Search

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can manifest itself in several ways, including coagulopathy and thrombosis. These complications can be the first and sometimes only manifestations of SARS-CoV-2 infection and can occur early or late in the course of the disease. However, these symptoms are more prevalent in hospitalized patients with venous thromboembolism, particularly those admitted to intensive care units. Moreover, various forms of arterial and venous thrombosis, or micro- or macro-vasculature embolisms, have been reported during the current pandemic. They have led to harmful consequences, such as neurological and cardiac events, nearly all resulting from the hypercoagulable state caused by this viral infection. The severe hypercoagulability observed in patients with COVID-19 accounts for most cases of the disease that become critical. Therefore, anticoagulants seem to be one of the most vital therapeutics for treating this potentially life-threatening condition. In the current paper, we present a thorough review of the pathophysiology of COVID-19-induced hypercoagulable state and the use of anticoagulants to treat SARS-CoV-2 infections in different patient groups, as well as their pros and cons., (© 2023 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

The coronavirus disease 2019 (COVID-19) has various presentations, of which immune dysregulation or the so-called cytokine storm syndrome (COVID-CSS) is prominent. Even though cytokines are vital regulators of body immunoinflammatory responses, their exaggerated release can be harmful. This hyperinflammatory response is more commonly observed during severe COVID-19 infections, caused by the excessive release of pro-inflammatory cytokines, such as interleukin-1 (IL-1), IL-6, IL-8, tumour necrosis factor, granulocyte-macrophage colony-stimulating factor, and interferon-gamma, making their blockers and antagonists of great interest as therapeutic options in this condition. Thus, the pathophysiology of excessive cytokine secretion is outlined, and their most important blockers and antagonists are discussed, mainly focussing on tocilizumab, an interleukin-6 receptor blocker approved to treat severe COVID-19 infections., (© 2022 John Wiley & Sons Ltd.)

Since the start of the pandemic, thrombotic events have been a well-known and severe complication associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nevertheless, the initiation of vaccination programs brought another rare yet highly fatal thrombotic event, vaccine-induced immune thrombotic thrombocytopaenia, which has caused extensive debate regarding the safety of vaccines. This review defines the thromboembolic events following infection and vaccination, identifies their risk factors, describes their pathophysiology, and discusses their management, treatment, and prevention., (© 2022 John Wiley & Sons Ltd.)

A novel coronavirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the causative agent of coronavirus disease 2019 (COVID-19). In early 2020, the World Health Organization declared COVID-19 the sixth public health emergency of international concern. The COVID-19 pandemic has substantially affected many groups within the general population, but particularly those with extant clinical conditions, such as having or being treated for cancer. Cancer patients are at a higher risk of developing severe COVID-19 since the malignancy and chemotherapy may negatively affect the immune system, and their immunocompromised condition also increases the risk of infection. Substantial international efforts are currently underway to develop specific methods for diagnosing and treating COVID-19. However, cancer patients' risk profiles, management, and outcomes are not well understood. Thus, the main objective of this review is to discuss the relevant evidence to understand the prognosis of COVID-19 infections in cancer patients more clearly, as well as helping to improve the clinical management of these patients., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Coronavirus disease 2019 (COVID‐19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), can manifest itself in several ways, including coagulopathy and thrombosis. These complications can be the first and sometimes only manifestations of SARS‐CoV‐2 infection and can occur early or late in the course of the disease. However, these symptoms are more prevalent in hospitalized patients with venous thromboembolism, particularly those admitted to intensive care units. Moreover, various forms of arterial and venous thrombosis, or micro‐ or macro‐vasculature embolisms, have been reported during the current pandemic. They have led to harmful consequences, such as neurological and cardiac events, nearly all resulting from the hypercoagulable state caused by this viral infection. The severe hypercoagulability observed in patients with COVID‐19 accounts for most cases of the disease that become critical. Therefore, anticoagulants seem to be one of the most vital therapeutics for treating this potentially life‐threatening condition. In the current paper, we present a thorough review of the pathophysiology of COVID‐19‐induced hypercoagulable state and the use of anticoagulants to treat SARS‐CoV‐2 infections in different patient groups, as well as their pros and cons. [ABSTRACT FROM AUTHOR]

