Mild Respiratory Infection Research Articles

Study of serum albumin as a marker of severity in COVID-19 positive SARI and COVID-19 negative SARI patients

Background: COVID-19 a pandemic caused by SARS CoV-2 has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Hypoalbuminemia in COVID-19 indicates severe disease. The aim of the study was to determine incidence of hypoalbuminemia and correlation of severity of hypoalbuminemia with COVID-19 positive SARI and COVID negative SARI patients.Methods: A study was conducted on 265 SARI patients who were admitted in hospitals attached to BMCRI. History was taken, general physical examination and a detailed systemic examination was done. Patients were categorized into mild, moderate and severe illness. RT-PCR for COVID-19 patients done using throat and nasal swab. Total WBC counts and differential counts, platelet counts were estimated. Serum albumin levels were correlated with pneumonia severity and compared between COVID-19 positive and Negative SARI. And also, correlation with comorbities was done.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. Patients categorized into moderate and severe SARI. Mean age of subjects with COVID-19 positive (severe) was higher- 58.70±15.598 followed by COVID-19 positive (moderate)- 55.13±14.480. About 30% (N=90) were belong to severe SARI group, Chi-square test showed statistical significant association with respect to age. Chi-square test showed no statistical significant association with respect to gender. Independent sample t test showed statistical difference with respect to S. albumin levels between COVID positive and COVID negative subjects. In COVID positive subjects, S. albumin levels showed statistical significant difference between moderate and severe sub groups whereas there was no statistical significant difference seen in COVID negative sub groups.Conclusions: The relationship between hypoalbuminemia and reduced survival in COVID-19 may have several explanations. First, acting as an anti-inflammatory and antioxidant protein, albumin may protect against cytokine storm. Second, albumin encompasses anticoagulant properties and inhibits oxidative stress-related clotting and platelet activation that occurs in severe COVID-19. Third, albumin is an inverse acute phase reactant. In our present study hypoalbuminemia was more significant in severe COVID-19 positive SARI patients compared to COVID-19 negative SARI patients hence, we could say that hypoalbuminemia is inversely related with COVID-19 severity and also more significant hypoalbuminemia in COVID-19 positive SARI.

Comparison of neutrophil-lymphocyte ratio among severe acute respiratory illness COVID-19 positive and negative patients and to correlate with disease severity

Background: COVID-19, a pandemic caused by SARS-CoV-2, has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Neutrophil-lymphocyte (NL) ratio is an indicator of systemic inflammatory response. Many previous studies have shown NL ratio to be good prognostic marker for COVID-19 pneumonia.Methods: A study was conducted on 265 SARI (severe acute respiratory illness) patients who were admitted in hospitals attached to BMCRI between May 2020 and September 2020. History was taken, general and systemic examination was done. Patients were categorized into moderate and severe illness. RT-PCR for all patients was done using throat and nasal swab. Total WBC counts and differential counts were estimated. NL ratio was correlated with pneumonia severity and compared between COVID-19 positive and negative SARI.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. The patients were further sub-categorised into moderate and severe SARI. Mean age for COVID-19 positive severe SARI was higher than the moderate SARI. Males were majority of the subjects. Out of 265, 99 patients (37.4%) had diabetes. Out of this, 34 (42%) were COVID-19 positive (severe) followed by 28 (51.9%) COVID-19 positive (moderate). Mean NL ratio was higher in COVID-19 positive (severe) subjects 15.95±10.31 followed by COVID-19 positive (moderate) subjects 8.99±6.22. There was significant difference with respect to NL ratio between COVID-19 positive and negative subjects. NL ratio levels were high in subjects having diabetes in COVID-19 positive severe sub group and COVID-19 positive severe hypertension sub group as compared to other sub groups.Conclusions: NL ratio was higher in patients with COVID-19 positive SARI as compared to COVID-19 negative SARI. There was significant correlation between increase in NL ratio and disease severity of COVID-19 positive pneumonia. We found that increase in NL ratio was associated with co-morbidities like diabetes mellitus and hypertension.

