Clinical manifestation and disease progression in COVID-19 infection

COVID-19 Associated Guillain–Barré Syndrome: A Report of Nine New Cases and a Review of the Literature

Background: Guillain–Barré syndrome (GBS)—a rare condition characterized by acute-onset immune-mediated polyneuropathy—has been registered as a neurological manifestation of COVID-19, suggesting a possible link between these two conditions. Methods: We report a case series of patients with COVID-19-related GBS hospitalized in the Neurology Department of Colentina Clinical Hospital, Bucharest, Romania, between March 2020 and March 2021. Several variables were analyzed, such as the mean interval between the onset of COVID-19 symptoms and neurological ones, clinical features, treatment course, and outcome. Further on, we conducted a thorough literature review based on the PubMed and ScienceDirect scientific databases. Results: A total of 9 COVID-19 patients developed symptoms of GBS, out of which in 7, it manifested as an acute inflammatory demyelinating polyneuropathy (AIDP). Five patients presented respiratory failure, 2 requiring mechanical ventilation. All patients received a course of intravenous immunoglobulins, 2 additionally requiring plasma exchange. Upon discharge, all but 1 patient (who had not regained the ability to walk) had a positive outcome, and 1 died during admission. In the literature review, we analyzed the published sources at the time of writing. Conclusions: A link between COVID-19 and GBS might be possible; therefore, increased vigilance is required in the early identification of these cases for prompt diagnosis and treatment. Some notable differences such as an earlier onset of GBS symptoms, higher respiratory dysfunction, and higher mortality rates in COVID-19 patients have been observed between the presentation of GBS in the context of COVID-19 and GBS of other causes.

Metabolic Reprogramming in SARS-CoV-2 Infection Impacts the Outcome of COVID-19 Patients

Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection triggers inflammatory clinical stages that affect the outcome of patients with coronavirus disease 2019 (COVID-19). Disease severity may be associated with a metabolic imbalance related to amino acids, lipids, and energy-generating pathways. The aim of this study was to characterize the profile of amino acids and acylcarnitines in COVID-19 patients. A multicenter, cross-sectional study was carried out. A total of 453 individuals were classified by disease severity. Levels of 11 amino acids, 31 acylcarnitines, and succinylacetone in serum samples were analyzed by electrospray ionization-triple quadrupole tandem mass spectrometry. Different clusters were observed in partial least squares discriminant analysis, with phenylalanine, alanine, citrulline, proline, and succinylacetone providing the major contribution to the variability in each cluster (variable importance in the projection >1.5). In logistic models adjusted by age, sex, type 2 diabetes mellitus, hypertension, and nutritional status, phenylalanine was associated with critical outcomes (odds ratio=5.3 (95% CI 3.16-9.2) in the severe vs. critical model, with an area under the curve of 0.84 (95% CI 0.77-0.90). In conclusion the metabolic imbalance in COVID-19 patients might affect disease progression. This work shows an association of phenylalanine with critical outcomes in COVID-19 patients, highlighting phenylalanine as a potential metabolic biomarker of disease severity.

SARS‐CoV ‐2, HIV , and Mycobacterium tuberculosis triple co‐infection

Tuberculosis (TB)‐related death has increased for the first time in a decade due to the coronavirus disease 2019 (COVID‐19), globally. People living with HIV (PLWHIV) might be at a higher risk of developing COVID‐19‐related complications. Herein, we describe the first case of a patient surviving from SARS‐CoV‐2‐TB‐HIV triple co‐infection in Cameroon. A 36‐year‐old Cameroonian woman presented at the emergency unit of the Jamot Hospital, Yaoundé with symptoms of anorexia, productive cough, weight loss, and fever. The SARS‐CoV‐2 rapid antigen test on nasopharyngeal sample was positive. Chest X‐ray showed bilateral parenchymal and tracheal calcifications most consistent with prior pulmonary histoplasmosis, varicella, or TB. She was tested HIV positive, and the sputum sample tested positive for TB on auramine staining. TB therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol) and COVID‐19 treatment were initiated, and the symptoms improved after 2 weeks of treatment. The SARS‐CoV‐2 rapid antigen and real‐time polymerase chain reaction tests were negative after 2 weeks. She was discharged home on antiretroviral therapy and TB therapy. Coinfection with both TB, HIV, and SARS‐CoV‐2 may be common in Cameroon but not reported. The similar clinical features of COVID‐19 and TB usually lead to misdiagnosis. Early diagnosis and initiation of appropriate treatment improve outcome.

COVID‐19, TB, and HIV are infectious diseases of global public health concern. Triple Co‐infection with these diseases can create a diagnostic and therapeutic dilemma. We present a 36‐year‐old Cameroonian woman who survived SARS‐CoV‐2 – HIV‐TB triple co‐infection. Timely diagnosis and appropriate management of these infections may improve outcomes and prevent complications.

Cardiac resynchronization therapy defibrillator: de novo implant in a COVID-19 patient by an echo-guided axillary venous approach

The COVID-19 pandemic has seriously revolutionized the management of patients who need an implanted cardiac implantable electronic device. We report, for the first time, a successful cardiac resynchronization therapy defibrillator implantation procedure in an 82-year-old man affected by COVID-19, recent myocardial infarction, second-degree 2:1 atrioventricular block and left bundle branch block.

