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Voidarou C, Rozos G, Stavropoulou E, Giorgi E, Stefanis C, Vakadaris G, Vaou N, Tsigalou C, Kourkoutas Y, Bezirtzoglou E. COVID-19 on the spectrum: a scoping review of hygienic standards. Front Public Health 2023; 11:1202216. [PMID: 38026326 PMCID: PMC10646607 DOI: 10.3389/fpubh.2023.1202216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic.
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Affiliation(s)
| | - Georgios Rozos
- Veterinary Directorate, South Aegean Region, Ermoupolis, Greece
| | - Elisavet Stavropoulou
- Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Elpida Giorgi
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Stefanis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Vakadaris
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Natalia Vaou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Yiannis Kourkoutas
- Laboratory of Applied Microbiology and Biotechnology, Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eugenia Bezirtzoglou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Effect of Coronavirus Disease (COVID-19) on Human Semen: No Evidence of Coronavirus in Semen of Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6204880. [PMID: 36132075 PMCID: PMC9484874 DOI: 10.1155/2022/6204880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
Background In December 2019, a severe acute respiratory syndrome (SARS-COV-2) was found in China. The coronavirus can impact different organs, as shown by the virus having been detected in urine, blood, oropharyngeal, and feces. This study was done to assess the impact of COVID-19 on semen analysis and to evaluate the existence of the virus in the semen of infected men. Methodology. Forty fertile men with COVID-19 were confirmed by an oropharyngeal sample. The men were divided into two groups. The semen of twenty men in the acute stage of COVID-19 and twenty men in the clinical recovery stage was analyzed, and the parameters of semen were compared between two groups. In addition, a PCR test of patients' semen was done. Result The analysis showed that all patients' semen specimens tested negative. Semen analysis revealed no significant difference in sperm count, concentration, or motility, and the sperm of both groups was found to be normal. However, viability and morphology parameters were significantly lower in men with the acute disease. Conclusion Coronavirus (COVID-19) was not secreted in the semen of infected men but had a negative effect on the morphology and viability of the sperm of men in the acute stage.
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Honarmand A, Sheybani F, Aflatoonian E, Saberinia A. COVID-19 patients at referral to hospital during the first peak of disease: Common clinical findings including myalgia and fatigue. Eur J Transl Myol 2022; 32. [PMID: 36036352 PMCID: PMC9580529 DOI: 10.4081/ejtm.2022.10731] [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: 07/11/2022] [Accepted: 08/03/2022] [Indexed: 01/08/2023] Open
Abstract
The wide range of manifestations and clinical symptoms of COVID-19 has made it a unique disease. Investigating the epidemiology of different clinical manifestations of this disease in patients referred to medical centers is one of the most effective steps in adopting a suitable diagnostic and treatment approach. These findings also provide a basis for comparing the evolution of the virus and its clinical manifestations over time and at different peaks of the disease. Therefore, the present study was aimed at investigating common clinical findings at the time of referral in patients with COVID-19 in Afzalipour Hospital, Kerman, during the first peak of the disease. This descriptive-analytical cross-sectional study was performed on hospitalized patients diagnosed with COVID-19, between March 2020 and June 2020. The patients were included in the study by census method, and the research variables related to demographic indicators, disease course and clinical symptoms were extracted from the patients' medical records, and then subjected to statistical analysis. In this study, a total of 210 patients were examined, consisted mainly of male patients (59.5%). The mean age was found to be 53.95 ± 19.55 years. Also, 20.3% of patients needed admission in the intensive care unit. In addition, 1% of patients were infected in February 2020, 24% in March 2020, 47.4% in April 2020 and 27.4% in May 2020. The mean onset of symptoms until hospitalization was also found as 6.51 days. The most common clinical symptoms included shortness of breath (75.7%), dry cough (52.9%), fever (50.5%), myalgia (45.7%) and fatigue (41.9%). Fever at admission time was significantly more common in ages less than 50 years (p=0.034). Our study showed that the most common clinical symptoms were shortness of breath, dry cough, fever, myalgia and fatigue. No statistically significant difference was found in common symptoms between men and women. Among the common clinical symptoms, only fever at admission time was observed to be significantly higher in those under 50 years of age.
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Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2021. [PMID: 32462305 DOI: 10.1007/s00345-%20020-%2003246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
PURPOSE AND OBJECTIVE We performed a systematic review on COVID-19 and its potential urological manifestations. METHODS A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. RESULTS There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30-13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46-100%) amongst them. 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71-83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. CONCLUSIONS Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
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Joukar F, Yaghubi Kalurazi T, Khoshsorour M, Taramian S, Mahfoozi L, Balou HA, Jafarinezhad A, Pourkazemi A, Hesni E, Asgharnezhad M, Shenagari M, Jahanzad I, Naghipour M, Maroufizadeh S, Mansour-Ghanaei F. Persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19: a hospital-based longitudinal study. Virol J 2021; 18:134. [PMID: 34210325 PMCID: PMC8248752 DOI: 10.1186/s12985-021-01599-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19. METHODS In this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence. RESULTS The median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91-9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07-7.93), 6 days (95% CI 4.16-8.41), and 13 days (95% CI 6.96-19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively. CONCLUSION According to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.
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Affiliation(s)
- Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, GI Cancer Screening and Prevention Research Center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave, 41448-95655 Rasht, Iran
| | - Tofigh Yaghubi Kalurazi
- Department of Health, Nutrition and Infectious Diseases, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahmoud Khoshsorour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sonbol Taramian
- Department of Health, Nutrition and Infectious Diseases, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Lida Mahfoozi
- Department of Health, Nutrition and Infectious Diseases, Guilan University of Medical Sciences, Rasht, Iran
| | - Heydar Ali Balou
- Department of Internal Medicine, School of Medicine, Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Aydin Pourkazemi
- Department of Health, Nutrition and Infectious Diseases, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ezat Hesni
- Department of Health, Nutrition and Infectious Diseases, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Asgharnezhad
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Shenagari
- Department of Microbiology, School of Medicine, Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, GI Cancer Screening and Prevention Research Center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave, 41448-95655 Rasht, Iran
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Joukar F, Yaghubi Kalurazi T, Khoshsorour M, Taramian S, Mahfoozi L, Balou HA, Jafarinezhad A, Pourkazemi A, Hesni E, Asgharnezhad M, Shenagari M, Jahanzad I, Naghipour M, Maroufizadeh S, Mansour-Ghanaei F. Persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19: a hospital-based longitudinal study. Virol J 2021. [PMID: 34210325 DOI: 10.1186/s12985-021-01599-9.pmid:34210325;pmcid:pmc8248752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19. METHODS In this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence. RESULTS The median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91-9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07-7.93), 6 days (95% CI 4.16-8.41), and 13 days (95% CI 6.96-19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively. CONCLUSION According to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.
