Frontier Therapeutics and Vaccine Strategies for SARS-CoV-2 (COVID-19): A Review

Small-molecule metabolites in SARS-CoV-2 treatment: a comprehensive review

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has quickly spread all over the world. In this respect, traditional medicinal chemistry, repurposing, and computational approaches have been exploited to develop novel medicines for treating this condition. The effectiveness of chemicals and testing methods in the identification of new promising therapies, and the extent of preparedness for future pandemics, have been further highly advantaged by recent breakthroughs in introducing noble small compounds for clinical testing purposes. Currently, numerous studies are developing small-molecule (SM) therapeutic products for inhibiting SARS-CoV-2 infection and replication, as well as managing the disease-related outcomes. Transmembrane serine protease (TMPRSS2)-inhibiting medicinal products can thus prevent the entry of the SARS-CoV-2 into the cells, and constrain its spreading along with the morbidity and mortality due to the coronavirus disease 2019 (COVID-19), particularly when co-administered with inhibitors such as chloroquine (CQ) and dihydroorotate dehydrogenase (DHODH). The present review demonstrates that the clinical-stage therapeutic agents, targeting additional viral proteins, might improve the effectiveness of COVID-19 treatment if applied as an adjuvant therapy side-by-side with RNA-dependent RNA polymerase (RdRp) inhibitors.

Vitamin K: A Simple and Efficient Add-on to the Current Treatment Regime of COVID-19

Background:

: Intravascular thrombosis and pulmonary fibrosis in COVID-19 patients with pneumonia is significantly associated with the severity of disease. Vitamin K is known to balance the coagulation mechanisms and also prevents calcification and fibrosis of the extrahepatic soft tissues. This narrative review focuses on the role of Vitamin K as a linking factor for thrombotic as well as pulmonary complications of COVID-19.

Methods and Results:

Article search was performed in databases of WHO, PubMed, Scopus and Clinical Trial Registry using appropriate key words. Original articles included very few observational studies which showed a reduced level of Vitamin K as well as activated extrahepatic Vitamin K Dependent Proteins (VKDP) in COVID-19 patients when compared to healthy controls. Chronic treatment with Vitamin K Antagonists did not reduce the risk of in-hospital death. Docking study was performed using Swiss dock and it gave a significant interaction between menaquinone and SARS-CoV-2 main Protease (SARS-CoV-2 Mpro).

Discussion:

Deficiency of Vitamin K in COVID-19 can be due to excess use of antagonists or defective ingestion or absorption. This triggers an imbalance in the normal coagulation-anticoagulation mechanism by channelling the available Vitamin K to the liver and thereby causing a deficiency of the same in extrahepatic tissues and finally leading to thrombosis. This also prevents carboxylation and activation of extrahepatic VKDP required to prevent the calcification of soft tissues and thus leading to lung fibrosis.

Conclutions:

Supplementation of Vitamin K should be considered as a potentially modifiable risk factor in severe COVID-19. Randomized control trials are highly recommended to give clearer evidence on the same.

Epidemiology of COVID-19: An updated review

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a zoonotic infection, is responsible for COVID-19 pandemic and also is known as a public health concern. However, so far, the origin of the causative virus and its intermediate hosts is yet to be fully determined. SARS-CoV-2 contains nearly 30,000 letters of RNA that allows the virus to infect cells and hijack them to make new viruses. On the other hand, among 14 detected mutations in the SARS-CoV-2 S protein that provide advantages to virus for transmission and evasion form treatment, the D614G mutation (substitution of aspartic acid [D] with glycine [G] in codon 614 was particular which could provide the facilitation of the transmission of the virus and virulence. To date, in contrary to the global effort to come up with various aspects of SARS-CoV-2, there are still great pitfalls in the knowledge of this disease and many angles remain unclear. That's why, the monitoring and periodical investigation of this emerging infection in an epidemiological study seems to be essential. The present study characterizes the current epidemiological status (i.e., possible transmission route, mortality and morbidity risk, emerging SARS-CoV-2 variants, and clinical feature) of the SARS-CoV-2 in the world during these pandemic.

Comparison of Anxiety Levels in Patients with Coronavirus Disease (COVID-19) and their Families

Very little research has been done on the anxiety of the families of patients with covid-19. Considering the vital role of the family in the continuation of supportive-psychological therapies and the direct impact on the patient's anxiety level, in this study, we examined the anxiety level of the family of patients with Covid-19 and compared their with their patient's anxiety level. In this comparative study, the samples were 60 people who were given a definitive diagnosis of covid-19 in selected hospitals (Masih Daneshvari Hospital and Besat Hospital). From the family members, the person who, according to the patient, is most affected and has an emotional relationship with him (spouse-father-mother-child) was selected. The standard Spielberger Anxiety Questionnaire has been used to measure apparent (state) and hidden (trait) anxiety. The questionnaire was completed by both groups (patient-family) and compared with each other. The mean of evident anxiety in patients and caregivers was 70.82 and 74.2, respectively, which this difference was statistically significant (P = 0.023). It is also observed that the mean of hidden anxiety in patients and caregivers was 68.83 and 74.71, respectively, which the mean of hidden anxiety in patients was significantly less than caregivers (P = 0.006). After identifying anxiety, nurses can better and more effectively deal with these unwanted conditions in the patient and her family by providing appropriate and correct education.

