SARS-CoV-2 infection (COVID-19) and male fertility: Something we should be worried about?

As of 2021, roughly 5 million deaths were linked to SARS-CoV-2 infection based on World Health Organization estimates. The pandemic takes its staggering death toll, severely affecting the healthcare systems and leading to detrimental implications globally. While the severe impact on the respiratory system is well-established, the exact effect on male reproduction is still largely uncharted territory. When it comes to gender, men appear more vulnerable compared to women. Increasing evidence suggests that COVID-19 adversely affects spermatogenesis and hormonal balance in diverse ways. Semen parameters seem to be compromised at least temporarily, while long-term worsening needs to be clarified in studies with extended follow-up. For the time being, no data support the adverse effect of COVID-19 vaccines on a male's reproductive health. In the present article, we examine the available literature and briefly discuss the impact of the virus on reproduction and fertility. We further provide a comprehensive overview of the current status of vaccination and its potential effect on male fertility. Ultimately, we address the need for future well-designed large-scale trials before drawing definite conclusions on the exact impact of the virus on a male's fecundity.

Fear and anxiety in professionals about COVID-19: Brazilian versions of measures / Medo e ansiedade de profissionais frente à COVID-19: versões brasileiras de medidas

The objective of this study was to adapt and verify the psychometric properties of the Fear of COVID-19 Scale and Coronavirus Anxiety Scale, from the data collection conducted with professionals who work directly in the fight against COVID-19 in Brazil. A total of 232 professionals participated (Mage = 32.9; SD = 7.6), most of them female (68.1%), who answered the Fear of COVID-19 Scale, the Coronavirus Anxiety Scale, and the Depression, Anxiety, and Stress Scale instruments and a sociodemographic questionnaire. The adaptation process allowed identifying the content validity of the Brazilian versions and exploratory factorial analyses, followed by correlation studies showing evidence of internal structure validity and in relation to other (convergent) Fear of COVID-19 Scale and Coronavirus Anxiety Scale variables, which presented equally satisfactory reliability rates. Thus, the Brazilian versions of the Fear of COVID-19 Scale and Coronavirus Anxiety Scale scales were made available with satisfactory psychometric qualities for use in the research and assessment of psychological aspects of health professionals.

Objetivou-se adaptar e verificar as propriedades psicométricas das escalas Fear of COVID-19 Scale e Coronavirus Anxiety Scale a partir da coleta de dados realizada com profissionais que atuam diretamente no combate à COVID-19 no Brasil. Participaram do estudo 232 profissionais (Midade = 32,9 anos; DP = 7,6), sendo a maioria do sexo feminino (68,1%), que responderam aos instrumentos Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Depression, Anxiety and Stress Scale e um questionário sociodemográfico. O processo de adaptação permitiu identificar a validade de conteúdo das versões brasileiras e análises fatoriais exploratórias, seguidas de estudos de correlação que atestaram evidências de validade de estrutura interna e em relação com outras variáveis (convergente) da Fear of COVID-19 Scale e da Coronavirus Anxiety Scale, as quais apresentaram índices de confiabilidade igualmente satisfatórios. Dessa forma, foram disponibilizadas versões brasileiras das escalas Fear of COVID-19 Scale e Coronavirus Anxiety Scale com qualidades psicométricas satisfatórias para o uso em pesquisas e avaliação de aspectos psicológicos de profissionais de saúde.

Angiotensin Converting Enzyme 2 (ACE2)-A macromolecule and its impact on human reproduction during COVID-19 pandemic

Coronavirus disease 2019 (COVID 19) is caused by severe acute respiratory syndrome novel coronavirus 2 (SARS-nCoV-2). It has been declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, several researchers have worked/ are working on this virus by a multifactorial approach to finding out the mechanism of entry, transmission route, post-infection replication process, survival, and post-recovery utilities. As we know, SARS, MERS, and Zika viruses have affected human reproductive potentials, consequently, COVID 19 also can affect both men's and women's reproductive potential through ACE2 macromolecule. This study aimed to summarize the role of ACE2-macromolecule in COVID 19 entry and further processes in the reproductive path of both men and women. Research articles were searched in NCBI-NLM, Google Scholar, and Scopus databases. We searched based on the phrase ―COVID 19”, ―ACE2”, ―ACE2 in testes”, ―ACE2 in the female reproductive tract”, ―ACE2 during pregnancy”, ―ACE2 during early embryo”, ―COVID 19 and impact in human reproduction” and selected the articles for summarizing this article. Most recent articles and the mechanism of COVID 19 were selected for our understanding. The results of the study revealed that COVID 19 impacts the reproductive potential of both men and women. Testes are the most vulnerable organ prone to infection in men, and vaginal fluid and the uterus could be the choice of infection in the female. Till now, COVID 19 has not been directly detected in semen samples and vaginal fluid. Results of the study can be concluded that ACE2 plays a major role in COVID 19 infection, ACE2 expression could Angiotensin Converting Enzyme 2 (ACE2) - A macromolecule and its impact on human reproduction. © 2022, Editorial board of Journal of Experimental Biology and Agricultural Sciences. All rights reserved.

