ABSTRACT
Objective: To determine the prevalence of anxiety and depression among the COVID-19 infected patients. Study design: Descriptive cross-sectional study. Place and Duration of Study: Rawalpindi Medical University and Allied Hospitals Covid designated wards from 1stApril 2019 and 30thJune 2020 Methodology: Hundred patients of either gender presented with Covid-19 infection were enrolled. Detailed demographics and complete medical examination was done after taking informed written consent. Those patients who fulfil the clinical criteria Hamilton rating scale for anxiety (HAMA) and Hamilton rating scale for depression (HRSD) were applied to assess the severity of anxiety and/or depression. Result(s): There were 69 (69%) males and 31 (31%) females. Eighty two (82%) patients fall in the age range of 21 to 50 years with the mean of 38 years. There is high level of anxiety as well as depression among admitted patients suffering from COVID-19. Seventy five (75%) patients suffered from depression and 72 (72%) of patients suffered from anxiety ranging from mild to severe. Conclusion(s): It is concluded that patients suffering from Covid-19 disease had high prevalence of depression and anxiety. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
ABSTRACT
The immune system is comprised of lymph glands, lymph nodes, thymus gland, spleen, bone marrow, lymphocytes, and molecules such as antibodies and cytokines. It has a vast array of functionally different cells such as T and B lymphocytes, macrophages, neutrophils and mast cells. The ontogenesis of the immune system is comprised of the innate immune cells and the adaptive immune cells, where innate immune cells are the first defense mechanisms to respond to pathogenic environmental factors. There are multiple components of the adaptive immune cells, including immunoglobulins (Igs), T-cell receptors (TCR), and major histocompatibility complex (MHC) responsible for adaptive immunity. However, many elements of both the innate and adaptive immune systems are conserved in our bodies. The adaptive immunity is a type of immunity that develops when a person’s immune cells respond to a pathogen such as microorganism or vaccination. Environmental factors such as pathogenic bacteria or viruses, solar exposure, age, exercise, stress, diet, sleep quality and air pollutants can influence the immune system. There may be marked decline in the immune function due to attack of COVID-19. Most patients with mild COVID-19 develop an appropriate immune response that culminates with viral clearance. However, severe disease manifestations have been linked to lymphopenia and immune hyper-responsiveness leading to cytokine storm. It has been observed that in COVID-19, alveolar macrophages are epigenetically altered after inflammation, leading to long-term lung immune-paralysis. Western diets are known to have adverse effects on the immune function. However, Mediterranean-type diets rich in short-and long-chain polyunsaturated fatty acids (PUFA), vegetables, nuts and fruits, dairy products and fish and red wine, due to high content of vitamins, minerals and flavonoids may be useful in boosting immunity. Moderate physical activity may also cause an extensive increase in numerous and varied lipid super-pathway metabolites, including oxidized derivatives called oxylipins. Emerging evidence suggests that dietary supplements containing flavonoids, carotenoids, coenzyme Q10 (CoQ10), vitamins, minerals and antioxidants modulate gene and protein expression and thereby modify endogenous metabolic pathways, and consequently enhance the immunity. Mediterranean-type diet and multiple bioactive nutrients, fatty acids, amino acids, vitamins and minerals as well as moderate physical activity may be crucial for enhancing immunomodulation.
ABSTRACT
ABSTRACT: The rapid spread of COVID-19 brought forth a rapid increase in hospitalization rates, requiring changes in hospital use and medical personnel structure. Physician assistants (PAs) and NPs in pediatric critical care were cross-trained and redeployed to our pediatric biocontainment unit to address the clinician strain in providing high-quality patient care during these unprecedented times. This manuscript discusses the effectiveness of using these clinicians while recognizing the challenges of managing a novel virus in a new unit.
