Severe Acute Respiratory Syndrome Infection Research Articles

Government Restriction Efficiency on Curbing COVID-19 Pandemic Transmission in Western Europe

The World Health Organization (WHO)-confirmed pandemic (March 2020) of the new Coronavirus 2 severe acute respiratory syndrome infection (SARS-CoV-2) reported in Wuhan, China, in December 2019 (first reported cases), then spread to Italy and successively around the world. The objective of this study is to evaluate the effectiveness of the restrictions implemented by different governments from a statistical point of view. We quantitatively evaluated how restrictions influenced the temporal evolution of the distribution of the weekly number of hospitalized patients in the intensive care unit (ICU) for different countries that applied different levels of restrictions, which can be summarized with the average stringency index, a synthetic index that represents a metric for quantifying the severity of the restrictions applied. We found that the stringency index is strongly correlated with the distribution skewness, while standard deviation and kurtosis are poorly and moderately influenced. Furthermore, we compared the values of the skewness of the distribution of hospitalized patients during several pre-pandemic influenza outbreaks in Italy (data not available for other countries). Analysis shows that for normal flu, there is a substantial difference in skewness (as much as 70%) in the distribution with respect to the first COVID-19 pandemic outbreak, where social restrictions were applied. This large difference highlights that the restrictions implemented modify the symmetry of the peak of the distribution of the hospitalized patient in the ICU. Therefore, skewness can be used as a valid indicator to assess whether restriction has any effect on pandemic transmission and can be used as a support for decision makers.

The effect of COVID-19 pandemic on infant and child nutrition

DSÖ tarafından Mart 2020’de pandemi olarak ilan edilen Şiddetli Akut Solunum Yolu Sendromu enfeksiyonu (SARS- CoV-2) ekonomik ve sosyal krizlere yol açan eşi benzeri görülmemiş bir halk sağlığı sorunu haline gelmiştir. Teyit edilen ilk pediatrik vaka 20 Ocak’ta Çin Halk Cumhuriyetinin Shenzhen şehrinde bildirilmiş, o tarihten sonra çok fazla çocuk olgu sunumu ve olgu serisi rapor edilmiştir. Bu raporlarda çocuklarda hastalığın seyrinin asemptomatik olmasının yanında respiratuvar distres sendromu, multiorgan disfonksiyon sendromu gibi daha ciddi komplikasyonlar olabileceği belirtilmektedir. Ancak, hastalığın direk etkilerinin yanında gizlenen diğer sorunların, pandeminin indirek etkilerinin, daha ciddi sorunlara yol açtığı ve açmaya devam edeceği vurgulanmaktadır. Okulların kapanması, akran etkileşiminin azalması gibi nedenler ile birlikte pandeminin çocukların mental ve fiziksel sağlığına olan etkileri endişe yaratmaktadır. Pandemi sürecinde gıda güvensizliği sorunu daha da derinleşmiş, bebek ve çocuk beslenmesi etkilenmiştir. Bu doğrultuda bu derleme, SARS-CoV-2 pandemisi süresince bebek ve çocuk besleme sorunlarını, bu sorunlara neden olan faktörleri ve bu sorunları önlemeye yönelik stratejileri, çocuk ve ailesine yapılacak olan bilgilendirme ve danışmanlıktaki rollerimizi ortaya koymaktır.

Chronic Inflammation and Chronic Diseases: Potential Healing with Glutathione‐Inspired Fragments

AbstractGlutathione is one of the foremost human body antioxidant that enables him to cope with the oxidative stress and its by‐products. This compound is depleted by age, illness, viral infections, including Severe Acute Respiratory Syndrome infections (SARS). Restoring its levels is therefore crucial to good health. Since its oral bioavailability is very poor, it is important to develop stable derivatives or fragments with improved antioxidant properties. The relationship between chronic inflammation, chronic diseases and oxidative stress is widely documented. Compounds that have high antioxidant activities arouse much interest as they could contribute to cope with detrimental health conditions because of oxidative stress, thus chronic inflammation. We synthesized some interesting glutathione‐inspired fragments from available starting materials and assessed their antioxidant power. Our compounds were analysed and identified by usual physicochemical and spectroscopic techniques. Their antioxidant activity was assessed using Diphenylpicrylhydrazine radical and Ferric Reducing Antioxidant Power assays. Our results showed interesting antioxidant activities IC50 values ranging from 1.35 mg/mL to 3.40 mg/mL, some among them with values (2.32 mg/mL) better than cysteine (IC50=3.025 mg/mL) (IC50=3.03), which is the best precursor of glutathione.