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Affiliation(s)
- Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, GI Cancer Screening and Prevention Research Center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave, 41448-95655, Rasht, Iran
| | - Tofigh Yaghubi Kalurazi
- Department of Health, Nutrition and Infectious Diseases, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahmoud Khoshsorour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sonbol Taramian
- Department of Health, Nutrition and Infectious Diseases, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Lida Mahfoozi
- Department of Health, Nutrition and Infectious Diseases, Guilan University of Medical Sciences, Rasht, Iran
| | - Heydar Ali Balou
- Department of Internal Medicine, School of Medicine, Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Aydin Pourkazemi
- Department of Health, Nutrition and Infectious Diseases, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ezat Hesni
- Department of Health, Nutrition and Infectious Diseases, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Asgharnezhad
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Shenagari
- Department of Microbiology, School of Medicine, Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, GI Cancer Screening and Prevention Research Center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave, 41448-95655, Rasht, Iran.
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Park M, Pawliuk C, Nguyen T, Griffitt A, Dix-Cooper L, Fourik N, Dawes M. Determining the communicable period of SARS-CoV-2: A rapid review of the literature, March to September 2020. Euro Surveill 2021; 26:2001506. [PMID: 33834961 PMCID: PMC8034061 DOI: 10.2807/1560-7917.es.2021.26.14.2001506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
IntroductionStandard testing for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is based on RT-PCR tests, but detection of viral genetic material alone does not indicate ongoing infectious potential. The ability to isolate whole virus represents a better proxy for infectivity.AimThe objective of this study was to gain an understanding of the current literature and compare the reported periods of positive SARS-CoV-2 detection from studies that conducted RT-PCR testing in addition to experiments isolating whole virus.MethodsUsing a rapid review approach, studies reporting empirical data on the duration of positive RT-PCR results and/or successful viral isolation following SARS-CoV-2 infection in humans were identified through searches of peer-reviewed and pre-print health sciences literature. Articles were screened for relevance, then data were extracted, analysed, and synthesised.ResultsOf the 160 studies included for qualitative analysis, 84% (n = 135) investigated duration of positive RT-PCR tests only, 5% (n = 8) investigated duration of successful viral isolations, while 11% (n = 17) included measurements on both. There was significant heterogeneity in reported data. There was a prolonged time to viral clearance when deduced from RT-PCR tests compared with viral isolations (median: 26 vs 9 days).DiscussionFindings from this review support a minimum 10-day period of isolation but certain cases where virus was isolated after 10 days were identified. Given the extended time to viral clearance from RT-PCR tests, future research should ensure standard reporting of RT-PCR protocols and results to help inform testing policies aimed at clearance from isolation.
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Affiliation(s)
- Mina Park
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Pawliuk
- School of Information, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tribesty Nguyen
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Griffitt
- School of Information, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nadia Fourik
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Martin Dawes
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Ye C, Qi L, Wang J, Zheng S. COVID-19 Pandemic: Advances in Diagnosis, Treatment, Organoid Applications and Impacts on Cancer Patient Management. Front Med (Lausanne) 2021; 8:606755. [PMID: 33855032 PMCID: PMC8039300 DOI: 10.3389/fmed.2021.606755] [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] [Received: 09/15/2020] [Accepted: 03/05/2021] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally and rapidly developed into a worldwide pandemic. The sudden outburst and rapid dissemination of SARS-CoV-2, with overwhelming public health and economic burdens, highlight an urgent need to develop effective strategies for the diagnosis and treatment of infected patients. In this review, we focus on the current advances in the diagnostics and treatment for SARS-CoV-2 infection. Notably, we also summarize some antineoplastic drugs repurposed for COVID-19 treatment and address the diagnostic and therapeutic challenges for oncologists to manage cancer patients in this COVID-19 era. In addition, we emphasize the importance of organoid technology as a valuable experimental virology platform to better understand the pathogenesis of COVID-19 and assist rapid screening of drugs against COVID-19.
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Affiliation(s)
- Chenyang Ye
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lina Qi
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Ji Wang
- Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
- Department of Surgical Oncology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China
| | - Shu Zheng
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- Reseach Center for Air Pollution and Health, School of Medicine, Zhejiang University, Hangzhou, China
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9
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Fan C, Lu W, Li K, Ding Y, Wang J. ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Infection in COVID-19 Patients. Front Med (Lausanne) 2021; 7:563893. [PMID: 33521006 PMCID: PMC7838217 DOI: 10.3389/fmed.2020.563893] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
In December 2019, a new type of pneumonia caused by SARS-Cov-2 (COVID-19) occurred in Wuhan and has been discovered in many countries around the world. ACE2 (angiotensin-converting enzyme 2) has been shown to be one of the major receptors that mediate the entry of SARS-Cov-2 into human cells. Here in this study, we used the online datasets to analyze ACE2 expression in different human organs. The results indicated that ACE2 highly expresses in renal tubular cells, Sertoli cells, Leydig cells, and cells in seminiferous ducts in testis. Recombinant SARS-CoV-2 spike protein (RBD) domain and ACE2 of RPTEC/SerC cell-binding assays confirmed that SARS-Cov-2 can bind to ACE2 on the surface of these cells. Our results suggest that ACE2 expression could contribute to kidney and testis infection after COVID-19 infection. Renal function evaluation and special care should be performed during clinical work. Clinicians should also pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow-up, especially the assessment and appropriate intervention in young patients' fertility.
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Affiliation(s)
- Caibin Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Lu
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Kai Li
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Yanhong Ding
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Jianqing Wang
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
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10
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Azghandi M, Kerachian MA. Detection of novel coronavirus (SARS-CoV-2) RNA in peripheral blood specimens. J Transl Med 2020; 18:412. [PMID: 33138836 PMCID: PMC7605324 DOI: 10.1186/s12967-020-02589-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
The latest outbreak of pneumonia caused by SARS-CoV-2 presents a significant challenge to global public health and has a major impact on clinical microbiology laboratories. In some situations, such as patients in coma condition, the oropharyngeal or nasopharyngeal sampling is seldom feasible, and blood sampling could be an alternative. In the current article, a comprehensive literature search has been conducted for detecting coronavirus disease 2019 (COVID-19) using plasma or serum samples. To date, twenty-six studies have used SARS-CoV-2 nucleic acid in plasma or serum (RNAaemia) to diagnose COVID-19. The pros and cons are discussed in this article. While the detection of SARS-CoV-2 viral load in respiratory specimens is commonly used to diagnose COVID-19, detecting SARS-CoV-2 RNA in plasma or serum should not lose sight and it could be considered as an alternative diagnostic approach.