Safety of mRNA-Platform based Covid-19 Vaccines in Pediatric Population: An Analysis of the European Pharmacovigilance Database Eudravigilance: An International Journal of Medical Toxicology and Drug Experience

Introduction: Recently mRNA-based COVID-19 vaccines have been approved also for use in pediatric population. Vaccines safety require particular attention in this population. Analysis of pharmacovigilance database allows to extrapolate important information to identify possible safety signals. Objective: Our pharmacovigilance study aims to describe and evaluate the onset of adverse events following immunization (AEFIs) with COVID-19 mRNA vaccines in the pediatric population. Methods: We retrieved all pediatric Individual Case Safety Reports (ICSRs) collected in the European pharmacovigilance database, Eudravigilance from the 01/01/2021 to 4/03/2022 related to Spikevax and Comirnaty. We carried out a disproportionality analysis (Reporting Odds Ratio-95% CI) to compare the reporting probability of some AEFIs of interest (seizure, pericarditis, myocarditis, multisystem inflammatory syndrome (MIS), menstrual disorders, failure and anaphylactic shock) between Comirnaty and Spikevax. Results: We retrieved in Eudravigilance 25.019 ICSR related to Comirnaty describing a total of 75.040 AEFIs and 1.862 ICSRs referred to Spikevax reporting overall 5.361 AEFIs occurred in pediatric population. Majority of ICSRs reported well-known general disorders (headache, pyrexia, fatigue and nausea) for both mRNA vaccines. ICSRs were more frequently referred the adolescent patients (Comirnaty, 86.2%;Spikevax, 86.4%). We found a slight prevalence of female gender for both mRNA vaccine (Spikevax, 52.6 %;Comirnaty 53.9%). Reproductive system disorders were more frequently referred to females. In particular, these events included menstrual disorders (N = 609, Comirnaty;N = 23, Spikevax), amenorrhoea (N = 408, Comirnaty;N = 16, Spikevax) or intermenstrual bleeding (N = 169, Comirnaty;N = 10, Spikevax), polymenorrhoea (N = 172, Comirnaty;N = 10, Spikevax). Few cases described reproductive system disorders in males, mainly related to Comirnaty. These AEFIs included testicular pain (N = 14, Comirnaty;N = 1, Spikevax), erectile dysfunction (N = 5, Comirnaty), testicular torsion (N = 4, Comirnaty) or swelling (N = 4, Comirnaty), scrotal pain (N = 3, Comirnaty) or oedema (N = 1, Comirnaty). Outcome of AEFIs was unknown in 14.8% and 21.1% cases for Spikevax and Comirnaty, respectively. AEFIs had a favorable outcome in more than 50% of cases for both mRNA vaccines, including a complete resolution (30%) or an ongoing resolution (20%). From disproportionality analysis emerged a statistically significant ROR for menstrual disorders (ROR 1.72, 95% CI 1.43-2.10;p < 0.05), failure (ROR 8.11, 95% CI 5.05-13.97;p < 0.05) and seizure (ROR 1.54, 95% CI 1.03-2.41;p = 0.037) when compared Comirnaty versus Spikevax. Conclusion: Majority of pediatric AEFIs are mild and with a positive outcome, supporting the role of ongoing COVID-19 vaccination campaign in this population as a critical public health tool for disease prevention and control of pandemic. Further investigations are needed in this population.

SARS-CoV-2 Effects on the Male Genitourinary System.

SARS-CoV-2 infection arose in 2019 and has changed life as we know it. With our ever-advancing knowledge, therapies, and vaccines, more functions of the SARS-CoV-2 virus are being investigated outside of its pulmonary invasion. Here, we set out to review the current and pertinent literature on the impact of SARS-CoV-2 on the male genitourinary system including the bladder, lower urinary tract, prostate, testis, and penis. The biggest newsworthy stake was if SARS-CoV-2 could be transmitted through semen. Although initially thought to occur, more recent studies have opposed this hypothesis. Outside of the reproductive spread of SARS-CoV-2, multiple studies in this review highlight where the virus resides and what effect it may be having on this genitourinary system including increased voiding problems, viral persistence months after systemic clearance, and rare penile complications post-infection. Long-term outcomes are still needed to fully understand how SARS-CoV-2 infection can alter the genitourinary system.

