COVID-19 and post-mortem microbiological studies

The effects of mouth rinsing and gargling with mouthwash containing povidone-iodine and hydrogen peroxide on the cycle threshold value of Severe Acute Respiratory Syndrome Coronavirus 2: A randomized controlled trial of asymptomatic and mildly symptomatic patients

Background

Coronavirus disease 2019 can spread rapidly. Surgery in the oral cavity poses a high risk of transmission of severe acute respiratory syndrome coronavirus 2. The American Dental Association and the Centers for Disease Control and Prevention recommend the use of mouthwash containing 1.5% hydrogen peroxide (H 2O 2) or 0.2% povidone iodine (PI) to reduce the viral load in the upper respiratory tract and decrease the risk of transmission. The aim of the present study was to analyze the effect of mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2O 2, or 1.5% H 2O 2 and water on the cycle threshold (CT) value obtained by real-time reverse transcription polymerase chain reaction (RT-PCR).

Methods

This study is a randomized single blind controlled clinical trial which has been registered in the International Standard Randomized Controlled Trial Number (ISRCTN) registry on the 3 rd February 2022 (Registration number: ISRCTN18356379). In total, 69 subjects recruited from Persahabatan General Hospital who met the inclusion criteria were randomly assigned to one of four treatment groups or the control group. The subjects were instructed to gargle with 15 mL of mouthwash for 30 s in the oral cavity followed by 30 s in the back of the throat, three times per day for 5 days. CT values were collected on postprocedural days 1, 3, and 5.

Results

The results of the Friedman test significantly differed among the groups (n=15). The CT values increased from baseline (day 0) to postprocedural days 1, 3, and 5.

Conclusions

Mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2O 2, or 1.5% H 2O 2 and water increased the CT value.

A case of persistent severe sequelae of COVID-19 infection: potential role in sudden death?

Depending on the stage of the disease, autopsy findings of COVID-19 may include a spectrum of cardiopulmonary pathologies including alveolar hyaline membrane formation, vascular thrombosis, and intracardiac thrombi. Identification of a COVID-19 positive decedent in the absence of clinical history relies primarily on post-mortem nasopharyngeal (NP) or oropharyngeal (OP) swabs for real time polymerase chain reaction (RT-PCR). In the absence of definitive microbiology testing, post-mortem computed tomography (PMCT) may be a powerful adjunct tool for screening. Persistence of pathological changes may prolong physiological alterations and increase the risk of cardiopulmonary compromise. This current case outlines the forensic presentation, utilization of screening tools including PMCT, and the autopsy findings of a recent toxicology related sudden death case in the context of severe sequelae of COVID-19 pneumonia. This case demonstrates the limitation of NP and OP swabs in the post-mortem setting, the value of PMCT as an adjunct screening tool, and raises the consideration of COVID-19 sequelae as a potential contributing risk factors in sudden death cases in the community.

Microbiota-Gut-Brain Communication in the SARS-CoV-2 Infection

The coronavirus disease of 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). In addition to pneumonia, individuals affected by the disease have neurological symptoms. Indeed, SARS-CoV-2 has a neuroinvasive capacity. It is known that the infection caused by SARS-CoV-2 leads to a cytokine storm. An exacerbated inflammatory state can lead to the blood-brain barrier (BBB) damage as well as to intestinal dysbiosis. These changes, in turn, are associated with microglial activation and reactivity of astrocytes that can promote the degeneration of neurons and be associated with the development of psychiatric disorders and neurodegenerative diseases. Studies also have been shown that SARS-CoV-2 alters the composition and functional activity of the gut microbiota. The microbiota-gut-brain axis provides a bidirectional homeostatic communication pathway. Thus, this review focuses on studies that show the relationship between inflammation and the gut microbiota-brain axis in SARS-CoV-2 infection.

Persistence of SARS-CoV-2 Viral RNA in Nasopharyngeal Swabs after Death: An Observational Study

The aim of this study was to investigate the persistence of SARS-CoV-2 in post-mortem swabs of subjects who died from SARS-CoV-2 infection. The presence of the virus was evaluated post-mortem from airways of 27 SARS-CoV-2 positive patients at three different time points (T1 2 h; T2 12 h; T3 24 h) by real-time PCR. Detection of antibodies to SARS-CoV-2 was performed by Maglumi 2019-nCoV IgM/IgG chemiluminescence assay. SARS-CoV-2 viral RNA was still detectable in 70.3% of cases within 2 h after death and in 66,6% of cases up to 24 h after death. Our data showed an increase of the viral load in 78,6% of positive individuals 24 h post-mortem (T3) in comparison to that evaluated 2 h after death (T1). Noteworthy, we detected a positive T3 post-mortem swab (24 h after death) from 4 subjects who were negative at T1 (2 h after death). The results of our study may have an important value in the management of deceased subjects not only with a suspected or confirmed diagnosis of SARS-CoV-2, but also for unspecified causes and in the absence of clinical documentation or medical assistance.