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Affiliation(s)
- Marjan Azghandi
- Cancer Genetics Research Unit, Reza Radiotherapy and Oncology Center, Mashhad, Iran
- Department of Animal Science, Faculty of Agriculture, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mohammad Amin Kerachian
- Cancer Genetics Research Unit, Reza Radiotherapy and Oncology Center, Mashhad, Iran.
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Patel KP, Vunnam SR, Patel PA, Krill KL, Korbitz PM, Gallagher JP, Suh JE, Vunnam RR. Transmission of SARS-CoV-2: an update of current literature. Eur J Clin Microbiol Infect Dis 2020; 39:2005-2011. [PMID: 32638221 PMCID: PMC7339796 DOI: 10.1007/s10096-020-03961-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent for the 2019 coronavirus disease (COVID-19) pandemic, has caused a public health emergency. The need for additional research in viral pathogenesis is essential as the number of cases and deaths rise. Understanding the virus and its ability to cause disease has been the main focus of current literature; however, there is much unknown. Studies have revealed new findings related to the full transmission potential of SARS-CoV-2 and its subsequent ability to cause infection by different means. The virus is hypothesized to be of increased virulence compared with previous coronavirus that caused epidemics, in part due to its overall structural integrity and resilience to inactivation. To date, many studies have discussed that the rationale behind its transmission potential is that viral RNA has unexpectedly been detected in multiple bodily fluids, with some samples having remained positive for extended periods of time. Additionally, the receptor by which the virus gains cellular entry, ACE2, has been found to be expressed in different human body systems, thereby potentiating its infection in those locations. In this evidence-based comprehensive review, we discuss various potential routes of transmission of SARS-CoV-2-respiratory/droplet, indirect, fecal-oral, vertical, sexual, and ocular. Understanding these different routes is important as they pertain to clinical practice, especially in taking preventative measures to mitigate the spread of SARS-CoV-2.
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Affiliation(s)
- Kishan P Patel
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Srinivas R Vunnam
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Puja A Patel
- Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Kaleigh L Krill
- Department of Medicine, Division of Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Parker M Korbitz
- University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - John P Gallagher
- University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Jane E Suh
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rama R Vunnam
- Department of Medicine, Division of Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
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12
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Haghpanah A, Masjedi F, Alborzi S, Hosseinpour A, Dehghani A, Malekmakan L, Roozbeh J. Potential mechanisms of SARS-CoV-2 action on male gonadal function and fertility: Current status and future prospects. Andrologia 2020; 53:e13883. [PMID: 33108833 PMCID: PMC7645932 DOI: 10.1111/and.13883] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus was recognised in December 2019 and caught humanity off guard. The virus employs the angiotensin‐converting enzyme 2 (ACE2) receptor for entry into human cells. ACE2 is expressed on different organs, which is raising concern as to whether these organs can be infected by the virus or not. The testis appears to be an organ enriched with levels of ACE2, while the possible mechanisms of involvement of the male reproductive system by SARS‐CoV‐2 are not fully elucidated. The major focus of the present studies is on the short‐term complications of the coronavirus and gains importance on studying the long‐term effects, including the possible effects of the virus on the male reproductive system. The aim of this review was to provide new insights into different possible mechanisms of involvement of male gonads with SARS‐CoV‐2 including investigating the ACE2 axis in testis, hormonal alterations in patients with COVID‐19, possible formation of anti‐sperm antibodies (ASA) and subsequently immunological infertility as a complication of SARS‐CoV‐2 infection. Finally, we suggest measuring the sperm DNA fragmentation index (DFI) as a determiner of male fertility impairment in patients with COVID‐19 along with other options such as sex‐related hormones and semen analysis. Invasion of SARS‐CoV‐2 to the spermatogonia, Leydig cells and Sertoli cells can lead to sex hormonal alteration and impaired gonadal function. Once infected, changes in ACE2 signalling pathways followed by oxidative stress and inflammation could cause spermatogenesis failure, abnormal sperm motility, DNA fragmentation and male infertility.
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Affiliation(s)
- Abdolreza Haghpanah
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Masjedi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Alborzi
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Gynecology and Obstetrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Hosseinpour
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Dehghani
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Rahmani AR, Leili M, Azarian G, Poormohammadi A. Sampling and detection of corona viruses in air: A mini review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 740:140207. [PMID: 32554029 PMCID: PMC7295527 DOI: 10.1016/j.scitotenv.2020.140207] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 05/19/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a strain of coronaviruses that causes coronavirus disease 2019 (COVID-19). In these days, the spread of the SARS-CoV-2 virus through the air has become a controversial topic among scientists. Various organizations provide standard methods for monitoring biological agents in the air. Nevertheless, there has been no standard recommended method for sampling and determination of viruses in air. This manuscript aimed at reviewing published papers for sampling and detection of corona viruses, especially SARS-Cov-2 as a global health concern. It was found that SARS-Cov 2 was present in some air samples that were collected from patient's rooms in hospitals. This result warrants its airborne transmission potential. However, due to the fact that in the most reviewed studies, sampling was performed in the patient's room, it seems difficult to discriminate whether it is airborne or is transmitted through respiratory droplets. Moreover, some other disrupting factors such as patient distance from the sampler, using protective or oxygen masks by patients, patient activities, coughing and sneezing during sampling time, air movement, air conditioning, sampler type, sampling conditions, storage and transferring conditions, can affect the results. About the sampling methods, most of the used samplers such as PTFE filters, gelatin filers and cyclones showed suitable performance for trapping SARS-Co and MERS-Cov viruses followed by PCR analysis.