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers

ABSTRACT The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15–136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202–10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8–15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals.

COVID-19 infection, progression, and vaccination: Focus on obesity and related metabolic disturbances.

SummaryCoronaviruses are constantly circulating in humans, causing common colds and mild respiratory infections. In contrast, infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), responsible for coronavirus disease‐2019 (COVID‐19), can cause additional severe complications, particularly in patients with obesity and associated metabolic disturbances. Obesity is a principal causative factor in the development of the metabolic syndrome; a series of physiological, biochemical, clinical, and metabolic factors that increase the risk of obesity‐associated diseases. “Metabolically unhealthy” obesity is, in addition to metabolic disturbances, also associated with immunological disturbances. As such, patients with obesity are more prone to develop serious complications from infections, including those from SARS‐CoV‐2. In this review, we first describe how obesity and related metabolic disturbances increase the risk of SARS‐CoV‐2 infection. Then, mechanisms contributing to COVID‐19 complications and poor prognosis in these patients are discussed. Finally, we discuss how obesity potentially reduces long‐term COVID‐19 vaccination efficacy. Despite encouraging COVID‐19 vaccination results in patients with obesity and related metabolic disturbances in the short‐term, it is becoming increasingly evident that long‐term COVID‐19 vaccination efficacy should be closely monitored in this vulnerable group.

Limosilactobacillus reuteri DSM-17938 for preventing cough in adults with mild allergic asthma: A double-blind randomized placebo-controlled cross-over study.

Cough is a common troublesome symptom in asthma which is neuronally mediated. Limosilactobacillus reuteri DSM-17938 (L.reuteri DSM-17938) is a probiotic shown to be effective in pre-clinical models at suppressing neuronal responses to capsaicin, a transient receptor potential vanilloid agonist (TRPV1). Investigate the effects of DSM-17938 versus matched placebo on capsaicin-evoked coughs in mild allergic asthmatics. We performed a 4-visit, randomized, double-blind, placebo-controlled, two-way cross-over study comparing full dose cough responses with inhaled capsaicin in mild allergic asthmatics after 1month of treatment with DSM-17938 compared with matched placebo. Randomization and allocation to trial group were carried out by a central computer system. Histamine skin prick testing, airway hyper-responsiveness and inflammatory cells in induced sputum were measured at every visit. Blood was collected to extract PBMCs and stimulated with CD3/CD28 to ascertain the effects of DSM-17938 /placebo on T-cell cytokine responses. Seventeen subjects were recruited and 15 completed the study (8 females, mean age 27.3years). There was no difference in the change in maximum capsaicin-evoked coughs (Emax) after treatment with L.reuteri DSM-17938 compared with placebo [mean difference 2.07 coughs (95% CI -2.77 to 6.91, p=.38) or relative changes in geometric mean ratios for the dose evoking at least half the Emax (ED50) [1.05 (95% CI 0.31-3.58, p=.94)], concentration evoking 2 coughs (C2) [0.63 (0.26-1.53), p=.28] and 5 coughs (C5) [0.79 (0.25-2.50), p=.67]. There was no effect on histamine skin prick wheal size, intensity of itch sensation, methacholine PC20, airway inflammation or T-cell responses after stimulation with CD3/CD28. There were no serious adverse events. One subject developed a mild upper respiratory tract infection and another mild transient nausea whilst on DSM-17938. In this small study in adults with mild allergic asthma, we found no evidence that L.reuteri DSM-17938has any systemic effects on airway nerves, smooth muscle, sputum inflammatory cells, skin responses or T-cell responses after oral consumption. Clinicaltrials.gov Identifier: NCT03603522.

Negative Impact of Citral on Susceptibility of Pseudomonas aeruginosa to Antibiotics.