Prognostic Value of Transaminases and Bilirubin Levels at Admission to Hospital on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

Introduction: Given the impact of COVID-19 on the world healthcare system, and the efforts of the healthcare community to find prognostic factors for hospitalization, disease progression, and mortality, the aim of the present study was to investigate the prognostic impact of transaminases and bilirubin levels at admission to hospital on disease progression and mortality in COVID-19 patients. Methods: Using the CoviCamp database, we performed a multicenter, observational, retrospective study involving 17 COVID-19 Units in southern Italy. We included all adult patients hospitalized for SARS-CoV-2 infection with at least one determination at hospital admission of aminotransaminases and/or total bilirubin. Results: Of the 2054 patients included in the CoviCamp database, 1641 were included in our study; 789 patients (48%) were considered to have mild COVID-19, 347 (21%) moderate COVID-19, 354 (22%) severe COVID-19, and 151 patients (9%) died during hospitalization. Older age (odds ratio (OR): 1.02; 95% confidence interval (CI) 1.01–1.03), higher Charlson comorbidity index (CCI) (OR 1.088; 95%CI 1.005–1.18), presence of dementia (OR: 2.20; 95% CI: 1.30–3.73), higher serum AST (OR: 1.002; 95% CI: 1.0001–1.004), and total bilirubin (OR: 1.09; 95% CI: 1.002–1.19) values were associated with a more severe clinical outcome. Instead, the 151 patients who died during hospitalization showed a higher serum bilirubin value at admission (OR 1.1165; 95% CI: 1.017–1.335); the same did not apply for AST. Discussion: Patients with COVID-19 with higher levels of AST and bilirubin had an increased risk of disease progression.

SARS-CoV-2 seroprevalence around the world: an updated systematic review and meta-analysis

BACKGROUND

Covid-19 has been one of the major concerns around the world in the last 2 years. One of the challenges of this disease has been to determine its prevalence. Conflicting results of the serology test in Covid explored the need for an updated meta-analysis on this issue. Thus, this systematic review aimed to estimate the prevalence of global SARS-CoV-2 serology in different populations and geographical areas.

METHODS

To identify studies evaluating the seroprevalence of SARS-CoV-2, a comprehensive literature search was performed from international databases, including Medline (PubMed), Web of Sciences, Scopus, EMBASE, and CINHAL.

RESULTS

In this meta-analysis, the results showed that SARS-CoV-2 seroprevalence is between 3 and 15% worldwide. In Eastern Mediterranean, the pooled estimate of seroprevalence SARS-CoV-2 was 15% (CI 95% 5-29%), and in Africa, the pooled estimate was 6% (CI 95% 1-13%). In America, the pooled estimate was 8% (CI 95% 6-11%), and in Europe, the pooled estimate was 5% (CI 95% 4-6%). Also the last region, Western Pacific, the pooled estimate was 3% (CI 95% 2-4%). Besides, we analyzed three of these areas separately. This analysis estimated the prevalence in subgroups such as study population, diagnostic methods, sampling methods, time, perspective, and type of the study.

CONCLUSION

The present meta-analysis showed that the seroprevalence of SARS-CoV-2 has been between 3 and 15% worldwide. Even considering the low estimate of this rate and the increasing vaccination in the world, many people are still susceptible to SARS-CoV-2.

The Role of Cytokines and Chemokines in Severe Acute Respiratory Syndrome Coronavirus 2 Infections

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in countless infections and caused millions of deaths since its emergence in 2019. Coronavirus disease 2019 (COVID-19)-associated mortality is caused by uncontrolled inflammation, aberrant immune response, cytokine storm, and an imbalanced hyperactive immune system. The cytokine storm further results in multiple organ failure and lung immunopathology. Therefore, any potential treatments should focus on the direct elimination of viral particles, prevention strategies, and mitigation of the imbalanced (hyperactive) immune system. This review focuses on cytokine secretions of innate and adaptive immune responses against COVID-19, including interleukins, interferons, tumor necrosis factor-alpha, and other chemokines. In addition to the review focus, we discuss potential immunotherapeutic approaches based on relevant pathophysiological features, the systemic immune response against SARS-CoV-2, and data from recent clinical trials and experiments on the COVID-19-associated cytokine storm. Prompt use of these cytokines as diagnostic markers and aggressive prevention and management of the cytokine storm can help determine COVID-19-associated morbidity and mortality. The prophylaxis and rapid management of the cytokine storm appear to significantly improve disease outcomes. For these reasons, this study aims to provide advanced information to facilitate innovative strategies to survive in the COVID-19 pandemic.

Coagulation Profile and Outcomes of COVID-19 Patients at Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: Coronavirus disease 2019 (COVID-19) is a viral pneumonia infection that spreads rapidly globally (with a number of cases > 15,000,000 worldwide and mortality of ±4%) until it is designated a pandemic by the World Health Organization (WHO). One of the complications of COVID-19 is the incidence of coagulopathy and thromboembolism. The coronavirus, SARS-CoV-2, activates inflammatory and thrombotic processes. Coagulopathy and abnormal coagulation parameters are indicated among the most significant biomarkers of poor prognosis in COVID-19 patients. COVID-19-associated coagulopathy is characterized by a decreased platelet count and the presence of a cytokine storm indicating an extreme hypercoagulable state. This study aims to determine the coagulation profile of moderate-severe patients and outcomes in COVID-19 patients Methods: The study was conducted in a hospital in Makassar: Infection Center RS. Wahidin Sudirohusodo. Medical Record Data for all inpatients who have been diagnosed with COVID-19 through the RT-PCR test taken from January 2021-August 2021.Statistical tests in the form of the Kolmogorov-Smirnov test to assess the Normality of the Data, Chi-Square test, and the calculation of the out ratio (OR) Mann-Whitney test, Independent T-Test. Multivariate analysis was carried out using a Multiple Logistic Regression-Backward Wald Method. The results of the statistical test were significant if the p-value <0.05.   Results: The research subjects were 231 patients with confirmed COVID-19. The mean PT, D-Dimer, and Fibrinogen were higher in severe COVID-19 than moderate COVID-19 and had significant results. While PLT did not have significant results against moderate-severe COVID-19. The relationship between groups of coagulation marker variables was found to have a significant relationship with moderate to severe COVID-19. 4.     All coagulation markers were significantly related to the outcome (p<0.05). The mean value of each variable was found to be greater in patients with outcomes who died   Conclusion: There was an increase in all coagulation markers in moderate to severe COVID-19 except for PLT which was not significant. All coagulation markers are significantly related to outcome

