Special Issue: Advancements in COVID-19

SPECIAL ISSUE

Advancements in COVID-19 - 2020

COVID-19 resume

This Special issue will highlight recent developments in our understanding of COVID-19 and possible paths towards new therapies.

REVIEW ARTICLES

Shumail Fatima1 ,  Syed Bukhari2 ,John Pacella 2

1. University of Pittsburgh Medical Center, Mckeesport Hospital, Department of Internal Medicine 

2. University of Pittsburgh Medical Center, Presbyterian Hospital, Heart and Vascular Institute. 

Abstract

Alternative splicing enables the generation of different proteins from a single gene, greatly increasing the use of genetic information. The resultant protein isoforms often have different biological properties effecting the phenotype of the cell in which it is expressed. Dysregulation of alternative splicing is a common occurrence in cancer and may lead to the formation of truncated or degraded proteins through the introduction of immature stop codons or nonsense mediated decay. Increasing evidence indicates that cancer-associated splicing variants play an important role in tumor initiation and progression. In this review, we summarize the evidence supporting the relevance of alternative splicing in glioblastoma multiforme (GBM). Specifically, we focus on the role of alternative splicing in GBM pathogenesis with an emphasis on the effect of aberrant alternative splicing of FGFR, GLI-1, and EGFR. The significance of exploiting alternatively spliced isoforms as potential biomarkers which may contribute to the development of diagnostic and prognostic methods, in addition to serving as molecular targets in GBM, will be discussed.

Selva Rivas-Arancibia1, Jennifer Balderas-Miranda1, Lizbeth Belmont-Zúñiga1, Martín Martínez-Jáquez1, Eduardo Hernández-Orozco1, Vanessa Cornejo-Trejo1, Citlali Reséndiz-Ramos1, Iván Cruz-García1, Isaac Espinosa-Caleti1, Marlen Valdés-Fuentes2, Erika Rodríguez Martínez1

1.Departamento de Fisiología, Facultad de Medicina. Universidad Nacional Autónoma de México

2.Departamento de Investigación, Tecnológico de Estudios Superiores de Huixquilucan. Estado de México. México

Abstract

Patients with degenerative diseases present a chronic oxidative stress state, which puts them at a disadvantage when facing viral infections such as COVID-19. This is because there is a close relationship between redox signaling and this inflammatory response. Therefore, chronic changes in the redox balance cause alterations in the regulation of the immune system. An inflammatory response that must be reparative and self-limited loses its function and remains over time. In a chronic state of oxidative stress, there is a deficiency of antioxidants. This results in low levels of hormones, vitamins and trace elements, which are essential for the regulation of these systems.
Furthermore, low levels of antioxidants imply a diminished capacity for a regulated inflammatory responses are much more vulnerable to a cytokine storm that mainly attacks the lungs, since they present a vicious circle between the null or diminished response of the antioxidant systems and the loss of regulation of the inflammatory process. Therefore, these patients are at a disadvantage in counteracting the response of defense systems to infection from SAR-COV19. A plausible option may be to restore the levels of Vitamins A, B, C, D, E and of essential trace elements such as manganese, selenium, zinc, in the body, which are key to either preventing or reducing the severity of the response of the immune system to the disease caused by SAR-CoV2.
For the present review, we searched the specific sites of the Cochrane library database, PubMed and Medscape. The inclusion criteria were documents written in English or Spanish, published during the last 10 years.

Subhendu Sekhar Bag 1,2, Sayantan Sinhab2, and Isao Saito3

1.Chemical  Biology/Genomics  Laboratory,Department  of  Chemistry,  Indian  Institute  of  Technology  Guwahati, India – 781039

2.Centre for The Environment, Indian Institute of Technology Guwahati, India-781039

3.Institute of Advanced Energy, Kyoto University, Biofunctional Chemistry Research Section

Abstract

Since the emergence of SARS-CoV-2 infection in Wuhan, China, in December 2019, the spread has caused COVID19 disease in over 8.1 million people and more than 439 thousand deaths across the globe as on 16th June 2020. Absence of any particular cure or vaccine lead the health care system to treat the patients with the existing potential antiviral drugs. Recently, Favipiravir, a potential RdRp inhibitor of SARS-COV-2 sheds the ray of hope for treating COVID-19 patients efficiently.

