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1.
Chest ; 160(3): 944-955, 2021 09.
Article in English | MEDLINE | ID: covidwho-1275208

ABSTRACT

BACKGROUND: Working in the ICU during the first COVID-19 wave was associated with high levels of mental health disorders. RESEARCH QUESTION: What are the mental health symptoms in health care providers (HCPs) facing the second wave? STUDY DESIGN AND METHODS: A cross-sectional study (October 30-December 1, 2020) was conducted in 16 ICUs during the second wave in France. HCPs completed the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised (for post-traumatic stress disorder), and the Maslach Burnout Inventory. RESULTS: Of 1,203 HCPs, 845 responded (70%) (66% nursing staff, 32% medical staff, 2% other professionals); 487 (57.6%) had treated more than 10 new patients with COVID-19 in the previous week. Insomnia affected 320 (37.9%), and 7.7% were taking a psychotropic drug daily. Symptoms of anxiety, depression, post-traumatic stress disorder, and burnout were reported in 60.0% (95% CI, 56.6%-63.3%), 36.1% (95% CI, 32.9%-39.5%), 28.4% (95% CI, 25.4%-31.6%), and 45.1% (95% CI, 41.7%-48.5%) of respondents, respectively. Independent predictors of such symptoms included respondent characteristics (sex, profession, experience, personality traits), work organization (ability to rest and to care for family), and self-perceptions (fear of becoming infected or of infecting family and friends, feeling pressure related to the surge, intention to leave the ICU, lassitude, working conditions, feeling they had a high-risk profession, and "missing the clapping"). The number of patients with COVID-19 treated in the first wave or over the last week was not associated with symptoms of mental health disorders. INTERPRETATION: The prevalence of symptoms of mental health disorders is high in ICU HCPs managing the second COVID-19 surge. The highest tiers of hospital management urgently need to provide psychological support, peer-support groups, and a communication structure that ensure the well-being of HCPs.


Subject(s)
Anxiety/epidemiology , COVID-19/complications , Critical Care , Depression/epidemiology , Health Personnel/psychology , Mental Health , Physicians/psychology , Adult , Anxiety/etiology , Burnout, Professional/psychology , COVID-19/epidemiology , Cross-Sectional Studies , Depression/etiology , Female , France/epidemiology , Humans , Male , Pandemics , Prevalence
2.
Curr Opin Neurol ; 33(5): 545-552, 2020 10.
Article in English | MEDLINE | ID: covidwho-1219145

ABSTRACT

PURPOSE OF REVIEW: To provide an update on immunomodulating and immunosuppressive therapies in myasthenia gravis and highlight newly approved, or pending approval, therapies with new biologics. RECENT FINDINGS: Preoperative IVIg is not needed to prevent myasthenic crisis in stable myasthenia gravis patients scheduled for surgery under general anesthesia, based on controlled data. Rituximab, if initiated early in new-onset myasthenia gravis, can lead to faster and more sustained remission even without immunotherapies in 35% of patients at 2 years. Biomarkers determining the timing for follow-up infusions in Rituximab-responding AChR-positive patients are discussed. Most patients with MuSK-positive myasthenia gravis treated with Rituximab have sustained long-term remission with persistent reduction of IgG4 anti-MuSK antibodies. Eculizumb in the extension REGAIN study showed sustained long-term pharmacological remissions and reduced exacerbations. Three new biologic agents showed promising results in phase-II controlled myasthenia gravis trials: Zilucoplan, a subcutaneous macrocyclic peptide inhibiting complement C5; Efgartigimod, an IgG1-derived Fc fragment binding to neonatal FcRn receptor; and Rozanolixizumab, a high-affinity anti-FcRn monoclonal antibody. Finally, the safety of ongoing myasthenia gravis immunotherapies during COVID19 pandemic is discussed. SUMMARY: New biologics against B cells, complement and FcRn receptor, are bringing us closer to successful targeted immunotherapies in the chronic management of myasthenia gravis promising an exciting future for antibody-mediated neurological diseases.