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there have been multiple peaks of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus virus 2) infection, mainly due to the emergence of new variants, each with a new set of mutations in the viral genome, which have led to changes in the pathogenicity, transmissibility, and morbidity. The Omicron variant is the most recent variant of concern (VOC) to emerge and was recognized by the World Health Organization (WHO) on 26 November 2021. The Omicron lineage is phylogenetically distinct from earlier variants, including the previously dominant Delta SARS-CoV-2 variant. The reverse transcription–polymerase chain reaction (RT–PCR) test, rapid antigen assays, and chest computed tomography (CT) scans can help diagnose the Omicron variant. Furthermore, many agents are expected to have therapeutic benefits for those infected with the Omicron variant, including TriSb92, molnupiravir, nirmatrelvir, and their combination, corticosteroids, and interleukin-6 (IL-6) receptor blockers. Despite being milder than previous variants, the Omicron variant threatens many lives, particularly among the unvaccinated, due to its higher transmissibility, pathogenicity, and infectivity. Mounting evidence has reported the most common clinical manifestations of the Omicron variant to be fever, runny nose, sore throat, severe headache, and fatigue. This review summarizes the essential features of the Omicron variant, including its history, genome, transmissibility, clinical manifestations, diagnosis, management, and the effectiveness of existing vaccines against this VOC. [ABSTRACT FROM AUTHOR]

A novel coronavirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the causative agent of coronavirus disease 2019 (COVID-19). In early 2020, the World Health Organization declared COVID-19 the sixth public health emergency of international concern. The COVID-19 pandemic has substantially affected many groups within the general population, but particularly those with extant clinical conditions, such as having or being treated for cancer. Cancer patients are at a higher risk of developing severe COVID-19 since the malignancy and chemotherapy may negatively affect the immune system, and their immunocompromised condition also increases the risk of infection. Substantial international efforts are currently underway to develop specific methods for diagnosing and treating COVID-19. However, cancer patients' risk profiles, management, and outcomes are not well understood. Thus, the main objective of this review is to discuss the relevant evidence to understand the prognosis of COVID-19 infections in cancer patients more clearly, as well as helping to improve the clinical management of these patients. [ABSTRACT FROM AUTHOR]

Background: In March 2020, the World Health Organization (WHO) declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, upper gastrointestinal cancer patients, similar to other immunosuppressed patients, are vulnerable to developing more severe infections. Most of the routine activities of medical centers, especially cancer surgery centers worldwide, are affected by the epidemic. Thus, some modifications are needed to adjust international protocols to deal with upper gastrointestinal cancers worldwide. Methods: The headings of upper gastrointestinal cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in upper gastrointestinal cancer management at the first peak of COVID-19 in Iran in March 2020. The discussions were done through an interactive application (WhatsApp and Telegram) in which participants considered the headlines and the latest news about COVID-19. Under each heading, we provide the consensus of all members in the related disciplines. Recommendations and Conclusion: All members agreed to choose the most effective and the least hazardous recommendations regarding patients and medical staff in each specialty. The members understand that some recommendations may intervene with the standard best practice and reduce the best outcome that the patient can gain with standard management. Therefore, these recommendations are legitimate simply at the peak of the epidemic COVID-19 situation or the surge of any other unknown situations that we may encounter in the future. According to the consensus of cancer surgery professors in several cancer surgery centers, patients with T1 and T2 gastric cancer without lymph node involvement should undergo upfront surgery. Patients with T3 or more and/or lymph node involvement will have total neoadjuvant chemotherapy, and the surgery should be delayed until the end of the COVID-19 peak. Diagnostic laparoscopy should be postponed during the peak of COVID-19 till after the completion of neoadjuvant chemotherapy. Upfront surgery should be performed in patients with esophageal cancer (adenocarcinoma or SCC) with T1 or T2 and without lymph node involvement. In patients with T3 or more and/or lymph node involvement, neoadjuvant chemoradiotherapy (CRT) is recommended. Endoscopic stent placement is preferred for patients who complete neoadjuvant CRT during the peak of COVID 19 and have severe dysphagia. A PET-CT scan will be performed in patients without dysphagia. In the status of high uptake, surgery is reasonable, but in low uptake status without any dysphagia, only conservation is our suggestion. [ABSTRACT FROM AUTHOR]

Lower gastrointestinal cancer patients, like other immunosuppressed patients, are vulnerable to develop more severe infections. Iran is one of the countries with a high incidence of COVID-19, and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose the minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in the epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with the COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted in a patient with rectal cancer who presents with obstructive symptoms, and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient would undergo open surgery considering the patient's health and protection tips. [ABSTRACT FROM AUTHOR]