Barotrauma in a Previously Healthy and Young COVID-19 Patient: an Autopsy Case Report

Introduction/Objective Since the emergence of a novel SARS-CoV-2 virus caused coronavirus disease 2019 (COVID-19), a great number of autopsy studies have been published. However, histopathologic studies focused on pulmonary barotrauma are very rare. Here we report an autopsy confined to the lungs on a young COVID-19 patient. Methods/Case Report The patient was a 37-year-old male, non-smoker, with no significant past medical history, and a body mass index of 24.1, who presented with shortness of breath and cough. A computerized tomography (CT) showed features of atypical pneumonia. The main abnormal laboratory data included elevated partial thromboplastin time, fibrinogen, and D-Dimer. The patient had been on mechanical ventilation for 35 days, and was complicated by recurrent pneumothoraces, hypotension, and worsening hypoxia. An autopsy limited to the lungs was performed after the patient expired. Grossly, the lungs showed increased weight, adhesions on visceral pleural surface, patchy consolidation and dilated subpleural cysts. Histological examination revealed cystically dilated/remodeled airspaces with extensive coagulative necrosis, focal alveolar hemorrhage and edema, focal confluent fibrosis, and subpleural blebs. Fresh fibrinous thrombi were seen in small- and medium-sized vessels. Viral cytopathic changes or significant inflammation were not observed. The findings in the lungs were consistent with barotrauma in COVID-19. Results (if a Case Study enter NA) NA. Conclusion This case demonstrates various histopathologic changes of the lungs in a previously healthy and young COVID-19 patient with prolonged hospital course of mechanical ventilation. The features of diffuse alveolar damage with inflammation usually seen in the early stage of barotrauma are not identified. Our findings in the lungs may represent the histopathologic characteristics of the later stage of barotrauma in COVID-19.

Cellular tropism of SARS-CoV-2 in various organs - A Histopathology and Immunohistochemistry study on Covid-19 Deaths

Background and objectives: SARS-C0V-2 infections have varied manifestations among individuals ranging from asymptomatic or mild symptoms to severe disease and death. This study is done to look into various histopathological changes in lung, liver, and kidney tissues among Covid19 positive autopsies with cellular tropism and viral load among various organs by immunohistochemistry (IHC) for the SARS-C0V-2 viral marker. Method(s): A prospective descriptive study of core biopsies from covid19 positive autopsies from the lung, liver, and kidneys were taken from 20 cases. A routine histopathological examination of the tissues with IHC staining for SARS-CoV-2 cocktail antibodies was performed and assessed. Result(s): Histopathological changes in the lung, liver, and kidney tissues showed changes of varying severity. On IHC, in the lung, the tropism for SARS-CoV-2 was seen in pneumocytes, bronchial epithelial cells, endothelial cells, and macrophages. In the kidney, tropism was seen towards tubular epithelial cells and endothelial cells. In the liver, hepatocytes and bile duct epithelial cells were positive. Variable viral density was seen in different organs which varied from case to case. The density of the viral load was highest in the lung and lower in the kidney and least in the liver. Conclusion(s): In this study the various histopathological changes and cellular tropism of the SARS-CoV-2 among Lung, liver, and kidney tissues have been described and compared with various similar studies across the globe.Copyright © 2023 International Journal of Life Sciences Biotechnology and Pharma Research. All rights reserved.

SCIENCE DIGEST

Needlestick injuries (3.1%) were associated with mental health problems presumably related to the transmission of infectious diseases and liquid nitrogen related injuries were reported in 3.1% of respondents. Overall the survey concluded that embryologists experienced a number of occupational health problems of which musculoskeletal and mental health and work stress issues were the dominate issues emerging from the survey which appeared to be linked to lack of control of workflow and irregular breaks as well as workplace stress. [...]these have been difficult to describe but with the ability to sequence multiple genes in a single assay decisions will have to be made on which genes should be identified as being responsible for susceptibility to breast cancer. Recently two high quality major studies (4,5) have identified a number of genes that are statistically associated with breast cancer risk.