Subject(s)
Immunologic Factors/therapeutic use , Immunotherapy/methods , Myasthenia Gravis/drug therapy , Autoantibodies/immunology , COVID-19 , Humans , Immunologic Factors/adverse effects , Immunotherapy/adverse effects , Myasthenia Gravis/immunology , SARS-CoV-2
3.
Front Immunol ; 12: 656700, 2021.
Article in English | MEDLINE | ID: covidwho-1211815

ABSTRACT

SARS-CoV-2, the novel coronavirus infection has consistently shown an association with neurological anomalies in patients, in addition to its usual respiratory distress syndrome. Multi-organ dysfunctions including neurological sequelae during COVID-19 persist even after declining viral load. We propose that SARS-CoV-2 gene product, Spike, is able to modify the host exosomal cargo, which gets transported to distant uninfected tissues and organs and can initiate a catastrophic immune cascade within Central Nervous System (CNS). SARS-CoV-2 Spike transfected cells release a significant amount of exosomes loaded with microRNAs such as miR-148a and miR-590. microRNAs gets internalized by human microglia and suppress target gene expression of USP33 (Ubiquitin Specific peptidase 33) and downstream IRF9 levels. Cellular levels of USP33 regulate the turnover time of IRF9 via deubiquitylation. Our results also demonstrate that absorption of modified exosomes effectively regulate the major pro-inflammatory gene expression profile of TNFα, NF-κB and IFN-ß. These results uncover a bystander pathway of SARS-CoV-2 mediated CNS damage through hyperactivation of human microglia. Our results also attempt to explain the extra-pulmonary dysfunctions observed in COVID-19 cases when active replication of virus is not supported. Since Spike gene and mRNAs have been extensively picked up for vaccine development; the knowledge of host immune response against spike gene and protein holds a great significance. Our study therefore provides novel and relevant insights regarding the impact of Spike gene on shuttling of host microRNAs via exosomes to trigger the neuroinflammation.


Subject(s)
COVID-19/metabolism , Exosomes/metabolism , Interferon-Stimulated Gene Factor 3, gamma Subunit/metabolism , MicroRNAs/metabolism , Microglia/metabolism , SARS-CoV-2/metabolism , Spike Glycoprotein, Coronavirus/metabolism , Ubiquitin Thiolesterase/metabolism , COVID-19/genetics , COVID-19/physiopathology , COVID-19/virology , Cell Line , Central Nervous System/immunology , Central Nervous System/physiopathology , Central Nervous System/virology , Endopeptidases/metabolism , Exosomes/genetics , Exosomes/pathology , Humans , Inflammation/immunology , Inflammation/virology , Interferon-beta/metabolism , MicroRNAs/genetics , Microglia/pathology , NF-kappa B/metabolism , Protein Stability , Tumor Necrosis Factor-alpha/metabolism
4.
Indian J Orthop ; 54(4): 411-425, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1205040

ABSTRACT

BACKGROUND: A mysterious cluster outbreak of pneumonia in Wuhan, China in December 2019 was traced to Severe Acute Respiratory Syndrome Coronavirus 2 and declared a Pandemic by WHO on 11th March 2020. The pandemic has spread rapidly causing widespread devastation globally. PURPOSE: This review provides a brief understanding of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge as well as best practices for orthopaedic surgeons. These are likely to change as knowledge and evidence is gained. RESULTS: Orthopaedic surgeons, like other front-line workers, carry the risk of getting infected during their practice, which as such is already substantially affected. Implementation of infection prevention and control as well as other safety measures for health care workers assumes great importance. All patients/visitors and staff visiting the hospital should be screened. Conservative treatment should be the first line of treatment except for those requiring urgent/emergent care. During lockdown all elective surgeries are to be withheld. All attempts should be made to reduce hospital visits and telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned authorities. All patients being admitted to the hospital in and around containment zones should be tested for COVID-19. There are special considerations for anaesthesia with preference for regional anaesthesia. A separate Operation room with specific workflow should be dedicated for COVID-19 positive cases. CONCLUSIONS: Despite the magnitude of challenge, the pandemic offers significant lessons for the orthopaedic surgeon who should seek the opportunity within the adversity and use this time wisely to achieve his/her Ikigai.

5.
ACS Pharmacol Transl Sci ; 4(2): 1018-1020, 2021 Apr 09.
Article in English | MEDLINE | ID: covidwho-1172545

ABSTRACT

The emergence of vaccine-resistant variants suggests a complicated endemic scenario in the vaccination aftermath for COVID-19. The situation prompts us to enquire whether the antigen adopted by extant vaccines, the trimeric spike (S) protein, is the optimal in the sense of inducing an immunity that leaves the virus with no evolutionary route of evasion. The patterns of glycosylation camouflage suggest that the answer is negative while also suggesting an alternative antigen that appears to be better optimized, eliciting an additional immune attack as the virus gets primed for cell penetration. This type of vaccine is expected to induce antibodies capable of defusing the virus during the priming phase while also circumventing antigenic drift.

