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Bureau BL, Obeidat A, Dhariwal MS, Jha P. Peripheral Neuropathy as a Complication of SARS-Cov-2. Cureus 2020; 12:e11452. [PMID: 33214969 PMCID: PMC7673277 DOI: 10.7759/cureus.11452] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
Previous reports have shown various neurological manifestations in about 36.4% of patients infected with SARS-Cov-2. However, peripheral neuropathy was only reported once before. A 40-year-old healthy woman presented with two weeks of cough, nasal congestion, sore throat, intermittent fevers, fatigue, and myalgia but no weakness. She tested positive for the SARS-Cov-2. Physical exam showed no neurologic deficit. Two weeks later, respiratory symptoms were improving but she developed sudden leg pain, numbness, and weakness. She described it as a "pain crisis". Neurological exam showed bilateral symmetrical, non-ascending lower extremity weakness and normal, symmetric reflexes. She had normal magnetic resonance imaging of the brain and spine, spinal fluid analysis, serum studies including creatinine kinase and C-reactive protein. She had elevated lactate dehydrogenase, low serum copper (72.9 (ref: 80.0-155.0 ug/dL)) and low vitamin B6 (14.6 (ref: 20.0-125.0 nmol/L)). A diagnosis of SARS-Cov-2-associated peripheral neuropathy was considered. We pursued empiric treatment with intravenous steroids (1000 mg methylprednisolone for three days), followed by a total of 2 g/kg of intravenous immunoglobulins (IVIG) given over five days. Pain management was done with gabapentin and ketorolac. We replaced copper and vitamin B6. Six weeks later, she reported improvement and was closer to baseline, but she endorsed residual, exertional, mild bilateral lower extremity pain, numbness, and weakness. Previous reports of treatment of SARS-Cov-2-associated neuropathy included corticosteroids and IVIG. Our patient saw the most symptomatic improvement with gabapentin. In our case, the preserved reflexes, lack of ascending pattern, sudden onset of symptoms, and normal cerebrospinal fluid (CSF) argued against Guillain-Barre syndrome. Copper deficiency can result in myelopathy but not peripheral neuropathy, so is unlikely the sole explanation. Awareness and early treatment of peripheral neuropathy in SARS-Cov-2 can result in improved clinical outcomes for patients.
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Affiliation(s)
- Britta L Bureau
- Internal Medicine/Neurology, Medical College of Wisconsin, Wauwatosa, USA
| | - Ahmed Obeidat
- Neurology, Medical College of Wisconsin, Wauwatosa, USA
| | | | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
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102
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Patil S, Us VR, Arakeri G, Patil S, Brennan PA. Does Yadgir population have copper-mediated intrinsic immunity to resist COVID-19 challenge? Med Hypotheses 2020; 146:110362. [PMID: 33246693 PMCID: PMC7649035 DOI: 10.1016/j.mehy.2020.110362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shekar Patil
- Department of Medical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
| | - Vishal Rao Us
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India; COVID Consultative Group, Bengaluru, Karnataka, India
| | - Gururaj Arakeri
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India; COVID Consultative Group, Bengaluru, Karnataka, India.
