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Soliman S, Soliman H, Crézé M, Brillet PY, Montani D, Savale L, Jais X, Bulifon S, Jutant EM, Rius E, Devilder M, Beurnier A, Colle R, Gasnier M, Pham T, Morin L, Noel N, Lecoq AL, Becquemont L, Figueiredo S, Harrois A, Bellin MF, Monnet X, Meyrignac O. Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort. Eur Radiol 2024; 34:1037-1052. [PMID: 37572192 DOI: 10.1007/s00330-023-10044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. MATERIALS AND METHODS We conducted a prospective single-center study among patients hospitalized for COVID-19 between March and May 2020. Patients with residual symptoms or admitted into intensive care units were investigated 4 months after discharge by a chest CT (CCT) and pulmonary function tests (PFTs). The primary endpoint was the rate of persistent radiological fibrotic lesions after 4 months. Secondary endpoints included further CCT evaluation at 9 and 16 months, correlation of fibrotic lesions with clinical and PFT evaluation, and assessment of predictive factors. RESULTS Among the 1151 patients hospitalized for COVID-19, 169 patients performed a CCT at 4 months. CCTs showed pulmonary fibrotic lesions in 19% of the patients (32/169). These lesions were persistent at 9 months and 16 months in 97% (29/30) and 95% of patients (18/19) respectively. There was no significant clinical difference based on dyspnea scale in patients with pulmonary fibrosis. However, PFT evaluation showed significantly decreased diffusing lung capacity for carbon monoxide (p < 0.001) and total lung capacity (p < 0.001) in patients with radiological lesions. In multivariate analysis, the predictive factors of radiological pulmonary fibrotic lesions were pulmonary embolism (OR = 9.0), high-flow oxygen (OR = 6.37), and mechanical ventilation (OR = 3.49). CONCLUSION At 4 months, 19% of patients investigated after hospitalization for COVID-19 had radiological pulmonary fibrotic lesions; they persisted up to 16 months. CLINICAL RELEVANCE STATEMENT Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. The prevalence of persisting lesions after COVID-19 remains unclear. We assessed this prevalence and predictive factors leading to fibrotic lesions in a large cohort. The respiratory clinical impact of these lesions was also assessed. KEY POINTS • Nineteen percent of patients hospitalized for COVID-19 had radiological fibrotic lesions at 4 months, remaining stable at 16 months. • COVID-19 fibrotic lesions did not match any infiltrative lung disease pattern. • COVID-19 fibrotic lesions were associated with pulmonary function test abnormalities but did not lead to clinical respiratory manifestation.
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Affiliation(s)
- Samer Soliman
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
| | - Heithem Soliman
- Service de Gastro-Entérologie, Université Paris-Cité, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
| | - Maud Crézé
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Pierre-Yves Brillet
- Service de Radiologie Diagnostique, Université Sorbonne Paris-Nord, AP-HP, Hôpital Avicenne, Bobigny, France
| | - David Montani
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Sophie Bulifon
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Etienne-Marie Jutant
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Emily Rius
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Matthieu Devilder
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Antoine Beurnier
- DMU 5 Thorinno, Service de Physiologie Et d'Explorations Fonctionnelles Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Romain Colle
- DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France
| | - Matthieu Gasnier
- DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France
| | - Tài Pham
- DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Luc Morin
- Service de Réanimation Pédiatrique Et Médecine Néonatale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Santé de L'Enfant Et de L'Adolescent, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- DMU 7 Endocrinologie-Immunités-Inflammations Cancer-Urgences, Service de Médecine Interne Et Immunologie Clinique, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - Samy Figueiredo
- DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-France Bellin
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Olivier Meyrignac
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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2
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Lucijanic M, Krecak I, Busic I, Atic A, Stojic J, Sabljic A, Soric E, Veic P, Marevic S, Derek L, Mitrovic J, Luksic I. Estimated plasma volume status in COVID-19 patients and its relation to comorbidities and clinical outcomes. J Thromb Thrombolysis 2024; 57:50-57. [PMID: 37572182 DOI: 10.1007/s11239-023-02882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
Blood plasma is a large reservoir of circulating mediators of inflammation and its expansion has been associated with unfavorable outcomes in patients with inflammatory and cardiovascular diseases. The aim of this study was to determine clinical and prognostic value of estimated plasma volume status (ePVS) in hospitalized patients with COVID-19. We retrospectively investigated 5871 consecutive COVID-19 patient hospitalized in our tertiary-level institution in period 3/2020-6/2021. ePVS was determined using the Strauss-derived Duarte formula and was correlated with clinical characteristics and unwanted outcomes. Median ePVS was 4.77 dl/g with interquartile range 4.11-5.74. Higher ePVS was significantly associated with older age, female sex, higher comorbidity burden, worse functional status, less severe COVID-19 clinical presentation with lower severity and longer duration of symptoms, but more pronounced inflammatory profile with higher C-reactive protein, interleukin-6 and D-dimer levels (P < 0.05 for all analyses). In the multivariate regression analysis U shaped relationship of ePVS with mortality was revealed, present independently of age, sex, COVID-19 severity and comorbidity burden. In addition, higher ePVS was independently associated with higher tendency for mechanical ventilation, intensive care unit treatment, venous thromboembolism, major bleeding and bacteriemia and lower ePVS was independently associated with tendency for arterial thrombotic events. Higher ePVS, indicative of plasma volume expansion and inflammatory cytokine accumulation, may predispose respiratory deterioration and venous thromboembolism, despite less severe initial clinical presentation. Lower ePVS, indicative of hemoconcentration, may predispose arterial thrombotic events. Both may be associated with higher mortality in hospitalized COVID-19 patients.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, Croatia.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Ivan Krecak
- Internal medicine department, General hospital of Sibenik-Knin county, Sibenik, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Iva Busic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Armin Atic
- Nephrology Department, University Hospital Center Zagreb, Zagreb, Croatia
| | - Josip Stojic
- Gastroenterology, Hepatology and Clinical Nutrition Department, University Hospital Dubrava, Zagreb, Croatia
| | - Anica Sabljic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, Croatia
| | - Ena Soric
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, Croatia
| | - Petra Veic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sanja Marevic
- Clinical Department for Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Lovorka Derek
- Clinical Department for Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Josko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Clinical Immunology, Allergology and Rheumatology department, University hospital Dubrava, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivica Luksic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Maxillofacial surgery Department, University Hospital Dubrava, Zagreb, Croatia
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Cappelletti P, Gallo G, Marino R, Palaniappan S, Corbo M, Savoia C, Feligioni M. From cardiovascular system to brain, the potential protective role of Mas Receptors in COVID-19 infection. Eur J Pharmacol 2023; 959:176061. [PMID: 37775018 DOI: 10.1016/j.ejphar.2023.176061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been declared a new pandemic in March 2020. Although most patients are asymptomatic, those with underlying cardiovascular comorbidities may develop a more severe systemic infection which is often associated with fatal pneumonia. Nonetheless, neurological and cardiovascular manifestations could be present even without respiratory symptoms. To date, no COVID-19-specific drugs are able for preventing or treating the infection and generally, the symptoms are relieved with general anti-inflammatory drugs. Angiotensin-converting-enzyme 2 (ACE2) may function as the receptor for virus entry within the cells favoring the progression of infection in the organism. On the other hand, ACE2 is a relevant enzyme in renin angiotensin system (RAS) cascade fostering Ang1-7/Mas receptor activation which promotes protective effects in neurological and cardiovascular systems. It is known that RAS is composed by two functional countervailing axes the ACE/AngII/AT1 receptor and the ACE/AngII/AT2 receptor which counteracts the actions mediated by AngII/AT1 receptor by inducing anti-inflammatory, antioxidant and anti-growth functions. Subsequently an "alternative" ACE2/Ang1-7/Mas receptor axis has been described with functions similar to the latter protective arm. Here, we discuss the neurological and cardiovascular effects of COVID-19 highlighting the role of the stimulation of the RAS "alternative" protective arm in attenuating pulmonary, cerebral and cardiovascular damages. In conclusion, only two clinical trials are running for Mas receptor agonists but few other molecules are in preclinical phase and if successful these drugs might represent a successful strategy for the treatment of the acute phase of COVID-19 infection.
