In the recent months, a number of transcriptomic studies have generated high-resolution data on the genes and pathways that are dysregulated in the patients infected with SARS-CoV-2 and enriched our understanding of the disease biology of this novel viral infection. The cumulative evidence collected from these data are considered in this article. Three motifs emerge with potential for future research and clinical translation. First, instead of a broad cytokine storm, one needs to interrogate the disease in terms of timing of specific cytokine up-regulation. Second, there is a subpopulation of immature or developing neutrophils in the patients with severe COVID-19 illness. This needs to be probed further for mechanistic insight and possible drug targets. Third, complement and coagulation cascades are significantly dysregulated in COVID-19, leading to the common clinical observation of a hypercoagulable state being associated with poor outcome. Interactions of these pathways with other immune-inflammatory pathways are important areas of future research. Finally, with rapid advances in relevant technologies in medicine (clinical transcriptomics, systems biology and artificial intelligence), we envisage deployment of these platforms in the clinical laboratory which shall benefit timely management of critical infectious illnesses such as COVID-19 and sepsis.

COVID-19, the multifactorial disease caused by the novel coronavirus SARS-CoV-2 is mediated by specific antiviral and inflammatory responses. It is now recognized that in most severe cases of COVID-19 an excessive and uncontrolled inflammatory response exacerbates lung damage caused by viral infection, and contributes to acute respiratory distress syndrome and respiratory failure. This hyperinflammatory syndrome is characterized by multiple cellular and molecular events, including aberrant neutrophil and lymphocyte function, amplification of the inflammatory response by release of damage associated molecular patterns, cytokine storm, lung damage and edema and a pro-fibrotic condition, ultimately leading to respiratory failure. This review discusses these molecular events in correlation with stages of viral infection and disease progression, underscoring the key points that characterize the clinical manifestations of the hyperinflammatory syndrome in COVID-19. Furthermore, it discusses the available or potential therapeutics that target various important mediators of this hyperinflammatory response that are being considered for treatment of COVID-19.

In 2019, a new coronavirus (SARS-CoV-2) infecting Humans first identified in Wuhan, China, has caused the worst pandemic of the 21st century. This virus infection leads to the clinical symptoms that may range from asymptomatic condition to life-threatening illness. The insights from the recent studies suggest that SARS-CoV-2 requires a host enzyme, Furin to activate receptor-binding domain (RBD) of its S protein. Upon binding of RBD to host cell membrane-bound Angiotensin Convertase Enzyme 2 (ACE2), it facilitates the entry of virus in the host cell. Evidence from the literature also suggests that HIF-1α (Hypoxia-inducible factor 1-α) is one of the factors regulating the expression of Furin. In addition, it is also well documented that the interior of solid tumours, which grow very fast, leads to the hypoxic tumour microenvironment, resulting in overexpression and release of HIF-1α. The SARS-CoV-2 infected patients with severe tissue damage and inflammatory injury also suffer from tissue hypoxia. So, we hypothesize that hypoxic condition due to tumour microenvironment in cancer patients upregulates the HIF-1α, leading to increased expression of Furin. Upon infection of cancer patients with SARS-CoV-2 having increased Furin expression in the cells due to upregulation of HIF-1α, leads to the entry of a greater number of SARS-CoV-2 virus in these cells resulting in severe infection. The vicious cycle of the virus infection in which virus is more easily invaded into surrounding tissue leads to the involvement of multiple organs and ultimately poor prognosis in the disease outcome. Therefore, we suggest evaluating the expression of HIF-1α in SARS-CoV-2 infections at an early phase of infection particularly in patients with comorbidities like solid malignancies as well as patients having signs and symptoms of hypoxia. It is also suggested that continuous monitoring of the SpO2 level and early institution of preventive O2 therapy at an early stage in these patients may lead to lesser morbidity as well as mortality in COVID-19 patients.

Interactions of current pandemic COVID-19 and pre-existing major health burden Diabetes Mellitus have posed a serious global public health crisis. The emergence of COVID-19 as a communicable viral infection along with the presence of non-communicable diabetes, have transformed the health system into a knife with two sharp ends. Though diabetes worldwide is almost 20 times more than COVID-19 positive cases, the severe virulence and pathogenesis coincides with the routine treatment and pathogenesis of diabetes making it one of the most serious comorbid factors. The first three deaths due to COVID-19 reported in China were diabetes patients. The severity of the association of diabetes with COVID-19 ranges from 5 to 20%. Type 1 diabetes mellitus and type 2 diabetes mellitus increase the susceptibility to infections and their complications. The present study was attempted to review probable interaction between these two global health burdens and possible suggestive management to control their detrimental effect. An intensive online search was conducted using two databases, PubMed and Google Scholar. Most hypothesized pathways for COVID-19 infection are the ACE2 receptors and RAAS system followed by the DPP4 receptor pathway. This review proposes that proper and timely management of the COVD-19 patients with diabetes comorbidity might reduce COVID-19 disease burden.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the global pandemic in 2020 resulting a massive morbidity & mortality. The lung is the predominant organ involved in symptomatic patients with Coronavirus disease-2019 (COVID-19) along with involvement of other organs. Understanding the histopathological changes of lung and other organs in COVID-19 become essential for not only formulating future management protocols but also for determing prognosis. The collection of potentially contaminated tissues during the autopsy and further processing of them in histopathology laboratory with proper maintenance of safety protocol is of immense importance. A review of the available scientific articles shows the diffuse alveolar damage and microvascular thrombi are common observation found in lung tissue in patients who died due to COVID-19.

