COVID-19 infection and its deadly cytokine storm in a young obese adult

SARS-CoV-2 is a novel coronavirus that was initially described in Wuhan China in December 2019. In the USA (US), the person to be diagnosed with the novel Coronavirus infection (COVID) was on 19 January 2020. On 18 March 2020, a 31-year-old morbidly obese African American woman presented with severe dyspnea with associated hypoxemia, fever and bilateral interstitial pulmonary ground glass infiltrates consistent with viral pneumonitis. Nasopharyngeal PCR testing was positive for SARS-CoV-2. Despite initiation of hydroxychloroquine and azithromycin along with supplemental oxygen therapy, rapid disease progression consistent with cytokine release syndrome ensued, leading to initiation of mechanical ventilatory support. Anti-Interleukin (IL)-6 receptor monoclonal antibody (tocilizumab) was administered. Acute respiratory distress syndrome (ARDS) leads to refractory hypoxemia and demise. Severe morbid obesity as well as race may be unidentified risk factors for the development of severe Illness in patients with COVID-19.

Successful use of tPA for thrombolysis in COVID related ARDS: a case series

We describe successful usage of low dose Tissue plasminogen activator (tPA) (30-50 mg) in three COVID19 critically ill patients, who were in worsening respiratory failure in-spite of being on therapeutic anticoagulation. All patients had respiratory rate > 40; FiO₂ > 0.7(on NIV); PiO₂/FiO₂ ratio < 100 and D-dimer>1000 ng/ml. C.T. Pulmonary Angiography could not be done in these patients due to poor general condition, but 2D echo was normal and none of the patients was in shock. So there was no conventional indication of thrombolysis in these patients, yet after thrombolysis, we saw dramatic changes in oxygenation. All patients became off oxygen within 3-7 days and were discharged within 2 weeks. The whole idea was to prevent intubation, since mortality rates are very high in intubated COVID19 patients. tPA is associated with <1% risk of fatal bleed. In this unprecedented pandemic with high mortality rates, thrombolysis could be an effective and safe option in carefully selected critically ill patients of COVID19.

What Nurses Should Know About COVID-19

Coronavirus disease 19 (COVID-19) is a highly infectious illness caused by novel SARS-CoV-2 coronavirus. The World Health Organization recently designated SARS-CoV-2 associated COVID-19 to be a global pandemic. The fear or spread of COVID-19 has touched every continent. The importance of understanding the drivers of COVID-19 on community health is amplified by the ability of SARS-CoV-2 to rapidly change genetic structure, our restricted knowledge about the disease, and limited or non-existent vaccines and treatment options. An understanding of basic COVID-19 epidemiology is a prerequisite for curtailing transmission, preventing morbidity and mortality, developing efficacious vaccines, implementing effective infection control protocols, and applying treatment algorithms.

COVID-19-Induced Cytokine Release Syndrome Associated with Pulmonary Vein Thromboses, Atrial Cardiomyopathy, and Arterial Intima Inflammation

Coronavirus disease 2019 (COVID-19) is a viral disease induced by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which may cause an acute respiratory distress syndrome (ARDS). First reports have shown that elevated levels of inflammatory cytokines might be involved in the development of organ dysfunction in COVID-19. Here, we can present a case of cytokine release syndrome induced by SARS-CoV-2 causing multiorgan failure and death. Of note, we can report on pulmonary vein thromboses as potential source of cerebrovascular embolic events. Furthermore, we present a specific form of an isolated inflammatory atrial cardiomyopathy encompassing atrial myocardium, perivascular matrix, as well as atrial autonomic nerve ganglia, causing atrial fibrillation, sinus node arrest, as well as atrial clot formation in the right atrial appendage. An associated acute glomerulonephritis caused acute kidney failure. Furthermore, all the described pathologies of organs and vessels were associated with increased local expression of interleukin-6 and monocyte chemoattractant protein-1 (MCP-1). This report provides new evidence about fatal pathologies and summarizes the current knowledge about organ manifestations observed in COVID-19.

African-Americans Have a Higher Propensity for Death from COVID-19: Rationale and Causation

The purpose of this article is to provide an understanding about the mechanisms that contribute to the proliferation of COVID-19 morbidity and mortality among high-risk populations, and especially African-Americans. African-Americans are succumbing to novel SARS-CoV-2 (COVID-19) at an alarming rate. Current data indicate that while African-Americans represent less than 13.4% of the United States' population, they account for one-third of more than 4.77 million persons with verified COVID-19 infections. Currently, more than 50,258 African-Americans have succumbed to the disease. African-Americans are disproportionately impacted by COVID-19 to an extent unobserved in other racial/ethnic subgroups. In addition, this article describes the physiological event inflammation-mediation storming (cytokine storming). Social determinants of health such as income, education, and employment are hypothesized to impact cogent health care delivery for African-Americans. Included in this article are data on clinical outcomes that highlight the role of pre-existing (health disparities) conditions like diabetes, hypertension, cardiovascular disease, obesity, and lung disease, as barriers to optimal outcomes among African-Americans who are hospitalized with COVID-19. Also explored in this article is causation for vascular complications. A further aim of this article is to provide insight into cause and effect rationales for COVID-19 and health disparities, from both biosocial and health inequality perspectives. Linkages between these selected health disparities and COVID-19 are examined to determine possible deteriorating effects of COVID-19. Finally, techniques are offered to render culturally competent care to African-Americans diagnosed with COVID-19 who present concomitantly with health disparities.

Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry

The COVID19 pandemic is an unprecedented disaster. In India, the spread of COVID19 infection and the subsequent lockdown coincided with a crucial period of the annual examination in almost all educational institutions. The pandemic has created hurdles in the conduct of examination due to many reasons, some of which are spread of infection and associated safety issues, lack of public transport for patients as well as the postgraduates in outstation and examiners, and lack of workforce due to round-the-clock service for rendering health services leading to difficulty in arranging logistics at the examination center. Currently, there are no guidelines or policies on how examinations need to be carried out during such a pandemic. Hence, there is an urgent need to look at solutions within the profession for the completion of examination. Teachers of psychiatry play an important role in the national mental health services. Their expertise can be valuable for finding solutions that work. This article has compiled suggestions from Indian teachers of psychiatry.

Coronavirus Disease - 2019-nCoV (COVID-19)

According to the World Health Organization (WHO) (2020b), coronaviruses refer to a large family of viruses known to be zoonotic (transmitted from animals to humans) and cause a variety of illnesses from the common cold to more concerning diseases such as severe lower respiratory tract infections (LRTIs). These viruses are called coronaviruses because their surfaces have crown-like spikes and "corona" is the Latin word for crown (WHO, 2020b). The potential community health risk caused by the current coronavirus (2019-nCoV) is high for young children, older adults, persons with comorbid cardiac or respiratory diseases, and immunocompromised individuals because their immune systems may be weak, making them more susceptible to contracting the coronavirus. Other members of the community that are at risk include healthcare and essential community workers at the forefront of this global epidemic, anyone with close person to person contact, and recent travelers to Wuhan and its surrounding provinces in China (Chinazzi et al., 2020). Healthcare and other frontline workers must be knowledgeable and prepared for the global outbreak of the coronavirus.

COVID19 and the Media Introductory Note

All of the authors who have contributed to this issue on COVID19 and the Media have stepped out of the rush of change, if only for a 2000-word moment, to look into a corner of the mediated pandemic and grapple with the significance of what's happening in our field, our societies, our lives. We appreciate their insights, and hope you do too.

Successful containment of Covid-19 outbreak in a large maternity and perinatal center while continuing clinical service

With increasing number of SARS-CoV-2 infections and COVID-19 patients to be taken care of by the health system, more and more health workers become affected by the disease. It has been reported that right from the beginning of the outbreak in Lombardy up to 20% of the doctors and nurses became infected. Under these circumstances, the regular operation of health institutions already suffering from a shortage of staff becomes difficult. This has led to complete or partial shutdowns of hospitals, either due to a lack of uninfected personnel or because of uncontrollable chains of infection endangering patients. In one of the largest university perinatal center in Bavaria with more than 3000 births per year, an outbreak of COVID-19 occurred in March 2020, affecting 36 staff members, including doctors, nurses, and midwives. Here, we describe the outbreak and present the measures contributing to the successful containment of the outbreak within three weeks. At the same time, clinical services could be maintained, however, not without deployment of personnel exposed to employees infected with SARS-CoV-2. Apart from massive testing of personnel in pre-defined phases and increased hygiene measures, including a general obligation to wear surgical face masks, we identified the need to monitor cases of illness across all groups of employees, to ensure social distancing within personnel and to evaluate contacts of clinical personnel outside of the hospital environment, in order to be able to interpret chains of infections and to disrupt them. Overall, only a bundle of measures is needed to contain such an outbreak.

COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation

PURPOSE

The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic.

METHODS AND MATERIALS

We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided.

RESULTS

There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources.

CONCLUSIONS

Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.

COVID19 Infection in Health Care Professionals: Risks, Work-Safety and Psychological Issues

COVID-19 infection has spread widely over past 5 months to become a pandemic of global proportions affecting almost every country. While HCPs are expected to tackle this crisis by working in hospital and intensive care setting, there is real risk of them contracting infection and even dying. This article aims to report cases of healthcare personnel (HCPs) contracting COVID19 in various settings in a tertiary care hospital, a designated COVID centre, with view to disseminate information and review safety and psychological health issues of healthcare professionals. This study is a cross-sectional hospital-based survey from April 2020-June 2020. Data on demographics, workplace safety and psychological parameters from HCPs was collected by both interview and an online questionnaire form. A total of 40 healthcare workers were infected in the hospital in a period of 2 months since the first COVID case was admitted in the hospital. Almost 57.5% reported positive on several psychological parameters like anxiety, fear, anger, irritability and insomnia. About 42.5% had no psychological counselling after testing positive. These cases illustrate work-place risks for healthcare workers of acquiring COVID19 and highlight the problems faced in terms of risks of transmission to patients and colleagues, isolation of contacts in departments leading to near-breakdown of services and psychological stress to healthcare workers. Healthcare workers being at frontline of exposure to corona patients are at increased risk of developing COVID19 infections. Healthcare workers are working under tremendous stress in this pandemic and it is necessary to combat fear with facts and work towards safe work atmosphere so that they can discharge their duties to best of their ability.

Regional Association of Disability and SARS-CoV-2 Infection in 369 Counties of the United States

Background

There have been outbreaks of SARS-CoV-2 in long term care facilities and recent reports of disproportionate death rates among the vulnerable population. The goal of this study was to better understand the impact of SARS-CoV-2 infection on the non-institutionalized disabled population in the United States using data from the most affected states as of April 9th, 2020.

Methods

This was an ecological study of county-level factors associated with the infection and mortality rate of SARS-CoV-2 in the non-institutionalized disabled population. We analyzed data from 369 counties from the most affected states (Michigan, New York, New Jersey, Pennsylvania, California, Louisiana, Massachusetts) in the United States using data available by April 9th, 2020. The variables include changes in mobility reported by Google, race/ethnicity, median income, education level, health insurance, and disability information from the United States Census Bureau. Bivariate regression analysis adjusted for state and median income was used to analyze the association between death rate and infection rate.