Essential oils (EOs) or their components are widely used by inhalation or nebulization to fight mild respiratory bacterial infections. However, their interaction with antibiotics is poorly known. In this study we evaluated the effects of citral, the main component of lemongrass oil, on in vitro susceptibility of Pseudomonas aeruginosa to antibiotics. Exposure of strain PA14 to subinhibitory concentrations of citral increased expression of operons encoding the multidrug efflux systems MexEF-OprN and MexXY/OprM, and bacterial resistance to anti-pseudomonal antibiotics including imipenem (twofold), gentamicin (eightfold), tobramycin (eightfold), ciprofloxacin (twofold), and colistin (≥128-fold). Use of pump deletion mutants showed that in addition to efflux other mechanisms were involved in this citral-induced phenotype. Determination of Zeta potential suggested that citral impairs the cell surface binding of aminoglycosides and colistin used at low concentrations (≤10 μg/mL). Moreover, experiments based on Raman spectroscopy and high-resolution mass spectrometry demonstrated formation of a Schiff base between the aldehyde group of citral and amino-groups of tobramycin and colistin. Chemical synthesis of tobracitryl, the imine compound resulting from condensation of citral and tobramycin, confirmed the loss of antibiotic activity due to adduct formation. Altogether these data point to the potential risk concern of self-medication with EOs containing citral in patients suffering from P. aeruginosa chronic lung infections and being treated with aerosols of aminoglycoside or colistin.

COVID-19-associated coagulopathy and immuno-thrombosis

The global pandemic Coronavirus disease 2019 (COVID-19) is caused by a novel highly virulent beta-coronavirus SARS-CoV-2. The infection SARS-CoV-2 is associated with a broad spectrum of clinical syndromes, ranging from mild upper respiratory infection to life-threatening cardiovascular complications in humans. COVID-19-associated coagulopathy, endotelitis and immune-thrombosis are typical examples that thrombosis and inflammation mutually reinforce each other. Among the basic features of the COVID-19 disease are the endothelial vascular changes affecting the whole vascular system and leading to micro-thrombosis, mainly localized in the pulmonary microcirculation. The anticoagulants are gold stone of the therapy also for its increased anti-inflammatory and endothelial protective activity. Patients with COVID-19 are at increased risk of venous thromboembolism, and therefore pharmacologic prophylaxis with use of low-molecular-weight heparin, or fondaparinux is recommended not only when hospitalized but also after discharge for up to 45 days in patients at high risk for VTE and low risk of bleeding, independently of the patient recovering mobility. For hospitalized COVID-19 patients with proximal deep vein thrombosis or pulmonary embolism, standard initial parenteral anticoagulation with therapeutic weight adjusted doses is suggested. In general, a one-size-fits-all strategy cannot be applied to COVID-19 patients. These patients need an individualized approach carefully balancing thrombotic and hemorrhagic risk. Further research is required to provide better knowledge of the pathogenesis of COVID-19, more precisely targeted treatment and the correct timing of thromboprophylaxis for this vascular disease.

Case reports of cerebral sinus venous thrombosis in COVID-19 patients

BackgroundCoronavirus disease 2019 (COVID-19) pandemic has started in December 2019 and still ongoing. The disease has been expanding rapidly with a high variety of phenotypes from asymptomatic, mild respiratory tract infection, multiple organ system dysfunction, and death. Neurological manifestations also appear in patients with COVID-19, such as headache, seizures, a decrease of consciousness, and paralysis. The hypercoagulable state in patients with COVID-19 is associated with the thromboembolic incident including ischemic strokes, venous thromboembolism, pulmonary artery embolism, and many further. Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular emergency that is often found in critically ill patients. We report two cases of CSVT with different onsets, neurologic manifestations, and prognoses.Case presentationTwo cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory, hematology, and coagulation disarrangements, which was triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The first patient, which was presented with a seizure, had hypertension and diabetes mellitus as comorbidities. The latter case had no comorbidity but showed more severe presentations of COVID-19 such as brain and lung thrombosis, although already had several days of intravenous anticoagulant administrations. These two cases also have a different course of disease and outcomes, which were interesting topics to study.ConclusionsCSVT is one of the neurological complications of the COVID-19 when the brainstem venous drainage is involved. Despite successful alteration to the negative result of SARS-CoV-2 through the rt-PCR test, thrombogenesis and coagulation cascade continuing. Therefore, a high level of neutrophil to lymphocyte ratio (NLR), D-dimer, fibrinogen, and C-reactive protein (CRP) are paramount indicators of poor prognosis.