6.
Indian J Crit Care Med ; 24(11): 1125-1127, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1106287

ABSTRACT

R0 (R naught) is the basic reproduction number, also known as basic reproduction ratio or rate which is an epidemiological metric used to measure the transmissibility of infectious agents. R0 is a derivative of the following variables-the duration of infectivity after the patient gets infected, the likelihood of transmission of infection per contact between a susceptible person and an infectious individual, and the contact rate. R0 is usually estimated retrospectively from serial epidemiological data or using theoretical mathematical models. Epidemiologists can calculate R0 using contact-tracing data, the most common method is to use cumulative incidence data. When mathematical models are used, R0 values are estimated using ordinary differential equations. R0 of COVID-19 as initially estimated by the World Health Organization (WHO) was between 1.4 and 2.4. The forecast is of critical importance as it will help the governments to have an estimate as well as strategize quickly to avoid any unfavorable condition. HOW TO CITE THIS ARTICLE: Achaiah NC, Subbarajasetty SB, Shetty RM. R0 and Re of COVID-19: Can We Predict When the Pandemic Outbreak will be Contained? Indian J Crit Care Med 2020;24(11):1125-1127.

7.
J Public Health Res ; 9(Suppl 1): 1968, 2020 Nov 17.
Article in English | MEDLINE | ID: covidwho-1106169

ABSTRACT

Background: COVID-19 is affecting all spheres of life. As of 8 September 2020, there have been 321,595 confirmed cases of COVID-19 and 4,107 deaths in Saudi Arabia. The concerns regarding work from offices and contacting others is a global concern during this pandemic. Most of workers are mainly concerns about getting infected and spread it to their families. Therefore, to cope with the COVID-19 pandemic, architects, urban planners, and designers have already switched their attention to visualizing the post-pandemic era; however, there are inadequate studies on how the antivirus-built environment will look. Accordingly, this study aims to reflect on perceptions of the work environment during the COVID-19 pandemic in Saudi Arabia. Design and Methods: An online questionnaire consisting of five questions was designed to collect the data and was distributed via SurveyMonkey in August 2020. Research ethics approval was sought from the institutional review board. A total of 87 respondents participated in this study. Results: The result shows that 57.83% of respondents were female and 42.17% were male. The majority of the respondents were from the public sector (49.40% - public sector, 43.37% - private sector, and 7.23% - other sectors). Overall, female participants were more concerned about work environments during the pandemic. Most of the participants were working in individual offices. Conclusion: The virus does not discriminate by gender. In order to respond effectively to the crisis, we need a whole-society approach to understand its differential impact on women and men. The findings will encourage policymakers and business owners to respond to the areas highlighted in this study as causing concern such as elevators, restrooms, and common areas.

8.
Z Gerontol Geriatr ; 54(2): 141-145, 2021 Mar.
Article in German | MEDLINE | ID: covidwho-1098934

ABSTRACT

BACKGROUND: Following the COVID-19 pandemic residents of nursing homes, their visitors and families as well as employees are faced with new challenges. Protective measures have a strong impact on the well-being of all these groups of persons. MATERIAL AND METHODS: A systematic search was carried out for studies investigating the psychosocial consequences of the COVID-19 pandemic for residents, their visitors and families as well as nursing home staff. Results were analyzed by narrative synthesis. RESULTS: A total of 756 studies were screened and 15 studies were included. These studies were conducted between February and June 2020 with participants from 14 countries. Participants reported loneliness, grief and depressive symptoms among residents. Some gave an account of fear as a reaction of residents to social distancing. Residents with cognitive impairment suffered more although there are conflicting reports. The well-being of visitors and friends was compromised and their feeling of loneliness increased. Nursing home personnel reported fear of getting infected and of infecting residents or their own families. Infected workers in the USA expressed anger about a lack of protection. Furthermore, an increase in workload was reported. CONCLUSION: Studies conducted during the first months of the pandemic reported negative consequences for the psychosocial well-being of residents, their visitors and nursing home staff. Individual needs for future support of these groups are distinct and need further evaluation during the on-going pandemic.


