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Metabolic acidosis with elevated anion gap and euglycemic ketoacidosis in pregnant and postpartum women with severe Covid-19.
Melo Mendes, IC, Martins de Oliveira, AL, Pinheiro Trindade, PM, Mendes da Silva, W, Pimentel, C, Perlingeiro, RM, Melo Guedes, C, Caminha Escosteguy, C, Galliez, RM
Annals of medicine. 2025;(1):2445189
Abstract
BACKGROUND/OBJECTIVES Pregnant and postpartum women have a higher risk for developing severe Covid-19 and other clinical and obstetric complications. This study aims to evaluate the frequency of metabolic acidosis with elevated anion gap and describe a case series of euglycemic ketoacidosis (EKA) in pregnant and postpartum women with severe confirmed or suspected Covid-19. MATERIALS AND METHODS Observational retrospective study carried in a reference intensive care unit from May 2020 to June 2022. Cases were confirmed with positive RT-PCR or rapid antigen test. Cases with compatible clinical and radiologic findings were also included. Ketoacidosis was defined as the presence of metabolic acidosis with high anion gap (bicarbonate < 15 mEq/L and AG > 10 mEq/L) and ketonuria (2+ or more in urine test). Statistical analyses were made with R software. RESULTS Of 101 admissions, 61 (60.4%) presented metabolic acidosis with high anion gap. The median age was 29 years, and most were in the third trimester. Evolution to invasive mechanical ventilation (54.0%) and obstetric complications (78.0%) were frequent. The prevalence of metabolic acidosis with high anion gap and absence of hyperlactatemia was of 43.6% (44/101). Six (5.94%) women met the criteria for EKA. Despite severity, there were no deaths. CONCLUSIONS The prevalence of metabolic acidosis and EKA in pregnant and postpartum women with severe Covid-19 was high. This condition should be routinely, so it can be promptly treated.
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Factors associated with long Covid in nursing professionals.
Vasconcelos, DSS, Pompeo, DA, Antonio-Viegas, MCR, Miasso, AI, Arruda, GO, Teston, EF, Saraiva, EF, Giacon-Arruda, BCC
Revista da Escola de Enfermagem da U S P. 2025;:e20240268
Abstract
OBJECTIVE To analyze the association between sociodemographic variables, lifestyle and mental health habits, and long Covid in nursing professionals. METHOD Quantitative, observational, cross-sectional and analytical study, with 109 nursing professionals who had Covid-19 between 2020 and 2022. Data collection was carried out using an online form, with the following variables of interest: resilience, subjective well-being, age, sex, professional category, vaccination, physical activity, presence of symptoms resulting from Covid-19 infection after the acute phase of the disease and long Covid. Data were analyzed descriptively and inferentially using Poisson regression with robust variance and a significance level of 5%. RESULTS Male sex, high resilience, and high positive affect decrease the prevalence of long Covid by 71% (RP = 0.29), 40% (RP = 0.60) and 43% (RP = 0.57), respectively, while being in the nursing technician category increases its prevalence by 74% (RP = 1.74). CONCLUSION The results emphasize the importance and support the development of promotion, prevention, treatment, and rehabilitation actions for individuals with long Covid. To achieve this, multidisciplinary care, centered on the person and directed at the context and work environment is required.
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Psychological attributes and eating behaviors in 5- to 12-year-old children during periods of stress.
