Long-Term Lung Sequelae in Survivors of Severe/Critical COVID-19 Pneumonia: The “Non-Steroid”, “Non-Interventional” Approach

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(2), P. 347 - 347

Published: Jan. 8, 2025

Introduction: Long-term lung sequelae in severe COVID-19 survivors, as well their treatment, are poorly described the current literature. Objective: To investigate fibrotic survivors of severe/critical pneumonia and fate according to a "non-interventional" approach. Methods: Prospective study above after hospital discharge from March 2020 October 2022. Re-evaluation lasted 3-12 months included chest HRCT, PFTs, dyspnea, overall health evaluation by modified Medical Research Council (mMRC) St. George's Respiratory Questionnaire (SGRQ), respectively. Results: In this study, 198 patients (61.1% male) with median age 57 years (IQR 49-66). After 3 months, 187 (94.4%) were assessed; 6 82 (41.1%) 12 16 (8%) assessed. At each time point, significant reduction was observed extent COVID-19-associated opacities (p < 0.001 p = 0.002) parenchymal bands 0.014 0.025). Persisting fibrotic-like changes 18 (9%) (apical findings 2 patients, non-specific interstitial pneumonia-like 14 minimal patients). predicted FVC% 93% (80-100%) DLCO% 65% (58-78%) statistically improvement at both 0.001). Moreover, 81.1% had mMRC ≤ 1 SGRQ 11.65 [0-24.3] dyspnea 0.001) 0.027) persisting months. Conclusions: This prospective including only pneumonia, documented all imaging, functional, clinical parameters applying These data do not indicate any post-COVID-19 "epidemic widespread pulmonary fibrosis".

Language: Английский

---

PEGylation Improves the Therapeutic Index of Dexamethasone To Treat Acute Respiratory Distress Syndrome with Obesity Background in Mouse

Molecular Pharmaceutics, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 17, 2025

With increasing prevalence globally, obesity presents unique challenges to the clinical management of other diseases. In case acute respiratory distress syndrome (ARDS), glucocorticoid therapy (e.g., dexamethasone (DEX)) represents one few pharmacological treatment options, but it comes with severe adverse effects, especially when long-term usage (>1 week) is required. One important reason for effects DEX its nonspecific accumulation in healthy tissues upon systemic administration. Therefore, we hypothesize that refining pharmacokinetics (PK) and vivo biodistribution may improve therapeutic index (higher efficacy, lower toxicity) thus make safer obese populations. To achieve this goal, was conjugated polyethylene glycol (PEG) three different molecular weights (Mw, 2K, 5K, 10K) via a reactive oxygen species (ROS)-cleavable linker. Their anti-inflammatory efficacy were evaluated murine obesity-ARDS model. Strikingly, DEX-PEG-2K (conjugates 2K PEG Mw) provided optimal compared free two conjugates longer PEGs (Mw 5K 10K): While retaining comparable DEX, significantly reduced liver spleen, which led 51% reduction fatty area 32% blood triglycerides concentration. DEX-induced apoptosis thymus also rescued by under normal conditions. The PK investigated elicit underlying mechanism. summary, here chemical modification strategy possibly drugs ARDS an background.

Language: Английский

---

The evolving landscape of COVID-19: factors associated with in-hospital COVID-19 related mortality during the 2023–2024 phase of JN.1 subvariant dominance

BMC Infectious Diseases, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 27, 2025

