COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications.

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

Retroperitoneal lymphatic malformation in a dog.

BACKGROUND: Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic. CASE PRESENTATION: An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure. CONCLUSIONS: To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.

Corneal invasion by hemangiosarcoma in a horse.

A 15-year-old gray Arabian gelding presented for evaluation of a lateral limbal mass extending across approximately 30% of the cornea. Grossly, the raised mass appeared nonpigmented, smooth, and irregular in shape, with an area of central necrosis and serosanguinous discharge. The mass was removed via lamellar keratectomy and histopathologic evaluation revealed features characteristic of hemangiosarcoma (HSA), including irregular vascular channels lined by a plump spindle cell population. Immunohistochemistry results showed that the neoplastic cells lining the vascular channels present diffuse and strong cytoplasmic reaction with von Willebrand Factor and the perivascular spindle cells exhibit moderate cytoplasmic reaction for smooth muscle actin. A lack of cytokeratin staining definitively excluded a diagnosis of atypical squamous cell carcinoma. Smooth muscle actin staining of the perivascular cells adjacent to the neoplastic endothelial cells is not a feature commonly described in HSA and has not been reported in previous cases of equine HSA. The horse remained in good health 21 months postkeratectomy and has exceeded the survival time of previously documented equine ocular HSA cases where more extreme surgical excision was performed.

Pseudoangiomatous squamous cell carcinoma in the oral cavity of a dog.

An 8-year-old, spayed, female Labrador Retriever mixed-breed dog was presented to the Cornell University Hospital for Animals with an invasive oral mass involving the upper left fourth premolar and first molar teeth. Initial biopsy results suggested a poorly differentiated squamous cell carcinoma, whereas further histologic examination of the surgically removed mass revealed a hemangiosarcoma-like mass composed of numerous vascular clefts and variable numbers of keratinizing epithelial cells. Histologic and immunohistochemical characteristics were compatible with pseudoangiomatous squamous cell carcinoma, a well-recognized human variant of acanthomatous squamous cell carcinoma. Because of histomorphologic similarities with canine gingival hemangiosarcoma, diagnosticians should be aware of the present tumor variant as a differential diagnosis for vascular-like growths in the oral cavity of dogs.