A Case of a Relapsing Remitting Macrophage Activating Syndrome After Covid-19 Vaccine In a Teenager with UNC13D Heterozygous Variant of Uncertain Significance

Introduction: Macrophage activation syndrome (MAS) is a severe hyper inflammatory condition caused by the over-activation and proliferation of T cells, NK cells and macrophages. It is often associated with complications of rheumatic/immune diseases. We present a case of a 15-year-old female who experiences recurrent episodes of MAS without any known definitive underlying etiology. Case Presentation: A 15-year-old previously healthy female developed fatigue, fevers, myalgia, chest pain, splenomegaly and lymphadenopathy 10 days after receiving her first Pfizer COVID-19 vaccine. Her symptoms recurred 10 days after receiving the second dose. Her myocarditis, MIS-C, and infectious work up was negative except for positive EBV IgG. Laboratory studies revealed anemia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. She initially responded to decadron;however, her symptoms recurred with steroid taper. Bone marrow biopsy revealed hemophagocytosis. Whole exome sequencing (WES) revealed a heterozygous variant of uncertain significance in UNC13D c.962C>A (p.Thr321Asn). She had multiple re-admissions with significantly elevated inflammatory markers, including extremely high IL2-R, IL-18 and CXCL9. Each episode was complicated by an acute viral infection. She responds to high dose steroids, anti-IL-1, and JAK inhibitors. Nonetheless, it has been difficult to wean decadron without triggering a flare. She continues to require increasing doses of baricitinib. Discussion(s): MAS may be seen as a complication of rheumatic diseases, as well as inborn errors of immunity. However, none of these conditions have been diagnosed in this patient despite extensive testing, including WES. The degree of her immune dysregulation has been very severe making her disease process unpredictable and extremely difficult to control. She has frequent flares precipitated by viral infections or attempts at adjusting her immunomodulators. Weaning her medications has been challenging as she continues to require increasing doses of baricitinib and corticosteroids. The UNC13D gene is associated with autosomal recessive familial hemophagocytic lymphohistiocytosis type 3 (FHL3). Our patient is heterozygous for an UNC13D variant of uncertain significance. Additional genetic inquiries with whole genome sequencing to help elucidate the underlying etiology of her severe condition is being conducted. We hypothesize she developed MAS due to a combination of genetic predisposition, prior EBV infection, and immune stress associated with the COVID-19 vaccine. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023 Elsevier Inc.

Angiotensin-converting enzyme 2 (ACE2) in COVID-19 and other diseases.

The coronavirus SARS-CoV-2 was detected in isolates of pneumonia patients in January 2020. The virus cannot multiply extracellularly but requires access to the cells of a host organism. SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as a receptor, to which it docks with its spikes. ACE2 belongs to the renin angiotensin system (RAS), whose inhibitors have been used for years against high blood pressure. Renin is an endopeptidase that is predominantly formed in the juxtaglomerular apparatus of the kidney and cleaves the decapeptide angiotensin I (Ang I) from angiotensinogen. Through the angiotensin-converting enzyme (ACE), another 2 C-terminal amino acids are removed from Ang I, so that finally the active octapeptide angiotensin II (Ang II) is formed. The biological effect of Ang II via the angiotensin II receptor subtype 1 (AT1-R) consists of vasoconstriction, fibrosis, proliferation, inflammation, and thrombosis formation. ACE2 is a peptidase that is a homolog of ACE. ACE2 is predominantly expressed by pulmonary alveolar epithelial cells in humans and has been detected in arterial and venous endothelial cells. In contrast to the dicarboxy-peptidase ACE, ACE2 is a monocarboxypeptidase that cleaves only one amino acid from the C-terminal end of the peptides. ACE2 can hydrolyze the nonapeptide Ang-(1-9) from the decapeptide Ang I and the heptapeptide Ang-(1-7) from the octapeptide Ang II. Ang-(1-7) acts predominantly antagonistically (vasodilatory, anti-fibrotic, anti-proliferative, anti-inflammatory, anti-thrombogenetically) via the G protein-coupled Mas receptor to the AT1-R-mediated effects of Ang II. In the pathogenesis of COVID-19 infection, it is therefore assumed that there is an imbalance due to overstimulation of the AT1 receptor in conjunction with a weakening of the biological effects of the Mas receptor.Copyright © 2022 Dustri-Verlag Dr. K. Feistle.