Sena, C, Della Torre, J, Garg, E, Zheng, H, Partida, I, Thaker, SK, Woo Baidal, J, Shamsian, DV, Rausch, JC, Thaker, VV
Obesity (Silver Spring, Md.). 2025;(1):134-145
Abstract
OBJECTIVE The objective of this study was to investigate the association between psychological attributes and obesogenic behaviors in children during the period of COVID-19 pandemic-induced stress. METHODS This observational study collected data from caregivers of 5- to 12-year-old children from three diverse groups assessing sociodemographic, economic, and perceived stress, along with the Strengths and Difficulties Questionnaire (SDQ) and the Family Eating and Activity Habits Questionnaire, revised (FEAHQ-R), in October 2020 and June 2021. The outcome measures were SDQ and FEAHQ-R scores. The SDQ subscales were compared with US child norms. Linear mixed models were used to examine the association between the SDQ subscales and FEAHQ-R domains, adjusting for socioeconomic covariates. RESULTS A total of 361 families (496 children) completed the SDQ and FEAHQ-R. The SDQ subscale scores were higher than those of age/gender norms (p = 0.006-<0.001). Eating style (p < 0.001) and food stimulus exposure scores (p = 0.005-0.01) were associated with the SDQ subscales, but not satiety response. Perceived stress was a significant covariate (p < 0.01). The baseline obesity status of the children was not statistically significant. CONCLUSIONS Psychological stress is associated with higher hedonic behavior in children. Food stimulus exposure and leisure access can be targeted for intervention during periods of prolonged stress.
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The EPICOVID19-BS study: a web-based epidemiological survey in bariatric patients.
Prinelli, F, Adorni, F, Giovanelli, A, Ravelli, M, Ceresoli, S, Asteria, C
Journal of endocrinological investigation. 2025;(1):173-189
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Abstract
PURPOSE To assess the occurrence and severity of SARS-CoV-2 infection/COVID-19, frequency of symptoms, clinical manifestations and behaviours in a sample of patients undergoing bariatric surgery (BS). METHODS The EPICOVID19-BS is an observational cross-sectional study conducted in Italy during the second wave of the COVID-19 pandemic (September 2021-February 2022). Patients with severe/extreme obesity undergoing BS were asked to complete an online multiple-choice questionnaire and to provide additional clinical information and blood biochemistry. Positive COVID-19 cases were defined by the combination of positive nasopharyngeal swab test results and/or positive serological test results. Sociodemographic, clinical and behavioural characteristics were compared between positive and negative COVID-19 cases. RESULTS A total of 745 participants were enrolled (mean age 44.5 ± 10.5 years SD, 78% female). The proportion of positive COVID-19 cases was 20.4%. They were more likely to be health care workers, to have close contacts with confirmed cases, to use anti-inflammatory drugs, to have immune system disorders, to have previous CMV infection, to have lower cholesterol levels and to have less metabolic syndrome than negative cases. Infected participants significantly increased their use of national health resources for minor health problems. The majority of participants experienced flu-like symptoms and taste and smell disturbances. Only 9.6% were hospitalised and none required intubation. CONCLUSIONS Our results seem to support the evidence that patients undergoing BS have a low rate of severe SARS-CoV2. Further longitudinal studies in multiple obesity treatment centres are needed to more effectively monitor and control obesity in this specific population.
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Risk-Prioritised Versus Universal Medical Nutrition Therapy for Gestational Diabetes: A Retrospective Observational Study.
Smith, RA, Boaro, M, Mak, KH, Wong, V
Nutrients. 2025;(2)
Abstract
BACKGROUND The optimal application of medical nutrition therapy (MNT) in treating gestational diabetes remains uncertain. MNT involves individualised nutrition assessment and counselling, which is labour-intensive and is not the sole type of intervention offered by clinical dietitians. OBJECTIVE To determine whether pregnancy outcomes differed for individuals with gestational diabetes who were offered MNT on a risk-prioritised (RP) versus universal basis. METHODS Observational data from two cohorts of individuals who were offered MNT only if they met the high-risk criteria following general group-based dietary education (RP1, n = 369; RP2, n = 446) were compared with a baseline cohort who were universally offered at least one MNT consultation (UM, n = 649). The RP1 cohort were seen during community-wide COVID-19 restrictions in 2021, while RP2 were seen after restrictions had lifted in 2022. Furthermore, the RP approach primarily utilised telemedicine, while the UM approach was delivered in person. RESULTS MNT consultations halved under the RP approach (59 vs. 119 sessions per 100 diagnoses for RP2 vs. UM) and saved more than 20 h of dietitian time per 100 diagnoses (95 vs. 73 h for RP2 vs. UM). No significant increases were observed (p < 0.05) for any pregnancy outcomes in the RP cohorts compared with the UM cohort, including usage of diabetes medications, maternal weight gain below and above target, early deliveries, induced deliveries, emergency caesarean sections, large- and small-for-gestational-age (SGA) infants, infant macrosomia, neonatal hypoglycaemia and neonatal intensive care admissions. The use of both basal insulin (27% vs. 33%, OR 0.62, 95% CI 0.46 to 0.84) and metformin (6% vs. 10%, OR 0.52, 95% CI 0.31 to 0.88) was lower in the RP1 cohort during pandemic restrictions compared with the UM cohort; however, these differences were not retained in the RP2 cohort. Additionally, there were fewer SGA infants under the RP approach, particularly for the RP2 cohort (6% vs. 11% for RP2 vs. UM, OR 0.55, 95% CI 0.34 to 0.89). CONCLUSIONS Risk-prioritised MNT was a more efficient dietetic service approach to gestational diabetes than the universal MNT model, with comparable pregnancy outcomes. Similar approaches may represent a strategic way to address sustainable health service planning amidst the rising global prevalence of this condition. However, further research is needed to investigate consumer perspectives, wider service impacts and post-partum maternal and child health outcomes.
