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Article ; Online: New technological devices for the assessment of systemic inflammation in the primary prevention of cardiovascular disease.

Lazzarino, Antonio Ivan

2017 Volume 32, Issue 4, Page(s) 448–453

Abstract: Purpose of review: The prediction of cardiovascular disease (CVD) events is of strategic importance for the primary prevention of one of the big killers in the world. Predictive models have a history of decades, but still the desired accuracy is not ... ...

Abstract	Purpose of review: The prediction of cardiovascular disease (CVD) events is of strategic importance for the primary prevention of one of the big killers in the world. Predictive models have a history of decades, but still the desired accuracy is not reached by any of the existing models. The inclusion of inflammatory factors in the models did not increase their accuracy. In this review, we discuss the possible reasons for that failure and we propose a paradigm shift. Recent findings: Systemic inflammation is a very volatile phenomenon. The blood concentration of inflammatory biomarkers may change considerably in one individual with a timescale of seconds. Sudden changes in environmental conditions can trigger rapid modifications in the inflammatory profile of an individual. In routine clinical practice, the blood tests for inflammation are carried out at one point in time, not in standard environmental conditions, and are therefore inadequate. Summary: We have to direct CVD research toward the understanding of the synchronic relationship between external environmental conditions and internal physiological reactions. CVD risk assessment must be carried out by using continuous real-time monitoring of external and internal parameters together, something that may become possible with the advent of new technological devices.
Language	English
Publishing date	2017-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	645186-x
ISSN	1531-7080 ; 0268-4705
ISSN (online)	1531-7080
ISSN	0268-4705
DOI	10.1097/HCO.0000000000000409
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Article: COVID-19 Vaccination Prioritization Strategies in Malaysia: A Retrospective Analysis of Early Evidence.

Hamdan, Nor Elyzatul Akma / Fahrni, Mathumalar Loganathan / Lazzarino, Antonio Ivan

Vaccines

2022 Volume 11, Issue 1

Abstract: The coronavirus disease 2019 (COVID-19) that can cause extreme acute respiratory syndrome has posed a catastrophic threat to public health. The vaccines had indeed restored optimism and, after more than two years of battling the pandemic, there is ... ...

Abstract	The coronavirus disease 2019 (COVID-19) that can cause extreme acute respiratory syndrome has posed a catastrophic threat to public health. The vaccines had indeed restored optimism and, after more than two years of battling the pandemic, there is renewed hope for the transition to endemicity. At the start of vaccination efforts, when supply shortages of vaccines were inevitable, every nation determined the high-risk population groups to be given priority for the COVID-19 vaccines. In this paper, the characteristics of the initial COVID-19 vaccine recipients in Malaysia are described. In line with the policies of many other countries, Malaysia firstly inoculated frontline healthcare workers, and subsequently the list of front liners grew to include defense and security personnel and those involved in the provision of essential services. People with disabilities or those with special needs and several underlying medical conditions that increased their risk of developing severe COVID-related illnesses were included in the priority categories. These included patients with severe lung disease, chronic heart disease, chronic kidney disease, chronic liver disease, neurological disease, diabetes mellitus and obesity in adults, splenic dysfunction, and severe mental illness. With little information and under circumstances of great uncertainty, the Health Ministry of a middle-income country had developed a vaccination priority-list based on the disease's epidemiology and clinical data, vaccine type, operational considerations, and risk evaluation. Early evidence was presented and suggested that the full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in the country had been highly effective in preventing COVID-19 infections, COVID-19-related ICU admissions, and death. As many SARS-CoV-2 variants of concern (VoC), such as the Omicron BA.2/4/5, are emerging, future vaccination strategies may necessitate the need to change the immunogen of the vaccine, as well as considerations for when to give high-risk groups booster injections. These considerations are valuable for future planning by policymakers and healthcare providers to make vaccination policy and decisions, especially for the inclusion of the COVID-19 vaccines into national immunization programs.
Language	English
Publishing date	2022-12-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines11010048
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Article ; Online: The paradoxical effect of IL-6 and implications for the use of Tocilizumab in Covid-19 patients.

