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  1. Article ; Online: Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19.

    Cook, Joshua R / Ausiello, John

    Reviews in endocrine & metabolic disorders

    2021  Volume 23, Issue 2, Page(s) 151–170

    Abstract: SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been ... ...

    Abstract SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been implicated in a broad array of human pathology. The RAS is composed of two competing pathways that work in opposition to each other: the "conventional" arm involving angiotensin converting enzyme (ACE) generating angiotensin-2 and the more recently identified ACE2 pathway that generates angiotensin (1-7). Following the original SARS pandemic, additional studies suggested that coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme. Given the similarities between the two viruses, many have posited a similar process with SARS-CoV-2. Proponents of this ACE2 deficiency model argue that downregulation of ACE2 limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS. In this review we critically examine this model. The available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.
    MeSH term(s) Angiotensin-Converting Enzyme 2/deficiency ; Angiotensins ; COVID-19/physiopathology ; Humans ; Pandemics ; Renin-Angiotensin System ; SARS-CoV-2
    Chemical Substances Angiotensins ; ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
    Language English
    Publishing date 2021-07-01
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 2185718-0
    ISSN 1573-2606 ; 1389-9155
    ISSN (online) 1573-2606
    ISSN 1389-9155
    DOI 10.1007/s11154-021-09663-z
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  2. Article ; Online: Heart rate variability and adrenal size provide clues to sudden cardiac death in hospitalized COVID-19 patients.

    Ranard, Benjamin L / Megjhani, Murad / Terilli, Kalijah / Yarmohammadi, Hirad / Ausiello, John / Park, Soojin

    Journal of critical care

    2022  Volume 71, Page(s) 154114

    Abstract: Purpose: To examine the association between a measure of heart rate variability and sudden cardiac death (SCD) in COVID-19 patients.: Methods: Patients with SARS-COV-2 infection admitted to Columbia University Irving Medical Center who died between 4/ ...

    Abstract Purpose: To examine the association between a measure of heart rate variability and sudden cardiac death (SCD) in COVID-19 patients.
    Methods: Patients with SARS-COV-2 infection admitted to Columbia University Irving Medical Center who died between 4/25/2020 and 7/14/2020 and had an autopsy were examined for root mean square of successive differences (RMSSD), organ weights, and evidence of SCD.
    Results: Thirty COVID-19 patients were included and 12 had SCD. The RMSSD over 7 days without vs with SCD was median 0.0129 (IQR 0.0074-0.026) versus 0.0098 (IQR 0.0056-0.0197), p < 0.0001. The total adjusted adrenal weight of the non-SCD group was 0.40 g/kg (IQR 0.35-0.55) versus 0.25 g/kg (IQR 0.21-0.31) in the SCD group, p = 0.0007.
    Conclusions: Hospitalized patients with COVID-19 who experienced SCD had lower parasympathetic activity (RMSSD) and smaller sized adrenal glands. Further research is required to replicate these findings.
    MeSH term(s) Autopsy ; COVID-19 ; Death, Sudden, Cardiac/epidemiology ; Heart Rate ; Humans ; Risk Factors ; SARS-CoV-2
    Language English
    Publishing date 2022-07-18
    Publishing country United States
    Document type Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2022.154114
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  3. Article: Ectopic ACTH Syndrome Emerging 5 Years after the Diagnosis of Neuroendocrine Tumor.

    Liu, Minghao / Hamele-Bena, Diane / Ausiello, John / Page-Wilson, Gabrielle

    Case reports in endocrinology

    2019  Volume 2019, Page(s) 6583467

    Abstract: Ectopic ACTH syndrome (EAS) arising years after the diagnosis of a neuroendocrine tumor (NET) is exceedingly rare. We describe a case of EAS occurring five years after the diagnosis of a metastatic lung NET in a 61-year-old woman. She presented with ... ...

