ABSTRACT
Objective: Although the neurological and olfactory symptoms of coronavirus disease 2019 have been identified, the neurotropic properties of the causative virus, severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2), remain unknown. We sought to identify the susceptible cell types and potential routes of SARS-CoV-2 entry into the central nervous system, olfactory system, and respiratory system. Method(s): We collected single-cell RNA data from normal brain and nasal epithelium specimens, along with bronchial, tracheal, and lung specimens in public datasets. The susceptible cell types that express SARS-CoV-2 entry genes were identified using single-cell RNA sequencing and the expression of the key genes at protein levels was verified by immunohistochemistry. We compared the coexpression patterns of the entry receptor angiotensin-converting enzyme 2 (ACE2) and the spike protein priming enzyme transmembrane serine protease (TMPRSS)/cathepsin L among the specimens. Result(s): The SARS-CoV-2 entry receptor ACE2 and the spike protein priming enzyme TMPRSS/cathepsin L were coexpressed by pericytes in brain tissue;this coexpression was confirmed by immunohistochemistry. In the nasal epithelium, ciliated cells and sustentacular cells exhibited strong coexpression of ACE2 and TMPRSS. Neurons and glia in the brain and nasal epithelium did not exhibit coexpression of ACE2 and TMPRSS. However, coexpression was present in ciliated cells, vascular smooth muscle cells, and fibroblasts in tracheal tissue;ciliated cells and goblet cells in bronchial tissue;and alveolar epithelium type 1 cells, AT2 cells, and ciliated cells in lung tissue. Conclusion(s): Neurological symptoms in patients with coronavirus disease 2019 could be associated with SARS-CoV-2 invasion across the blood-brain barrier via pericytes. Additionally, SARS-CoV-2-induced olfactory disorders could be the result of localized cell damage in the nasal epithelium.Copyright © Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
Coronavirus Disease: From Origin to Outbreak provides a comprehensive review of coronaviruses, particularly COVID-19, its transmission, and disease pathology. The book covers the viral structure and genetics of coronaviruses, the pathogenesis and unique characteristics of coronavirus infection, and the evolving nature of our understanding of coronaviruses and disease. It also looks at the history of SARS-CoV and MERS-CoV infections and its global spread. The book examines the effectiveness of various preventive measures and new therapeutic agents that are either currently available or expected to available. Finally, it details the psychological and societal impact the virus and disease has in outbreak regions and what the financial impact an outbreak has on the healthcare system and local economies. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Objectives: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy). Materials and Methods: We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders. Results: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p=0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p=0.9) or death or non-routine discharge (p=0.2). Conclusions: Patients with acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.
ABSTRACT
Background: Undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may be seen in acute stroke patients. Rapid screening is important to reduce exposure to medical professionals and other patients during acute assessment and treatment. Chest computed tomographic (CT) scan may be another time-sensitive option for identification of SARS-CoV-2 infection in acute stroke patients. Objective: We report our experience of incorporating chest CT scan in the initial neuroimaging protocol for evaluation of acute stroke patients. Methods: All acute stroke patients underwent chest CT scan concurrent to CT head, CT angiogram of head and neck and CT perfusion for 10 months. We identified patients who had chest CT scan findings that were suggestive of SARS-CoV-2 infection including bilateral, multilobar ground glass opacification with a peripheral or posterior distribution, and/or consolidation. All patients subsequently underwent polymerase chain reaction (PCR) testing using nasopharyngeal specimen for identification of SARS-CoV-2 with contact isolation. Sensitivity, specificity, and likelihood ratios were calculated. Results: A total of 530 consecutive acute stroke patients (mean age in years 65.6± SD;15.4;280 were men) underwent neuroimaging with concurrent chest CT scan. The chest CT scan identified findings suggestive of SARS-CoV-2 infection in 34 (6.4%) patients. Subsequent PCR testing confirmed the diagnosis of SARS-CoV-2 infection in 21 of 34 patients. Among 491 patients in whom chest CT scan did not identify any findings suggestive of SARS-CoV-2 infection, 387 underwent PCR tests;PCR testing confirmed the diagnosis of SARS-CoV-2 infection in 13 of 34 patients. Sensitivity and specificity of chest CT scan for detecting SARS-CoV-2 infection was 61.9% and 96.2%, respectively. Positive and negative likelihood ratio of chest CT scan for detecting SARSCoV-2 infection is 16.26 and 0.39, respectively. Conclusions: Although specificity was high, the relatively low sensitivity of chest CT scan in identifying SARS-CoV-2 infection limits the value of adding this imaging to standard neuroimaging in acute stroke patients. At our institution, we have subsequently discontinued the protocol.
