The interplay between lncRNAs, RNA-binding proteins and viral genome during SARS-CoV-2 infection reveals strong connections with regulatory events involved in RNA metabolism and immune response.

Rationale: Viral infections are complex processes based on an intricate network of molecular interactions. The infectious agent hijacks components of the cellular machinery for its profit, circumventing the natural defense mechanisms triggered by the infected cell. The successful completion of the replicative viral cycle within a cell depends on the function of viral components versus the cellular defenses. Non-coding RNAs (ncRNAs) are important cellular modulators, either promoting or preventing the progression of viral infections. Among these ncRNAs, the long non-coding RNA (lncRNA) family is especially relevant due to their intrinsic functional properties and ubiquitous biological roles. Specific lncRNAs have been recently characterized as modulators of the cellular response during infection of human host cells by single stranded RNA viruses. However, the role of host lncRNAs in the infection by human RNA coronaviruses such as SARS-CoV-2 remains uncharacterized. Methods: In the present work, we have performed a transcriptomic study of a cohort of patients with different SARS-CoV-2 viral load and analyzed the involvement of lncRNAs in supporting regulatory networks based on their interaction with RNA-binding proteins (RBPs). Results: Our results revealed the existence of a SARS-CoV-2 infection-dependent pattern of transcriptional up-regulation in which specific lncRNAs are an integral component. To determine the role of these lncRNAs, we performed a functional correlation analysis complemented with the study of the validated interactions between lncRNAs and RBPs. This combination of in silico functional association studies and experimental evidence allowed us to identify a lncRNA signature composed of six elements - NRIR, BISPR, MIR155HG, FMR1-IT1, USP30-AS1, and U62317.2 - associated with the regulation of SARS-CoV-2 infection. Conclusions: We propose a competition mechanism between the viral RNA genome and the regulatory lncRNAs in the sequestering of specific RBPs that modulates the interferon response and the regulation of RNA surveillance by nonsense-mediated decay (NMD).

An evaluation of liver function tests in severe acute respiratory syndrome - Corona virus 2 (SARS-CoV-2) infection in the backdrop of chronic kidney disease.

Background: The SARS-CoV-2 pandemic has emerged as the most challenging global health problem of this century. The concomitant presence of co-morbidities like chronic kidney disease (CKD), diabetes, CHD, further complicates the problem. Aim: To assess the patterns of LFT abnormalities in patients of SARS-CoV-2 infection with and without CKD and evaluate the probable outcomes. Materials and Methods: A cross-sectional retrospective observational study done on 600 patient samples (Group 1: SARS-CoV-2 without CKD, Group 2: SARS-CoV-2 with CKD and Group 3: CKD uninfected with SARS-CoV-2) which were processed for LFT and KFT. Results: AST and ALT were significantly higher in all SARS-CoV-2 infected; Group 1 mean ± 2SD, (63.63 ± 42.89U/L & 50.25 ± 46.53U/L), group 2 (90.59 ± 62.51U/L & 72.09 ± 67.24 U/L) as compared to Group 3 (25.24 ± 7.47U/L & 24.93 ± 11.44U/L). A statistically significant elevation is seen in these two parameters in Group 2 as compared to Group 1. There was a negative significant correlation between eGFR and AST/ALT levels in Group 1 (p < 0.05). In Group 2, a weak positive correlation was seen with ALT. Group 3, eGFR's showed strong correlations with AST and ALT levels; reduction in kidney function correlated well with increase in serum ALP levels. Conclusions: This study establishes that SARS-CoV-2 infected, with CKD, show higher elevations in serum aminotransferase levels in comparison to those without CKD. In contrast, the CKD group not infected, shows a decline in serum aminotransferase levels. Serum ALT values in SARS-CoV-2 show significant correlation with eGFR. Also, elevated ALP values in CKD patients may be used as an indicator of declining kidney function.

Perioperative Obstetric Care in Coronavirus Infectious Disease 2019: Anesthetic Perspective.

