Current Coronavirus Disease Research Articles

Comparison of model-specific histopathology in mouse models of COVID-19.

A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has been identified as the causative agent of the current coronavirus disease 2019 pandemic. Development of animal models that parallel the clinical and pathologic features of disease are highly essential to understanding the pathogenesis of SARS‐CoV‐2 infection and the development of therapeutics and prophylactics. Several mouse models that express the human angiotensin converting enzyme 2 (hACE2) have been created, including transgenic and knock‐in strains, and viral vector‐mediated delivery of hACE2. However, the comparative pathology of these mouse models infected with SARS‐CoV‐2 are unknown. Here, we perform systematic comparisons of the mouse models including K18‐hACE2 mice, KI‐hACE2 mice, Ad5‐hACE2 mice and CAG‐hACE2 mice, which revealed differences in the distribution of lesions and the characteristics of pneumonia induced. Based on these observations, the hACE2 mouse models meet different needs of SARS‐CoV‐2 researches. The similarities or differences among the model‐specific pathologies may help in better understanding the pathogenic process of SARS‐CoV‐2 infection and aiding in the development of effective medications and prophylactic treatments for SARS‐CoV‐2.

Study protocol for the St James's Hospital, Tallaght University Hospital, Trinity College Dublin Allied Researchers' (STTAR) Bioresource for COVID-19

Background: The current coronavirus disease 2019 (COVID-19) pandemic began in Ireland with the first confirmed positive case in March 2020. In the early stages of the pandemic clinicians and researchers in two affiliated Dublin hospitals identified the need for a COVID-19 biobanking initiative to support and enhance research into the disease. Through large scale analysis of clinical, regional, and genetic characteristics of COVID-19 patients, biobanks have helped identify, and so protect, at risk patient groups The STTAR Bioresource has been created to collect and store data and linked biological samples from patients with SARS-CoV-2 infection and healthy and disease controls. Aim: The primary objective of this study is to build a biobank, to understand the clinical characteristics and natural history of COVID-19 infection with the long-term goal of research into improved disease understanding, diagnostic tests and treatments. Methods: This is a prospective dual-site cohort study across two tertiary acute university teaching hospitals. Patients are recruited from inpatient wards or outpatient clinics. Patients with confirmed COVID-19 infection as well as healthy and specific disease control groups are recruited. Biological samples are collected and a case report form detailing demographic and medical background is entered into the bespoke secure online Dendrite database. Impact: The results of this study will be used to inform national and international strategy on health service provision and disease management related to COVID-19. In common with other biobanks, study end points evolve over time as new research questions emerge. They currently include patient survival, occurrence of severe complications of the disease or its therapy, occurrence of persistent symptoms following recovery from the acute illness and vaccine responses.

Barriers and Motives for Complying With "Sexual Distancing" Among Men Who Have Sex With Men During the First COVID-19 Pandemic Lockdown in Amsterdam: A Qualitative Study.

Between March 15 and May 31, 2020, the Dutch government imposed lockdown and health measures to curb the coronavirus disease 2019 (COVID-19) pandemic. As part of social distancing, sexual distancing was one of these measures. Sexual distancing implied refraining from sex with partners outside of one's household. We aimed to elucidate barriers and motives for complying with sexual distancing and related factors that could have led to (non)compliance among men who have sex with men. In this exploratory qualitative study, we interviewed men who have sex with men who visited the center for sexual health in Amsterdam during the first COVID-19 lockdown using a semistructured interview guide from March to May 2020. We interviewed both men who complied and did not comply with sexual distancing. The interviews were transcribed verbatim and analyzed using an open-coding process in MAXQDA. We included 18 noncompliers and 4 compliers to COVID-19 sexual distancing. Barriers to compliance were the following: lack of information on, or understanding of, the need for sexual distancing; being single; having had an active sex life before COVID-19; a high perceived importance of the social aspect of sex; a strong urge for sex; using sex to cope with the negative impact of the pandemic; being under the influence of alcohol or drugs; and not perceiving COVID-19 as a serious health threat. Motives for compliance were the following: perceiving COVID-19 as a serious health threat, direct confrontation with critically ill COVID-19 patients, protecting someone dear from COVID-19, and being convinced of the importance of social and/or sexual distancing measures. Information on sexual distancing needs to be made more explicit, accessible, understandable, inclusive, customized to individual barriers, and relatable to the key populations. This may improve the effectiveness of measures and health recommendations in both the current COVID-19 pandemic and future respiratory outbreaks.