Vision of the causes of death by COVID-19 with the experiences of autopsies

On January 30, 2020, the World Health Organization (WHO) declared SARS-CoV-2 infection an international public health emergency. The autopsy, considered the best method of studying the patient and the disease, corroborates that patients can die from the direct action of the virus (who died from COVID-19), while others positive for SARS-CoV-2 did not show morphological lung changes attributed to the action of the virus. It is proposed to establish the morphological diagnostic criteria in the context of the SARS-CoV-2 and COVID-19 epidemic in the deceased in Cuba based on the systematic study of autopsies. The morphological patterns that are established in the lungs of patients who died under the effect of COVID-19 have been identified. The pulmonary edema of permeability with the widening of the pulmonary septum, the deposit of the disorganized hyaline membrane inside the alveoli, the detachment of epithelial cells (pneumocytes and bronchial and bronchiolar cells), followed by epithelial hyperplasia with sometimes the presence of metaplastic changes and atypia, and finally, fibrosis. When autopsies are performed, it is possible to locate each disease in its place, in chronopathogram, which allows death certificates repair to be carried out to assess the place that COVID-19 has occupied as a cause of death in the population studied. In the opinion of the group, identifying morphological alterations is essential to prepare the chronopathogram of the deceased and the adequate clinical-pathological evaluation of the patient. © 2022, Editorial Ciencias Medicas. All rights reserved.

Egyéni védőfelszerelés, valamint az infrastrukturális elemek biztosította légzésvédelem lehetőségei a patológiai munkavégzésben

A bonctermi munkavégzés speciális esetekben a megszokottól eltéro munkavédelmi kihívásokat rejthet magában. Ezen esetek közé tartozik, ha az elhunyt olyan fertozo betegségben szenvedett, vagy olyan vegyi, esetleg sugárzóanyaggal szennyezodött halálát megelozoen, amely a post mortem vizsgálati folyamat során egészségügyi kockázatot jelent a végrehajtó állománynak. A kockázatok minimalizálása, valamint a környezet épsége, a személyzet egészségének védelme érdekében ilyenkor mind a boncterem infrastrukturális elemeihez sorolható berendezések alkalmazásával, mind pedig egyéni védofelszerelések használatával kell a szükséges post mortem eljárásokat kivitelezni. Jelen tanulmányban a légzésvédelem lehetoségeit mutatom be és tekintem át, a fontosabb bonctermi veszélyek tükrében.Alternate :During autopsy procedures, special work safety issues can arise in cases where the decedents were infected with dangerous pathogens or the bodies were contaminated with hazardous chemical, radiological or nuclear agents. These cases represent an increased health risk for post mortem operations done by the pathology staff. In order to minimise the risks and to protect the integrity of the environment and the safety of medical personnel, the necessary post-mortem procedures shall be carried out using personal protective equipment and infrastructural installations. In this study, the possibilities of respiratory protection are summarised and presented, in the light of autopsy procedures.

INNOVATIONS IN EMERGENCY AIRWAY MANAGEMENT: LESSONSLEARNED FROM EARLY CROSS-CULTURAL MANAGEMENT OF COVID-19

The Texas Tech University Center for Emerging Energy Sciences Research Group implemented rapid translation and analytics of Chinese COVID-19 medical literature in February 2020, which enabled emerging innovations in patient care. Specifically, techniques to optimize patient care through improved ventilation and oxygenation recognizing newly discovered pathophysiology were designed and prototyped in this invention. COVID-19 respiratory distress distinguishes itself from acute respiratory distress syndrome (ARDS) and pathophysiology of SARS-COV-2 by requiring higher O2 and lower pressure requirements for adequate oxygenation. Specifically, low positive end-expiratory pressure ventilator parameters are necessary to optimize patient care. Paradoxically, COVID-19 patients display severe "silent" hypoxemia often associated with near normal respiratory compliance. This clinical presentation is considered unusual for severe ARDS patients and implies non-uniformity in disease management of acute respiratory and pre-hospital patients. A clinical need for new innovative approaches to management that may also benefit decompression sickness, high altitude pulmonary edema and other chronic respiratory disease patients. We present these observations as an example of the need for closely-collaborating, plinary teams to rapid innovation when sudden, severe health threats first emerge. This approach is invaluable to medical innovations needed to counter threats due natural to man-made conditions.