Small Intestine Perforation in a 69-Year-Old Man with COVID-19

Coronavirus disease 2019 (COVID-19) had caused pandemia with a high rate of mortality and morbidity. Lung involvement is the main cause of mortality, but central nervous system and cardiac disease, and thromboemboli may participate in increasing mortality. A wide spectrum of organs involvement and complication has been reported as data gathering during the pandemia has progressed. We report a 69-year-old man who was admitted to Imam Khomeini hospital in Tehran and complained of severe abdominal pain and fever. He had been admitted 10 days earlier because of dyspnea and fever. At the first admission, based on the findings in the lung computed tomography (CT) and a positive nasopharyngeal polymerase chain reaction (PCR) test for COVID-19, he was treated with intravenous remdesivir for 5 days and prophylactic anti-coagulant heparin during hospital admission. Two days before the new admission, he was discharged with relative recovery. During the new admission, because of the absence of hypoxemia and leukocytosis diagnostic approach to abdominal pain was planned. In abdominal imaging, evidence of bowel perforation appeared. In laparotomy, suppurative peritonitis and proximal jejunal perforation without definite etiology were seen, and bowel resection and primary anastomosis were done. After 5 days, the patient was discharged in good condition. This case is reported to inform that bowel perforation due to ischemia or vasculitis may complicate the course of COVID-19 and, in cases of gastrointestinal symptoms, should be considered.

Putative Role of the Lung-Brain Axis in the Pathogenesis of COVID-19-Associated Respiratory Failure: A Systematic Review

The emergence of SARS-CoV-2 and its related disease caused by coronavirus (COVID-19) has posed a huge threat to the global population, with millions of deaths and the creation of enormous social and healthcare pressure. Several studies have shown that besides respiratory illness, other organs may be damaged as well, including the heart, kidneys, and brain. Current evidence reports a high frequency of neurological manifestations in COVID-19, with significant prognostic implications. Importantly, emerging literature is showing that the virus may spread to the central nervous system through neuronal routes, hitting the brainstem and cardiorespiratory centers, potentially exacerbating the respiratory illness. In this systematic review, we searched public databases for all available evidence and discuss current clinical and pre-clinical data on the relationship between the lung and brain during COVID-19. Acknowledging the involvement of these primordial brain areas in the pathogenesis of the disease may fuel research on the topic and allow the development of new therapeutic strategies.

Persistence of Naturally Acquired and Functional SARS-CoV-2 Antibodies in Blood Donors One Year after Infection

The developmental course of antibodies produced after a SARS-CoV-2 infection has been insufficiently investigated so far. Therefore, the aim of this study was to investigate the dynamics of SARS-CoV-2 antibody levels against the viral nucleocapsid- and spike-protein among Austrian blood donors as a representative group of a supposedly healthy population within the first year after a SARS-CoV-2 infection. The impact of age, sex, vaccination status, AB0-blood group and awareness about the infection was evaluated. Our study shows that the level of anti-N antibodies is declining, while anti-S antibody levels remain stable. Antibodies detected were functional in vitro. Age, sex and blood group do not influence antibody dynamics. However, blood group AB shows significantly lower antibody levels and in vitro functionality compared to other blood groups. Our data reveal that one out of five individuals was not aware of a previous SARS-CoV-2 infection and that the disease course neither affects the level of antibody production nor the in vitro functionality. We also found that 14% of participants show persisting COVID-19-related symptoms for up to nine months. Our results provide valuable insights into the dynamics of the immune response after a SARS-CoV-2 infection in a representative cohort of adult blood donors in Central Europe.

COVID-19 Disease in Syrian Patients With Cancer: Clinical Manifestations, Laboratory Findings, Treatment, and Outcomes

PURPOSE

This study aims to describe the clinical manifestations, laboratory findings, treatment, and outcomes of patients with cancer with COVID-19 infection in Syria. The primary objective was to identify the overall survival (OS) time, and the secondary objectives were to identify factors associated with severe COVID-19 infection.

METHODS

This multicenter retrospective study was undertaken at four hospitals in Damascus, Syria, between March 28, 2020, and March 29, 2021. Data extracted from medical records included clinical manifestations, radiologic findings, laboratory results, treatment, and outcomes. Survival analysis was done by using the Kaplan-Meier method and Cox regression model for follow-up and anticancer treatment patients to study the effect on OS time. The effects of potential risk factors of developing severe COVID-19 were studied by multivariable logistic regression.

RESULTS

Of 114 patients included, 61 (53.51%) were male. Smokers represented 29 (25.44%), and 63 (55.26%) patients had a history of coexisting chronic diseases. The most common cancer type was breast cancer 17 (14.91%). Sixty-eight (59.65%) patients were receiving anticancer treatment within 1 month of being diagnosed with COVID-19 infection and 46 (40.35%) were outpatient follow-ups. Multiple logistic regression analysis showed that comorbidities (odds ratio: 2.814, P = .044) and anticancer treatment (odds ratio: 8.790, P < .05) were risk factors linked to severe to critical COVID-19 infection. OS time was 245 (95% CI, 217.96 to 272.47) days, lower among patients with cancer with COVID-19 infection receiving anticancer treatment compared with follow-up patients (P value < .05).