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Association Between the Ultrasound Evaluation of Muscle Mass and Adverse Outcomes in Critically Ill Patients: A Prospective Cohort Study.
Umbrello, M, Formenti, P, Artale, A, Assandri, M, Palandri, C, Ponti, S, Venco, R, Waccher, G, Muttini, S
Anesthesia and analgesia. 2025;(2):427-436
Abstract
BACKGROUND Computed tomography (CT)-derived low muscle mass is associated with adverse outcomes in critically ill patients. Muscle ultrasound is a promising strategy for quantitating muscle mass. We evaluated the association between baseline ultrasound rectus femoris cross-sectional area (RF-CSA) and intensive care unit (ICU) mortality. Secondary outcomes were the determinants of RF-CSA, and the diagnostic performance of RF-CSA after adjustment for body size. METHODS A prospective, single-center, observational cohort study was conducted in 3 ICUs (general, neuroscience, coronavirus disease-2019 [COVID-19]) of a university-affiliated hospital. Consecutive, mechanically ventilated patients with predicted length of stay >72 hours were included. RF-CSA was assessed at the dominant leg by ultrasound. Association with ICU mortality was tested using multivariable logistic regression. Diagnostic performance of RF-CSA was compared after adjustment by sex (CSA-sex), body surface area (CSA-BSA), and squared height (CSA-H2). RESULTS A total of 316 patients were enrolled: age 69 [60-76], 211 men and 183 ICU survivors. Older age (odds ratio, OR [95% confidence interval, CI], 1.03 [1.01-1.05]), the type of ICU (neuroscience: 0.82 [0.38-1.79], COVID-19: 4.1 [2.01-8.38]), a higher modified Nutrition and Rehabilitation Investigators Consortium (NUTRIC) score (1.43 [1.21-1.70]), and a lower RF-CSA (0.41 [0.29-0.58]) were associated with ICU mortality. Baseline RF-CSA was lower in women, with higher nutritional risk, older age, and larger body size. Unadjusted RF-CSA had an area under the receiver operating characteristic (ROC) curve for ICU mortality of 0.720 [0.663-0.776], and this value was not significantly different from that of CSA-sex, CSA-BSA, and CSA-H2 (P = .1487). CONCLUSIONS Low baseline RF-CSA was associated with increased ICU mortality. Admission RF-CSA was lower in women, with high nutritional risk, in older subjects and with lower body size. Absolute muscle mass was significantly associated with mortality, with no significant increase in this relationship when adjusting for sex or body size.
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Do dynamic changes in haematological and biochemical parameters predict mortality in critically ill COVID-19 patients?
