ABSTRACT
In the COVID-19 Era, multilobe ground-glass opacities (GGOs) and septal thickening on chest Computed Tomography (CT) have been recognized as a radiological finding highly suggestive for SARS-CoV-2 pneumonia. However, these findings can be misleading. Here, we report about an 81-year-old woman, evaluated in the Emergency Room (ER) for a traumatic hip fracture, who, despite negative molecular testing on the nasopharyngeal sample for SARS-CoV-2, was admitted to a COVID-Unit because of flu-like symptoms with GGOs and interlobular septal thickening on the chest CT. During the hospital stay, focusing on the patient’s medical history, the interstitial lung disease was defined to be a chronic complication of long-term use of Amiodarone and rheumatoid arthritis. Therefore, especially during SARS global pandemic, CT pathological findings suggestive for interstitial pneumopathy should be critically analyzed considering patient history. They can reflect, in fact, other pathological conditions different from SARS-CoV-2 infection as other viral and non-viral infections or chronic inflammatory diseases. © by Società Italiana di Gerontologia e Geriatria (SIGG).
ABSTRACT
Despite being the target of extensive research efforts due to the COVID-19 (coronavirus disease 2019) pandemic, relatively little is known about the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication within cells. We investigate and characterize the tightly orchestrated virus assembly by visualizing the spatiotemporal dynamics of the four structural SARS-CoV-2 proteins at high resolution. The nucleoprotein is expressed first and accumulates around folded endoplasmic reticulum (ER) membranes in convoluted layers that contain viral RNA replication foci. We find that, of the three transmembrane proteins, the membrane protein appears at the Golgi apparatus/ER-to-Golgi intermediate compartment before the spike and envelope proteins. Relocation of a lysosome marker toward the assembly compartment and its detection in transport vesicles of viral proteins confirm an important role of lysosomes in SARS-CoV-2 egress. These data provide insights into the spatiotemporal regulation of SARS-CoV-2 assembly and refine the current understanding of SARS-CoV-2 replication.
ABSTRACT
BACKGROUND: Sarcopenia was reported to be associated with poor clinical outcome, higher incidence of community-acquired pneumonia, increased risk of infections and reduced survival in different clinical settings. The aim of our work is to evaluate the prognostic role of sarcopenia in patients with the 2019 novel coronavirus disease (COVID-19). MATERIALS AND METHODS: 272 COVID-19 patients admitted to the University Hospital of Modena (Italy) from February 2020 to January 2021 were retrospectively studied. All included patients underwent a chest computed tomography (CT) scan to assess pneumonia during their hospitalization and showed a positive SARS-CoV-2 molecular test. Sarcopenia was defined by skeletal muscle area (SMA) evaluation at the 12th thoracic vertebra (T12). Clinical, laboratory data and adverse clinical outcome (admission to Intensive Care Unit and death) were collected for all patients. RESULTS: Prevalence of sarcopenia was high (41.5%) but significantly different in each pandemic wave (57.9% vs 21.6% p < 0.0000). At the multivariate analysis, sarcopenia during the first wave (Hazard Ratio 2.29, 95% confidence intervals 1.17 to 4.49 p = 0.0162) was the only independent prognostic factor for adverse clinical outcome. There were no significant differences in comorbidities and COVID19 severity in terms of pulmonary involvement at lung CT comparing during the first and second wave. Mixed pattern with peripheral and central involvement was found to be dominant in both groups. CONCLUSION: We highlight the prognostic impact of sarcopenia in COVID-19 patients hospitalized during the first wave. T12 SMA could represent a potential tool to identify sarcopenic patients in particular settings. Further studies are needed to better understand the association between sarcopenia and COVID-19.
Subject(s)
COVID-19 , Sarcopenia , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Sarcopenia/diagnosis , Sarcopenia/epidemiologyABSTRACT
Introduction: During the 1st wave of the COVID-19 pandemic in Spring 2020, restrictions and 'lockdowns' impacted how healthcare was provided to many patients in Europe and the US. Objective: To understand the impact of COVID-19 on consultations between neurologists and Relapsing-Remitting Multiple Sclerosis (RRMS) patients in Europe and US during the 1st wave of the pandemic. Methods: A multi-centre online retrospective chart-review study of patients with MS was conducted in Q2 2020 (04/2020-06/2020) and Q4 2020 (10/2020-12/2020) in Europe (UK, FR, DE, IT, ES) and US amongst neurologists (MS Nurses included in the UK). Respondents screened for duration of practice in specialty (≥3yrs) and caseload (≥15 MS patients/mo). De-identified patient charts were recorded for the next 10 eligible patients seen during the consultation period. Descriptive statistics were used to analyse the data. Results: 321 and 101 (Q2), 324 and 101 (Q4) respondents were recruited in Europe and US respectively, reporting on 2244 and 709 (Q2), 2264 and 704 (Q4) RRMS patients, respectively. In Q2 2020, 39% (Europe) and 31% (US) reported RRMS patients saw their neurologist (or MS Nurse in the UK) in person, compared to 50% (Europe)/19% (US) where the consultation was conducted by phone, 6% (Europe)/ 42% (US) by telemedicine and 6% (Europe)/ 8% (US) via internet. By Q4 2020, the proportion of reported RRMS patients seen in person significantly increased to 71% in Europe and 68% in the US [p<0.01]. Reported patients seen in person were directionally more likely to have active or highly active MS and be suffering from a relapse vs those seen virtually (active or highly active: Europe: Q2 51% vs 35%, Q4 44% vs 36%;US Q2 47% vs 39%;Q4 46% vs 42%. Currently suffering a relapse: Europe: Q2 18% vs 6%, Q4 15% vs 8%;US: Q2 16% vs 7%;Q4 16% vs 5%). In Europe, consultations were significantly more likely [p<0.01] to be in person vs. virtual for reported patients who had initiated or switched disease-modifying therapy in the previous 12 mo. (Q2 36% vs 26%, Q4 30% vs 22%). Conclusions: In the sample surveyed, in person consultations were significantly lower [p<0.01] in the first wave of the pandemic vs. the latter half of 2020. Reported patients with more active disease who started treatment recently were directionally more likely to be seen in person. Further research is needed to understand the impact of virtual appointments on the care of RRMS patients with lower disease burden.
ABSTRACT
Despite being the target of extensive research efforts due to the COVID-19 pandemic, relatively little is known about the dynamics of SARS-CoV-2 replication within cells. We investigate and characterise the tightly orchestrated sequence of events during different stages of the infection cycle by visualising the spatiotemporal dynamics of the four structural proteins of SARS-CoV-2 at high resolution. The nucleoprotein is expressed first and accumulates around folded ER membranes in convoluted layers that connect to viral RNA replication foci. We find that of the three transmembrane proteins, the membrane protein appears at the Golgi apparatus/ERGIC before the spike and envelope proteins. Relocation of the lysosome marker LAMP1 towards the assembly compartment and its detection in transport vesicles of viral proteins confirm an important role of lysosomes in SARS-CoV-2 egress. These data provide new insights into the spatiotemporal regulation of SARS-CoV-2 assembly, and refine current understanding of SARS-CoV-2 replication.