    Abstract Ectopic ACTH syndrome (EAS) arising years after the diagnosis of a neuroendocrine tumor (NET) is exceedingly rare. We describe a case of EAS occurring five years after the diagnosis of a metastatic lung NET in a 61-year-old woman. She presented with severe hypokalemia but was not overtly Cushingoid on exam. Serum cortisol was 61mcg/dL after an overnight 1mg dexamethasone suppression test (<1.8mcg/dL) and urinary free cortisol was 7544 mcg/24h (<45mcg/24h), establishing the diagnosis of Cushing's syndrome. Plasma levels of peptides which have been associated with EAS, Agouti-related peptide (AgRP) and the ACTH precursors POMC (31-kDa) and pro-ACTH (22-kDa), were elevated. Metyrapone was initiated, but hypercortisolism persisted and the patient succumbed to pneumonia shortly after presentation. Retrospective examination of biopsy tissues showed rare ACTH immunoreactivity at the time of initial diagnosis, followed by staining in a greater proportion of cells as the disease progressed, consistent with EAS arising years after the diagnosis of NET. Given the increase in mortality associated with EAS, this unusual case highlights the importance of early detection and raises the possibility that early immunohistochemical stains for ACTH and measurements of ACTH precursors may facilitate the identification of NETs at high risk for EAS.
    Language English
    Publishing date 2019-05-28
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2627633-1
    ISSN 2090-651X ; 2090-6501
    ISSN (online) 2090-651X
    ISSN 2090-6501
    DOI 10.1155/2019/6583467
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  4. Article: Postoperative assessment of the patient after transsphenoidal pituitary surgery.

    Ausiello, John C / Bruce, Jeffrey N / Freda, Pamela U

    Pituitary

    2008  Volume 11, Issue 4, Page(s) 391–401

    Abstract: While most transsphenoidal pituitary surgery is accomplished without complication, monitoring is required postoperatively for a set of disorders that are specific to this surgery. Postoperative assessments are tailored to the early and later ... ...

    Abstract While most transsphenoidal pituitary surgery is accomplished without complication, monitoring is required postoperatively for a set of disorders that are specific to this surgery. Postoperative assessments are tailored to the early and later postoperative periods. In the early period, which spans the first few weeks after surgery, both monitoring of anterior and posterior pituitary function and managing neurosurgical issues are the focus of care. Potential disruption of pituitary-adrenal function is covered with perioperative glucocorticoids. Various strategies exist for ensuring the integrity of this axis, but typically this is done by measuring a morning cortisol on the 2nd or 3rd postoperative days. Patients with levels <10 microg/l should continue therapy with reassessment in the later postoperative period. Monitoring for water imbalances, which are due to deficiency or excess of ADH (DI or SIADH, respectively), is accomplished by continuous accounting of fluid intake, urine output and specific gravities coupled with daily serum electrolyte measurements. DI is characterized by excess volumes of inappropriately dilute urine, which can lead to hypernatremia. Most patients maintain adequate fluid intake and euvolemia, but desmopressin therapy is required for some. SIADH, which peaks in incidence on 7th postoperative day, presents with hyponatremia that can be severe and symptomatic. Management consists of fluid restriction. Neurosurgical monitoring is primarily for disturbances in vision or neurological function, and although uncommon, for CSF leak and infections such as meningitis. In the later postoperative period, the adrenal, thyroid and gonadal axes are assessed. New persistent hypopituitarism is rare when transsphenoidal surgery is performed by an experienced surgeon. Various strategies are available for assessing each axis and for providing replacement therapy in patients with deficiencies. Long term monitoring with assessments of visual, neurological and pituitary function coupled with pituitary imaging is necessary for all patients who have undergone surgery, irrespective of the hormone status of their tumors.
    MeSH term(s) Humans ; Pituitary Function Tests ; Pituitary Gland/diagnostic imaging ; Pituitary Gland/physiopathology ; Pituitary Gland/surgery ; Pituitary Hormones, Anterior/metabolism ; Pituitary Neoplasms/pathology ; Pituitary Neoplasms/surgery ; Pituitary-Adrenal System ; Postoperative Care ; Postoperative Complications/diagnosis ; Radionuclide Imaging ; Sphenoid Bone/diagnostic imaging ; Sphenoid Bone/surgery ; Thyroid Gland/physiology ; Water-Electrolyte Balance
    Chemical Substances Pituitary Hormones, Anterior
    Language English
    Publishing date 2008-03-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1385151-2
    ISSN 1573-7403 ; 1386-341X
    ISSN (online) 1573-7403
    ISSN 1386-341X
    DOI 10.1007/s11102-008-0086-6
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  5. Article: Trends in medication use for osteoarthritis treatment.