Subject(s)
COVID-19 , Nursing Staff , Humans , Nursing Homes , Pandemics , SARS-CoV-2
9.
Cognit Comput ; : 1-14, 2021 Feb 17.
Article in English | MEDLINE | ID: covidwho-1095748

ABSTRACT

Around the world, scientists are racing hard to understand how the COVID-19 epidemic is spreading and growing, thus trying to find ways to prevent it before medications are available. Many different models have been proposed so far correlating different factors. Some of them are too localized to indicate a general trend of the pandemic while some others have established transient correlations only. Hence, in this study, taking Bangladesh as a case, a 4P model has been proposed based on four probabilities (4P) which have been found to be true for all affected countries. Efficiency scores have been estimated from survey analysis not only for governing authorities on managing the situation (P(G)) but also for the compliance of the citizens ((P(P)). Since immune responses to a specific pathogen can vary from person to person, the probability of a person getting infected ((P(I)) after being exposed has also been estimated. And the vital one is the probability of test positivity ((P(T)) which is a strong indicator of how effectively the infected people are diagnosed and isolated from the rest of the group that affects the rate of growth. All the four parameters have been fitted in a non-linear exponential model that partly updates itself periodically with everyday facts. Along with the model, all the four probabilistic parameters are engaged to train a recurrent neural network using long short-term memory neural network and the followed trial confirmed a ruling functionality of the 4Ps.

10.
Clin Epidemiol Glob Health ; 10: 100705, 2021.
Article in English | MEDLINE | ID: covidwho-1071136

ABSTRACT

INTRODUCTION: COVID19* is a new disease with significant mortality risk. Because of the scarcity of the study on factors associated with the mortality in Tamil Nadu present study was done to determine the factors associated with the outcome of the COVID19 patients admitted in a tertiary care hospital, Madurai. METHODOLOGY: 4530 lab confirmed COVID19 patients admitted from March to August 31st, 2020; excluding the non-responders or who gave incomplete information were included in the study. Data retrieved from Case Investigation Forms *filled through telephonic interview. Chi -square test, Univariate and multivariate logistic regression were used to find out the association between the factors and risk of death(outcome). RESULTS: Out of 4530 COVID19 positive patients 381(8.4%) died and 4149(91.6%) were discharged. Using multivariate logistic regression* following were the factors predicted to be associated with mortality:Age group <17yrs(PR = 4.12),30-44yrs(PR = 2.28),45-59(PR = 3.12),60-69(PR = 4.26) and ≥ 70(PR = 7.05); male gender(PR = 1.26); breathlessness at the time of admission(PR = 7.05); with 1symptom (PR = 2.58), 2symptoms(PR = 3.16) and ≥ 3 symptoms(PR = 2.45); chronic kidney disease(PR = 3.07), malignancy(PR = 2.39); other chronic diseases(PR = 1.89); having only diabetes(PR = 1.58); diabetes with hypertension (PR = 1.70); diabetes with heart disease(PR = 1.94); Hypertension with heart disease(PR = 2.30); diabetes with hypertension and heart disease(PR = 1.58). Survival probability* was more than 90% when patient gets admitted within a week after symptom onset,<80% for between 7 and 10 days and declines thereafter. CONCLUSION: Early insights into factors associated with COVID-19 deaths have been generated in the context of a global health emergency *which may help the treating physician.

11.
Int J Ment Health Addict ; : 1-15, 2021 Jan 20.
Article in English | MEDLINE | ID: covidwho-1047330

ABSTRACT

Despite the pandemic, the Government of Bangladesh decided to keep the banks open to a limited extent to keep the country's economy afloat. The aim of this study is to assess the psychological impact of COVID-19 among the bankers who are usually more exposed to random people that put them at great risk to be affected. A total of 248 bankers willingly answered our questionnaire consisting of DASS-21 and relevant questions. Cronbach's reliability coefficient for the DASS-21 scale ranges from 0.84 to 0.90 which advocates that DASS-21 scales are highly reliable measures for this study. Results show that among participants, 11.1% were severe to extremely stressed, 10.6% of bankers were severe to extremely anxious, and 12.1% of them were severe to extremely depressed. The study illustrated, among the Bankers whose colleagues were infected (B=2.251, 95% CI: - 1.473, 3.029), who smoking more (B= 1.505, 95% CI: 0.411, 2.599), who wake up from sleep having a bad dreams (B = 1.018, 95% CI: 0.057, 1.979), their fear of getting infected (B = 1.717, 95% CI: 0.392, 3.04), who use public transportation (B = 1.378, 95% CI: 0.430, 2.236), who misbehave with family members (B = 1.033, 95% CI: 0.071, 1.995) and who beaten children (B = 1.210, 95% CI: 0.141, 2.279) were responsible for higher stress, depression and anxiety scores respectively. Whereas, taking nutritious food (B = -0.229, 95% CI: -0.30, 1.763), doing physical exercises (B = -0.325, 95% CI: -1.158, 0.508) reduced depression, stress and anxiety scores. The authors believed that the result of the study will be beneficial for the government and its policymakers to take psychological intervention strategies and to make certain sufficient corporal settlement of the banking professionals.