Autopsy Histopathologic Cardiac Findings in 2 Adolescents Following the Second COVID-19 Vaccine Dose/In Reply

The authors correctly stated that the Centers for Disease Control and Prevention (CDC) performed testing for SARS-CoV-2 and found no evidence of SARS-CoV-2 infection in autopsy tissues from the decedents. Molecular analysis included polymerase chain reaction (PCR) assays on nucleic acid extracted from FFPE heart tissue, including SARS-CoV-2 and enterovirus reverse transcriptase PCR (RT-PCR) assays2,3 and conventional PCR for parvovirus B19. Clostridium septicum produces multiple toxins that cause necrosis of striated muscle cells9,11 and inhibit influx of neutrophils to infected tissues;indeed, paucity of neutrophilic infiltrates in tissues infected with C septicum is considered a hallmark of this disease.9,12 Clostridium septicum is not considered normal flora of the human intestinal tract,13,14 but rather an opportunistic invader of immunologically compromised hosts, particularly persons with colonic adenocarcinoma, leukemia, diabetes, bowel ischemia, or cyclic, congenital, or acquired neutropenia.7,8 Spontaneous infections have been described for a few pediatric patients with no recognized risk factor and for whom microscopic breaches in the mucosa of the large intestine were considered the likely portal of entry.8,15 No representative samples of the small or large intestine were provided to the IDPB for evaluation;however, histologic evidence of bacterial invasion of the external surfaces of the adrenals, kidneys, liver, and spleen support an intraabdominal source of infection. The findings and conclusions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. doi: 10.5858/arpa.2022-0084-LE In Reply.-We thank the Centers for Disease Control and Prevention's (CDC's) Infectious Diseases Pathology Branch laboratory for performing these tests and for sharing the full extent of its workup.

THE PHON EFFECT IN THE ABANDONED MUMMIFIED

Social isolation, confinement in the domestic context up to abandonment, phenomena as serious as they are frequent in modern society, has been emphasized by the advent of the Sars-Covid19 pandemic. The authors report the case of a 39-year-old woman found lifeless and in a partial state of mummification ("hair dryer effect"), lying on her back on the bed and covered, in part, by a quilt. At the foot of the bed a hairdryer was found connected to the electrical outlet. The environmental conditions favored the initiation of special transformative putrefactive processes, such as that of mummification. Investigating a mummified body found, to determine the cause and manner of death, can be difficult for the forensic pathologist. For the definition of the time of death we generally use the degree of evolution ofpostmortal transformative phenomena which, as we move away from the moment of death, offer less and less possibilities to delimit this period within narrow time limits, especially when these phenomena are strongly affected by the environmental factors in the context of which the corpse has stayed, as occurred in the present case. A careful analysis of the places where the death occurred and the circumstantial data possibly available to the coroner can provide useful data for the proper assessment of the case. The reporting of this event must be considered an important isolated case study for the analysis of the mummification process, as well as a warning light on an increasingly widespread social problem.