Role of Social Distancing, Hand Hygiene and Wearing Mask in Controlling COVID-19 Pandemic: A review

BACKGROUND: Coronavirus disease 2019(COVID-19) continues to spread all over world and is outpacing the resources and capacity of health care systems. This rapidly spreading COVID-19 infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been challenging the medical community and keeping the whole world in great threat to an unprecedented degree. OBJECTIVES: The objective of this review article is to describe details of social distancing, hand hygiene and wearing face masks including there role in controlling the current COVID-19 pandemic. METHOD: We conducted an electronic search of Google Scholar, Scopus, Medline and PubMed databases for articles between June to September 2021. RESULTS: The novel SARS-CoV-2 virus is transmitted from person to person by respiratory droplets or contact with an infected person. There are no established medications and vaccine available until now to restrain the transmission of the COVID-19 infection. Currently, social distancing, hand hygiene and wearing a mask are key steps to lower the transmission of the SARS-CoV-2 virus in COVID-19 pandemic. As this infection is highly contagious via a respiratory pathway through coughing, sneezing and contact with an infected surface, the spread can be reduced by the proper practice of social distancing, hand hygiene or frequent hand washing and wearing mask. These universal precautions should be done as COVID-19 patients may be asymptomatic. CONCLUSION: Social distancing, hand washing and wearing face masks are cheap and widely acceptable methods for the prevention of the COVID-19 infection. The goal of this review paper is to discuss social distancing, hand hygiene and face mask information, including its role in managing the current COVID-19 pandemic

The workplace and psychosocial experiences of Australian junior doctors during the COVID-19 pandemic.

BackgroundJunior doctors experience high levels of psychological distress and emotional exhaustion. The current Coronavirus disease 2019 (COVID‐19) pandemic has resulted in significant changes to healthcare globally, with quantitative studies demonstrating increased fatigue, depression and burnout in junior doctors. However, there has been limited qualitative research to examine junior doctors' experiences, challenges and beliefs regarding management of future crises.AimsTo investigate the workplace and psychosocial experiences of Australian junior doctors working during the second wave of the COVID‐19 pandemic.MethodsAustralian healthcare workers were invited to participate in a nationwide, voluntary, anonymous, single time point, online survey between 27 August and 23 October 2020. A qualitative descriptive study of responses to four free‐text questions from 621 junior doctors was undertaken, with responses analysed using inductive content analysis.ResultsParticipants were predominantly female (73.2%), aged 31–40 years (48.0%) and most frequently reported working in medical specialties (48.4%), emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) participants had 0–5 years of clinical experience since medical graduation. Junior doctors described experiences related to four key themes: a hierarchical, difficult workplace culture; challenging working conditions; disrupted training and career trajectories; and broader psychosocial impacts. The COVID‐19 pandemic exacerbated longstanding, workplace issues and stressors for junior doctors and highlighted the threat that crises pose to medical workforce retention. There is an urgent need for authentic, positive workplace cultural interventions to engage, validate and empower junior doctors.ConclusionsChallenging workplace cultures and conditions, which have worsened during the COVID‐19 pandemic, are associated with poor psychological well‐being in junior doctors. There exists a need for long‐term, widespread improvements in workplace culture and working conditions to ensure junior doctors' well‐being, facilitate workforce retention and enhance the safety and quality of patient care in Australia.

New endemic and pandemic pathologies with interhuman airborne transmission through ear, nose and throat anatomical sites.