Daratumumab Monotherapy in Thirty-Two Heavily Pre-Treated Patients with Advanced Systemic Light-Chain Amyloidosis

BackgroundSystemic light-chain amyloidosis (AL) is a life-threatening disease caused by the misfolding and deposition of clonal free light-chains (FLC). The current standard of therapy is targeting the malignant plasma cells with chemotherapy to reduce the circulating FLC burden.Daratumumab is a human monoclonal IgG kappa antibody targeting CD38 which is mainly expressed on plasma cells. It has been approved as a monotherapy in the European Union in May 2016 for treatment in patients with multiple myeloma (MM) exposed to proteasome inhibitors (PI) and immunomodulatory drugs (IMID). Sher et al. (Blood 2016) first published a case report with an FLC response in a patient with cardiac AL and a hematologic complete remission (CR) in a patient with renal AL. Kaufman et al. (Blood 2017) reported a hematologic response (>PR) in 19 of 25 pretreated patients with systemic AL.Patients and MethodsThis is a retrospective analysis of 32 consecutive patients treated with daratumumab monotherapy starting from October 2016 for symptomatic AL at our institution. Only patients with an underlying MM (smoldering or CRAB+) were initiated on daratumumab. Hematologic remission and NT-ProBNP response were assessed according to Palladini et al., JCO 2012, renal response according to Palladini et al., Blood 2014. Daratumumab 16 mg/kg of total body weight was applied intravenously after premedication with dexamethasone (commonly 20 mg), intravenous paracetamol and antihistamine. Infusions were initiated weekly in 17 patients and every other week in 15 patients due to reduced performance status. For evaluation of hematologic progression-free survival (PFS) the addition of a second therapeutic agent was also considered as an event. Hematologic PFS was calculated using SPSS v.24.0 statistical software (IBM, Armonk, New York, USA)Patient cohort: For patient characteristics please refer to the tables .ResultsHematologic response: Twenty-three of 32 patients achieved a hematologic remission after a median duration of 49 days (range: 5-287). Patients received a median of 8 (range: 2-17) infusions of daratumumab. CR was achieved in 3 patients, a very good partial remission (VGPR) in 14 and a partial remission (PR) in 6 patients (see figure).The 3 month overall response rate among 27 evaluable patients was 63% with CR in 3 patients, VGPR in 10 patients and PR in 4 patients.Progression and survival: After a median follow-up time for patients alive of 134 days from the first daratumumab infusion median PFS is not reached (figure). Currently, 21 patients are still on and four patients are off therapy without hematologic progress. One patient died from a cardiac event after discontinuing daratumumab for no response. Another patient with a VGPR died after infectious complications.Organ response at 3 months: For 14 of 25 patients with cardiac AL NT-ProBNP analysis was performed. Two patients had an NT-ProBNP response and six patients had an NT-ProBNP increase. Renal response assessment was performed in 9 of 15 patients with renal involvement not on dialysis and showed a response in 3 patients and a progression in 3 patients.Complications: One patient with cardiac AL and terminal renal failure on peritoneal dialysis died after developing peritonitis after 90 days of first daratumumab infusion. Another four patients with cardiac AL were admitted to hospital for lower respiratory tract infections (3) or cardiac decompensation (1). Mild upper respiratory tract infections were reported in six patients. One patient newly developed atrial fibrillation. Two patients with symptomatic MM experienced dyspnoea during the first infusion. One patient with symptomatic MM required a blood transfusion.SummaryDaratumumab monotherapy can induce fast hematologic responses in heavily pre-treated AL patients who cannot tolerate or are refractory to proteasome inhibitors or immunomodulatory drugs. NT-ProBNP and renal responses can be achieved, although NT-ProBNP progression under therapy was common in our cohort. As expected, patients with advanced cardiac AL are at a higher risk of severe complications. [Display omitted] DisclosuresSchönland:Sanofi: Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; prothena: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Speakers Bureau. Hegenbart:Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Prothena: Membership on an entity's Board of Directors or advisory committees.