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Affiliation(s)
- Pamela Cappelletti
- Department of Neuro-Rehabilitation Sciences, Casa di Cura Igea, Milan, Italy.
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rachele Marino
- European Brain Research Institute (EBRI) Rita Levi Montalcini Foundation, Rome, Italy
| | | | - Massimo Corbo
- Department of Neuro-Rehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Carmine Savoia
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Feligioni
- Department of Neuro-Rehabilitation Sciences, Casa di Cura Igea, Milan, Italy; European Brain Research Institute (EBRI) Rita Levi Montalcini Foundation, Rome, Italy.
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4
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Zareef R, Salameh E, Hammoud R, Tannouri T, Bitar F, Arabi M. COVID-19 in congenital heart disease patients: what did we learn?! Front Cardiovasc Med 2023; 10:1235165. [PMID: 37719985 PMCID: PMC10501459 DOI: 10.3389/fcvm.2023.1235165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Aim COVID-19 pandemic has spread widely at unpreceded pace. Cardiovascular comorbidities are significantly correlated with severe and critical illness. Nevertheless, studies examining the impact of congenital heart disease on COVID-19 severity are scarce and restricted to hospitalized patients. This study aims to explore the course of COVID-19 illness, severity and complications in patients with concomitant congenital heart disease. Methodology This study is a cross sectional survey that includes patients with congenital heart disease who are registered at the Children Heart Center at the American University of Beirut Medical Center. The survey was conducted in the pediatric cardiology outpatient clinics or remotely via phone calls. Results A total of 238 patients participated in the study, of which 47.9% had suspected or confirmed diagnosis of SARS-CoV-2 infection. The majority of patients had mild illness. The symptoms ranged between rhinorrhea (15.6%), cough (15.6%), low-grade fever (11.2%), anosmia (2.7%), ageusia (2.5%), headache (9.8%), high-grade fever (8.5%), gastrointestinal symptoms (7.6%), lethargy (6.3%), muscle aches (5.6%), difficulty breathing (5.4%), joint pain (4.7%), and chills (4.7%). 20% of the surveyed patients required treatment at home. Hospitalization and oxygen therapy was required in 3.5% of cases, while only 1.5% demanded intensive care admission. Only one fatality was encountered. Conclusion COVID-19 infection in pateints with congenital heart disease exhibits a mild to moderate course, and doesn't necessarily increase risk of complicated disease. No correlation could be found between specific congenital heart lesion and disease severity.
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Affiliation(s)
- Rana Zareef
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elio Salameh
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawan Hammoud
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Theresia Tannouri
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric and Adolescent Medicine Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric and Adolescent Medicine Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric and Adolescent Medicine Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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5
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Frasier KM, Gallagher-Poehls C, Cochrane M, Roy D. Secondary Vasculitis Attributable to Post-COVID Syndrome. Cureus 2023; 15:e44119. [PMID: 37638271 PMCID: PMC10456143 DOI: 10.7759/cureus.44119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 08/29/2023] Open
Abstract
While the acute phase of the COVID-19 pandemic has largely come to pass, the chronic physiologic effects of the coronavirus continue to unfold. Specifically, the number of COVID-19-associated vasculitis cases has steadily increased since the onset of the pandemic. Data have shown that vasculitis may develop less than two weeks after COVID-19 or during a later onset of the disease. At this time, research has demonstrated that the novel coronavirus invades more than just the lungs; it can also attack the nervous system, cardiovascular system, and kidneys. In addition, there is a greater understanding of the pathogenesis regarding COVID-19-induced vasculitis via humoral immunity and immune complex disease. Recent case reports have shown an association between COVID-19 and secondary vasculitis. This review paper discusses case reports and data that suggest that COVID-19 may lead to specific vasculitis diseases such as giant cell arteritis, ophthalmic arteritis, aortitis, and Kawasaki-like disease. More research needs to be performed on this association to aid in diagnosis and treatment.
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Affiliation(s)
- Kelly M Frasier
- Public Health, AT Still University - School of Osteopathic Medicine, Mesa, USA
| | | | - Mikayla Cochrane
- Public Health, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Debosree Roy
- Research, A.T. Still University School of Osteopathic Medicine, Mesa, USA
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Vottero P, Tavernini S, Santin AD, Scheim DE, Tuszynski JA, Aminpour M. Computational Prediction of the Interaction of Ivermectin with Fibrinogen. Int J Mol Sci 2023; 24:11449. [PMID: 37511206 PMCID: PMC10380762 DOI: 10.3390/ijms241411449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Hypercoagulability and formation of extensive and difficult-to-lyse microclots are a hallmark of both acute COVID-19 and long COVID. Fibrinogen, when converted to fibrin, is responsible for clot formation, but abnormal structural and mechanical clot properties can lead to pathologic thrombosis. Recent experimental evidence suggests that the spike protein (SP) from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly bind to the blood coagulation factor fibrinogen and induce structurally abnormal blood clots with heightened proinflammatory activity. Accordingly, in this study, we used molecular docking and molecular dynamics simulations to explore the potential activity of the antiparasitic drug ivermectin (IVM) to prevent the binding of the SARS-CoV-2 SP to fibrinogen and reduce the occurrence of microclots. Our computational results indicate that IVM may bind with high affinity to multiple sites on the fibrinogen peptide, with binding more likely in the central, E region, and in the coiled-coil region, as opposed to the globular D region. Taken together, our in silico results suggest that IVM may interfere with SP-fibrinogen binding and, potentially, decrease the formation of fibrin clots resistant to degradation. Additional in vitro studies are warranted to validate whether IVM binding to fibrinogen is sufficiently stable to prevent interaction with the SP, and potentially reduce its thrombo-inflammatory effect in vivo.
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Affiliation(s)
- Paola Vottero
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (P.V.); (M.A.)
| | - Scott Tavernini
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada;
| | - Alessandro D. Santin
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, P.O. Box 208063, New Haven, CT 06520-8063, USA;
| | - David E. Scheim
- US Public Health Service, Commissioned Corps, Inactive Reserve, Blacksburg, VA 24060-6367, USA;
| | - Jack A. Tuszynski
- Department of Physics, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
- Department of Data Science and Engineering, The Silesian University of Technology, 44-100 Gliwice, Poland
| | - Maral Aminpour
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (P.V.); (M.A.)