Results

The independent sample t-test of two groups (group 1: Death rate≥ 3.4% [median] and group 2: Death rate < 3.4%) indicates that counties with a higher total population, a lower percentage of Black males and females, higher median income, higher education, and lower percentage of disabled population have a lower rate (< 3.4%) of SARS-CoV-2 related mortality (all p-values<4.3E-02). The results of the bivariate regression when controlled for median income and state show counties with a higher White disabled population (est: 0.19, 95% CI: 0.01-0.37; p-value:3.7E-02), and higher population with independent living difficulty (est: 0.15, 95% CI: -0.01-0.30; p-value: 6.0E-02) have a higher rate of SARS-CoV-2 related mortality. Also, the regression analysis indicates that counties with higher White disabled population (est: -0.22, 95% CI: -0.43-(-0.02); p-value: 3.3E-02), higher population with hearing disability (est: -0.26, 95% CI: -0.42-(-0.11); p-value:1.2E-03), and higher population with disability in the 18-34 years age group (est: -0.25, 95% CI: -0.41-(-0.09); p-value:2.4E-03) show a lower rate of SARS-CoV-2 infection.

Conclusion

Our results indicate that while counties with a higher percentage of non-institutionalized disabled population, especially White disabled population, show a lower infection rate, they have a higher rate of SARS-CoV-2 related mortality.

SARS-CoV2 may evade innate immune response, causing uncontrolled neutrophil extracellular traps formation and multi-organ failure

We demonstrate that the general clinical conditions, risk factors and numerous pathological and biological features of COVID-19 are analogous with various disorders caused by the uncontrolled formation of neutrophil extracellular traps and their by-products. Given the rapid evolution of this disease's symptoms and its lethality, we hypothesize that SARS-CoV2 evades innate immune response causing COVID-19 progresses under just such an amplifier loop, leading to a massive, uncontrolled inflammation process. This work allows us to propose new strategies for treating the pandemic.

Mild SARS-CoV-2 infections in children might be based on evolutionary biology and linked with host reactive oxidative stress and antioxidant capabilities

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to significant morbidity and mortality in elderly individuals. Children typically have mild illness with rare mortalities. Age and co-morbid medical conditions are the most important determinant of the infection outcome. Currently there is no clear explanation for the difference in disease severity and outcome in different age groups. Based on evolutionary biology and translational research this review suggests that the high antioxidant capacity of children leading to a balanced redox state is the key factor for mild SARS-CoV-2 infections in this age group. On the other hand, elderly individuals with low antioxidant capacity and low angiotensin-converting enzyme 2 expression are prone to severe infections by redox-sensitive immune modulation.

Evidence for transmission of COVID-19 prior to symptom onset

We collated contact tracing data from COVID-19 clusters in Singapore and Tianjin, China and estimated the extent of pre-symptomatic transmission by estimating incubation periods and serial intervals. The mean incubation periods accounting for intermediate cases were 4.91 days (95%CI 4.35, 5.69) and 7.54 (95%CI 6.76, 8.56) days for Singapore and Tianjin, respectively. The mean serial interval was 4.17 (95%CI 2.44, 5.89) and 4.31 (95%CI 2.91, 5.72) days (Singapore, Tianjin). The serial intervals are shorter than incubation periods, suggesting that pre-symptomatic transmission may occur in a large proportion of transmission events (0.4-0.5 in Singapore and 0.6-0.8 in Tianjin, in our analysis with intermediate cases, and more without intermediates). Given the evidence for pre-symptomatic transmission, it is vital that even individuals who appear healthy abide by public health measures to control COVID-19.

Evidence for transmission of COVID-19 prior to symptom onset

We collated contact tracing data from COVID-19 clusters in Singapore and Tianjin, China and estimated the extent of pre-symptomatic transmission by estimating incubation periods and serial intervals. The mean incubation periods accounting for intermediate cases were 4.91 days (95%CI 4.35, 5.69) and 7.54 (95%CI 6.76, 8.56) days for Singapore and Tianjin, respectively. The mean serial interval was 4.17 (95%CI 2.44, 5.89) and 4.31 (95%CI 2.91, 5.72) days (Singapore, Tianjin). The serial intervals are shorter than incubation periods, suggesting that pre-symptomatic transmission may occur in a large proportion of transmission events (0.4-0.5 in Singapore and 0.6-0.8 in Tianjin, in our analysis with intermediate cases, and more without intermediates). Given the evidence for pre-symptomatic transmission, it is vital that even individuals who appear healthy abide by public health measures to control COVID-19.

Virtual drug repurposing study against SARS-CoV-2 TMPRSS2 target

Currently, the world suffers from a new coronavirus SARS-CoV-2 that causes COVID-19. Therefore, there is a need for the urgent development of novel drugs and vaccines for COVID-19. Since it can take years to develop new drugs against this disease, here we used a hybrid combined molecular modeling approach in virtual drug screening repurposing study to identify new compounds against this disease. One of the important SARS-CoV-2 targets namely type 2 transmembrane serine protease (TMPRSS2) was screened with NPC’s NIH small molecule library which includes approved drugs by FDA and compounds in clinical investigation. We used 6654 small molecules in molecular docking and top-50 docking scored compounds were initially used in short (10-ns) molecular dynamics (MD) simulations. Based on average MM/GBSA binding free energy results, long (100-ns) MD simulations were employed for the identified hits. Both binding energy results as well as crucial residues in ligand binding were also compared with a positive control TMPRSS2 inhibitor, Camostat mesylate. Based on these numerical calculations we proposed a compound (benzquercin) as strong TMPRSS2 inhibitor. If these results can be validated by in vitro and in vivo studies, benzquercin can be considered to be used as inhibitor of TMPRSS2 at the clinical studies.