    Ausiello, John C / Stafford, Randall S

    The Journal of rheumatology

    2002  Volume 29, Issue 5, Page(s) 999–1005

    Abstract: Objective: To investigate recent national trends in nonsteroidal antiinflammatory drug (NSAID) and acetaminophen use for osteoarthritis (OA).: Methods: Using data from the 1989-98 National Ambulatory Medical Care Survey, a representative sample of US ...

    Abstract Objective: To investigate recent national trends in nonsteroidal antiinflammatory drug (NSAID) and acetaminophen use for osteoarthritis (OA).
    Methods: Using data from the 1989-98 National Ambulatory Medical Care Survey, a representative sample of US office based physician visits, we assessed 4471 visits by patients 45 years or older with a diagnosis of OA. We examined cross sectional and longitudinal patterns of OA pharmacotherapy. The independent effects of patient and physician characteristics on NSAID and acetaminophen use were examined using multiple logistic regression analysis.
    Results: Pharmacological treatment for OA (either NSAID, acetaminophen, or both) has steadily decreased from 49% of visits (1989-91) to 46% (1992-94) to 40% (1995-98) (p = 0.001). Reduced NSAID use over this time period (46% to 33%; p = 0.001) was partially offset by a modest increase in acetaminophen use (5% to 10%; p = 0.001). Among individual NSAID, ibuprofen (5.7% of OA visits), nabumetone (4.9%), naproxen (4.6%), and aspirin (4.4%) were the most frequently reported in 1995-98. For patient visits in 1995-98, 45 to 59-year-olds (38%) received NSAID more often than 60 to 74-year-olds (34%) or patients older than 75 (28%; p = 0.029). Other possible predictors of OA therapy included patient race and physician specialty.
    Conclusion: The decline in the use of NSAID from 1989 to 1998, especially among elderly patients, and the frequent selection of safer medications may reflect awareness of the literature citing the risks of nonsteroidals for OA. However, variations in prescribing patterns among different patient populations and the modest use of acetaminophen, despite evidence supporting its efficacy, suggest that better assimilation of the literature into medical practice is needed to optimize OA therapy.
    MeSH term(s) Acetaminophen/therapeutic use ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Butanones/therapeutic use ; Drug Utilization/trends ; Female ; Humans ; Ibuprofen/therapeutic use ; Male ; Middle Aged ; Naproxen/therapeutic use ; Osteoarthritis/drug therapy ; United States
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal ; Butanones ; Acetaminophen (362O9ITL9D) ; Naproxen (57Y76R9ATQ) ; nabumetone (LW0TIW155Z) ; Aspirin (R16CO5Y76E) ; Ibuprofen (WK2XYI10QM)
    Language English
    Publishing date 2002-05
    Publishing country Canada
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 194928-7
    ISSN 1499-2752 ; 0315-162X
    ISSN (online) 1499-2752
    ISSN 0315-162X
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  6. Article: OUTCOME OF IMPLEMENTATION OF A MULTIDISCIPLINARY TEAM APPROACH TO THE CARE OF PATIENTS AFTER TRANSSPHENOIDAL SURGERY.