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Küçük U, Kırılmaz B, Şener A, Alkan S, Vurucu S, Akşit E. Lipoprotein(a): A New Intensive Care Unit Admission Predictor in Coronavirus Disease 2019 Patients. THORACIC RESEARCH AND PRACTICE 2023; 24:214-219. [PMID: 37485711 PMCID: PMC10542482 DOI: 10.5152/thoracrespract.2023.22065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/10/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Endothelium-related events in patients with coronavirus disease 2019 are linked to a poor prognosis. Lipoprotein(a) plays a role in vascular endothelial cell dysfunction. This research aims to investigate whether baseline serum lipoprotein(a) levels could be a predictor for intensive care unit admission and related clinical parameters in coronavirus disease 2019 patients. MATERIAL AND METHODS The research covers 126 patients who were hospitalized in intensive care unit or the non-intensive care unit in our hospital. This prospective cohort study was conducted from January 2021 to June 2021. The patients who were positive for severe acute respiratory syndrome coronavirus 2 according to real-time polymerase chain reaction test results were included in the study. Two groups were created according to the status of intensive care unit admission. Lipoprotein(a) was studied from blood samples taken at the time of hospital admission. RESULTS According to the results of the first clinical evaluation, 46 patients were admitted to the intensive care unit and 80 patients were admitted to non-intensive care unit in the hospital. Patients with intensive care unit admission had significantly higher serum lipoprotein(a) levels than patients without intensive care unit admission (40.9 ng/mL and 17.4 ng/mL, P < .001, respectively). The regres- sion analysis revealed that serum lipoprotein(a) levels were independently related to intensive care unit admission (odds ratio 1.242, 95% CI 1.109-1.391, P < .001). In receiver operating characteristic curve analysis, lipoprotein(a) level ≥31.42 ng/mL had 82.6% sensitivity and 72.5% specificity in predicting intensive care unit admission. The risk of intensive care unit admission was seen to be 12.522-fold higher in cases with lipoprotein(a) level ≥31.42. CONCLUSION Lipoprotein(a) could be used as a useful biomarker for the triage of coronavirus disease 2019 patients. Baseline serum lipoprotein(a) levels may serve as a useful prognostic biomarker in patients hospitalized for coronavirus disease 2019.
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Affiliation(s)
- Uğur Küçük
- Department of Cardiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Bahadır Kırılmaz
- Department of Cardiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Servan Vurucu
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Ercan Akşit
- Department of Cardiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
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Vinson AJ, Anzalone A, Schissel M, Dai R, French ET, Olex AL, Mannon RB. Hormone Replacement Therapy and COVID-19 Outcomes in Solid Organ Transplant Recipients Compared with the General Population. Am J Transplant 2023:S1600-6135(23)00424-0. [PMID: 37105315 PMCID: PMC10129906 DOI: 10.1016/j.ajt.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Exogenous estrogen is associated with reduced COVID mortality in non-immunosuppressed/immunocompromised (non-ISC) post-menopausal females. Here, we examined the association of estrogen or testosterone hormone replacement therapy (HRT) with COVID outcomes in solid organ transplant recipients (SOTR) compared to non-ISC individuals, given known differences in sex-based risk in these populations. SOTR >45y with COVID-19 between 04-01-2020 and 07-31-2022 were identified using the National COVID Cohort Collaborative. The association of HRT use in the last 24 months (exogenous systemic estrogens for females; testosterone for males) with major adverse renal or cardiac events (MARCE) in the 90-days post COVID diagnosis and other secondary outcomes were examined using multivariable cox proportional hazards models and logistic regression. We repeated these analyses in a non-ISC control group for comparison. Our study included 1,135 SOTR and 43,383 immunocompetent patients on HRT with COVID-19. In non-ISC, HRT use was associated with lower risk of MARCE (aHR 0.61, 95% CI 0.57-0.65 for females; aHR 0.70, 0.65-0.77 for males), and all secondary outcomes. In SOTR, HRT reduced the risk of AKI (aHR 0.79, 0.63-0.98) and mortality (aHR 0.49, 0.28-0.85) in males with COVID, but not in females. The potentially modifying effects of immunosuppression on the benefits of HRT requires further investigation.
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Affiliation(s)
| | - Alfred Anzalone
- University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Ran Dai
- University of Nebraska Medical Center, Omaha, NE, United States
| | - Evan T French
- Virginia Commonwealth University, Richmond, VA, United States
| | - Amy L Olex
- Virginia Commonwealth University, Richmond, VA, United States
| | - Roslyn B Mannon
- University of Nebraska Medical Center, Omaha, NE, United States
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9
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Miceli G, Basso MG, Rizzo G, Pintus C, Tuttolomondo A. The Role of the Coagulation System in Peripheral Arterial Disease: Interactions with the Arterial Wall and Its Vascular Microenvironment and Implications for Rational Therapies. Int J Mol Sci 2022; 23:ijms232314914. [PMID: 36499242 PMCID: PMC9739112 DOI: 10.3390/ijms232314914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
Peripheral artery disease (PAD) is a clinical manifestation of atherosclerotic disease with a large-scale impact on the economy and global health. Despite the role played by platelets in the process of atherogenesis being well recognized, evidence has been increasing on the contribution of the coagulation system to the atherosclerosis formation and PAD development, with important repercussions for the therapeutic approach. Histopathological analysis and some clinical studies conducted on atherosclerotic plaques testify to the existence of different types of plaques. Likely, the role of coagulation in each specific type of plaque can be an important determinant in the histopathological composition of atherosclerosis and in its future stability. In this review, we analyze the molecular contribution of inflammation and the coagulation system on PAD pathogenesis, focusing on molecular similarities and differences between atherogenesis in PAD and coronary artery disease (CAD) and discussing the possible implications for current therapeutic strategies and future perspectives accounting for molecular inflammatory and coagulation targets. Understanding the role of cross-talking between coagulation and inflammation in atherosclerosis genesis and progression could help in choosing the right patients for future dual pathway inhibition strategies, where an antiplatelet agent is combined with an anticoagulant, whose role, despite pathophysiological premises and trials' results, is still under debate.
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Affiliation(s)
- Giuseppe Miceli
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90100 Palermo, Italy
- Correspondence: ; Tel.: +39-(091)-6552115; Fax: +39-(091)-6552142
| | - Maria Grazia Basso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90100 Palermo, Italy
| | - Giuliana Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90100 Palermo, Italy
| | - Chiara Pintus
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90100 Palermo, Italy
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90100 Palermo, Italy
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10
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Kciuk M, Mujwar S, Rani I, Munjal K, Gielecińska A, Kontek R, Shah K. Computational Bioprospecting Guggulsterone against ADP Ribose Phosphatase of SARS-CoV-2. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27238287. [PMID: 36500379 PMCID: PMC9739500 DOI: 10.3390/molecules27238287] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Coronavirus Disease-2019 (COVID-19) is a highly contagious disease caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2). The World Health Organization (WHO) classified the disease a as global public health hazard on 11 March 2020. Currently, there are no adequate measures to combat viral infections, including COVID-19, and the medication guidelines for the management of COVID-19 are dependent on previous findings from SARS-CoV and MERS-CoV research. Natural products have achieved widespread acceptance around the world as a means of enhancing healthcare and disease prevention. Plants are a potential source of antiviral factors such as flavonoids, phenolic acids, terpenoids, and others. Some of these agents exhibit a broad spectrum of antiviral activity. This study aimed to screen herbal leads for possible inhibitors of the SARS-CoV-2 ADP Ribose Phosphatase enzyme (ARP). Guggulsterone was found to be highly stabilized within the active site of the viral ARP enzyme by molecular dynamic simulation with very little fluctuation throughout the simulation timeframe of 100 ns. Thus, guggulsterone can be further used to develop a safe and competent medication for evolving therapy against SARS-CoV-2 in post-preclinical and clinical trials.