Jandric, M, Zlojutro, B, Momcicevic, D, Dragic, S, Kovacevic, T, Djajic, V, Stojiljkovic, MP, Loncar-Stojiljkovic, D, Skrbic, R, Djuric, DM, et al
Technology and health care : official journal of the European Society for Engineering and Medicine. 2025;(1):275-286
Abstract
BACKGROUND Critically ill COVID-19 patients are usually subjected to clinical, laboratory, and radiological diagnostic procedures resulting in numerous findings. Utilizing these findings as indicators for disease progression or outcome prediction is particularly intriguing. OBJECTIVES Exploring the significance of dynamic changes in haematological and biochemical parameters in predicting the mortality of critically ill COVID-19 patients. METHODS The present study was a prospective and observational study involving mechanically ventilated 75 critically ill adult COVID-19 patients with hypoxemic respiratory failure. The collected data included baseline patient characteristics, treatment options, outcome, and laboratory findings at admission and 7 days after. The dynamics of the obtained findings were compared between survivors and non-survivors. RESULTS The 28-day survival rate was 61.3%. In the group of non-survivors significant dynamic changes were found for C-reactive protein (p= 0.001), interleukin-6 (p< 0.001), lymphocyte (p= 0.003), neutrophil-lymphocyte ratio (p= 0.003), platelets (p< 0.001), haemoglobin (p< 0.001), iron (p= 0.012), and total iron-binding capacity (p< 0.001). Statistically significant changes over time were found for ferritin (p= 0.010), D-dimer (p< 0.001), hs-troponin T (p< 0.002), lactate dehydrogenase (p= 0.001), glucose (p= 0.023), unsaturated iron-binding capacity (p= 0.008), and vitamin D (p< 0.001). CONCLUSION The dynamic changes in inflammatory, haematological and biochemical parameters can predict disease severity, and outcome.
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Neutrophil Elastase, Neuron-Specific Enolase, and S100B Protein as Potential Markers of Long-Term Complications Caused by COVID-19 in Patients with Type 2 Diabetes Mellitus (T2DM) and Advanced Stage of Diabetic Nephropathy (NfT2DM)-Observational Studies.
Rabczyński, M, Chwałek, S, Adamiec-Mroczek, J, Lewandowski, Ł, Trocha, M, Nowak, B, Misiuk-Hojło, M, Bednarska-Chabowska, D, Kuźnik, E, Lubieniecki, P, et al
International journal of molecular sciences. 2024;(21)
Abstract
Despite numerous studies conducted by various research teams, predicting long-term outcomes (known as Post-COVID-19 Syndrome, PCS) that may result from Coronavirus Disease 2019 (COVID-19) remains challenging. PCS affects over a million people, primarily those with comorbid conditions. Therefore, it is crucial to undertake research aimed at developing a predictive model for early diagnosis of PCS, which in turn would enable faster preventive actions. The aim of this study was to assess the value of measuring and attempt a quantitative evaluation using Enzyme-Linked Immunosorbent Assay (ELISA) tests of three non-serum proteins, whose presence in the blood during COVID-19 was associated with severe disease progression: neutrophil elastase (NE), calcium-binding protein S100B, and neuron-specific enolase (NSE). The concentrations of these proteins were measured in blood serum samples collected before the COVID-19 pandemic from (1) patients with type 2 diabetes (T2DM); (2) advanced stage diabetic nephropathy (NfT2DM); (3) a healthy group; and in blood serum samples collected two years after recovering from COVID-19 from patients with (4) T2DM and (5) NfT2DM. It was found that elevated levels of NE and NSE were significantly more common (p < 0.05) in patients with NfT2DM after recovering from COVID-19 compared to the other groups, while elevated levels of S100B were significantly more frequently observed in patients with T2DM after recovering from COVID-19 (p < 0.05). Demonstrating differences in the prevalence of NE, NSE, and S100B in individuals who recovered from COVID-19 with T2DM and NfT2DM makes these proteins important components of the developing predictive model for early detection of PCS. To our knowledge, this is the first study showing the significance of NE, NSE, and S100B in PCS in the context of T2DM and NfT2DM.
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Periodic Fasting and Acute Cardiac Events in Patients Evaluated for COVID-19: An Observational Prospective Cohort Study.