12.
Dermatol Ther ; 33(5): e13778, 2020 09.
Article in English | MEDLINE | ID: covidwho-1005541

ABSTRACT

The immune system of cancer patient gets compromised because of cancer therapy, surgery, and malignancy and thus the probability of infection are increased than the general patients. Immunosuppression can expose cancer patients to serious complications which can lead to delay in diagnosis and unnecessary hospitalizations that may adversely affect the prognosis of the disease. Patients who received chemotherapy or surgery within the 30 days before novel coronavirus disease pandemic have more risk of infection than the patients who had not undergone chemotherapy or surgery.


Subject(s)
COVID-19/etiology , Neoplasms/complications , SARS-CoV-2 , Humans , Neoplasms/immunology , Neoplasms/therapy , Risk , Severity of Illness Index
13.
Curr Pharm Des ; 27(32): 3454-3461, 2021.
Article in English | MEDLINE | ID: covidwho-1005544

ABSTRACT

In 2019, a new virus -SARS-COV2 possibly emerged in China, which infected many people affecting mainly the respiratory system. SARS-COV2 gets transmitted by inhalation of droplets from the infected persons. Symptoms start to appear after the incubation period of the virus which ranges from 2 to 14 days. In most people, symptoms are usually mild such as fever, sore throat, cough, chest tightness and fatigue. In other people, the disease might progress into severe pneumonia leading to several fatal consequences. Treatment is usually supportive and the role of antiviral is not established yet. Home isolation for mild cases is important for the prevention of the transmission of infection. Although the rate of transmission of this virus is faster than other viruses from the family, such as MERS-CoV, it has a lower fatality rate. The main difference in the genome structure of this family, which makes it distinguishable from other viruses is its use of (+) ssRNA as genetic material, which comprise 5' cap located at one end and 3' polyadenylation tract at the other end. During infection of an exposed host cell, viral-encoded protease cleaves the polyprotein that results from translation of 5' open reading frame (ORF) of the genome, culminating in the release of multiple nonstructural proteins such as helicase (Hel), adenosine triphosphate (ATPase) and RNA-dependent RNA polymerase (Rep). These proteins are responsible for the replication process in addition to the syntheses of the sub genomic mRNA used as transcription template strand. In this review article, we discussed the transmission pathways, genetic sequence and current treatment approach of COVID-19.


Subject(s)
COVID-19 , Middle East Respiratory Syndrome Coronavirus , Cough , Humans , RNA, Viral , SARS-CoV-2
14.
Int J Clin Pract ; 75(2): e13912, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-975525

ABSTRACT

OBJECTIVE: Restrictions imposed for the COVID-19 pandemic and the people's fear of getting infected have caused a significant drop in the number of emergency service admissions. Herein, we aimed to investigate the reflections of our otherwise crowded emergency services' quietness in the period of normalisation. METHODOLOGY: Our study retrospectively investigated three groups of patients: the patients who were admitted to the emergency service in the 'Period of Restrictions' when the restrictions were imposed to limit the spread of the COVID-19 infection; the patients who were admitted to the emergency service in the 'Period of Normalisation' when normalisation attempts were made and the restrictions were lifted; and the patients who were admitted to the emergency service in the 'Period of Pre-pandemic Normal' exactly 1 year before the normalisation period, which would reflect the normal functioning of the emergency service at that time. The three groups were compared with respect to the demographic characteristics and patient outcomes (death/hospitalisation/discharge). RESULTS: A total of 69 474 patients were admitted to the emergency service in the 'Period of Pre-pandemic Normal' whereas 21 278 patients were admitted in the 'Period of Restrictions'. The number of emergency service admissions in the 'Period of Restrictions' was significantly lower (P < .01). A total of 72 843 patients were admitted to the emergency service in the 'Period of Normalisation'. There was no statistically significant difference between the 'Period of Pre-pandemic Normal' and the 'Period of Normalisation' in terms of the number of emergency service admissions (P = .127). A total of 9421 (13.5%) patients were hospitalised in the 'Period of Pre-pandemic Normal' and the corresponding figure for the 'Period of Normalisation' was 19 876 (27.2%). A total of 24 (0.03%) patients died in the 'Period of Pre-pandemic Normal', whereas 172 (0.23%) patients died in the 'Period of Normalisation'. The number of patients who were hospitalised and lost in the 'Period of Normalisation' was significantly higher than that of patients who were hospitalised and lost in the 'Period of Pre-pandemic Normal' (P < .01). CONCLUSION: In the period of COVID-19 pandemic, fear of getting infected and the restrictions imposed to limit the spread of the disease have kept people out of hospitals. We believe that while the restrictions imposed on various activities have prevented the virus from spreading, they also caused the course of non-COVID-19 diseases to worsen and mortality rates to rise. Therefore, we are of the opinion that the public should be informed about the importance of uninterrupted treatment/follow-up and 'Life-threatening Urgent Conditions' that should necessarily prompt hospital visits in possible pandemics.