Hospital mortality in patients with rare diseases during pandemics: lessons learnt from the COVID-19 and SARS pandemics

BackgroundThe threat and experience of pandemics occur differently for different groups. The rare disease population is at particular risk of being further marginalised during pandemics. In this study, our objective was to assess the hospital mortality patterns in the rare disease and the general populations during the coronavirus disease of 2019 (COVID-19) and severe acute respiratory syndrome (SARS) pandemics in Hong Kong.MethodsAll admission records during the COVID-19 pandemic (January 23–August 23, 2020) and SARS pandemic (March 11–June 30, 2003) were extracted from the local public healthcare database. Patients with rare diseases were identified using one or more of the 1084 10th version International Classification of Diseases and Related Health Problems (ICD-10) codes cross-referenced with 467 ORPHAcodes. Hospital mortality patterns were compared in patients with and without COVID-19/SARS infection. Admission records during the same period in 2019 and 2002 were retrieved for comparison.ResultsDuring the COVID-19 pandemic, 407,219 patients were admitted to one or more of the 43 public hospitals in Hong Kong, of which, 13,894 were patients with rare diseases (3.4%). A total of 4381 and 77 patients from the general and rare disease populations were infected with COVID-19. Rare disease patients had an adjusted 3.4 times odds of COVID-19-related hospital mortality compared with that of the general population (95% C.I. 1.24–9.41). COVID-19-related mortality was almost exclusively seen in patients ≥ 60 years. While age-related increase in mortality was also observed for the general population during the SARS pandemic, the pattern observed in the rare disease population was significantly different, with a 12.5 times higher SARS-related mortality observed in rare disease patients ≤ 18 years than those in the general population (12.5% vs 1.0%). Patients admitted during the same pandemic periods without coronavirus infection had a significantly higher hospital mortality compared with those admitted one year before the pandemic (p < 0.001).ConclusionThis population-based study demonstrated the differential impacts of the COVID-19 and SARS pandemics on the rare disease population. In the era of budget and resource scarcity, this study warrants cautious healthcare planning, with consideration of the rare disease population in healthcare prioritisation.

A portable triboelectric spirometer for wireless pulmonary function monitoring

Coronavirus disease 2019 (COVID-19) as a severe acute respiratory syndrome infection has spread rapidly across the world since its emergence in 2019 and drastically altered our way of life. Patients who have recovered from COVID-19 may still face persisting respiratory damage from the virus, necessitating long-term supervision after discharge to closely assess pulmonary function during rehabilitation. Therefore, developing portable spirometers for pulmonary function tests is of great significance for convenient home-based monitoring during recovery. Here, we propose a wireless, portable pulmonary function monitor for rehabilitation care after COVID-19. It is composed of a breath-to-electrical (BTE) sensor, a signal processing circuit, and a Bluetooth communication unit. The BTE sensor, with a compact size and light weight of 2.5 cm3 and 1.8 g respectively, is capable of converting respiratory biomechanical motions into considerable electrical signals. The output signal stability is greater than 93% under 35%–81% humidity, which allows for ideal expiration airflow sensing. Through a wireless communication circuit system, the signals can be received by a mobile terminal and processed into important physiological parameters, such as forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). The FEV1/FVC ratio is then calculated to further evaluate pulmonary function of testers. Through these measurement methods, the acquired pulmonary function parameters are shown to exhibit high accuracy (>97%) in comparison to a commercial spirometer. The practical design of the self-powered flow spirometer presents a low-cost and convenient method for pulmonary function monitoring during rehabilitation from COVID-19.

Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece.