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Affiliation(s)
- Mateusz Kciuk
- Department of Molecular Biotechnology and Genetics, University of Lodz, 90-237 Lodz, Poland
- Doctoral School of Exact and Natural Sciences, University of Lodz, 90-237 Lodz, Poland
- Correspondence:
| | - Somdutt Mujwar
- Chitkara College of Pharmacy, Chitkara University, Chandigarh 140401, Punjab, India
| | - Isha Rani
- Spurthy College of Pharmacy, Marasur Gate, Bengaluru 562106, Karnataka, India
| | - Kavita Munjal
- Department of Pharmacognosy, M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to Be University) Mullana, Ambala 133207, Haryana, India
| | - Adrianna Gielecińska
- Department of Molecular Biotechnology and Genetics, University of Lodz, 90-237 Lodz, Poland
| | - Renata Kontek
- Department of Molecular Biotechnology and Genetics, University of Lodz, 90-237 Lodz, Poland
| | - Kamal Shah
- Institute of Pharmaceutical Research, GLA University, Mathura 281406, Uttar Pradesh, India
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11
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Chen AIH, Lin SC, Wei JCC. Correspondence on 'Lung involvement in macrophage activation syndrome and severe COVID-19: results from a cross-sectional study to assess clinical, laboratory and artificial intelligence-radiological differences' by Ruscitti et al. Ann Rheum Dis 2022; 81:e220. [PMID: 32907800 DOI: 10.1136/annrheumdis-2020-218876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Sheng-Chieh Lin
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan .,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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12
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Sim R, Cheung G, Ting D, Wong E, Wong TY, Yeo I, Wong CW. Retinal microvascular signs in COVID-19. Br J Ophthalmol 2022; 106:1308-1312. [PMID: 33741583 PMCID: PMC7985973 DOI: 10.1136/bjophthalmol-2020-318236] [Citation(s) in RCA: 26] [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: 10/19/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS To explore if retinal findings are associated with COVID-19 infection. METHODS In this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records. RESULTS 108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs-eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03). CONCLUSION One in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.
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Affiliation(s)
- Ralene Sim
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Gemmy Cheung
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Daniel Ting
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Edmund Wong
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Ian Yeo
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
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13
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Jamali H, Sadeghi E, Nowroozzadeh MH. Suprachoroidal hemorrhage during phacoemulsification surgery associated with recent
COVID
‐19: A report of two cases. Clin Case Rep 2022; 10:e6204. [PMID: 35957767 PMCID: PMC9361714 DOI: 10.1002/ccr3.6204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/03/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022] Open
Abstract
To report two cases of suprachoroidal hemorrhage during otherwise uncomplicated phacoemulsification, in whom COVID‐19 was documented with a positive PCR test about 1 month before the surgery and the importance of postponing elective surgeries for several months after infection.
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Affiliation(s)
- Hossein Jamali
- Department of Ophthalmology Shiraz University of Medical Sciences Shiraz Iran
| | - Elham Sadeghi
- Department of Ophthalmology Shiraz University of Medical Sciences Shiraz Iran
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14
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Merbouh M, El Aidouni G, Serbource J, Couprie LM, Bernardoni C, Housni B, Monchi M. Isolated severe rhabdomyolisis revealing COVID-19: case report. Oxf Med Case Reports 2022; 2022:omac039. [PMID: 35619684 PMCID: PMC9127949 DOI: 10.1093/omcr/omac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 01/06/2023] Open
Abstract
Covid-19 remains a multisystem viral-related disease surprising the healthcare teams. We report the case of a patient presenting with rhabdomyolysis in the context of COVID-19 disease.
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Affiliation(s)
- M Merbouh
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco.,Intensive Care Unit, Sud ile de France Hospital Group, Melun, France
| | - G El Aidouni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - J Serbource
- Intensive Care Unit, Sud ile de France Hospital Group, Melun, France
| | - L M Couprie
- Intensive Care Unit, Sud ile de France Hospital Group, Melun, France
| | - C Bernardoni
- Intensive Care Unit, Sud ile de France Hospital Group, Melun, France
| | - B Housni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco.,Oujda Medical Simulation Training Center
| | - M Monchi
- Intensive Care Unit, Sud ile de France Hospital Group, Melun, France
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15
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Mujwar S, Harwansh RK. In silico bioprospecting of taraxerol as a main protease inhibitor of SARS-CoV-2 to develop therapy against COVID-19. Struct Chem 2022; 33:1517-1528. [PMID: 35502321 PMCID: PMC9046011 DOI: 10.1007/s11224-022-01943-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/13/2022] [Indexed: 12/19/2022]
Abstract
COVID-19 was caused by a novel coronavirus known as SARS-CoV-2. The COVID-19 disease outbreak has been avowed as a global pandemic by the World Health Organization at the end of March 2020. It leads to the global economic crash, resulting in the starvation of a large population belonging to economically backward countries. Hence, the development of an alternative medicine along with the vaccine is of the utmost importance for the management of COVID-19. Therefore, screening of several herbal leads was performed to explore their potential against SARS-CoV-2. Furthermore, viral main protease was selected as a key enzyme for performing the study. Various computational approaches, including molecular docking simulation, were used in the current study to find potential inhibitors of viral main protease from a library of 150 herbal leads. Toxicity and ADME prediction of selected molecules were also analysed by Osiris molecular property explorer software. Molecular dynamic simulation of the top 10 docked herbal leads was analysed for stability using 100 ns. Taraxerol (−10.17 kcal/mol), diosgenin (10.12 kcal/mol), amyrin (−9.56 kcal/mol), and asiaticoside (−9.54 kcal/mol) were among the top four herbal leads with the highest binding affinity with the main protease enzyme. Thus, taraxerol was found to be an effective drug candidate against the main protease enzyme for the management of COVID-19. Furthermore, its clinical effect and safety profile need to be established through an in vivo model.
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Affiliation(s)
- Somdutt Mujwar
- Department of Pharmaceutical Chemistry, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to Be University) Mullana, Ambala, Haryana 133207 India
| | - Ranjit K. Harwansh
- Institute of Pharmaceutical Research, GLA University, Uttar Pradesh, Mathura, 281406 India
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16
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Abstract
BACKGROUND The coronavirus disease 2019 has displayed multi-system manifestations since its first presentation. This article highlights an unusual presentation of COVID-19 that was reviewed by our instituition's otolaryngology and ophthalmology team. METHODS We present 2 cases of COVID-19 which presented with unilateral otalgia and ipsilateral pulsatile headaches involving the temporal area. They were referred to the otolaryngology team for assessment of otalgia and subsequently referred to the ophthalmology team for possible giant cell arteritis (GCA). Both patients had no jaw claudication, scalp pain, or tenderness. RESULTS Serology testing showed raised C-reactive protein (CRP) but normal platelets and erythrocyte sedimentation rate. Case 1 was tested for COVID-19 as part of a preoperative workup which returned positive. With a marked similarity in presentation, Case 2 was tested for COVID-19 which also returned positive. CONCLUSIONS These 2 cases highlight another set of symptoms that COVID-19 patients may present with. In the context of a COVID-19 pandemic, if a patient presents symptoms similar to GCA but with isolated CRP, it should prompt consideration for COVID testing.
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Affiliation(s)
- Benjamin Wai Yin Au
- Departments of Ophthalmology (BWYA, SJS) and Otolaryngology (DJK), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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17
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Scheim DE. A Deadly Embrace: Hemagglutination Mediated by SARS-CoV-2 Spike Protein at Its 22 N-Glycosylation Sites, Red Blood Cell Surface Sialoglycoproteins, and Antibody. Int J Mol Sci 2022; 23:2558. [PMID: 35269703 PMCID: PMC8910562 DOI: 10.3390/ijms23052558] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
Rouleaux (stacked clumps) of red blood cells (RBCs) observed in the blood of COVID-19 patients in three studies call attention to the properties of several enveloped virus strains dating back to seminal findings of the 1940s. For COVID-19, key such properties are: (1) SARS-CoV-2 binds to RBCs in vitro and also in the blood of COVID-19 patients; (2) although ACE2 is its target for viral fusion and replication, SARS-CoV-2 initially attaches to sialic acid (SA) terminal moieties on host cell membranes via glycans on its spike protein; (3) certain enveloped viruses express hemagglutinin esterase (HE), an enzyme that releases these glycan-mediated bindings to host cells, which is expressed among betacoronaviruses in the common cold strains but not the virulent strains, SARS-CoV, SARS-CoV-2 and MERS. The arrangement and chemical composition of the glycans at the 22 N-glycosylation sites of SARS-CoV-2 spike protein and those at the sialoglycoprotein coating of RBCs allow exploration of specifics as to how virally induced RBC clumping may form. The in vitro and clinical testing of these possibilities can be sharpened by the incorporation of an existing anti-COVID-19 therapeutic that has been found in silico to competitively bind to multiple glycans on SARS-CoV-2 spike protein.