Role of statins in clinical evolution of octogenarian patients admitted due to COVID-19. / Papel de las estatinas en la evolución clínica de los pacientes octogenarios ingresados por COVID-19.

INTRODUCTION AND OBJECTIVES: coronavirus disease 2019 (COVID-19) causes high mortality in elderly patients. Some studies have shown a benefit of statin treatment in the evolution of this disease. Since there are no similar publications in this population group, the aim of this study is to analyze in-hospital mortality in relation to preadmission treatment with statins in an exclusively elderly population of octogenarian patients. MATERIALS AND METHODS: A single-center retrospective cohort study was performed including a total of 258 patients ≥80 years with hospital admission for confirmed COVID-19 between March 1 and May 31, 2020. They were divided into two groups: taking statins prior to admission (n=129) or not (n=129). RESULTS: In-hospital mortality due to COVID-19 in patients ≥80 years (86.13±4.40) during the first wave was 35.7% (95% CI: 30.1-41.7%). Mortality in patients previously taking statins was 25.6% while in those not taking statins was 45.7%. Female sex (RR 0.62 [0.44-0.89]; p=0.008), diabetes (RR 0.61 [0.41-0.92]; p=0.017) and pre-admission treatment with statins (RR 0.58 95% CI [0.41-0.83]; p=0.003) were associated with lower in-hospital mortality. Severe lung involvement was associated with increased in-hospital mortality (RR 1.45 95% CI [1.04-2.03]; p=0.028). Hypertension, obesity, age, cardiovascular disease and a higher Charlson index did not, however, show influence on in-hospital mortality. CONCLUSIONS: In octogenarian patients treated with statins prior to admission for COVID-19 in the first wave, lower in-hospital mortality was observed.

Insights Into the Role of Angiotensin-Converting Enzyme 2 in the Onset of Severe Acute Respiratory Syndrome Coronavirus 2 Pathogenesis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the outbreak of pneumonia which originated in Wuhan, China, at the end of 2019 has turned into a global pandemic—now termed coronavirus diseases 2019 (COVID-19). Like previously reported SARS-CoV strains, the newly discovered SARS-CoV-2 was also found to initiate the pathogenesis by binding with the angiotensin-converting enzyme 2 (ACE2), a receptor produced by various organs in the human body. Hence, COVID-19 is a viral multisystem disease which particularly infects the vascular system expressing ACE2 and reduced the ACE2 function;this further complexed by organ-specific pathogenesis related to the damage of cells expressing ACE2, such as alveolus, glomerulus, endothelium, and cardiac microvasculature. Under these conditions, it was advocated that the upregulation of ACE2 expression in predisposing individuals with aberrant renin–angiotensin system (RAS) level to advanced viral load on infection and relatively a greater number of cell death. Recently, a significant role of decreased ACE2 production and inequality between the RAS and ACE2/angiotensin-(1–7)/ MAS (mitochondrial Ang system) after the onset of SARS-CoV-2 infection was established as a key factor for multiple organ injury in SARS-CoV-2-infected individuals. Furthermore, restoration of this imbalance has been suggested as a therapeutic approach to attenuate organ injuries in SARS-CoV-2 infection. Based on available data, this chapter presents the updated mechanism of the multi-organ diseases causes by COVID-19 via ACE2 which can be further helpful in the development of specific therapeutics. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.

Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease.