Birgit M. Pruess

Department of Microbiological Sciences, North Dakota State University, Fargo ND 58108

Abstract

SARS CoV-2 and its associated disease Covid-19 first occurred in China at the end of 2019 and conquered the world in a storm. As of June 24, 2020, the World Health Organization listed 9,129,146 confirmed cases, accompanied by 473,797 deaths. An initial response by many countries was to lock down their economies, which helped flattening the curve at a high economic cost. The long-term solution will be vaccines to prevent infection and treatment drugs.

This minireview focuses on drugs against the virus itself. Among the drugs that interfere with the virus’ ability to attach to and invade the human cell, camostat mesylate looks promising in vitro, but clinical trials have not been completed yet. A phase II trial has been completed for recombinant human angiotension converting enzyme 2 that blocks the spike protein from binding to cellular ACE-2. Hydroxychloroquine is probably the most controversial of all drugs; after initial excitement, the Federal Drug Administration revoked the emergency use of this drug against SARS CoV-2. Among the inhibitors of the RNA dependent RNA polymerase of the virus, remdesivir, faripiravir which is already in a phase IV trial, and tenofovir will be discussed. Additional drugs included in this study are lopinavir/ritonavir that have previously been used against HIV and the antiparasitic drug ivermectin. Many of the presented drugs have previously been used for a different disease and are currently being trialed against SARS CoV-2.

RESEARCH ARTICLES

Ian C. Clift, PhD, MLS(ASCP)CM1,2
1.Indiana University, Department of Clinical Laboratory Science.
2.Biomedical Associates

Abstract

Background:
The global focus on COVID-19 provides a spotlight for the critical role of the clinical laboratory scientist in monitoring and managing pandemic disease. Laboratory management and the laboratory team must understand the signs, symptoms and routes of transmission of the pandemic infectious disease , ensure the safety of their employees, and determine the most effective testing methods for implementation in a rapid time frame.

Methods:
An examination of the current literature regarding characteristics of airborne viral outbreaks, safety practices, and emergency use testing methods were compiled.

Results:
The protection of laboratory employees is mediated by emergency preparedness plans prior to pandemic threats, insurance that personnel are vaccinated when possible and have appropriate PPE available; includes respirators or face masks. The primary method of early detection of novel pandemic viral threats, such as COVID-19, is molecular testing via
nucleic acid extraction from patient specimens and rRT-PCR as indicated from the issuance of FDA Emergency Use Authorizations (EUAs) from February to April of 2020.

Conclusions:
Prior pandemics and standard laboratory practice have prepared clinical laboratories for mitigating the spread of disease among employees. NAAT (nucleic acid amplification testing)has emerged as the earliest testing modality for monitoring
pandemic viral disease presence and other methods include viral culture, serological assays, and biomarker testing
will be used to monitor progression and treatment. The clinical laboratory investigations and response to viral
pandemics has the benefit of increasing our technical knowledge in handling future pandemic threats.

Keywords:
COVID-19, NAAT, PCR, Pandemic, Viral, Infectious Disease, Laboratory Medicine

Qamar Ahmad, MD1; Sarah E DePerrior, MPH2; Sunita Dodani MD, FCPS, MSc, PhD2; Joshua F Edwards, MPH2; Paul E Marik, MD, FCCP, FCCM1

1.Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia

2 EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia

Abstract

Background: Inflammatory cytokines have been implicated in the pathophysiology and prognosis of severe COVID-19. Inflammatory biomarkers may guide the clinician in making treatment decisions as well as in the allocation of resources.

 Objective: This study aimed to assess how levels of inflammatory biomarkers predict disease severity and mortality in patients with COVID-19 by testing a predictive scoring model developed by Zhou et al and further refining the model in a population of patients hospitalized with COVID-19.

Study Design and Methods: This retrospective study included patients with COVID-19 admitted to ten Virginia hospitals from January 1, 2020, to June 15, 2020. Inflammatory markers including CRP, D-Dimer, ferritin, N/L ratio, and procalcitonin were studied and logistic regression models were applied to ascertain the risk of ICU admission and mortality with elevated markers.