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Affiliation(s)
- David E Scheim
- US Public Health Service, Commissioned Officer, Inactive Reserve, Blacksburg, VA 24060, USA
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18
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Pneumonie à Sars-CoV-2 : broncho-pneumonie ou vasculopathie ? Focus sur le signe scanographique du « vaisseau élargi » et corrélations radio-histologiques. JOURNAL D'IMAGERIE DIAGNOSTIQUE ET INTERVENTIONNELLE 2022. [PMCID: PMC8384502 DOI: 10.1016/j.jidi.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction La pandémie de Sars-CoV-2 évolue depuis un an et, à ce jour, la physiopathologie des lésions engendrées par cette atteinte virale n’est que partiellement élucidée. Le scanner thoracique est un outil diagnostique et pronostique essentiel de la prise en charge des patients et les lésions typiques de la pneumonie à Sars-CoV-2 sont à présent bien établies. Cependant, certaines anomalies vasculaires rencontrées chez la plupart des patients, qui se traduisent par un aspect épaissi et irrégulier des vaisseaux pulmonaires au sein des zones pathologiques, sont sous-estimées et peu connues des radiologues. Données récentes Les études histologiques soulignent la prépondérance des atteintes pariétales vasculaires au niveau pulmonaire qui peuvent être corrélées aux anomalies scanographiques. Ces dernières permettent d’orienter le diagnostic en cas de doute biologique ou de progression des lésions en verre dépoli. Elles suggèrent que l’atteinte alvéolo-interstitielle, sans anomalie bronchique ou bronchiolaire associée, pourrait être secondaire aux lésions vasculaires. Enfin, des études complémentaires sont nécessaires pour rechercher un éventuel intérêt pronostique de la quantification de ces lésions. Conclusion Ce travail illustre les corrélations radio-histologiques des atteintes vasculaires et pulmonaires du Sars-Cov-2 et propose une iconographie didactique des principales lésions rencontrées.
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19
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Ignatov PN, Neykova KN. SARS-CoV-2 infection and a subsequent secondary atrophy/atresia of one of the umbilical arteries. J Matern Fetal Neonatal Med 2022; 35:9317-9319. [DOI: 10.1080/14767058.2022.2029840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peter N. Ignatov
- Department of Fetal Medicine Orthogyn Medical Center, Sofia, Bulgaria
| | - Konstantsa N. Neykova
- Department of High-Risk Pregnancy University Hospital “Maichin dom”, Sofia, Bulgaria
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20
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Janus Kinase Signaling Pathway and Its Role in COVID-19 Inflammatory, Vascular, and Thrombotic Manifestations. Cells 2022; 11:cells11020306. [PMID: 35053424 PMCID: PMC8773838 DOI: 10.3390/cells11020306] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
Acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection continues to be a worldwide public health crisis. Among the several severe manifestations of this disease, thrombotic processes drive the catastrophic organ failure and mortality in these patients. In addition to a well-established cytokine storm associated with the disease, perturbations in platelets, endothelial cells, and the coagulation system are key in triggering systemic coagulopathy, involving both the macro- and microvasculatures of different organs. Of the several mechanisms that might contribute to dysregulation of these cells following SARS-CoV-2 infection, the current review focuses on the role of activated Janus kinase (JAK) signaling in augmenting thrombotic processes and organ dysfunction. The review concludes with presenting the current understanding and emerging controversies concerning the potential therapeutic applications of JAK inhibitors for ameliorating the inflammation-thrombosis phenotype in COVID-19 patients.
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21
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Moradi H, Mouzannar S, Miratashi Yazdi SA. Post COVID-19 splenic infarction with limb ischemia: A case report. Ann Med Surg (Lond) 2021; 71:102935. [PMID: 34659749 PMCID: PMC8500846 DOI: 10.1016/j.amsu.2021.102935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction and importance: COVID-19 has been associated with thrombotic events in a variety of organs and systems, with pulmonary embolism being the most prevalent. Splenic infarction, renal infarction, and intestinal ischemia have all been documented recently as abdominal visceral infarctions. Case presentation A 59 years old female patient with a history of COVID-19 disease was admitted to our hospital due to her left upper quadrant abdominal and left flank pain. She had a history of left heel color change in few days. We perform an ultrasound and it was shown vein thrombosis. So, heparin infusion was started for her. We also performed a thoraco-abdominopelvic computed tomography (CT) with intravenous and oral contrast. Total evidence suggests a splenic system infarction. A regular clinical examination for malignancy was performed on the patient and there was no evidence of cancer. Other probable reasons were ruled out. The patient was diagnosed with splenic infarction, Due to coagulopathy caused by SARS-Cov-2 infection. Treatment with heparin was continued for 5 days and she was discharged home on day 9 with oral agents. The patient was asymptomatic when she returned. The spleen had decreased in size on the follow-up CT, and there were no clinical complications. Discussion and conclusions Spleen artery thrombosis is a rare complication of COVID-19. In this report, we described a 59 years old female with a history of COVID-19. She was discharged home and in follow-up, there was no evidence of thrombosis anymore. Due to COVID-19 pandemic, it is important to report any new cases. Splenic infarction is reported as a COVID-19 complication. Limb ischemia simultaneously with spleen infarction is very rare. It is important to notice coagulopathy and its treatment in COVID-19 patients.