Hydroxychloroquine, an antimalarial, is being used worldwide for prophylaxis and treatment of Corona virus disease-19 (COVID-19). Though the drug is commonly used in many chronic inflammatory diseases for protracted periods, its safety in the new indication is still under scrutiny. Therefore, this institute based study sought to assess the acute adverse effects of hydroxychloroquine among in-house health care professionals who were taking the drug for COVID-19 prophylaxis. A questionnaire seeking information on the use of the drug was prepared and disseminated electronically to the target population. The responses were also received electronically and analysed. The participants (n=54) had taken prophylaxis for 1-7 weeks. The most common adverse effects in the cohort were nausea (02) and skin rash (02). The total number of adverse effects reported by the participants was 08. One incidence each of gastric upset (01), dizziness (01), pain abdomen (01), and chest tightness (01) was reported. None of the adverse effects were serious. Our study indicates that the prophylactic weekly single dose of hydroxychloroquine is not associated with any serious adverse effects within 1-7 weeks of initiation. Elucidation of the long term and chronic adverse effects, if any, requires further studies.

SARS-CoV-2 infection in pregnancy and its adverse outcome on the mother as well on the fetus is emerging as an important concern, but knowledge about the prognosis is limited. In our prospective observational study total of 56 pregnant women admitted in the isolation ward of our institution were included. All women were presented with common symptoms like fever, tiredness, headache, sore throat, and cough. Three women diagnosed SARS-CoV-2/COVID-19 positive by Reverse Transcription Polymerase Chain Reaction (RTPCR) examination of the nasopharyngeal swab. All three neonates were tested negative for SARS-CoV-2 infection. The three mothers also recovered with routine care and returned home after 7 days with advice for a safe home for further 7 days. SARS-CoV-2 infection in pregnancy mostly appears inthe later part of pregnancy and management is almost like the general population. There is no increased risk of severe disease during pregnancy. Neonates are mostly protected from disease transmission due to immune modulation during pregnancy.

This paper analyses COVID-19 research papers in international collaboration by Indian researchers indexed in the web of Science core collection database through co-authorship. Indian researchers have published 290 publications out of which 128 (44.14%) were in international collaboration. The papers in international collaboration have received 63.19% of total citations as compared to 36.80% received by non-international collaborative papers. The impact of publication in international collaboration is 2.56 while non-international collaborative papers have 1.15 citations per publication. Dr D Y Patil Vidyapeeth, Pune is the most productive organization whereas Hainan Medical University China is the most preferred collaboration organizations. Among the countries, Peoples Republic of China is the most preferred country for collaboration followed by USA, Thailand and England.

Many recent studies have reported that patients infected with novel coronavirus 2019 or SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) might have a liver injury. However, few studies have focussed on the levels of Gamma glutamyl-transferase (GGT) alone and the variations associated with it. We retrospectively analysed the GGT levels of 476 admitted patients with confirmed COVID-19 in a tertiary care centre, PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh. Out of the total 476 COVID-19 patients studied, 35% had elevated GGT levels. ICU care was required for 51.19% (P <0.0001) of these patients and their hospital stay was of longer duration as compared to the patients with normal GGT levels. The incidence of GGT elevation was found to be more pronounced in males and elderly patients. The male population displayed higher GGT levels with 52% having raised levels compared to females where only 21.6% had elevated GGT levels. Although the number of COVID-19 cases was majorly from young age groups, the elevation in GGT levels has been reported more in elderly patients. GGT levels can therefore serve as a predictor for the extent of liver injury and severity in COVID-19 patients.

Recent advances in technology and associated methodology have made the current period one of the most exciting in molecular biology and medicine. Underlying these is an appreciation that modern research is driven by increasing large amounts of data being interpreted by interdisciplinary collaborative teams which are often geographically dispersed. The availability of cheap computing power, high speed informatics networks and high quality analysis software has been essential to this as has the application of modern quality assurance methodologies. In this review, we discuss the application of modern 'High-Throughput' molecular biological technologies such as 'Microarrays' and 'Next Generation Sequencing' to scientific and biomedical research as we have observed. Furthermore in this review, we also offer some guidance that enables the reader as to understand certain features of these as well as new strategies and help them to apply these i-Gene tools in their endeavours successfully. Collectively, we term this 'i-Gene Analysis'. We also offer predictions as to the developments that are anticipated in the near and more distant future.