Common Peroneal Nerve Injury in a Patient with COVID-19 Infection

This report described a 46-year man with the characteristic Computerized Tomography (CT) scan findings of Corona Virus Disease Infection 19 (COVID-19) who presented to the hospital with right ankle weakness three weeks after the pneumonitis. He had been initially hospitalized, complaining of fever, myalgia, cough, and dyspnea. Electromyogram (EMG) revealed obvious evidence of increased insertional activity (IA) and significant denervation potentials, including positive sharp waves (PSW) and fibrillation potentials, particularly in ankle dorsiflexor muscles. Moreover, no voluntary motor unit action potential (MUAP) was observed. Eventually, the patient was diagnosed with severe axonal mononeuropathy of the right CPN, which could be considered a rare complication of COVID-19.

Emerging Technologies for the Treatment of COVID-19

The new coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), turned into a pandemic affecting more than 200 countries. Due to the high rate of transmission and mortality, finding specific and effective treatment options for this infection is currently of urgent importance. Emerging technologies have created a promising platform for developing novel treatment options for various viral diseases such as the SARS-CoV-2 virus. Here, we have described potential novel therapeutic options based on the structure and pathophysiological mechanism of the SARS-CoV-2 virus, as well as the results of previous studies on similar viruses such as SARS and MERS. Many of these approaches can be used for controlling viral infection by reducing the viral damage or by increasing the potency of the host response. Owing to their high sensitivity, specificity, and reproducibility, siRNAs, aptamers, nanobodies, neutralizing antibodies, and different types of peptides can be used for interference with viral replication or for blocking internalization. Receptor agonists and interferon-inducing agents are also potential options to balance and enhance the innate immune response against SARS-CoV-2. Solid evidence on the efficacy and safety of such novel technologies is yet to be established although many well-designed clinical trials are underway to address these issues.

Guillain-Barré syndrome associated with COVID-19: a case report study

Acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is spreading around the world. Patients with coronavirus disease 2019 (COVID-19) typically present fever, cough, and respiratory illnesses. It has been revealed that the comorbidities can turn it into severe types, and the managements meet unpredicted complications. Here, we report a case of coronavirus disease 2019 (COVID-19) coincidence with confirmed acute Guillain-Barré syndrome (GBS). Ten days after admission and therapeutic process, the patient developed autonomic dysfunction. Despite respiratory support and receiving intravenous immunoglobulin, the patient died due to cardiac arrest. Albeit it is yet scientifically doubtful, there are raising concerns toward a possible association between GBS and SARS-CoV-2 infection, demonstrating potential neurological symptoms of COVID-19.

Treatment of SARS-CoV-2 (COVID-19) cases by the oral administration of montelukast tablets

According to the hypothesis, montelukast may have therapeutic action against severe acute respiratory syndrome (SARS) occurred by coronavirus 2 (CoV-19). The research was aimed to evaluate the therapeutic effects of montelukast tablet on coronavirus infectious disease (COVID-19) patients. A total of 20 COVID-19 confirmed patients were included in this study. The presence of COVID-19 infections in all patients was confirmed using real-time polymerase chain reaction (PCR) and computerized tomography (CT) scan. Confirmed cases were treated with oral administration of montelukast (10 mg) tablet for 10 days. The study population was included 18 to 82 years old patients (10 males and 10 females). The mean age of studied men and women individuals were 44.7±17 and 41±17.45 years, respectively. Frequency of respiratory distress, cough, abdominal cramps/diarrhea, fever, and odor disorder clinical signs amongst the examined patients were 85%, 90%, 20%, 70%, and 65%, respectively. Our findings revealed that all patients who were received 10 days of oral administration of montelukast tablets (10 mg) were recovered from the COVID-19 disease. Additionally, all of the clinical signs of COVID-19 patients, including respiratory distress, cough, and odor disorder, were gradually disappeared. Our findings revealed that widespread oral administration of montelukast tablets (10 mg) is a potential treatment for COVID-19 disease. However, several double-blind and multifactorial clinical trials should perform to determine the other clinical aspects of the treatment of COVID-19 patients by oral administration of montelukast.