    Carminucci, Arthur S / Ausiello, John C / Page-Wilson, Gabrielle / Lee, Michelle / Good, Laura / Bruce, Jeffrey N / Freda, Pamela U

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

    2015  Volume 22, Issue 1, Page(s) 36–44

    Abstract: Objective: Transsphenoidal surgery (TS) for sellar lesions is an established and safe procedure, but complications can occur, particularly involving the neuroendocrine system. We hypothesized that postoperative care of TS patients would be optimized ... ...

    Abstract Objective: Transsphenoidal surgery (TS) for sellar lesions is an established and safe procedure, but complications can occur, particularly involving the neuroendocrine system. We hypothesized that postoperative care of TS patients would be optimized when performed by a coordinated team including a pituitary neurosurgeon, endocrinologists, and a specialty nurse.
    Methods: We implemented a formalized, multidisciplinary team approach and standardized postoperative protocols for the care of adult patients undergoing TS by a single surgeon (J.N.B.) at our institution beginning in July 2009. We retrospectively compared the outcomes of 214 consecutive TS-treated cases: 113 cases prior to and 101 following the initiation of the team approach and protocol implementation. Outcomes assessed included the incidence of neurosurgical and endocrine complications, length of stay (LOS), and rates of hospital readmission and unscheduled clinical visits.
    Results: The median LOS decreased from 3 days preteam to 2 days postteam (P<.01). Discharge occurred on postoperative day 2 in 46% of the preteam group patients compared to 69% of the postteam group (P<.01). Rates of early postoperative diabetes insipidus (DI) and readmissions within 30 days for syndrome of inappropriate antidiuretic hormone (SIADH) or other complications did not differ between groups.
    Conclusion: Implementation of a multidisciplinary team approach was associated with a reduction of LOS. Despite earlier discharge, postoperative outcomes were not compromised. The endocrinologist is central to the success of this team approach, which could be successfully applied to care of patients undergoing TS, as well as other types of endocrine surgery at other centers.
    MeSH term(s) Adenoma/epidemiology ; Adenoma/surgery ; Female ; Health Plan Implementation/organization & administration ; Health Plan Implementation/standards ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/adverse effects ; Neurosurgical Procedures/rehabilitation ; Neurosurgical Procedures/standards ; Patient Care Team/organization & administration ; Patient Care Team/standards ; Pituitary Neoplasms/epidemiology ; Pituitary Neoplasms/surgery ; Postoperative Care/standards ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Retrospective Studies ; Sphenoid Bone/surgery ; Treatment Outcome
    Language English
    Publishing date 2015-10-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1473503-9
    ISSN 1530-891X
    ISSN 1530-891X
    DOI 10.4158/EP15894.OR
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  7. Article ; Online: Langerhans Cell Histiocytosis: Diagnosis on Thyroid Aspirate and Review of the Literature.

    Saqi, Anjali / Kuker, Adriana P / Ebner, Susana A / Ausiello, John / Jobanputra, Vaidehi / Bhagat, Govind / Giorgadze, Tamar A

    Head and neck pathology

    2015  Volume 9, Issue 4, Page(s) 496–502

    Abstract: Thyroid gland involvement by Langerhans cell histiocytosis is extremely rare. A 35-year-old woman with a history of a suprasellar mass previously diagnosed as a ganglioglioma and complicated by diabetes insipidus, hypogonadotropic hypogonadism, and ... ...