BACKGROUND: The novel coronavirus infectious disease-2019 (COVID-19) is a global pandemic involving many countries and has affected more than seventy-nine million people worldwide, with greater than a million deaths in the current scenario. AIMS: The aim of the study is to improvise perioperative obstetric healthcare in a tertiary healthcare center. SETTINGS AND DESIGN: This is a retrospective case series of parturients infected with COVID-19. MATERIALS AND METHODS: We present a case series of COVID-19-infected parturients. There is no evidence that pregnant women are more likely to become seriously affected by coronavirus, yet these groups of patients are vulnerable to infection. Hence, the objectives in the management of such patients which includes caring for the range of the asymptomatic to critically ill women in the peripartum period and protection of healthcare providers from exposure to the disease while treating them while treating them is of paramount importance. RESULTS: There is limited literature available about the effect of this disease and the risk of complications in pregnancy. The variables affect the respiratory system and exacerbate the susceptibility to infections. This complicates or delays the diagnosis in COVID-19-infected parturients, which affect their clinical outcome. Thus, there is a need on focused and optimal management in a tertiary healthcare center. Of the total 109 lower segment cesarean section patients in our hospital, there were only two maternal and neonatal deaths among the 12 emergency cases performed. CONCLUSIONS: Collaborative efforts are imperative among experts such as anesthesiologists and obstetricians to tackle the impact of this disease. There must be surveillance systems in place for reporting maternal and fetal data during this pandemic.

Reinventing Medical education in the COVID-19 era

Since the beginning of the year 2020, COVID-19 pandemic has engulfed the whole world. Many cities across the globe have been under lockdown during this outbreak and the regular classes, clinical, laboratory sessions have been suspended in most medical schools. In the midst of this pandemic, we have had to reinvent the pedagogy of undergraduate medical teaching. The ongoing crisis has motivated medical teachers to come up with a contingency plan for continuing training in the face of adversary. As in-person training had to be avoided, the traditional methods of teaching like didactic lectures, tutorials, case discussions and practical laboratory sessions were of no value in the midst of this pandemic. This led the educationists to explore e-learning resources in order to carry on the medical school training program. There are several challenges in designing a successful e-learning program. Medical institutions must identify sustainable e-learning solutions specially in resource-constrained settings. This perspective article discusses how medical education has been affected by COVID-19 around the world and how it has made educators rethink their teaching strategy. The paradigm shift to e-learning during this outbreak may encourage medical schools to revisit and redesign their curriculum to more versatile programs in future. The experiences gathered during this period might bring about groundbreaking changes in how medicine is taught. [ABSTRACT FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

COVID-19 Testing.

OBJECTIVES: To illustrate how patient risk and clinical costs are driven by false-positive and false-negative results. METHODS: Molecular, antigen, and antibody testing are the mainstay to identify infected patients and fight the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To evaluate the test methods, sensitivity (percent positive agreement [PPA]) and specificity (percent negative agreement [PNA]) are the most common metrics utilized, followed by the positive and negative predictive value-the probability that a positive or negative test result represents a true positive or negative patient. The number, probability, and cost of false results are driven by combinations of prevalence, PPA, and PNA of the individual test selected by the laboratory. RESULTS: Molecular and antigen tests that detect the presence of the virus are relevant in the acute phase only. Serologic assays detect antibodies to SARS-CoV-2 in the recovering and recovered phase. Each testing methodology has its advantages and disadvantages. CONCLUSIONS: We demonstrate the value of reporting probability of false-positive results, probability of false-negative results, and costs to patients and health care. These risk metrics can be calculated from the risk drivers of PPA and PNA combined with estimates of prevalence, cost, and Reff number (people infected by 1 positive SARS-CoV-2 carrier).

Pre-analytical, analytical, and post-analytical considerations while processing samples of COVID-19 patients: Perspective from a clinical chemistry laboratory in India

Background: Since its detection in December 2019 in the city of Wuhan, China, the COVID-19 pandemic has grappled the world. Laboratories have been central in the diagnosis, prognosis and therapeutic monitoring of COVID-19 patients. With this pandemic spreading, laboratory personnel have become vital in the efforts to halt the advance of the virus. Aims and Objective: In this article, we will address various concerns in all the three phases of testing of the COVID-19 blood and serum samples in a clinical chemistry laboratory and discuss the issues pertaining to a resource-limited setting. Materials and Methods: International, national and regional guidelines on bio-safety and operational management available at the time of preparation of this manuscript were analyzed. Additionally, literature search through PubMed was done on the keywords “bio-safety”, “pre-analytical”, “analytical”, “post-analytical” and “COVID-19”. Results: The pre-analytical, analytical, post analytical, general management problems we faced in our laboratory and the best practices that we followed to address the same has been included in this paper. Conclusion: Some unprecedented challenges the laboratories have encountered during this outbreak are maintaining the lab safety of highest standards, management of human resource while sustaining the quality of testing. Laboratories will have to constantly innovate in order to meet the demands of this outbreak.