Cambios en fuerza explosiva y agilidad tras un entrenamiento online en jóvenes jugadores de baloncesto confinados por COVID-19 (Changes in explosive strength and agility after an online training in young basketball players confined by COVID-19)

The closure of sports centers and suspension of training and competitions caused by COVID-19 led to a significant decrease in physical activity of high performance basketball players. The aim of this study was to investigate if a strength online training program was able to improve height and power in jumping, and to mitigate the effects of the quarantine in agility. Fifty-one elite youth basketball players (72.74 ± 13.30 kg;1.85 ± .10 m), were divided into three age categories (Infants (U-14): 20 players, 13.45 ± .51 years;Cadets (U-16): 22 players, 15.59 ± .50 years;Juniors (U-18): 9 players, 17.00 ± .50 years) and evaluated for parameters related to body composition, explosive strength during jumping (bilateral and unilateral Abalakov test), and agility (V-Cut test). Weight and BMI were negatively affected. Explosive strength improved after the intervention (p < .001) in all variables and categories, while agility worsened significantly (p < .001), confirming that the lack of space to move and the absence of perceptual-cognitive orientation in training are important limitations, with worse consequences as age increases. Mandatory quarantine can (and should) be an opportunity for the development of basic physical skills such as strength (paying special attention to training loads), provided that a planned and specific work of reintegration into the game is carried out afterwards. Physical trainers should pay special attention to loads in confinement, as they may be insufficient for more capable and trained athletes. Alternate : El cierre de centros deportivos y suspensión de entrenamientos y competiciones provocadas por la COVID-19 conllevó una merma importante en la actividad física de los deportistas de alto rendimiento. El objetivo de este estudio fue conocer si un programa de entrenamiento supervisado online, orientado a la fuerza, fue capaz de mejorar la altura y potencia en el salto, y mitigar los efectos de la cuarentena en la agilidad. 51 jugadores de baloncesto de élite en formación (72.74 ± 13.30 kg;1.85 ± .10 m), fueron divididos según categoría de edad (Infantil (U-14): 20 jugadores, 13.45 ± .51 años;Cadete (U-16): 22 jugadores, 15.59 ± .50 años;y Junior (U-18): 9 jugadores, 17.00 ± .50 años) y evaluados de composición corporal, fuerza explosiva (test de salto Abalakov, bilateral y unilateral) y agilidad (test V-Cut). Peso y BMI se vieron negativamente afectados. La fuerza explosiva mejoró tras la intervención (p < .001) en todas las variables y categorías, mientras la agilidad empeoró significativamente (p < .001), confirmando que la falta de espacio para realizar desplazamientos y la ausencia de orientación perceptiva-cognitiva en el entrenamiento son limitaciones determinantes, con peores consecuencias cuando aumenta la edad. La cuarentena obligatoria puede (y debe) verse como una oportunidad para el desarrollo de habilidades físicas básicas como la fuerza (prestando especial atención a las cargas de entrenamiento), siempre que se realice después un trabajo planificado y específico de reinserción al juego. Los preparadores físicos deben prestar especial atención a las cargas en un confinamiento, pues pueden ser insuficientes para deportistas más capaces y formados.Alternate :O fechamento de centros esportivos e a suspensão de treinamentos e competições provocados pelo COVID-19 levaram a uma diminuição significativa da atividade física de atletas de alto rendimento. O objetivo deste estudo foi descobrir se um programa de treinamento on-line supervisionado e orientado para a força era capaz de melhorar a altura e a potência no salto e mitigar os efeitos da quarentena na agilidade. 51 jogadores de basquete de elite em treinamento (72,74 ± 13,30 kg;1,85 ± 0,10 m), foram divididos de acordo com a categoria de idade (Infantil (Sub-14): 20 jogadores, 13,45 ± 0,51 anos;Cadete (Sub-16) : 22 jogadores, 15,59 ± 0,50 anos;e Júnior (U-18): 9 jogadores, 17,00 ± 0,50 anos) e avaliados quanto à composição corporal, força explosiva (teste de salto de Abalakov, bilateral e unilateral) e agilidade (teste V -Cortar). Peso e IMC foram afetados negativamente. A força explosiva melhorou após a intervenção (p <0,001) em todas as variáveis ​​e categorias, enquanto a agilidade piorou significativamente (p <0,001), confirmando que a falta de espaço para realizar os movimentos e a ausência de orientação perceptivo-cognitiva em os treinamentos são limitações determinantes, com consequências piores com o aumento da idade. A quarentena obrigatória pode (e deve) ser vista como uma oportunidade para o desenvolvimento de habilidades físicas básicas como força (com atenção especial às cargas de treinamento), desde que um trabalho planejado e específico de reintegração ao jogo seja realizado posteriormente. Os treinadores devem prestar atenção especial às cargas em confinamento, pois podem ser insuficientes para atletas mais capazes e instruídos.