 Results: Data from a total of 701 patients were analyzed. In bivariate tests age, CRP, D-Dimer, and N/L ratio were associated with in-hospital mortality as well as admission to the ICU.  Procalcitonin was associated with admission to the ICU but not mortality. Males and African Americans were more likely to require ICU-level care. In final models, age and CRP were significantly associated with mortality (OR 1.06, 95% CI 1.04-1.08, and OR 1.06, 95% CI 1.03-1.10 respectively) as well as ICU admissions (OR 1.02, 95% CI 1.01-1.03 and OR 1.03, 95% CI 1.01-1.06 respectively). The previously established composite scores of CRP, D-Dimer, and N/L ratio were predictive of mortality (Area under the curve [AUC] 0.69 for multiplicative score) as well as ICU admissions (AUC 0.61 for multiplicative score). However, improved accuracy was obtained with age and CRP for predicting mortality (AUC 0.77) and ICU admission (AUC 0.62).

Conclusions: CRP and age appear to be the strongest predictors for ICU admission and mortality compared to D-Dimer, Ferritin, Procalcitonin, and N/L ratio in patients with COVID-19.

Nathan Roberts1,Robert E.Brown MD1, L.Maximilan Buja MD1, Priya Weerasinghe, MD, PhD1

Abstract

Turmeric (Curcuma Longa) has a near 4000-year history of extensive medical use in South Asia. Its main physiologically active phytochemical is curcumin (diferuloylmethane), derived from the rhizome of turmeric. Curcumin is a hydrophobic polyphenol with a diketone moiety connecting two phenoxy rings. It is widely available, and exerts systemic and pleiotropic effects via several key mechanisms. Most famously, it is known to inhibit pro-inflammatory pathways such as PI3k/akt/NF-kB activation. It is also a potent antioxidant and free radical scavenger via a sequential proton loss electron transfer mechanism in ionizing solvents due to its extended conjugating ability across the entire molecule, and its ability to induce NRF-2. It has been implicated in the treatment of diseases ranging from asthma to various cancers, and is also a broad spectrum anti-microbial. COVID-19 is a novel beta-coronavirus that was declared a pandemic by the WHO in March, 2020. It is primarily a respiratory disorder, but it can spread hematogenously and effect many other organs such as the heart, nervous system, and kidneys. There is a significant intersection between the clinical manifestations of COVID-19 and curcumin’s therapeutic effects. In addition, curcumin has been shown to inhibit initial viral infectivity. Thus, there is potential for curcumin to safely both prevent and treat COVID-19 infection across the globe.

David D. Busath, MD
 

Abstract

It is common in medicine that simple, inexpensive remedies are held hostage to medical prejudice, financial or political interest, and legal precedent. The purpose of this review is to take the point of view of the victims of COVID-19 and address whether scientific information, including randomized-control trials, can answer whether the hydroxychloroquine should be dispensed for those testing positive and their immediate recent contacts at the point of testing. Although the FDA in the United States is yet to be convinced, the demonstration of positive effects in clinical trials cannot be ignored and there is a large amount of information in the pipeline (published pre-prints and registered clinical trials) that could tip the scales towards making the drug readily available for early disease and contact-prophylactic usage to reduce peak symptoms, symptom duration, contagiousness, hospitalizations and mortality. 

Priya Kumthekar

Feinberg School of Medicine at Northwestern Univ 710 North Lake Shore Drive Abbott Hall Room 1122 Chicago, IL 60611

Abstract

Clinical trials that involve medical products are critical to advancing treatments in any medical field and are designed with careful thought and attention to detail. These details include careful assessment of safety parameters from patient safety visits, lab work and deliberately placed screening parameters. Meticulous planning for primary, secondary and correlative outcomes is completed by the study team and the biostatisticians involved in each study design. These precise measures are then methodically written as a clinical trial protocol and submitted to regulatory bodies such as the Food and Drug Administration (FDA) often as an Investigational Drug Application (IND) and also submitted to the Institutional Review Board (IRB) so that a study can have the appropriate regulatory approval to be tested for the desired outcome. The Principal Investigator (PI) and study team are required to follow these protocols and regulatory requirements with exactitude to maintain clinical trial integrity. While there are many models projecting variances in the timeframe of this pandemic, it is very possible that these modifications will be in place for months/years to come in varying intensities, so it is imperative that we understand them if we participate in clinical trials moving forward.