COVID-19 infected neonate presenting with cytokine storm and sepsis

COVID-19, a clinical syndrome caused by the coronavirus (SARS-CoV-2) became a pandemic following an outbreak of viral pneumonitis, first identified in Wuhan, China. The disease manifestations vary ranging from mild upper respiratory tract infection to severe pneumonitis, acute respiratory distress syndrome (ARDS) and even death. Although most of the neonatal cases are asymptomatic, rarely, they can present with cytokine storm mimicking with similar features of sepsis. This is a case report of SARS-CoV19 positive neonate presenting with sepsis and cytokine storm, 5-day old baby born to SARS-COVID 19 positive mother presented with fever and investigations showed elevated total counts with neutrophilic predominance, thrombocytopenia suggestive of sepsis and increased inflammatory markers suggestive of cytokine storm. Blood culture was sent and baby was started on intravenous antibiotics. In view of cytokine storm intravenous dexamethasone 0.5 mg/kg/day was given intravenously for 5 days. Neonate recovered from illness after 1 week as evidenced clinically and and by the fall in inflammatory markers before discharge. This report opens the possibility of having both sepsis and cytokine storm in a SARS-CoV19 positive neonate.

Rhinovirus Reduces the Severity of Subsequent Respiratory Viral Infections by Interferon-Dependent and -Independent Mechanisms.

ABSTRACTCoinfection by heterologous viruses in the respiratory tract is common and can alter disease severity compared to infection by individual virus strains. We previously found that inoculation of mice with rhinovirus (RV) 2 days before inoculation with a lethal dose of influenza A virus [A/Puerto Rico/8/34 (H1N1) (PR8)] provides complete protection against mortality. Here, we extended that finding to a second lethal respiratory virus, pneumonia virus of mice (PVM), and analyzed potential mechanisms of RV-induced protection. RV completely prevented mortality and weight loss associated with PVM infection. Major changes in host gene expression upon PVM infection were delayed compared to PR8. RV induced earlier recruitment of inflammatory cells, which were reduced at later times in RV-inoculated mice. Findings common to both virus pairs included the upregulated expression of mucin-associated genes and dampening of inflammation-related genes in mice that were inoculated with RV before lethal virus infection. However, type I interferon (IFN) signaling was required for RV-mediated protection against PR8 but not PVM. IFN signaling had minor effects on PR8 replication and contributed to controlling neutrophilic inflammation and hemorrhagic lung pathology in RV/PR8-infected mice. These findings, combined with differences in virus replication levels and disease severity, suggest that the suppression of inflammation in RV/PVM-infected mice may be due to early, IFN-independent suppression of viral replication, while that in RV/PR8-infected mice may be due to IFN-dependent modulation of immune responses. Thus, a mild upper respiratory viral infection can reduce the severity of a subsequent severe viral infection in the lungs through virus-dependent mechanisms.IMPORTANCE Respiratory viruses from diverse families cocirculate in human populations and are frequently detected within the same host. Although clinical studies suggest that infection by multiple different respiratory viruses may alter disease severity, animal models in which we can control the doses, timing, and strains of coinfecting viruses are critical to understanding how coinfection affects disease severity. Here, we compared gene expression and immune cell recruitment between two pairs of viruses (RV/PR8 and RV/PVM) inoculated sequentially in mice, both of which result in reduced severity compared to lethal infection by PR8 or PVM alone. Reduced disease severity was associated with suppression of inflammatory responses in the lungs. However, differences in disease kinetics and host and viral gene expression suggest that protection by coinfection with RV may be due to distinct molecular mechanisms. Indeed, we found that antiviral cytokine signaling was required for RV-mediated protection against lethal infection by PR8 but not PVM.