SUMMARYThe current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has once again stigmatised the importance of airborne pathogens and their clinical, social and public health impact. Respiratory viruses are transmitted between individuals when the pathogen is released from the upper airways or from the lower respiratory tract of an infected individual. Airborne transmission is defined as the inhalation of the infectious aerosol, named droplet nuclei which size is smaller than 5 mm and that can be inhaled at a distance up to 2 metres. This route of transmission is relevant for viral respiratory pathogens, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS)-CoV, influenza virus, human rhinovirus, respiratory syncytial virus (RSV) and other respiratory virus families that differ in viral and genomic structures, susceptibility of a population to the infection, severity, transmissibility, ways of transmission and seasonal recurrence. Human respiratory viruses generally infect cells of the upper respiratory tract, eliciting respiratory signs and symptoms, sometimes without the possibility to differentiate them clinically. As seen by the current Coronavirus Disease 2019 (COVID-19) pandemic, human respiratory viruses can substantially contribute to increased morbidity and mortality, economic losses and, eventually, social disruption. In this article, we describe the structural, clinical and transmission aspects of the main respiratory viruses responsible for endemic, epidemic and pandemic infections.

Gender Discrimination in Igbo Society under the Covid-19: Its Effect on the Economy of Igbo Women of the Southeast Nigeria

This paper is targeted at analyzing how the current coronavirus affected the business of women in the south east of Nigeria. The current Coronavirus Disease (Covid-19) outbreak has affected over 200 countries in the world including Nigeria. The Covid-19 pandemic has devastated the global economy which Nigeria is inclusive. It has rendered many of the world's population impoverished. This article focuses on the economic impact of Covid-19 on the Igbo women of the south east. The article also reviews the recent trends and updates on the impact of Covid-19 aimed at further understanding of the problem of coronaviruses on the economy of the south east women in particular. The article is divided into different points; each points deals with the most important aspects of the Covid-19 on how it affected Igbo women’s economy in the south east of Nigeria. The first section describes the genesis of Covid-19 and methods of infection. The second sections described the economic impact of Covid-19 on Nigeria and how it affected the development of the state in the south east of Nigeria. It also focuses on the impact on the buying and selling of food stuffs. The other section reflected on the reactions of people and impact of Covid-19 on the economy of the south east women of Nigeria. The study recommends that governments should invest in health and education improvement and stimulate the economies of people to create employment that could propagate the growth and improve on the poverty alleviation and economic growth of the south east women of Nigeria.

Convalescent plasma in COVID-19: renewed focus on the timing and effectiveness of an old therapy.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has strained health care systems worldwide and resulted in high mortality. The current COVID-19 treatment is based on supportive and symptomatic care. Therefore, convalescent plasma (CP), which provides passive immunization against many infectious diseases, has been studied for COVID-19 management. To date, a large number of randomized and non-randomized clinical trials as well as many systematic reviews have revealed conflicting results. This article summarizes the basic principles of passive immunization, particularly addressing CP in COVID-19. It also evaluates the effectiveness of CP as a therapy in patients with COVID-19, clinical trial reports and systematic reviews, regulatory considerations and different protocols that are authorized in different countries to use it safely and effectively. An advanced search was carried out in major databases (PubMed, Cochrane Library, and MEDLINE) and Google Scholar using the following key words: SARS-CoV-2, COVID-19, convalescent plasma, and the applied query was “convalescent plasma” AND “COVID-19 OR SARS-CoV-2”. The results were filtered and duplicate data were removed. Collective evidence indicates that two cardinal players determine the effectiveness of CP use, time of infusion, and quality of CP. Early administration of CP with high neutralizing anti-spike IgG titer is hypothesized to be effective in improving clinical outcome, prevent progression, decrease the length of hospital stay, and reduce mortality. However, more reliable, high quality, well-controlled, double-blinded, randomized, international and multicenter collaborative trials are still needed.

First allergy conference in Qatar: Let's explore allergy with a new lens.