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Affiliation(s)
- Ali Reza Rahmani
- Department of Environmental Health Engineering, Faculty of Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Leili
- Department of Environmental Health Engineering, Faculty of Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghasem Azarian
- Department of Environmental Health Engineering, Faculty of Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Poormohammadi
- Center of Excellence for Occupational Health, Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
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14
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Siam MHB, Nishat NH, Ahmed A, Hossain MS. Stopping the COVID-19 Pandemic: A Review on the Advances of Diagnosis, Treatment, and Control Measures. J Pathog 2020; 2020:9121429. [PMID: 33133697 PMCID: PMC7588828 DOI: 10.1155/2020/9121429] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/27/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
With the continued spread of COVID-19 across the world, rapid diagnostic tools, readily available respurposable drugs, and prompt containment measures to control the SARS-CoV-2 infection are of paramount importance. Examples of recent advances in diagnostic tests are CRISPR technology, IgG assay, spike protein detection, and use of artificial intelligence. The gold standard reverse transcription polymerase chain (RT-PCR) has also been upgraded with point-of-care rapid tests. Supportive treatment, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) remain the primary choice, while therapeutic options include antivirals, antiparasitics, anti-inflammatories, interferon, convalescent plasma, monoclonal antibody, hyperimmunoglobulin, RNAi, and mesenchymal stem cell therapy. Different types of vaccines such as RNA, DNA, and lentiviral, inactivated, and viral vector are in clinical trials. Moreover, rapidly deployable and easy-to-transport innovative vaccine delivery systems are also in development. As countries have started easing down on the lockdown measures, the chance for a second wave of infection demands strict and rational control policies to keep fatalities minimized. An improved understanding of the advances in diagnostic tools, treatments, vaccines, and control measures for COVID-19 can provide references for further research and aid better containment strategies.
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Affiliation(s)
- Md. Hasanul Banna Siam
- Biomedical Research Foundation (BRF), Dhaka, Bangladesh
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
| | - Nahida Hannan Nishat
- Biomedical Research Foundation (BRF), Dhaka, Bangladesh
- Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Ahsan Ahmed
- Biomedical Research Foundation (BRF), Dhaka, Bangladesh
- Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Mohammad Sorowar Hossain
- Biomedical Research Foundation (BRF), Dhaka, Bangladesh
- School of Environment and Life Science, Independent University Bangladesh (IUB), Dhaka, Bangladesh
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15
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Kunz Y, Horninger W, Pinggera GM. [What should urologists know about SARS-CoV-2? Risk analysis for urological operations and recommendations for action in clinical routine]. Urologe A 2020; 59:1361-1370. [PMID: 33048213 PMCID: PMC7550842 DOI: 10.1007/s00120-020-01264-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hintergrund Die COVID-19 („coronavirus disease 2019“) stellt Gesundheitssysteme weltweit vor eine große Herausforderung. Mit steigenden Infektionsraten geraten auch Urologen wegen eines Infektionsrisikos mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) bei operativen Eingriffen in den Fokus. Hierdurch entsteht die Notwendigkeit über das Coronavirus sinnvolle und umsetzbare Handlungsempfehlungen zu erstellen. Ziel der Arbeit Es wurde eine umfassende Einschätzung des Infektionsrisikos mit SARS-CoV‑2 bei urologischen Eingriffen erstellt. Auf Basis der Datenlage sowie aktueller Empfehlungen nationaler und internationaler Richtlinien soll einerseits das Infektionsrisiko im Umgang mit humanen Geweben und Stoffen beurteilt und andererseits notwendige hygienische Maßnahmen beleuchtet werden. Letztlich sollen hieraus Handlungsempfehlungen und zu treffende Schutzmaßnahmen für die urologische Praxis abgeleitet und erklärt werden. Material und Methoden In PubMed, bioRxiv und medRxiv sowie den Datenbanken der WHO und des RKI wurde eine Literatursuche über SARS-CoV‑2 und das chirurgische Prozedere bei infizierten Patienten durchgeführt. Der Zeitraum der Literatursuche war bis 21.04.2020. Diskussion Auf Basis der recherchierten Daten können generelle und spezifische Handlungsempfehlungen für die urologische Praxis abgeleitet werden. Zwar bleibt unklar, ob SARS-CoV‑2 letztlich über die entstehenden Aerosole übertragen wird, aber allgemeine Schutzempfehlungen bieten gerade bei chirurgischen Eingriffen in Zeiten der SARS-CoV-2-Pandemie vermutlich keinen suffizienten Schutz und sollten sorgfältig überdacht werden. Entscheidend dürfte hierbei ein konsequenter Einsatz von FFP-2-Masken, Schutzbrillen und Vollkörperanzug sein. Um eine Kontaminationsbelastung von Luft und Oberflächen einzudämmen, sollen komplexe Filtersysteme (HEPA), der Einsatz von zumindest begrenzt viruziden Oberflächendesinfektionsmitteln und intraoperative Absaugvorrichtungen Verwendung finden. Eine Fokussierung auf wenige, aber optimierte eigens hierfür bereitgestellte COVID-OPs ist nicht zuletzt unter dem Gesichtspunkt der Ressourcenschonung sinnvoll. Unter Einhaltung der entsprechenden Handlungsmaßnahmen kann ein für Urologen und medizinisches Personal sicheres Arbeitsumfeld geschaffen werden. Daher sehen die Autoren nach derzeitigem Wissensstand keine Kontraindikation für dringliche und Notfalleingriffe, vorausgesetzt entsprechende Vorsichtsmaßnahmen in ihrer Schutzwirkung werden eingehalten.
