266
Abstract
(1) Background: During the global spread of COVID-19, Japan has been among the top countries to maintain a relatively low number of infections, despite implementing limited institutional interventions and its high population density. This study investigated how limited intervention policies have affected public [...] Read more.
(1) Background: During the global spread of COVID-19, Japan has been among the top countries to maintain a relatively low number of infections, despite implementing limited institutional interventions and its high population density. This study investigated how limited intervention policies have affected public health and economic conditions in the COVID-19 context and aimed to gain insight into the effective and sustainable measures against new infectious diseases in densely inhabited areas. (2) Methods: A system dynamics approach was employed. Qualitative causal loop analysis and stock and quantitative flow model analysis were performed, using a Tokyo Metropolitan area dataset. (3) Results: A causal loop analysis suggested that there were risks in prematurely terminating such interventions. Based on this result and the subsequent quantitative modeling, we found that the short-term effectiveness of a short-term pre-emptive stay-at-home request caused a resurgence in the number of positive cases, whereas an additional request provided a limited negative add-on effect for economic measures (e.g., number of electronic word-of-mouth communications and restaurant visits). (4) Conclusions: These findings suggest the superiority of a mild and continuous intervention as a long-term countermeasure under epidemic pressures when compared with strong intermittent interventions. Full article
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Article
Vitamin D Levels in Asymptomatic Children and Adolescents with Atopy during the COVID-19 Era
J. Pers. Med. 2021, 11(8), 712; https://doi.org/10.3390/jpm11080712 - 25 Jul 2021
Cited by 1 | Viewed by 1758
Abstract
This study assessed vitamin D status in asymptomatic children and adolescents in Greece, with and without atopy, and possible changes during the coronavirus disease 2019 (COVID-19) pandemic. Serum levels of 25-hydroxy-vitamin D (25(OH)D) and total immunoglobulin E (IgE), and eosinophil count were measured [...] Read more.
This study assessed vitamin D status in asymptomatic children and adolescents in Greece, with and without atopy, and possible changes during the coronavirus disease 2019 (COVID-19) pandemic. Serum levels of 25-hydroxy-vitamin D (25(OH)D) and total immunoglobulin E (IgE), and eosinophil count were measured in 340 asymptomatic children and adolescents (155 males, 185 females), mean age 8.6 ± 4.6 years, recruited over a period of 24 months (February 2019–January 2021). Atopy, defined by high level of IgE for age, was associated with vitamin D deficient status (p = 0.041). Subjects with and without atopy showed similar rates of insufficient and normal levels of 25(OH)D. The median level of 25(OH)D was significantly higher in subjects recruited during the pandemic, when home confinement rules were observed, than before the pandemic, and significantly more children had normal levels of 25(OH)D (p < 0.001), but no differences were noticed for IgE levels or eosinophil count. These results support a link between vitamin D and allergic and infectious inflammations, and specifically the association of vitamin D deficiency with asymptomatic atopy, defined as increased IgE level for age. Full article
(This article belongs to the Special Issue Personalized Understanding and Management of Asthma and Allergy)
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Article
Evaluation of Cytokines as Robust Diagnostic Biomarkers for COVID-19 Detection
J. Pers. Med. 2021, 11(7), 681; https://doi.org/10.3390/jpm11070681 - 20 Jul 2021
Cited by 10 | Viewed by 2225
Abstract
Antigen tests or polymerase chain reaction (PCR) amplification are currently COVID-19 diagnostic tools. However, developing complementary diagnosis tools is mandatory. Thus, we performed a plasma cytokine array in COVID-19 patients to identify novel diagnostic biomarkers. A discovery–validation study in two independent prospective cohorts [...] Read more.