Greece imposed a nationwide lockdown in March 2020 to mitigate transmission of severe acute respiratory syndrome coronavirus 2 during the first epidemic wave. We conducted a survey on age-specific social contact patterns to assess effects of physical distancing measures and used a susceptible-exposed-infectious-recovered model to simulate the epidemic. Because multiple distancing measures were implemented simultaneously, we assessed their overall effects and the contribution of each measure. Before measures were implemented, the estimated basic reproduction number (R0) was 2.38 (95% CI 2.01–2.80). During lockdown, daily contacts decreased by 86.9% and R0 decreased by 81.0% (95% credible interval [CrI] 71.8%–86.0%); each distancing measure decreased R0 by 10%–24%. By April 26, the attack rate in Greece was 0.12% (95% CrI 0.06%–0.26%), one of the lowest in Europe, and the infection fatality ratio was 1.12% (95% CrI 0.55%–2.31%). Multiple social distancing measures contained the first epidemic wave in Greece.

Possible Potential Outcomes from COVID-19 Complications on Testes: Lesson from SARS Infection.

Coronavirus infection disease-2019 (COVID-19) gained worldwide fame after deadly outbreak in China and its subsequent spread to many countries. So far, COVID-19 is not fully contained, and new cases are arising on daily bases in various countries. Due to zoonotic nature and human-to-human spread, COVID-19 is considered pandemic with more causalities in developing countries. Full genome analysis revealed its resemblance with severe acute respiratory syndrome (SARS) virus with minor variation in non-structural proteins. Both viruses use the common angiotensin converting enzyme (ACE2) receptor to attach to the epithelial cells of the target organs. Currently, COVID-19 patients are treated with drugs that are used for lungs infections. However, ACE2 has high expression in other human organs such as kidney and testes. Thus, it is assumed that, like SARS, it may have adverse effects on other vital organs, which have dominant expression of ACE2. In testis, SARS affected patients displayed peritubular fibrosis, extensive germ cell disruption, damage of blood-testis barrier integrity and more frequent occurrence of apoptosis. Here, we critically discuss the possible adverse effects of COVID-19 on the testes of patients along with future precautions to overcome the complications of reproductive organs. Key Words: COVID-19; SARS; ACE2, Testes.

Parenteral fish oil: An adjuvant pharmacotherapy for coronavirus disease 2019?

The new coronavirus associated with severe acute respiratory syndrome (SARS-CoV-2), surprisingly, does not affect only the lungs. The severe response to SARS-CoV-2 appears to include a “cytokine storm,” which indicates a state of hyperinflammation and subsequent dysfunction of multiple organs and tissues in the most severe cases. This could be the reason why populations at the highest risk for death from the SARS-CoV-2 infection–induced disease (coronavirus disease 2019 [COVID-19]) are those suffering from chronic low-grade inflammation, but prone to hyperinflammation. This includes individuals of advanced age and those with obesity, type 2 diabetes, hypertension, and metabolic syndrome. Inflammation resolution is strongly dependent on lipid mediators, the specialized pro-resolution mediators (SPMs). ω-3 polyunsaturated fatty acids (ω-3 PUFAs) are precursors of very potent SPMs, including resolvins, protectins, and maresins. Additionally, they are associated with a less aggressive inflammatory initiation, after competing with ω-6 fatty acids for eicosanoid synthesis. Therefore, it makes sense to consider the use of ω-3 PUFAs for clinical management of COVID-19 patients. ω-3 PUFAs may be given by oral, enteral, or parenteral routes; however, the parenteral route favors faster incorporation into plasma phospholipids, blood cells, and tissues. Here, we discuss these aspects to propose the parenteral infusion of ω-3 PUFAs as adjuvant immunopharmacotherapy for hospitalized patients with COVID-19.