Background: Multisystem inflammatory syndrome in children (MIS-C), is a severe complication of coronavirus disease 2019 (COVID-19), characterized by persistent fever, systemic inflammatory response, and organ failure. MIS-C with a history of COVID-19 may share clinical features with other well-defined syndromes such as macrophage activation syndrome, Kawasaki disease, hemophagocytic syndrome and toxic shock syndrome. Case 1: An 11-year-old male with a history of hypothyroidism and precocious puberty with positive antibody test for COVID-19 was admitted for fever, poor general condition, severe respiratory distress, refractory shock, and multiple organ failure. His laboratory examination showed elevated inflammatory parameters, and bone marrow aspirate showed hemophagocytosis. Case 2: A 13-year-old male with a history of attention deficit hyperactivity disorder and cognitive delay presented clinical manifestations of Kawasaki disease, fever, conjunctival congestion, exanthema, and hyperemia in oral mucosa, tongue, and genitals, with refractory shock and multiple organ failure. Reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies for COVID-19 were negative, inflammation parameters were elevated, and bone marrow aspirate showed hemophagocytosis. Patients required intensive care with invasive mechanical ventilation, vasopressor support, intravenous gamma globulin, systemic corticosteroids, low molecular weight heparin, antibiotics, and monoclonal antibodies and, patient 2 required renal replacement therapy. Conclusions: Multisystemic inflammatory syndrome in children can have atypical manifestations, and identifying them early is very important for the timely treatment and prognosis of patients.

Understanding of the News Published in the Press about COVID-19 by University Students of Careers in Communication Area in Alicante (2021)

As a result of COVID-19, journalists have had to disseminate information on health issues, being in charge of translating complex terms into a language understandable to the general population. Objective: To assess the reading comprehension of communication degree students on news published in the press related to COVID-19;specifically 1) Identify your frequency of exposure to news;2) Determine their perception of risk and 3) assess their understanding of specific terminology. Methodology: Online questionnaire for students of degrees in Journalism, Advertising and Public Relations and Audiovisual Communication, from the UA and the UMH. Results: 79.6% (n=225) frequently read news related to COVID-19 to stay informed about health problems. Less than half of them declared knowing terms such as "prevalence" or "screening"', and less than 20% correctly identified the definition of the concept. Conclusions: Low understanding of specific terminology, which may imply an incorrect perception of risk. © 2023 Universidad Complutense de Madrid. All rights reserved.

An Intelligent Collaborative Image-Sensing System for Disease Detection

With the growth of smart medical devices and applications in smart hospitals, home care facilities, nursing, and the Internet of Medical Things (IoMT) are becoming more ubiquitous. It uses smart medical devices and cloud computing services, and basic Internet of Things (IoT) technology, to detect key body indicators, monitor health situations, and generate multivariate data to provide just-in-time healthcare services. In this article, we present a novel collaborative disease detection system based on IoMT amalgamated with captured image data. The system can be based on intelligent agents, where every agent explores the interaction between different medical data obtained by smart sensor devices using reinforcement learning as well as targets to detect diseases. The agents then collaborate to make a reliable conclusion about the detected diseases. Intensive experiments were conducted using medical data. The results show the importance of using intelligent agents for disease detection in healthcare decision-making. Moreover, collaboration increases the detection rate, with numerical results showing the superiority of the proposed framework compared with baseline solutions for disease detection. © 2001-2012 IEEE.

Academic supervision of doctors in indigenous areas during the Covid-19 pandemic / Supervisão acadêmica de médicos em áreas indígenas durante a pandemia de Covid-19 / Supervisión académica de médicos en áreas indígenas durante la pandemia de Covid-19

Trata-se de estudo qualitativo sobre o papel da supervisão acadêmica do Grupo Especial de Supervisão do Projeto Mais Médicos para o Brasil de Roraima (GES-RR) durante a pandemia de Covid-19. Foi realizada uma cartografia, com entrevistas e uma roda de conversa. Durante a pandemia, a Atenção à Saúde Indígena passou por rearranjos e a supervisão acadêmica do GES-RR exerceu-se remotamente, o que reduziu seu potencial, mas manteve sua relevância. O acolhimento dos médicos pelos supervisores potencializou a capacidade transformadora da assistência e diminuiu a sensação de isolamento e abandono. O GES-RR foi importante para a mediação de conflitos com a gestão, para a qualificação do trabalho médico, para a reflexão sobre as relações e condições de trabalho e como espaço privilegiado de Educação Permanente em Saúde. O estudo mostrou a importância dos papéis exercidos e da retomada presencial em momento oportuno.(AU)