Joseph A. Elengickal1, Marshall J. Weber1, Jennifer R. Morris1, Alice S. Win1, John A. Carico1, Hana I. Nazir1, Matthew C. Stagg1, Nicholas M. Teague1, Rishabh Agrawal1, Kush S. Patel1, Rodger D. MacArthur1

1.Medical College of Georgia at Augusta University

Abstract

Since late 2019, SARS-CoV-2 has differentially impacted geographies and population demographics as it spread. As of June 30, 2020, two hotspots within the United States of America—the states of Georgia and Michigan—exhibited similar numbers of cases while Michigan had over twice the case fatality rate (CFR) of Georgia. Given the similar populations, land areas, and pandemic timelines of these states, such a large difference is unexpected. The primary goal of this paper is to examine why Michigan experienced much higher COVID-19 mortality than Georgia, which may point to at-risk comorbidities and vulnerable populations.

We examined publicly available data on demographics, rates of comorbidities, environmental factors, and other population differences at the state and local levels (the cities of Detroit, Michigan; Atlanta, Georgia; and Albany, Georgia) that have known or identified associations with health outcomes. We also outlined the timeline of the pandemic in each state to determine if the actions of state governments may have contributed to the observed difference in CFR.

While the difference in state CFR may imply that Michigan handled the pandemic poorly, the data show that inherent characteristics of Detroit may have led to the higher statewide CFR. Notable differences between the states include elderly populations, agricultural statistics, and drinking habits. Notable differences between the cities included population density, health system quality, per capita income, race, education, media access, and air pollution. Hypertension (among blacks), diabetes (at the city level), chronic kidney disease, asthma, heart disease, and cancer differed in prevalence by location and were associated with increased severity and/or mortality of COVID-19. There were more deaths due to COVID-19 in African American communities and nursing homes in Michigan. A combination of these factors likely explains the differential impact between these two states.

Arieh S Solomon, MD, PhD

Abstract

The pandemic of COVID-19, named by World Health Organization (WHO) SARS –CoV-2, revealed a novel type of corona virus. Gradually, starting  from December 2019 in China, the data about the symptoms and systemic involvement started to be collected from medical centers all over the world. As far as now, it is known that the virus involves upper respiratory tract , lungs, kidneys, gastrointestinal system, coagulation system, brain and eye. In this review we present the clinical aspects of the eye and findings in patients hospitalized with severe condition as result of SARS-CoV-2 infection. There are reports of sporadic cases of people who presented conjunctivitis which is called “pink eye”. According to different sources of information, the eye is involved in      COVid-19 pandemic in 1% – 3% of  cases actively involved. 

Tiffany Field1,2, Samantha Poling2, Shantay Mines2, Debra Bendell2 and Connie Veazey2
 
Veazey
2
Affiliations
1
University of Miami/Miller School of Medicine
2
Fielding Graduate University
Correspondence
 1.University of Miami/Miller School of Medicine
2.Fielding Graduate University
 

Abstract

Background: Touch deprivation has rarely been studied except in wartime nurseries and in very few orphanages in the world. Pandemics like COVID-19 are susceptible to touch deprivation at least for those living alone and to a lesser degree for friends social distancing in public places.

Methods: A Survey Monkey study was conducted during April 2020. Respondents (N=260 individuals >18 years) completed several COVID-related stress scales.

Results: Sixty per cent of the sample reported experiencing low to high levels of touch deprivation. Correlation analyses suggested that touch deprivation was more prevalent in individuals living alone and was negatively related to health practices scale scores and positively related to scores on scales measuring COVID-related stress, negative mood states including anxiety and depression, fatigue, sleep disturbances, and posttraumatic stress symptoms. Analyses of variance revealed significant differences between touch-deprived and non-touch deprived groups on these measures. Outside exercise was studied as a potential buffer to touch deprivation inasmuch as touching and exercise have been noted to have similar effects on mood states and physical health. Correlation analyses suggested that outside exercise was positively related to health practices and negatively related to COVID-related stress, anxiety, depression, fatigue, sleep disturbances and PTSD symptoms.

Discussion: These data suggest the widespread prevalence of touch deprivation during COVID-19 lockdown and its relationship to negative mood states and sleep disturbances. Exercise was noted to decrease these problems as it has in previous non-COVID research.

Conclusion: Exercise can reduce touch deprivation related problems during pandemics like COVID-19.