CONCLUSION

Patients with cancer with COVID-19 infection receiving anticancer treatment had a lower OS time. It may be worth considering stopping anticancer treatment in patients with cancer with COVID-19 when possible in search of better outcomes.

Nursing diagnoses in hospitalized patients with COVID-19 in Indonesia

Background

The COVID-19 pandemic has become a global public health issue, and the roles of nurses are very much needed in providing nursing services in the current situation. The enforcement of appropriate nursing diagnoses for patients with COVID-19 is also fundamental in determining proper nursing care to help the patients achieve maximum health.

Objective

This study aimed to describe and analyze nursing diagnoses in patients with COVID-19 treated in the isolation rooms and ICUs.

Methods

This study used a secondary data analysis from hospital medical record data of patients with COVID-19 from early December 2020 to the end of February 2021. Data were selected using a cluster random sampling technique and analyzed using descriptive statistics.

Results

The results showed that the signs and symptoms of the patients with COVID-19 that often appeared were fever, cough, shortness of breath, and decreased consciousness. The common nursing diagnoses in the hospitalized patients with COVID-19 were hyperthermia, ineffective airway clearance, gas exchange disorder, self-care deficit, spontaneous ventilation disorder, spontaneous circulation disorder, knowledge deficit, and shock risk.

Conclusion

This study offers an insight into nursing practices in the hospital setting, which can be used as a basis for nurses to perform complete nursing assessments and nursing diagnoses during the pandemic.

SARS-CoV-2 Gene Expression as a Prognosis Predictor for COVID-19

Introduction: Real time quantitative PCR is the gold standard for detection of SARS-CoV-2 which is specific, sensitive, and simple quantitative. The target of RT-qPCR is to assess the expression level of the SARS-CoV-2 gene through cycle threshold values (CT-value). The purpose of this study was to analyze the association of the level of SARS-CoV-2 gene expression and the severity of COVID-19 in patients hospitalized. Method: This research is an analytic observational study with cross sectional method. While the research sample was taken using a consecutive sampling technique from the Medical Records of Sumedang Hospital and Cideres Hospital, West Java, Indonesia from December 2020 to March 2021. Patient parameters include analysis of age, sex, comorbidity, and disease severity. The severity of the patient is classified based on complaints and oxygen saturation. The expression level of the SARS-CoV-2 N gene and E gene were assessed by calculating the relative quantification by comparing the expression of the E and N gene with the expression of the internal control gene by Livak formula (2-ΔΔCT Formula). Result: The Spearman correlation test showed that there was a relationship between the expression of SARS-CoV-2 genes E and N genes with the severity of COVID-19 patients (with r=0.374 and p<0.0001) and (with r=0.452 and p<0.0001). Conclusions:  There is an correlation between the level of expression of genes E and gene N with the severity of patients.  

A study on knowledge, attitude and practices towards the COVID-19 pandemic among the non-COVID-19 patients at Outpatient Department in a Teaching Hospital, Northern Sri Lanka

Background:

Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) has infected millions of people all over the world and Sri Lanka is not an exception for the impact of Coronavirus Disease (COVID-19). As there are no effective therapeutic agents at present and newly developed vaccines are not freely available for many countries, preventive measures such as handwashing, social distancing, and respiratory etiquette are key to control of spread. The effective implementation of these measures depends on public knowledge and attitude towards COVID-19 and adherence to key practices.

Methods:

This is a cross-sectional study conducted among 500 non-COVID-19 patients who attended the Outpatient Department (OPD) of the Teaching Hospital Jaffna, Sri Lanka. Knowledge, attitude and practices (KAP) was assessed through a self-administered questionnaire and analysis was performed by using SPSS 26.

Results:

The majority were females (67.8%) and the mean age of the participants was 36.9 (range: 15–85). Most of the participants were homemakers. Two hundred and twenty-two patients (44.4%: 40.1–48.8) showed a suboptimal knowledge score regarding COVID-19. The males, age above 65, were significantly associated with low knowledge score (P < 0.05). Similarly, a significant proportion (36.4%: 32.3–40.7) showed a suboptimal attitude score but the majority of the participants have adopted positive behaviours such as frequently washing hands (88.4%) and wearing masks in appropriate places (91.6%). The major sources for information regarding COVID-19 among the participants were the news media (54.0%) followed by social media (23.2%).

Conclusion:

As a significant proportion of the participants showed a poor knowledge score and gaps in specific aspects related to COVID-19, the primary care physicians have a significant role to play to improve community knowledge by educating specific groups such as the males and elderly by using appropriate news media and social media platforms.