We conducted a qualitative study to investigate the academic supervision role of the Special Supervision Group for the More Doctors Project for Brazil in Roraima (GES-RR) during the Covid-19 pandemic. We constructed a map based on interviews and conversation circles. During the pandemic, indigenous health care underwent reshaping and academic supervision was performed by the GES-PR remotely, reducing its potential but maintaining its relevance. The support provided to the doctors by the supervisors enhanced the transformative capacity of care and reduced the sensation of isolation and abandonment. The GES-RR played an important role in mediating conflicts with management, improving the quality of medical work, and stimulating reflection on working relations and conditions, and is uniquely positioned to provide permanent health education. The findings highlight the importance of the roles and of returning to face-to-face working at the appropriate time.(AU)

Se trata de un estudio cualitativo sobre el papel de la supervisión académica del Grupo Especial de Supervisión del Proyecto Más Médicos para Brasil de Roraima (GES-RR) durante la pandemia de Covid-19. Se realizó una cartografía, con entrevistas y una ronda de conversaciones. Durante la pandemia, la Atención de la Salud Indígena pasó por reorganizaciones y la supervisión académica del GES-RR se ejerció remotamente, pero mantuvo su relevancia. La acogida a los médicos por parte de los supervisores potencializó la capacidad transformadora de la asistencia y disminuyó la sensación de aislamiento y abandono. El GES-RR fue importante en la mediación de conflictos con la gestión, calificación del trabajo médico, para la reflexión sobre las relaciones y condiciones de trabajo y como espacio privilegiado de Educación Permanente de Salud. El estudio mostró la importancia de los papeles ejercidos y de la retomada presencial en momento oportuno.(AU)

Chronic alcohol intake regulates expression of SARS-CoV2 infection-relevant genes in an organ-specific manner.

BACKGROUND: Chronic alcohol consumption and alcohol use disorder have a tremendous impact on the patient's psychological and physiological health. There is evidence that chronic alcohol consumption influences SARS-CoV2 infection risk, but so far, the molecular mechanism underlying such an effect is unknown. METHODS: We generated the expression data of SARS-CoV2 infection-relevant genes (Ace2, Tmprss2, and Mas) in different organs in rat models of chronic alcohol exposure and alcohol dependence. Ace2 and Tmprss2 represent the virus entry point, whereas Mas activates the anti-inflammatory response once the cells are infected. RESULTS: Across three different chronic alcohol test conditions, we found a consistent upregulation of Ace2 gene expression in the lung, which has been shown to be the most affected organ in COVID-19 patients. Other organs such as liver, ileum, kidney, heart, and brain also showed upregulation of Ace2 and Mas gene expression but less consistently across the different animal models, while Tmprss2 expression was unaffected in all conditions. CONCLUSIONS: We conclude that alcohol-induced upregulation of Ace2 gene expression can lead to an elevated stochastic probability of virus entry into cells and may thus confer a molecular risk for SARS-CoV2 infection.

New Coronavirus Infection Covid-19 and Women's Reproductive Health. Facts and Assumptions

The review presents data on the possible ways in which the SARS-CoV-2 and COVID-19 virus affects the female reproductive system and the already recorded negative consequences. Recommendations on pregnancy planning and the specifics of using hormonal contraceptive methods, as well as approaches to specific prevention of a new coronavirus infection from the standpoint of safety and preserving the reproductive health of women during the COVID-19 pandemic are outlined.

First report of a patient meeting criteria for both multisystem inflammatory syndrome in children and adult onset Still's disease.

BACKGROUND: COVID-19 is associated with a postinfectious hyperinflammatory disorder, multisystem inflammatory syndrome in children (MIS-C), that shares characteristics with still's disease, known as systemic juvenile idiopathic arthritis (SJIA) in children younger than 16, and adult onset Still's disease (AOSD) in children 16 and older. Both MIS-C and SJIA/AOSD can be complicated by macrophage activation syndrome (MAS), a potentially fatal condition of cytokine storm. CASE PRESENTATION: We present a 16 year-old male who developed quotidian fever, headache, conjunctival injection, sore throat, nausea and vomiting, diarrhea, rash, and symmetrical polyarticular arthralgia/arthritis 4 weeks after exposure to SARS-CoV-2 and 2 weeks after his first vaccination against COVID-19. Our patient's laboratory results were significant for elevated inflammatory markers and acute phase reactants. He met criteria for diagnosis with both MIS-C and AOSD. After receiving first-line treatment for both diseases, IVIG and methylprednisolone, our patient improved. CONCLUSION: MAS is a life-threatening rheumatological emergency, and physicians must be able to identify diseases, like MIS-C and AOSD, that may be complicated by MAS. Our patient's distinguishing feature on presentation was symmetrical polyarticular arthralgia/arthritis, which has not been associated with MIS-C. Simultaneously, AOSD-which is associated with polyarticular arthralgia/arthritis-is only now being recognized as a possible post-infectious entity in the aftermath of COVID-19 infection. In patients like our own, who meet criteria for both MIS-C and AOSD, administering first line treatment for both diseases may be best practice.

