Incidence of Secondary Hemophagocytic Lymphohistiocytosis in Critically-Ill COVID-19 Patients.

Objective Coronavirus disease 2019 (COVID-19) is associated with diffuse lung injury that can progress to acute respiratory distress syndrome, multisystem-organ failure, and death. The inflammatory storm seen in many COVID-19 patients closely resembles secondary hemophagocytic lymphohistiocytosis (sHLH) which has been described in other virus-associated severe sepsis. We sought to describe the incidence of sHLH in COVID-19 infected patients. Design In this retrospective study, we reviewed the records of critically ill COVID-19 positive patients to determine the incidence of sHLH. An H-score for sHLH diagnosis was determined for each study participant, with a score greater than 169 points needed for diagnosis. Setting A quaternary referral center in suburban Pennsylvania, USA. Patients All study participants had a positive COVID-19 test, and were deemed critically ill defined as receiving invasive mechanical ventilation and/or who expired. Measurements and Main Results Of the 246 records identified, 242 records met inclusion criteria and were reviewed. Eighty five patients were excluded from analysis due to missing H-score data parameters. Overall, 32 of 157 (20.38%, 95% CI:14.38-27.54%) patients met diagnostic criteria for sHLH. The average age was 69.42 years (standard deviation (SD) 14.81). Patients diagnosed with sHLH were more likely to be younger (61.09 years vs 69.38 years, P = 0.0036), male (71.88% vs 52.00%, P = 0.0433), and require mechanical ventilation (96.88% vs 72.80%, P = 0.0035). Conclusions Among critically ill COVID-19 positive patients, the incidence of sHLH is higher than previously reported in patients with non-COVID-19 related sepsis. Clinicians caring for COVID-19 patients should consider this secondary diagnosis and subsequent appropriate treatments, especially in those requiring mechanical ventilation.

Living with respiratory viruses: The next saga in human/viral coexistence?

Testing for respiratory viruses and SARS-CoV-2 in clinical and epidemiological settings has contrasting purposes and utility. Symptomatic patients are best tested with respiratory virus panels to establish the pathogen and guide personalized treatment. Asymptomatic patients are tested for a single infectious pathogen to establish carrier status and guide containment.

Predicting COVID-19 Using Retrospective Data: Impact of Obesity on Outcomes of Adult Patients With Viral Pneumonia.

Background Community-acquired pneumonia due to viral pathogens is an under-recognized cause of healthcare-associated mortality and morbidity worldwide. We aimed to compare mortality rates and outcome measures of disease severity in obese vs non-obese patients admitted with viral pneumonia. Methods Adult patients admitted with viral pneumonia were selected from the Nationwide Inpatient Sample of 2016 and 2017. The arms were stratified based on the presence of a secondary discharge diagnosis of obesity. The primary outcome was inpatient mortality. Secondary outcomes included sepsis, acute respiratory failure, acute respiratory distress syndrome, acute kidney injury, and pulmonary embolism. Results and interpretation In total, 89,650 patients admitted with viral pneumonia were analyzed, and 17% had obesity. There was no significant difference in mortality between obese and non-obese patients (aOR: 0.98, 95% CI: 0.705 - 1.362, p < 0.001). Compared to non-obese patients, obese patients had higher adjusted odds of developing acute hypoxic respiratory failure (aOR: 1.37, 95% CI: 1.255 - 1.513, p < 0.001), acute respiratory distress syndrome (aOR: 2.29, 95% CI: 1.554 - 3.381, p < 0.001), need for mechanical ventilation (aOR: 1.50, 95% CI: 1.236 - 1.819, p < 0.001), and pulmonary embolism (aOR: 1.69, 95% CI: 1.024 - 2.788, p = 0.040). Conclusions Obesity was not found to be an independent predictor of inpatient mortality in patients admitted with viral pneumonia. However, obesity is associated with worse clinical outcomes and disease severity as defined by the presence of complications, greater incidence of acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), need for mechanical ventilation, acute kidney injury (AKI), pulmonary embolism (PE), stroke, and sepsis.

Clinical Perspective on 2019 Novel Coronavirus Pneumonia: A Systematic Review of Published Case Reports.

The ongoing pandemic of 2019 novel coronavirus (2019-nCoV), which originated from Wuhan, China, has led to 68,279 deaths due to 2019-nCoV pneumonia as of May 5, 2020. We conducted a systematic review and included 16 case reports to summarize the transmission and pathology of 2019-nCoV, and clinical presentation, laboratory and imaging findings, and treatment in 2019-nCoV pneumonia. The disease is mild in most people; in some, it may progress to severe pneumonia with acute respiratory distress syndrome (ARDS). Patients with mild illness usually recover at home, with supportive care and isolation in accordance with guidelines. Patients who have moderate to severe pneumonia are usually monitored in the hospital. Although there is no definitive treatment for 2019-nCoV pneumonia so far, some antiviral drugs have shown promising results. The use of lopinavir/ritonavir and remdesivir was associated with significant clinical improvement in severe pneumonia. Nonetheless, we need more randomized clinical trials (RCTs) and treatment guidelines for developing effective management of the 2019-nCoV and improve patient outcomes by reducing mortality in high-risk patients. We also need more clinical trials and management guidelines for the effective management of 2019-nCoV pneumonia.

Pitfalls of Computed Tomography in the Coronavirus 2019 (COVID-19) Era: A New Perspective on Ground-Glass Opacities.