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Affiliation(s)
- Hazhir Moradi
- Medical Student, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samah Mouzannar
- Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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22
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Di Lella D, Petrone G, Martelli E, Vigliotti RC, Vigliotti G. Monocentric case-series of mesenteric vascular disease occurred in the first month of the COVID-19 pandemic. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2021; 1:100004. [PMID: 35783489 PMCID: PMC8542417 DOI: 10.1016/j.avsurg.2021.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Daniela Di Lella
- Division of Vascular Surgery, Del Mare Hospital, Via Enrico Russo, 80147 Naples, Italy
| | - Giuseppe Petrone
- Division of Vascular Surgery, Del Mare Hospital, Via Enrico Russo, 80147 Naples, Italy
| | - Eugenio Martelli
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, Caserta, Italy. Saint Camillus International University of Health Sciences, Rome, Italy
- Department of General and Specialist Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Rossella Chiara Vigliotti
- Residency Program in Vascular Surgery, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Gennaro Vigliotti
- Division of Vascular Surgery, Del Mare Hospital, Via Enrico Russo, 80147 Naples, Italy
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23
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Qin Z, Liu F, Blair R, Wang C, Yang H, Mudd J, Currey JM, Iwanaga N, He J, Mi R, Han K, Midkiff CC, Alam MA, Aktas BH, Heide RSV, Veazey R, Piedimonte G, Maness NJ, Ergün S, Mauvais-Jarvis F, Rappaport J, Kolls JK, Qin X. Endothelial cell infection and dysfunction, immune activation in severe COVID-19. Theranostics 2021; 11:8076-8091. [PMID: 34335981 PMCID: PMC8315069 DOI: 10.7150/thno.61810] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Rationale: Pulmonary vascular endotheliitis, perivascular inflammation, and immune activation are observed in COVID-19 patients. While the initial SARS-CoV-2 infection mainly infects lung epithelial cells, whether it also infects endothelial cells (ECs) and to what extent SARS-CoV-2-mediated pulmonary vascular endotheliitis is associated with immune activation remain to be determined. Methods: To address these questions, we studied SARS-CoV-2-infected K18-hACE2 (K18) mice, a severe COVID-19 mouse model, as well as lung samples from SARS-CoV-2-infected nonhuman primates (NHP) and patient deceased from COVID-19. We used immunostaining, RNAscope, and electron microscopy to analyze the organs collected from animals and patient. We conducted bulk and single cell (sc) RNA-seq analyses, and cytokine profiling of lungs or serum of the severe COVID-19 mice. Results: We show that SARS-CoV-2-infected K18 mice develop severe COVID-19, including progressive body weight loss and fatality at 7 days, severe lung interstitial inflammation, edema, hemorrhage, perivascular inflammation, systemic lymphocytopenia, and eosinopenia. Body weight loss in K18 mice correlated with the severity of pneumonia, but not with brain infection. We also observed endothelial activation and dysfunction in pulmonary vessels evidenced by the up-regulation of VCAM1 and ICAM1 and the downregulation of VE-cadherin. We detected SARS-CoV-2 in capillary ECs, activation and adhesion of platelets and immune cells to the vascular wall of the alveolar septa, and increased complement deposition in the lungs, in both COVID-19-murine and NHP models. We also revealed that pathways of coagulation, complement, K-ras signaling, and genes of ICAM1 and VCAM1 related to EC dysfunction and injury were upregulated, and were associated with massive immune activation in the lung and circulation. Conclusion: Together, our results indicate that SARS-CoV-2 causes endotheliitis via both infection and infection-mediated immune activation, which may contribute to the pathogenesis of severe COVID-19 disease.
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Affiliation(s)
- Zhongnan Qin
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Fengming Liu
- Tulane National Primate Research Center, Covington, LA 70433, USA
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Robert Blair
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Chenxiao Wang
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Haoran Yang
- Departments of Medicine and Pediatrics, Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Joseph Mudd
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Joshua M Currey
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Naoki Iwanaga
- Departments of Medicine and Pediatrics, Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Jibao He
- Coordinated Instrumentation Facility, Tulane University, New Orleans LA 70118, USA
| | - Ren Mi
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Kun Han
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | | | | | - Bertal H Aktas
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Ronald Veazey
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Giovanni Piedimonte
- Departments of Pediatrics, Biochemistry & Molecular Biology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Nicholas J Maness
- Tulane National Primate Research Center, Covington, LA 70433, USA
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, Julius-Maximilians-Universität Würzburg, Koellikerstrasse 6, 97070 Würzburg, Germany
| | - Franck Mauvais-Jarvis
- Department of Medicine, Section of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA 70112, USA
- Southeast Louisiana Veterans Health Care System, New Orleans, LA 70119, USA
- Tulane Center of Excellence in Sex-Based Biology & Medicine, LA 70112, USA
| | - Jay Rappaport
- Tulane National Primate Research Center, Covington, LA 70433, USA
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Jay K. Kolls
- Departments of Medicine and Pediatrics, Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Xuebin Qin
- Tulane National Primate Research Center, Covington, LA 70433, USA
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Jafari Khaljiri H, Jamalkhah M, Amini Harandi A, Pakdaman H, Moradi M, Mowla A. Comprehensive Review on Neuro-COVID-19 Pathophysiology and Clinical Consequences. Neurotox Res 2021; 39:1613-1629. [PMID: 34169404 PMCID: PMC8225460 DOI: 10.1007/s12640-021-00389-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023]
Abstract
Aside from the respiratory distress as the predominant clinical presentation of SARS-CoV-2 infection, various neurological complications have been reported with the infection during the ongoing pandemic, some of which cause serious morbidity and mortality. Herein, we gather the latest anatomical evidence of the virus's presence within the central nervous system. We then delve into the possible SARS-CoV-2 entry routes into the neurological tissues, with the hematogenous and the neuronal routes as the two utmost passage routes into the nervous system. We then give a comprehensive review of the neurological manifestations of the SARS-CoV-2 invasion in both the central and peripheral nervous system and its underlying pathophysiology via investigating large studies in the field and case reports in cases of study scarcity.
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Affiliation(s)
- Helia Jafari Khaljiri
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Monire Jamalkhah
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Moradi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Mowla
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
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Satarker S, Tom AA, Shaji RA, Alosious A, Luvis M, Nampoothiri M. JAK-STAT Pathway Inhibition and their Implications in COVID-19 Therapy. Postgrad Med 2021; 133:489-507. [PMID: 33245005 PMCID: PMC7784782 DOI: 10.1080/00325481.2020.1855921] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
As the incidence of COVID-19 increases with time, more and more efforts are made to pave a way out for the therapeutic strategies to deal with the disease progression. Inflammation being a significant influencer in COVID-19 patients, it drives our focus onto the signaling cascades of the JAK/STAT pathway. JAK phosphorylation mediated by cytokine receptor activation leads to phosphorylation of STATs that translocate into the nucleus to translate for inflammatory mediators. The SARS-CoV-2 structural proteins like spike, nucleocapsid, membrane and envelope proteins along with the non- structural proteins 1-16 including proteases like 3CL pro and PLpro promote its entry and survival in hosts. The SARS-CoV-2 infection triggers inflammation via the JAK/STAT pathway leading to recruitment of pneumocytes, endothelial cells, macrophages, monocytes, lymphocytes, natural killer cells and dendritic cells progressing towards cytokine storm. This produces various inflammatory markers in the host that determine the disease severity. The JAK/STAT signaling also mediates immune responses via B cell and T cell differentiation.With an attempt to reduce excessive inflammation, JAK/STAT inhibitors like Ruxolitinib, Baricitinib, Tofacitinib have been employed that mediate its actions via suppressors of cytokine signaling, cytokine inducible SH2 containing protein, Protein inhibitor of activated STAT and protein tyrosine phosphatases. Even though they are implicated with multiple adverse effects, the regulatory authorities have supported its use, and numerous clinical trials are in progress to prove their safety and efficacy. On the contrary, the exact mechanism of JAK/STAT inhibition at molecular levels remains speculative for which further investigations are required.
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Affiliation(s)
- Sairaj Satarker
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Antriya Annie Tom
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | - Roshitha Ann Shaji
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | - Aaja Alosious
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | - Mariya Luvis
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | - Madhavan Nampoothiri
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
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RETRAIT : Pneumonie à Sars-CoV-2: broncho-pneumonie ou vasculopathie ? Focus sur le signe scanographique du « vaisseau élargi » et corrélations radio-histologiques. JOURNAL D'IMAGERIE DIAGNOSTIQUE ET INTERVENTIONNELLE 2021. [PMCID: PMC8175762 DOI: 10.1016/j.jidi.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disponible en ligne : 4 juin 2021. L’éditeur a le regret de vous informer que cet article ayant déjà été mis en ligne dans la Journal d'imagerie diagnostique et interventionnelle, le 25 août 2021, https://doi.org/10.1016/j.jidi.2021.06.001.
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Sahu KK, Cerny J. A review on how to do hematology consults during COVID-19 pandemic. Blood Rev 2021; 47:100777. [PMID: 33199084 PMCID: PMC7648889 DOI: 10.1016/j.blre.2020.100777] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023]
Abstract
The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA, USA.