Targeting SARS-CoV-2 main protease by teicoplanin: A mechanistic insight by docking, MM/GBSA and molecular dynamics simulation

First emerged in late December 2019, the outbreak of novel severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) pandemic has instigated public-health emergency around the globe. Till date there is no specific therapeutic agent for this disease and hence, the world is craving to identify potential antiviral agents against SARS-CoV-2. The main protease (M^Pro) is considered as an attractive drug target for rational drug design against SARS-CoV-2 as it is known to play a crucial role in the viral replication and transcription. Teicoplanin is a glycopeptide class of antibiotic which is regularly used for treating Gram-positive bacterial infections, has shown potential therapeutic efficacy against SARS-CoV-2 in vitro. Therefore, in this study, a mechanistic insight of intermolecular interactions between teicoplanin and SARS-CoV-2 M^Pro has been scrutinized by molecular docking. Both monomeric and dimeric forms of M^Pro was used in docking involving blind as well as defined binding site based on the known inhibitor. Binding energies of teicoplanin-M^Pro complexes were estimated by Molecular Mechanics/Generalized Born Surface Area (MM/GBSA) computations from docking and simulated trajectories. The dynamic and thermodynamics constraints of docked drug in complex with target proteins under specific physiological conditions was ascertained by all-atom molecular dynamics simulation of 100 ns trajectory. Root mean square deviation and fluctuation of carbon α chain justified the stability of the bound complex in biological environments. The outcomes of current study are supposed to be fruitful in rational design of antiviral drugs against SARS-CoV-2.

Common Inflammatory Mechanisms in COVID-19 and Parkinson's Diseases: The Role of Microbiome, Pharmabiotics and Postbiotics in Their Prevention

In the last decade, metagenomic studies have shown the key role of the gut microbiome in maintaining immune and neuroendocrine systems. Malfunction of the gut microbiome can induce inflammatory processes, oxidative stress, and cytokine storm. Dysfunction of the gut microbiome can be caused by short-term (virus infection and other infectious diseases) or long-term (environment, nutrition, and stress) factors. Here, we reviewed the inflammation and oxidative stress in neurodegenerative diseases and coronavirus infection (COVID-19). Here, we reviewed the renin-angiotensin-aldosterone system (RAAS) involved in the processes of formation of oxidative stress and inflammation in viral and neurodegenerative diseases. Moreover, the coronavirus uses ACE2 receptors of the RAAS to penetrate human cells. The coronavirus infection can be the trigger for neurodegenerative diseases by dysfunction of the RAAS. Pharmabiotics, postbiotics, and next-generation probiotics, are considered as a means to prevent oxidative stress, inflammatory processes, neurodegenerative and viral diseases through gut microbiome regulation.

The Role of an Anti-Inflammatory Diet in Conjunction to COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), otherwise known as COVID-19, has challenged healthcare systems at an international level. COVID-19 suppresses the immune system by causing a systemic inflammatory response, also known as cytokine release syndrome, leaving COVID-19 patients with high levels of proinflammatory cytokines and chemokines. Nutrition's function in the respiratory and immune systems has been investigated in much research, and its significance cannot be overstated, as the nutritional status of patients has been shown to be directly connected with the severity of the disease. Key dietary components such as vitamin C, D, omega-3 fatty acids, and zinc have shown potential in their anti-inflammatory effects, as well as the famous Mediterranean diet. This review aims to discuss the use of anti-inflammatory dietary approaches to prevent Sars-CoV-2 or lessen COVID-19 effects.

Lactoferrin as Antiviral Treatment in COVID-19 Management: Preliminary Evidence

Lactoferrin (Lf), a multifunctional cationic glycoprotein synthesized by exocrine glands and neutrophils, possesses an in vitro antiviral activity against SARS-CoV-2. Thus, we conducted an in vivo preliminary study to investigate the antiviral effect of oral and intranasal liposomal bovine Lf (bLf) in asymptomatic and mild-to-moderate COVID-19 patients. From April 2020 to June 2020, a total of 92 mild-to-moderate (67/92) and asymptomatic (25/92) COVID-19 patients were recruited and divided into three groups. Thirty-two patients (14 hospitalized and 18 in home-based isolation) received only oral and intranasal liposomal bLf; 32 hospitalized patients were treated only with standard of care (SOC) treatment; and 28, in home-based isolation, did not take any medication. Furthermore, 32 COVID-19 negative, untreated, healthy subjects were added for ancillary analysis. Liposomal bLf-treated COVID-19 patients obtained an earlier and significant (p < 0.0001) SARS-CoV-2 RNA negative conversion compared to the SOC-treated and untreated COVID-19 patients (14.25 vs. 27.13 vs. 32.61 days, respectively). Liposomal bLf-treated COVID-19 patients showed fast clinical symptoms recovery compared to the SOC-treated COVID-19 patients. In bLf-treated patients, a significant decrease in serum ferritin, IL-6, and D-dimers levels was observed. No adverse events were reported. These observations led us to speculate a potential role of bLf in the management of mild-to-moderate and asymptomatic COVID-19 patients.

Effect of Age on Innate and Adaptive Immunity in Hospitalized COVID-19 Patients

An effective but balanced cellular and inflammatory immune response may limit the severity of coronavirus disease (COVID-19), whereas uncontrolled inflammation leads to disease progression. Older age is associated with higher risk of COVID-19 and a worse outcome, but the underlying immunological mechanisms for this age-related difference are not clear. We investigated the impact of age on viral replication, inflammation, and innate and adaptive cellular immune responses in 205 hospitalized COVID-19 patients. During the early symptomatic phase of COVID-19, we found that patients above 65 years had significantly higher viral load, higher levels of proinflammatory markers, and inadequate mobilization and activation of monocytes, dendritic cells, natural killer cells, and CD8 T cells compared to those below 65 years. Our study points toward age-related deficiencies in the innate immune cellular response to SARS-CoV-2 as a potential cause of poorly controlled viral replication and inflammation during the early symptom phase and subsequent disease progression.