Autopsy findings in COVID-19 infection-related death: a systematic review

IntroductionCoronavirus-19 disease (COVID-19) has been declared as pandemic by the World Health Organization (WHO) in March 2020. As of 28 November 2021, there were more than 260 million cases and nearly 5.2 million deaths caused by COVID-19. The most affected system by COVID-19 infection was the respiratory system although several other studies suggested multi-organ involvement with pathophysiology that was not clearly understood. Autopsy findings were beneficial to researchers to determine the mechanism behind these organ failures. The objective of this review was to summarize the autopsy findings related to COVID-19 death.MethodOnline literature search was conducted via online databases such as Scopus, PubMed and Google Scholar. The keywords inputted during the search were “post-mortem”, “autopsy” and “COVID-19” in title, and keywords. The inclusion criteria were the topic related with the title of this review, published in 2020–2021, have full text available and in English language. Any articles that were not related, duplicated studies, review articles including systematic review and meta-analysis and in other languages were excluded.ResultsA total of 20 articles were included in this review. The articles reviewed were mostly case reports and case series while others were case-control and cohort study ranging from one to 348 cases. Majority were originated from the United States of America (USA).ConclusionThe most frequent system described in autopsy findings in COVID-19 death was the respiratory system, with the most common histological finding of diffuse alveolar damage (DAD). Majority of the findings of other organs were related to chronic diseases.

Postmortem brain 7T MRI with minimally invasive pathological correlation in deceased COVID-19 subjects

BackgroundBrain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to investigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Two mouse monoclonal anti-coronavirus (SARS-CoV-2) antibodies were employed in immunohistochemical (IHC) reactions.ResultsSeven deceased COVID-19 patients underwent MIA with brain MR and CT images, six of them with tissue sampling. Imaging findings included infarcts, punctate brain hemorrhagic foci, subarachnoid hemorrhage and signal abnormalities in the splenium, basal ganglia, white matter, hippocampi and posterior cortico-subcortical. Punctate brain hemorrhage was the most common finding (three out of seven cases). Brain histological analysis revealed reactive gliosis, congestion, cortical neuron eosinophilic degeneration and axonal disruption in all six cases. Other findings included edema (5 cases), discrete perivascular hemorrhages (5), cerebral small vessel disease (3), perivascular hemosiderin deposits (3), Alzheimer type II glia (3), abundant corpora amylacea (3), ischemic foci (1), periventricular encephalitis foci (1), periventricular vascular ectasia (1) and fibrin thrombi (1). SARS-CoV-2 RNA was detected with RT-PCR in 5 out of 5 and IHC in 6 out 6 patients (100%).ConclusionsDespite limited sampling, MIA was an effective tool to evaluate underlying pathological brain changes in deceased COVID-19 patients. Imaging findings were varied, and pathological features corroborated signs of hypoxia, alterations related to systemic critically ill and SARS-CoV-2 brain invasion.

What the psychiatrist needs to know about the coroner's court in England and Wales

SUMMARYIt is highly likely that a psychiatrist will be called to an inquest at some point in their career. Our aim in this article is to educate psychiatrists in relation to the law and processes of a coroner's court in England and Wales and provide guidance on engaging with the system. To achieve this we review and discuss the relevant law and medico-legal aspects of inquests. Knowledge and preparation are key to negotiating any inquest and we would hope that the understanding and guidance offered in this article will reduce anxiety, make the situation manageable and aid professionalism, in often tragic circumstances.

Build It Better for Public Health: Improved Data Infrastructure Is Vital to Bending the Curve of the Overdose Crisis

For most decedents, the COD is determined by the attending physician or nurse;however, death investigations are required for cases in which the COD is sudden or unexpected, is not of natural causes, is unattended, or is unexplained.2 Therefore, coroners and medical examiners are typically the authorized certifiers of death in cases involving overdose.3 In this issue of AJPH (p. S36), Merlin et al. provide a timely analysis of overdose surveillance in the health care settings, where deaths may be miscategorized by attending physicians for decedents with underlying illness. According to Centers for Disease Control and Prevention (CDC) data, of the 28 states with county coroners, 22 states do not have a state medical examiner, and half do not require the coroner position to be held by a medical professional or an individual with certified credentials to conduct autopsies, such as pathology, toxicology, and forensic medicine.4 The accuracy of COD related to drugs is higher for medical examiners than for coroners. [...]the specific drug was not listed for 38% of death certificates in states with decentralized county coroner systems, compared with 8% in states with a statewide medical examiner system, leading to underestimates for death rates.3 Even in situations where medical examiners are present, death investigations continue to be substantially underfunded and threaten the accuracy of COD data. COD determination exists within a broader context of institutional racism and racial bias in clinical policy and practice.11 Genomic research has unequivocally determined that race is not a biological categorization;yet, erroneous beliefs persist in the medical community about biological differences between Black and White individuals.12 These biases are associated with clinical recommendations and how services are delivered.13 Recognizing signs that overdose may have occurred is also limited by the lack of foundational training provided by medical institutions for substance use disorder, despite its being a leading COD for unintentional injury.