SARS‐CoV‐2’nin Erkek Üreme Sistemi Üzerindeki Etkileri

Yeni Koronavirüs (SARS-CoV-2) ilk olarak Çin’in Vuhan şehrinde ortaya çıkmış ve Yeni Koronavirüs Hastalığı’na (Covid-19) neden olmuştur. Covid-19 dünya çapında hızla yayılmakta ve vaka sayısı tüm ülkelerde artmaktadır. 22 Kasım verilerine göre dünya genelinde vaka sayısının 57.8 milyonu geçtiği ve 1.3 milyon kişinin hayatını kaybettiği bildirilmiştir. SARS‐CoV‐2’nin, hücrelere girmek için bir reseptör olarak anjiyotensin-dönüştürücü enzim 2’yi (ACE2) kullandığı bilinmektedir. ACE2 ekspresyon dağılımının organa özgü olduğu, testis ve böbrek dokuları başta olmak üzere kardiyovasküler ve gastrointestinal sistemde de bulunduğu belirtilmiştir. ACE2 reseptörlerinin ekspresyonu hem erkek hem de dişi üreme organlarında yer almaktadır. SARS‐CoV‐2’nin enfeksiyon oranları yaş gruplarına göre farklılık göstermektedir. Erkekler kadınlardan daha yüksek hastalık prevalansına sahiptir. Normal testis dokularında ACE2 antikorunun kullanıldığı immünohistokimyasal (ÍHK) analizlerde, seminifer tübül ve Leydig hücrelerinde yüksek boyanmaya neden olduğu görülmüştür. SARS‐CoV‐2’den etkilenen hücrelerin spermatogenezi engelleyeceği ve erkek infertilitesine neden olabileceği belirtilmiştir. SARS-CoV-2’nin üreme sistemini etkileme düzeyini belirlemek oldukça güçtür. Bu hastalığın tedavisinde kullanılacak kesin bir ilaç veya aşı olmadığı için, çalışmaların uzun bir süre devam edeceği ve daha çok şey öğreneceğimiz düşünülmektedirAlternate :The New Coronavirus (SARS-CoV-2) first appeared in Wuhan, China and caused the New Coronavirus Disease (Covid-19). Covid-19 is spreading rapidly around the world and the number of cases is increasing in all countries. According to the data of 22 November, it has been reported that the number of cases exceeded 57.8 million and 1.3 million people died worldwide. SARS‐CoV‐2 is known to use angiotensin-converting enzyme 2 (ACE2) as a receptor to enter cells. It has been reported that the distribution of ACE2 expression is organ-specific, and it is found in the cardiovascular and gastrointestinal systems, especially in testes and kidney tissues. Expression of ACE2 receptors is located in both male and female reproductive organs. The infection rates of SARS‐CoV‐2 vary according to age groups. Men have a higher prevalence of the disease than women. In immunohistochemical (IHC) analyzes using ACE2 antibody in normal testicular tissues, it was observed that it caused high staining in seminiferous tubule and Leydig cells. It has been stated that cells affected by SARS‐CoV‐ 2 will inhibit spermatogenesis and cause male infertility. It is very difficult to determine the effect level of SARS-CoV-2 on the reproductive system. Since there is no definitive drug or vaccine to be used in the treatment of this disease, it is thought that the studies will continue for a long time and we will learn more.

COVID-19: a risk for diabetes induced male subfertility. (Special Issue: Covid-19 in India.)

The latest corona virus epidemic COVID-19 triggered by the SARS-Cov2 virus has become exponentially high across the globe. Moderate and extreme pneumonia along with respiratory distress, fever, fatigue and malaise are clinically decripted among infected persons. Patients with severe COVID-19 can also develop a systemic inflammatory response that leads to multisystem organ dysfunction. Case studies across many countries suggest that severe acute respiratory syndrome corona viruses (SARS-CoV and SARS-CoV-2) can invade islet cells via angiotensin converting enzyme-2 (ACE-2) receptors and is responsible for reversible beta-cell damage and transient hyperglycemia and diabetic ketoacidosis. Also, hypercytokinemia might have indirect destabilizing effect on pancreatic islets in COVID-19 patients that accelerate development of insulin resistance and type 2 Diabetes Mellitus (T2DM). Testicular resistance of insulin and altered insulin signalling on the other hand is responsible for decreased steroidogenesis by Leydig cells. Cytokine and chemokines in diabetic testicular tissue also induce sperm cell apoptosis. Additionally, ACE2 expression in the testis is restricted to the Leydig and Sertoli cells in humans which suggests that SARS-Cov2 has the likelihood of infecting the male gonad. Autopsied testicular and epididymal tissues of COVID-19 patients also showed signature of inflammation and germ cell apoptosis. This review work hypothesize that the male subfertility observed in COVID 19 survivors may be due to direct invading of SARS Cov 2 virus in testis or by development of diabetes and transient glucose metabolic disorders.