Antigen tests or polymerase chain reaction (PCR) amplification are currently COVID-19 diagnostic tools. However, developing complementary diagnosis tools is mandatory. Thus, we performed a plasma cytokine array in COVID-19 patients to identify novel diagnostic biomarkers. A discovery–validation study in two independent prospective cohorts was performed. The discovery cohort included 136 COVID-19 and non-COVID-19 patients recruited consecutively from 24 March to 11 April 2020. Forty-five cytokines’ quantification by the MAGPIX system (Luminex Corp., Austin, TX, USA) was performed in plasma samples. The validation cohort included 117 patients recruited consecutively from 15 to 25 April 2020 for validating results by ELISA. COVID-19 patients showed different levels of multiple cytokines compared to non-COVID-19 patients. A single chemokine, IP-10, accurately identified COVID-19 patients who required hospital admission (AUC: 0.962; 95%CI (0.933–0.992); p < 0.001)). The results were validated in an independent cohort by multivariable analysis (OR: 25.573; 95%CI (8.127–80.469); p < 0.001) and AUROC (AUC: 0.900; 95%CI (0.846–0.954); p < 0.001). Moreover, showing IP-10 plasma levels over 173.35 pg/mL identified COVID-19 with higher sensitivity (86.20%) than the first SARS-CoV-2 PCR. Our discover–validation study identified IP-10 as a robust biomarker in clinical practice for COVID-19 diagnosis at hospital. Therefore, IP-10 could be used as a complementary tool in clinical practice, especially in emergency departments. Full article
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Article
Evolution of CT Findings and Lung Residue in Patients with COVID-19 Pneumonia: Quantitative Analysis of the Disease with a Computer Automatic Tool
J. Pers. Med. 2021, 11(7), 641; https://doi.org/10.3390/jpm11070641 - 06 Jul 2021
Cited by 4 | Viewed by 1643
Abstract
Purpose: the purpose of this study was to assess the evolution of computed tomography (CT) findings and lung residue in patients with COVID-19 pneumonia, via quantified evaluation of the disease, using a computer aided tool. Materials and methods: we retrospectively evaluated 341 CT [...] Read more.
Purpose: the purpose of this study was to assess the evolution of computed tomography (CT) findings and lung residue in patients with COVID-19 pneumonia, via quantified evaluation of the disease, using a computer aided tool. Materials and methods: we retrospectively evaluated 341 CT examinations of 140 patients (68 years of median age) infected with COVID-19 (confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR)), who were hospitalized, and who received clinical and CT examinations. All CTs were evaluated by two expert radiologists, in consensus, at the same reading session, using a computer-aided tool for quantification of the pulmonary disease. The parameters obtained using the computer tool included the healthy residual parenchyma, ground glass opacity, consolidation, and total lung volume. Results: statistically significant differences (p value ≤ 0.05) were found among quantified volumes of healthy residual parenchyma, ground glass opacity (GGO), consolidation, and total lung volume, considering different clinical conditions (stable, improved, and worsened). Statistically significant differences were found among quantified volumes for healthy residual parenchyma, GGO, and consolidation (p value ≤ 0.05) between dead patients and discharged patients. CT was not performed on cadavers; the death was an outcome, which was retrospectively included to differentiate findings of patients who survived vs. patients who died during hospitalization. Among discharged patients, complete disease resolutions on CT scans were observed in 62/129 patients with lung disease involvement ≤5%; lung disease involvement from 5% to 15% was found in 40/129 patients, while 27/129 patients had lung disease involvement between 16 and 30%. Moreover, 8–21 days (after hospital admission) was an “advanced period” with the most severe lung disease involvement. After the extent of involvement started to decrease—particularly after 21 days—the absorption was more obvious. Conclusions: a complete disease resolution on chest CT scans was observed in 48.1% of discharged patients using a computer-aided tool to quantify the GGO and consolidation volumes; after 16 days of hospital admission, the abnormalities identified by chest CT began to improve; in particular, the absorption was more obvious after 21 days. Full article
(This article belongs to the Special Issue Cancer Challenges during COVID-19 Pandemic)
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Article
Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis
J. Pers. Med. 2021, 11(7), 628; https://doi.org/10.3390/jpm11070628 - 01 Jul 2021
Cited by 8 | Viewed by 1749
Abstract
Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. [...] Read more.
Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = −0.41; 95% CI: −0.68 −0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = −0.52; 95% CI: −0.82 −0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients’ characteristics. Full article
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Article
Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic
J. Pers. Med. 2021, 11(7), 599; https://doi.org/10.3390/jpm11070599 - 25 Jun 2021
Cited by 3 | Viewed by 2000
Abstract
During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We [...] Read more.