Post SARS-CoV-2 infection reactive arthritis: a brief report of two pediatric cases

BackgroundAlthough, preliminary reports of Severe Acute Respiratory Syndrome (SARS)-CoV-2 infection suggest that the infection causes a less severe illness in children, there is now growing evidence of other rare or even serious complications of disease.Case presentationDuring the recent COVID-19 pandemic in Kerman, Iran, two children (an 8 year-old boy and a 6 year-old girl) were referred to outpatient Clinic of Pediatric Rheumatology with complaints of limping. Both children had experienced fever and mild respiratory tract infection. At the beginning of the second week of infection, they developed joint effusion. They both tested positive for coronavirus infection and were therefore diagnosed with post Coronavirus reactive arthritis. Both children were treated successfully with rest and Non-Steroidal Anti-Inflammatory Drugs (NSAID). They did not have any medical problems in the two months fallow up.ConclusionsThese two cases suggest that COVID-19 may be rheumatogenic. Highlighting the need for awareness of physicians, especially pediatricians, regarding the pathogenesis margins of this virus, as late presentations are of great importance.

Impact of Genetics on Predisposition and Prognosis of COVID-19

The global pandemic of COVID-19 accounts for more than 3 million deaths globally. COVID-19 is a contagious infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Wide range of clinical manifestations from gastrointestinal (GI) symptoms, loss of smell and taste and mild and severe respiratory infection to death has been reported with COVID-19. However, not much is known about the role of genetics in predisposition and progression of COVID-19. It is assumed that immense diversity of symptoms in infected individuals may be due to differences in host genetic characteristics and that genetic variations may be involved in determining the outcome of disease. However, the exact underlying mechanisms of these variations is unknown to date. Profound understanding of the underlying factors such as host genetics that determine the degree of susceptibility to infection and the disease severity may assist in better prediction of the population with the highest risk of infection along with achieving better medical treatment. In this review, we focused on the play of genetic variants associated with the susceptibility and severity of COVID-19 disease in the recent pandemic.

English

BACKGROUND The clinical spectrum of SARS–CoV-2 infection encompasses asymptomatic infection, mild upper respiratory tract infection, and severe viral pneumonia with respiratory failure and even death. This study attempts to estimate the time interval between symptoms onset to severity, time taken for hospitalization, length of stay in hospital along with demographic and clinical characteristics of deceased patients infected with Covid-19. METHODS This retrospective study was conducted in SSMC associated Dedicated Covid Hospital, Rewa district, India. Covid-19 positive deaths (112) that occurred from May 2020 to January 2021 in this institute were considered for this study. Information regarding socio-demographic profile, systemic diseases / underlying medical conditions, signs and symptoms of the disease, clinical course, and investigations were collected and analysed. Time duration variables included were time from the initial symptom to breathlessness, time taken to seek treatment, delay in hospitalization, and length of stay in the hospital. RESULTS Elderly males with 2 or more comorbid conditions were found to be at higher risk of mortality. Median duration from onset of initial symptom to treatment seeking / hospitalization in DCH was 5 days. While mean duration from onset of initial symptoms to onset of breathlessness was 2 days 6 hrs. There was a delay of 3 days in hospitalization after experiencing breathlessness. 90 % patients had bilateral lung involvement at the time of admission. More than half of the patients had multiple organ involvement. Positive correlation was observed in delay in hospitalization, with syndrome severity at the time of admission and negative correlation with length of stay in hospital. CONCLUSIONS Delay in hospitalization is observed as an important factor which affects clinical course. Disease severity increases and length of stay decreases with delayed presentation at the time of admission. It should be addressed with awareness generation activities in community and self-assessment tool appropriate and suitable for implementing in general population. KEYWORDS Covid 19, Covid Infection, Mortality, Time Delay, Length of Stay (LoS)

Neonatal SARS-CoV-2 Infection: Practical Tips.