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Affiliation(s)
- Y Kunz
- Abteilung für Urologie, Medizinische Universitätsklinik Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - W Horninger
- Abteilung für Urologie, Medizinische Universitätsklinik Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - G-M Pinggera
- Abteilung für Urologie, Medizinische Universitätsklinik Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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16
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Chedid NR, Udit S, Solhjou Z, Patanwala MY, Sheridan AM, Barkoudah E. COVID-19 and Rhabdomyolysis. J Gen Intern Med 2020; 35:3087-3090. [PMID: 32671722 PMCID: PMC7363012 DOI: 10.1007/s11606-020-06039-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Nicholas R Chedid
- Internal Medicine Residency Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Swalpa Udit
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhabiz Solhjou
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Maria Y Patanwala
- Internal Medicine Residency Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alice M Sheridan
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ebrahim Barkoudah
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Hospital Medicine Unit and the Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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17
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Hansrivijit P, Qian C, Boonpheng B, Thongprayoon C, Vallabhajosyula S, Cheungpasitporn W, Ghahramani N. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis. J Investig Med 2020; 68:1261-1270. [PMID: 32655013 PMCID: PMC7371487 DOI: 10.1136/jim-2020-001407] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is a complication of COVID-19. However, the incidence of AKI in COVID-19 varies among studies. Thus, we aimed to evaluate the pooled incidence of AKI and its association with mortality in patients with COVID-19 using a meta-analysis. We search Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible publications reporting the clinical characteristics of patients with COVID-19 without language restriction. Incidence of AKI and mortality were reported. Meta-regression was used to describe the association between outcomes. From 26 studies (n=5497), the pooled incidence of AKI in patients with COVID-19 was 8.4% (95% CI 6.0% to 11.7%) with a pooled incidence of renal replacement therapy of 3.6% (95% CI 1.8% to 7.1%). The incidence of AKI was higher in critically ill patients (19.9%) compared with hospitalized patients (7.3%). The pooled estimated odds ratio for mortality from AKI was 13.33 (95% CI 4.05 to 43.91). No potential publication bias was detected. By using meta-regression analyses, the incidence of AKI was positively associated with mortality after adjusted for age and sex (Q=26.18; p=0.02). Moreover, age (p<0.01), diabetes (p=0.02), hypertension (p<0.01) and baseline serum creatinine levels (p=0.04) were positively associated with AKI incidence in adjusted models. In conclusion, AKI is present in 8.3% of overall patients with COVID-19 and in 19.9% of critically ill patients with COVID-19. Presence of AKI is associated with 13-fold increased risk of mortality. Age, diabetes, hypertension, and baseline serum creatinine levels are associated with increased AKI incidence.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - Chenchen Qian
- Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - Boonphiphop Boonpheng
- Division of Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | | | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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18
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Ferreira AO, Polonini HC, Dijkers ECF. Postulated Adjuvant Therapeutic Strategies for COVID-19. J Pers Med 2020; 10:E80. [PMID: 32764275 PMCID: PMC7565841 DOI: 10.3390/jpm10030080] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023] Open
Abstract
The number of COVID-19 patients is still growing exponentially worldwide due to the high transmissibility of the SARS-CoV-2 virus. Therapeutic agents currently under investigation are antiviral drugs, vaccines, and other adjuvants that could relieve symptoms or improve the healing process. In this review, twelve therapeutic agents that could play a role in prophylaxis or improvement of the COVID-19-associated symptoms (as add-on substances) are discussed. Agents were identified based on their known pharmacologic mechanism of action in viral and/or nonviral fields and are postulated to interact with one or more of the seven known mechanisms associated with the SARS-CoV-2 virus: (i) regulation of the immune system; (ii) virus entrance in the cell; (iii) virus replication; (iv) hyperinflammation; (v) oxidative stress; (vi) thrombosis; and (vii) endotheliitis. Selected agents were immune transfer factor (oligo- and polypeptides from porcine spleen, ultrafiltered at <10 kDa; Imuno TF®), anti-inflammatory natural blend (Uncaria tomentosa, Endopleura uchi and Haematoccocus pluvialis; Miodesin®), zinc, selenium, ascorbic acid, cholecalciferol, ferulic acid, spirulina, N-acetylcysteine, glucosamine sulfate potassium hydrochloride, trans-resveratrol, and maltodextrin-stabilized orthosilicic acid (SiliciuMax®). This review gives the scientific background on the hypothesis that these therapeutic agents can act in synergy in the prevention and improvement of COVID-19-associated symptoms.
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Affiliation(s)
- Anderson O. Ferreira
- Fagron. Lichtenauerlaan 182, 3062 Rotterdam, The Netherlands; (H.C.P.); (E.C.F.D.)
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19
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Abstract
Since its initial outbreak in China, in December, 2019, COVID-19 has spread rapidly across the globe. At the time of writing, on April 29, 2020, infections had been confirmed in more than 200 countries and regions and 3,018,681 infections and 207,973 deaths had been recorded. In Japan, the first confirmed case of SARS-CoV-2 infection was reported on January 16, 2020, since when, the number of domestic infections and the death toll have reached 13,852 and 389, respectively, representing exponential increases. Moreover, both domestically and internationally, the shortage of medical resources and the spread of infection among medical personnel, caused by nosocomial transmissions have become problematic. The pathology of COVID-19, including the exact infection route, remains largely unknown. Given the unavailability of an effective cure and vaccine, people are required to respond to this adversity without becoming complacent. The global efforts against the COVID-19 pandemic are ongoing endeavors, far from over. New epidemiological data and clinical findings are emerging on a daily basis, making it critical to always refer to the latest information.
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Affiliation(s)
- Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center Manabu Watanabe, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
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20
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Raina R, Chakraborty R, Sethi SK, Bunchman T. Kidney Replacement Therapy in COVID-19 Induced Kidney Failure and Septic Shock: A Pediatric Continuous Renal Replacement Therapy [PCRRT] Position on Emergency Preparedness With Resource Allocation. Front Pediatr 2020; 8:413. [PMID: 32719758 PMCID: PMC7347905 DOI: 10.3389/fped.2020.00413] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
The recent worldwide pandemic of COVID-19 has had a detrimental worldwide impact on people of all ages. Although data from China and the United States indicate that pediatric cases often have a mild course and are less severe in comparison to adults, there have been several cases of kidney failure and multisystem inflammatory syndrome reported. As such, we believe that the world should be prepared if the severity of cases begins to further increase within the pediatric population. Therefore, we provide here a position paper centered on emergency preparation with resource allocation for critical COVID-19 cases within the pediatric population, specifically where renal conditions worsen due to the onset of AKI.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General, Akron Nephrology Associates, Akron, OH, United States
- Department of Nephrology, Akron Children's Hospital, Akron, OH, United States
| | - Ronith Chakraborty
- Department of Nephrology, Cleveland Clinic Akron General, Akron Nephrology Associates, Akron, OH, United States
| | - Sidharth Kumar Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Timothy Bunchman
- Pediatric Nephrology & Transplantation, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, United States
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21