Bruzzese, Vincenzo / Lazzarino, Antonio Ivan

Medical hypotheses

2020 Volume 144, Page(s) 110284

Abstract: In the context of the current SARS-CoV-2 pandemic, patients affected by chronic obstructive pulmonary disease (COPD) should be more vulnerable to Covid-19, whereas they seem to be protected against severe Covid-19. That paradox has important practical ... ...

Abstract	In the context of the current SARS-CoV-2 pandemic, patients affected by chronic obstructive pulmonary disease (COPD) should be more vulnerable to Covid-19, whereas they seem to be protected against severe Covid-19. That paradox has important practical implications for the use of the drug Tocilizumab in Covid-19. Interleukin-6 (IL-6) orchestrates the so-called cytokine storm leading to the Acute Respiratory Distress Syndrome (ARDS), the life-threatening condition that is responsible for Covid-19 deaths. However, IL-6 has a paradoxical effect in many viral infections. For pathogens such as HIV and Hepatitis B for example, high elevations show a toxic effect and are associated with higher mortality (e.g. they promote progression to AIDS in HIV patients), whereas mild elevations show a protective effect. IL-6 can be therefore considered as being both a pro-inflammatory and an anti-inflammatory cytokine. Several studies have shown that severe COPD is associated with extremely-high levels of IL-6, whereas mild COPD is associated with mild elevations of IL-6. It is plausible that the chronic, mildly-elevated concentrations of IL-6 found in mild COPD patients is protective against the deterioration of Covid-19, as it is the case for other viral diseases. That may explain why COPD is surprisingly an uncommon comorbidity in Covid-19 intensive care units. This may have an important practical implication for the treatment of Covid-19 patients: our hypothesis is that Tocilizumab must be used exclusively in patients with an ongoing cytokine storm. Otherwise, an early use of Tocilizumab can be harmful, especially in patients affected by COPD or other conditions with mildly-elevated IL-6.
MeSH term(s)	Anti-Inflammatory Agents/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; COVID-19/complications ; COVID-19/drug therapy ; COVID-19/immunology ; Cytokines/metabolism ; HIV Infections/complications ; Hepatitis B/complications ; Humans ; Inflammation ; Interleukin-6/metabolism ; Models, Theoretical ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Pulmonary Disease, Chronic Obstructive/immunology ; Respiratory Distress Syndrome/immunology ; Respiratory Distress Syndrome/virology ; Treatment Outcome
Chemical Substances	Anti-Inflammatory Agents ; Antibodies, Monoclonal, Humanized ; Cytokines ; Interleukin-6 ; tocilizumab (I031V2H011)
Language	English
Publishing date	2020-09-18
Publishing country	United States
Document type	Editorial
ZDB-ID	193145-3
ISSN	1532-2777 ; 0306-9877
ISSN (online)	1532-2777
ISSN	0306-9877
DOI	10.1016/j.mehy.2020.110284
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Article: The Race for Global Equitable Access to COVID-19 Vaccines.

Md Khairi, Lukman Nul Hakim / Fahrni, Mathumalar Loganathan / Lazzarino, Antonio Ivan

Vaccines

2022 Volume 10, Issue 8

Abstract: COVID-19 vaccines are possibly the most effective medical countermeasures to mitigate and ultimately bring to a halt the COVID-19 pandemic. As we transition to endemicity, inequitable access to vaccines, and particularly in low- and middle-income ... ...