The recent viral pandemic in Wuhan, Hubei, China has led to the identification of a new species of beta-coronavirus, able to infect humans, the 2019-nCoV, later named SARS-CoV-2. SARS-CoV-2 causes a clinical syndrome named COVID-19, which presents with a spectrum of symptoms ranging from mild upper respiratory tract infection to severe pneumonia, with acute respiratory distress syndrome and frequent death. All age groups are susceptible to the infection, but children, especially infants, seem to be partially spared, having a more favorable clinical course than other age groups. There is currently no clear evidence showing vertical transmission and intrauterine SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy, and even if transmission is possible, the SARS-CoV2 positivity of the mother does not require delivery by caesarean section, does not contraindicate the management of the infant in rooming-in and allows breastfeeding. This review provides an overview on the biology of the virus, on the pathogenesis of the infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of infection in newborns and young infants and summarizes the international recommendations currently available on the clinical care of neonates with SARS-CoV2 infection or at risk of catching the virus. The main objective of the review is to provide an update especially focused to the clinical management of COVID-19 infection in the perinatal and neonatal age.

SARS-CoV-2 infects human adult donor eyes and hESC-derived ocular epithelium.

The SARS-CoV-2 pandemic has caused unparalleled disruption of global behavior and significant loss of life. To minimize SARS-CoV-2 spread, understanding the mechanisms of infection from all possible routes of entry is essential. While aerosol transmission is thought to be the primary route of spread, viral particles have been detected in ocular fluid, suggesting that the eye may be a vulnerable point of viral entry. To this end, we confirmed SARS-CoV-2 entry factor and antigen expression in post-mortem COVID-19 patient ocular surface tissue and observed productive viral replication in cadaver samples and eye organoid cultures, most notably in limbal regions. Transcriptional analysis of ex vivo infected ocular surface cells and hESC-derived eye cultures revealed robust induction of NF-κB in infected cells as well as diminished type I/III interferon signaling. Together these data suggest that the eye can be directly infected by SARS-CoV-2 and implicate limbus as a portal for viral entry.

Enhanced Significance of Laboratory Biosafety and Biosecurity During COVID-19 Pandemic

Seven coronavirus species, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cause respiratory diseases in humans. Four of these species, namely, HCoV 229E, HCoV NL63, HCoV HKU1, and HCoV OC43, typically cause mild upper respiratory infection in babies, kids, and the elderly. Severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, and SARS-CoV-2 lead to more serious diseases in humans by infecting the lower respiratory tract. Epidemic and pandemic situations are the consequences of the rapid transmission of SARS-CoV-2 and large number of deaths. Evaluations related to the recent COVID-19 pandemic have revealed some requirements, which are not well known but essential for fighting against this disease. These requirements include the obligation to work at laboratories with high biosafety level (BSL) and conduction of studies under the guidance of biosafety and biosecurity simultaneously. Likewise, to overcome the hazardous microorganisms, laboratory research is required alongside therapeutic and diagnostic services in the field. This article aims to explain biosafety and biosecurity practices at BSL-3 laboratories, which are necessary for the studies of SARS-CoV-2 as the causative agent of COVID-19.