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Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Spijker R, Taylor-Phillips S, Adriano A, Beese S, Dretzke J, Ferrante di Ruffano L, Harris IM, Price MJ, Dittrich S, Emperador D, Hooft L, Leeflang MM, Van den Bruel A. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev 2020; 6:CD013652. [PMID: 32584464 PMCID: PMC7387103 DOI: 10.1002/14651858.cd013652] [Citation(s) in RCA: 432] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and resulting COVID-19 pandemic present important diagnostic challenges. Several diagnostic strategies are available to identify current infection, rule out infection, identify people in need of care escalation, or to test for past infection and immune response. Serology tests to detect the presence of antibodies to SARS-CoV-2 aim to identify previous SARS-CoV-2 infection, and may help to confirm the presence of current infection. OBJECTIVES To assess the diagnostic accuracy of antibody tests to determine if a person presenting in the community or in primary or secondary care has SARS-CoV-2 infection, or has previously had SARS-CoV-2 infection, and the accuracy of antibody tests for use in seroprevalence surveys. SEARCH METHODS We undertook electronic searches in the Cochrane COVID-19 Study Register and the COVID-19 Living Evidence Database from the University of Bern, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. We conducted searches for this review iteration up to 27 April 2020. SELECTION CRITERIA We included test accuracy studies of any design that evaluated antibody tests (including enzyme-linked immunosorbent assays, chemiluminescence immunoassays, and lateral flow assays) in people suspected of current or previous SARS-CoV-2 infection, or where tests were used to screen for infection. We also included studies of people either known to have, or not to have SARS-CoV-2 infection. We included all reference standards to define the presence or absence of SARS-CoV-2 (including reverse transcription polymerase chain reaction tests (RT-PCR) and clinical diagnostic criteria). DATA COLLECTION AND ANALYSIS We assessed possible bias and applicability of the studies using the QUADAS-2 tool. We extracted 2x2 contingency table data and present sensitivity and specificity for each antibody (or combination of antibodies) using paired forest plots. We pooled data using random-effects logistic regression where appropriate, stratifying by time since post-symptom onset. We tabulated available data by test manufacturer. We have presented uncertainty in estimates of sensitivity and specificity using 95% confidence intervals (CIs). MAIN RESULTS We included 57 publications reporting on a total of 54 study cohorts with 15,976 samples, of which 8526 were from cases of SARS-CoV-2 infection. Studies were conducted in Asia (n = 38), Europe (n = 15), and the USA and China (n = 1). We identified data from 25 commercial tests and numerous in-house assays, a small fraction of the 279 antibody assays listed by the Foundation for Innovative Diagnostics. More than half (n = 28) of the studies included were only available as preprints. We had concerns about risk of bias and applicability. Common issues were use of multi-group designs (n = 29), inclusion of only COVID-19 cases (n = 19), lack of blinding of the index test (n = 49) and reference standard (n = 29), differential verification (n = 22), and the lack of clarity about participant numbers, characteristics and study exclusions (n = 47). Most studies (n = 44) only included people hospitalised due to suspected or confirmed COVID-19 infection. There were no studies exclusively in asymptomatic participants. Two-thirds of the studies (n = 33) defined COVID-19 cases based on RT-PCR results alone, ignoring the potential for false-negative RT-PCR results. We observed evidence of selective publication of study findings through omission of the identity of tests (n = 5). We observed substantial heterogeneity in sensitivities of IgA, IgM and IgG antibodies, or combinations thereof, for results aggregated across different time periods post-symptom onset (range 0% to 100% for all target antibodies). We thus based the main results of the review on the 38 studies that stratified results by time since symptom onset. The numbers of individuals contributing data within each study each week are small and are usually not based on tracking the same groups of patients over time. Pooled results for IgG, IgM, IgA, total antibodies and IgG/IgM all showed low sensitivity during the first week since onset of symptoms (all less than 30.1%), rising in the second week and reaching their highest values in the third week. The combination of IgG/IgM had a sensitivity of 30.1% (95% CI 21.4 to 40.7) for 1 to 7 days, 72.2% (95% CI 63.5 to 79.5) for 8 to 14 days, 91.4% (95% CI 87.0 to 94.4) for 15 to 21 days. Estimates of accuracy beyond three weeks are based on smaller sample sizes and fewer studies. For 21 to 35 days, pooled sensitivities for IgG/IgM were 96.0% (95% CI 90.6 to 98.3). There are insufficient studies to estimate sensitivity of tests beyond 35 days post-symptom onset. Summary specificities (provided in 35 studies) exceeded 98% for all target antibodies with confidence intervals no more than 2 percentage points wide. False-positive results were more common where COVID-19 had been suspected and ruled out, but numbers were small and the difference was within the range expected by chance. Assuming a prevalence of 50%, a value considered possible in healthcare workers who have suffered respiratory symptoms, we would anticipate that 43 (28 to 65) would be missed and 7 (3 to 14) would be falsely positive in 1000 people undergoing IgG/IgM testing at days 15 to 21 post-symptom onset. At a prevalence of 20%, a likely value in surveys in high-risk settings, 17 (11 to 26) would be missed per 1000 people tested and 10 (5 to 22) would be falsely positive. At a lower prevalence of 5%, a likely value in national surveys, 4 (3 to 7) would be missed per 1000 tested, and 12 (6 to 27) would be falsely positive. Analyses showed small differences in sensitivity between assay type, but methodological concerns and sparse data prevent comparisons between test brands. AUTHORS' CONCLUSIONS The sensitivity of antibody tests is too low in the first week since symptom onset to have a primary role for the diagnosis of COVID-19, but they may still have a role complementing other testing in individuals presenting later, when RT-PCR tests are negative, or are not done. Antibody tests are likely to have a useful role for detecting previous SARS-CoV-2 infection if used 15 or more days after the onset of symptoms. However, the duration of antibody rises is currently unknown, and we found very little data beyond 35 days post-symptom onset. We are therefore uncertain about the utility of these tests for seroprevalence surveys for public health management purposes. Concerns about high risk of bias and applicability make it likely that the accuracy of tests when used in clinical care will be lower than reported in the included studies. Sensitivity has mainly been evaluated in hospitalised patients, so it is unclear whether the tests are able to detect lower antibody levels likely seen with milder and asymptomatic COVID-19 disease. The design, execution and reporting of studies of the accuracy of COVID-19 tests requires considerable improvement. Studies must report data on sensitivity disaggregated by time since onset of symptoms. COVID-19-positive cases who are RT-PCR-negative should be included as well as those confirmed RT-PCR, in accordance with the World Health Organization (WHO) and China National Health Commission of the People's Republic of China (CDC) case definitions. We were only able to obtain data from a small proportion of available tests, and action is needed to ensure that all results of test evaluations are available in the public domain to prevent selective reporting. This is a fast-moving field and we plan ongoing updates of this living systematic review.
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Affiliation(s)
- Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sian Taylor-Phillips
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ada Adriano
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sophie Beese
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Janine Dretzke
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lavinia Ferrante di Ruffano
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Isobel M Harris
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | | | | | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Biomarker and Test Evaluation Programme (BiTE), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Mabillard H, Sayer JA. SARS-CoV-2 and hypokalaemia: evidence and implications. F1000Res 2020; 9:587. [PMID: 33093945 PMCID: PMC7533733 DOI: 10.12688/f1000research.24441.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 01/11/2024] Open
Abstract
The global pandemic secondary to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is leading to unprecedented global morbidity and mortality. With a bewildering array of complications, renal involvement in various forms is common, including serum electrolyte derangements. Hypokalaemia secondary to SARS-CoV-2 was common in a reported Chinese cohort. Here we review the emerging evidence on hypokalaemia and SARS-CoV-2 infection, the potential pathophysiological mechanisms based on early clinical and histopathological data and important clinical implications. Mechanisms of hypokalaemia are multifactorial and so the electrolyte disturbance can be difficult to avoid. We provide further support to the theory of renin-angiotensin-aldosterone (RAS) activation, discuss the strengths and weaknesses of implicating RAS involvement and highlight the importance of calculating the transtubular potassium gradient to identify those at risk of hypokalaemia and its complications.