César Morcillo Serra1,  Daniel Tizon Galisteo2, Domingo Marzal Martín3,  José Francisco Tomás Martínez 4

1.Medical Director, Sanitas Digital Hospital. Internal medicine, Sanitas Cima Hospital.
2.Information technology systems and artificial intelligence, Sanitas Hospitals.
3.Medical Director, Sanitas Hospitals.
4.Managing Director, Sanitas Hospitals

Abstract

Introduction: Digital health facilitates patient-centered, accessible, safe, and more efficient care, through technologies such as telemedicine, big data, bots, artificial intelligence, and other technologies. Undoubtedly, its implementation has been accelerated thanks to the COVID-19 pandemic, where they have demonstrated their effectiveness, by maintaining continuity of care and facilitating early interventions thanks to the analysis of data and the deployment of bots, telemonitoring and virtual care platforms. 

Objective and methods: Prospective observational study to describe the digital health solutions implemented by Sanitas hospitals, a health insurance company with around 2 million costumers, 5 teaching hospitals and many outpatient health care facilities throughout Spain, to maintain continuity of care during COVID-19 pandemic. We outline the results of using the Sanitas telemedicine platform (video consultations and Connected Health application) and chatbot. 

Results: During the first 2 months of the COVID-19 outbreak, we have experienced an exponential increase in the number of video consultations, coming from an average of 300 a day before the COVID-19 crisis to around 5000 a day, going from 27.058 virtual visits made during 2019, to 114.598 in the first 5 months of 2020. The Connected Health mobile phone application allowed to remote monitoring 95 patients after hospital discharge for COVID-19 infection, measuring vital signs with a connected pulse oximeter, answer health questionnaires daily, and alert the medical team who received alerts for pain from 80% of patients and a decrease in oxygen saturation in 12% of cases. Bots has also helped to fight the COVID-19 crisis, making information available by providing the best answer to patients whenever they want it 24/7. Our bot SanIA has experienced 16.858 consultations about COVID-19 during the first 2 months of the outbreak.

 Conclusions: Digital health, throughout video consultations, telemonitoring platform and bots, has helped to maintain continuity of care during the COVID-19 crisis. The COVID-19 pandemic has brought a sudden change in the adoption of digital health strategies, which will undoubtedly continue in the long term, and has served us, both health staff and the population, to be better prepared for this next digital age.

 X.Cid1, C. Royse 1,2,3, A. Wang 1, D. Canty1,4, L. Bridgford1, A. Denault5,6,D. El-Ansary7, X. Hu8, X. Li9, A. Royse1,10.

  1. Department of Surgery, The University of Melbourne, Melbourne, Australia
  2. Department of Anesthesia and Pain, Royal Melbourne Hospital
  3. Outcomes Research Consortium, Cleveland Clinic, Cleveland, USA
  4. Department of Medicine, Monash University, Melbourne, Australia
  5. Division of Critical Care, Centre Hospitalier de l ́Université de Montréal, Montreal, Quebec, Canada.
  6. Department of Anesthesiology and Critical Care Division, Montreal Heart Institute.
  7. Swinburne University of Technology, Melbourne, Australia.
  8. Department of Critical Care Medicine, Shandong Provincial Hospital affiliated to Shandong First Medical University Shandong, China.
  9. Department of Anesthesiology West China Hospital, China.
  10. Department of Surgery, the Royal Melbourne Hospital, Melbourne, Australia

Abstract

In the context of the coronavirus disease 2019 (COVID-19) pandemic, lung ultrasound has emerged as an accurate and reliable alternative for assessment of lung pathology.

The main lung ultrasound findings in COVID-19 patients are interstitial syndrome, irregular and broken aspect of the pleural line, and sub-pleural consolidation. Consolidations are usually a late finding appearing during the second week since symptoms onset.

Translating into the practice, lung ultrasound can improve diagnostic accuracy and contribute with relevant information to the triage of these patients. It can be used as part of the routinely assessment of patients admitted to the medical ward allowing early identification of disease progression. Among patients mechanically ventilated, it is useful evaluating response to prone position and/or recruiting maneuvers. Finally, in all the previous scenarios, lung ultrasound may also detect common complications seen in these patients such as cardiogenic pulmonary edema and pulmonary embolism.

In this review, we have summarized the information available and suggest simple algorithm to incorporate lung ultrasound into the assessment of COVID-19 patients.