Prospective observational study of SARS-CoV-2 infection, transmission and immunity in a cohort of households in Liverpool City Region, UK (COVID-LIV): a study protocol

INTRODUCTION

The emergence and rapid spread of COVID-19 have caused widespread and catastrophic public health and economic impact, requiring governments to restrict societal activity to reduce the spread of the disease. The role of household transmission in the population spread of SARS-CoV-2, and of host immunity in limiting transmission, is poorly understood. This paper describes a protocol for a prospective observational study of a cohort of households in Liverpool City Region, UK, which addresses the transmission of SARS-CoV-2 between household members and how immunological response to the infection changes over time.

METHODS AND ANALYSIS

Households in the Liverpool City Region, in which members have not previously tested positive for SARS-CoV-2 with a nucleic acid amplification test, are followed up for an initial period of 12 weeks. Participants are asked to provide weekly self-throat and nasal swabs and record their activity and presence of symptoms. Incidence of infection and household secondary attack rates of COVID-19 are measured. Transmission of SARS-CoV-2 will be investigated against a range of demographic and behavioural variables. Blood and faecal samples are collected at several time points to evaluate immune responses to SARS-CoV-2 infection and prevalence and risk factors for faecal shedding of SARS-CoV-2, respectively.

ETHICS AND DISSEMINATION

The study has received approval from the National Health Service Research Ethics Committee; REC Reference: 20/HRA/2297, IRAS Number: 283 464. Results will be disseminated through scientific conferences and peer-reviewed open access publications. A report of the findings will also be shared with participants. The study will quantify the scale and determinants of household transmission of SARS-CoV-2. Additionally, immunological responses before and during the different stages of infection will be analysed, adding to the understanding of the range of immunological response by infection severity.

Corneal transplantation during COVID-19 pandemic: need for special considerations-A live review

Corneal blindness is the fourth leading cause of blindness worldwide, with 10 million people having bilateral corneal blindness, nearly 80% of all corneal blindness cases are avoidable and are reversible. Corneal transplantation (CT) is the most frequently performed type of transplant across the world. This review was conducted with the objective of identifying if it is safe to harvest the cornea from the patients died due to COVID-19 and preventing the chances of transmission from donor to the recipient or healthcare worker handling the harvested cornea. A total of 45 articles were found with the keywords and out of all, only 16 fulfilled the inclusion criteria. RT-PCR is the technique of choice for detection of virus in the corpse and the sample analyzed was a pharyngeal swab. Available literature states unavailability of sufficient evidence-based studies proving presence of virus in the cornea or tear of COVID affected patients There is no proven consensus on presence of Virus in cornea. It is important to follow preferred practice guidelines so as to restart eye banking and do at least the emergency surgeries without having risk of disease transmission and keeping ourselves safe.

[Emergency and intensive care medicine aspects of COVID-19 infections]

CLINICAL ISSUE

The COVID 19 pandemic led to a profound adaptation of the German healthcare system in preparation of a massive increase of SARS-CoV-2-associated diseases. While general practitioners care for COVID patients who are less severely ill, hospitals are focused on the care of severely ill COVID-19 patients.

STANDARD TREATMENT

The role of emergency medicine (EM) is to rapidly detect the virus, to classify disease severity, and to initiate therapy. In addition, the flow of patients into the hospital must be directed in such a way that optimal care is provided without risk of infecting health care personnel and patients. Despite optimal intensive care treatment, the mortality of patients remains high if organ failure develops, especially in patients who are older or have pre-existing conditions.

TREATMENT INNOVATIONS

Rapid diagnosis of patients with SARS-CoV‑2 infection together with assessment of disease severity and awareness of organ failure are the mainstays of emergency care. Intensive care is needed for the treatment of SARS-CoV-2-induced organ failure, whereby lung failure in these patients requires differentiated ventilation therapies.

DIAGNOSTIC WORK-UP

The polymerase chain reaction (PCR) test is performed to diagnose SARS-CoV‑2 infection. Adjunctive diagnostic measures which enhance diagnostic specificity are lung ultrasound, x‑ray, and computed tomography of the lungs. This also allows categorization of the type of COVID-19 pneumonia.

PRACTICAL RECOMMENDATIONS

For early detection and appropriate treatment of SARS-CoV‑2 infection, PCR is needed. Adjunctive sonographic and radiological examinations allow the treatment of COVID-19 patients to be tailored according to the specific type of pneumonia.