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      COVID‐19 susceptibility in endometriosis patients: A case control study

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          Abstract

          Problem

          Starting from November 2019, the world has had to face a devastating pandemic caused by SARS‐CoV‐2. Various studies have identified potential risk factors facilitating the infection, however it has not been demonstrated whether endometriosis might represent one of them.

          The purpose of this study was to evaluate if patients with endometriosis had a higher risk of contracting COVID‐19 infection and, in such case, whether they developed a more severe infection than the general population. Furthermore, this study evaluated the possible correlation with the stage of endometriosis, based on the r‐ASRM score, and the potential worsening of the disease during the SARS‐CoV‐2 infection.

          Method of study

          A case‐control study was conducted from March 2020 to April 2021 at Macedonio Melloni Hospital, in Milan. A total of 401 women were recruited. The cases were 201 women with clinical or surgical diagnosis of endometriosis. The control group consisted of 200 women, without the disease. All women completed a self‐administered questionnaire which evaluated their demographic and clinical characteristics, as well as a potential diagnosis of Covid‐19.

          Results

          Comparison between the two groups showed that women with endometriosis had a higher frequency of COVID‐19 than the control subjects (23% vs. 13.5%, P = .014), with a greater prevalence of fever (14.4% vs. 6%, P = .008) and myalgias or arthralgias (11.4% vs. 4.5%, P = .01).

          In multivariable logistic regression analyses, women with endometriosis had a higher risk of contracting SARS‐CoV‐2 infection (OR = 2.11, 95% IC: 1.20–3.80), regardless the stage of the disease.

          Conclusion

          Endometriosis increases the susceptibility to COVID‐19, and women who suffer from it should be considered as fragile patients, worthy of prior access to SARS‐CoV‐2 vaccination campaign.

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          Most cited references71

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Antigen-specific adaptive immunity to SARS-CoV-2 in acute COVID-19 and associations with age and disease severity

            Limited knowledge is available on the relationship between antigen-specific immune responses and COVID-19 disease severity. We completed a combined examination of all three branches of adaptive immunity at the level of SARS-CoV-2-specific CD4+ and CD8+ T cell and neutralizing antibody responses in acute and convalescent subjects. SARS-CoV-2-specific CD4+ and CD8+ T cells were each associated with milder disease. Coordinated SARS-CoV-2-specific adaptive immune responses were associated with milder disease, suggesting roles for both CD4+ and CD8+ T cells in protective immunity in COVID-19. Notably, coordination of SARS-CoV-2 antigen-specific responses was disrupted in individuals > 65 years old. Scarcity of naive T cells was also associated with ageing and poor disease outcomes. A parsimonious explanation is that coordinated CD4+ T cell, CD8+ T cell, and antibody responses are protective, but uncoordinated responses frequently fail to control disease, with a connection between ageing and impaired adaptive immune responses to SARS-CoV-2.
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              The COVID-19 Cytokine Storm; What We Know So Far

              COVID-19 is a rapidly spreading global threat that has been declared as a pandemic by the WHO. COVID-19 is transmitted via droplets or direct contact and infects the respiratory tract resulting in pneumonia in most of the cases and acute respiratory distress syndrome (ARDS) in about 15 % of the cases. Mortality in COVID-19 patients has been linked to the presence of the so-called “cytokine storm” induced by the virus. Excessive production of proinflammatory cytokines leads to ARDS aggravation and widespread tissue damage resulting in multi-organ failure and death. Targeting cytokines during the management of COVID-19 patients could improve survival rates and reduce mortality.
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                Author and article information

                Contributors
                m.barretta2112@gmail.com
                Journal
                Am J Reprod Immunol
                Am J Reprod Immunol
                10.1111/(ISSN)1600-0897
                AJI
                American Journal of Reproductive Immunology
                John Wiley and Sons Inc. (Hoboken )
                1046-7408
                1600-0897
                26 July 2022
                26 July 2022
                : e13602
                Affiliations
                [ 1 ] Department of Biomedical Science for the Health University of Milan Milan Italy
                Author notes
                [*] [* ] Correspondence

                Marta Barretta, Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, via Macedonio Melloni 52, 20129 Milan, Italy.

                Email: m.barretta2112@ 123456gmail.com

                Author information
                https://orcid.org/0000-0002-9045-9397
                Article
                AJI13602
                10.1111/aji.13602
                9349658
                35867851
                e97bd202-1ed1-4b50-8a8f-56b2129f1608
                © 2022 The Authors. American Journal of Reproductive Immunology published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 12 July 2022
                : 16 February 2022
                : 18 July 2022
                Page count
                Figures: 1, Tables: 3, Pages: 11, Words: 6474
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:04.08.2022

                Immunology
                coronavirus,covid‐19 susceptibility,endometriosis,hyperinflammatory diseases,immunologic factors,risk factors,sars‐cov‐2

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