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circle Plain language summaries (PLS) are accessible, short, peerreviewed summaries of scholarly journal articles written in nontechnical language. circle The aim of PLS is to enable a broader audience of experts and non-experts to understand the original article. circle Here, we outline the evidence base for the value and impact of PLS and how they can enable diversity, equity, inclusion and accessibility in scholarly publishing. circle PLS can diversify readership and authorship, address information inequity, include typically under-represented stakeholders and provide an accessible route into scholarly literature.
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Cumulative evidence indicates that SARS-CoV-2 can induce hyper-stimulation of the immune system, leading to the synthesis of multiple autoantibodies. That is why the virus and the disease have been associated with various autoimmune disorders, including type 1 diabetes, Graves' disease, autoimmune hemolytic anemia, polyneuritis cranialis, postural orthostatic tachycardia syndrome, systemic lupus erythematosus, antiphospholipid syndrome, Guillain-Barré syndrome, rheumatoid arthritis, immune thrombocytopenic purpura, Miller-Fisher syndrome, NMDA receptor encephalitis, vasculitis, Kawasaki disease, and more. Because of this, and many other reasons, SARS-CoV-2 has been called the autoimmune virus. However, experimental evidence is needed to support the induction of autoimmunity by this virus. In this review article, the following molecular and immunological experimental evidence will be discussed to strengthen the connection between SARS-CoV-2 and many autoimmune diseases: 1. Identification of cross-reactive epitopes from SARS-CoV-2 that share homology with human proteomes that participate in autoimmune diseases 2. Reaction of both animal and human monoclonal antibodies to SARS-CoV-2 antigens with human tissue antigens 3. Reaction of antibodies made against human tissue with SARS-CoV-2 spike proteins and nucleoproteins 4. Detection of autoantibodies against human autoantigens in the sera of COVID-19 patients that cross-reacted with SARS-CoV-2 proteins This experimental evidence further supports that the title of autoimmune virus given to SARS-CoV-2 is very well deserved. © 2023 Elsevier Inc. All rights reserved.
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Background: Renal (acute kidney injury, AKI) involvement in COVID-19 patients is associated with high mortality and morbidity. Critically ill COVID-19 patients are at twice the risk of in hospital mortality compared to nonCOVID AKI patients. The cell types that succumb to direct or indirect damage and the associated abnormal biological responses are unclear. New generation single cell technologies have the potential to provide insights into physiological states and molecular mechanisms in COVID-AKI. One of the key limitations is that biopsies are not routinely performed and the risks of procuring an additional research core is indeterminate making it difficult to get direct insights into the landscape of COVID-AKI disease in the kidney at genome wide and cellular scale. Method(s): We developed an innovative method that used remnant kidney biopsy tissue from OCT-embedded frozen diagnostic pathology biopsy core and generated single nucleus transcriptome (snRNAseq) of COVID-AKI from as little as 1 mm3 of tissue. Comparative analysis of snRNAseq of 4 COVID-AKI and 4 control cortical biopsies was done in conjunction with urine transcriptomics to find overlapping genes in these two datasets representing COVID-AKI-enriched genes and the corresponding cell types in the kidney. Result(s): snRNAseq of COVID-AKI remnant or control frozen kidney biopsies (15659 and 15604 nuclei passing QC, respectively) identified all major and minor cell types. Differential expression analysis of COVID-AKI biopsies showed pathways enriched in viral response, kidney regeneration, WNT signaling, cancer, kidney development and cytokines in several nephron epithelial cells including kidney injury markers and fibrosis indicating robust remodelling in various cell types. Ten genes were also detected in urine cells of COVID-AKI patients as potential biomarkers. Two of these genes, LRP1B and PDE3A, have been recently implicated in driving fibrosis in COVID-AKI model systems. Conclusion(s): snRNAseq is feasible on leftover kidney biopsy tissue using minimum amount of sample and enabled identification of altered kidney cell types and states with several novel genes associated with tissue injury, remodelling and fibrosis.
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Introduction: For families with type 1 diabetes (T1D), anxiety from the COVID-19 pandemic may be elevated due to potential for increased vulnerability. Objectives: We aimed to describe the impact of the pandemic on adolescents with T1D and their parents. Methods: In a 2-site (Seattle WA, Houston TX USA) clinical trial of a psychosocial intervention targeting stress/resilience, adolescents 13-18 years old with T1D ≥ 1 year and diabetes distress (PAID-T ≥30) were enrolled with a parent. Using a mixed-methods approach, participants enrolled August 2020-June 2021 completed a survey about the pandemic, including an open-ended question about how COVID impacted T1D management. Survey responses were summarized using frequencies and percentages, and associations between variables were assessed by Chi-squared tests. A1C was extracted from clinical records. Results: Adolescents (n=122) were 56% female, 80% White race, 18% Hispanic, mean A1c = 8.5±2.1%. Parents (n=102) were 79% White, 14% Hispanic, 61% college graduate, 67% reporting annual household income ≥75K USD. 10% of adolescents reported history of COVID-19 infection, 51% had a family member/other important person diagnosed, and 12% had a family member/other important person die from COVID-19 complications. 49% of parents reported loss of job or salary reduction. 29% of adolescents and 33% of parents reported significant struggle to manage T1D during the pandemic (Table 1). Adolescents who reported more difficulty with T1D management were more likely to have A1C ≥ 8%, p<.01. Qualitative themes indicated perceived positive, negative, and neutral effects of the pandemic on: T1D self-care, exercise, food, mental health, telehealth, and motivation. Conclusions: Discussing how the pandemic impacted families' T1D management may be an important focus for clinicians, especially for adolescents with above-target A1C. Strategies to improve resilience for ongoing and future stress may be of value. (Table Presented).