Tristan M. Sissung1,  William D. Figg1

1.Clinical Pharmacology Program, Office of the Clinical Director, National Cancer Institute, Bethesda, MD

Abstract

The term “quack” has always been synonymous with shouting about one’s dubious medical remedies in the public marketplace; however, modern quacks amplify their aggressive and deceptive advertising campaigns worldwide using social media and internet-based mechanisms. While many in the United States have suffered significant illness and economic hardship as the result of the COVID-19 pandemic, purveyors of pseudoscientific therapies have enriched themselves. The United States Food and Drug Administration has taken steps to mitigate the claims of over 65 individuals or companies claiming to prevent or treat SARS-CoV2, but this effort has been eclipsed by the sheer number of individuals who continue to surface and exploit public credulity. Moreover, those selling the same types of products and making the same types of claims received FDA warning letters during previous public health crises. The majority of letter recipients were selling products in five categories: colloidal silver, cannabis or related products, essential oils, vitamins, and minerals. Those in the rapidly expanding self-care industry will continue to spread medical caveat emptor both now and during the next pandemic unless the medical community begins directly opposing the normalization of unproven and misleading advertising claims.

Jaime Berumen, MD1, Max J.Schmulson2, Guadalupe Guerrero3, Еlizabeth Barrera1, Jorge Larriva-Sahd4, Gustavo Olaiz5, Rebeca García -Leyva1, Rosa María Wong-Chew6, Miguel Betancourt Cravioto7, Hector Gallardo7, Germán Fajardo-Dolci8, Roberto Tapia-Conyer7

1.Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México(UNAM), Mexico City, Mexico.

2.Laboratorio de Hígado, Páncreas y Motilidad (HIPAM)- Unidad de Investigación en Medicina Experimental, Facultad de Medicina-

Universidad Nacional Autónoma de México (UNAM).

3.Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico.

4Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Querétaro Mexico

5.Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.

6.División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico

7.Fundación Carlos Slim, Mexico City, Mexico

8.Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico

Abstract

Aims. To analyze the role of temperature, humidity, date of first case diagnosed (DFC) and behavior of the growth-curve of cumulative frequency (CF) [number of days to rise (DCS) and reach the first 100 cases (D100), and the difference between them (ΔDD)] with the doubling time (Td) of COVID-19 cases in 67 countries grouped by climate zone.

Methods. Retrospective study based on the WHO registry of cumulative incidence of COVID-19 cases. 1,706,914 subjects diagnosed between 12-29-2019 and 4-15-2020 were analyzed based on exposure to SARS-CoV-2 virus, ambient humidity, temperature, and climate areas (temperate, tropical/subtropical). DCS, D100, ΔDD, DFC, humidity, temperature, Td for the first (Td10) and second (Td20) ten days of the CF growth-curve between countries and were compared according to climate zone, and identification of factors involved in Td, as well as predictors of  CF using lineal regression models.

Results. Td10 and Td20 were ≥3 days longer in tropical/subtropical vs. temperate areas (2.8±1.2 vs. 5.7±3.4; p=1.41E-05 and 4.6±1.8 vs. 8.6±4.2; p=9.7E-05, respectively). The factors involved in Td10 (DFC and ΔDD) were different than those in Td20 (Td10 and climate areas). After D100, the fastest growth-curves during the first 10 days, were associated with Td10<2 and Td10<3 in temperate and tropical/subtropical countries, respectively. The fold change Td20/Td10 >2 was associated with earlier flattening of the growth-curve. In multivariate models, Td10, DFC and ambient temperature were negatively related with CF and explained 44.7% (r2 = 0.447) of CF variability at day 20 of the growth-curve, while Td20 and DFC were negatively related with CF and explained 63.8% (r2 = 0.638) of CF variability towards day 30 of the growth-curve.

Conclusions. Larger Td in tropical/subtropical countries is positively related to DFC and temperature. Td and environmental factors explain up to 64% of CF variability. However, pandemic containment measures may explain the remaining variability.

Soo Ji Seo1, Ronny Priefer1

Abstract

Since the very first medical use of dexamethasone (DEX) in 1958, this glucocorticoid (GC) has been widely used in various clinical applications. Compared to other GCs, DEX is highly potent and comes in multiple formulations for ease of local and systemic administrations. Recently, DEX has a new application for treating COVID-19 patients. DEX mainly inhibits expressions of inflammatory proteins and transcription factors necessarily for cell proliferation. DEX can both upregulate and downregulate expressions of the genes that facilitates anti- inflammatory effects and immunosuppression. Key proteins involved in DEX pathways are NF- B, AP-1, COX-2, and annexin A1. When used appropriately, DEX can minimize inflammatory pain and damage but it can also delay patient recovery by immunosuppression. Due to this duality, DEX should be used with caution for treatment considerations. Long-term systemic use could lead to debilitating adverse reactions and firm recommendations should be established in treating both acute and chronic disease with DEX.

