Prognostic value of elevated cardiac and inflammatory biomarkers in patients with severe COVID-19: a single-center, retrospective study

Background The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health emergency. Many patients with COVID-19 experience cardiac injury. Patients with COVID-19 admitted to the intensive care unit (ICU) with acute myocardial injury showed increased high-sensitivity troponin levels. Abnormal troponin levels may indicate myocardial injury and are commonly associated with COVID-19. Methods We conducted a retrospective observational study of 44 patients with severe COVID-19 in ICU during the second wave. The primary end point of our retrospective study was 28-day mortality, and the time of ICU admission was designated as day 0. We extracted and analyzed cardiac biomarkers, such as creatine kinase (CK), creatine kinase-MB (CK-MB), B-type natriuretic peptide (BNP), and high-sensitivity cardiac troponin I (hs-cTnI), and various inflammatory markers such as C-reactive protein (CRP) level, interleukin 6 (IL-6), d-dimer, ferritin, lactate dehydrogenase, IL-6, and procalcitonin in patients with severe COVID-19 at ICU admission and 72 hours after ICU admission from our electronic medical record system. Results The best cutoff of BNP were 326.8 and 398.5 pg/mL, CK were 195.95 and 180.12 U/L, CK-MB were 112.10 and 108.5 U/L, and hs-cTnI were 0.035 and 0.025 ng/mL, at ICU admission and 72 hours after ICU admission for predicting 28-day mortality among nonsurvivors. Conclusion In patients with severe COVID-19, CK and hs-cTnI may be considered effective and valuable predictive cardiac biomarkers among nonsurvivors and predict poor prognosis.

COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts.

The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I 2 = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I 2 = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.

A current novel perspective approach for coronavirus disease-2019 pandemic outbreak.

Coronavirus disease-2019 is a serious health threat around the globe. Across the world, approximately 142 million people were infected, and three million deaths happened. The fast propagation is also associated with constant anxiety, mental stress, and discomfort in public and health-care professionals. Lack of approved drugs regimen to combat the pandemic challenge concretely is a challenging project for all who are committed to developing remedial assistance. However, the successful development of three vaccines gives a solid roadmap to combat this disease. In this review, we highlighted the current development and challenges of this pandemic.

Twenty years of progress in angiotensin converting enzyme 2 and its link to SARS-CoV-2 disease.

The virulence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the aggressive nature of the disease has transformed the universal pace of research in the desperate attempt to seek effective therapies to halt the morbidity and mortality of this pandemic. The rapid sequencing of the SARS-CoV-2 virus facilitated identification of the receptor for angiotensin converting enzyme 2 (ACE2) as the high affinity binding site that allows virus endocytosis. Parallel evidence that coronavirus disease 2019 (COVID-19) disease evolution shows greater lethality in patients with antecedent cardiovascular disease, diabetes, or even obesity questioned the potential unfavorable contribution of angiotensin converting enzyme (ACE) inhibitors or angiotensin II (Ang II) receptor blockers as facilitators of adverse outcomes due to the ability of these therapies to augment the transcription of Ace2 with consequent increase in protein formation and enzymatic activity. We review, here, the specific studies that support a role of these agents in altering the expression and activity of ACE2 and underscore that the robustness of the experimental data is associated with weak clinical long-term studies of the existence of a similar regulation of tissue or plasma ACE2 in human subjects.

Epidemiology, risk, myths, pharmacotherapeutic management and socio economic burden due to novel COVID-19: A recent update

[...]date there is not even a single drug or vaccine that can be used for the effective treatment for this disease. The lung epithelial cells are the primary target of the virus because host cell is the first step of viral infection followed by the fusion with the cell membrane hence it has been reported that human to human transmission of SARS-CoV2 occurs by the binding between the receptor-binding domains of virus spikes with the cell, which has been identified as angiotensin-converting enzyme-2 (ACE2) receptor. The sample should be stored in laboratory for the amplification of the genetic material extracted from the mucus or saliva sample is through a reverse transcription polymerase chain reaction (RT-PCR), which involves the synthesis of a double-stranded (ds) DNA molecule from an RNA. The probes are taken on the initial gene sequence released by the Shanghai Public Health Clinical Centre & School of Public Health, Fudan University, Shanghai, China on Virological.org, and subsequent confirmatory evaluation by other labs. If the test result is positive, it is recommended that the test is repeated for verification [27].

Is Sex a Determinant of COVID-19 Infection? Truth or Myth?

PURPOSE OF REVIEW: Angiotensin-converting enzyme 2 (ACE2), a specific high-affinity angiotensin II-hydrolytic enzyme, is the vector that facilitates cellular entry of SARS-CoV-1 and the novel SARS-CoV-2 coronavirus. SARS-CoV-2, which crossed species barriers to infect humans, is highly contagious and associated with high lethality due to multi-organ failure, mostly in older patients with other co-morbidities. RECENT FINDINGS: Accumulating clinical evidence demonstrates that the intensity of the infection and its complications are more prominent in men. It has been postulated that potential functional modulation of ACE2 by estrogen may explain the sex difference in morbidity and mortality. We review here the evidence regarding the role of estrogenic hormones in ACE2 expression and regulation, with the intent of bringing to the forefront potential mechanisms that may explain sex differences in SARS-CoV-2 infection and COVID-19 outcomes, assist in management of COVID-19, and uncover new therapeutic strategies.