Stroke and COVID19: Not only a large-vessel disease

Recent evidence has underlined the association between large-vessel stroke and COVID-19, probably due to a proinflammatory and prothrombotic microenvironment induced by SARS-CoV-2. Here, we report the case of a young fit woman affected by COVID-19 without any flu-like symptom, who suffered from speech disorder and left hemiparesis. Brain magnetic resonance evidenced two small acute brain infarctions in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction. Diagnostic workup excluded cardiac embolic sources, acquired and inherited thrombophilia or autoimmune diseases. Two positive nasopharyngeal swab tests and high titers of serum specific IgA/IgM confirmed COVID-19 diagnosis. In our case stroke seems to be the only manifestation of SARS-COV-2 infection. Therefore the hypothesis of an underlying viral infection, as COVID-19, should be investigated in all the cases of small vessel cryptogenic stroke.

Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic

Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.

The Coincidence of 2 Epidemics, Coccidioidomycosis and SARS-CoV-2: A Case Report

In the middle of a pandemic, patients with cough and fever are thought to have SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It should be remembered that in the desert southwest of the United States, we have an ongoing epidemic of coccidioidomycosis (CM). There are additionally many other respiratory illnesses that could be confused with CoV-2 or overlooked. This is a case report of CoV-2 engrafted on chronic cavitary pulmonary CM. In a time where the coronavirus pandemic is becoming rampant, we demonstrate the case of a coinfection with cavitary pulmonary CM. In this case, the importance of detection of the coronavirus and treatment of the coinfection is explored.

Herpes zoster might be an indicator for latent COVID 19 infection

Various cutaneous manifestations have been observed in patients with COVID‐19 infection. Herpes zoster is a viral skin disease caused by varicella zoster that remains dormant in the dorsal root ganglia of cutaneous nerves following a primary chicken pox infection. In this report, we describe two cases COVID infection who first presented with herpes zoster. We are here by suggesting that the clinical presentation of HZ at the time of the current pandemic even in patients giving mild or no suggestive history of upper respiratory symptoms should be considered as an alarming sign for a recent subclinical SARS CoV2 infection.

A Protracted Course of COVID19 Infection in a Metastatic Breast Cancer Patient During CDK4/6 Inhibitor Therapy

We describe the first case report of a patient with COVID19 infection and metastatic breast cancer, while on systemic therapy with a CDK4/6 inhibitor. The patient had unique disease course, characterized with delayed symptomatology. The case highlights novel findings and stress careful and extended follow-up during COVID19 infection in patients taking biologic therapies affecting the immune system.

Two Detailed Plaque Assay Protocols for the Quantification of Infectious SARS-CoV-2

Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has been identified as the causal agent of COronaVIrus Disease‐19 (COVID‐19), an atypical pneumonia‐like syndrome that emerged in December 2019. While SARS‐CoV‐2 titers can be measured by detection of viral nucleic acid, this method is unable to quantitate infectious virions. Measurement of infectious SARS‐CoV‐2 can be achieved by tissue culture infectious dose−50 (TCID₅₀), which detects the presence or absence of cytopathic effect in cells infected with serial dilutions of a virus specimen. However, this method only provides a qualitative infectious virus titer. Plaque assays are a quantitative method of measuring infectious SARS‐CoV‐2 by quantifying the plaques formed in cell culture upon infection with serial dilutions of a virus specimen. As such, plaque assays remain the gold standard in quantifying concentrations of replication‐competent lytic virions. Here, we describe two detailed plaque assay protocols to quantify infectious SARS‐CoV‐2 using different overlay and staining methods. Both methods have several advantages and disadvantages, which can be considered when choosing the procedure best suited for each laboratory. These assays can be used for several research purposes, including titration of virus stocks produced from infected cell supernatant and, with further optimization, quantification of SARS‐CoV‐2 in specimens collected from infected animals. © 2019 The Authors.

Basic Protocol: SARS‐CoV‐2 plaque assay using a solid double overlay method

Alternate Protocol: SARS‐CoV‐2 plaque assay using a liquid overlay and fixation‐staining method

A super-spreader of COVID-19 in Ningbo city in China

An outbreak of Coronavirus Disease 2019 (COVID-19) has spread rapidly. It is imperative to control the epidemic by understanding the epidemiological feature, preventative quarantine, and effective hygiene measures. In the present study, we report a case of super-spreader who transmitted the disease to over twenty-eight persons in Ningbo, Zhejiang. Identifying and isolated super-spreaders, understanding the reasons behind the efficient transmission ability are important for the control and management of the ongoing COVID-19 pandemic.

Vehicle related injury patterns during the COVID-19 pandemic: What has changed?

BACKGROUND

Following the emergence of the COVID-19 pandemic, normal daily life in the United States (US) has changed dramatically. As the US population shifts to practice social distancing, there are undoubtedly changes in the pattern of traumatic injuries presenting to Emergency Departments across the US. This analysis aims to analyze previously undocumented trends on how the COVID-19 pandemic has changed the pattern of vehicle related injuries in selected US states.

METHODS

A retrospective analysis was performed utilizing public vehicle collision data gathered from the Department of Transportation of Florida, New York, and Massachusetts from October 1, 2019 to March 31, 2020 regarding 158,341 motor vehicle collisions. Descriptive statistical analysis and linear regression was performed to investigate the counts and trends of motor vehicle collisions and injuries during the study period in order to determine what effect, if any, COVID-19 has had on the incidence and pattern of these events.

RESULTS

In Florida, New York, and Massachusetts, there was a general downward trend of vehicle collisions and vehicle related injuries over this time period, with statistically significant association between number of total vehicle collisions vs. date (p < 0.001), as well as number of vehicle related injuries vs. date (p < 0.001).