ARTICLES

Annekathryn Goodman
 

Abstract

N/A

Ben J.M.Ale 1, Des N.D. Hartford2 , David H. Slater3

1.Technical University Delft, PO Box 5015, 2600 GA Delft, Netherlands

2.BC Hydro, 6911 Southpoint Drive, Burnaby, BC, V3N 4X8, Canada

3.BC Hydro, 6911 Southpoint Drive, Burnaby, BC, V3N 4X8, Canada

Abstract

The scene for the COVID-19 crisis was set in the decades that preceded it. These decades can be characterized by increased profusion of market thinking in the care sector and by continuous but largely ignored warnings. International bodies and national institutes repeatedly warned that a worldwide influenza pandemic was very likely in the medium term and the potential consequences would be catastrophic. In risk management theories, resilience has become accepted as a new way of dealing with risks. By “engineering-in” resilience, it is argued that it is logical to expect that a system will be better equipped to absorb, resist and bounce back from adverse events. More recently though some have viewed resilience as an alternative to relying on precautionary risk management and it has obtained a more ominous meaning, supporting the idea that such precautionary measures are unnecessary and unjustified, given the opportunity costs of committing money for events that may not happen. As a result, the risks of a pandemic were accepted, in spite of the “science”, without any additional, specific, or noticeable precautions. But in a modern democracy “science” cannot prescribe political decisions. People are often inclined not to spend money on precaution, or prevention, and are more inclined to complain only after a risk has materialized in a disaster, or crisis. These are always value judgments at best and power broking at worst. Judgments are essentially subjective and the exercise of power is the ultimate political game. This may be hard to swallow for some in the “scientific” risk profession. The COVID 19 situation is moving fast. It changes even while we are writing this paper. Since our understanding of the coronavirus behavior, will determine to a certain extent any judgment on the way the risk is being dealt with, this paper reflects our current perception.

MJ Tladi1, LP TLadi2,SM Tladi3

1.Louis Pasteur Hospital, Pretoria, South Africa.

2.Sefako Makgatho Health Science University, Pretoria, South Africa

3.Medforum Mediclinic Hospital, Pr etoria, South Africa
 

Abstract

Cell phones are routinely used for various reasons when people are engaged in their daily activities. They play a key role in health care systems and health care workers frequently make use of these gadgets. Prevention of nosocomial infection is an integral part of health policies in order to prevent the high treatment costs. Although various micro-organisms have been found on these electronic devices from both health workers and patients, the majority of health care workers fail to decontaminate their cell phones. The world is now under attack by the Covid-19 virus that started in 2019. Many people have lost loved ones and the number of infections continues to rise globally. One of the preventive measures to combat the Covid-19 virus is through regular sanitization. However, non-health care people need to know how to sanitize their hands in order to have no micro-organisms. The aim of this brief manuscript is to highlight the importance of regular cell phone sanitization in the fight against the Covid-19 pandemic. 

Sarah Adelaide Crawford, Ph.D.

Abstract

Having recently made the evolutionary transition from bats to humans, the novel Coronavirus SARS-Cov-2 has single-handedly created a defining moment in human history as the world reluctantly embraces a new paradigm in which the devastating effects of rapidly emerging diseases underscore the fragility of human life. The purpose of this review is to take a broad-spectrum view of the challenges that lie ahead in defeating this ongoing pandemic. In the absence of a complete understanding of the SARS-CoV-2 virus and its pathogenic potential, the accomplishments of modern medicine in the molecular age, nevertheless, allow unprecedented insight into fine-tuned molecular mechanisms of infection and our increasing ability to monitor and assess this disease and its global consequences. This review attempts to define the virulence mechanisms and pathophysiological consequences of the SARS-Cov-2 virus that, based on our current understanding, will most likely respond to preventive and therapeutic approaches.

Chaibi Aicha, PharmD1,2, Mrani Alaoui Amal PharmD1,2, Lasri Fatima-Zahra, PharmD3, Abouqal Redouane, MD3, Madani Naoufel, MD3

1.Department of Clinical Pharmacy, Ibn Sina University Hospital Center, Rabat, Morocco

2.Laboratory of Medicinal Chimistry and Clinical Pharmacy, Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco

3.Acute medical unit of Ibn Sina University Hospital Center, Rabat, Morocco; Laboratory of Medicinal Chimistry and Clinical Pharmacy, Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco.

