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  • 1.
    Jerndal, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Normark, J.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Norrland's University Hospital- Västerbotten County Council, Infectious Disease Clinic, Umeå, Sweden.
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Norrland's University Hospital- Västerbotten County Council, Infectious Disease Clinic, Umeå, Sweden.
    Fors Connolly, Anne-Marie
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    WCN23-0624 acute kidney injury and covid-192023In: Kidney International Reports, Supplements, ISSN 2468-0249, Vol. 8, no 3, p. S438-S438, article id WCN23-0624Article in journal (Refereed)
    Abstract [en]

    Introduction: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This emerging disease has become a public health emergency worldwide.

    Acute Kidney Injury (AKI) secondary to COVID-19 has been described in different studies, but information characterising patients with subsequent AKI is limited. The cause of kidney involvement in COVID-19 is thought to be multifactorial. Cardiovascular comorbidity and predisposing factors (e.g. sepsis and nephrotoxins) are considered as important contributors. The tubular damage has been linked to the cytopathic effects of kidney-resident cells and cytokine storm syndrome. To gain better understanding of the effect of COVID-19 on renal function, large clinical and register based studies have been requested.

    The objective of this study was to quantify the risk of acute kidney injury during and after covid-19.

    Methods: This was a Swedish prospective cohort study where Generalised Estimating Equation methods (GEE) was used to map the kinetics of kidney injury markers such as serum-creatinine (s-creatinine), cystatin and eGFR for the hospitalised patients in the cohort, comparing patients with moderate and severe COVID-19 during and after the acute infection. Furthermore, we will investigate if patients with kidney dysfunction during COVID-19 have more severe disease outcome compared with the whole cohort, adjusting for age, sex, and comorbidities. We will also compare start values of kidney injury markers with the latest values and count the percentage worsening among all disease severity groups.

    Cohort: Approximately 550 COVID-19 patients were recruited to the study following informed and signed consent at 2 Swedish University Hospitals. A case report form was filled in at pre-specified time points, and samples collected consecutively. A database was then created containing dates and information regarding symptoms, laboratory samples, complications, and disease severity (e.g., need of oxygen, intensive care, mechanical ventilation, death).

    Results: There was a significant increase in s-creatinine among hospitalised and intensive care unit patients (n=126) during the acute phase of COVID-19 (day 0-6 post disease onset) when compared to the follow up samples after 90 days from disease onset. There was also a decrease in s-creatinine in day 11-21 and 31-70 among hospitalised and intensive care unit COVID-19 patients when compared to the same follow up samples. This analysis was adjusted for age and sex. See figure 1.

    Conclusions: Our preliminary results show that s-creatinine was increased during the first days of COVID-19 followed by decreased levels compared to baseline.

    The higher levels of s-creatinine day 0-6 of COVID-19 could be an effect of the acute infection, but it could also be caused by other factors such as dehydration or medication. The lower levels of s-creatinine might be caused by dietary changes or loss of muscle mass due to immobilisation during hospitalisation. Knowledge about fluctuations in s-creatinine in COVID-19 patients may be of use for treating physicians.

  • 2.
    Katsoularis, Ioannis
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Fonseca Rodriguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Jerndal, Hanna
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Kalucza, Sebastian
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Fors Connolly, Anne-Marie
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Risk of atrial tachycardias after covid-19: nationwide self-controlled cases series and matched cohort study2023In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no Suppl. 2, article id ehad655.449Article in journal (Refereed)
    Abstract [en]

    Background: COVID-19 is a multiorgan disease. We previously identified COVID-19 as a risk factor for myocardial infarction, stroke (1), venous thromboembolism and bleeding (2). Less evidence exists on the risk of arrhythmias after COVID-19. Previous studies included mainly hospitalized patients with severe COVID-19, and there are no nationwide studies published.

    Purpose: The aim of this study was to estimate the risk of atrial tachycardias (atrial fibrillation and atrial flutter) following COVID-19, including all individuals tested positive for SARS-CoV-2 in Sweden, regardless of disease severity.

    Method: COVID-19 has been a notifiable disease in Sweden. All individuals in Sweden who were tested positive for SARS-CoV-2 between February 1, 2020 and May 25, 2021 were included in the study. We identified four control individuals for each COVID-19 individual matched on age, sex, and county of residence. Using Personal Identification Numbers, we cross-linked data from national registries: COVID-19 registry; Inpatient and Outpatient Registry; Cause of Death Registry; Prescribed Pharmaceutical Registry and Intensive Care Registry. Outcomes are cardiovascular events, defined using ICD-10 diagnosis codes for atrial fibrillation and atrial flutter in the registries. We performed a ‘’first-ever event’’ analysis, i.e., we excluded individuals with events before the study period. The self-controlled case series (SCCS) method was used to determine the incidence rate ratio (IRR) of a first atrial tachycardia during the risk periods 1-7, 8-14, 15-30, 31-60, 61-90, and 91-180 days after COVID-19. In the matched cohort study (MCS), Poisson regression was performed to calculate the risk ratio (RR) of a first arrhythmia event in the risk period 1-30 days following COVID-19, after adjusting for the effect of confounders, such as cardiac disease, treatment with antiarrhythmics, comorbidities and vaccination status.