The impact of COVID-19 in pregnancy: Part II. Vaccination to pregnant women

Effective strategies are urgently needed to decrease the risk of untoward outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) infection. Pregnant women are a vulnerable population to infectious disease pandemics with dramatically increased infectious diseases-related serious complications, such as the need of hospitalizations, the need of admission to intensive care unit, and the final disease-related death compared with those nonpregnant counterparts or those pregnant women without infection. Several studies have shown that vaccinations in pregnancy are a safe and highly effective strategy, not only for pregnant women but also for fetus and/or newborn because of the passive transplacental transfer of antibodies to the offspring. Active and passive prevention of infectious diseases is approved as effective strategies for women who attempt to become pregnant or during pregnancy. Despite the large and proven scientific evidence, pregnant women still puzzle over whether they should get vaccinated. The question therefore arises: Why are pregnant women so reluctant to receive vaccination? The explanation is more likely in the way that the benefits of vaccination have been communicated "confusedly." In fact, like virtually all clinical trials, all the COVID-19 vaccine trials have excluded pregnant and lactating women from participating, contributing to uncertainty of safety and efficacy in COVID-19 vaccines that have been well prepared and available for the general adult population worldwide. Moreover, messenger RNA vaccine is a relatively brand-new vaccine, and experience with this type of vaccine is still scarce. It is hard to overcome this innovation deadlock. The knowledge and awareness of pregnant women who are at risk, and full information on the knowledge of vaccines and related preventable diseases in pregnant women may avoid hesitancy and increase vaccine acceptance. The current review is a part two addressing the impact of COVID-19 on pregnant women. We focus on the up-to-date information about the application of vaccination on pregnant women, especially during this COVID-19 pandemic.

In vitro induction of interleukin-8 by SARS-CoV-2 Spike protein is inhibited in bronchial epithelial IB3-1 cells by a miR-93-5p agomiR

One of the major clinical features of COVID-19 is a hyperinflammatory state, which is characterized by high expression of cytokines (such as IL-6 and TNF-α), chemokines (such as IL-8) and growth factors and is associated with severe forms of COVID-19. For this reason, the control of the “cytokine storm” represents a key issue in the management of COVID-19 patients. In this study we report evidence that the release of key proteins of the COVID-19 “cytokine storm” can be inhibited by mimicking the biological activity of microRNAs. The major focus of this report is on IL-8, whose expression can be modified by the employment of a molecule mimicking miR-93-5p, which is able to target the IL-8 RNA transcript and modulate its activity. The results obtained demonstrate that the production of IL-8 protein is enhanced in bronchial epithelial IB3-1 cells by treatment with the SARS-CoV-2 Spike protein and that IL-8 synthesis and extracellular release can be strongly reduced using an agomiR molecule mimicking miR-93-5p.

Survival from a Triple Co-Infection of COVID-19, HIV, and Tuberculosis: A Case Report

Introduction

The triple burden of COVID-19, human immune virus (HIV), and TB co-infection is one of the contemporary challenges to this globe. People living with chronic medical diseases such as HIV and TB are more likely to experience poor outcomes from COVID-19. This study aimed to report survival from triple co-infection with PTB, HIV, and COVID-19 in Wollega University referral hospital (WURH), western Ethiopia.

Case Presentation

A 55-year-old male known HIV patient on HAART for the last 3 years presented to WURH on May 26, 2021, with chief complaints of shortness of breath of 5 days' duration associated with productive cough, history of high-grade fever, and severe headache. He had produced a lot of bloody sputum one month prior to the current complaints. On 1st day of his presentation, a Gene Expert test was done from sputum, and he was positive for pulmonary TB. On the same day, a nasopharyngeal sample for COVID-19 using polymerase chain reaction (PCR) was positive. On his 2nd day of admission, he was transferred to the COVID-19 treatment center with the diagnosis of severe COVID-19, PTB, and WHO stage-3 RVI. During his stay in the hospital, he was provided with oxygen via a nasal cannula. Intensive phase anti-TB treatment was initiated on the 3rd day of admission. HAART was continued with the same regimen he was taking prior to his presentation. On June 6, 2021, the patient was recovered and discharged from the hospital after 10 days of hospital stay.

Conclusion

This case report suggests, after 10 days of admission with triple infections, there is a good clinical prognosis and survival from COVID-19. On admission, further diagnosis and investigations of TB co-infection should be performed for all patients admitted with COVID-19 due to their similar and non-specific clinical manifestations.

A symptomatic near-term pregnant woman recovered from SARS-CoV-2 infection

OBJECTIVE

Coronavirus-2019 (COVID-19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are described in Taiwan. We share our experience to manage a pregnant women with COVID-19 in the third trimester and subsequent delivery at term.

CASE REPORT

A 43-year-old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory-confirmed SARS-CoV-2 infection at the 35 gestational weeks (GW). During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37 GW. Finally, she delivered a female baby with Apgar score of 8-9 points at 38 GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS-CoV-2 infection) were discharged uneventfully.

CONCLUSION

Our report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.

The impact of COVID-19 in pregnancy: Part I. Clinical presentations and untoward outcomes of pregnant women with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019, COVID-19) is a pandemic disease with rapidly and widely disseminating to the world. Based on experiences about the H1N1, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) coronavirus pandemics, pregnant women who are infected are disproportionately more likely to develop severe illness and need more hospitalizations, intensive care, and finally die of diseases compared with those nonpregnant counterparts or those pregnant women without infection. Although more than one half of pregnant women with COVID-19 are asymptomatic, and as well as their symptoms are frequently mild, this observation presents a further challenge regarding service provision, prevention, and management, in which this may result in overlooking the risk of COVID-19 during pregnancy. As predictable, despite much advance in critical care in recent decades, during the 2020 COVID-19 pandemic, pregnant women with COVID-19 are really at higher risk to progress to severe illness; require hospitalization; need intensive care, such as the use of mechanical ventilation as well as extracorporeal membrane oxygenation (ECMO), and of most important, die than their nonpregnant counterparts and pregnant women without COVID-19. The magnitude of the risk to pregnant women further extend to their newborn from COVID-19 with resultant significantly increasing perinatal and neonatal morbidity and mortality rates. The heightened risk of untoward outcomes in pregnant women emphasizes an urgent need of national or international recommendations and guidelines to optimize prevention and management strategies for COVID-19 in pregnancy. Active and passive prevention of COVID-19 is approved as effective strategies for women who attempt to be pregnant or during pregnancy. Understanding that pregnant women who are a vulnerable population is essential to improve the care in the novel and urgent COVID-19 pandemic. The current review is a part I to summarize the up-to-date information about the impact of laboratory-confirmed SARS-CoV-2 infection on pregnant women and focus on clinical presentations and untoward pregnancy outcomes of these pregnant women infected with SARS-CoV-2.