Questioning The Early Events Leading To The Covid-19 Pandemic

Sixteen months after the January 30, 2020 declaration by the World Health Organization of a Public Health Emergency of International Concern regarding the spread of COVID-19, SARS-CoV-2 had infected ~ 170 million humans world-wide of which > 3.5 million had died. We critically examine information on the virus origin, when and where the first human cases occurred, and point to differences between Chinese and later clinical presentations. The official patient Zero was hospitalized in Wuhan, Hubei province, China, on December 8, 2019, but retrospective analyses demonstrate prior viral circulation. Coronaviruses are present in mammals and birds, but whether a wild animal (e.g. bat, pangolin) was the source of the human pandemic remains disputed. We present two contamination models, the spillover versus the circulation model;the latter brings some interesting hypotheses about previous SARS-CoV-2 virus circulation in the human population. The age distribution of hospitalized COVID-19 patients at the start of the epidemic differed between China and the USA–EU;Chinese hospitalized patients were notably younger. The first Chinese publications did not describe anosmia-dysgeusia, a cardinal symptom of COVID-19 in Europe and USA. The prominent endothelial involvement linked with thrombotic complications was discovered later. These clinical discrepancies might suggest an evolution of the virus. © 2021,Health Risk Analysis.All Rights Reserved.

[COVID-19-associated deaths]. / COVID-19-assoziierte Sterbefälle: Erste Daten aus Münchner Todesbescheinigungen.

INTRODUCTION: In December 2019, the new infectious coronavirus disease 2019 (COVID-19) first appeared in China. So far, no systematic evaluation of death certificates of COVID-19-associated deaths has been presented. METHODS: The death certificates of all deaths in Munich during the period from 1 March to 31 July 2020 were analyzed. The previously defined inclusion criteria were the indication of corona, COVID-19 and SARS-CoV­2 in the death certificates. The variables were entered anonymously according to a developed key. The collected data were evaluated descriptively. RESULTS: In the period under investigation, a total of 5840 people died in the Munich City area. Of these deaths 332 (5.7%) were COVID-19-associated. In 281 deaths (84.6%) there was a definite COVID-19 and in 51 deaths (15.4%) the suspicion of this disease. The most frequent causes of death were acute respiratory distress syndrome or respiratory insufficiency (59.1%), multiple organ failure (21.4%) and sepsis (10%). An average of 1.8 pre-existing illnesses were reported in the death certificates. Most frequently mentioned were diseases of the circulatory system (54.8%), the nervous system (22.8%) and metabolic diseases (18.9%). The average age at death was 79 years and the most frequent place of death was a hospital (85%). An autopsy was attempted by the doctors who issued the death certificates for 18.1% of the collective, most frequently in the case of unexplained or unnatural causes of death and young age of the deceased. Clinical pathological autopsies were performed on 11% of the collective and judicial autopsies on 1%. DISCUSSION: This study is the first evaluation of death certificates with respect to the novel infectious COVID-19. Number and essential characteristics of COVID-19-associated deaths in Munich during the so-called first wave could be mapped. The interest of physicians in autopsies was rather low despite the appearance of a new infectious disease.