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28
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Castro GRA, Collaço IA, Dal Bosco CLB, Corrêa GG, Dal Bosco GB, Corrêa GL. Splenic infarction as a complication of covid-19 in a patient without respiratory symptoms: A case report and literature review. IDCases 2021; 24:e01062. [PMID: 33777695 PMCID: PMC7980490 DOI: 10.1016/j.idcr.2021.e01062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/14/2021] [Accepted: 03/09/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and thrombotic events have been recorded in several organs and systems. We report a patient with no respiratory symptoms, presented with abdominal pain and an extensive splenic infarction after COVID-19. Case report A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The patient denied respiratory symptoms but referred contact with family members positive for COVID-19. He tested positive for COVID-19 and had increased D-dimer levels. Imaging studies revealed splenic infarcts and ground-glass opacities in bilateral pulmonary bases. He was treated with full-dose anticoagulation and was discharged home on oral Rivaroxaban. Discussion Although rare in the literature, cases of acute abdomen in COVID-19 patients associated with vascular infarctions have increased. Coagulopathy may be present even without clinical respiratory manifestations of the disease. Patients meeting disseminated intravascular coagulation criteria or with markedly elevated D-dimer may benefit from anticoagulant therapy. Conclusion Clinicians should suspect of abdominal visceral infarctions in COVID-19 patients presented with acute abdominal pain, despite the absence of respiratory symptoms.
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Affiliation(s)
- Gustavo Rodrigues Alves Castro
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Iwan Augusto Collaço
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Caroline L Balcewicz Dal Bosco
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Gustavo Gusso Corrêa
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Giovana Balcewicz Dal Bosco
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Giovana Luiza Corrêa
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
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29
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Kalbhenn J, Glonnegger H, Wilke M, Bansbach J, Zieger B. Hypercoagulopathy, acquired coagulation disorders and anticoagulation before, during and after extracorporeal membrane oxygenation in COVID-19: a case series. Perfusion 2021; 36:592-602. [PMID: 33719738 DOI: 10.1177/02676591211001791] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Thromboembolism and bleeding contribute to Coronavirus disease 2019 (COVID-19)'s morbidity and mortality and are also frequent complications of venovenous extracorporeal membrane oxygenation (vvECMO). As the interaction of the underlying pathologies caused by vvECMO in COVID-19 is barely understood, we designed this study to better differentiate coagulation disorders in COVID-19 patients before, during and after vvECMO-support. METHODS Observational case series, six consecutive patients with Coronavirus acute respiratory distress syndrome supported with vvECMO treated in the anaesthesiologic ICU in a third level University ECMO-centre. We measured routine coagulation parameters and assessed coagulation factors. We also conducted advanced von Willebrand factor (VWF) multimer analysis, platelet aggregometry and immunological screening. RESULTS We identified various phases of coagulation disorders: Initially, intensely activated coagulation with highly increased VWF and factor VIII activity in acute COVID-19, then severe acquired von Willebrand syndrome and platelet dysfunction during vvECMO leading to spontaneous bleeding and finally, hypercoagulopathy after vvECMO explantation. Five of six patients developed immunological abnormalities enhancing coagulation. CONCLUSIONS Coronavirus-induced coagulopathy and bleeding disorders during vvECMO cannot be discriminated via 'routine' coagulation tests. Precise and specific analyses followed by the appropriate treatment of coagulation disorders may help us develop tailored therapeutic concepts to better manage the phases described above.
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Affiliation(s)
- Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannah Glonnegger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maya Wilke
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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30
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Gebremeskel S, Schanin J, Coyle KM, Butuci M, Luu T, Brock EC, Xu A, Wong A, Leung J, Korver W, Morin RD, Schleimer RP, Bochner BS, Youngblood BA. Mast Cell and Eosinophil Activation Are Associated With COVID-19 and TLR-Mediated Viral Inflammation: Implications for an Anti-Siglec-8 Antibody. Front Immunol 2021; 12:650331. [PMID: 33777047 PMCID: PMC7988091 DOI: 10.3389/fimmu.2021.650331] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/18/2021] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection represents a global health crisis. Immune cell activation via pattern recognition receptors has been implicated as a driver of the hyperinflammatory response seen in COVID-19. However, our understanding of the specific immune responses to SARS-CoV-2 remains limited. Mast cells (MCs) and eosinophils are innate immune cells that play pathogenic roles in many inflammatory responses. Here we report MC-derived proteases and eosinophil-associated mediators are elevated in COVID-19 patient sera and lung tissues. Stimulation of viral-sensing toll-like receptors in vitro and administration of synthetic viral RNA in vivo induced features of hyperinflammation, including cytokine elevation, immune cell airway infiltration, and MC-protease production—effects suppressed by an anti-Siglec-8 monoclonal antibody which selectively inhibits MCs and depletes eosinophils. Similarly, anti-Siglec-8 treatment reduced disease severity and airway inflammation in a respiratory viral infection model. These results suggest that MC and eosinophil activation are associated with COVID-19 inflammation and anti-Siglec-8 antibodies are a potential therapeutic approach for attenuating excessive inflammation during viral infections.
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Affiliation(s)
| | | | - Krysta M Coyle
- Department of Molecular Biology and Biochemistry, Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | | | - Thuy Luu
- Allakos Inc., Redwood City, CA, United States
| | | | - Alan Xu
- Allakos Inc., Redwood City, CA, United States
| | - Alan Wong
- Allakos Inc., Redwood City, CA, United States
| | - John Leung
- Allakos Inc., Redwood City, CA, United States
| | | | - Ryan D Morin
- Department of Molecular Biology and Biochemistry, Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Robert P Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bruce S Bochner
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Younis JS, Skorecki K, Abassi Z. The Double Edge Sword of Testosterone's Role in the COVID-19 Pandemic. Front Endocrinol (Lausanne) 2021; 12:607179. [PMID: 33796068 PMCID: PMC8009245 DOI: 10.3389/fendo.2021.607179] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/19/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a complex disease with a multifaceted set of disturbances involving several mechanisms of health and disease in the human body. Sex hormones, estrogen, and testosterone, seem to play a major role in its pathogenesis, development, spread, severity, and mortalities. Examination of factors such as age, gender, ethnic background, genetic prevalence, and existing co-morbidities, may disclose the mechanisms underlying SARS-CoV-2 infection, morbidity, and mortality, paving the way for COVID-19 amelioration and substantial flattening of the infection curve. In this mini-review, we focus on the role of testosterone through a discussion of the intricate mechanisms of disease development and deterioration. Accumulated evidence suggests that there are links between high level (normal male level) as well as low level (age-related hypogonadism) testosterone in disease progression and expansion, supporting its role as a double-edged sword. Unresolved questions point to the essential need for further targeted studies to substantiate these contrasting mechanisms.
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Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
- *Correspondence: Johnny S. Younis,
| | - Karl Skorecki
- Azrieili Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
| | - Zaid Abassi
- Department of Physiology, Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Laboratory Medicine, Rambam Health Care Campus, Haifa, Israel
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Pharmacological and cardiovascular perspectives on the treatment of COVID-19 with chloroquine derivatives. Acta Pharmacol Sin 2020; 41:1377-1386. [PMID: 32968208 PMCID: PMC7509225 DOI: 10.1038/s41401-020-00519-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and an ongoing severe pandemic. Curative drugs specific for COVID-19 are currently lacking. Chloroquine phosphate and its derivative hydroxychloroquine, which have been used in the treatment and prevention of malaria and autoimmune diseases for decades, were found to inhibit SARS-CoV-2 infection with high potency in vitro and have shown clinical and virologic benefits in COVID-19 patients. Therefore, chloroquine phosphate was first used in the treatment of COVID-19 in China. Later, under a limited emergency-use authorization from the FDA, hydroxychloroquine in combination with azithromycin was used to treat COVID-19 patients in the USA, although the mechanisms of the anti-COVID-19 effects remain unclear. Preliminary outcomes from clinical trials in several countries have generated controversial results. The desperation to control the pandemic overrode the concerns regarding the serious adverse effects of chloroquine derivatives and combination drugs, including lethal arrhythmias and cardiomyopathy. The risks of these treatments have become more complex as a result of findings that COVID-19 is actually a multisystem disease. While respiratory symptoms are the major clinical manifestations, cardiovascular abnormalities, including arrhythmias, myocarditis, heart failure, and ischemic stroke, have been reported in a significant number of COVID-19 patients. Patients with preexisting cardiovascular conditions (hypertension, arrhythmias, etc.) are at increased risk of severe COVID-19 and death. From pharmacological and cardiovascular perspectives, therefore, the treatment of COVID-19 with chloroquine and its derivatives should be systematically evaluated, and patients should be routinely monitored for cardiovascular conditions to prevent lethal adverse events.
