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1. The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper

Author

Sergio Pillon, Mariella Catalano, Benjamin Brenner, Zsolt Pecsvarady, Ismail Elalamy, Joseph Lewis, Jean-Claude Wautrecht, D. Olinic, Vincent Maréchal, Mouna Sassi, Isabelle Mahé, Anna Falanga, Nusrat Jabeen, Charles A. Carter, Mary-Paula Colgan, Alexander Makatsariya, Alfonso Tafur, Kasse Aa, Tazi Mezalek Zoubida, Meletios-Athanasios Dimopoulos, Michèle Sabbah, Darko Antic, Yiannis Theodorou, Alex C. Spyropoulos, Vladimir Chekhonin, Meganathan Kannan, Katalin Farkas, Peter Klein-Wegel, Job Harenberg, P Massamba Mbaye, Joseph Gligorov, Manuel Monreal Bosch, Grigoris T. Gerotziafas, Pier Luigi Antignani, Hikmat Abdel-Razeq, James D. Douketis, Gerit Schernthaner, Petros Agathaggelou, Ali T. Taher, Jawed Fareed, Essam Abo Elnazar, Irina Panovska-Stavridis, Patrick Van Dreden, Fabio Leivano, Gerry Fowkes, Fakiha Siddiqui, Mark A. Ligocki, Tishya Indran, Kostantinos Konstantinidis, Bulent Kantarcioglu, Jin Shiomura, Bahare Fazeli, Chryssa Papageorgiou, Yongquan Gu, Anny Slama-Schwok, Eduardo Ramacciotti, Zenguo Zhai, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Università degli Studi di Milano = University of Milan (UNIMI), Centre d'Immunologie et des Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sechenov First Moscow State Medical University, Campbell University [Buies Creek, NC, USA] (CU), University of Karachi, Heidelberg University, Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), Loyola University [Chicago], Cyprus Institute (CyI), University of Belgrade [Belgrade], Nuova Villa Claudia [Rome, Italy] (NVC), Universidad Católica San Antonio de Murcia (UCAM), Rambam Health Care Campus [Haifa, Israel], Technion - Israel Institute of Technology [Haifa], Ministry of Health of the Russian Federation (MHRF), St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Trinity College Dublin, National and Kapodistrian University of Athens (NKUA), McMaster University [Hamilton, Ontario], Firestone Institute for Respiratory Health [Hamilton, ON, Canada] (FIRH), Ministry of Health [Saudi Arabia], Szent Imre Hospital [Budapest, Hungary] (SIH), Mashhad University of Medical Sciences, University of Edinburgh, Capital University of Medical Sciences [Beijing] (CUMS), Hôpitaux Universitaires de l'Est Parisien [Paris] (HUEP), Monash Medical Centre [Clayton, Australia], Central University of Tamil Nadu [Thiruvarur, India] (CUTN), Central University of Tamil Nadu (CUTN), Okmeydani Training and Research Hospital [Istanbul, Turkey] (OTRH), Centre International de Cancérologie de Dakar [Dakar, Senegal] (CICD), Aristotle University of Thessaloniki, University Hospital Southampton NHS Foundation Trust, Université Virtuelle du Sénégal [Dakar, Senegal] (UVS), Innovations thérapeutiques en hémostase (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), University Clinic of Hematology [Skopje, Republic of North Macedonia] (UCH), University of Medicine and Pharmacy [Cluj-Napoca, Romania] (UMP), Service d'Anesthésie réanimation [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Flor Ferenc Teaching Hospital [Kistarcsa, Hungary] (2FTH), San Camillo Forlanini Hospital [Rome], Loyola University Medical Center (LUMC), Science Valley Research Institute [São Paulo, Brazil] (SVRI), King Hussein Cancer Center [Amman, Jordan] (KH2C), CHU Fattouma Bourguiba [Monastir] (HFB), Medizinische Universität Wien = Medical University of Vienna, Nobelpharma Co. Ltd. [Tokyo, Japan], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), North Shore University Cardiologists [Skokie, Illinois, USA] (NSUC), American University of Beirut Faculty of Medicine and Medical Center (AUB), Klinikum Ernst von Bergmann [Potsdam, Germany] (KEVB), Peking University [Beijing], Chinese Academy of Medical Sciences [Beijing, China] (CAMS), Peking Union Medical College [Beijing, China], Université Mohammed V de Rabat [Agdal] (UM5), Scientific Reviewer Committee: Gregory Y H Lip, Michael Makris, Sam Schulman, Wolfgang Siess, Christian Weber, Sabbah, Michèle, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Milan, Centre d'Immunologie et de Maladies Infectieuses (CIMI), Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and University of Mohammed V

Subjects
medicine.medical_specialty, Telemedicine, Economic growth, COVID-19 Vaccines, Population, Psychological intervention, Disease, 030204 cardiovascular system & hematology, Risk Assessment, Herd immunity, 03 medical and health sciences, COVID-19 Testing, 0302 clinical medicine, Consensus Paper, Pandemic, medicine, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, 030212 general & internal medicine, Disease management (health), education, Pandemics, thrombosis, education.field_of_study, SARS-CoV-2, Immunization Programs, pandemic, Public health, COVID-19, Disease Management, health care systems, Hematology, 3. Good health, Public Health, Business
Abstract

Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a second and even third generation of vaccines has already been acknowledged by the WHO and governments. Perspectives There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organizations (i.e., telemedicine, e-Health, artificial intelligence, and machine-learning technology) is of major importance for the preservation of citizens' health and life world-wide.