    Abstract Thyroid gland involvement by Langerhans cell histiocytosis is extremely rare. A 35-year-old woman with a history of a suprasellar mass previously diagnosed as a ganglioglioma and complicated by diabetes insipidus, hypogonadotropic hypogonadism, and central hypothyroidism presented with acute onset of neck enlargement. On ultrasound examination, almost the entire thyroid appeared replaced by abnormal lobulated hypoechoic tissue with increased vascularity. Fine needle aspiration (FNA) of the thyroid was performed and revealed singly scattered and loosely cohesive large cells with abundant cytoplasm, including some with irregular nuclear contours and nuclear grooves. No thyroid follicular cells were noted. Based on the cytomorphologic findings and ancillary studies (immunohistochemistry and flow cytometry analysis) a cytological diagnosis of "positive for neoplastic cells" with features suggestive of monocytic/histiocytic origin, possibly Langerhans cell histiocytosis (LCH) was rendered. Following FNA, the patient underwent an incisional thyroid biopsy that confirmed the cytological impression of LCH. In light of the new diagnosis of LCH, the prior suprasellar mass biopsy slides were re-reviewed and rare cells suspicious for LCH were observed. Appropriate treatment for systemic LCH was initiated successfully. This case demonstrates that the presence of enlarged and loosely cohesive cells, especially those with irregular nuclear contours, in thyroid FNA specimens should raise suspicion for LCH. The diagnosis of LCH in FNA specimens is challenging. Additional material should be allocated for ancillary studies to confirm the morphological impression. In our case, not only was the thyroid FNA crucial in diagnosing LCH, but instrumental in initiating a thorough diagnostic work-up for multisystem involvement and thus unmasking the true etiology of the patient's suprasellar mass and associated endocrinopathies.
    MeSH term(s) Adult ; Biopsy, Fine-Needle ; Female ; Flow Cytometry ; Histiocytosis, Langerhans-Cell/diagnosis ; Humans ; Immunohistochemistry ; Thyroid Diseases/diagnosis
    Language English
    Publishing date 2015-12
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2407834-7
    ISSN 1936-0568 ; 1936-055X
    ISSN (online) 1936-0568
    ISSN 1936-055X
    DOI 10.1007/s12105-015-0608-2
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  8. Article ; Online: Post-acute COVID-19 syndrome.

    Nalbandian, Ani / Sehgal, Kartik / Gupta, Aakriti / Madhavan, Mahesh V / McGroder, Claire / Stevens, Jacob S / Cook, Joshua R / Nordvig, Anna S / Shalev, Daniel / Sehrawat, Tejasav S / Ahluwalia, Neha / Bikdeli, Behnood / Dietz, Donald / Der-Nigoghossian, Caroline / Liyanage-Don, Nadia / Rosner, Gregg F / Bernstein, Elana J / Mohan, Sumit / Beckley, Akinpelumi A /
    Seres, David S / Choueiri, Toni K / Uriel, Nir / Ausiello, John C / Accili, Domenico / Freedberg, Daniel E / Baldwin, Matthew / Schwartz, Allan / Brodie, Daniel / Garcia, Christine Kim / Elkind, Mitchell S V / Connors, Jean M / Bilezikian, John P / Landry, Donald W / Wan, Elaine Y

    Nature medicine

    2021  Volume 27, Issue 4, Page(s) 601–615

    Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients ... ...

    Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
    MeSH term(s) Acute Disease ; COVID-19/complications ; COVID-19/epidemiology ; COVID-19/ethnology ; COVID-19/therapy ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/therapy ; Humans ; Patient Advocacy ; SARS-CoV-2 ; Syndrome ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/therapy ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/prevention & control
    Language English
    Publishing date 2021-03-22
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1220066-9
    ISSN 1546-170X ; 1078-8956
    ISSN (online) 1546-170X
    ISSN 1078-8956
    DOI 10.1038/s41591-021-01283-z
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  9. Article: National Patterns of Depression Treatment in Primary Care.

    Stafford, Randall S. / Ausiello, John C. / Misra, Bismruta / Saglam, Demet

    Primary care companion to the Journal of clinical psychiatry

    2004  Volume 2, Issue 6, Page(s) 211–216

    Abstract: BACKGROUND: While past studies suggest that primary care physicians underdiagnose and undertreat depression, little is known about recent national patterns of depression treatment. METHOD: Using the 1995 and 1996 National Ambulatory Medical Care Surveys, ...