Abstract

In Morocco, the first case of a respiratory illness due to a new form of coronavirus, the SARS-CoV-2, was registered on the evening of March 1st according to the Ministry of Health.

As the pandemic threatened to develop, the Technical and Scientific Committee of the Ministry of Health decided to prescribe a combination of chloroquine/ hydroxychloroquine with azithromycin for all symptomatic patients confirmed COVID-19 in spite of the fact that the combination has not been approved for COVID-19 indication.

This off-label use exposes to an iatrogenic risk. The aim of this paper is to establish an integrated strategy for pharmaceutical care services which a focus on COVID-19 hospitalized patients (excluding patients in intensive care units) and Clinical Pharmacists, in order to improve COVID-19 patients’ outcome, reduce mortality and drug-related iatrogenia and facilitate pandemic control.

Clinical Pharmacists have played an important role in optimizing the management of COVID-19 patients within the hospital structure from the admission to the discharge of patients. Clinical Pharmacists participate in the therapeutic decision, manage drug Interactions and adjust therapy for special risk population and patients with combined underlying diseases. They also monitor and evaluate medication safety (Medication errors, drug interactions and adverse drug reactions). They have developed practical help sheets that constitute a reliable, and “easy to search” database.

During this crisis, Clinical Pharmacists have not only developed protocols and practical sheets but they have also been the guarantors of the rational use of drugs, providing medical advice to frontline medical staff, especially regarding off label drugs.

Castigliano M Bhamidipati1, DO PhD MSc,Alan Morasch, CAE Ben Morasch Jayne Mitchell, ANP Tamara Atkinson, MD Charles R Cannan, MBChB FACC Brian Gross, MD FACC Pasala Ravichandran, MBBS FACC Aly Rahimtoola, MD FACC Tyler Gluckman, MD FACC Scott Chadderdon, MD

 

Abstract

The Sars-Cov-2 (COVID-19) pandemic has created unprecedented challenges, and revamped the way we live and work. Overall, this pandemic and its isolating consequences has forced societies to become more creative and develop new ways to engage. Professionally, employees are more secluded with attempts to work from home, while in the medical community, physicians have needed to either be on the frontlines treating patients or have adapted to interacting with patients virtually. Even with today’s technological advances to virtually connect with patients, physicians have had to relearn and re-engage.

David L. Smalley, PhD1,3 , Patricia M. Cisarik, OD, PhD1,2

1.American Esoteric Laboratories, Memphis, Tennessee,

2.Southern College of Optometry, Memphis,Tennessee

3.University of Tennessee, Department of Pathology, Memphis, Tennessee

Abstract

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CASE REPORTS

Jayasree Sundar, MBBS, DGO, FRCOG1, Chanchal Singh, MD (ObGyn), MRCOG, FICOG2, Shivani Sabharwal, MBBS, PGDHHM, MBA (FMS)3, Neha Khandelwal, MBBS, MS (ObGyn)4, Naveen Prakash Gupta, MD (Paeds), DNB (Neonatology)5

1.Director and Head, Department of Obstetrics and Gynaecology Birthright, by Rainbow Hospitals, New Delhi, India.

2.Lead Consultant, Fetal Medicine Birthright, by Rainbow Hospitals, New Delhi, India.

3.Medical Director, Madhukar Rainbow Children’s Hospitals, New Delhi, India.

4.Senior Consultant, Dept of Obstetrics and Gynaecology Birthright, by Rainbow Hospitals, New Delhi, India.

5.Senor Consultant, Neonatology, Madhukar Rainbow Children’s Hospitals, New Delhi, India.

Abstract

Objective: The exponential rise in pregnant women infected with COVID19 mandates that more and more hospitals cater to infected women while continuing their routine work. The aim of this paper is to report on rapid adaptation of an existing perinatal facility to provide care for COVID-positive pregnant women while safeguarding routine care and suggest a workflow algorithm. There is still no consensus on routine testing of asymptomatic women requiring admission for delivery.

Case report: We report delivery of our first two COVID-positive women, one of whom was asymptomatic and found to be positive on testing prior to planned induction of labour.

Conclusion: It is imperative that hospitals provide a safe zone within an existing facility to optimise care of infected women and their newborns without affecting routine obstetric care. Routine testing of asymptomatic women at high-risk of infection may make triage and segregation easier and minimise spread of infection.