Published
2021

2. Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19

Author

P Vandreden, M.A. Dimopoulos, Ismail Elalamy, Evangelos Terpos, Theodora Psaltopoulou, Theodoros N. Sergentanis, Alexandre Elabbadi, Guillaume Voiriot, M Farto, Ludovic Lassel, Antoine Parrot, Matthieu Turpin, Grigorios T. Gerotziafas, G Pialloux, Loula Papageorgiou, Jacques Cadranel, Chryssa Papageorgiou, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Hématologie biologique [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), National and Kapodistrian University of Athens (NKUA), Service d'Anesthésie réanimation [CHU Tenon], Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Service des maladies infectieuses et tropicales [CHU Tenon], Diagnostica Stago, Service de Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Maladies infectieuses et tropicales [CHU Tenon], Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], and Gestionnaire, Hal Sorbonne Université

Subjects
Male, [SDV]Life Sciences [q-bio], Disease, 030204 cardiovascular system & hematology, law.invention, Cohort Studies, 0302 clinical medicine, law, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, 80 and over, Greece, medicine.diagnostic_test, Acute kidney injury, Hematology, Middle Aged, Intensive care unit, 3. Good health, Hospitalization, [SDV] Life Sciences [q-bio], antithrombin, Predictive value of tests, Disease Progression, Female, France, Risk assessment, Coagulation and Fibrinolysis, Cohort study, Adult, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), D-dimers, Risk Assessment, Young Adult, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Diabetes mellitus, medicine, Humans, In patient, Derivation, disseminated intravascular coagulation, Aged, Prothrombin time, SARS-CoV-2, business.industry, COVID-19, medicine.disease, business
Abstract

The prospective observational cohort study COMPASS-COVID-19 aimed to develop a risk assessment model for early identification of hospitalized COVID-19 patients at risk for worsening disease. Patients with confirmed COVID-19 (n = 430) hospitalized between March 18 and April 21, 2020 were divided in derivation (n = 310) and validation (n = 120) cohorts. Two groups became evident: (1) good prognosis group (G-group) with patients hospitalized at the conventional COVID-19 ward and (2) Worsening disease group (W-group) with patients admitted to the intensive care unit (ICU) from the emergency departments. The study end point was disease worsening (acute respiratory failure, shock, myocardial dysfunction, bacterial or viral coinfections, and acute kidney injury) requiring ICU admission. All patients were routinely evaluated for full blood count, prothrombin time, fibrinogen, D-dimers, antithrombin (AT), and protein C activity. Data from the first hospitalization day at the conventional ward or the ICU were analyzed. Cardiovascular risk factors and comorbidities were routinely registered. Obesity, hypertension, diabetes and male gender, increased fibrinogen and D-dimers, thrombocytopenia, AT deficiency, lymphopenia, and an International Society on Thrombosis and Haemostasis (ISTH) score for compensated disseminated intravascular coagulation score (cDIC-ISTH) ≥5 were significant risk factors for worsening disease. The COMPASS-COVID-19 score was derived from multivariate analyses and includes obesity, gender, hemoglobin, lymphocyte, and the cDIC-ISTH score (including platelet count, prothrombin time, D-dimers, AT, and protein C levels). The score has a very good discriminating capacity to stratify patients at high and low risk for worsening disease, with an area under the receiver operating characteristic curve value of 0.77, a sensitivity of 81%, and a specificity of 60%. Application of the COMPASS-COVID-19 score at the validation cohort showed 96% sensitivity. The COMPASS-COVID-19 score is an accurate clinical decision-making tool for an easy identification of COVID-19 patients being at high risk for disease worsening.

Published
2020

3. Endothelial dysfunction in conduit arteries and in microcirculation. Novel therapeutic approaches

Author

Tousoulis, Dimitris Simopoulou, Chryssa Papageorgiou, Nikos and Oikonomou, Evangelos Hatzis, George Siasos, Gerasimos and Tsiamis, Eleftherios Stefanadis, Christodoulos

Abstract

The vascular endothelium not only is a single monolayer of cells between the vessel lumen and the intimal wall, but also plays an important role by controlling vascular function and structure mainly via the production of nitric oxide (NO). The so called “cardiovascular risk factors” are associated with endothelial dysfunction, that reduces NO bioavailability, increases oxidative stress, and promotes inflammation contributing therefore to the development of atherosclerosis. The significant role of endothelial dysfunction in the development of atherosclerosis emphasizes the need for efficient therapeutic interventions. During the last years statins, angiotensin-converting enzyme inhibitors, angiotensin-receptor antagonists, antioxidants, beta-blockers and insulin sensitizers have been evaluated for their ability to restore endothelial function (Briasoulis et al., 2012). As there is not a straightforward relationship between therapeutic interventions and improvement of endothelial function but rather a complicated interrelationship between multiple cellular and sub-cellular targets, research has been focused on the understanding of the underlying mechanisms. Moreover, the development of novel diagnostic invasive and non-invasive methods has allowed the early detection of endothelial dysfunction expanding the role of therapeutic interventions and our knowledge. In the current review we present the available data concerning the contribution of endothelial dysfunction to atherogenesis and review the methods that assess endothelial function with a view to understand the multiple targets of therapeutic interventions. Finally we focus on the classic and novel therapeutic approaches aiming to improve endothelial dysfunction and the underlying mechanisms. (C) 2014 Elsevier Inc. All rights reserved.

Published
2014

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