Subject(s)
COVID-19/therapy , Critical Pathways/organization & administration , Emergency Service, Hospital/organization & administration , Health Care Rationing/organization & administration , Adult , COVID-19/epidemiology , Female , Humans , Infection Control/organization & administration , Male , Middle Aged , Patient Discharge/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Turkey
15.
Indian J Med Res ; 153(1 & 2): 175-181, 2021.
Article in English | MEDLINE | ID: covidwho-910270

ABSTRACT

BACKGROUND & OBJECTIVES: To handle the current COVID-19 pandemic in India, multiple strategies have been applied and implemented to slow down the virus transmission. These included clinical management of active cases, rapid development of treatment strategies, vaccines computational modelling and statistical tools to name a few. This article presents a mathematical model for a time series prediction and analyzes the impact of the lockdown. METHODS: Several existing mathematical models were not able to account for asymptomatic patients, with limited testing capability at onset and no data on serosurveillance. In this study, a new model was used which was developed on lines of susceptible-asymptomatic-infected-recovered (SAIR) to assess the impact of the lockdown and make predictions on its future course. Four parameters were used, namely ß, γ, η and ε. ß measures the likelihood of the susceptible person getting infected, and γ denotes recovery rate of patients. The ratio ß/γ is denoted by R0 (basic reproduction number). RESULTS: The disease spread was reduced due to initial lockdown. An increase in γ reflects healthcare and hospital services, medications and protocols put in place. In Delhi, the predictions from the model were corroborated with July and September serosurveys, which showed antibodies in 23.5 and 33 per cent population, respectively. INTERPRETATION & CONCLUSIONS: The SAIR model has helped understand the disease better. If the model is correct, we may have reached herd immunity with about 380 million people already infected. However, personal protective measures remain crucial. If there was no lockdown, the number of active infections would have peaked at close to 14.7 million, resulted in more than 2.6 million deaths, and the peak would have arrived by June 2020. The number of deaths with the current trends may be less than 0.2 million.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Models, Theoretical , Pandemics , Antibodies, Viral/blood , COVID-19/prevention & control , Humans , India/epidemiology
16.
Front Immunol ; 11: 570122, 2020.
Article in English | MEDLINE | ID: covidwho-895300

ABSTRACT

The COVID-19 is an acute and contagious disease characterized by pneumonia and ARDS. The disease is caused by SARS-CoV-2, which belongs to the family of Coronaviridae along with MERS-CoV and SARS-CoV-1. The virus has the positive-sense RNA as its genome encoding for ~26 proteins that work together for the virus survival, replication, and spread in the host. The virus gets transmitted through the contact of aerosol droplets from infected persons. The pathogenesis of COVID-19 is highly complex and involves suppression of host antiviral and innate immune response, induction of oxidative stress followed by hyper inflammation described as the "cytokine storm," causing the acute lung injury, tissue fibrosis, and pneumonia. Currently, several vaccines and drugs are being evaluated for their efficacy, safety, and for determination of doses for COVID-19 and this requires considerable time for their validation. Therefore, exploring the repurposing of natural compounds may provide alternatives against COVID-19. Several nutraceuticals have a proven ability of immune-boosting, antiviral, antioxidant, anti-inflammatory effects. These include Zn, vitamin D, vitamin C, curcumin, cinnamaldehyde, probiotics, selenium, lactoferrin, quercetin, etc. Grouping some of these phytonutrients in the right combination in the form of a food supplement may help to boost the immune system, prevent virus spread, preclude the disease progression to severe stage, and further suppress the hyper inflammation providing both prophylactic and therapeutic support against COVID-19.