SYSTEMATIC REVIEW ON MECHANISM OF ACTION, MORTALITIES, MORBIDITIES, AND PREVENTION FROM COVID-19

: Coronaviruses are enveloped, positive-sense, single-stranded RNA viruses which belong to family Coronaviridae. These viruses are responsible for mild to severe respiratory ailments such as common cold to SARS, MERS and COVID-19. Pandemic COVID-19 is an ongoing issue of 2020. It starts from Wuhan city of China that later extended to the whole world (203 countries). However, according to another report of World Health Organization (WHO) the virus may start from some other part of the world rather than Wuhan city of China. The major structural components of COVID-19 are spike, envelope and nucleocapsid proteins. It enters the cell via cellular receptors angiotensin-converting enzyme 2 (ACE-2). Its symptoms are high fever, dry cough, fatigue, dyspnea, tiredness, headache, body-aches, pneumonia, and difficult breathing. Its man to man transmission is extraordinarily high and has ability to infect all age groups however, morbidity cases are noticed higher in elderly group of people. It can be transferred by the carriers via cough, sneeze or when they touched the surfaces or any object. It is concluded that there are more chances for the spread of disease in casual and workplaces. To control pandemic COVID-19 there is need to spread awareness about its structure, way of transmission and prevention. The present review discusses structure, mechanism of action, incubation period, most affected age groups, symptoms, transmission, and precautions to stop its progress.

[SARS-CoV-2-associated deaths in adult persons up to 50 years of age]. / SARS-CoV-2-assoziierte Todesfälle von erwachsenen Personen bis 50 Jahre: Eine retrospektive Auswertung der COVID-19-assoziierten Todesfälle im Jahr 2020 im Institut für Rechtsmedizin Hamburg, Deutschland.

INTRODUCTION: Several evaluations of deaths in persons of advanced age associated with SARS-CoV­2 can be found in the international literature. The aim of this work was the evaluation of deaths associated with SARS-CoV­2 of persons of younger or middle age (up to 50 years) at the Institute of Legal Medicine in Hamburg, Germany, with presentation of frequency, comorbidities and disease courses. MATERIAL AND METHODS: A total of 735 SARS-CoV-2-associated cases of decedents with registered addresses in Hamburg were evaluated in 2020 at the Institute of Legal Medicine in Hamburg, Germany, using various examination methods. The selection and performance of the respective methods was based on the consent given by the relatives. In addition, more autopsies of decedents with a registered address outside Hamburg and positive SARS-CoV­2 detection were performed. RESULTS AND CONCLUSION: Of the 735 decedents 9 with a registered Hamburg address and 3 of the deaths studied with an external registered address (n = 12; 7 men and 5 women) were aged 50 years or younger, with an average age of 39.8 years. Essentially, there were cardiovascular, neurological, and malignant pre-existing diseases, as well as obesity. The SARS-CoV­2 was detected post-mortem for the first time in two cases; these were found to have a virus-independent cause of death. Of the individuals 7 died from COVID-19 pneumonia, 3 individuals from the consequences of the necessary intensive medical treatment.Several studies have demonstrated an association between obesity and severe SARS-CoV-2-related disease progression, particularly in younger patients and this was confirmed in the legal medicine study population.

Enhanced Expression of Autoantigens During SARS-CoV-2 Viral Infection.

Immune homeostasis is disturbed during severe viral infections, which can lead to loss of tolerance to self-peptides and result in short- or long-term autoimmunity. Using publicly available transcriptomic datasets, we conducted an in-silico analyses to evaluate the expression levels of 52 autoantigens, known to be associated with 24 autoimmune diseases, during SAR-CoV-2 infection. Seven autoantigens (MPO, PRTN3, PADI4, IFIH1, TRIM21, PTPRN2, and TSHR) were upregulated in whole blood samples. MPO and TSHR were overexpressed in both lung autopsies and whole blood tissue and were associated with more severe COVID-19. Neutrophil activation derived autoantigens (MPO, PRTN3, and PADI4) were prominently increased in blood of both SARS-CoV-1 and SARS-CoV-2 viral infections, while TSHR and PTPRN2 autoantigens were specifically increased in SARS-CoV-2. Using single-cell dataset from peripheral blood mononuclear cells (PBMCs), we observed an upregulation of MPO, PRTN3, and PADI4 autoantigens within the low-density neutrophil subset. To validate our in-silico analysis, we measured plasma protein levels of two autoantigens, MPO and PRTN3, in severe and asymptomatic COVID-19. The protein levels of these two autoantigens were significantly upregulated in more severe COVID-19 infections. In conclusion, the immunopathology and severity of COVID-19 could result in transient autoimmune activation. Longitudinal follow-up studies of confirmed cases of COVID-19 could determine the enduring effects of viral infection including development of autoimmune disease.