Human ACE2 and TMPRSS2 interaction with SARS-CoV-2 in COVID-19 patient: a review on male reproductive disorders

Since its inception in 2019 from China, the novel Coronavirus has caused an unprecedented havoc in the economic and public health sector. Many countries were forced to close their borders and cross-border interactions in order to limit the spread of the disease. Furthermore, many economic and commercial activities were adversely affected as many businesses had to close. The only ones that the pandemic spared were the ones providing essential services. By March 2020, many public healthcare facilities had already been overrun. Other governments devised alternative means of managing significant cases of COVID-19, such as introducing home-based care to give room for more critical cases to be taken care of in intensive care units. It is imperative to identify the disease's risk factors to mitigate the unexpected devastation caused by the SARS-CoV-2. Global epidemiological results indicate that men, especially the elderly, are more susceptible to Coronavirus infection. The number of reported Coronavirus cases varies by gender, and this disparity continues to grow in favor of male participants until they reach the age of 60. Other studies have also established that men more than women are susceptible to coronavirus infection. Further, male patients diagnosed with coronavirus infection were shown to have an elevated mortality rate. SARS-CoV-2 is the Covid-19 pathogen that is transmitted via respiratory globules, through indirect or direct interaction. Evaluation of the genome has revealed that SARS-CoV-2 is 79% similar to SARS-CoV-2;they employ ACE2 receptors to attack cells, meanwhile it has been established that TMPRSS2 promotes ACE2, therefore causing more severe reactions in comparison to the other types of coronaviruses. Studies describe ACE2 as a gateway for viruses to enter cells. It is directly associated with the COVID-19 clinical symptoms. Research has shown that TMPRSS2 and ACE2 are expressed in the male reproductive system tract and testis and are controlled by testosterone. Thus, the male reproductive system has all the mechanism needed to bid SARs-CoV-2, and these possibilities raise the capability of ACE2 and TMPRSS2 as potential vectors of COVID-19. This review examines how the novel Coronavirus find its way into the human cells through known receptors such as ACE2, antibody Fcy R, etc. The examination is also done on the mechanisms of its spike proteins transition with the help of proteases such as cathepsins, Furin, and TMPRSS2. The study reviewed six articles selected based on PRISMA criteria.

The potential impact of COVID-19 on male reproductive health.

The SARS-CoV-2 virus continues to overwhelm health care systems impairing human to human social and economic interactions. Invasion or damage to the male reproductive system is one of the documented outcomes of viral infection. Existing studies have reported that SARS-CoV-2 may contribute to this loss in relation to inflammatory responses and the formation of cytokine storms in COVID-19 patients. Although direct infection of the testes and entry of SARS-CoV-2 into semen as well as subsequent consequences on the male reproductive system need to be studied more systematically, warnings from two organising ASRM and SART for prospective parents when infected with SARS-CoV-2 should be considered. In the context of an increasingly complex pandemic, this review provides preliminary examples of the potential impact of COVID-19 on male reproductive health and guidance for prospective parents currently infected with or recovering from SARS-CoV-2.

Prospective two-arm study of the testicular function in patients with COVID-19.

BACKGROUND: The COVID-19 pandemic has led the international community to conduct extensive research into potential negative effects of the disease on multiple organs and systems in the human body. One of the most discussed areas is potential of the virus to compromise the testicular function. However, the lack of prospective studies on this topic makes it impossible to draw reliable conclusions on whether the disease affects the male reproductive system and, if so, to what extent. OBJECTIVES: The current trial is aimed at investigating the effect of SARS-CoV-2 on the testicular function, hormone levels and determining the extent of impact on spermatogenesis and damage to testicular tissue. MATERIALS AND METHODS: This prospective study included healthy controls and cases of patients suffering from viral pneumonia based on chest computed tomography (CT) and a positive SARS-CoV-2 throat swab exhibited moderate symptoms (World Health Organization (WHO) classification). Epidemiological, clinical, laboratory and ultrasound data were collected. A semen analysis was performed in cases during their hospital stay and 3 months after the discharge home. We also assessed the testicles obtained during autopsies of patients who died of COVID-19 (n = 20). RESULTS: A total of 88 participants were included (44 controls and 44 cases). Blood testosterone levels were significantly decreased in 27.3% of the cases (12/44). The mean level (7.3±2.7 nmol/L) was lower than that in the healthy controls (13.5±5.2 nmol/L, p < 0.001). An increase in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) was also detected compared to the healthy controls (p = 0.04 and p = 0.002). The semen analysis revealed decreased motility in COVID-19 patients (p = 0.001), and a higher number of immobile sperm (during COVID-19: 58.8% and at 3 months 47.4%, p = 0.005). All parameters returned to normal at 3 months after discharge. Direct mixed agglutination reaction (MAR) test at 3 months showed an increase of Ig A (p = 0.03). In the majority of autopsies (18/20), structural disorders of the testicular tissue, with signs of damage to germ cells were observed. DISCUSSION AND CONCLUSION: COVID-19 and its management strategies significantly affect male hormone levels and sperm quality at the onset of the disease. Postmortem examination of testicular tissue confirmed inflammation and viral infiltration of the testicles. However, in patients with moderate to severe disease, the studied parameters of the testicular function returned to normal values within 3 months.

