Association between gastrointestinal cytomegalovirus infection and COVID-19 infection

BackgroundCoronavirus disease 2019 (COVID-19), which was first reported in Wuhan City, China, is a major public health burden worldwide. Systemic corticosteroid therapy is an effective treatment for severe COVID-19 with ARDS. It ameliorates COVID-19-induced cytokine storm and improves patient outcomes;however, it can trigger immunosuppression, which causes a myriad of secondary infections.MethodsFifteen patients suffering from gastrointestinal complaints during COVID-19 related illness underwent gastroscopic/colonoscopic examination.ResultsWe report 15 cases of gastrointestinal (GI) Cytomegalovirus (CMV) infection diagnosed on biopsy. The mean age at diagnosis was 57 years;13 were males and 2 were females. The most common presentation was bleeding per rectum in 12 patients, dysphagia in 2 patients and abdominal pain in 1 patient. The most common site was the colon seen in 10 patients, 1 patient had Ileo-caecal valve involvement, and 2 each had gastric and esophageal involvement. Among colonic involvement, 2 patients had pan-colonic involvement. Out of 15 patients, 9 patients had either past history of steroid intake or ongoing intake for COVID-19 associated lung injury. Nine patients were diabetic, and 2 were suffering from chronic liver disease.ConclusionsImmunosuppressive state inhibits the activity of crucial transcriptional regulators of proinflammatory genes and reducing lymphocyte levels. Therefore, exposure to systemic corticosteroids can be a risk factor for CMV infection in patients with severe COVID-19.

Recent Trends in AI-Based Intelligent Sensing

In recent years, intelligent sensing has gained significant attention because of its autonomous decision-making ability to solve complex problems. Today, smart sensors complement and enhance the capabilities of human beings and have been widely embraced in numerous application areas. Artificial intelligence (AI) has made astounding growth in domains of natural language processing, machine learning (ML), and computer vision. The methods based on AI enable a computer to learn and monitor activities by sensing the source of information in a real-time environment. The combination of these two technologies provides a promising solution in intelligent sensing. This survey provides a comprehensive summary of recent research on AI-based algorithms for intelligent sensing. This work also presents a comparative analysis of algorithms, models, influential parameters, available datasets, applications and projects in the area of intelligent sensing. Furthermore, we present a taxonomy of AI models along with the cutting edge approaches. Finally, we highlight challenges and open issues, followed by the future research directions pertaining to this exciting and fast-moving field.

India's food system in the time of COVID-19

India's complete lockdown has caused unnecessary disruptions in the food supply chain, with the scarcity of labour making it even worse. A sharp decline in demand is imminent with the financial sector being in a freeze and incomes having shrunk for everyone, except for the small salaried class. Consumer sentiment and business outlook on recovery are bleak. While ensuring the free movement of essential goods and availability and safety of labour can mitigate the immediate disruptions in the supply chain, unclogging the financial sector and restoring optimism in the market will take time and heroic efforts from the government.

Overview of Early Cases of Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Centre in North India

Introduction: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. Materials and Methods: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March-4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. Results,: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32 degrees A 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. Conclusion: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease.

In silico multi-epitope vaccine against covid19 showing effective interaction with HLA-B*15:03 (preprint)

The recent outbreak of severe acute respiratory syndrome (SARS) coronavirus (CoV)-2 (SARS-CoV-2) causing coronavirus disease (covid19) has posed a great threat to human health. Previous outbreaks of SARS-CoV and Middle East respiratory Syndrome CoV (MERS-CoV) from the same CoV family had posed similar threat to human health and economic growth. To date, not even a single drug specific to any of these CoVs has been developed nor any anti-viral vaccine is available for the treatment of diseases caused by CoVs. Subunits present in spike glycoproteins of SARS-CoV and SARS-CoV-2 are involved in binding to human ACE2 Receptor which is the primary method of viral invasion. As it has been observed in the previous studies that there are very minor differences in the spike glycoproteins of SARS-CoV and SARS-CoV-2. SARS-CoV-2 has an additional furin cleavage site that makes it different from SARS-CoV (Walls et al., 2020). In this study, we have analyzed spike glycoproteins of SARS-CoV-2 and SARS-CoV phylogenetically and subjected them to selection pressure analysis. Selection pressure analysis has revealed some important sites in SARS-CoV-2 and SARS-CoV spike glycoproteins that might be involved in their pathogenicity. Further, we have developed a potential multi-epitope vaccine candidate against SARS-CoV-2 by analyzing its interactions with HLA-B*15:03 subtype. This vaccine consists of multiple T-helper (TH) cells, B-cells, and Cytotoxic T-cells (CTL) epitopes joined by linkers and an adjuvant to increase its immunogenicity. Conservation of selected epitopes in SARS, MERS, and human hosts, suggests that the designed vaccine could provide cross-protection. The vaccine is designed in silico by following a reverse vaccinology method acknowledging its antigenicity, immunogenicity, toxicity, and allergenicity. The vaccine candidate that we have designed as a result of this work shows promising result indicating its potential capability of simulating an immune response.