    Results: 1 057 174 cases and 4 074 844 controls were included in the study. In the SCCS, the risk of first atrial tachycardia was significantly increased up to 60 days following COVID-19. Specifically, during days 1-7 and 8-14 post-COVID-19 the IRRs were approximately 12 and 10 respectively. Similarly, in the MCS the RR for the first atrial tachycardia during day 1-30 post-COVID-19 was approximately 11. The risks were higher in patients with more severe COVID-19; and during the first pandemic wave compared to the second and third wave.

    Conclusions: This study suggests that COVID-19 is a risk factor for atrial tachycardias, based on information obtained on all people who tested positive for SARS-CoV-2 in Sweden, regardless of disease severity. These results could impact recommendations on diagnostic and prophylactic strategies against atrial tachycardias after COVID-19. The importance of preventive strategies, such as risk factor control; vaccination to prevent severe COVID-19; and early review of high-risk individuals after COVID-19, is indicated.

  • 3.
    Katsoularis, Ioannis
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Fonseca-Rodríguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Farrington, Paddy
    School of Mathematics and Statistics, The Open University, Milton Keynes, UK.
    Jerndal, Hanna
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Häggström Lundevaller, Erling
    Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Fors Connolly, Anne-Marie
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study2022In: The BMJ, E-ISSN 1756-1833, Vol. 377, article id e069590Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19.

    DESIGN: Self-controlled case series and matched cohort study.

    SETTING: National registries in Sweden.

    PARTICIPANTS: 1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants.

    MAIN OUTCOMES MEASURES: Self-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event).

    RESULTS: Compared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding.

    CONCLUSIONS: The findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.

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  • 4.
    Katsoularis, Ioannis
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jerndal, Hanna
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Kalucza, Sebastian
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
    Fonseca Rodriguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Fors Connolly, Anne-Marie
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study2023In: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, no 6, article id oead120Article in journal (Refereed)
    Abstract [en]

    Aims: COVID-19 increases the risk of cardiovascular disease, especially thrombotic complications. There is less knowledge on the risk of arrhythmias after COVID-19. In this study, we aimed to quantify the risk of arrhythmias following COVID-19.

    Methods and Results: This study was based on national register data on all individuals in Sweden who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021. The outcome was incident cardiac arrhythmias, defined as international classification of diseases (10th revision) codes in the registers as follows: atrial arrhythmias; paroxysmal supraventricular tachycardias; bradyarrhythmias; and ventricular arrhythmias. A self-controlled case series study and a matched cohort study, using conditional Poisson regression, were performed to determine the incidence rate ratio and risk ratio, respectively, for an arrhythmia event following COVID-19.A total of 1 057 174 exposed (COVID-19) individuals were included in the study as well as 4 074 844 matched unexposed individuals. The incidence rate ratio of atrial tachycardias, paroxysmal supraventricular tachycardias, and bradyarrhythmias was significantly increased up to 60, 180, and 14 days after COVID-19, respectively. In the matched cohort study, the risk ratio during Days 1–30 following COVID-19/index date was 12.28 (10.79–13.96), 5.26 (3.74–7.42), and 3.36 (2.42–4.68), respectively, for the three outcomes. The risks were generally higher in older individuals, in unvaccinated individuals, and in individuals with more severe COVID-19. The risk of ventricular arrhythmias was not increased.

    1 057 174 exposed (COVID-19) individuals were included in the study as well as 4 074 844 matched unexposed individuals. The incidence rate ratio of atrial tachycardias, paroxysmal supraventricular tachycardias and bradyarrhythmias was significantly increased up to 60, 180 and 14 days after COVID-19, respectively. In the matched cohort study, the risk ratio during day 1-30 following COVID-19/index date was 12.28 (10.79-13.96), 5.26 (3.74-7.42) and 3.36 (2.42-4.68), respectively for the three outcomes. The risks were generally higher in older individuals, unvaccinated individuals and in individuals with more severe COVID-19. The risk of ventricular arrhythmias was not increased.

    Conclusion: There is an increased risk of cardiac arrhythmias following COVID-19, and particularly increased in elderly vulnerable individuals, as well as in individuals with severe COVID-19.

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  • 5.
    Katsoularis, Ioannis
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jerndal, Hanna
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Kalucza, Sebastian
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Fonseca Rodriguez, Osvaldo
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Fors Connolly, Anne-Marie
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Risks of arrhythmias after covid-19: nationwide self-controlled cases series and matched cohort studyManuscript (preprint) (Other academic)
  • 6.
    Velin, Lotta
    et al.
    Lunds universitet, Lund, Sverige.
    Stjernkqvist, Matilda
    Lunds universitet, Lund, Sverige.
    Bielik, Julia
    Sjukhuset Arvika, Arvika, Sverige.
    von Essen, Fredrika
    IFMSA-Sweden.
    Jerndal, Hanna
    Infektionskliniken, Umeå universitetssjukhus, Umeå, Sverige.
    Ekman, Anna-Theresia
    Karolinska institutet, Sverige.
    Studenter - kraften för en progressiv rörelse för global hälsa?2021In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 98, no 2, p. 244-251Article in journal (Other academic)
    Abstract [sv]

    Engagemang i global hälsa innebär stora möjligheter för lärande och personlig utveckling för studenter. Utöver den personliga nyttan för studenten tror vi att studenter utgör en samlad kraft för den progressiva global hälsa-rörelsen. I denna text vill vi dela ett studentperspektiv utifrån erfarenheter från två studentföreningar - Svenska Läkaresällskapets Kandidat- och Underläkarförening samt IFMSA-Sweden. För att belysa frågan presenterar vi även resultaten från en enkät vi genomfört bland svenska läkarstudenter.

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