Human Coronaviruses: Counteracting the Damage by Storm

Over the past 18 years, three highly pathogenic human (h) coronaviruses (CoVs) have caused severe outbreaks, the most recent causative agent, SARS-CoV-2, being the first to cause a pandemic. Although much progress has been made since the COVID-19 pandemic started, much about SARS-CoV-2 and its disease, COVID-19, is still poorly understood. The highly pathogenic hCoVs differ in some respects, but also share some similarities in clinical presentation, the risk factors associated with severe disease, and the characteristic immunopathology associated with the progression to severe disease. This review aims to highlight these overlapping aspects of the highly pathogenic hCoVs-SARS-CoV, MERS-CoV, and SARS-CoV-2-briefly discussing the importance of an appropriately regulated immune response; how the immune response to these highly pathogenic hCoVs might be dysregulated through interferon (IFN) inhibition, antibody-dependent enhancement (ADE), and long non-coding RNA (lncRNA); and how these could link to the ensuing cytokine storm. The treatment approaches to highly pathogenic hCoV infections are discussed and it is suggested that a greater focus be placed on T-cell vaccines that elicit a cell-mediated immune response, using rapamycin as a potential agent to improve vaccine responses in the elderly and obese, and the potential of stapled peptides as antiviral agents.

Assessment of depression, anxiety and stress in COVID-19 infected individuals and their families

Background

Pandemics have been associated with widespread psychological distress in the normal population due to quarantine and lockdown, however there are only few studies on psychiatric symptoms in COVID infected patients and their families. This study was planned to assess the depressive, anxiety and stress symptoms in individuals and their families infected with COVID19, during current pandemic.

Methods

A cross-sectional, observational study was conducted on hospitalised, COVID infected patients and their immediate family members. Ninety-three, COVID patients and fifty-four family members were studied through Google forms which contained socio-demographic proforma and Depression Anxiety Stress Scale-21 (DASS21). Collected data was tabulated to assess depression, anxiety and stress symptoms in the given population and study their relation with various sociodemographic variables.

Results

Almost one-third of the sample showed increased score on depression and anxiety subscales and one-fifth on stress subscales. 30–45% of the family members studied had higher score on either of the subset. There was also a high correlation between the scores of depression, anxiety and stress subset in the study sample.

Conclusion

This study, reflects high magnitude of depression, anxiety and stress symptoms in these patients and their families which alert us to the need for definitive interventions in these affected individuals.

Hypotheses and facts for genetic factors related to severe COVID-19

Genome-wide association analysis allows the identification of potential candidate genes involved in the development of severe coronavirus disease 2019 (COVID-19). Hence, it seems that genetics matters here, as well. Nevertheless, the virus's nature, including its RNA structure, determines the rate of mutations leading to new viral strains with all epidemiological and clinical consequences. Given these observations, we herein comment on the current hypotheses about the possible role of the genes in association with COVID-19 severity. We discuss some of the major candidate genes that have been identified as potential genetic factors associated with the COVID-19 severity and infection susceptibility: HLA, ABO, ACE2, TLR7, ApoE, TYK2, OAS, DPP9, IFNAR2, CCR2, etc. Further study of genes and genetic variants will be of great benefit for the prevention and assessment of the individual risk and disease severity in different populations. These scientific data will serve as a basis for the development of clinically applicable diagnostic and prognostic tests for patients at high risk of COVID-19.

Clinical significance of olfactory dysfunction in patients of COVID-19

BACKGROUND

Currently, as the coronavirus disease (COVID-19) has become a pandemic, rapidly obtaining accurate information of patient symptoms and their progression is crucial and vital. Although the early studies in China have illustrated that the representative symptoms of COVID-19 include (dry) cough, fever, headache, fatigue, gastrointestinal discomfort, dyspnea, and muscle pain, there is increasing evidence to suggest that olfactory and taste disorder are related to the COVID-19 pandemic. Therefore, we conduct this study to review the present literature about the correlation between anosmia or dysgeusia and COVID-19.

METHODS

A comprehensive literature search in 2020 of the electronic journal databases, mainly PubMed or Web of Science, was performed using the keywords COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with hyposmia, anosmia, dysgeusia, olfactory disorder, or olfactory dysfunction. The country, study period, case number, inpatient or outpatient medical visit, evaluation method (subjective complaints of dysfunction or objective evaluation), and occurrence rate of olfactory or gustatory function were reviewed.

RESULTS

Many studies reported that the recoverable olfactory or gustatory dysfunction may play an important role as the early clinical symptom of COVID-19. It is associated with better prognosis, although further investigation and validation should be carried out.