CONCLUSION

Incidence of vehicle collisions and vehicle related injuries have significantly decreased during the COVID-19 pandemic. The creation of improved public transport modalities and use of virtual/remote replacements for social activities could serve as long-term solutions to reduce vehicle collisions and vehicle related injuries.

Computational analysis of microRNA-mediated interactions in SARS-CoV-2 infection

MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression found in more than 200 diverse organisms. Although it is still not fully established if RNA viruses could generate miRNAs, there are examples of miRNA like sequences from RNA viruses with regulatory functions. In the case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), there are several mechanisms that would make miRNAs impact the virus, like interfering with viral replication, translation and even modulating the host expression. In this study, we performed a machine learning based miRNA prediction analysis for the SARS-CoV-2 genome to identify miRNA-like hairpins and searched for potential miRNA-based interactions between the viral miRNAs and human genes and human miRNAs and viral genes. Overall, 950 hairpin structured sequences were extracted from the virus genome and based on the prediction results, 29 of them could be precursor miRNAs. Targeting analysis showed that 30 viral mature miRNA-like sequences could target 1,367 different human genes. PANTHER gene function analysis results indicated that viral derived miRNA candidates could target various human genes involved in crucial cellular processes including transcription, metabolism, defense system and several signaling pathways such as Wnt and EGFR signalings. Protein class-based grouping of targeted human genes showed that host transcription might be one of the main targets of the virus since 96 genes involved in transcriptional processes were potential targets of predicted viral miRNAs. For instance, basal transcription machinery elements including several components of human mediator complex (MED1, MED9, MED12L, MED19), basal transcription factors such as TAF4, TAF5, TAF7L and site-specific transcription factors such as STAT1 were found to be targeted. In addition, many known human miRNAs appeared to be able to target viral genes involved in viral life cycle such as S, M, N, E proteins and ORF1ab, ORF3a, ORF8, ORF7a and ORF10. Considering the fact that miRNA-based therapies have been paid attention, based on the findings of this study, comprehending mode of actions of miRNAs and their possible roles during SARS-CoV-2 infections could create new opportunities for the development and improvement of new therapeutics.

A Cohort of Patients with COVID-19 in a Major Teaching Hospital in Europe

Background: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. Methods: Our cohort included all patients consecutively hospitalized who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from 25 February (first case admitted) to 19 April 2020. The data were manually entered into an electronic case report form, which was monitored prior to the analysis. Results: We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients’ median age was 61 years, and 51.8% were women. The most common comorbidity was arterial hypertension (41.3%), and the most common symptom on admission was fever (71.2%). The median time from disease onset to hospital admission was 6 days. The overall mortality was 20.7% and was higher in men (26.6% vs. 15.1%). Seventy-five patients with a final outcome were transferred to the intensive care unit (ICU) (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. Conclusions: We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male sex, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.

COVID-19 pandemic: Emerging perspectives and future trends

World is living on the edge. The human cost of COVID pandemic could be extraordinary. We find ourselves in a time of great economic, social, and medical uncertainty. The pandemic demands action on many fronts, from prevention to testing to treatment. We need to create simple, cheap, more accessible testing for SARS-CoV-2. A faster way has to be developed to identify antibodies that neutralize the virus. More than 100 vaccines for the SARS-CoV-2 are at various stages of development. Some six groups have already begun injecting formulations into volunteers in safety trials; others have started testing in animals. The biggest challenge is to determine which vaccine is ideal. Reason and science have to guide us. There is urgent need to critically appraise evidence in deciding how to treat patients. We need a drug or combination of drugs that work. Remdesivir has generated hope. It may prove to be a magic bullet. Countries like Taiwan, Vietnam, Singapore, Hong Kong, South Korea, New Zealand have done exceptionally well to contain the spread of COVID-19. It is widely believed that during the pandemic treatment suffers. Patients with diseases like cancer, diabetes, renal failure, CAD and pregnant women need special attention. As the pandemic pushes up levels of hunger among the global poor, governments must prevent devastating nutrition and health consequences for children missing out on school meals amid school closures. Nations will have endemic SARS-CoV-2 infection for the foreseeable future. A structured and well-coordinated approach is critical for tackling this global crisis.

Asymptomatic carriage and transmission of SARS-CoV-2: What do we know?

Purpose

Risk to healthcare workers treating asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the operating room depends on multiple factors. This review examines the evidence for asymptomatic or pre-symptomatic carriage of SARS-CoV-2, the risk of transmission from asymptomatic patients, and the specific risks associated with aerosol-generating procedures. Protective measures, such as minimization of aerosols and use of personal protective equipment in the setting of treating asymptomatic patients, are also reviewed.

Source

We examined the published literature as well as Societal guidelines.

Principal findings

There is evidence that a proportion of those infected with SARS-CoV-2 have detectable viral loads prior to exhibiting symptoms, or without ever developing symptoms. The degree of risk of transmission from asymptomatic patients to healthcare providers will depend on the prevalence of disease in the population, which is difficult to assess without widespread population screening. Aerosol-generating procedures increase the odds of viral transmission from infected symptomatic patients to healthcare providers, but transmission from asymptomatic patients has not been reported. Techniques to minimize aerosolization and appropriate personal protective equipment may help reduce the risk to healthcare workers in the operating room. Some societal guidelines recommend the use of airborne precautions during aerosol-generating procedures on asymptomatic patients during the coronavirus disease pandemic, although evidence supporting this practice is limited.

Conclusion

Viral transmission from patients exhibiting no symptoms in the operating room is plausible and efforts to reduce risk to healthcare providers include reducing aerosolization and wearing appropriate personal protective equipment, the feasibility of which will vary based on geographic risk and equipment availability.