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Affiliation(s)
- Holly Mabillard
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newacstle upon Tyne, Tyne and Wear, NE77DN, UK
| | - John A. Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newacstle upon Tyne, Tyne and Wear, NE77DN, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE45PL, UK
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23
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Abstract
The global pandemic secondary to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is leading to unprecedented global morbidity and mortality. With a bewildering array of complications, renal involvement in various forms is common, including serum electrolyte derangements. Hypokalaemia secondary to SARS-CoV-2 was common in a reported Chinese cohort. Here we review the emerging evidence on hypokalaemia and SARS-CoV-2 infection, the potential pathophysiological mechanisms based on early clinical and histopathological data and important clinical implications. Mechanisms of hypokalaemia are multifactorial and so the electrolyte disturbance can be difficult to avoid. We provide further support to the theory of renin-angiotensin-aldosterone (RAS) activation, discuss the strengths and weaknesses of implicating RAS involvement and highlight the importance of calculating the transtubular potassium gradient to identify those at risk of hypokalaemia and its complications.
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Affiliation(s)
- Holly Mabillard
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newacstle upon Tyne, Tyne and Wear, NE77DN, UK
| | - John A. Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newacstle upon Tyne, Tyne and Wear, NE77DN, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE45PL, UK
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24
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Loh TP, Horvath AR, Wang CB, Koch D, Adeli K, Mancini N, Ferrari M, Hawkins R, Sethi S, Lippi G. Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey. Clin Chem Lab Med 2020; 58:1441-1449. [PMID: 32549122 DOI: 10.1515/cclm-2020-0710] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/18/2022]
Abstract
Objectives The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on COVID-19 conducted a global survey to understand how biochemistry laboratories manage the operational challenges during the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods An electronic survey was distributed globally to record the operational considerations to mitigate biosafety risks in the laboratory. Additionally, the laboratories were asked to indicate the operational challenges they faced. Results A total of 1210 valid submissions were included in this analysis. Most of the survey participants worked in hospital laboratories. Around 15% of laboratories restricted certain tests on patients with clinically suspected or confirmed COVID-19 over biosafety concerns. Just over 10% of the laboratories had to restrict their test menu or services due to resource constraints. Approximately a third of laboratories performed temperature monitoring, while two thirds of laboratories increased the frequency of disinfection. Just less than 50% of the laboratories split their teams. The greatest reported challenge faced by laboratories during the COVID-19 pandemic is securing sufficient supplies of personal protective equipment (PPE), analytical equipment, including those used at the point of care, as well as reagents, consumables and other laboratory materials. This was followed by having inadequate staff, managing their morale, anxiety and deployment. Conclusions The restriction of tests and services may have undesirable clinical consequences as clinicians are deprived of important information to deliver appropriate care to their patients. Staff rostering and biosafety concerns require longer-term solutions as they are crucial for the continued operation of the laboratory during what may well be a prolonged pandemic.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore, Phone: (+65) 67724345, Fax: (+65) 67771613
| | - Andrea Rita Horvath
- Department of Clinical Chemistry and Endocrinology, New South Wales Health Pathology, Prince of Wales Hospital, Sydney, Australia
| | - Cheng-Bin Wang
- Department of Laboratory Medicine, Chinese PLA General Hospital, Beijing, P.R. China
| | - David Koch
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Khosrow Adeli
- Clinical Biochemistry, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nicasio Mancini
- Laboratory of Microbiology and Virology, University Vita-Salute San Raffaele, Milan, Italy.,IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Robert Hawkins
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sunil Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
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25
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Parasa S, Desai M, Thoguluva Chandrasekar V, Patel HK, Kennedy KF, Roesch T, Spadaccini M, Colombo M, Gabbiadini R, Artifon ELA, Repici A, Sharma P. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2011335. [PMID: 32525549 PMCID: PMC7290409 DOI: 10.1001/jamanetworkopen.2020.11335] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/02/2020] [Indexed: 01/10/2023] Open
Abstract
Importance Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. Objective To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19. Data Sources An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included "COVID-19," "SARS-Cov-2," and/or "novel coronavirus." Study Selection Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms. Data Extraction and Synthesis Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2). Main Outcomes and Measures Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed. Results Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted. Conclusions and Relevance These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen.
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Affiliation(s)
| | - Madhav Desai
- Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | | | | | | | - Thomas Roesch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Spadaccini
- Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy
| | - Matteo Colombo
- Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy
| | - Roberto Gabbiadini
- Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy
| | - Everson L. A. Artifon
- Division of Gastrointestinal Endoscopy, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Alessandro Repici
- Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy
| | - Prateek Sharma
- Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
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26
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Abstract
AIM In addition to respiratory symptoms, COVID-19 can present with gastrointestinal complaints suggesting possible faeco-oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS-CoV-2 in patients with COVID-19. METHODS A systematic literature review identified studies describing COVID-19 patients tested for faecal virus. Search terms for MEDLINE included 'clinical', 'faeces', 'gastrointestinal secretions', 'stool', 'COVID-19', 'SARS-CoV-2' and '2019-nCoV'. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence-Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco-oral transmission of the virus. RESULTS Twenty-six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID-19 is transmitted via faecally shed virus. CONCLUSION There is a high rate of positive polymerase chain reaction tests with persistence of SARS-CoV-2 in faecal samples of patients with COVID-19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco-oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.
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Affiliation(s)
- S Gupta
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Parker
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - S Smits
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Underwood
- Division of Infection and Immunity, Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK
| | - S Dolwani
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
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27
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Gupta S, Parker J, Smits S, Underwood J, Dolwani S. Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review. Colorectal Dis 2020; 22:611-620. [PMID: 32418307 PMCID: PMC7276890 DOI: 10.1111/codi.15138] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/02/2020] [Accepted: 05/09/2020] [Indexed: 12/16/2022]
Abstract
AIM In addition to respiratory symptoms, COVID-19 can present with gastrointestinal complaints suggesting possible faeco-oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS-CoV-2 in patients with COVID-19. METHODS A systematic literature review identified studies describing COVID-19 patients tested for faecal virus. Search terms for MEDLINE included 'clinical', 'faeces', 'gastrointestinal secretions', 'stool', 'COVID-19', 'SARS-CoV-2' and '2019-nCoV'. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence-Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco-oral transmission of the virus. RESULTS Twenty-six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID-19 is transmitted via faecally shed virus. CONCLUSION There is a high rate of positive polymerase chain reaction tests with persistence of SARS-CoV-2 in faecal samples of patients with COVID-19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco-oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.