Inpatient and home-based rehabilitation regimen after COVID-19 illness

The severe acute respiratory coronavirus-2 syndrome infection has spread worldwide and has an abrupt effect on human, economic, and health system. The data are collected from various relevant sources such as PubMed, Infection Prevention Control, World Health Organization novel coronavirus disease (COVID-19) situation update report, Australian and New Zealand Intensive Care Society guidelines, Society of Critical Care Medicine, World Confederation for Physical therapy guidelines, and from other Internet sources. It is observed that about 30% of COVID-19 patients with sepsis needed hospital rehabilitation, while 20% requires a home-based rehabilitation program. Based on the evidence, it is anticipated that severe and critical COVID-19 patients develop postintensive care syndrome, resulting in pulmonary disabilities, dyspnea on exertion, physical deconditioning, cognitive impairment, and mental health disturbances. Most of these symptoms may also occur in patients recovered from symptoms, or who were not admitted to intensive care unit, or in older adults with chronic health conditions, or who have been deconditioned due to mobility disability, social isolation, etc. Such patients need access to effective pulmonary therapy, functional rehabilitation, and stress management in the hospital- and home-based settings to regain their previous independence level. The evidence suggests that viruses could even survive in the oropharyngeal cavity and stool for up to 15 days after COVID-19 infection has been declared cured. The physiotherapist must take proper safety measures before managing patients at home; a virtual care therapy is therefore highly recommended. Due to the increasing demands of hospital beds, the patients may need to be discharged earlier than expected. Rehabilitation act as adjuvant therapy in preparing patients for discharges, reducing the experience of disability, and ensuring the quality of treatment among recovered/discharged COVID-19 patients in hospital- or home-based settings.

Human-Leukocyte Antigen Class I Cw 1502 and Class II DR 0301 Genotypes Are Associated with Resistance to Severe Acute Respiratory Syndrome (SARS) Infection

One-hundred and thirty confirmed cases of severe acute respiratory syndrome (SARS) were recruited to evaluate their anti-SARS-coronavirus (CoV) antibody status and human leukocyte antigen (HLA) types in September 2006, 3 y after the SARS outbreaks in Taiwan. Western blot assay showed that 6.9% of participants still had anti-spike and anti-nucleocapside antibodies. A case-control study of the association of HLA with SARS revealed that the HLA-Cw1502 and DR0301 alleles conferred resistance against SARS infection (p<0.05).

Effectiveness of Ribavirin and Corticosteroids for Severe Acute Respiratory Syndrome

Objective Ribavirin and corticosteroids were used widely as front-line treatments for severe acute respiratory syndrome; however, previous evaluations were inconclusive. We assessed the effectiveness of ribavirin and corticosteroids as the initial treatment for severe acute respiratory syndrome using propensity score analysis. Methods We analyzed data on 1755 patients in Hong Kong and 191 patients in Toronto with severe acute respiratory syndrome using a generalized propensity score approach. Results The adjusted excess case fatality ratios of patients with severe acute respiratory syndrome receiving the combined therapy of ribavirin and corticosteroids within 2 days of admission, compared with those receiving neither treatment within 2 days of admission, were 3.8% (95% confidence interval, −1.5 to 9.2) in Hong Kong and 2.1% (95% confidence interval, −44.3 to 48.5) in Toronto. Conclusions Our results add strength to the hypothesis that the combination of ribavirin and corticosteroids has no therapeutic benefit when given early during severe acute respiratory syndrome infection. Further studies may investigate the effects of these treatments later in disease course.

IL-12 RB1 Genetic Variants Contribute to Human Susceptibility to Severe Acute Respiratory Syndrome Infection among Chinese

BackgroundCytokines play important roles in antiviral action. We examined whether polymorphisms of interleukin (IL)-12 receptor B1 (IL-12RB1) affect the susceptibility to and outcome of severe acute respiratory syndrome (SARS).MethodsA case-control study was carried out in Chinese SARS patients and healthy controls. The genotypes of 4SNPs on IL-12 RB1 gene, +705A/G,+1158T/C, +1196G/C and +1664 C/T, were determined by PCR-RFLP. Haplotypes were estimated from the genotype data using the expectation-maximisation algorithm.ResultsComparison between patients and close contacts showed that individuals with the +1664 C/T (CT and TT) genotype had a 2.09-fold (95% confidence interval [CI], 1.90–7.16) and 2.34-fold (95% CI, 1.79–13.37) increased risk of developing SARS, respectively. For any of the other three polymorphisms, however, no significant difference can be detected in allele or genotype frequencies between patients and controls. Additionally, estimation of the frequencies of multiple-locus haplotypes revealed potential risk haplotypes (GCCT) for SARS infection.ConclusionsOur data indicate that genetic variants of IL12RB1confer genetic susceptibility to SARS infection, but not necessary associated with the progression of the disease in Chinese population.

