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2.
Clin Exp Dermatol ; 46(3): 462-472, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33207021

ABSTRACT

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.


Subject(s)
COVID-19/complications , Skin Diseases, Viral/pathology , Adolescent , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/diagnosis , COVID-19/pathology , COVID-19 Testing , Child , Dermatologic Agents/therapeutic use , Exanthema/drug therapy , Exanthema/pathology , Exanthema/virology , Humans , Nicolau Syndrome/drug therapy , Nicolau Syndrome/pathology , Nicolau Syndrome/virology , Pityriasis Rosea/pathology , Pityriasis Rosea/virology , Purpura/drug therapy , Purpura/pathology , Purpura/virology , SARS-CoV-2 , Skin Diseases, Viral/drug therapy , Urticaria/drug therapy , Urticaria/pathology , Urticaria/virology
3.
Clin Exp Dermatol ; 46(3): 451-461, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33166429

ABSTRACT

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults, as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discussed one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions. In this part of the review, we describe other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.


Subject(s)
COVID-19/complications , Erythema Multiforme/virology , Mucocutaneous Lymph Node Syndrome/virology , Urticaria/virology , Adolescent , COVID-19/pathology , Child , Erythema Multiforme/pathology , Exanthema/pathology , Exanthema/virology , Humans , SARS-CoV-2 , Urticaria/pathology
4.
Clin Exp Dermatol ; 46(3): 444-450, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33180982

ABSTRACT

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestation of COVID-19, chilblain-like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome, while in Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children, for both COVID-19 and any other pre-existing conditions.


Subject(s)
COVID-19/complications , Chilblains/virology , Adolescent , COVID-19/diagnosis , COVID-19/pathology , COVID-19/therapy , COVID-19 Testing , Chilblains/immunology , Chilblains/pathology , Child , Humans , Interferon Type I/immunology , Remission, Spontaneous , Risk Factors , SARS-CoV-2 , Thrombosis/etiology , Vasculitis/etiology
5.
Br J Dermatol ; 2020 Sep 30.
Article in English | MEDLINE | ID: mdl-33000464

ABSTRACT

We fully agree that the interpretation of electron microscopy findings can be challenging, even for experts. Differences between viral pathogens and normal subcellular organelles may be subtle, and some cellular components can masquerade as viruses. The size and shape of the particle shown in our paper fit with other descriptions of SARS-CoV-2, but there may be a bias in interpretation.

8.
Br J Dermatol ; 183(4): 729-737, 2020 10.
Article in English | MEDLINE | ID: mdl-32562567

ABSTRACT

BACKGROUND: Chilblains ('COVID toes') are being seen with increasing frequency in children and young adults during the COVID-19 pandemic. Detailed histopathological descriptions of COVID-19 chilblains have not been reported, and causality of SARS-CoV-2 has not yet been established. OBJECTIVES: To describe the histopathological features of COVID-19 chilblains and to explore the presence of SARS-CoV-2 in the tissue. METHODS: We examined skin biopsies from seven paediatric patients presenting with chilblains during the COVID-19 pandemic. Immunohistochemistry for SARS-CoV-2 was performed in all cases and electron microscopy in one. RESULTS: Histopathology showed variable degrees of lymphocytic vasculitis ranging from endothelial swelling and endotheliitis to fibrinoid necrosis and thrombosis. Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were also seen. SARS-CoV-2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of endothelial cells on electron microscopy. CONCLUSIONS: Although the clinical and histopathological features were similar to other forms of chilblains, the presence of viral particles in the endothelium and the histological evidence of vascular damage support a causal relation of the lesions with SARS-CoV-2. Endothelial damage induced by the virus could be the key mechanism in the pathogenesis of COVID-19 chilblains and perhaps also in a group of patients severely affected by COVID-19 presenting with features of microangiopathic damage. What is already known about this topic? Despite the high number of cases of chilblains seen during the COVID-19 pandemic, a definite causative role for SARS-CoV-2 has not yet been proven. Different pathogenetic hypotheses have been proposed, including coagulation anomalies, interferon release and external factors. What does this study add? The demonstration of SARS-CoV-2 in endothelial cells of skin biopsies by immunohistochemistry and electron microscopy confirms that these lesions are part of the spectrum of COVID-19. Virus-induced vascular damage and secondary ischaemia could explain the pathophysiology of COVID-19 chilblains. Our findings support the hypothesis that widespread endothelial infection by SARS-CoV-2 could have a pathogenetic role in the severe forms of COVID-19. Linked Comment: Wetter. Br J Dermatol 2020; 183:611.


Subject(s)
Chilblains/virology , Coronavirus Infections/complications , Endothelium, Vascular/pathology , Pneumonia, Viral/complications , Skin Diseases/virology , Vasculitis/virology , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , Biopsy , COVID-19 , Chilblains/pathology , Child , Coronavirus Infections/pathology , Coronavirus Infections/virology , Endothelial Cells/pathology , Endothelial Cells/ultrastructure , Endothelial Cells/virology , Endothelium, Vascular/virology , Humans , Immunohistochemistry , Microscopy, Electron , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , SARS-CoV-2 , Skin/blood supply , Skin/pathology , Skin/virology , Skin Diseases/pathology , Vasculitis/pathology
9.
Chem Sci ; 8(5): 4082-4086, 2017 May 01.
Article in English | MEDLINE | ID: mdl-30155213

ABSTRACT

Arginine-rich antimicrobial peptides (AMPs) are emerging therapeutics of interest. However, their applicability is limited by their short circulation half-life, caused in part by their small size and digestion by blood proteases. This study reports a strategy to temporarily mask arginine residues within AMPs with methoxy poly(ethylene glycol). Based on the reagent used, release of AMPs occurred in hours to days in a completely traceless fashion. In vitro, conjugates were insensitive to serum proteases, and released native AMP with full in vitro bioactivity. This strategy is thus highly relevant and should be adaptable to the entire family of arginine-rich AMPs. It may potentially be used to improve AMP-therapies by providing a more steady concentration of AMP in the blood after a single injection, avoiding toxic effects at high AMP doses, and reducing the number of doses required over the treatment duration.

10.
Int J Neural Syst ; 21(4): 311-7, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21809477

ABSTRACT

The assessment of the risk of default on credit is important for financial institutions. Different Artificial Neural Networks (ANN) have been suggested to tackle the credit scoring problem, however, the obtained error rates are often high. In the search for the best ANN algorithm for credit scoring, this paper contributes with the application of an ANN Training Algorithm inspired by the neurons' biological property of metaplasticity. This algorithm is especially efficient when few patterns of a class are available, or when information inherent to low probability events is crucial for a successful application, as weight updating is overemphasized in the less frequent activations than in the more frequent ones. Two well-known and readily available such as: Australia and German data sets has been used to test the algorithm. The results obtained by AMMLP shown have been superior to state-of-the-art classification algorithms in credit scoring.


Subject(s)
Algorithms , Artificial Intelligence , Neural Networks, Computer , Neuronal Plasticity , Databases, Factual , Humans
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