CT Characterization of COVID-19 Infection: Analysis of 1000 PCR Positive Cases in First and Second Waves

Background: There is a wide variety of CT radiological findings of COVID-19 infection, this study aimed to analyze retrospectively the similarities and differences of CT radiological findings between first and second waves in the confirmed coronavirus patients. Materials and methods: comparative retrospective study between two COVID-19 pandemic waves was conducted on 1000 patients who were diagnosed as COVID-19 patients, at Assiut University hospital, 500 patients in the period from May 2020 to August 2020, while the other 500 patients were in the period from October 2020 to January 2021, all underwent MSCT chest and a comparison between similarities and differences of CT radiological findings was done. Results: Both waves showed nearly the same mean and percentage of total CT severity score with no significant difference between them as p-value > 0.05. There is also a positive moderate correlation between age and total MSCT severity score of the lung in the first wave (r=0.51, p-value<0.001), while a significant positive mild correlation in the second wave (r=0.31 and p-value <0.001), atypical findings were encountered in the second wave more than in the first wave with the most common one was pulmonary fibrosis by (7.2%). Conclusion: Great similarity in CT radiological findings between the two COVID-19 pandemic waves was detected. However, the main difference between them was in the severity of lung involvement in different age groups and demonstration of atypical findings which was more common in the second wave. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.

Prevalence, Clinical Course and Etiology of Viral Myocarditis in the COVID-19 Era

Background: Myocarditis is one of the most suspected etiologies in patients with unexplained heart failure (HF). We studied the in-hospital prevalence of viral myocarditis and recognize the etiologic cardiotropic viruses in patients admitted with unexplained HF during the COVID era. Method: This is a prospective observational study. We recruited patients with unexplained HF presenting at a university hospital from 1st October 2020 till 31st March 2021 (Fig.1). Patients were included if they present with unexplained acute HF associated with normal coronary angiography (CA). All patients were subjected to full history and examination, ECG, echocardiography, cardiac magnetic resonance (CMR) and CA. Sera were obtained from all suspected patients for detection of antibodies against the viruses by using ELISA and polymerase chain reaction (PCR). Results: Fifty-one patients fulfilled the inclusion criteria. 72.5% were males with mean age 39±16 years. We classified patients into 2 categories based on CMR results: Group A (CMR positive myocarditis) 12 patient (23.5%) and group B (CMR negative myocarditis) 35 (68.6%) patients. 51% of the patients presented with dyspnea, 27.5% with chest pain, 33.3% had LVEF >50%,19.6% with cardiogenic shock. 65.9% of patients (n=31/47) were associated with antibodies against the common cardiotropic viruses. Parvovirus B19 22 (46.8%) and Coxackie 16 (34%) were observed. 3 patients died at 6 months clinical follow up;91.5% from patients had recovered left ventricular ejection fraction. Conclusion: The in-hospital prevalence of myocarditis was 5 times higher in the COVID era. CMR is a good positive test for the diagnose acute myocarditis. Parvovirus B19 and Coxackie viruses represent most common pathogens in our locality. (Clinical trial registration no=NCT04312490, STDF grant no=26393 ) [Formula presented]

SARS-CoV-2 associated pathogenesis, immune dysfunction and involvement of host factors: a comprehensive review

Infectious diseases, especially viral infections, have emerged as a major concern for public health in recent years. Recently emerged COVID-19, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been declared a pandemic by World Health Organization since March 2020. It was first identified in Wuhan, China, in December 2019 and has since claimed more than a million lives. Complicated symptoms are associated with rising incidence and fatality rates, while many of the vaccine candidates are in the final stages of clinical trials. This review encompasses a summary of existing literature on COVID-19, including the basics of the disease such as the causative agent's genome characterization. modes of transmission of the virus, pathogenesis, and clinical presentations like associated immune responses, neurological manifestations, the variety of host genetic factors influencing the disease and the vulnerability of different groups being affected by COVID-19.

CYP2D6 and CYP3A4 variants influence the risk and outcome of COVID-19 infection among rheumatoid arthritis patients maintained on hydroxychloroquine

Hydroxychloroquine (HCQ) has been used as an off label for the management of coronavirus disease (Covid-19) infection with other drugs. However, different genetic variants can affect the metabolism of HCQ leading to inter-individual differences in its efficacy. In this study, we investigated the effects of variants in CYP2D6, CYP3A4 and CYP3A5 on the risk of Covid-19 infection among patients receiving HCQ for controlling rheumatoid arthritis (RA). A total of 60 patients were genotyped for CYP2D6∗2XN, CYP2D6∗4, CYP3A4∗1B and CYP3A5∗2. They were receiving HCQ for the treatment of RA. The patients were evaluated clinically for fever and dry cough, radiologically via chest computed tomography (CT) and immunologically via anti-Covid-19 IgG and IgM titers. Variants in CYP2D6 significantly affected the grade of ground glass (CYP2D6∗4 AA carriers showed the higher risk for grade 3) and the risk of positive anti-Covid-19 IgM (CYP2D6∗2XN CC and CYP3A4∗1B AA had the lowest risk), the duration of HCQ, the use of corticosteroids or gender did not affect the Covid-19 status significantly. In general, the outcome of the studied patients receiving HCQ was good (no deaths, no intubation needed). CYP2D6 variants could affect the outcome of Covid-19 infection.

Mapping the effect of drugs on ACE2 as a novel target site for COVID-19 therapy.

Angiotensin converting enzyme 2 (ACE2) has potentially conflicting roles in health and disease. COVID-19 coronavirus binds to human cells via ACE2 receptor, which is expressed on almost all body organs. Boosting the ACE2 receptor levels on heart and lung cells may provide more cellular enter to virus thereby worsening the infection. Therefore, among the drug targets, ACE2 is suggested as a vital target of COVID-19 therapy. This hypothesis is based on the protective role of the drugs acting on ACE2. Therefore, this review discusses the impact and challenges of using ACE2 as a target in the current therapy of COVID-19.

The interplay between vitamin D and COVID-19: protective or bystander?

The world is currently facing the COVID-19 pandemic, caused by the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Due to a lack of specific treatment and prophylaxis, protective health measures that can reduce infection severity and COVID-19 mortality are urgently required. Clinical and epidemiological studies have shown that vitamin D deficiency can be linked to an increased risk of viral infection, including COVID-19. Therefore, in this review, we looked at various possible roles of vitamin D in reducing the risk of COVID-19 infection and severity. We describe in this article that individuals at high risk of vitamin D deficiency should consider taking vitamin D supplements to keep optimal concentrations. Moreover, we discuss different possible mechanisms by which vitamin D can efficiently reduce the risk of infections through modulation of innate and adaptive immunity against various types of infections. It is advisable to perform further studies addressing the observed influence of vitamin D levels to reduce the risk of COVID-19 infection and mortality.