During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We conducted an observational, analytical, ambispective cohort study with longitudinal follow-up of mothers with confirmed SARV-CoV-2 infection from different hospitals in our country between March–November 2020. We recruited 1295 pregnant women with SARS-CoV2 infection from 78 hospitals, 846 (65.3%) of whom were diagnosed during the first wave and 449 (34.7%) during the second wave. Our results show that patients developing COVID-19 during the first wave had more symptoms at triage, early in pregnancy with greater rates of COVID-19-related maternal morbidity; caesarean section and preterm birth in the first wave. We register two cases of maternal mortality and only during the first wave. Maternal morbidity events showed a strong link to perinatal mortality events in the first wave compared to the second wave, in which maternal morbidity was more associated with pneumonia. Likewise, maternal morbidity showed a strong correlation with perinatal morbidity events in both waves. We describe the differences between the patients’ profiles and management between the two waves and related to maternal and perinatal outcomes. Differences were also observed in the management of pregnant women with COVID-19. Thus, there were fewer caesarean sections, and maternal and perinatal morbidity events were reduced in the second wave, while the impacts of respiratory symptoms and their severity, including a greater need for maternal treatment, were greater in this last period. Identifying the impact that changes in the profile as well as in the treatment have on maternal–perinatal morbidity and mortality will help improve the well-being of our patients and their newborns. Full article
(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)
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Article
The Relationship between Psychological Distress during the Second Wave Lockdown of COVID-19 and Emotional Eating in Italian Young Adults: The Mediating Role of Emotional Dysregulation
J. Pers. Med. 2021, 11(6), 569; https://doi.org/10.3390/jpm11060569 - 17 Jun 2021
Cited by 19 | Viewed by 2733
Abstract
This cross-sectional study aims to investigate the impact of psychological distress experienced during the second wave of the COVID-19 pandemic on emotional eating and to assess the mediating role of emotional dysregulation in a sample of Italian young adults (20–35). A total of [...] Read more.
This cross-sectional study aims to investigate the impact of psychological distress experienced during the second wave of the COVID-19 pandemic on emotional eating and to assess the mediating role of emotional dysregulation in a sample of Italian young adults (20–35). A total of 437 participants provided demographical data and were assessed using the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire. Correlational analyses were performed to assess the relationship between continuous variables, while ANOVA was conducted to detect differences between males and females for emotional eating. To assess whether demographic and clinical data predicted emotional eating, hierarchical linear regression was performed. Then, a mediation analysis was conducted to assess whether emotional dysregulation was a mediator between psychological distress and emotional eating. Emotional eating was associated with psychological distress and emotional dysregulation. Moreover, higher levels of emotional eating were found in females than in males. Predictors of emotional eating were sex, psychological distress, and emotional dysregulation. Mediation analyses showed that the indirect effect of psychological distress on emotional eating through emotional dysregulation was significant (b = 0.0069; SE = 0.0024; CI = 0.0024–0.0118), confirming that the relationship between psychological distress and emotional eating was mediated by emotional dysregulation, controlling for sex. The model explained 26.8% (R2 = 0.2680) of the variance. These findings may help to plan and develop psychological interventions aimed at addressing emotional eating in young adults by targeting emotional dysregulation. Full article
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Article
Severe COVID-19 in Hospitalized Carriers of Single CFTR Pathogenic Variants
J. Pers. Med. 2021, 11(6), 558; https://doi.org/10.3390/jpm11060558 - 15 Jun 2021
Cited by 8 | Viewed by 5394
Abstract
The clinical presentation of COVID-19 is extremely heterogeneous, ranging from asymptomatic to severely ill patients. Thus, host genetic factors may be involved in determining disease presentation and progression. Given that carriers of single cystic fibrosis (CF)-causing variants of the CFTR gene—CF-carriers—are more susceptible [...] Read more.
The clinical presentation of COVID-19 is extremely heterogeneous, ranging from asymptomatic to severely ill patients. Thus, host genetic factors may be involved in determining disease presentation and progression. Given that carriers of single cystic fibrosis (CF)-causing variants of the CFTR gene—CF-carriers—are more susceptible to respiratory tract infections, our aim was to determine their likelihood of undergoing severe COVID-19. We implemented a cohort study of 874 individuals diagnosed with COVID-19, during the first pandemic wave in Italy. Whole exome sequencing was performed and validated CF-causing variants were identified. Forty subjects (16 females and 24 males) were found to be CF-carriers. Among mechanically ventilated patients, CF-carriers were more represented (8.7%) and they were significantly (p < 0.05) younger (mean age 51 years) compared to noncarriers (mean age 61.42 years). Furthermore, in the whole cohort, the age of male CF-carriers was lower, compared to noncarriers (p < 0.05). CF-carriers had a relative risk of presenting an abnormal inflammatory response (CRP ≥ 20 mg/dL) of 1.69 (p < 0.05) and their hazard ratio of death at day 14 was 3.10 (p < 0.05) in a multivariate regression model, adjusted for age, sex and comorbidities. In conclusion, CF-carriers are more susceptible to the severe form of COVID-19, showing also higher risk of 14-day death. Full article
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Article
Machine Learning to Predict In-Hospital Mortality in COVID-19 Patients Using Computed Tomography-Derived Pulmonary and Vascular Features
J. Pers. Med. 2021, 11(6), 501; https://doi.org/10.3390/jpm11060501 - 03 Jun 2021
Cited by 12 | Viewed by 2182
Abstract
Pulmonary parenchymal and vascular damage are frequently reported in COVID-19 patients and can be assessed with unenhanced chest computed tomography (CT), widely used as a triaging exam. Integrating clinical data, chest CT features, and CT-derived vascular metrics, we aimed to build a predictive [...] Read more.