Perspectives into the possible effects of the B.1.1.7 variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on spermatogenesis.

B.1.1.7 is a recently discovered variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with increased transmissibility. Recent findings indicate that this variant has a propensity to infect adolescents and children at higher rates than adults. The virus gains entry into various body cells utilizing angiotensin-converting enzyme 2 (ACE-2) and basigin (CD147) as receptors. The virus mainly affects type II pneumocytes of lungs, endothelial cells, enterocytes, and renal tubular cells. It is reported to affect testes, causing testicular pain, and producing histopathological changes, as observed in some autopsies. The B.1.1.7 variant can also affect various cells in the testes. This raises a major concern regarding the long-term effects of the viral infection on spermatogenesis and highlights the pressing need for a robust database of serum samples from infected male children.

Early and late endocrine complications of COVID-19.

Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.

Interplay between endocrinology, metabolism and COVID-19 infection.

There are more than 170 million confirmed cases of COVID-19 worldwide, yet its effects on the endocrine system remain under-reported due to lack of awareness by the public, primary care givers and specialists. This is a narrative review using up-to-date literature discussing the consequences that infection with SARS-CoV-2 can have on diabetes and the endocrine glands including the adrenals, thyroid and pituitary, as well as hyponatremia and hypogonadism. Endocrinologists, internists and primary care physicians need to be aware of the involvement of the endocrine organs when dealing with people recovering from COVID-19 and actively manage any complications to reduce mortality and improve the quality of life of those affected.

[SARS-CoV-2 pandemic and assisted reproduction]. / Pandemia del SARS-CoV-2 y reproducción asistida.

The pandemic caused by the new SARS-CoV-2 virus has led to a process of adaptation to the new situation by society as a whole and, therefore, by assisted reproduction centres. After the acute phase of the health crisis, when activity was drastically reduced, cycles have resumed, guided by the recommendations of scientific societies.In this article, a review is presented of all the published information regarding the virus and the reproductive system, pointing out the presence of angiotensin-converting enzyme 2 (ACE2) in the female and male reproductive system, at the testicular, ovarian, endometrial and embryonic levels. In addition, a comparative analysis is carried out between the recommendations of the scientific societies regarding the screening of infection, performance standards, and general laboratory measurements.

SARS-CoV-2 Infects Hamster Testes.

The COVID-19 pandemic continues to affect millions of people worldwide. Although SARS-CoV-2 is a respiratory virus, there is growing concern that the disease could cause damage and pathology outside the lungs, including in the genital tract. Studies suggest that SARS-CoV-2 infection can damage the testes and reduce testosterone levels, but the underlying mechanisms are unknown and evidence of virus replication in testicular cells is lacking. We infected golden Syrian hamsters intranasally, a model for mild human COVID-19, and detected viral RNA in testes samples without histopathological changes up to one month post-infection. Using an ex vivo infection model, we detected SARS-CoV-2 replication in hamster testicular cells. Taken together, our data raise the possibility that testes damage observed in severe cases of COVID-19 could be partly explained by direct SARS-CoV-2 infection of the testicular cells.

SARS-CoV-2 and the reproductive system: known and the unknown..!!