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Saudi Arabia
| | - Peter A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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103
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Barh D, Tiwari S, Weener ME, Azevedo V, Góes-Neto A, Gromiha MM, Ghosh P. Multi-omics-based identification of SARS-CoV-2 infection biology and candidate drugs against COVID-19. Comput Biol Med 2020; 126:104051. [PMID: 33131530 PMCID: PMC7547373 DOI: 10.1016/j.compbiomed.2020.104051] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
SARS-CoV-2 has ushered a global pandemic with no effective drug being available at present. Although several FDA-approved drugs are currently under clinical trials for drug repositioning, there is an on-going global effort for new drug identification. In this paper, using multi-omics (interactome, proteome, transcriptome, and bibliome) data and subsequent integrated analysis, we present the biological events associated with SARS-CoV-2 infection and identify several candidate drugs against this viral disease. We found that: (i) Interactome-based infection pathways differ from the other three omics-based profiles. (ii) Viral process, mRNA splicing, cytokine and interferon signaling, and ubiquitin mediated proteolysis are important pathways in SARS-CoV-2 infection. (iii) SARS-CoV-2 infection also shares pathways with Influenza A, Epstein-Barr virus, HTLV-I, Measles, and Hepatitis virus. (iv) Further, bacterial, parasitic, and protozoan infection pathways such as Tuberculosis, Malaria, and Leishmaniasis are also shared by this virus. (v) A total of 50 candidate drugs, including the prophylaxis agents and pathway specific inhibitors are identified against COVID-19. (vi) Betamethasone, Estrogen, Simvastatin, Hydrocortisone, Tositumomab, Cyclosporin A etc. are among the important drugs. (vii) Ozone, Nitric oxide, plasma components, and photosensitizer drugs are also identified as possible therapeutic candidates. (viii) Curcumin, Retinoic acids, Vitamin D, Arsenic, Copper, and Zinc may be the candidate prophylaxis agents. Nearly 70% of our identified agents are previously suggested to have anti-COVID-19 effects or under clinical trials. Among our identified drugs, the ones that are not yet tested, need validation with caution while an appropriate drug combination from these candidate drugs along with a SARS-CoV-2 specific antiviral agent is needed for effective COVID-19 management.
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Affiliation(s)
- Debmalya Barh
- Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur, WB, India.
| | - Sandeep Tiwari
- Laboratório de Genética Celular e Molecular, Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marianna E Weener
- Clinical Research Center, Oftalmic, CRO, 119334, Bardina Str.22/4, Moscow, Russia
| | - Vasco Azevedo
- Laboratório de Genética Celular e Molecular, Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Aristóteles Góes-Neto
- Laboratório de Biologia Molecular e Computacional de Fungos, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - M Michael Gromiha
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras (IIT-M), Chennai, 600036, India
| | - Preetam Ghosh
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, 23284, USA
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104
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Sahin E, Orhan C, Uckun FM, Sahin K. Clinical Impact Potential of Supplemental Nutrients as Adjuncts of Therapy in High-Risk COVID-19 for Obese Patients. Front Nutr 2020; 7:580504. [PMID: 33195370 PMCID: PMC7642511 DOI: 10.3389/fnut.2020.580504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China at the end of 2019 caused a major global pandemic and continues to be an unresolved global health crisis. The supportive care interventions for reducing the severity of symptoms along with participation in clinical trials of investigational treatments are the mainstay of COVID-19 management because there is no effective standard therapy for COVID-19. The comorbidity of COVID-19 rises in obese patients. Micronutrients may boost the host immunity against viral infections, including COVID-19. In this review, we discuss the clinical impact potential of supplemental nutrients as adjuncts of therapy in high-risk COVID-19 for obese patients.