Spectral selective composite mask media for personal cooling and efficient PM 2.5 removal

Face masks are commonly used to protect an individual's respiratory system from inhaling fine particulate matter (PM2.5) in polluted air, as well as the airborne pathogens, especially during the ongoing coronavirus disease 2019 (COVID-19) pandemic. However, all conventional masks with anti-PM2.5 function suffer from insufficient facial thermal comfort, particularly in a hot and humid environment. Herein, we demonstrated a novel infrared-transmittance visible-opaque PM2.5 media for radiative cooling utilizing rutile titanium dioxide particle-embedded polyamide 6 (PA6-TiO2). The transmission of visible light and infrared and PM2.5 removal performance of composite media containing a variety of microstructures, such as TiO2 particles of varying sizes, shapes, and contents, were numerically examined to determine the optimal ranges. Then the PA6-TiO2 media was effectively electrospun by controlling the arrangement of fibers and the morphology of TiO2 particles. By transmitting more than 85% of the thermal radiation from the human body and selectively blocking solar irradiance, the developed PA6-TiO2(flower-shaped) media cooled the simulative skin by 10.3°C as compared with commercial masks under strong solar irradiance. Additionally, they demonstrated a high PM2.5 removal efficiency of 95.3%, a low air resistance of 22.5 Pa (at 5.3 cm/s), and a sound water vapor transmission rate of 0.0169 g cm−2 h−1. This study presents an effective strategy for making thermally comfortable anti-PM2.5 masks, which will significantly benefit the public health prevention and control. © The Author(s) 2022.

The alternative renin-angiotensin-system (RAS) signalling pathway in prostate cancer and its link to the current COVID-19 pandemic.

BACKGROUND: The renin-angiotensin system is known to maintain blood pressure and body fluids. However, it has been found to consist of at least two major constituents, the classic and the alternative pathway, balancing and supporting each other's signalling in a very intricate way. Current research has shown that the renin-angiotensin system is involved in a broad range of biological processes and diseases, such as cancer and infectious diseases. METHODS AND RESULTS: We conducted a literature review on the interaction of the renin-angiotensin system and prostate cancer and explored the research on the possible impact of the SARS-CoV-2 virus in this context. This review provides an update on contemporary knowledge into the alternative renin-angiotensin system, its role in cancer, specifically prostate cancer, and the implications of the current COVID-19 pandemic on cancer and cancer care. CONCLUSION: In this work, we aim to demonstrate how shifting the RAS signalling pathway from the classic to the alternative axis seems to be a viable option in supporting treatment of specific cancers and at the same time demonstrating beneficial properties in supportive care. It however seems to be the case that the infection with SARS-CoV-2 and subsequent impairment of the renin-angiotensin-system could exhibit serious deleterious long-term effects even in oncology.

A Short and Highly Efficient Method for Producing Meltblown Nano Yarn with a Helical Structure and High Conductivity

The COVID-19 outbreak has led to the overproduction of meltblown fabrics commonly used in personal protective equipment such as face mask. Moreover, the yield ofconventional fabrication methods for meltblown fabrics have poor mechanical properties and lack accessional value and functional applicability. In this study, a short and highly efficient process was employed to produce polypropylene/polypyrrole (PPy) meltblown nanoyarn (PPMNY). The mechanical properties were improved by utilizing a helical structure, and the conductivity was enabled using a combination of PPy nanoparticles. The breaking force of the proposed PPMNY was as high as 10.1cN/tex at 9T/10 cm, nearly 3.3 times more than PPMNY without the helical structure. The breaking force of the proposed PPMNY was unaffected by the washing process, and the frictional properties and snarling information were similarly maintained by the helical structure. Additionally, the optimal conductivity of the proposed PPMNY reached 0.044S·m-1. Therefore, the novel methods investigated in this study can improve the properties of meltblown fabrics to yield a highly efficient and low-cost technique to produce conductive PPMNY. This concept can be extended for solving the problems of the single two-dimensional structure with poor mechanical properties and application on Smart Wearable with preferable conductivity. © Textile Bioengineering and Informatics Symposium Proceedings 2022 - 15th Textile Bioengineering and Informatics Symposium, TBIS 2022.