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Affiliation(s)
- S. Gupta
- Division of Population MedicineCardiff University School of MedicineCardiffUK
| | - J. Parker
- Division of Population MedicineCardiff University School of MedicineCardiffUK
| | - S. Smits
- Division of Population MedicineCardiff University School of MedicineCardiffUK
| | - J. Underwood
- Division of Infection and ImmunityDepartment of Infectious DiseasesCardiff and Vale University Health BoardCardiff UniversityCardiffUK
| | - S. Dolwani
- Division of Population MedicineCardiff University School of MedicineCardiffUK
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Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and abnormal, overactivated innate immunity and “cytokine storms” have been proposed as potential pathological mechanisms for rapid COVID-19 progression. Theoretically, asthmatic patients should have increased susceptibility and severity for SARS-CoV-2 infection due to a deficient antiviral immune response and the tendency for exacerbation elicited by common respiratory viruses. However, existing studies have not shown an expected prevalence of asthmatic individuals among COVID-19 patients. Certain aspects of type 2 immune response, including type 2 cytokines (IL-4, IL-13, etc.) and accumulation of eosinophils, might provide potential protective effects against COVID-19. Furthermore, conventional therapeutics for asthma, including inhaled corticosteroids, allergen immunotherapy (AIT), and anti-IgE monoclonal antibody, might also reduce the risks of asthmatics suffering infection of the virus through alleviating inflammation or enhancing antiviral defense. The interactions between COVID-19 and asthma deserve further attention and clarification.
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29
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Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2020; 39:3127-3138. [PMID: 32462305 PMCID: PMC7251800 DOI: 10.1007/s00345-020-03246-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose and objective We performed a systematic review on COVID-19 and its potential urological manifestations. Methods A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. Results There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30–13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46–100%) amongst them. 5.74% (95% CI 2.88–9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71–83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. Conclusions Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures. Electronic supplementary material The online version of this article (10.1007/s00345-020-03246-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
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30
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Shokrollahi K, Kyriazidis I, Zak-Williams S, Jones C, Murgatroyd E, Gurusinghe D. Is the use of a powered dermatome an aerosol-generating procedure (AGP)? Implications for personal protection against COVID-19 virus. Scars Burn Heal 2020; 6:2059513120951920. [PMID: 35154810 PMCID: PMC8832324 DOI: 10.1177/2059513120951920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Many healthcare workers have contracted SARS-CoV-2 during the pandemic, many cases of which have resulted in severe illness and death. No studies have assessed the potential for powered dermatomes to generate aerosol, an essential technique in burns and plastic surgery. The primary aim of the present study was to capture video footage to illustrate the potential for a powered dermatome to generate significant spray and hence aerosol. Methods: We utilised a simulated skin graft harvest experimental method. Fluorescein-stained saline was used with ultraviolet (UV) backlighting to demonstrate fluorescent spray from a popular brand of air-powered dermatome. Ultra-slow-motion (960 frames/s) video was used to demonstrate the oscillation of the dermatome blade and the origin within the machine of any spray generated, and the extent of spray generated. Results: The key finding from this study is the captured video footage linked with this paper. Droplets of various sizes are seen spraying out from the leading edge at the sides where the blade oscillates. UV backlighting provides a clear demonstration of the dermatome generating fine spray. Conclusion: Our study demonstrates that powered dermatome usage is likely to generate aerosol from blood or blood-contaminated fluid, but does not demonstrate or quantify to what extent this may be clinically relevant in terms of viral transmission potential. We suggest ways to reduce the risk of spray from dermatomes including limiting donor-site bleeding and avoiding a wet donor area. Lay Summary A dermatome is a device used by surgeons to harvest split skin grafts (SSGs). SSGs are an essential component of burns and reconstructive plastic surgery. Aerosol-generating procedures (AGPs) have implications for transmission of viruses including COVID-19. It has not previously been formally assessed whether use of a dermatome should be classified as an AGP. This study uses a fluorescent dye in the context of simulated surgery using a dermatome to see if any, and how much, fine spray is generated from the device and also utilises ultra-slow-motion videography to see how any spray may be generated. At the heart of this study is the included video footage that demonstrates considerable fine spray generation which suggests it is best to assume that dermatomes are likely to generate some degree of aerosol depending on the clinical scenario and how it is used. However, this information does not translate to providing any information about the risk of transmission of the virus from using a dermatome, especially in relation to COVID-19, and separate research would be required to answer this.
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Affiliation(s)
- Kayvan Shokrollahi
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Ioannis Kyriazidis
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Shomari Zak-Williams
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Claire Jones
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Elisa Murgatroyd
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Dilnath Gurusinghe
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
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Fan C, Lu W, Li K, Ding Y, Wang J. ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Infection in COVID-19 Patients. Front Med (Lausanne) 2020; 7:563893. [PMID: 33521006 DOI: 10.1101/2020.02.12.20022418] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/07/2020] [Indexed: 05/20/2023] Open
Abstract
In December 2019, a new type of pneumonia caused by SARS-Cov-2 (COVID-19) occurred in Wuhan and has been discovered in many countries around the world. ACE2 (angiotensin-converting enzyme 2) has been shown to be one of the major receptors that mediate the entry of SARS-Cov-2 into human cells. Here in this study, we used the online datasets to analyze ACE2 expression in different human organs. The results indicated that ACE2 highly expresses in renal tubular cells, Sertoli cells, Leydig cells, and cells in seminiferous ducts in testis. Recombinant SARS-CoV-2 spike protein (RBD) domain and ACE2 of RPTEC/SerC cell-binding assays confirmed that SARS-Cov-2 can bind to ACE2 on the surface of these cells. Our results suggest that ACE2 expression could contribute to kidney and testis infection after COVID-19 infection. Renal function evaluation and special care should be performed during clinical work. Clinicians should also pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow-up, especially the assessment and appropriate intervention in young patients' fertility.
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Affiliation(s)
- Caibin Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Lu
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Kai Li
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Yanhong Ding
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Jianqing Wang
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
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