[Benign prostatic hyperplasia management during COVID-19 pandemia.]

OBJECTIVES

The pandemic caused by the new SARS / Cov-2 Coronavirus represents an unprecedented scenario in modern medicine that affects many aspects of daily healthcare. Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has a high prevalence and is related to high consumption of health resources. For this reason, we performed a revision of the management of LUTS and HBP during and after COVID-19 pandemic.

MATERIAL AND METHODS

A group of experts in benign prostatic hyperplasia from different regions of Spain were selected to design a strategy to reorganize the management of benign prostatic hyperplasia and lower urinary tract symptoms during the pandemic. A comprehensive review of the literature was undertaken and a set of recommendations are generated.

RESULTS

Recommendations for the management of LUTS-BPH during and after the SARS/CoV2 coronavirus pandemic outbreak consist of promoting telemedicine and developing joint protocols with Primary Care Attention .Clear diagnostic and treatment criteria and referral criteria must be established. Referral of patients for risk complications such as kidney failure, recurrent hematuria and obstructive uropathy are a priority. Surgeries due to BPH are generally potentially delayed until phases I and II of the pandemic, in which the percentage of hospitalized patients with COVID-19 does not exceed 25%, and it is necessary to determine COVID19 negativity. The surgical technique that associates the least complications and the shortest stay should be selected.

CONCLUSIONS

The diagnosis and prescription of treatment for BPH during the COVID-19 pandemic should be based on telemedicine and joint protocols for primary care attention and urology. Elective surgical treatment can be delayed until we are in phases I or II, individualizing the surgical and anaesthetic technique of choice to minimize risks.

Assessing the anxiety level of Iranian general population during COVID-19 outbreak

This study is aimed to assess the anxiety level of Iranian general population during COVID-19 outbreak. The online questionnaire surveyed 10,754 individuals from the general population of 31 provinces of Iran who completed the questionnaire on social networks from March 1 to March 9, 2020. The inferential statistics suggests that the level of anxiety was higher among women (95 % CI [0.1, 81.36], p < 0.001), people who more followed corona-related news (p < 0.001) and the age group of 21-40 years (p < 0.001). Ultimately, the level of anxiety was significantly higher among people who had at least one family member, relative, or friend who contracted COVID-19 disease (95 % CI [1.2, 35.03], p < 0.001). The health care system should adopt a package of psychosocial interventions to reduce the anxiety of high risk groups.

[Current situation in Urology practice in Spain during the COVID-19 pandemic.]

INTRODUCTION

On 11th March 2020the WHO declared COVID19 a global pandemic, a challenge previously unseen for sanitary systems, including the activity in Urology departments.

MATERIAL AND METHODS

Web and PubMed searchusing the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID surgery", "consensus methods","nominal group", "Delphi method". A narrative revision of the literature until the 20th May 2020, including articles and documents in English and Spanish.;RESULTS: Medical practice in Spain has been forced to rapidly adapt to the pandemic, dedicating most ofits material and human resources to the care of patients infected by SARS-CoV-2. This has meant a significant reduction of the routine practice in Urology, as in other medical specialities, limiting the medical attention tourgent and emergent cases. Programmed activity has been reserved for selected cases in which a delayed attention could compromise survival. Different scientific associations have made a significant effort to adapt their recommendations to the pandemic, prioritizing high-risk oncologic cases, and reducing the use of ventilators and hospital stays to the minimum. These restrictions must be dynamic, adapting to the de-escalating phases as the pandemic is more controlled, widening the range of services available. In this de-escalate there is an additional challenge, being the difficulty in generating quality scientific evidence. In order to obtain such evidence, consensus methods have been used, such as the nominal group technique or the Delphi method.

CONCLUSIONS

The COVID19 pandemic has meant a complete disruption in the routine activity in Urologyin Spain, with a need for prioritizing the attention of urgent and high-risk oncologic pathology. These restrictions must be progressively modified according to the de-escalating process in the general population.

SARS-CoV-2 Seroconversion in Humans: A Detailed Protocol for a Serological Assay, Antigen Production, and Test Setup

In late 2019, cases of atypical pneumonia were detected in China. The etiological agent was quickly identified as a betacoronavirus (named SARS-CoV-2), which has since caused a pandemic. Several methods allowing for the specific detection of viral nucleic acids have been established, but these only allow detection of the virus during a short period of time, generally during acute infection. Serological assays are urgently needed to conduct serosurveys, to understand the antibody responses mounted in response to the virus, and to identify individuals who are potentially immune to re-infection. Here we describe a detailed protocol for expression of antigens derived from the spike protein of SARS-CoV-2 that can serve as a substrate for immunological assays, as well as a two-stage serological enzyme-linked immunosorbent assay (ELISA). These assays can be used for research studies and for testing in clinical laboratories. © 2020 The Authors. Basic Protocol 1: Mammalian cell transfection and protein purification Basic Protocol 2: A two-stage ELISA for high-throughput screening of human serum samples for antibodies binding to the spike protein of SARS-CoV-2.

[Emergency surgery during COVID-19 pandemia.]

INTRODUCTION

The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test. In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario. OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation. Furthermore, we propose a general action protocol for these patients.

MATERIAL AND METHODS

The document is based ont he scarce evidence on SARS / Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country. A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19",  "COVID Urology", "COVID19 surgery" and "emergency care". A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English. After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria. Finally, a definitive version was made, agreed by all the authors on May 12, 2020.

RESULTS

General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures.

CONCLUSIONS

Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology. The information is changing, as the epidemiological knowledge of the disease advances. The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended. Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with protective measures for the patient and other healthcare personnel.