Allergic diseases are common medical conditions that now show an increasing trend globally and contributes to poor quality of life of the affected individual. Allergies can be fatal in a few instances such as anaphylaxis, severe asthma, and hereditary angioedema if the symptoms are not recognized and treated correctly. (1, 2) The first Allergy Conference in Qatar aimed to highlight the burden of allergic diseases in Qatar and globally with a special focus on educating both the physicians and the community. The preparation for this conference over the past three years threw up a few challenges, mainly owing to the coronavirus disease 2019 (COVID-19) pandemic that affected all forms of face-to-face interactions and social gatherings. Therefore, our conference was held virtually on February 05, 2022, which was more than two years from the first planned date. The conference was sponsored by the Hamad Medical Corporation in partnership with the Qatar Allergy and Immunology Society. In our scientific program, the scientific committees selected topics related to 3 major areas in allergy practice (systemic, respiratory, and skin allergy disorders). submissions were encouraged in areas related to audits, case reports, service development, and clinical and basic research in the field of allergy. Additional topics were included related to the current COVID-19 pandemic and COVID-19 vaccinations. We received 34 abstracts and accepted 28 for poster abstracts. Among them, 6 received approval for oral presentations; and 6 (21.4%) had the term COVID-19 or SARS-CoV-2 in their title, which supported the burden related to COVID-19 in our community and association between this new pandemic and our allergy practice and disorders.

Optimization of Anti-SARS-CoV-2 Neutralizing Antibody Therapies: Roadmap to Improve Clinical Effectiveness and Implementation.

One of the major breakthroughs to combat the current Coronavirus Disease 2019 (COVID-19) pandemic has been the development of highly effective vaccines against the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Still, alternatives are needed for individuals who are at high risk of developing severe COVID-19 and are not protected by vaccination. Monoclonal antibodies against the spike protein of SARS-CoV-2 have been shown to be effective as prophylaxis and treatment against COVID-19. However, the emergence of variants of concern (VOCs) challenges the efficacy of antibody therapies. This review describes the neutralization resistance of the clinically-approved monoclonal antibody therapies against the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P1), Delta (B.1.617.2), and the Omicron (B.1.1.529) variants. To guide the development of monoclonal antibody therapies and to anticipate on the continuous evolution of SARS-CoV-2, we highlight different strategies to broaden the antibody activity by targeting more conserved epitopes and/or simultaneously targeting multiple sites of vulnerability of the virus. This review further describes the contribution of antibody Fc effector functions to optimize the antibody efficacy. In addition, the main route of SARS-CoV-2 antibody administration is currently intravenously and dictates a monthly injection when used as prophylactic. Therefore, we discusses the concept of long-acting antibodies (LAABs) and non-intravenously routes of antibody administration in order to broaden the clinical applicability of antibody therapies.

Creating an institutional ecosystem for cash transfer programmes in post-disaster settings: A case from Indonesia.

Humanitarian and disaster management actors have increasingly adopted cash transfer as an approach to reduce the suffering and vulnerability of the survivors. Cash transfers have also been used as a key instrument in the current coronavirus disease 2019 (COVID-19) pandemic. This article uses an exploratory research strategy to understand how non-governmental organisations (NGOs) and governments implement humanitarian cash transfer in a post-disaster setting. This article asks: what are the institutional constraints and opportunities faced by humanitarian emergency responders in ensuring an effective humanitarian cash transfer, and how do humanitarian actors address such institutional constraints? In this article, we have introduced a new conceptual framework, namely the humanitarian and disaster management ecosystem for cash transfer. This framework allows non-governmental actors to restore complex relations amongst state, disaster survivors (citizen), local market economy and civil society. Mixed methods and multistage research strategies were used to collect and analyse primary and secondary data. The authors conclude that by implementing cash transfers in the context of post-tsunamigenic earthquakes and liquefaction hazards, NGOs must co-create an ecosystem of response that aims to restore disaster-affected people’s access to cash and basic needs. However, in order to ensure such access to basic needs, the responders must first restore relations between the states and their citizens before linking the at-risk communities with the private sectors to jump-start local livelihoods and market economy.

Rituximab-treated patients with lymphoma develop strong CD8 T-cell responses following COVID-19 vaccination.