Subject(s)
Antiviral Agents/therapeutic use , Coronavirus Infections/diet therapy , Coronavirus Infections/drug therapy , Drug Repositioning/methods , Phytochemicals/therapeutic use , Pneumonia, Viral/diet therapy , Pneumonia, Viral/drug therapy , Anti-Inflammatory Agents/therapeutic use , Antioxidants/therapeutic use , Betacoronavirus/drug effects , COVID-19 , Coronavirus Infections/pathology , Cytokine Release Syndrome/diet therapy , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/pathology , Cytokines/blood , Dietary Supplements , Humans , Inflammation/drug therapy , Oxidative Stress/physiology , Pandemics , Pneumonia, Viral/pathology , Probiotics/therapeutic use , SARS-CoV-2
17.
Ann Indian Acad Neurol ; 23(4): 510-514, 2020.
Article in English | MEDLINE | ID: covidwho-831794

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) is the largest pandemic of our times. We wanted to investigate the impact of COVID-19 pandemic on the psychological status, quality of life (QoL) and quality of sleep (QoS) of myasthenia gravis (MG) patients. METHODS: Data on the epidemiological and clinical characteristics of MG were collected. We used a self-designed questionnaire (consisting of 12 questions), a revised 15-item Myasthenia Gravis Quality of Life Questionnaire (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36), Pittsburgh sleep quality index (PSQI), Hamilton scales for the assessment of anxiety (HAM-A), and depression (HAMD) were used. We reassessed patients who were tested three years ago using the same questionnaires. RESULTS: The study included 64 MG patients. We noticed a statistically significant difference between the results obtained three years ago and the results from April 2020 in PSQI scores (P < 0.01). MGQOL15r, SF36, and PSQI scores correlate with severe clinical manifestation, high scores on HAM-A and HAM-D (P < 0.01). Higher scores on HAM-D and fear that MG symptoms will be worse if the patient gets an upper respiratory infection were independent predictors of the lower SF36 scores. Regarding MGQOL15r-independent predictors of the higher score were higher scores on HAM-D. CONCLUSIONS: There is a significant impact of the COVID-19 epidemic on the psychological status and especially on the quality of sleep of MG patients. Healthcare organizations need to provide professional therapeutic advice and psychosocial support for this population of patients during the pandemic.

18.
Microb Risk Anal ; 16: 100140, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-779468

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East respiratory syndrome coronavirus (MERS-CoV) infect the human respiratory tract. A prototype thermodynamic equilibrium model is presented here for the probability of the virions getting through the mucus barrier and infecting epithelial cells based on the binding affinity (Kmucin) of the virions to mucin molecules in the mucus and parameters for binding and infection of the epithelial cell. Both MERS-CoV and SARS-CoV-2 bind strongly to their cellular receptors, DDP4 and ACE2, respectively, and infect very efficiently both bronchus and lung ex vivo cell cultures which are not protected by a mucus barrier. According to the model, mucin binding could reduce the infectivity for MERS-CoV compared to SARS-CoV-2 by at least 100-fold depending on the magnitude of Kmucin. Specifically Kmucin values up to 106 M-1 have little protective effect and thus the mucus barrier would not remove SARS-CoV-2 which does not bind to sialic acids (SA) and hence would have a very low Kmucin. Depending on the viability of individual virions, the ID50 for SARS-CoV-2 is estimated to be ~500 virions (viral RNA genomic copies) representing 1 to 2 pfu. In contrast MERS-CoV binds both SA and human mucin and a Kmucin of 5 × 109 M-1 as reported for lectins would mop up 99.83% of the virus according to the model with the ID50 for MERS-CoV estimated to be ~295,000 virions (viral RNA genomic copies) representing 819 pfu. This could in part explain why MERS-CoV is poorly transmitted from human to human compared to SARS-CoV-2. Some coronaviruses use an esterase to escape the mucin, although MERS-CoV does not. Instead, it is shown here that "clustering" of virions into single aerosol particles as recently reported for rotavirus in extracellular vesicles could provide a co-operative mechanism whereby MERS-CoV could theoretically overcome the mucin barrier locally and a small proportion of 10 µm diameter aerosol particles could contain ~70 virions based on reported maximum levels in saliva. Although recent evidence suggests SARS-CoV-2 initiates infection in the nasal epithelium, the thermodynamic equilibrium models presented here could complement published approaches for modelling the physical entry of pathogens to the lung based on the fate and transport of the pathogen particles (as for anthrax spores) to develop a dose-response model for aerosol exposure to respiratory viruses. This would enable the infectivity through aerosols to be defined based on molecular parameters as well as physical parameters. The role of the spike proteins of MERS-CoV and SARS-CoV-2 binding to SA and heparan sulphate, respectively, may be to aid non-specific attachment to the host cell. It is proposed that a high Kmucin is the cost for subsequent binding of MERS-CoV to SAs on the cell surface to partially overcome the unfavourable entropy of immobilisation as the virus adopts the correct orientation for spike protein interactions with its protein cellular receptor DPP4.