Angiotensin-converting enzyme 2 in acute respiratory distress syndrome

.Angiotensin-converting enzyme (ACE) and ACE2 are highly homologous metalloproteases that provide essential catalytic functions in the renin-angiotensin system (RAS). Angiotensin II is one key effector peptide of the RAS, inducing vasoconstriction and exerting multiple biological functions. ACE cleaves angiotensin I to generate angiotensin II, whereas ACE2 reduces angiotensin II levels. Accumulating evidence has demonstrated a physiological and pathological role of ACE2 in the cardiovascular systems. Intriguingly, the SARS coronavirus, the cause of severe acute respiratory syndrome (SARS), utilizes ACE2 as an essential receptor for cell fusion and in vivo infections. Moreover, recent studies have demonstrated that ACE2 protects murine lungs from acute lung injury as well as SARS-Spike protein-mediated lung injury, suggesting a dual role of ACE2 in SARS infections and protection from ARDS.

Temporal changes in cytokine/chemokine profiles and pulmonary involvement in severe acute respiratory syndrome

Objective and background: Pathological changes in severe acute respiratory syndrome (SARS) suggest that SARS sequelae are associated with dysregulation of cytokine and chemokine production. To improve understanding of the immuno‐pathological processes involved in lung injury associated with SARS, the temporal changes in cytokine/chemokine profiles in the sera of SARS patients were compared with those of patients with community‐acquired pneumonia (CAP), according to the degree of lung involvement. Methods: Serum levels of 11 cytokines and chemokines, in 14 patients with SARS and 24 patients with CAP, were serially checked using a bead‐based multiassay system. Sera from 12 healthy subjects were used as normal controls. Results: The serum levels of interferon‐γ‐inducible protein‐10 (IP‐10), IL‐2 and IL‐6 were significantly elevated during SARS infection. In patients with CAP, but not in those with SARS, the levels of interferon‐γ, IL‐10, IL‐8 and monokine induced by interferon‐γ (MIG) were significantly elevated compared with the levels in healthy controls. Among the chemokines/cytokines, IL‐6 levels correlated most strongly with radiographic scores (r = 0.62). The elevation of IP‐10 and IL‐2 antedated the development of chest involvement and reached peak levels earlier than the radiographic scores. In contrast, the dynamic changes in IL‐6, C‐reactive protein and neutrophils occurred synchronously with the changes in radiographic scores. The mean ratio of IL‐6 to IL‐10 in SARS patients (4.84; range 0.41–21) was significantly higher than that in CAP patients (2.95; range 0.02–10.57) (P = 0.04). Conclusions: The early induction of IP‐10 and IL‐2, as well as the subsequent over‐production of IL‐6 and lack of IL‐10 production, probably contribute to the main immuno‐pathological processes involved in lung injury in SARS. These changes in cytokine/chemokine profile are remarkably different from those observed in CAP patients.

Nurses’ perceptions of severe acute respiratory syndrome: relationship between commitment and intention to leave nursing