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Affiliation(s)
- Emre Sahin
- Department of Nutrition, School of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Cemal Orhan
- Department of Nutrition, School of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Fatih M. Uckun
- COVID-19 Task Force, Reven Pharmaceuticals, Golden, CO, United States
- Department of Developmental Therapeutics, Immunology and Integrative Medicine, Ares Pharmaceuticals, St. Paul, MN, United States
| | - Kazim Sahin
- Department of Nutrition, School of Veterinary Medicine, Firat University, Elazig, Turkey
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105
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Moon N, Aryan M, Westerveld D, Nathoo S, Glover S, Kamel AY. Clinical Manifestations of Copper Deficiency: A Case Report and Review of the Literature. Nutr Clin Pract 2020; 36:1080-1085. [PMID: 33037701 DOI: 10.1002/ncp.10582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/05/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Copper is a mineral that is absorbed in the stomach, duodenum, and jejunum. Gastric bypass surgery, gastrectomy, and short-bowel syndrome commonly lead to copper malabsorption. Copper deficiency primarily presents with hematological and neurological sequelae, including macrocytic anemia and myelopathy. Although hematological disturbances often correct with copper supplementation, neurological manifestations of copper deficiency may be irreversible. We present the case of copper deficiency secondary to malabsorption and management strategies to prevent irreversible neurological sequelae. PRESENTATION A 48-year-old female with a history of hypothyroidism, ischemic stroke, and Crohn's disease, complicated by subtotal colectomy and small-bowel resections, was admitted for fatigue and progressive neurological deficiencies. Her vital signs were stable, and physical examination was remarkable for weakness of both upper and lower extremities, ataxia, and upper extremities paresthesia. Computed tomography scan of the head without contrast was unremarkable. Magnetic resonance imaging enterography revealed a focal area of narrowing of the remaining small bowel. Copper level was low at 39 µg/dL. After 5 days of intravenous replacement using trace element within parenteral nutrition, her copper level corrected to 81 µg/dL. Her ataxia improved after intravenous copper supplementation and did not recur. CONCLUSIONS Our patient presented with copper deficiency secondary to malabsoprtion. This case highlights the importance of copper testing in the bariatric surgery population and in patients with short-bowel syndrome. Given the irreversible nature of neurological symptoms when compared with the expense of nutrition supplements, routine copper testing should be considered in patients with malabsorptive states or altered anatomy, regardless of initial presentation.
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Affiliation(s)
- Nabeel Moon
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mahmoud Aryan
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Donevan Westerveld
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sunina Nathoo
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sarah Glover
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Amir Y Kamel
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Pharmacotherapy and Transitional Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
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106
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Fooladi S, Matin S, Mahmoodpoor A. Copper as a potential adjunct therapy for critically ill COVID-19 patients. Clin Nutr ESPEN 2020; 40:90-91. [PMID: 33183578 PMCID: PMC7518164 DOI: 10.1016/j.clnesp.2020.09.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/21/2022]
Abstract
COVID-19 is a major health problem affecting all people worldwide and has a high mortality rate especially in critically ill patients. Although much is known about its different clinical symptoms, there are significant knowledge gaps about its pathology and cellular responses to the virus. Copper plays an essential role in respiration, immune function and free-radical defense. Despite its important action in physiochemical properties, only small amount of copper is presented in biological fluid, none of which presents as free ion form that readily affirms its depletion in critically ill patients. Recent studies confirmed its anti-viral capacity. Closer understanding of copper signaling, its vulnerability, method of assessment and interpretation, administration rout and dosage opens up new perspectives regarding therapeutic copper administration against critically ill COVID-19 patients. So, it seems that physicians should consider copper insufficiency in their critically ill COVID-19 patients. However, an attention should be paid to copper toxicity and estimating the adverse responses depending on copper dose or severity of copper limitation, as well as the duration of copper misbalance.
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Affiliation(s)
- Shahnaz Fooladi
- Fellowship of Critical Care Medicine, Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Iran
| | - Somaieh Matin
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Iran
| | - Ata Mahmoodpoor
- Fellowship of Critical Care Medicine, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Iran.