Association of Renin Angiotensin System Blockers with Outcomes in Patients with Covid-19: A Systematic Review and Meta-analysis (preprint)

Background: Patients with cardiovascular disease are at increased risk of critical illness and mortality from Covid-19 disease. Conflicting findings have raised concerns regarding the association of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) use with likelihood or severity of infection during this pandemic. Objective: To study the cumulative evidence for association of ACEI/ARB use with outcomes among patients with confirmed Covid-19. Methods: The MEDLINE and EMBASE databases were thoroughly searched from November 01, 2019 to May 15, 2020 for studies reporting on outcomes based on ACEI/ARB use in patients with confirmed Covid-19. Preferred reporting items for systematic review and meta-analysis guidelines were used for the present study. Relevant data was collected and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects model. Main Outcome measures: In-hospital mortality was the primary end of interest. Second end-point was severe or critical illness defined as either need for intensive care unit, invasive mechanical ventilation, or mortality. Results: Fifteen studies with total of 23,822 patients (N ACEI/ARB=6,650) were included in the present analysis. Overall, prevalence of ACEI/ARB use ranged from 7.7% to 46.2% across studies. Among 10 studies, patients using ACEI/ARB had similar odds of mortality [OR 1.03 (0.69-1.55)] and severe or critical illness [1.18 (0.91-1.54)] compared to those not on ACEI/ARB. In an analysis restricted to patients with hypertension, ACEI/ARB use was associated with significantly lower mortality [0.64 (0.45-0.89)], while the odds of severe/critical illness [0.76(0.52-1.12); p=0.16] remained non-significant compared with non-ACEI/ARB users. Conclusion: There is no evidence for increased risk of severe illness or mortality in patients using ACEI/ARB compared with non-users. In patients with hypertension, ACE/ARB use might be associated with reduced mortality, however these findings need to be confirmed in prospective randomized controlled trials.

Computational Search for Potential COVID-19 Drugs from FDA-Approved Drugs and Small Molecules of Natural Origin Identifies Several Anti-Virals and Plant Products (preprint)

The world is facing COVID-19 pandemic at the present time, for which mild symptoms include fever and dry cough. In severe cases it could lead to pneumonia and ultimately death in some instances. The pathogen, SARS-CoV-2, is one of the human coronaviruses which was identified to infect humans first in December 2019. We have interrogated the capacity to repurpose around 2300 FDA-approved drugs and more than 300,000 small molecules of natural origin towards drug identification through virtual screening and molecular dynamics. Interestingly, we observed simple molecules like lactose, previously known anti-virals and few secondary metabolites of plants as promising hits.

COVID-19 and radiologist: Image wisely

On March 11, 2020, coronavirus disease-2019 (COVID-19) was announced as a pandemic by the World Health Organization (WHO). The WHO urged for international action and co-operation in the following key areas: adequate preparation and readiness;detection, protection, and treatment;reducing transmission;and innovation and learning. As this disease has caused a significant impact on our lives, the health-care workers are the worst hit, both mentally and physically. In such hours of crisis where this pandemic is spreading rapidly, our role is to prudently use the health resources and relieve any extra burden on the health-care workers. This article reviews the role of imaging in the management of COVID-19 and also discusses the recommendations and guidelines for judicious use of imaging.