Aim To study ground-glass opacities (GGO) not only from the coronavirus 2019 (COVID-19) pneumonia" perspective but also as a radiological presentation of other pathologies with comparable features. Methods We enrolled 33 patients admitted to Policlinico Universitario G. B. Rossi who underwent non-contrast-enhanced (NCE) or contrast-enhanced (CE) chest computed tomography (CT) between March 12 and April 12. All patients with CT-detected ground-glass opacity (GGO) were included. All patients resulted as COVID-19 negative at the reverse transcription-polymerase chain reaction (RT-PCR) assay. We studied the different pathologies underlying GGO features: neoplastic diseases and non-neoplastic diseases (viral pneumonias, interstitial pneumonias, and cardiopulmonary diseases) in order to avoid pitfalls and to reach the correct diagnosis. Results All CT scans detected GGOs. Symptomatic patients were 25/33 (75.7%). At the clinical presentation, they reported fever and dry cough; in six out of 25 cases, dyspnea was also reported (24%). Thirty-three (33; 100%) showed GGO at CT: 15/33 (45.45%) presented pure GGO, and 18/33 (54.54%) showed GGO with consolidation. The RT-PCR assay was negative in 100%. We investigated other potential underlying diseases to explain imaging features: neoplastic causes (8/33, 24.24%) and non-neoplastic causes, in particular, infectious pneumonias (16/33, 48,48 %, viral and fungal), interstitial pneumonias (4/33, 12,12%), and cardio-pulmonary disease (5/33, 15,15%). Conclusions GGO remains a diagnostic challenge. Although CT represents a fundamental diagnostic tool because of its sensitivity, it still needs to be integrated with clinical data to achieve the best clinical management. In the presence of typical imaging features (e.g. GGO and consolidation), the radiologist should focus on the pandemic and manage a suspect patient as COVID-19 positive until proven to be negative.

Synchronous shedding of multiple bat paramyxoviruses coincides with peak periods of Hendra virus spillover.

Within host-parasite communities, viral co-circulation and co-infections of hosts are the norm, yet studies of significant emerging zoonoses tend to focus on a single parasite species within the host. Using a multiplexed paramyxovirus bead-based PCR on urine samples from Australian flying foxes, we show that multi-viral shedding from flying fox populations is common. We detected up to nine bat paramyxoviruses shed synchronously. Multi-viral shedding infrequently coalesced into an extreme, brief and spatially restricted shedding pulse, coinciding with peak spillover of Hendra virus, an emerging fatal zoonotic pathogen of high interest. Such extreme pulses of multi-viral shedding could easily be missed during routine surveillance yet have potentially serious consequences for spillover of novel pathogens to humans and domestic animal hosts. We also detected co-occurrence patterns suggestive of the presence of interactions among viruses, such as facilitation and cross-immunity. We propose that multiple viruses may be interacting, influencing the shedding and spillover of zoonotic pathogens. Understanding these interactions in the context of broader scale drivers, such as habitat loss, may help predict shedding pulses of Hendra virus and other fatal zoonoses.

Calle 13 y su discurso social

Calle 13 era una banda puertorriqueña que a lo largo de su trayectoria musical produjo diferentes canciones que abren los ojos a la realidad por su discurso social y temas controversiales. También, estas promueven la búsqueda de identidad y resistencia a la opresión. Este artículo propone el análisis del último disco de la banda, Multi Viral (2014), el cual está dividido en diferentes apartados, como las raíces y las influencias del estilo de la banda con La Nueva Canción y el folclore. Además se explicarán temáticas como la violencia, manipulación, desigualdad y represión, presentadas en las canciones "El aguante", "Multi Viral", "Adentro" y "Cuando los pies besan el piso".

Calle 13 was a Puerto Rican band that throughtout its musical trajectory produced different songs that open the eyes due to social discourse and controversial subjects. Also, these songs promote the identity search and resistance to oppression. Thus, this article proposes an analysis about the band's last record, Multi Viral (2014); it is divided in different sections as the roots and the style influences of the band with La Nueva Canción and the folklore. Moreover, it explains topics like violence, manipulation, inequality and repression, that are presented in the songs "El aguante", "Multi Viral", "Adentro", and "Cuando los pies besan el piso".

Effects of the sequence characteristics of miRNAs on multi-viral resistance mediated by single amiRNAs in transgenic tobacco.

Artificial microRNA (amiRNA) has become the preferred viral defence that can be induced in plants. In this study, nine amiRNA target sites were selected that were based on the sequence characteristics of natural miRNAs in the cylindrical inclusion protein (CI), nuclear inclusion a protein (NIa), nuclear inclusion b protein (NIb), and coat protein (CP) genes of Potato virus Y (PVY(N)). These amiRNAs that exhibited high similarities to the sequences of PVY(N) and TEV-SD1 were considered. To study the effectiveness of gene silencing in amiRNA-mediated viral resistance, we constructed nine amiRNA plant expression vectors by replacing the functional sequences of miRNA319a precursors with our selected amiRNA sequences. These constructs were subsequently introduced to tobacco plants. A Northern blot assay verified that the nine amiRNA plant expression vectors could successfully express amiRNAs in plants. The analysis of viral resistance demonstrated that these transgenic tobacco plants could effectively inhibit PVY(N) and TEV-SD1 viral infections. The amiRNA that targeted the NIb and CP genes displayed a higher silencing efficiency than did the amiRNAs targeted CI and NIa genes. Northern blot analysis demonstrated that silencing was induced by the original amiRNAs and could be bilaterally extended by the siRNA pathway. That is, the amiRNA and the secondary siRNA mediated the degradation of viral RNA together. Genetic analysis demonstrated that the trait for viral resistance in transgenic plants can be consistently inherited via a single copy of the transgenic sequence. Considering the correlation between the sequence characteristics and the activity of amiRNA, we concluded that a few mismatched bases between the amiRNA and the target sequence could be allowed, particularly the mismatched bases in the 3' end of the amiRNA.