Wheat and chaffs in the interpretation of the current COVID19 outbreak in Italy

The COVID19 outbreak in Italy is still a big concern. The Italian Government has recommended citizens to respect faithfully any compulsory legal disposition in order to stay home and so contributing in escaping viral contacts and slowing down epidemic. Emergency has raised a widely animated debate about how to read and comprehend the daily case numbers, the medical and caregivers availability, the needs to swab asymptomatic subjects. In this review the authors discuss about the many wheat and chaffs of how this virus disease is addressed .

ESMO Management and treatment adapted recommendations in the COVID-19 era: Lung cancer

The COVID-19 pandemic, characterised by a fast and global spread during the first months of 2020, has prompted the development of a structured set of recommendations for cancer care management, to maintain the highest possible standards. Within this framework, it is crucial to ensure no disruption to essential oncological services and guarantee the optimal care.This is a structured proposal for the management of lung cancer, comprising three levels of priorities, namely: tier 1 (high priority), tier 2 (medium priority) and tier 3 (low priority)-defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and Magnitude of Clinical Benefit Scale.The manuscript emphasises the impact of the COVID-19 pandemic on lung cancer care and reconsiders all steps from diagnosis, staging and treatment.These recommendations should, therefore, serve as guidance for prioritising the different aspects of cancer care to mitigate the possible negative impact of the COVID-19 pandemic on the management of our patients.As the situation is rapidly evolving, practical actions are required to guarantee the best patients' treatment while protecting and respecting their rights, safety and well-being. In this environment, cancer practitioners have great responsibilities: provide timely, appropriate, compassionate and justified cancer care, while protecting themselves and their patients from being infected with COVID-19. In case of shortages, resources must be distributed fairly. Consequently, the following recommendations can be applied with significant nuances, depending on the time and location for their use, considering variable constraints imposed to the health systems. An exceptional flexibility is required from cancer caregivers.

Non-operative management of acute appendicitis in a pediatric patient with concomitant COVID-19 infection

Introduction

In late December 2019, reports emerged from Wuhan, China of a novel corovonavirus SARS-CoV-2, which caused severe acute respiratory distress syndrome referred to as COVID-19. As the virus spread, reports of severe perioperative complications, including fatalities, began to emerge in the literature. We present a case of a previously healthy patient who developed classic symptoms of appendicitis. The patient was also found to be positive for COVID-19. Given the risks to both the patient and surgical team, we elected to pursue a non-operative management strategy for this patient with appendicitis.

Materials and methods

A 13 year old female with COVID-19 presented with a day of right lower quadrant abdominal pain. A computerized tomography (CT) scan diagnosed uncomplicated appendicitis. The patient was successfully treated non-operatively with antibiotics and discharged home.

Conclusion

To our knowledge, this case illustrates the first report of a pediatric patient with concomitant appendicitis and COVID-19 infection. We have been able to utilize a non-operative management strategy to effectively treat the patient's acute appendicitis, while protecting her from the risks of undergoing a general anesthetic as well as the operative team. We hope this report can provide others with a potential management strategy for similar patients.

Novel therapeutic targets for SARS-CoV-2-induced acute lung injury: Targeting a potential IL-1β/neutrophil extracellular traps feedback loop

Most COVID-19 infected individuals present with mild flu-like symptoms; however, 5–10% of cases suffer from life-threatening pneumonia and respiratory failure. The pathogenesis of SARS-CoV-2 and its pathology of associated acute lung injury (ALI), acute respiratory distress syndrome (ARDS), sepsis, coagulopathy and multiorgan failure is not known. SARS-CoV-2 is an envelope virus with S (spike), M (membrane), N (nucleocapsid) and E (envelop) proteins. In a closely related coronavirus (SARS-CoV), the transmembrane E protein exerts an important role in membrane-ionic transport through viroporins, deletion of which reduced levels of IL-1β and a remarkably reduced lung edema compared to wild type. IL-1β is generated by macrophages upon activation of intracellular NLRP3 (NOD-like, leucine rich repeat domains, and pyrin domain-containing protein 3), part of the functional NLRP3 inflammasome complex that detects pathogenic microorganisms and stressors, while neutrophils are enhanced by increasing levels of IL-1β. Expiring neutrophils undergo “NETosis”, producing thread-like extracellular structures termed neutrophil extracellular traps (NETs), which protect against mild infections and microbes. However, uncontrolled NET production can cause acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), coagulopathy, multiple organ failure, and autoimmune disease. Herein, we present arguments underlying our hypothesis that IL-1β and NETs, mediated via NLRP3 inflammasomes, form a feed-forward loop leading to the excessive alveolar and endothelial damage observed in severe cases of COVID-19. Considering such assertions, we propose potential drug candidates that could be used to alleviate such pathologies. Considering that recent efforts to ascertain effective treatments of COVID-19 in severe patients has been less than successful, investigating novel avenues of treating this virus are essential.

Statement from the North American Society for Cardiovascular Imaging on imaging strategies to reduce the scarcity of healthcare resources during the COVID-19 outbreak

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an evolving global pandemic that is predicted to strain healthcare resources at multiple locations throughout North America and the World. As of April 6, 2020, the apex of infection rates is predicted to occur within 1 to 5 weeks at various locations. Widespread reports of personal protective equipment (PPE) shortages, and healthcare worker exposure to disease have become commonplace. To mitigate this crisis, we are suggesting imaging strategies that aim to use the least PPE, require the smallest number of potential staff exposures, and streamlines utilization of imaging. They are broadly organized by (1) substituting a noninvasive diagnostic test in place of a semi-invasive or invasive diagnostic tests, and (2) consolidating diagnostic imaging.