신경계 질환에 대한 COVID-19 범유행의 영향 : 신경재활을 위한 제언

A coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Currently, the rapid spread of COVID-19 is one of the world’s most important health issues, having threatened the general health of people worldwide. Advanced age and comorbidities such as hypertension, diabetes, cardiovascular and respiratory disorders, and obesity are risk factors for the occurrence of critical illness and increased mortality. Although neurological symptoms and complications remain minor, they last a long time, resulting from the direct invasion of the virus into the central nervous system and systemic effects of the viral infection. For these reasons, patients with neurological impairment are more vulnerable to serious conditions caused by SARS-CoV-2 infection. However, for people with mild respiratory infections or those who are asymptomatic, it is not easy to find clear evidence of a relationship between COVID-19 and neurological disorders. Therefore, research and clinical practice should highlight the impact of the COVID-19 pandemic on neurological conditions in order to provide management guidelines and rehabilitation services in an effective way. To prevent the spread of COVID-19, social distancing has been imposed, restricting social activity and participation and facilitating individual isolation from societal groups, both of which had negative impacts on rehabilitation of neurologic disorders. It is important to develop efficient solutions for unwanted problems in the COVID pandemic. Tele-rehabilitation is considered to have some benefits in overcoming its detrimental effects. Accordingly, this study aimed to demonstrate the clinical course and pathogenesis of the SARS-CoV-2 infection, to summarize the impact of COVID-19 on neurologic disorders, and finally to provide suggestions for effective management.

Coronaviruses: HCoV, SARS-CoV, MERS-CoV, and COVID-19

Coronaviruses (CoVs) are a group of viral pathogens that infect mammals and birds. The presentation in humans is typically that of a mild upper respiratory tract infection, similar to the common cold. However, in recent years, dramatic attention has arisen for more lethal members of this viral family (e.g., severe acute respiratory syndrome [SARS-CoV], Middle East respiratory syndrome [MERS-CoV], and coronavirus disease 2019 [COVID-19]). The epidemiology, clinical presentation, diagnosis, and management of these viruses are discussed in this review. Importantly, new guideline tables from the Centers for Disease Control and Prevention, as well as the World Health Organization are provided at the conclusion of the review. This review contains 12 tables, 3 figure and 48 references. Keywords: Coronavirus, severe acute respiratory distress syndrome (SARS), Middle East respiratory syndrome (MERS), COVID-19, respiratory infection, antiviral, real-time polymerase chain reaction

Characteristics of a COVID-19 confirmed case series in primary care (COVID-19-PC project): a cross\u2010sectional study

BackgroundTo estimate the prevalence of symptoms and signs related to a COVID-19 case series confirmed by polymerase chain reaction (PCR) for SARS-CoV-2. Risk factors and the associated use of health services will also be analysed.MethodsObservational, descriptive, retrospective case series study. The study was performed at two Primary Care Health Centres located in Madrid, Spain. The subjects studied were all PCR SARS-CoV-2 confirmed cases older than 18 years, diagnosed from the beginning of the community transmission (March 13) until April 15, 2020. We collected sociodemographic, clinical, health service utilization and clinical course variables during the following months. All data was gathered by their own attending physician, and electronic medical records were reviewed individually. Statistical analysis: A descriptive analysis was carried out and a Poisson regression model was adjusted to study associated factors to Health Services use.ResultsOut of the 499 patients studied from two health centres, 55.1% were women and mean age was 58.2 (17.3). 25.1% were healthcare professionals. The most frequent symptoms recorded related to COVID-19 were cough (77.9%; CI 95% 46.5–93.4), fever (77.7%; CI95% 46.5–93.4) and dyspnoea (54.1%, CI95% 46.6–61.4). 60.7% were admitted to hospital. 64.5% first established contact with their primary care provider before going to the hospital, with a mean number of 11.4 Healthcare Providers Encounters with primary care during all the follow-up period.The number of visit-encounters with primary care was associated with being male [IRR 1.072 (1.013, 1.134)], disease severity {from mild respiratory infection [IRR 1.404 (1.095, 1.801)], up to bilateral pneumonia [IRR 1.852 (1.437,2.386)]}, and the need of a work leave [IRR 1.326 (1.244, 1.413].ConclusionSymptoms and risk factors in our case series are similar to those in other studies. There was a high number of patients with atypical unilateral or bilateral pneumonia. Care for COVID has required a high use of healthcare resources such as clinical encounters and work leaves.