Pulmonary parenchymal and vascular damage are frequently reported in COVID-19 patients and can be assessed with unenhanced chest computed tomography (CT), widely used as a triaging exam. Integrating clinical data, chest CT features, and CT-derived vascular metrics, we aimed to build a predictive model of in-hospital mortality using univariate analysis (Mann–Whitney U test) and machine learning models (support vectors machines (SVM) and multilayer perceptrons (MLP)). Patients with RT-PCR-confirmed SARS-CoV-2 infection and unenhanced chest CT performed on emergency department admission were included after retrieving their outcome (discharge or death), with an 85/15% training/test dataset split. Out of 897 patients, the 229 (26%) patients who died during hospitalization had higher median pulmonary artery diameter (29.0 mm) than patients who survived (27.0 mm, p < 0.001) and higher median ascending aortic diameter (36.6 mm versus 34.0 mm, p < 0.001). SVM and MLP best models considered the same ten input features, yielding a 0.747 (precision 0.522, recall 0.800) and 0.844 (precision 0.680, recall 0.567) area under the curve, respectively. In this model integrating clinical and radiological data, pulmonary artery diameter was the third most important predictor after age and parenchymal involvement extent, contributing to reliable in-hospital mortality prediction, highlighting the value of vascular metrics in improving patient stratification. Full article
(This article belongs to the Special Issue Application of Artificial Intelligence in Personalized Medicine)
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Article
Comparing the Impact of COVID-19 on Nurses’ Turnover Intentions before and during the Pandemic in Qatar
J. Pers. Med. 2021, 11(6), 456; https://doi.org/10.3390/jpm11060456 - 24 May 2021
Cited by 34 | Viewed by 5124
Abstract
Background: Although several studies examining nurses’ turnover intentions have been conducted, few studies have been conducted to explore how COVID-19 contributes to nurses’ turnover intentions. This study aims to compare nurses’ turnover (TO) intentions before and during COVID-19. Methods: The cross-sectional study was [...] Read more.
Background: Although several studies examining nurses’ turnover intentions have been conducted, few studies have been conducted to explore how COVID-19 contributes to nurses’ turnover intentions. This study aims to compare nurses’ turnover (TO) intentions before and during COVID-19. Methods: The cross-sectional study was conducted using the Turnover Intention Scale (TIS-6) and a convenience sample of participants from the largest healthcare provider in Qatar between August and September 2020. Results: A total of 512 nurses were included in the final analysis. The majority were between 31 and 40 years of age (61.5%), 67.6% were females, 76.4% were married, 79.7% had a BSN, 43% had less than 5 years of experience, and 60.4% had worked in COVID-19 designated facilities. The turnover intentions were higher compared with before COVID-19 (p < 0.01). Conclusion: Nurses in Qatar have higher TO intentions during COVID-19. The participants’ characteristics and stress levels are playing a major role in nurses’ decision to leave during COVID-19. Understanding the factors that contribute to turnover intentions is crucial for workforce planning, especially during pandemics. Full article
(This article belongs to the Special Issue Personalized Clinical and Community Nursing)
Article
Evolution of a Cohort of COVID-19 Infection Suspects Followed-Up from Primary Health Care
J. Pers. Med. 2021, 11(6), 459; https://doi.org/10.3390/jpm11060459 - 24 May 2021
Cited by 5 | Viewed by 1328
Abstract
Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose [...] Read more.
Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p < 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission. Full article
(This article belongs to the Special Issue Personalized Medicine for Covid-19 Patients-Clinical Considerations)
Article
The Prevalence of Heterozygous Familial Hypercholesterolemia in Selected Regions of the Russian Federation: The FH-ESSE-RF Study
J. Pers. Med. 2021, 11(6), 464; https://doi.org/10.3390/jpm11060464 - 24 May 2021
Cited by 9 | Viewed by 1555
Abstract
Heterozygous familial hypercholesterolemia (HeFH) is one of the most common genetic conditions but remains substantially underdiagnosed. The aim of our study was to investigate the prevalence of HeFH in the population of 11 different regions of Russia. Individuals were selected from the Epidemiology [...] Read more.
Heterozygous familial hypercholesterolemia (HeFH) is one of the most common genetic conditions but remains substantially underdiagnosed. The aim of our study was to investigate the prevalence of HeFH in the population of 11 different regions of Russia. Individuals were selected from the Epidemiology of Cardiovascular Risk Factors and Diseases in Regions of the Russian Federation Study. All participants who had low-density lipoprotein cholesterol (LDL-C) higher than 4.9 mmol/L, or LDL-C lower than 4.9 mmol/L, but had statin therapy, were additionally examined by FH experts. FH was diagnosed using the Dutch Lipid Clinic Network criteria, incorporating genetic testing. HeFH prevalence was assessed for 18,142 participants. The prevalence of patients with definite or probable HeFH combined was 0.58% (1 in 173). A total of 16.1% of patients with definite or probable HeFH had tendon xanthomas; 36.2% had mutations in one of the three genes; 45.6% of FH patients had coronary artery disease; 63% of HeFH patients received statins; one patient received an additional PCSK9 inhibitor; no patients received ezetimibe. Only 3% of patients reached the LDL-C goal based on 2019 ESC/EAS guidelines. Underdiagnosis and undertreatment of FH in Russia underline the need for the intensification of FH detection with early and aggressive cholesterol-lowering treatment. Full article
(This article belongs to the Section Epidemiology)
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Action and Reaction of Pre-Primary and Primary School-Age Children to Restrictions during COVID-19 Pandemic in Greece
J. Pers. Med. 2021, 11(6), 451; https://doi.org/10.3390/jpm11060451 - 23 May 2021
Cited by 6 | Viewed by 2742
Abstract
The fast-spreading coronavirus disease 2019 (COVID-19) pandemic forced countries to apply restrictive measures to counteract it. School closure was quickly adopted by health authorities. We aimed to investigate the compliance of children aged 4 to 12 years with the COVID-19 lockdown restrictions and [...] Read more.
The fast-spreading coronavirus disease 2019 (COVID-19) pandemic forced countries to apply restrictive measures to counteract it. School closure was quickly adopted by health authorities. We aimed to investigate the compliance of children aged 4 to 12 years with the COVID-19 lockdown restrictions and evaluate the impact of school closure on the children’s educational, social, economic, and psychological outcomes. An online survey was distributed through a social networking platform to parents of pre-primary and primary school-age children. The study period was defined as from 27 November 2020 to 3 December 2020, two weeks after the school closure due to the general lockdown in Greece. This study showed that the school units were well-informed and complied with the protection measures against COVID-19. The pupils quickly adopted the protection measures, even those whose parents suggested masks were less effective. The quarantine-forced school closure highly impacted primary school children’s physical activity, quality of sleep, psychological status, eating habits, academic performance, and household income. Web use showed an increase, with the children over-spending extracurricular time in web activities. Our study highlights the need for long term monitoring of these aforementioned indices, and the development of COVID-19 mitigation measures that carefully incorporate effectiveness and societal impact. Full article
(This article belongs to the Special Issue Personalized Clinical and Community Nursing)
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Article
Biomarkers Linked with Dynamic Changes of Renal Function in Asymptomatic and Mildly Symptomatic COVID-19 Patients
J. Pers. Med. 2021, 11(5), 432; https://doi.org/10.3390/jpm11050432 - 19 May 2021
Cited by 4 | Viewed by 1267
Abstract
The catastrophic coronavirus disease 2019 (COVID-19) pandemic is currently a critical global issue. One well-known complication of COVID-19 in severe cases is acute kidney injury, but no research has given a description of its impact on the kidney in patients with mild symptoms. [...] Read more.