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Introduction: The COVID-19 pandemic has been a major stressor for adolescents with T1D, a group already at risk for elevated mood concerns. Objectives: We aimed to describe teens' perspectives on pandemicrelated stress and their coping strategies and resilience resources. Methods: In a 2-site clinical trial of a psychosocial resiliencepromotion intervention, enrolled adolescents were 13-18 years old with T1D ≥ 1 year and diabetes distress (PAID-T) ≥30. Participants enrolled August 2020-June 2021 were asked to write responses to 2 open-ended prompts about: 1) how COVID-19 affected their lives and 2) what was helping them through the pandemic. Qualitative analysis included: conventional content analysis by 3 coders to develop code categories and thematic analysis to identify overarching themes reflecting pandemic-related stress and resilience. Themes were subsequently mapped onto 3 domains of resilience. Results: Adolescents (n=120) were 56% female, 75% White race, 18% Hispanic with mean A1C of 8.5% ± 2.1%. Adolescents described numerous negative effects of COVID-19 cutting across many major domains of life: Family, Social, School, Medical/Physical, and Mental Health. They also described numerous resources and strategies consistent with stress, coping and resilience theories. Note: 6 participants reported nothing was helping them through the pandemic. Conclusions: Adolescents' responses underscore the pervasive stress impact of COVID-19 across nearly all major life domains. Coping strategies align with theory and suggest likely resilience in the face of pervasive stress. Given the elevated risks for distress in this population, there is a need for interventions to offer diverse stress management tools and resilience resources for adolescents with T1D. (Table Presented).
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During 2 July- 11 August, 2020, an outbreak of coronavirus disease 2019 (COVID-19) occurred at a boys' overnight summer school retreat in Wisconsin. The retreat included 152 high school-aged boys, counselors, and staff members from 21 states and territories and two foreign countries. All attendees were required to provide documentation of either a positive serologic test result* within the past 3 months or a negative reverse transcription polymerase chain reaction tests result for SARS-CoV-2 7 days before travel, to self-quarantine within their households for 7 days before travel, and to wear masks during travel. On 15 July, the Wisconsin Department of Health Services began an investigation after being notified that two students at the retreat had received positive SARS-CoV-2 RT-PCR test results. WDHS offered RT-PCR testing to attendees on 28 July and serologic testing on August 5 and 6. Seventy-eight attendees received positive RT-PCR results, and 38 met clinical criteria for COVID-19 without a positive RT-PCR result. By the end of the retreat, 118 persons had received a positive serologic test result. Among 24 attendees with a documented positive serologic test result before the retreat, all received negative RT-PCR results. After RT-PCR testing on 28 July, WDHS recommended that remaining susceptible persons (asymptomatic and with negative RT-PCR test results) quarantine from other students and staff members at the retreat. Recommended end dates for isolation or quarantine were based on established guidance and determined in coordination with CDC. All attendees were cleared for interstate and commercial air travel to return home on 11 August. This outbreak investigation documented rapid spread of SARS-CoV-2, likely from a single student, among adolescents and young adults in a congregate setting. Mitigation plans that include prearrival quarantine and testing, cohorting, symptom monitoring, early identification and isolation of cases, mask use, enhanced hygiene and disinfection practices, and maximal outdoor programming are necessary to prevent COVID-19 outbreaks in these settings.
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Doctors from various specialties across the world are faced with the management of coronavirus disease 2019 (COVID-19). The typical presentation is one of viral pneumonia, with a large spectrum of disease severity. Increasingly, extra-pulmonary manifestations are being reported, often in those with significant pulmonary pathology. Here we discuss a novel presentation of COVID-19, with no pulmonary involvement and the challenges faced by clinicians in achieving the correct diagnosis. A previously fit and well 30-year-old female presented with gastroenteritis, pyrexias, myalgia, rashes, conjunctivitis, and myocarditis. There were no respiratory features, either from her history or clinical examination. Initial and subsequent reverse transcription polymerase chain reaction (RT-PCR) swabs were negative for severe acute respiratory failure coronavirus 2 (SARS-CoV-2), alongside normal appearances of her lungs on computed tomography scans. Her third and final COVID-19 RT-PCR swab was positive, just prior to transfer for her ongoing myocarditis management, at a specialist cardiac critical care. She went on to make a full recovery. Novel presentations of COVID-19 signify a new challenge to clinicians. Correct diagnosis is important for the patient, as well as staff safety. Atypical presentations often have non-specific clinical features, and so a strong index of suspicion, appropriate exclusion of differentials and a multi-disciplinary approach are needed. © Journal of Emergency and Critical Care Medicine. All rights reserved.