Are Antisense Long Non-Coding RNA Related to COVID-19?

Fighting external pathogens relies on the tight regulation of the gene expression of the immune system. Ferroptosis, which is a distinct form of programmed cell death driven by iron, is involved in the enhancement of follicular helper T cell function during infection. The regulation of RNA is a key step in final gene expression. The present study aimed to identify the expression level of antisense lncRNAs (A2M-AS1, DBH-AS1, FLVCR1-DT, and NCBP2AS2-1) and FLVCR1 in COVID-19 patients and its relation to the severity of the disease. COVID-19 patients as well as age and gender-matched healthy controls were enrolled in this study. The expression level of the antisense lncRNAs was measured by RT-PCR. Results revealed the decreased expression of A2M-AS1 and FLVCR1 in COVID-19 patients. Additionally, they showed the increased expression of DBH-AS1, FLVCR1-DT, and NCBP2AS2. Both FLVCR1-DT and NCBP2AS2 showed a positive correlation with interleukin-6 (IL-6). DBH-AS1 and FLVCR1-DT had a significant association with mortality, complications, and mechanical ventilation. A significant negative correlation was found between A2M-AS1 and NCBP2AS2-1 and between FLVCR1 and FLVCR1-DT. The study confirmed that the expression level of the antisense lncRNAs was deregulated in COVID-19 patients and correlated with the severity of COVID-19, and that it may have possible roles in the pathogenesis of this disease.

Case Report: Secondary Hemophagocytic Lymphohistiocytosis (sHLH) and Candida auris Fungemia in Post-acute COVID-19 Syndrome: A Clinical Challenge.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a disease (COVID-19) with multisystem involvement. The world is now entering a phase of post-COVID-19 manifestations in this pandemic. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event triggered by viral infections, including SARS-CoV-2. Both Multisystem Inflammatory Syndrome-Adults (MIS-A) and Cytokine Storm Syndrome (CSS) are considered close differentials of sHLH and add to the spectrum of Post-acute COVID-19 syndrome (PACS). In this report, we presented the case of a middle-aged Asian man who was initially discharged upon recovery from severe COVID-19 infection after 17 days of hospitalization to a private institute and later came to our hospital 13 days post-discharge. Here, he was diagnosed with sHLH, occurring as an extension of CSS, with delayed presentation falling within the spectrum of PACS. The diagnosis of sHLH was made holistically with the HLH-2004 criteria. Our patient initially responded to intravenous immunoglobulin (IVIG) and dexamethasone, later complicated by disseminated Candida auris infection and had a fatal outcome. Though many cases of HLH during active COVID-19 and a few cases post COVID-19 recovery have been reported, based on H-score, which has limitations as a diagnostic tool. We report the first case report of post-COVID-19 sHLH using the HLH-2004 criteria, complicated by disseminated Candidemia, emphasizing that the care of patients with COVID-19 does not conclude at the time of hospital discharge. We highlight the importance of surveillance in the post-COVID phase for early detection of sHLH which may predispose to fatal opportunistic infections (OIs).

High-Resolution Magic-Angle Spinning NMR Spectroscopy for Evaluation of Cell Shielding by Virucidal Composites Based on Biogenic Silver Nanoparticles, Flexible Cellulose Nanofibers and Graphene Oxide.