COVID-19 remains a complex health challenge. We analysed the characteristics and outcomes of COVID-19-related hospitalisations during JN.1 variant dominance. Conducted in hospital serving socioeconomically deprived population, this study included all adults hospitalised with from 1st November 2023 to 31st August 2024. The primary outcome was in-hospital mortality, relation demographic, clinical, laboratory parameters. Among 122 individuals (median age 76 years, 58.2% males, median comorbidity index 5), 114/122 (93.4%) had received ≥ 1 SARS-CoV-2 vaccination, 23 months elapsed since last dose. Fever (67/122, 54.9%) dyspnoea (49/122, 40.2%) were common presenting symptoms, 78/122 (64%) showing CT evidence pneumonia; 25/122 (20%) purely neurological presentations. Treatment remdesivir (115/122, 94.3%) and/or nirmatrelvir/ritonavir (9/122, 7.4%), sotrovimab (15/122, 12.3%), corticosteroids (61/122, 50.0%), oxygen supplementation (76/122, 62.3%). Whereas 107/122 (87.7%) discharged after seven days, mortality 15/122 (12.3%) 16 days. Baseline factors associated neutrophil-lymphocyte ratio > 8, D-dimer 1800 ng/mL, procalcitonin 1.0 albumin < 3.2 g/dL; admission, nasopharyngeal antigen positivity persisting for 12 hospitalisation 10 higher requirements resulting corticosteroid use, healthcare-associated bacteraemia increased odds mortality. parameters persistent despite antiviral therapy offer readily available prognostic insights patients COVID-19. It is imperative advocate up-to-date vaccination among older people other vulnerable groups.

Language: Английский

---

Ursodeoxycholic acid relieves clinical severity of COVID-19 in patients with chronic liver diseases

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 12

Published: Feb. 6, 2025

The potential effect of ursodeoxycholic acid (UDCA) on the clinical outcomes SARS-CoV-2 in patients with chronic liver diseases has been a subject ongoing debate since onset pandemic 2019. This study aims to investigate UDCA prognosis infection diseases. A total 926 who contracted their first during December 2022 January 2023, were included this study. Participants divided into two groups based use UDCA: cohort (n = 329) and non-UDCA 597). After performing 1:1 age-and sex-matching, analysis proceeded 309 from each group for further evaluation. In UDCA-treated cohort, incidence asymptomatic infections was significantly higher, 30.1% affected, compared 6.47% (p < 0.0001). Multivariable identified as protective factor against symptomatic infections, yielding an odds ratio (OR) 4.77 (95% CI: 2.70-8.44, p 0.001). Furthermore, age over 50 found be risk adjusted OR 1.51 1.01-2.24, 0.05). suggests that therapy may improve are infected SARS-CoV-2, highlighting its role improving within vulnerable population. However, research is required validate these findings elucidate mechanisms underlying UDCA's effect.

Language: Английский

---

Long COVID has variable incidence and clinical presentations: our 6-country collaborative study

Inflammopharmacology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 21, 2025

Language: Английский

---

Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis

Frontiers in Pharmacology, Journal Year: 2025, Volume and Issue: 16

Published: April 16, 2025

Remdesivir (RDV) and nirmatrelvir/ritonavir (NRM/RTV) are two antiviral agents for treating outpatient adults with mild to moderate symptomatic COVID-19 at high risk of developing a severe disease. The review objectives compare the efficacy safety these antivirals based on published RCT real-world data, evaluate costs from healthcare perspective. This study provides network meta-analysis RDV NRM/RTV early treatment COVID-19. outcomes analysed were hospitalisation any cause serious adverse events. A cost-analysis was performed incorporating drug costs, administration, hospitalisations, management budget impact analysis estimated University Hospital Padua. Our results indicated that showed trend towards lower compared (RR 1.59, 95% CI: 0.60-4.20), though this not statistically significant. For safety, demonstrated slightly events 0.92, 0.31-2.74), but without statistical significance. cost could save €550,854.46 per 1,000 patients. Finally, data Padua annual savings €210,977.25 if all treatments administered instead RDV. comparison therapies did yield significant differences in potential prevent or However, saving favour NRM/RTV.