This paper reports a study which aimed to: (1) investigate the relationship between nurses' commitment to the nursing profession and organization and their intention to leave; (2) investigate nurses' perceptions of the possibility of acquiring severe acute respiratory syndrome infection and its moderation of their commitment to the nursing profession and the organization and their consequent intentions to leave the profession and the organization following the severe acute respiratory syndrome outbreak. The outbreak of severe acute respiratory syndrome in 2003 resulted in a fatality rate of approximately 11%. Nurses in hospitals caring for patients with severe acute respiratory syndrome maintained close contact with the infected patients. The high risk of infection and death associated with caring for patients with severe acute respiratory syndrome had a great impact on nurse retention in hospitals. Nurse turnover in many countries where these outbreaks occurred has been high since the first outbreak occurred in March 2003. Three hundred and thirty nurses working at a Taiwan hospital during the time of the severe acute respiratory syndrome outbreak completed the Meyer, Allen & Smith Organizational and Occupational Commitment Scales, Intention to Leave and Perceived Stress of Infection Scales between July and August 2003. All three components of occupational and organizational commitments were negatively associated with nurses' intentions to leave the nursing profession and the organization. Nurses' perceptions of the possibility of acquiring severe acute respiratory syndrome infection through caring for these patients had a moderating effect on the relationship between commitment and the intention to leave. Perceived risk to life from infection has a possible influence on the commitment/intention-to-leave model in hospital nurses caring for patients with severe acute respiratory syndrome, and this information can inform hospital and nursing managers about nurse retention following a severe acute respiratory syndrome outbreak and the management of commitment in the context of nursing human resources management.

Viral load and outcome in SARS infection: The role of personal protective equipment in the emergency department

This study was conducted to evaluate the effectiveness of personal protective equipment (PPE) against severe acute respiratory syndrome (SARS). Sixteen patients in a SARS cluster, including 4 health care workers (HCWs) and 12 non-HCWs were studied. We compared the initial viral load by nasopharyngeal swabs, clinical progression, and outcome of this cluster. The HCWs had a lower viral load. The non-HCWs had a higher mean C-reactive protein, lower oxygen saturation, and a higher incidence of intubation and death. Secondary household transmission developed in three of the non-HCWs’ families. One month after discharge, non-HCWs had more signs of fibrosis on high resolution computed tomography (HRCT) scan and an impaired pulmonary function test. Although most of the PPE do not confer absolute protection against SARS, it seems that they may lower exposure to the virus, leading to a lower risk of secondary transmission, and be associated with relatively mild disease and a better early outcome.

Myopathic Changes Associated With Severe Acute Respiratory Syndrome

The March 2003 outbreak of the severe acute respiratory syndrome (SARS) resulted in significant morbidity and mortality. Muscle weakness and elevated serum creatine kinase levels are commonly encountered in patients with SARS. However, the nature and cause of myopathy associated with a SARS infection are unknown because, to our knowledge, there has been no report of histological or postmortem examination of the skeletal muscle from SARS-infected patients. To determine the exact nature of the myopathy associated with SARS. Postmortem skeletal muscles from 8 consecutive patients who died of SARS in March 2003 were studied under light and electron microscopy as well as immunohistochemistry. Focal myofiber necrosis was identified in 4 of 8 cases. Macrophage infiltration and regenerative fiber were scanty. All 4 patients treated with a steroid had significant myofiber atrophy. In situ hybridization for coronavirus was negative in all subjects. Viral cultures for coronavirus and examination for viral particles under electron microscopy were performed in 2 patients. The viral culture yielded no organisms and there were no viral particles seen on electron microscopic examination. There is a spectrum of myopathic changes associated with a SARS infection. Focal myofiber necrosis is common and possibly is immune mediated. Critical illness myopathy and superimposed steroid myopathy may also play an important role in SARS.