Upregulation of oxidative stress gene markers during SARS-COV-2 viral infection.

Severe viral infections, including SARS-COV-2, could trigger disruption of the balance between pro-oxidant and antioxidant mediators; the magnitude of which could reflect the severity of infection and lung injury. Using publicly available COVID-19 transcriptomic datasets, we conducted an in-silico analyses to evaluate the expression levels of 125 oxidative stress genes, including 37 pro-oxidant genes, 32 oxidative-responsive genes, and 56 antioxidant genes. Seven oxidative stress genes were found to be upregulated in whole blood and lung autopsies (MPO, S100A8, S100A9, SRXN1, GCLM, SESN2, and TXN); these genes were higher in severe versus non-severe COVID-19 leucocytes. Oxidative genes were upregulated in inflammatory cells comprising macrophages and CD8+ T cells isolated from bronchioalveolar fluid (BALF), and neutrophils isolated from peripheral blood. MPO, S100A8, and S100A9 were top most upregulated oxidative markers within COVID-19's lung autopsies, whole blood, leucocytes, BALF derived macrophages and circulating neutrophils. The calprotectin's, S100A8 and S100A9 were upregulated in SARS-COV-2 infected human lung epithelium. To validate our in-silico analysis, we conducted qRT-PCR to measure MPO and calprotectin's levels in blood and saliva samples. Relative to uninfected donor controls, MPO, S100A8 and S100A9 were significantly higher in blood and saliva of severe versus asymptomatic COVID-19 patients. Compared to other different viral respiratory infections, coronavirus infection showed a prominent upregulation in oxidative stress genes with MPO and calprotectin at the top of the list. In conclusion, SARS-COV-2 induce the expression of oxidative stress genes via both immune as well as lung structural cells. The observed correlation between oxidative stress genes dysregulation and COVID-19 disease severity deserve more attention. Mechanistical studies are required to confirm the correlation between oxidative stress gene dysregulation, COVID-19 severity, and the net oxidative stress balance.

High prevalence of hepatic steatosis and vascular thrombosis in COVID-19: A systematic review and meta-analysis of autopsy data.

BACKGROUND: Coronavirus disease 2019 (COVID-19) disease can frequently affect the liver. Data on hepatic histopathological findings in COVID-19 is scarce. AIM: To characterize hepatic pathological findings in patients with COVID-19. METHODS: We conducted a systematic review with meta-analysis registered on PROSPERO (CRD42020192813), following PRISMA guidelines. Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test. Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed. Articles including less than ten patients were excluded. Proportions were pooled using random-effects models. Q statistic and I 2 were used to assess heterogeneity and levels of evidence, respectively. RESULTS: We identified 18 studies from 7 countries; all were case reports and case series from autopsies. All the patients were over 15 years old, and 67.2% were male. We performed a meta-analysis of 5 studies, including 116 patients. Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1% [95% confidence interval (CI): 46.2-63.8], congestion of hepatic sinuses 34.7% (95%CI: 7.9-68.4), vascular thrombosis 29.4% (95%CI: 0.4-87.2), fibrosis 20.5% (95%CI: 0.6-57.9), Kupffer cell hyperplasia 13.5% (95%CI: 0.6-54.3), portal inflammation 13.2% (95%CI: 0.1-48.8), and lobular inflammation 11.6% (95%CI: 0.3-35.7). We also identified the presence of venous outflow obstruction, phlebosclerosis of the portal vein, herniated portal vein, periportal abnormal vessels, hemophagocytosis, and necrosis. CONCLUSION: We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features. Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation. Further studies are needed to establish the mechanisms and implications of these findings.