BACKGROUND: COVID-19 is the most recent zoonotic outbreak of coronaviruses. Mostly, it invades the cells of the respiratory system by binding to the receptor angiotensin-converting enzyme 2 (ACE2) which is also present in other organs like the kidney, testis, ovaries, breast, heart, and intestine, rendering them prone to be infected. The reproductive potential is a must for the sustenance of any species and it is our prime duty to safeguard the reproductive system of the present generation from such a deadly virus. The previously reported coronaviruses like severe acute respiratory syndrome coronavirus (SARS-CoV) had a detrimental impact on reproductive organs. There is a dearth of sufficient research to provide substantial evidence for the harmful effects of this novel virus on the reproductive system. Hence, our review compiles the knowledge available until now to boost research in this regard and to take the necessary steps in time. MAIN BODY OF ABSTRACT: Here we tried to compile all the data available on the effect of SARS-CoV-2 on the reproductive system as well as vertical transmission of the virus. All related articles published from February to August 2020 were reviewed and thoroughly analyzed. SARS-CoV-2 has been found to affect the sperm concentration and motility, thus degrading the fertility of males. In females, it is suspected that this virus affects the oocyte quality and ovarian function, resulting in infertility or miscarriage. Traces of SARS-CoV-2 virus have also been found in the breast milk of the infected mothers and the semen of infected males. Vertical transmission of SARS-CoV-2 has also been reported in some cases. CONCLUSION: Based on the literature review, SARS-CoV-2 seems to have the potential of affecting both male and female reproductive tracts. This review brings together the findings and observations made in the area of reproductive health during the current pandemic. The reproductive system of the young population is preordained for subsequent disorders, infertility, reduced sperm count, and motility. Therefore, the research and medical practices should focus on possible vulnerability being posed by SARS-CoV-2 to the gametes and future generations. We, hereby, recommend close monitoring of young and pregnant COVID-19 patients concerning reproductive health with utmost priority.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its effect on gametogenesis and early pregnancy.

SARS-CoV-2 infection and pregnancy has been the topic of hundreds of publications over the last several months; however, few studies have focused on the implications of infection in early pregnancy and reproductive tissues. Here, we analyzed available evidence pertaining to SARS-CoV-2 infection, in early pregnancy, and in reproductive tissues. We searched PubMed and Embase databases in accordance with guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for publications from inception to June 4, 2020. Four reviewers screened titles and abstracts and obtained full-text articles for analysis. Sixty-two studies were included in the review. Biological plausibility for infection with SARS-CoV-2 exists in testis, ovaries, and placenta as they express ACE2 receptor activity. In males, SARS-CoV-2 infection could lead to functional abnormalities leading to spermatogenic failure and male infertility. In females, an alteration of the ACE2 cascade via SARS-CoV-2 infection could lead to impairment in important follicular and luteal processes. There is also evidence of significant placental pathology in SARS-CoV-2 infection, but it is unclear what effects there may be for early pregnancy, though available data suggest less severe effects compared to other respiratory virus outbreaks. Further investigation is needed regarding SARS-CoV-2 in reproductive function and early pregnancy.

Additional diagnostic testing of the 2019 novel coronavirus (SARS-CoV-2).

PURPOSE OF REVIEW: Within the last two decades several members of the Coronaviridae family namely Severe Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV) have demonstrated epidemic potential. In late, 2019 an unnamed genetic relative, later named SARS-CoV-2 realized its potential in the highly populous neighborhoods of Wuhan, China. Unchecked, the virus rapidly spread among interconnected communities and related households before containment measures could be in acted. "Appropriate" diagnostic testing in response to the SARS-CoV-2 outbreak should be urgently considered. This perspective review gives particular attention to the potential diagnostic testing of the virus in semen and seminal fluids due to its high levels of angiotensin converting enzyme 2 (ACE2) precursor. RECENT FINDINGS: As many infectious viruses are stable in semen and have transmitted the respective diseases, the presence of SARS-CoV-2 should be tested in semen to assess their stabilities and half-life. As in case of Ebola virus, it was present in semen for longer period in a carrier man without any symptom. Additional hypothesis is that since ACE2 could serve as a mediator for the endocytosis of the previously SARS coronavirus, SARS-CoV-2 may enter the cells through similar mechanism. From the protein expression atlas, high levels of ACE2 precursor were found in intestines and testis. Hence, the testis and seminal fluids could be the host cell and/or reservoir. The results could be used as a suggestive guideline for the sexual activities after the discharge or declaration of disease free.

COVID-19: clinical and laboratory manifestations in novel coronavirus infection / COVID-19: manifestações clínicas e laboratoriais na infecção pelo novo coronavírus