Antiviral and non-toxic effects of silver nanoparticles onto in vitro cells infected with coronavirus were evaluated in this study using High-Resolution Magic-Angle Spinning Nuclear Magnetic Resonance (HR-MAS NMR) spectroscopy. Silver nanoparticles were designed and synthesized using an orange flavonoid-hesperetin (HST)-for reduction of silver(I) and stabilization of as obtained nanoparticles. The bio-inspired process is a simple, clean, and sustainable way to synthesize biogenic silver nanoparticles (AgNP@HST) with diameters of ∼20 nm and low zeta potential (-40 mV), with great colloidal stability monitored for 2 years. The nanoparticles were used for the fabrication of two types of antiviral materials: colloids (AgNP@HST spray) and 3D flexible nanostructured composites. The composites, decorated with AgNP@HST (0.05 mmol L-1), were made using cellulose nanofibers (CNF) obtained from orange peel and graphene oxide (GO), being denominated CNF@GO@AgNP@HST. Both materials showed high virucidal activity against coronaviruses in cell infection in vitro models and successfully inhibited the viral activity in cells. HR-MAS 1H-NMR technique was used for determining nanomaterials' effects on living cells and their influences on metabolic pathways, as well as to study viral effects on cells. It was proven that none of the manufactured materials showed toxicity towards the intact cells used. Furthermore, viral infection was reverted when cells, infected with the coronavirus, were treated using the as-fabricated nanomaterials. These significant results open possibilities for antiviral application of 3D flexible nanostructured composite such as packaging papers and filters for facial masks, while the colloidal AgNP@HST spray can be used for disinfecting surfaces, as well as a nasal, mouth, and eye spray.

Fatal Gets More Fatal: A COVID-19 Infection With Macrophage Activation Syndrome.

Coronavirus disease 2019 (COVID-19) continues to be fatal despite advances in the understanding of characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), global prevention strategies, new anti-viral treatments, and worldwide vaccination programs. The exact underlying mechanism through which SARS-CoV-2 leads to acute respiratory distress syndrome (ARDS) resulting in intensive care unit admission, mechanical ventilation, and eventually death remains elusive. Cytokine storm is one of the most favorable mechanisms that scientists show remarkable interest to target in randomized clinical trials with promising outcomes. Macrophage activation syndrome (MAS), the most serious form of cytokine storm, requires early recognition and treatment regardless of etiology. Here, we report a 59-year-old gentleman with a COVID-19 infection complicated by MAS. Our aim is to increase awareness of this condition among health care providers as it necessitates prompt diagnosis and treatment due to an extremely poor prognosis.

Insights into Cardiovascular Defects and Cardiac Epigenome in the Context of COVID-19.

Although few in number, studies on epigenome of the heart of COVID-19 patients show that epigenetic signatures such as DNA methylation are significantly altered, leading to changes in expression of several genes. It contributes to pathogenic cardiac phenotypes of COVID-19, e.g., low heart rate, myocardial edema, and myofibrillar disarray. DNA methylation studies reveal changes which likely contribute to cardiac disease through unknown mechanisms. The incidence of severe COVID-19 disease, including hospitalization, requiring respiratory support, morbidity, and mortality, is disproportionately higher in individuals with co-morbidities. This poses unprecedented strains on the global healthcare system. While their underlying conditions make patients more susceptible to severe COVID-19 disease, strained healthcare systems, lack of adequate support, or sedentary lifestyles from ongoing lockdowns have proved detrimental to their underlying health conditions, thus pushing them to severe risk of congenital heart disease (CHD) itself. Prophylactic vaccines against COVID-19 have ushered new hope for CHD. A common connection between COVID-19 and CHD is SARS-CoV-2's host receptor ACE2, because ACE2 regulates and protects organs, including the heart, in various ways. ACE2 is a common therapeutic target against cardiovascular disease and COVID-19 which damages organs. Hence, this review explores the above regarding CHDs, cardiovascular damage, and cardiac epigenetics, in COVID-19 patients.

Clinical aspects and presumed etiology of multisystem inflammatory syndrome in children (MIS-C): A review.

The COVID-19 outbreak sparked by SARS-CoV-2, begat significant rates of malady worldwide, where children with an abnormal post-COVID ailment called the Multisystem Inflammatory Syndrome (MIS-C), were reported by April 2020. Here we have reviewed the clinical characteristics of the pediatric patients and the prognosis currently being utilized. A vivid comparison of MIS-C with other clinical conditions has been done. We have addressed the probable etiology and fundamental machinery of the inflammatory reactions, which drive organ failure. The involvement of androgen receptors portrays the likelihood of asymptomatic illness in children below adolescence, contributing to the concept of antibody-dependent enhancement.