    Abstract BACKGROUND: While past studies suggest that primary care physicians underdiagnose and undertreat depression, little is known about recent national patterns of depression treatment. METHOD: Using the 1995 and 1996 National Ambulatory Medical Care Surveys, we analyzed 1322 primary care office visits by patients reported to have depression. Rates of psychotherapy/mental health counseling, antidepressant use, and benzodiazepine use were assessed. Independent predictors of depression therapy were examined using multiple logistic regression. Where instructive, we compared the practices of primary care physicians with those of psychiatrists (2418 depression visits). RESULTS: Primary care physicians reported depression in 7.8% of their office visits. For these depression visits, antidepressants (42%) were the most common form of treatment, followed by psychotherapy/mental health counseling (28%) and benzodiazepines (21%). Among specific antidepressants, selective serotonin reuptake inhibitors were most often prescribed by primary care physicians (26% of depression visits). Rates of antidepressant and benzodiazepine use varied significantly by primary care specialty. In addition, geographic region and health insurance status influenced the likelihood of receiving benzodiazepines. In their depression visits, psychiatrists reported psychotherapy/mental health counseling (88%) most frequently, followed by antidepressants (64%) and benzodiazepines (25%). CONCLUSION: The predominant use of selective serotonin reuptake inhibitors suggests that primary care physicians have begun to adopt new therapeutic strategies for depression. The modest rate of antidepressant therapy for a clinical population specifically identified by primary care physicians as having depression may indicate undertreatment of depression in primary care settings. Furthermore, high rates of benzodiazepine use are inconsistent with treatment guidelines, and variations in treatment patterns suggest that nonclinical factors influence depression management.
    Language English
    Publishing date 2004-03-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2211618-7
    ISSN 1523-5998
    ISSN 1523-5998
    DOI 10.4088/pcc.v02n0603
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  10. Article ; Online: Extrapulmonary manifestations of COVID-19.

    Gupta, Aakriti / Madhavan, Mahesh V / Sehgal, Kartik / Nair, Nandini / Mahajan, Shiwani / Sehrawat, Tejasav S / Bikdeli, Behnood / Ahluwalia, Neha / Ausiello, John C / Wan, Elaine Y / Freedberg, Daniel E / Kirtane, Ajay J / Parikh, Sahil A / Maurer, Mathew S / Nordvig, Anna S / Accili, Domenico / Bathon, Joan M / Mohan, Sumit / Bauer, Kenneth A /
    Leon, Martin B / Krumholz, Harlan M / Uriel, Nir / Mehra, Mandeep R / Elkind, Mitchell S V / Stone, Gregg W / Schwartz, Allan / Ho, David D / Bilezikian, John P / Landry, Donald W

    Nature medicine

    2020  Volume 26, Issue 7, Page(s) 1017–1032

    Abstract: Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary ... ...

    Abstract Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.
    MeSH term(s) Adaptive Immunity/physiology ; Betacoronavirus/pathogenicity ; Betacoronavirus/physiology ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/immunology ; Coronavirus Infections/pathology ; Coronavirus Infections/therapy ; Disease Progression ; Endothelium, Vascular/pathology ; Endothelium, Vascular/virology ; Humans ; Inflammation/etiology ; Inflammation/pathology ; Inflammation/virology ; Organ Specificity ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/immunology ; Pneumonia, Viral/pathology ; Pneumonia, Viral/therapy ; Renin-Angiotensin System/physiology ; SARS-CoV-2 ; Thrombosis/etiology ; Thrombosis/pathology ; Thrombosis/virology ; Virus Internalization
    Keywords covid19
    Language English
    Publishing date 2020-07-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Review
    ZDB-ID 1220066-9
    ISSN 1546-170X ; 1078-8956
    ISSN (online) 1546-170X
    ISSN 1078-8956
    DOI 10.1038/s41591-020-0968-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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