SummaryB‐cell depletion induced by anti‐cluster of differentiation 20 (CD20) monoclonal antibody (mAb) therapy of patients with lymphoma is expected to impair humoral responses to severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) vaccination, but effects on CD8 T‐cell responses are unknown. Here, we investigated humoral and CD8 T‐cell responses following two vaccinations in patients with lymphoma undergoing anti‐CD20‐mAb therapy as single agent or in combination with chemotherapy or other anti‐neoplastic agents during the last 9 months prior to inclusion, and in healthy age‐matched blood donors. Antibody measurements showed that seven of 110 patients had antibodies to the receptor‐binding domain of the SARS‐CoV‐2 Spike protein 3–6 weeks after the second dose of vaccination. Peripheral blood CD8 T‐cell responses against prevalent human leucocyte antigen (HLA) class I SARS‐CoV‐2 epitopes were determined by peptide‐HLA multimer analysis. Strong CD8 T‐cell responses were observed in samples from 20/29 patients (69%) and 12/16 (75%) controls, with similar median response magnitudes in the groups and some of the strongest responses observed in patients. We conclude that despite the absence of humoral immune responses in fully SARS‐CoV‐2‐vaccinated, anti‐CD20‐treated patients with lymphoma, their CD8 T‐cell responses reach similar frequencies and magnitudes as for controls. Patients with lymphoma on B‐cell depleting therapies are thus likely to benefit from current coronavirus disease 2019 (COVID‐19) vaccines, and development of vaccines aimed at eliciting T‐cell responses to non‐Spike epitopes might provide improved protection.

Vaccination

Vaccination

Study protocol for theSt James's Hospital, Tallaght University Hospital, Trinity College Dublin Allied Researchers' (STTAR) Bioresource for COVID-19.

Background: The current coronavirus disease 2019 (COVID-19) pandemic began in Ireland with the first confirmed positive case in March 2020. In the early stages of the pandemic clinicians and researchers in two affiliated Dublin hospitals identified the need for a COVID-19 biobanking initiative to support and enhance research into the disease. Through large scale analysis of clinical, regional, and genetic characteristics of COVID-19 patients, biobanks have helped identify, and so protect, at risk patient groups The STTAR Bioresource has been created to collect and store data and linked biological samples from patients with SARS-CoV-2 infection and healthy and disease controls. Aim: The primary objective of this study is to build a biobank, to understand the clinical characteristics and natural history of COVID-19 infection with the long-term goal of research into improved disease understanding, diagnostic tests and treatments. Methods: This is a prospective dual-site cohort study across two tertiary acute university teaching hospitals. Patients are recruited from inpatient wards or outpatient clinics. Patients with confirmed COVID-19 infection as well as healthy and specific disease control groups are recruited. Biological samples are collected and a case report form detailing demographic and medical background is entered into the bespoke secure online Dendrite database. Impact: The results of this study will be used to inform national and international strategy on health service provision and disease management related to COVID-19. In common with other biobanks, study end points evolve over time as new research questions emerge. They currently include patient survival, occurrence of severe complications of the disease or its therapy, occurrence of persistent symptoms following recovery from the acute illness and vaccine responses.

Diagnostic pitfalls after COVID-19 vaccination in melanoma and breast cancer patients: A case series

IntroductionDuring the current Coronavirus Disease 2019 (COVID-19) pandemic, significant COVID-19 disease-reducing developments have been made, culminating in the COVID-19 vaccines. However, COVID-19 vaccines may complicate oncological staging and follow-up oncological disease course since they may induce the enlargement of lymph nodes. Consequently, this uncertainty may lead to increased distress.Presentation of casesThis case series describes seven patients diagnosed with melanoma or breast cancer in whom lymphadenopathy was observed on oncology imaging after COVID-19 vaccination. Four of these patients underwent additional diagnostic testing, all without malignant cells on pathological examination or suspected metastasis on imaging. The remaining patients were re-evaluated, and the lymphadenopathy was interpreted as an adverse outcome of the recent COVID-19 vaccination. In addition, four out of seven patients were vaccinated in the ipsilateral arm relative to the tumor. Abnormal lymph nodes could be observed up to sixty-nine days after COVID-19 vaccination.Discussion and conclusionThese findings indicate that a COVID-19 vaccination may result in possible false-positive oncological imaging findings in melanoma and breast cancer patients. Moreover, it is advised to administer the vaccine in the contralateral arm of the primary tumor, suspected breast abnormalities, or after the oncologic imaging in melanoma and breast cancer patients.