The catastrophic coronavirus disease 2019 (COVID-19) pandemic is currently a critical global issue. One well-known complication of COVID-19 in severe cases is acute kidney injury, but no research has given a description of its impact on the kidney in patients with mild symptoms. We explore the renal function changes in mild COVID-19 patients. This retrospective, single-center study included 27 participants with laboratory-detected severe acute respiratory syndrome coronavirus two (SARS-CoV-2) infection who were admitted to the Tri-Service General Hospital from 4 February to 26 May 2020 and analyzed their clinical features, radiological findings, and laboratory data. Data collected upon admission and discharge showed a median estimated glomerular filtration rate (eGFR) of 106.7 mL/min/1.732 m2 and 112.2 mL/min/1.732 m2, respectively, with a p-value of 0.044. A correlation between renal function and the severity of infection was also found and was statistically significant upon admission. Patients with a lower lymphocyte count or higher C-reactive protein, neutrophil count, and neutrophil-to-lymphocyte ratio presented with a decreased eGFR during their early infection phase. The biomarkers (CRP and NLR) may be linked with dynamic changes of renal function in COVID-19 patients who are asymptomatic or have mild symptoms. Full article
(This article belongs to the Special Issue COVID-19 Related Complications)
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Complexity of Nurse Practitioners’ Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic
J. Pers. Med. 2021, 11(5), 433; https://doi.org/10.3390/jpm11050433 - 19 May 2021
Cited by 10 | Viewed by 2898
Abstract
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance [...] Read more.
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey. Full article
(This article belongs to the Special Issue Personalized Nursing and Health Care)
Article
Personalized Medicine Based on Nasal Epithelial Cells: Comparative Studies with Rectal Biopsies and Intestinal Organoids
J. Pers. Med. 2021, 11(5), 421; https://doi.org/10.3390/jpm11050421 - 16 May 2021
Cited by 13 | Viewed by 1629
Abstract
As highly effective CFTR modulator therapies (HEMT) emerge, there is an unmet need to find effective drugs for people with CF (PwCF) with ultra-rare mutations who are too few for classical clinical trials and for whom there are no drug discovery programs. Therefore, [...] Read more.
As highly effective CFTR modulator therapies (HEMT) emerge, there is an unmet need to find effective drugs for people with CF (PwCF) with ultra-rare mutations who are too few for classical clinical trials and for whom there are no drug discovery programs. Therefore, biomarkers reliably predicting the benefit from CFTR modulator therapies are essential to find effective drugs for PwCF through personalized approaches termed theranostics. Here, we assess CFTR basal function and the individual responses to CFTR modulators in primary human nasal epithelial (pHNE) cells from PwCF carrying rare mutations and compare these measurements with those in native rectal biopsies and intestinal organoids, respectively, in the same individual. The basal function in pHNEs shows good correlation with CFTR basal function in rectal biopsies. In parallel, CFTR rescue in pHNEs by CFTR modulators correlates to that in intestinal organoids. Altogether, results show that pHNEs are a bona fide theranostic model to assess CFTR rescue by CFTR modulator drugs, in particular for PwCF and rare mutations. Full article
(This article belongs to the Special Issue Cystic Fibrosis and Personalized Medicine)
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Article
Differences among COVID-19, Bronchopneumonia and Atypical Pneumonia in Chest High Resolution Computed Tomography Assessed by Artificial Intelligence Technology
J. Pers. Med. 2021, 11(5), 391; https://doi.org/10.3390/jpm11050391 - 10 May 2021
Cited by 4 | Viewed by 1625
Abstract
The aim of this study was to compare the results of automatic assessment of high resolution computed tomography (HRCT) by artificial intelligence (AI) in 150 patients from three subgroups: pneumonia in the course of COVID-19, bronchopneumonia and atypical pneumonia. The volume percentage of [...] Read more.