CHANG AND HUANG RESPOND

In our April 2004 article, we reported significant reductions in the utilization of medical services in Taiwan at the peak of the severe acute respiratory syndrome (SARS) epidemic. Our results suggested that the fear of SARS significantly influenced people’s utilization patterns and compromised their access to care. Ichikawa’s observation of apparent reductions in tuberculosis (TB) notifications in Hong Kong during the SARS epidemic in April and May of 2003 provide further evidence supporting this conclusion. More important, Ichikawa’s finding raises an interesting question: How did the fear of SARS influence the health care utilization of people with different types of diseases? In medicine, it is common to categorize diseases as acute or chronic. Within each category, diseases can be minor, progressive, or life threatening. Apart from TB, our preliminary analyses found that SARS affected ambulatory care utilization differently depending on the disease. The largest reductions in utilization were observed for minor acute diseases, such as acute respiratory tract infections, and modest reductions were found for chronic diseases that presented no immediate danger, such as diabetes. We found no change in utilization of medical services for life-threatening diseases, such as end-stage renal disease. One plausible explanation is that, faced with the terrifying risk of SARS infection, patients with minor acute ailments may have been more willing to forgo both necessary and unnecessary ambulatory care than patients with life-threatening diseases. Whereas patients with end-stage renal disease require regular kidney dialysis, patients with diabetes, a stable chronic disease, could easily put off their regular physician visits by asking for long-term prescriptions that allowed them to obtain 3 months’ worth of medication at a time. Thus we found considerably larger utilization reductions for patients with diabetes than for patients with life-threatening diseases. These findings reinforce the need for a thorough and systematic framework for evaluating the impacts of SARS on the general population. Because different diseases have different characteristics, hindered detection or treatment of diseases owing to the fear of SARS may result in different levels of health consequences for different members of the population. It is important to identify not only the overall effects of the fear of SARS on various services and diseases but also the smaller effects of the epidemic on people with different educational backgrounds, socioeconomic statuses, and health statuses. Future research can help advance our knowledge in this regard. A better understanding of the health impacts of the SARS epidemic can help public health agencies prevent avoidable health consequences and allocate resources more efficiently.

Polymorphisms of interferon-inducible genes OAS-1 and MxA associated with SARS in the Vietnamese population

We hypothesized that host antiviral genes induced by type I interferons might affect the natural course of severe acute respiratory syndrome (SARS). We analyzed single nucleotide polymorphisms (SNPs) of 2′,5′-oligoadenylate synthetase 1 (OAS-1), myxovirus resistance-A (MxA), and double-stranded RNA-dependent protein kinase in 44 Vietnamese SARS patients with 103 controls. The G-allele of non-synonymous A/G SNP in exon 3 of OAS-1 gene showed association with SARS ( p = 0.0090). The G-allele in exon 3 of OAS-1 and the one in exon 6 were in strong linkage disequilibrium and both of them were associated with SARS infection. The GG genotype and G-allele of G/T SNP at position −88 in the MxA gene promoter were found more frequently in hypoxemic group than in non-hypoxemic group of SARS ( p = 0.0195). Our findings suggest that polymorphisms of two IFN-inducible genes OAS-1 and MxA might affect susceptibility to the disease and progression of SARS at each level.

Osteonecrosis of Hip and Knee in Patients with Severe Acute Respiratory Syndrome Treated with Steroids

To evaluate whether there is a relationship between steroid treatment and risk for osteonecrosis of the hip and knee in patients with severe acute respiratory syndrome (SARS). The hospital ethics committee approved the study, and all patients provided written informed consent. A total of 254 patients with confirmed SARS treated with steroids underwent evaluation with magnetic resonance (MR) imaging for osteonecrosis. Clinical profiles, joint symptoms, relevant past medical and drug history, steroid dose, and radiographic and MR imaging evidence of osteonecrosis and other bone abnormalities were evaluated. Mann-Whitney, Kruskal-Wallis, and Pearson exact chi(2) tests were performed, and univariate and multivariate logistic regression analyses were applied. One hundred thirty-four (53%) of 254 patients had recent onset of large joint pain, but 211 (80%) of 264 painful joints were not associated with abnormality on MR images. MR images in 12 (5%) of 254 patients showed evidence of subchondral osteonecrosis in the proximal femur (n = 9), distal femur (n = 2), and proximal and distal femora and proximal tibiae (n = 1). Additional nonspecific subchondral and intramedullary bone marrow abnormalities were present in 77 (30%) of 254 patients. Results of multiple logistic regression analysis confirmed cumulative prednisolone-equivalent dose to be the most important risk factor for osteonecrosis. The risk of osteonecrosis was 0.6% for patients receiving less than 3 g and 13% for patients receiving more than 3 g prednisolone-equivalent dose. No relationship was found between additional nonspecific bone marrow abnormalities and steroid dose. An appreciable dose-related risk was found for osteonecrosis in patients receiving steroid therapy for SARS. Additional nonspecific bone marrow abnormalities were frequent. Joint pain was common after SARS infection and was not a useful clinical indicator of osteonecrosis.