Experience of a pediatric electrophysiology clinic during the COVID-19 pandemic.

Experience of a pediatric electrophysiology clinic during the COVID-19 pandemic.

Safety and Feasibility of Lung Cancer Surgery under the COVID-19 Circumstance.

Simple SummaryThe global coronavirus disease 2019 (COVID-19) pandemic has drastically changed the current practice of medicine worldwide. As more clinical data is collected and processed, we are beginning to have an understanding of which patients are more at risk for severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Preliminary data has shown that patients with lung cancer are disproportionally affected by the current COVID-19 pandemic. Furthermore, studies have shown that lung cancer patients are also significantly more likely to be admitted to the ICU and need mechanical ventilation. A specific subset of patients that are even more at risk for severe COVID-19 are those that require lung cancer surgery. To minimize the risk of SARS-CoV-2 infections in patients undergoing surgery, new treatment guidelines and preventive measures are necessary. In this review, we summarize the latest evidence regarding recommendations for patients undergoing lung cancer surgery in the COVID-19 era.The current coronavirus disease 2019 (COVID-19) pandemic has forced healthcare providers worldwide to adapt their practices. Our understanding of the effects of COVID-19 has increased exponentially since the beginning of the pandemic. Data from large-scale, international registries has provided more insight regarding risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and has allowed us to delineate specific subgroups of patients that have higher risks for severe complications. One particular subset of patients that have significantly higher risks of SARS-CoV-2 infection with higher morbidity and mortality rates are those that require surgical treatment for lung cancer. Earlier studies have shown that COVID-19 infections in patients that underwent lung cancer surgery is associated with higher rates of respiratory failure and mortality. However, deferral of cancer treatments is associated with increased mortality as well. This creates difficult situations in which healthcare providers are forced to weigh the benefits of surgical treatment against the possibility of SARS-CoV-2 infections. A number of oncological and surgical organizations have proposed treatment guidelines and recommendations for patients planned for lung cancer surgery. In this review, we summarize the latest data and recommendations for patients undergoing lung cancer surgery in the COVID-19 circumstance.

Coronavirus Disease 2019 (COVID-19)–Associated Rhino-Orbito-Cerebral Mucormycosis: A Multi-Institutional Retrospective Study of Imaging Patterns

BackgroundMucormycosis infection of the maxillofacial region and brain has been associated with coronavirus disease 2019 (COVID-19) infection. Mucormycosis was relatively a rare infection before COVID-19, and imaging findings are not very well described.Materials and MethodsA retrospective imaging study of 101 patients diagnosed with COVID-19–associated mucormycosis by histopathology and/or culture was performed. All patients underwent computed tomography and/or magnetic resonance imaging based on the clinical condition of the patient and on consensus decision by the team of treating physicians. A simple 3-stage classification system based on imaging findings was adopted.ResultsOne hundred one cases were included in the final analysis (mean age = 55.1 years; male/female ratio = 67:34). The affected patients had diabetes in 94% of the instances (n = 95), 80.1% (n = 81) received steroids), whereas 59.4% (n = 60) patients received supplemental oxygen. The majority underwent surgical intervention, whereas in 6 cases, patients were treated with antibiotic regimens. Sixty subjects improved following therapy, whereas 18 eventually succumbed to the illness. We noted a significant positive correlation between the imaging stage and outcomes. No association was seen between other clinical parameters and final clinical outcomes. Salient imaging findings include lack of normal sinonasal mucosal enhancement, perisinus inflammation, ischemic optic neuropathy, perineural spread, pachymeningeal enhancement, and presence of strokes.ConclusionsWe describe the imaging findings in the largest cohort of patients with rhino-orbito-cerebral mucormycosis in the context of the current COVID-19 pandemic. A simplified staging system described here is helpful for standardized reporting and carries prognostic information.