The aim of this study was to compare the results of automatic assessment of high resolution computed tomography (HRCT) by artificial intelligence (AI) in 150 patients from three subgroups: pneumonia in the course of COVID-19, bronchopneumonia and atypical pneumonia. The volume percentage of inflammation and the volume percentage of “ground glass” were significantly higher in the atypical (respectively, 11.04%, 8.61%) and the COVID-19 (12.41%, 10.41%) subgroups compared to the bronchopneumonia (5.12%, 3.42%) subgroup. The volume percentage of consolidation was significantly higher in the COVID-19 (2.95%) subgroup compared to the atypical (1.26%) subgroup. The percentage of “ground glass” in the volume of inflammation was significantly higher in the atypical (89.85%) subgroup compared to the COVID-19 (79.06%) subgroup, which in turn was significantly higher compared to the bronchopneumonia (68.26%) subgroup. HRCT chest images, analyzed automatically by artificial intelligence software, taking into account the structure including “ground glass” and consolidation, significantly differ in three subgroups: COVID-19 pneumonia, bronchopneumonia and atypical pneumonia. However, the partial overlap, particularly between COVID-19 pneumonia and atypical pneumonia, may limit the usefulness of automatic analysis in differentiating the etiology. In our future research, we plan to use artificial intelligence for objective assessment of the dynamics of pulmonary lesions during COVID-19 pneumonia. Full article
(This article belongs to the Special Issue Systems Medicine and Bioinformatics)
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Article
Salivary Biomarkers in COVID-19 Patients: Towards a Wide-Scale Test for Monitoring Disease Activity
J. Pers. Med. 2021, 11(5), 385; https://doi.org/10.3390/jpm11050385 - 08 May 2021
Cited by 9 | Viewed by 2024
Abstract
The ongoing outbreak of coronavirus disease 2019 (COVID-19), which impairs the functionality of several organs, represents a major threat to human health. One of the hardest challenges in the fight against COVID-19 is the development of wide-scale, effective, and rapid laboratory tests to [...] Read more.
The ongoing outbreak of coronavirus disease 2019 (COVID-19), which impairs the functionality of several organs, represents a major threat to human health. One of the hardest challenges in the fight against COVID-19 is the development of wide-scale, effective, and rapid laboratory tests to control disease severity, progression, and possible sudden worsening. Monitoring patients in real-time is highly demanded in this pandemic era when physicians need reliable and quantitative tools to prioritize patients’ access to intensive care departments. In this regard, salivary biomarkers are extremely promising, as they allow for the fast and non-invasive collection of specimens and can be repeated multiple times. Methods: We compare salivary levels of immunoglobulin A subclasses (IgA1 and IgA2) and free light chains (kFLC and λFLC) in a cohort of 29 SARS-CoV-2 patients and 21 healthy subjects. Results: We found that each biomarker differs significantly between the two groups, with p-values ranging from 10−8 to 10−4. A Receiving Operator Curve analysis shows that λFLC level is the best-suited candidate to discriminate the two groups (AUC = 0.96), with an accuracy of 0.94 (0.87–1.00 95% CI), a precision of 0.91 (0.81–1.00 95% CI), a sensitivity of 1.00 (0.96–1.00 95% CI), and a specificity of 0.86 (0.70–1.00 95% CI). Conclusion: These results suggest λFLC as an ideal indicator of patient conditions. This hypothesis is strengthened by the consideration that the λFLC half-life (approximately 6 h) is significantly shorter than the IgA one (21 days), thus confirming the potential of λFLC for effectively monitoring patients’ fluctuation in real-time. Full article
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Article
Special Attention to Physical Activity in Breast Cancer Patients during the First Wave of COVID-19 Pandemic in Italy: The DianaWeb Cohort
J. Pers. Med. 2021, 11(5), 381; https://doi.org/10.3390/jpm11050381 - 06 May 2021
Cited by 7 | Viewed by 1697
Abstract
Recent evidence highlights that physical activity (PA) is associated with decreased recurrence risk, improved survival and quality of life for breast cancer (BC) patients. Our study aimed to explore patterns of increased/decreased PA, and sedentary behaviors among BC women of the DianaWeb cohort [...] Read more.
Recent evidence highlights that physical activity (PA) is associated with decreased recurrence risk, improved survival and quality of life for breast cancer (BC) patients. Our study aimed to explore patterns of increased/decreased PA, and sedentary behaviors among BC women of the DianaWeb cohort during the first wave of COVID-19 pandemic, and examined the association with residential locations, work changes, different modality used to increase PA, and quality of life. The study analyzed the questionnaires completed by the 781 BC women (age 54.68 ± 8.75 years on both December 2019 and June 2020. Results showed a decrease of 22%, 57%, and 26% for walking activity, vigorous activity, and total PA, respectively. Sitting/lying time increased up to 54.2% of the subjects recruited. High quality of life was associated with lower odds of being sedentary (p = 0.003). Our findings suggest that innovative health management fostering compliance with current guidelines for PA and active behavior should be implemented, especially in unpredictable emergency conditions. Full article
(This article belongs to the Special Issue Cancer Challenges during COVID-19 Pandemic)
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