Abstract	COVID-19 vaccines are possibly the most effective medical countermeasures to mitigate and ultimately bring to a halt the COVID-19 pandemic. As we transition to endemicity, inequitable access to vaccines, and particularly in low- and middle-income countries (LMICs), still poses risks of unprecedented disruptions and the emergence of viral mutations, which potentially lead to notorious vaccine-resistant variants. The missteps learned from the previous responses to the human immunodeficiency virus (HIV) and influenza outbreaks founded the hypothetical plan to ensure that vaccine accessibility to LMICs is not impeded. The SARS-CoV-2 vaccines' social promise was to lessen the underlying racial, ethnic, and geographic inequities that COVID-19 has both made apparent and intensified. Vaccine nationalism was evident throughout the COVID-19 crisis. Many high-income countries directly negotiated large advance orders for the vaccines, leaving resource-limited countries scrambling for access. This occurred despite international initiatives to structure the development and equitable distribution of vaccines, channeled through a vaccine pillar: COVID-19 Vaccines Global Access (COVAX). The serious supply shortages and national procurement methods of some countries that bypassed the vaccine pillar hindered the optimal function of COVAX in delivering timely and adequate doses to participating countries. COVAX strategized its approach by promoting fundraising, coordinating vaccine donations from countries with surplus doses, expediting reviews of vaccine candidates, and facilitating the expansion of the manufacturing capacity. While increasing capacity for production, technology transfer led to lesser siloes, enhanced manufacturing standardization, and less secrecy over production data. Ultracold storage requirements for leading vaccines were a considerable hurdle to the global immunization efforts, and particularly in LMICs with limited equipment and resources to support sophisticated cold-chain systems. Manufacturers strived to ease cold-chain restrictions on the basis of stability data submitted to national regulatory bodies. The development of single-dose vaccines offered promising solutions to simplify the administrative and logistic complexities that existed within the COVID-19 vaccination programs. As such, the requirements for both ultracold storage conditions were eased, and concerns over booster doses were addressed. To expand coverage, the dosing intervals of the Oxford/AstraZeneca vaccines were extended according to data from Phase III clinical trials on effectiveness. In addition, with the recent outbreak of monkeypox, the lessons from past experiences of curbing infectious diseases, including COVID-19, must be learned and acted upon. The review summarizes the global efforts with respect to vaccine development, production, allocation, and deployment to achieve equitable access.
Language	English
Publishing date	2022-08-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines10081306
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Article ; Online: Hydrogen peroxide and viral infections: A literature review with research hypothesis definition in relation to the current covid-19 pandemic.

Caruso, Arturo Armone / Del Prete, Antonio / Lazzarino, Antonio Ivan

Medical hypotheses

2020 Volume 144, Page(s) 109910

Abstract: We reviewed the literature concerning the innate response from nasal and oral epithelial cells and their reaction to hydrogen peroxide ( ... ...

Abstract	We reviewed the literature concerning the innate response from nasal and oral epithelial cells and their reaction to hydrogen peroxide (H
MeSH term(s)	COVID-19/drug therapy ; COVID-19/immunology ; COVID-19/virology ; Epithelial Cells/drug effects ; Epithelial Cells/immunology ; Epithelial Cells/virology ; Humans ; Hydrogen Peroxide/administration & dosage ; Immunity, Innate/drug effects ; In Vitro Techniques ; Models, Immunological ; Mouthwashes/administration & dosage ; Nasal Sprays ; Pandemics ; SARS-CoV-2/drug effects ; Virus Diseases/drug therapy ; Virus Diseases/immunology ; Virus Diseases/virology
Chemical Substances	Mouthwashes ; Nasal Sprays ; Hydrogen Peroxide (BBX060AN9V)
Keywords	covid19
Language	English
Publishing date	2020-06-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193145-3
ISSN	1532-2777 ; 0306-9877
ISSN (online)	1532-2777
ISSN	0306-9877
DOI	10.1016/j.mehy.2020.109910
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Article ; Online: The paradoxical effect of IL-6 and implications for the use of Tocilizumab in Covid-19 patients

Bruzzese, Vincenzo / Lazzarino, Antonio Ivan

Medical Hypotheses

2020 Volume 144, Page(s) 110284

Keywords	General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	193145-3
ISSN	1532-2777 ; 0306-9877
ISSN (online)	1532-2777
ISSN	0306-9877
DOI	10.1016/j.mehy.2020.110284
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Article: The paradoxical effect of IL-6 and implications for the use of Tocilizumab in Covid-19 patients