Horne, BD, Anderson, JL, Haddad, F, May, HT, Le, VT, Knight, S, Bair, TL, Knowlton, KU
Nutrients. 2024;(13)
Abstract
BACKGROUND Periodic fasting was previously associated with greater longevity and a lower incidence of heart failure (HF) in a pre-pandemic population. In patients with coronavirus disease 2019 (COVID-19), periodic fasting was associated with a lower risk of death or hospitalization. This study evaluated the association between periodic fasting and HF hospitalization and major adverse cardiovascular events (MACEs). METHODS Patients enrolled in the INSPIRE registry from February 2013 to March 2020 provided periodic fasting information and were followed into the pandemic (n = 5227). Between March 2020 and February 2023, N = 2373 patients were studied, with n = 601 COVID-positive patients being the primary study population (2836 had no COVID-19 test; 18 were excluded due to fasting <5 years). A Cox regression was used to evaluate HF admissions, MACEs, and other endpoints through March 2023, adjusting for covariables, including time-varying COVID-19 vaccination. RESULTS In patients positive for COVID-19, periodic fasting was reported by 180 (30.0% of 601), who periodically fasted over 43.1 ± 19.2 years (min: 7, max: 83). HF hospitalization (n = 117, 19.5%) occurred in 13.3% of fasters and 22.1% of non-fasters [adjusted hazard ratio (aHR) = 0.63, CI = 0.40, 0.99; p = 0.044]. Most HF admissions were exacerbations, with a prior HF diagnosis in 111 (94.9%) patients hospitalized for HF. Fasting was also associated with a lower MACE risk (aHR = 0.64, CI = 0.43, 0.96; p = 0.030). In n = 1772 COVID-negative patients (29.7% fasters), fasting was not associated with HF hospitalization (aHR = 0.82, CI = 0.64, 1.05; p = 0.12). In COVID-positive and negative patients combined, periodic fasting was associated with lower mortality (aHR = 0.60, CI = 0.39, 0.93; p = 0.021). CONCLUSIONS Routine periodic fasting was associated with less HF hospitalization in patients positive for COVID-19.
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Emergency Free School Meal Distribution During the COVID-19 Pandemic in High-Poverty Urban Settings.
Bui, T, Melnick, EM, Tong, D, Acciai, F, Yedidia, MJ, Ohri-Vachaspati, P
Journal of the Academy of Nutrition and Dietetics. 2024;(5):636-643
Abstract
BACKGROUND The coronavirus disease 2019 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who were reliant on subsidized school meals at risk of experiencing hunger. In response, the US Department of Agriculture mobilized the Summer Food Service Program and Seamless Summer Option program to provide emergency free school meals. There is a need to investigate the effectiveness of these programs in covering underresourced communities during the pandemic. OBJECTIVE This study assessed associations between meal distribution and census tract demographics (ie, poverty level, race/ethnicity, and deprivation level based on social deprivation index score). DESIGN An observational study using longitudinal meal distribution data collected over an 18-month period following school closures (March 2020 to August 2021). PARTICIPANTS AND SETTING Monthly meal distribution data were collected for community sites serving 142 census tracts within 4 urban New Jersey cities predominantly populated by people with low incomes and from racial and ethnic minority groups. MAIN OUTCOME MEASURES Main outcome measures were the number of meals served monthly by Summer Food Service Program and Seamless Summer Option meal sites. STATISTICAL ANALYSES PERFORMED A 2-part multivariable regression approach was used to analyze the data. RESULTS In the first step, logistic regression models showed that high-deprivation tracts were more likely to serve meals during the observed period (odds ratio 3.43, 95% CI 1.001 to 11.77; P = 0.0499). In the second step, among tracts that served any meals during the observed period, mixed effects negative binomial regression models showed that high-poverty and high-deprivation tracts served comparatively more meals (incidence rate ratio [IRR] 2.83, 95% CI 2.29 to 3.51; P < 0.001 and IRR 1.94, 95% CI 1.65 to 2.28; P < 0.001, respectively). CONCLUSIONS Findings show that meal distribution during the pandemic was higher within census tracts with higher poverty and deprivation levels, indicating that underresourced communities with higher need had more free meals available during this unprecedented public health emergency.