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Afat S, Othman AE, Nikolaou K, Gassenmaier S. Dual-Energy Computed Tomography of the Lung in COVID-19 Patients: Mismatch of Perfusion Defects and Pulmonary Opacities. Diagnostics (Basel) 2020; 10:E870. [PMID: 33114478 PMCID: PMC7693945 DOI: 10.3390/diagnostics10110870] [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: 09/19/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023] Open
Abstract
To evaluate contrast-enhanced dual-energy computed tomography (DECT) chest examinations regarding pulmonary perfusion patterns and pulmonary opacities in patients with confirmed COVID-19 disease. Fourteen patients with 24 DECT examinations performed between April and May 2020 were included in this retrospective study. DECT studies were assessed independently by two radiologists regarding pulmonary perfusion defects, using a Likert scale ranging from 1 to 4. Furthermore, in all imaging studies the extent of pulmonary opacities was quantified using the same rating system as for perfusion defects. The main pulmonary findings were ground glass opacities (GGO) in all 24 examinations and pulmonary consolidations in 22 examinations. The total lung scores after the addition of the scores of the single lobes showed significantly higher values of opacities compared to perfusion defects, with a median of 12 (9-18) for perfusion defects and a median of 17 (15-19) for pulmonary opacities (p = 0.002). Furthermore, mosaic perfusion patterns were found in 19 examinations in areas with and without GGO. Further studies will be necessary to investigate the pathophysiological background of GGO with maintained perfusion compared to GGO with reduced perfusion, especially regarding long-term lung damage and prognosis.
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Affiliation(s)
| | - Ahmed E. Othman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, 72076 Tuebingen, Germany; (S.A.); (K.N.); (S.G.)
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Medetalibeyoglu A, Emet S, Kose M, Akpinar TS, Senkal N, Catma Y, Kaytaz AM, Genc S, Omer B, Tukek T. Serum Endocan Levels on Admission Are Associated With Worse Clinical Outcomes in COVID-19 Patients: A Pilot Study. Angiology 2020; 72:187-193. [PMID: 32969233 DOI: 10.1177/0003319720961267] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Thrombotic and embolic complications in the cardiovascular system are evident and associated with worse prognosis in coronavirus disease 2019 (COVID-19) patients. Endothelial-specific molecule 1 (endocan) plays a role in vascular pathology. We hypothesized serum endocan levels on admission are associated with primary composite end point (mortality and intensive care unit hospitalization) in COVID-19 patients. Patients (n = 80) with laboratory, clinical, and radiological confirmed COVID-19 were included in this cross-sectional study. Ten milliliter of peripheral venous blood were drawn within 24 hours of admission to estimate serum endocan levels. Data were analyzed using SPSS version 26.0 (IBM). Patients with the primary composite end point had significantly higher serum endocan levels than patients without (852.2 ± 522.7 vs 550.2 ± 440.8 ng/L, respectively; P < .01). In the logistic regression analysis, only increased serum endocan levels and increase in age were independent predictors of the primary composite end point (P < .05). In the receiver operating characteristics curve analysis, we found that a serum endocan level of 276.4 ng/L had a 97% sensitivity and 85% specificity for prediction of the primary composite end point. Baseline serum endocan levels may prove useful as a prognostic factor in patients hospitalized for COVID-19.
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Affiliation(s)
- Alpay Medetalibeyoglu
- Department of Internal Medicine, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Samim Emet
- Department of Cardiology, 64041Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Murat Kose
- Department of Internal Medicine, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Timur Selcuk Akpinar
- Department of Internal Medicine, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Naci Senkal
- Department of Internal Medicine, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yunus Catma
- Department of Internal Medicine, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Murat Kaytaz
- Department of Biochemistry, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Genc
- Department of Biochemistry, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Beyhan Omer
- Department of Biochemistry, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tufan Tukek
- Department of Internal Medicine, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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35
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Feldman C, Anderson R. Brief review: Cardiac complications and platelet activation in COVID-19 infection. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.107. [PMID: 34235425 PMCID: PMC7433708 DOI: 10.7196/ajtccm.2020.v26i3.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
COVID-19 pneumonia, much like that of bacterial and viral community-acquired pneumonia before it, is accompanied by a high rate of cardio- and cerebrovascular events that are associated with an increased risk of complications and a greater mortality. Although the mechanisms underlying the pathogenesis of these adverse events are not entirely clear and may be multifactorial, platelets appear to have a prominent aetiologic role and this, together with an overview of the clinical evidence, forms the basis of this short review.
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Affiliation(s)
- C Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Anderson
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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36
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Faqeeh S, Madkhali R. Acute reversible renal failure requiring temporary dialysis in a patient with COVID-19. Radiol Case Rep 2020; 15:2449-2452. [PMID: 32864030 PMCID: PMC7447211 DOI: 10.1016/j.radcr.2020.08.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19 infection is associated with increased risk of acute kidney injury, but the imaging changes of the kidneys are not fully investigated yet. We report the computed tomography findings in a 17-year-old male who developed severe reversible renal impairment. Those findings are similar to the changes observed in patients with vasculitis and can be contributed to the thromboembolic manifestations associated with corona virus infection.
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Affiliation(s)
- Samah Faqeeh
- Department of diagnostic radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Raad Madkhali
- Department of diagnostic radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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37
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Giraudo C. Special Issue "COVID-19: Diagnostic Imaging and Beyond". J Clin Med 2020; 9:E2721. [PMID: 32846885 PMCID: PMC7565391 DOI: 10.3390/jcm9092721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022] Open
Abstract
Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-COV2) outbreak in China at the end of 2019, clinicians relied on diagnostic imaging to characterize the disease's extension and severity [...].
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Affiliation(s)
- Chiara Giraudo
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35122 Padova, Italy
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38
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Kaur S, Tripathi DM, Yadav A. The Enigma of Endothelium in COVID-19. Front Physiol 2020; 11:989. [PMID: 32848893 PMCID: PMC7417426 DOI: 10.3389/fphys.2020.00989] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) has affected millions of people globally. Clinically, it presents with mild flu-like symptoms in most cases but can cause respiratory failure in high risk population. With the aim of unearthing newer treatments, scientists all over the globe are striving hard to comprehend the underlying mechanisms of COVID-19. Several studies till date have indicated a dysregulated host immune response as the major cause of COVID-19 induced mortality. In this Perspective, we propose a key role of endothelium, particularly pulmonary endothelium in the pathogenesis of COVID-19. We draw parallels and divergences between COVID-19-induced respiratory distress and bacterial sepsis-induced lung injury and recommend the road ahead with respect to identification of endothelium-based biomarkers and plausible treatments for COVID-19.
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Affiliation(s)
- Savneet Kaur
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Dinesh M. Tripathi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Angeera Yadav
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Guwahati, India
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