CONCLUSION

Studies have shown that smell and taste disturbances may represent an early symptom of COVID-19 and healthcare professionals must be very vigilant when managing patients with these symptoms. In the pandemic era, this implies testing for COVID-19 by healthcare workers with full personal protective equipment.

Gastrointestinal manifestations of human immunodeficiency virus and coronavirus disease 2019: Understanding the intersecting regions between the two epidemics

In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable.

GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions.

Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development.

Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Aims

COVID-19 is associated with diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and euglycaemic DKA (EDKA); however, evidence regarding parameters affecting outcome and mortality rates is scarce.

Methods

A systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 2020 to 7 January 2021 to identify all studies describing clinical profile, outcome and mortality rates regarding DKA, HHS, DKA/HHS and EDKA cases in COVID-19 patients. The appropriate Joanna Briggs Institute tools were used for quality assessment; quality of evidence was approached using GRADE. Univariate and multivariate analyses were used to assess correlations between clinical characteristics and outcome based on case reports. Combined mortality rates (CMR) were estimated from data reported in case report series, cross-sectional studies, and meta-analyses. The protocol was submitted to PROSPERO (ID: 229356/230737).

Results

From 312 identified publications, 44 were qualitatively and quantitatively analyzed. Critical COVID-19 necessitating ICU (P = 3 × 10^–8), DKA/HHS presence (P = 0.021), and AKI (P = 0.037) were independently correlated with death. Increased COVID-19 severity (P = 0.003), elevated lactates (P < 0.001), augmented anion gap (P < 0.001), and AKI (P = 0.002) were associated with DKA/HHS. SGLT-2i were linked with EDKA (P = 0.004) and negatively associated with AKI (P = 0.023). CMR was 27.1% (95% CI 11.2–46.9%) with considerable heterogeneity (I² = 67%).

Conclusion

Acute diabetes-related metabolic emergencies in COVID-19 patients lead to increased mortality; key determinants are critical COVID-19 illness, coexistence of DKA/HHS and AKI. Previous SGLT-2i treatment, though associated with EDKA, might preserve renal function in COVID-19 patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-021-00502-9.

Improved COVID-19 ICU admission and mortality outcomes following treatment with statins: a systematic review and meta-analysis

INTRODUCTION

Approximately 1% of the world population has now been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). With cases still rising and vaccines just beginning to rollout, we are still several months away from seeing reductions in daily case numbers, hospitalisations, and mortality. Therefore, there is a still an urgent need to control the disease spread by repurposing existing therapeutics. Owing to antiviral, anti-inflammatory, immunomodulatory, and cardioprotective actions, statin therapy has been considered as a plausible approach to improve COVID-19 outcomes.

MATERIAL AND METHODS

We carried out a meta-analysis to investigate the effect of statins on 3 COVID-19 outcomes: intensive care unit (ICU) admission, tracheal intubation, and death. We systematically searched the PubMed, Web of Science, Scopus, and ProQuest databases using keywords related to our aims up to November 2, 2020. All published observational studies and randomised clinical trials on COVID-19 and statins were retrieved. Statistical analysis with random effects modelling was performed using STATA16 software.

RESULTS

The final selected studies (n = 24 studies; 32,715 patients) showed significant reductions in ICU admission (OR = 0.78, 95% CI: 0.58-1.06; n = 10; I 2 = 58.5%) and death (OR = 0.70, 95% CI: 0.55-0.88; n = 21; I 2 = 82.5%) outcomes, with no significant effect on tracheal intubation (OR = 0.79; 95% CI: 0.57-1.11; n = 7; I 2= 89.0%). Furthermore, subgroup analysis suggested that death was reduced further by in-hospital application of stains (OR = 0.40, 95% CI: 0.22-0.73, n = 3; I 2 = 82.5%), compared with pre-hospital use (OR = 0.77, 95% CI: 0.60-0.98, n = 18; I 2 = 81.8%).

CONCLUSIONS

These findings call attention to the need for systematic clinical studies to assess both pre- and in-hospital use of statins as a potential means of reducing COVID-19 disease severity, particularly in terms of reduction of ICU admission and total mortality reduction.

Evaluation of pheniramine maleate and zofenopril in reducing renal damage induced by unilateral ureter obstruction. An experimental study

INTRODUCTION

Obstruction of the ureter may occur due to congenital, iatrogenic or other reasons. This can cause hydronephrosis in the early stage and can lead to cellular inflammation, necrosis and atrophy in the kidney tissue. The aim of this paper is to evaluate the protective effect of pheniramine maleate (PM) and zofenopril on renal damage caused by hydronephrosis due to unilateral partial ureter obstruction.

MATERIAL AND METHODS

Twenty-four female Sprague Dawley rats were divided into 4 groups. Group 1: sham group, group 2: partial unilateral ureteral obstruction (PUUO) group, group 3: PUUO + PM group, group 4: PUUO + zofenopril group. Paraoxonase (PON), total antioxidant status (TAS) and total oxidant status (TOS) of tissue and blood samples were measured and calculated. Tissue samples were evaluated histopathologically.

RESULTS

An increase in tissue TAS and a decrease in tissue TOS and OSI levels were detected in groups 3 and 4 compared to group 2 (both: p < 0.01). Tissue PON levels showed an increase in groups 3 and 4 compared to groups 1 and 2 (both: p < 0.01). Histopathological evaluation showed a decrease in interstitial inflammation and congestion in groups 3 and 4 compared to the control group (p < 0.001). The decrease was observed to be more significant in group 4 compared to group 3 (p < 0.01).

CONCLUSIONS

In our experimental study, we observed that PM and zofenopril reduce the oxidation and tissue damage caused by unilateral partial obstruction.