Subject(s)
COVID-19 , Nurse Practitioners , Physician Assistants , Child , Critical Care , Humans , SARS-CoV-2ABSTRACT
Introduction Un centre de vaccination a été mis en place dans l’unité de consultation de pneumologie et d’oncologie thoracique;un COPIL avait lieu chaque semaine au cours duquel les allocations de doses étaient réparties entre les services volontaires et les indications à la vaccination des patients éligibles selon les DGS-urgent étaient réactualisées. Méthodes Étude épidémiologique observationnelle rétrospective des patients suivis dans le service de pneumologie et d’oncologie thoracique et vaccinés dans le secteur de consultation entre le 23/01/2021 et le 04/06/2021. Résultats 387 patients (208 hommes et 179 femmes), âgés en moyenne de 63 ans (18–92) ont été vaccinés. 259 patients (66,5 %) avaient une pathologie tumorale thoracique. 204 patients (52,4 %) étaient sous un traitement actif (n=164 sous chimiothérapie ±immunothérapie, n=14 avaient une chirurgie thoracique, n=13 sous inhibiteur de tyrosine kinase, n=10 en cours de radiothérapie et n=3 sous immunosuppresseur). Au total, 196 doses de VAXZEVRIA et 512 doses de COMIRNATY ont été administrées. Aucun effet secondaire inattendu ou de grade 3–4 imputables au vaccin n’a été observé. 18 patients avaient eu une infection COVID19 avant la première dose (d1). Au cours du suivi, 9 patients (2,3 %) ont eu une infection COVID19 entre d1 et la seconde dose (d2). Aucun cas de COVID19 n’a été observé après d2. Parmi les 9 patients infectés par le COVID19, 3 ont été hospitalisés dont 1 est décédé du COVID19 et 6 ont eu une forme pauci symptomatique. Au cours du suivi, il y a eu au total 22 décès (16 liés au cancer, 3 liés à la pathologie chronique de fond, 2 par rupture d’anévrysme cérébral, 1 par COVID19). Conclusion Les vaccins VAXZEVRIA et COMIRNATY ont été très bien tolérés et très efficaces sur la cohorte de pneumologie et d’oncologie thoracique en association aux autres mesures barrières. La reconnaissance des patients était élevée. La mise en œuvre de la vaccination dans l’unité a été fédérateur et valorisant pour l’équipe soignante et a permis également d’améliorer la communication sur le vaccin et de lever des réticences.
ABSTRACT
Millions persons around the world are being associated with serious respiratory distress syndrome coronavirus-2 recognized as COVID-2 (SARS-CoV-2). Vitamin D deficiency also increased the chance COVID-19infections. Vitamin D works in the large number of functions for the human body alongside respiratory and immune system. Vitamin D does a significant mission in the advancement of COVID-19 infectious disease through immune responses involving HLA-DR, CD38, CD8, and CD4. Vitamin D intake in people with HIV/AIDS can help lower inflammatory responses, stimulate cognitive func-tions, and lead to increased immunity against contagious diseases. As Vitamin D income rises, it will decrease the risk of illness with the COVID-19 virus. Vitamin D can lessen the chance of infection as a re-sult of SARS-CoV-2. Individuals at stake of influenza and/or COVID-19 are recommended to consume 10,000 IU/d of vitamin D3 daily within two weeks to maximize vitamin D concentrations immediately preceded by 5,000 IU/d of vitamin D daily, in order to maintain hygiene purposes. Vitamin D consump-tion may help elderly who are extremely limited in vitamin D. In this essay, the communication among both Vitamin D and COVID-19 is discussed.
ABSTRACT
The world is currently facing a frightening coronavirus disease-2019 (COVID-19) epidemic. Severity of COVID-19 presentation is highly variable among infected individuals with increasingly recognized risk factors. Although observational studies suggested lower COVID-19 severity in populations consuming fermented foods, no controlled study investigated the role of diet. Yogurt, a fermented dairy product, exhibits interesting properties related to the presence of bioactive peptides and probiotics that may play a beneficial role in COVID-19 presentation and outcome. Peptides contained in yogurt are responsible for angiotensin-converting enzyme-inhibitory, bradykinin potentiating, antiviral, anti-inflammatory, antithrombotic, and antioxidant effects. The types and activity of these peptides vary widely depending on their amino acid sequence, on the probiotics used in yogurt production and on intestinal digestion. Additionally, probiotics used in yogurt exhibit direct angiotensin-converting enzyme-inhibitory, antiviral and immune boosting activities. Since COVID-19 pathogenesis involves angiotensin II accumulation and bradykinin deficiency, yogurt bioactive peptides appear as potentially beneficial. Therefore, epidemiological investigations and randomized controlled clinical trials to evaluate the exact role of yogurt consumption on COVID-19 manifestations and outcome should be encouraged.