Potential Therapeutic Targeting of Coronavirus Spike Glycoprotein Priming

Processing of certain viral proteins and bacterial toxins by host serine proteases is a frequent and critical step in virulence. The coronavirus spike glycoprotein contains three (S1, S2, and S2′) cleavage sites that are processed by human host proteases. The exact nature of these cleavage sites, and their respective processing proteases, can determine whether the virus can cross species and the level of pathogenicity. Recent comparisons of the genomes of the highly pathogenic SARS-CoV2 and MERS-CoV, with less pathogenic strains (e.g., Bat-RaTG13, the bat homologue of SARS-CoV2) identified possible mutations in the receptor binding domain and in the S1 and S2′ cleavage sites of their spike glycoprotein. However, there remains some confusion on the relative roles of the possible serine proteases involved for priming. Using anthrax toxin as a model system, we show that in vivo inhibition of priming by pan-active serine protease inhibitors can be effective at suppressing toxicity. Hence, our studies should encourage further efforts in developing either pan-serine protease inhibitors or inhibitor cocktails to target SARS-CoV2 and potentially ward off future pandemics that could develop because of additional mutations in the S-protein priming sequence in coronaviruses.

Mechanisms of Bioactivities of Fucoidan from the Brown Seaweed Fucus vesiculosus L. of the Barents Sea

The aim of this study was to elucidate some mechanisms of radical scavenging and the anti-inflammatory, anti-hyperglycemic, and anti-coagulant bioactivities of high molecular weight fucoidan from Fucus vesiculosus in several in vitro models. Fucoidan has displayed potent 1, 1-diphenyl-2-picryl hydrazil radical scavenging and reduction power activities. It significantly inhibits the cyclooxygenase-2 (COX-2) enzyme (IC₅₀ 4.3 μg mL⁻¹) with a greater selectivity index (lg(IC₈₀ COX-2/IC₈₀COX-1), −1.55) than the synthetic non-steroidal anti-inflammatory drug indomethacin (lg(IC₈₀ COX-2/IC₈₀COX-1), −0.09). A concentration-dependent inhibition of hyaluronidase enzyme with an IC₅₀ of 2.9 μg mL⁻¹ was observed. Fucoidan attenuated the lipopolysaccharide-induced expression of mitogen-activated protein kinase p38. Our findings suggest that the inhibition of dipeptidyl peptidase-IV (DPP-IV) (IC₅₀ 1.11 μg mL⁻¹) is one of the possible mechanisms involved in the anti-hyperglycemic activity of fucoidan. At a concentration of 3.2 μg mL⁻¹, fucoidan prolongs the activated partial thromboplastin time and thrombin time by 1.5-fold and 2.5-fold compared with a control, respectively. A significant increase of prothrombin time was observed after the concentration of fucoidan was increased above 80 μg mL⁻¹. This evidenced that fucoidan may have an effect on intrinsic/common pathways and little effect on the extrinsic mechanism. This study sheds light on the multiple pathways of the bioactivities of fucoidan. As far as we know, the inhibition of hyaluronidase and DPP-IV by high molecular fucoidan was studied for the first time in this work. Our results and literature data suggest that molecular weight, sulfate content, fucose content, and polyphenols may contribute to these activities. It seems that high molecular weight fucoidan has promising therapeutic applications in different pharmacological settings. Anti-oxidant, anti-inflammatory and anti-coagulant drugs have been used for the management of complications of COVID19. Taken as a whole, fucoidan could be considered as a prospective candidate for the treatment of patients with COVID19; however, additional research in this field is required.

Rapid Isothermal Amplification and Portable Detection System for SARS-CoV-2

The COVID-19 pandemic provides an urgent example where a gap exists between availability of state-of-the-art diagnostics and current needs. As assay details and primer sequences become widely known, many laboratories could perform diagnostic tests using methods such as RT-PCR or isothermal RT-LAMP amplification. A key advantage of RT-LAMP based approaches compared to RT-PCR is that RT-LAMP is known to be robust in detecting targets from unprocessed samples. In addition, RT-LAMP assays are performed at a constant temperature enabling speed, simplicity, and point-of-use testing. Here, we provide the details of an RT-LAMP isothermal assay for the detection of SARS-CoV-2 virus with performance comparable to currently approved tests using RT-PCR. We characterize the assay by introducing swabs in virus spiked synthetic nasal fluids, moving the swab to viral transport medium (VTM), and using a volume of that VTM for performing the amplification without an RNA extraction kit. The assay has a Limit-of-Detection (LOD) of 50 RNA copies/μL in the VTM solution within 20 minutes, and LOD of 5000 RNA copies/μL in the nasal solution. Additionally, we show the utility of this assay for real-time point-of-use testing by demonstrating detection of SARS-CoV-2 virus in less than 40 minutes using an additively manufactured cartridge and a smartphone-based reader. Finally, we explore the speed and cost advantages by comparing the required resources and workflows with RT-PCR. This work could accelerate the development and availability of SARS-CoV-2 diagnostics by proving alternatives to conventional laboratory benchtop tests.

Older Workers on the COVID-19-Frontlines without Paid Sick Leave

The rapid spread of COVID-19 has left many workers around the world - workers in food distribution, truckers, janitors, and home and personal health care workers - deeply concerned about contracting the virus from exposure at work. In particular, older workers in frontline occupations are vulnerable to illness and to the deadly and debilitating effects of COVID-19, especially with inadequate protective gear and inadequate sick leave. In the absence of strong unions, which ensure that employers provide workers with accurate information, robust training, adequate equipment, and paid leave in the event of quarantines or illness, the COVID-19 pandemic highlights the need for additional legislation to shore up worker protections and provide paid sick leave.