Bruzzese, Vincenzo / Ivan Lazzarino, Antonio

Medical Hypotheses

Abstract	In the context of the current SARS-CoV-2 pandemic, patients affected by chronic obstructive pulmonary disease (COPD) should be more vulnerable to Covid-19, whereas they seem to be protected against severe Covid-19 That paradox has important practical implications for the use of the drug Tocilizumab in Covid-19 Interleukin-6 (IL-6) orchestrates the so-called cytokine storm leading to the Acute Respiratory Distress Syndrome (ARDS), the life-threatening condition that is responsible for Covid-19 deaths However, IL-6 has a paradoxical effect in many viral infections For pathogens such as HIV and Hepatitis B for example, mild elevations of IL-6 show a protective effect whereas high elevations show a toxic effect and are associated with higher mortality (e g they promote progression to AIDS in HIV patients) IL-6 can be therefore considered as being both a pro-inflammatory and an anti-inflammatory cytokine Several studies have shown that severe COPD is associated with extremely-high levels of IL-6, whereas mild COPD is associated with mild elevations of IL-6 It is plausible that the chronic, mildly-elevated concentrations of IL-6 found in mild COPD patients is protective against the deterioration of Covid-19, as it is the case for other viral diseases That may explain why COPD is surprisingly an uncommon comorbidity in Covid-19 intensive care units This may have an important practical implication for the treatment of Covid-19 patients: our hypothesis is that Tocilizumab must be used exclusively in patients with an ongoing cytokine storm Otherwise, an early use of Tocilizumab can be harmful, especially in patients affected by COPD or other conditions with mildly-elevated IL-6
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #779456
Database	COVID19

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Article ; Online: Covid-19: Important potential side effects of wearing face masks that we should bear in mind.

Lazzarino, Antonio Ivan / Steptoe, Andrew / Hamer, Mark / Michie, Susan

BMJ (Clinical research ed.)

2020 Volume 369, Page(s) m2003

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Masks ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-05-21
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.m2003
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Article ; Online: Inequalities in mental health service utilisation by children and young people: a population survey using linked electronic health records from Northwest London, UK.

Lazzarino, Antonio Ivan / Salkind, Jessica Ann / Amati, Federica / Robinson, Tamsin / Gnani, Shamini / Nicholls, Dasha / Hargreaves, Dougal

Journal of epidemiology and community health

2023

Abstract: Background: Mental healthcare services for children and young people (CYP) are a very limited resource in the UK. To prevent health inequalities, measures to increase overall capacity must sit alongside measures that ensure utilisation matches need.: ... ...

Abstract	Background: Mental healthcare services for children and young people (CYP) are a very limited resource in the UK. To prevent health inequalities, measures to increase overall capacity must sit alongside measures that ensure utilisation matches need. Aim: Our aim was to identify subgroups of CYP with unexpectedly low mental health service utilisation, presumably representing unmet need, and to assess whether there is area variation in the socioeconomic gradient of mental healthcare use. Methods: This is a cross-sectional population survey of CYP (aged 5-24 years) using electronic health records from the Discover Now research platform, covering approximately 95% of the Northwest London resident population of 2.4 million people. Results: The total sample comprised 764 327 CYP, of whom 2.1% attended a mental healthcare appointment in 2021 (95% CI 2.1% to 2.2%), our outcome measure. Lower socioeconomic status (our main exposure factor) was related to higher occurrence of mental healthcare appointments (+5% for each quintile increase in deprivation (95% CI 2% to 7%, p<0.001]). However, interaction analyses showed that the boroughs with unexpectedly low utilisation rates were also those not showing a clear trend between socioeconomic conditions and services utilisation (interaction p<0.001), suggesting that in these boroughs the occurrence of mental disorders in disadvantaged people was not captured by our analysis based on service utilisation. In some London boroughs, we found lower-than-expected activity for the most disadvantaged CYP. Conclusions: The mental healthcare needs of many CYP from socioeconomically deprived areas of Northwest London may be unmet. More information is needed to confirm our results.
Language	English
Publishing date	2023-12-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	391868-3
ISSN	1470-2738 ; 0142-467X ; 0141-7681 ; 0143-005X
ISSN (online)	1470-2738
ISSN	0142-467X ; 0141-7681 ; 0143-005X
DOI	10.1136/jech-2023-221223
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Article ; Online: Hydrogen peroxide and viral infections

Caruso, Arturo Armone / Del Prete, Antonio / Lazzarino, Antonio Ivan

Medical Hypotheses

A literature review with research hypothesis definition in relation to the current covid-19 pandemic

2020 Volume 144, Page(s) 109910

Keywords	General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	193145-3
ISSN	1532-2777 ; 0306-9877
ISSN (online)	1532-2777
ISSN	0306-9877
DOI	10.1016/j.mehy.2020.109910
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