ABSTRACT
Hypozincemia is prevalent in severe acute respiratory syndrome coronavirus-2 (SARS-COV-2)-infected patients and has been considered as a risk factor in severe coronavirus disease-2019 (COVID-19). Whereas zinc might affect SARS-COV-2 replication and cell entry, the link between zinc deficiency and COVID-19 severity could also be attributed to the effects of COVID-19 on the body metabolism and immune response. Zinc deficiency is more prevalent in the elderly and patients with underlying chronic diseases, with established deleterious consequences such as the increased risk of respiratory infection. We reviewed the expected effects of zinc deficiency on COVID-19-related pathophysiological mechanisms focusing on both the renin-angiotensin and kinin-kallikrein systems. Mechanisms and effects were extrapolated from the available scientific literature. Zinc deficiency alters angiotensin-converting enzyme-2 (ACE2) function, leading to the accumulation of angiotensin II, des-Arg9-bradykinin and Lys-des-Arg9-bradykinin, which results in an exaggerated pro-inflammatory response, vasoconstriction and pro-thrombotic effects. Additionally, zinc deficiency blocks the activation of the plasma contact system, a protease cascade initiated by factor VII activation. Suggested mechanisms include the inhibition of Factor XII activation and limitation of high-molecular-weight kininogen, prekallikrein and Factor XII to bind to endothelial cells. The subsequent accumulation of Factor XII and deficiency in bradykinin are responsible for increased production of inflammatory mediators and marked hypercoagulability, as typically observed in COVID-19 patients. To conclude, zinc deficiency may affect both the renin-angiotensin and kinin-kallikrein systems, leading to the exaggerated inflammatory manifestations characteristic of severe COVID-19.
ABSTRACT
The coronavirus 2 (SARS-CoV-2) induces severe acute respiratory distress syndrome (ARDS)via the coronavirus receptor angiotensin-converting enzyme 2 (ACE2) in the host cell to facilitate entry into the lungs Over activation of the renin-angiotensin system (RAS) and the down regulation of ACE2 expression are involved in SARS-CoV induced lung injury. RAS is the main system that has a regulatory roleinmaintaining electrolyte balance, blood pressure, vascular tone and cardiovascular remodeling in the body. Angiotensin II receptor blockers (ARBs) and Inhibitors (ACEIs) are vital medications that are widely used for the treatment of cardiovascular diseases (CVDs). The question which now arises is: It is possible to continue using either ARBs or ACEIsor both medications in patients with SARS-CoV2? Both ARBs and ACEIs can facilitate COVID-19 entry into the host cell due to increase expression of ACE2. On the other hand, ARBs have a greater potential to reduce downstream pathogenicity of the SARS-CoV2 via different cell signaling pathways including free radical generation, up regulation of NF-κB pathway, toll-like receptors (TLRs) and pro-apoptotic protein by blocking the renin-angiotensin system more severely compared to the effect of ACEIs. The current hypothesis is that ARBs can perform better therapeutically compared to ACEIs in respiratory disorders such as ARDS which is induced by viral infection especially since more than 40 % of angiotensin II can be synthesized by other enzymes such as chymase, cathepsin. ARBs treatment can increase the levels of both angiotensin II (Ang II) and the ACE2 enzyme making Ang II a target substrate for hydrolysis by ACE2 into Ang 1-7 which in turn exerts anti-inflammatory, anti-apoptotic and anti-oxidant activities. These effects are achieved by the binding of Ang 1-7 to both angiotensin-type 2 receptor (AT2) and receptor mas' axis (Mas) and also by its ability to block Ang II/AT1 receptor-induced TLR4/MyD88 signaling thereby highlighting the potential therapeutic use of ARB sin preventing injury induced by COVID-19 virus. It is concluded that patients who are already on ARBs medications must continue to use them daily since ARBs have protective effects against COVID-19 virus. Moreover, ARB sexert their beneficial effects via their anti-inflammatory, anti-apoptotic, anti-oxidant and anti-fibrotic properties. On the other hand, those patients who are on ACEIs medications must change to other safe drugs since ACEIs can facilitate an increase in COVID-19 virus entry into the body as well as reducing levels and protecting effect of Ang 1-7. © 2020 Ubiquity Press. All rights reserved.
ABSTRACT
Remote monitoring has been a boon to the clinical research industry for a few years. According to ICH_GCP, the monitoring of the ongoing trails is the responsibility of the sponsor. The monitoring of the trials has become quite easy for CRA (a person appointed by the sponsor to monitor the ongoing trials) due to the evolution of the remote monitoring or centralized monitoring. The remote monitoring mainly reduces the time for preparation of the final reports of trails, thereby enhancing the work to be done on time. Majorly, it reduces the travel expenses for the sponsor. Remote monitoring is one of the innovative methods which can be used for the production of quality data and maintain the work-life balance of monitors. It involves the verification of the site documents from the remote place and should be electronically certified copies. Due to the unfolding COVID-19 pandemic, clinical trial sites and sponsors are facing circumstances that are decreasing potential of clinical research. With many monitors restricted from travel, sites and sponsors are reassessing ways to share information and collaborate virtually. As a result, sites and sponsors are exploring the potential of remote monitoring solutions. COVID-19 ramifications on clinical trial conduct continue to evolve at an astounding pace, requiring rapid adaptation, mitigation, and innovation. I believe the most valuable way to start that journey is by working together to forge ahead.