Multisystem inflammatory syndrome in adults: a\xa0case report\xa0and review of the literature

BackgroundThe current coronavirus disease pandemic has brought recognition of multisystem inflammatory syndrome in adults as a de novo entity, temporally associated with severe acute respiratory syndrome coronavirus 2 viral infection in adults. Hypothesis about its true pathophysiology remains controversial.Case reportThe patient was a 22-year-old African American female presenting to the emergency department with fever, sore throat, and neck swelling for the past 3 days. During her initial emergency department visit, her blood pressure was stable at 110/57 mmHg, temperature of 39.4 °C, and heart rate of 150 beats per minute. While in the emergency department, she received broad-spectrum antibiotics (vancomycin and ceftriaxone) and 30 cc/kg bolus of normal saline. Originally, she was admitted to a telemetry floor. The following night, a rapid response code was called due to hypotension. At that time, her blood pressure was 80/57 mmHg. She appeared comfortable without signs of respiratory distress. She received intravenous fluids and vasopressors, and was transferred to the intensive care unit. The patient had reported a previous coronavirus disease infection a few weeks prior. She was diagnosed and treated for multisystem inflammatory syndrome in adults. Intravenous immunoglobulin infusion was initiated and completed on hospital day 5. She was weaned off vasopressors by day 6, and discharged home on day 11.ConclusionOur case report is an example of the presentation, diagnosis, and management of multisystem inflammatory syndrome. Our research into previous case reports illustrates the wide range of presentations, degree of end organ damage, and treatment modalities. This diagnosis needs to be considered in the presence of recent coronavirus disease infection with new-onset end organ failure, as prompt diagnosis and treatment is crucial for better outcomes.

Co-Administration of Menstrual Blood-Derived Stem Cells and Remdesivir for the Treatment of Severe Coronavirus Disease 2019 (COVID-19) Induced Pneumonia: A Research Protocol

Introduction: Remdesivir (Veklury), a viral ribonucleic acid (RNA)-dependent RNA polymerase inhibitor designed by Gilead Sciences, has shown reductions in recovery time for coronavirus disease 2019 (COVID-19) patients, although its efficacy remains controversial. It has been proposed that combining remdesivir with immunomodulators may improve clinical efficacy. Mesenchymal stem cells (MSCs) exert immunomodulatory properties, which resolve COVID-19-induced pneumonia in early-phase trials. Menstrual blood-derived stem cells (MenSCs) present a novel MSC source, superior in availability, proliferative ability, and ethicality than traditional stem cell sources. This study aims to investigate the efficacy of remdesivir-MenSC combination therapy in resolving severe COVID-19-induced pneumonia. Methods: A randomized, double-blind, controlled study will be performed to assess two primary endpoints: time of recovery, defined as no longer requiring ongoing medical care, and normalization of the immune system, defined as the change in the concentration of key cytokines from baseline. Safety will also be measured as the frequency of treatment-related adverse events (AE). The study will aim to recruit 400 eligible subjects, aged 18 to 75, hospitalized with severe COVID-19, and they will be assigned to either receive intravenous (IV) infusions of MenSCs and remdesivir, or receive only remdesivir. A stratified log-rank test will be conducted to compare the time of recovery between study arms, with stratification by disease severity (baseline ordinal score). Two-way repeated measures ANOVA will be used to compare cytokine levels over time in the treatment group compared to the control group. Discussion: We expect remdesivir-MenSC combination therapy to surpass remdesivir in clinical efficacy and safety profile by improving clinical status, lowering duration of hospitalization, reducing mortality, and lowering the incidence of treatment-related AEs. Conclusion: Investigating this promising approach is an essential step in determining the feasibility of stem cell-based treatments in improving current COVID-19 therapeutics and patient outcomes. In particular, evaluating the clinical potential of MenSCs may provide insight into future therapeutic research as the literature has shown that MenSCs are superior to traditional MSC sources.