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107
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Galmés S, Serra F, Palou A. Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework. Nutrients 2020; 12:E2738. [PMID: 32911778 PMCID: PMC7551697 DOI: 10.3390/nu12092738] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
The pandemic caused by the new coronavirus has caused shock waves in many countries, producing a global health crisis worldwide. Lack of knowledge of the biological mechanisms of viruses, plus the absence of effective treatments against the disease (COVID-19) and/or vaccines have pulled factors that can compromise the proper functioning of the immune system to fight against infectious diseases into the spotlight. The optimal status of specific nutrients is considered crucial to keeping immune components within their normal activity, helping to avoid and overcome infections. Specifically, the European Food Safety Authority (EFSA) evaluated and deems six vitamins (D, A, C, Folate, B6, B12) and four minerals (zinc, iron, copper and selenium) to be essential for the normal functioning of the immune system, due to the scientific evidence collected so far. In this report, an update on the evidence of the contribution of nutritional factors as immune-enhancing aspects, factors that could reduce their bioavailability, and the role of the optimal status of these nutrients within the COVID-19 pandemic context was carried out. First, a non-systematic review of the current state of knowledge regarding the impact of an optimal nutritional status of these nutrients on the proper functioning of the immune system as well as their potential role in COVID-19 prevention/treatment was carried out by searching for available scientific evidence in PubMed and LitCovid databases. Second, a compilation from published sources and an analysis of nutritional data from 10 European countries was performed, and the relationship between country nutritional status and epidemiological COVID-19 data (available in the Worldometers database) was evaluated following an ecological study design. Furthermore, the potential effect of genetics was considered through the selection of genetic variants previously identified in Genome-Wide Association studies (GWAs) as influencing the nutritional status of these 10 considered nutrients. Therefore, access to genetic information in accessible databases (1000genomes, by Ensembl) of individuals from European populations enabled an approximation that countries might present a greater risk of suboptimal status of the nutrients studied. Results from the review approach show the importance of maintaining a correct nutritional status of these 10 nutrients analyzed for the health of the immune system, highlighting the importance of Vitamin D and iron in the context of COVID-19. Besides, the ecological study demonstrates that intake levels of relevant micronutrients-especially Vitamins D, C, B12, and iron-are inversely associated with higher COVID-19 incidence and/or mortality, particularly in populations genetically predisposed to show lower micronutrient status. In conclusion, nutrigenetic data provided by joint assessment of 10 essential nutrients for the functioning of the immune system and of the genetic factors that can limit their bioavailability can be a fundamental tool to help strengthen the immune system of individuals and prepare populations to fight against infectious diseases such as COVID-19.
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Affiliation(s)
- Sebastià Galmés
- Laboratory of Molecular Biology, Nutrition and Biotechnology, NUO Group, Universitat de les Illes Balears, 07122 Palma, Spain; (S.G.); (A.P.)
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Alimentómica S.L., Spin-off n.1 of the University of the Balearic Islands, 07121 Palma, Spain
| | - Francisca Serra
- Laboratory of Molecular Biology, Nutrition and Biotechnology, NUO Group, Universitat de les Illes Balears, 07122 Palma, Spain; (S.G.); (A.P.)
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Alimentómica S.L., Spin-off n.1 of the University of the Balearic Islands, 07121 Palma, Spain
| | - Andreu Palou
- Laboratory of Molecular Biology, Nutrition and Biotechnology, NUO Group, Universitat de les Illes Balears, 07122 Palma, Spain; (S.G.); (A.P.)
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
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108
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Chaari A, Bendriss G, Zakaria D, McVeigh C. Importance of Dietary Changes During the Coronavirus Pandemic: How to Upgrade Your Immune Response. Front Public Health 2020; 8:476. [PMID: 32984253 PMCID: PMC7481450 DOI: 10.3389/fpubh.2020.00476] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
The new coronavirus pandemic continues to spread causing further public health, social, and economic issues. The disparities in the rates of death between countries poses questions about the importance of lifestyle habits and the immune status of populations. An exploration of dietary habits and COVID-19-related death might unravel associations between these two variables. Indeed, while both nutritional excess and deficiency are associated with immunodeficiency, adequate nutrition leading to an optimally functioning immune system may be associated with better outcomes with regards to preventing infection and complications of COVID-19, as well as developing a better immune response to other pathogenic viruses and microorganisms. This article outlines the key functions of the immune system and how macronutrients, micronutrients, and metabolites from the gut microbiome can be essential in the development of an efficient immune system. In addition, the effects of intermittent fasting on the inflammatory state as well as metabolic parameters will be discussed.
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Affiliation(s)
- Ali Chaari
- Premedical Department, Weill Cornell Medicine, Qatar Foundation, Education City, Doha, Qatar
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