ABSTRACT
Background/Objective: To evaluate the impact of the COVID-19 pandemic on hospital admissions and outcomes in patients admitted with acute ischemic stroke. Methods: Single-center retrospective analysis of patients admitted to the hospital with acute ischemic stroke, between December 1st, 2019 and June 30th, 2020. Outcomes were classified as none-to-minimal disability, moderate-to-severe disability, and death based on discharge disposition, and compared between two time periods: pre-COVID-19 era (December 1st, 2019 to March 11th, 2020) and COVID19 era (March 12th to June 30th, 2020). We also performed a comparative trend analysis for the equivalent period between 2019 and 2020. Results: Five hundred and seventy-five patients with a mean age (years +/- SD) of 68 +/- 16 were admitted from December 1st, 2019 to June 30th, 2020, with a clinical diagnosis of acute ischemic stroke. Of these, 255 (44.3%) patients were admitted during the COVID-19 era. We observed a 22.1% and 39.5% decline in admission for acute ischemic stroke in April and May 2020, respectively. A significantly higher percentage of patients with acute ischemic stroke received intravenous thrombolysis during the COVID-1 9 era (p = 0.020). In patients with confirmed COVID-19, we found a higher percentage of older men with preexisting comorbidities such as hyperlipidemia, coronary artery disease, and diabetes mellitus but a lower rate of atrial fibrillation. In addition, we found a treatment delay in both intravenous thrombolysis (median 94.5 min versus 38 min) and mechanical thrombectomy (median 244 min versus 86 min) in patients with confirmed COVID-19 infection. There were no differences in patients' disposition including home, short-term, and long-term facility (p = 0.60). Conclusions: We observed a reduction of hospital admissions in acute ischemic strokes and some delay in reperfusion therapy during the COVID-1 9 pandemic. Prospective studies and a larger dataset analysis are warranted.
ABSTRACT
OBJECTIVES: Mandated social distancing has been applied globally to reduce the spread of coronavirus disease 2019 (COVID-19). However, the beneficial effects of this community-based intervention have not been proven or quantified for the COVID-19 pandemic. STUDY DESIGN: This is a regional population-level observational study. METHODS: Using publicly available data, we examined the effect of timing of mandated social distancing on the rate of COVID-19 cases in 119 geographic regions, derived from 41 states within the United States and 78 other countries. The highest number of new COVID-19 cases per day recorded within a geographic unit was the primary outcome. The total number of COVID-19 cases in regions where case numbers had reached the tail end of the outbreak was an exploratory outcome. RESULTS: We found that the highest number of new COVID-19 cases per day per million persons was significantly associated with the total number of COVID-19 cases per million persons on the day before mandated social distancing (ß = 0.66, P < 0.0001). These findings suggest that if mandated social distancing is not initiated until the number of existing COVID-19 cases has doubled, the eventual peak would result in 58% more COVID-19 cases per day. Subgroup analysis on those regions where the highest number of new COVID-19 cases per day has peaked showed increase in ß values to 0.85 (P < 0.0001). The total number of cases during the outbreak in a region was strongly predicted by the total number of COVID-19 cases on the day before mandated social distancing (ß = 0.97, P < 0.0001). CONCLUSIONS: Initiating mandated social distancing when the numbers of COVID-19 cases are low within a region significantly reduces the number of new daily COVID-19 cases and perhaps also reduces the total number of cases in the region.