ABSTRACT COVID-19 is a highly contagious disease caused by the coronavirus of severe acute respiratory syndrome 2 (SARS-CoV-2). In 2020, due to the outbreak, it was considered by the World Health Organization (WHO) as a pandemic. The infection caused by the novel coronavirus has high mortality in a small portion of the infected population, especially in elderly, immunosuppressed, diabetic, cardiac, and hypertensive individuals. Many infected are asymptomatic (and may be carriers) or present mild or moderate flu-like symptoms. The most severe clinical picture of COVID-19 is characterized by an inflammatory cytokine storm, with hematological changes and coagulation dysfunction, which can lead to tissue damage and death. Nonspecific laboratory biomarkers may be either increased or decreased as the course of the disease progresses and are often useful in predicting complications of the disease, such as the use of D-dimer and platelet/lymphocyte ratio. Specific laboratory diagnosis is based on the detection of viral ribonucleic acid (RNA) by real-time polymerase chain reaction (RT-PCR) of nasal and oropharyngeal swab samples; it is more effective when performed in the first days after symptom onset. Serological tests are useful in detecting the immune response, since both class M (IgM) and class G (IgG) immunoglobulin antibodies can be detected seven days after the onset of clinical symptoms, and may extend for more than 25 days, although not exempting the individual from remaining infectious, depending on their viral load and clinical presentation. The rational use of specific laboratory markers must respect the disease chronology, and the correct interpretation may provide subsidies for a better management of affected patients, as well as identifying asymptomatic carriers or those with mild symptoms.

RESUMEN La COVID-19 es una enfermedad altamente contagiosa causada por el coronavirus del síndrome respiratorio agudo grave (SARS-CoV-2). En 2002, a causa del brote, fue reconocida como una pandemia por la Organización Mundial de la Salud (OMS). La infección por el nuevo coronavirus provoca alta mortalidad en una pequeña parcela de la población infectada, especialmente en ancianos, pacientes inmunodeprimidos, diabéticos, cardiópatas e hipertensos. Muchos infectados son asintomáticos (y pueden ser portadores) o presentan síntomas leves a moderados, como en un estado gripal. El cuadro clínico de la COVID-19 en la forma más grave es caracterizado por una tormenta inflamatoria de citoquinas, con cambios hematológicos y de la coagulación que pueden llevar a daño tisular y muerte. Pruebas de laboratorio inespecíficas pueden presentar tasas más altas o bajas según el curso de la enfermedad, y muchas veces son útiles en la predicción de complicaciones, como el uso del dímero D y la ratio plaquetas/linfocitos. El diagnóstico de laboratorio específico se basa en la detección del ácido ribonucleico (ARN) viral por reacción en cadena de la polimerasa (PCR) en tiempo real de muestras de hisopado nasal y orofaríngeo; es más efectiva en los primeros días tras el inicio de los síntomas. Pruebas serológicas son útiles para detectar la respuesta inmune, pues tanto los anticuerpos de la inmunoglobulina M (IgM) como de la G (IgG) pueden se detectar siete días después del inicio de los síntomas clínicos, y pueden permanecer por más de 25 días, aunque no eximen al individuo de seguir infeccioso, dependiendo de su carga viral y presentación clínica. El uso racional de los marcadores de laboratorio específicos debe respetar la cronología de la enfermedad, y la interpretación correcta puede proporcionar recursos para un mejor manejo de los pacientes afectados, así como identificar portadores asintomáticos o con pocos síntomas.

RESUMO COVID-19 é uma doença altamente contagiosa provocada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). Em 2020, devido ao surto, foi caracterizada pela Organização Mundial da Saúde (OMS) como pandemia. A infecção causada pelo novo coronavírus tem alta mortalidade em uma pequena parcela da população infectada, especialmente em indivíduos idosos, imunodeprimidos, diabéticos, cardiopatas e hipertensos. Muitos infectados são assintomáticos (e podem ser portadores) ou apresentam sintomas leves a moderados, semelhantes ao estado gripal. O quadro clínico da COVID-19 na forma mais severa é caracterizado por uma tempestade inflamatória de citocinas, com alterações hematológicas e da coagulação que podem levar ao dano tecidual e morte. Exames laboratoriais inespecíficos podem apresentar-se mais elevados ou diminuídos conforme o curso da doença, e muitas vezes são úteis na predição de complicações, como o uso do D-dímero e a razão plaqueta/linfócitos. O diagnóstico laboratorial específico se baseia na detecção do ácido ribonucleico (RNA) viral por reação em cadeia da polimerase em tempo real (RT-PCR) de amostras de suabe nasal e orofaríngeo; é mais efetivo nos primeiros dias após o início dos sintomas. Testes sorológicos são úteis na detecção da resposta imune, pois tanto os anticorpos da imunoglobulina da classe M (IgM) quanto da classe G (IgG) podem ser detectados após sete dias do início dos sintomas clínicos, podendo se estender por mais de 25 dias, embora não isente o indivíduo de continuar infectante, dependendo de sua carga viral e apresentação clínica. O uso racional dos marcadores laboratoriais específicos deve respeitar a cronologia da doença, e a interpretação correta pode fornecer subsídios para um melhor manejo dos pacientes acometidos, bem como identificar portadores assintomáticos ou com pouco sintomas.