19.
J Pharm Policy Pract ; 13: 54, 2020.
Article in English | MEDLINE | ID: covidwho-771877

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the Lebanese government has taken the proactive anticipatory measure to minimize the infection rates. Despite the pivotal role of the pharmacists working in hospital settings, hospital pharmacists have not been engaged in the emergency preparedness for hospitals. The primary objective of this survey is to assess the knowledge, attitude, and practice of hospital pharmacists in Lebanon towards COVID-19 pandemic and explore the level of health emergency preparedness of Lebanese hospitals in response to this outbreak. METHODS: A standardized English-based, anonymous and online questionnaire was diffused via social media platforms to all Lebanese hospital pharmacists. The questionnaire consisted of 78 questions related to sociodemographic characteristics, knowledge-based, attitude-based, practice questions, and pandemic preparedness. Descriptive statistical analysis was used to summarize data. RESULTS: A total of 81 questionnaires were completed; the participants were able to know > 90% of the knowledge-based questions regarding COVID-19. Most of the respondents were concerned about getting infected and their families due to their professional exposure. Similarly, around 67% were following the safety recommendations. Most of the participants agreed that they are facing shortages, rising prices, and delays in supply of masks and sanitizers. In terms of COVID-19 readiness, about 50% of hospitals have taken practical steps. CONCLUSIONS: Our findings revealed an appropriate level of knowledge and good practice towards COVID-19, among the respondents from Lebanese hospitals. National organizations may benefit in utilizing the expertise of the hospital pharmacists to be able to minimize/avoid future waves of COVID-19 if it emerges.

20.
Front Cell Infect Microbiol ; 10: 499, 2020.
Article in English | MEDLINE | ID: covidwho-771526

ABSTRACT

SARS CoV appeared in 2003 in China, transmitted from bats to humans via eating infected animals. It affected 8,096 humans with a death rate of 11% affecting 21 countries. The receptor binding domain (RBD) in S protein of this virus gets attached with the ACE2 receptors present on human cells. MERS CoV was first reported in 2012 in Middle East, originated from bat and transmitted to humans through camels. MERS CoV has a fatality rate of 35% and last case reported was in 2017 making a total of 1,879 cases worldwide. DPP4 expressed on human cells is the main attaching site for RBD in S protein of MERS CoV. Folding of RBD plays a crucial role in its pathogenesis. Virus causing COVID-19 was named as SARS CoV-2 due its homology with SARS CoV that emerged in 2003. It has become a pandemic affecting nearly 200 countries in just 3 months' time with a death rate of 2-3% currently. The new virus is fast spreading, but it utilizes the same RBD and ACE2 receptors along with furin present in human cells. The lessons learned from the SARS and MERS epidemics are the best social weapons to face and fight against this novel global threat.


Subject(s)
Coronavirus Infections/transmission , Peptidyl-Dipeptidase A/genetics , Pneumonia, Viral/transmission , Receptors, Virus/genetics , Severe Acute Respiratory Syndrome/transmission , Spike Glycoprotein, Coronavirus/genetics , Angiotensin-Converting Enzyme 2 , Animals , Betacoronavirus/genetics , Betacoronavirus/metabolism , COVID-19 , Chiroptera/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Evolution, Molecular , Furin/metabolism , Genome, Viral/genetics , Humans , Middle East Respiratory Syndrome Coronavirus/genetics , Middle East Respiratory Syndrome Coronavirus/metabolism , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Protein Domains/genetics , Receptors, Virus/metabolism , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/pathology , Spike Glycoprotein, Coronavirus/metabolism
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