Language: Английский

---

Objective Sleep–Wake Findings in Patients with Post-COVID-19 Syndrome, Fatigue and Excessive Daytime Sleepiness

Clinical and Translational Neuroscience, Journal Year: 2025, Volume and Issue: 9(1), P. 15 - 15

Published: March 5, 2025

Sleep–wake disturbances are common in post-COVID-19 syndrome but lack extensive objective characterization. This study evaluated sleep–wake patterns 31 patients with referred for fatigue and excessive daytime sleepiness (EDS). Assessments included questionnaires (the severity scale, the Epworth Beck Depression Index-II), video polysomnography (V-PSG), multiple sleep latency test (MSLT, n = 15), actigraphy (n 29). Patients (70% female, mean age 45 years) had mostly mild acute SARS-CoV-2 infections were assessed a median of weeks post-infection. Fatigue (fatigue 6.33), depression (Beck inventory-II, 20) scores elevated. V-PSG showed moderate apnea 35.5%, increased arousal index 77.4%, stage percentages NREM1 (12%), NREM2 (37%), NREM3 (19%), REM (15.8%). MSLT revealed only 13.3% latencies under 8 min no sleep-onset periods. Actigraphy indicated inactivity 96.6%, high variability time bed. These findings highlight polysomnographic actigraphic profile clinophilia, alongside limited on MSLT. Addressing these multifactorial is crucial managing syndrome.

Language: Английский

---

Vasoactive Intestinal Peptide (VIP) in COVID-19 Therapy—Shedding of ACE2 and TMPRSS2 via ADAM10

International Journal of Molecular Sciences, Journal Year: 2025, Volume and Issue: 26(6), P. 2666 - 2666

Published: March 16, 2025

Patients infected with SARS-CoV-2 may develop mild respiratory symptoms but also Acute Respiratory Distress Syndrome (ARDS). Additionally, severe systemic inflammation contributes to morbidity and mortality. The virus enters the cell by binding angiotensin-converting enzyme 2 (ACE2) receptor, followed cleavage transmembrane serine protease (TMPRSS2). Vasoactive intestinal peptide (VIP) is known for its immune-modulating effects suppressing release of pro-inflammatory cytokines enhancing regulatory T-cells. Furthermore, it has been tested in SARS-CoV-2-related clinical trials. We set out investigate role setting infection vitro. Epithelial cells (CaCo-2) were stimulated spike protein, treated native VIP analyzed mRNA surface expression ACE2 TMPRSS2, activity TMPRSS2 rate a pseudovirus. downregulated expression. Beyond these direct effects, mediates shedding surface-expressed via upregulation sheddase (ADAM10). Functionally, dual mechanisms VIP-mediated downregulation proteins involved entry resulted reduced These data imply that hampers viral based on linkage ADAM10 stimulate research other indications beyond SARS-CoV-2.

Language: Английский

---

Tocilizumab in COVID-19: A Double-Edged Sword?

Biomedicines, Journal Year: 2024, Volume and Issue: 12(12), P. 2924 - 2924

Published: Dec. 23, 2024

Background/Objectives: SARS-CoV-2 was responsible for the global pandemic. Approximately 10–15% of patients with COVID-19 developed respiratory failure adult acute distress syndrome (ARDS), which required treatment in Intensive Care Unit (ICU). The cytokine storm observed severe frequently handled steroids. Synergically, tocilizumab, an anti-interleukin-6 receptor monoclonal antibody, gained popularity as a storm-suppressing agent. However, immunosuppression proven to increase predisposition infections resistant bacteria. Our study aimed assess relationship between positive tests secondary and survival COVID-19-attributed ARDS treated immunosuppressive agents. Methods: This included 342 qualified ICU mechanical ventilation (MV). were divided based on type immunomodulating therapy culture results. Results: results showed highest rate among <61 years, favoring combined (tocilizumab + steroids). Atrial fibrillation (AF) coronary heart disease (CHD) correlated lower than other comorbidities. Tocilizumab associated increased risk pathogen cultures, could potentially cause infections; however, these higher. Conclusions: MV procedures well application tocilizumab significantly decreased mortality COVID-19-related ARDS. suppression storms played crucial role survival. found be both efficient safe despite ‘side effect’ infections.

Language: Английский

---

Anticoagulation for COVID-19: Seeking Clarity and Finding Yet More Gray

Annals of Internal Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 23, 2024

Language: Английский

---