Volume 28, Supplement 1, 2020
Editorial
Could SARS-CoV-2/COVID-19 simply fade away?
Rosselli Diego,
Yucumá Daniela,
Rodríguez-Morales Alfonso J.,
Esposito Silvano
Not available
Should lCU COVID-19 patients empirically receive therapeutic doses of anticoagulant?
Piazza Ornella
Not available
Review
Emerging Coronaviruses: First SARS, second MERS and third SARS-CoV-2; Epidemiological updates of COVID-19.
Halaji Mehrdad,
Farahani Abbas,
Ranjbar Reza,
Heiat Mohammad,
Dehkordi Farhad Safarpoor
Since December 2019, the emergence of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection has been reported unexpectedly in Wuhan, China, with staggering infection speed across China and around the world. To date, seven known strains of HCoVs belonging to four genera (i.e., α−, β−, γ, and δ-CoV) have been recognized; the latest one has been identified as the SARS-CoV-2. Although the common transmission routes of SARS-CoV-2 is the respiratory tract, it seems that other routes such as the gastrointestinal tract may be effective for the entry of the virus in the body. Although there are no biological markers to predict the susceptibility of humans to COVID-19, several risk factors have been identified to predict the susceptibility of patients to COVID-19. Initial data revealed that males, pregnant women, elderly, and underlying conditions predispose patients to higher morbidity or mortality and also might be at risk for a severe infection of COVID-19. There is a greater need to better understand the mechanisms and risk factors of transmission routes. To date, despite the whole world effort to review various aspects of SARS-CoV-2, including epidemiology, clinical manifestations, diagnosis, and treatment options, there are still gaps in the knowledge of this disease and many issues remain unclear. Therefore, there is an urgent need for update data on SARS-CoV-2. Here, this study provide the current epidemiological status (transmission routes and risk of transmission, possible origins and source, mortality and morbidity risk, and geographical distribution) of the SARS-CoV-2 in the world in 2020.
COVID 19 diagnostic multiplicity and its role in community surveillance and control
Tripathi Satyendra C.,
Deshmukh Vishwajit,
Patil Ashlesh,
Tripathy Jaya Prasad
Diagnosis of persons exposed to/infected with severe acute respiratory syndrome–related coronavirus-2 (SARS-CoV-2) is central to controlling the global pandemic of COVID-19. Currently, several diagnostic modalities are available for COVID-19, each with its own pros and cons. Although there is a global consensus to increase the testing capacity, it is also essential to prudently utilize these tests to control the pandemic. In this paper, we have reviewed the current array of diagnostics for SARS–CoV-2, highlighted the gaps in current diagnostic modalities, and their role in community surveillance and control of the pandemic. The different modalities of COVID-19 diagnosis discussed are: clinical and radiological, molecular based (laboratory based and point-of-care), Immunoassay based (ELISA, rapid antigen and antibody detection tests) and digital diagnostics (artificial intelligence based algorithms). The role of rapid antigen/antibody detection tests in community surveillance has also been described here. These tests can be used to identify asymptomatic persons exposed to the virus and in community based seroprevalence surveys to assess the epidemiology of spread of the virus. However, there are few concerns about the accuracy of these tests which needs to evaluated beforehand.
Bacterial and fungal infections among patients with SARS-CoV-2 pneumonia
Antinori Spinello,
Galimberti Laura,
Milazzo Laura,
Ridolfo Anna Lisa
We reviewed studies reporting bacterial and fungal co-infections in patients with COVID-19. The majority were retrospective studies with poor quality data biased with short follow-up and selection of patients. Septic shock was reported in 4% to 33.1% of patients. Seventy-one to 100% of patients received antibacterial treatments. Invasive pulmonary aspergillosis seems to be an increasingly observed complication in critically ill patients with SARS-CoV-2 infection as previously reported in patients hospitalized in ICU with severe influenza. High quality prospective studies are urgently needed to verify the incidence of bacterial and fungal infections and their role on the outcome of COVID-19.
COVID-19 and gastrointestinal injury: a brief systematic review and data from Bulgaria.
Velev Valeri,
Popov Metodi,
Velikov Petar,
Dinkova Maria,
Ilieva Viktoria,
Gospodinova Gabriela,
Tcherveniakova Tatiana,
Pavlova Maria
In December 2019, a new Coronavirus (SARS-CoV-2) emerged in China, causing the pandemic disease COVID-19. The clinical presentation is variable, but the predominant symptoms are those of the upper respiratory tract.
Aim: The aim of the current study is to describe the incidence and type of the gastrointestinal injury (GI) in COVID-19, as well as their prognostic value.
Materials and Methods: We conducted a coincidental search on this topic in PubMed, Web of Science and EMBASE. We also followed a group of 31 Bulgarian COVID-19 patients throughout the course of their disease and analyzed their symptoms (catarrhal and other) and outcome.
Results: The publications concerning our survey followed a total of 1509 COVID-19 patients. In the Bulgarian cohort, only 14 from the 31 patients were laboratory-confirmed COVID-19 cases. Approximately 1/3 of the infected individuals presented with GI. In some patients this was the first, or only, symptom of the disease. It was also indicative of a more severe disease course. Conclusion: GI may be an important symptom and prognostic factor in COVID-19. Therefore, patients with acute gastrointestinal symptoms must be actively tested for SARS-CoV-2.
Neurologic aspects of covid-19: a concise review
Brouwer Matthijs C.,
Ascione Tiziana,
Pagliano Pasquale
In addition to the conventional respiratory symptoms, patients with COVID-19 can exhibit neurological complications. In this concise review, we aim to report the most frequent neurologic manifestations related to Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) infection. SARS-CoV2 can reach the central nervous system from the bloodstream or olfactory pathway by binding ACE-2 receptor and the spike protein protease TMPRSS2.
Headache is reported in more than 10% of affected patients and loss of smell and taste disturbance are reported in a slightly smaller percentage of cases. Acute cerebrovascular events are diagnosed in less than 3% of COVID-19 patients, but those with more severe manifestations have cerebrovascular events in more than 6% of the cases, as reported by two retrospective studies from Italy and China. Moreover, five cases of large-vessel stroke have been described in low-symptomatic COVID-19 patients aging less than 50 years suggesting that SARS-CoV2 can be associated with an increase of the risk of stroke in relatively young people.
Peripheral nerve diseases can be observed after an apparently uneventful SARS-CoV2. Based on a
literature review, nine patients experienced Guillain-Barrè syndrome (GBS) and 6 of these needed
mechanical ventilation. Two more cases have been described with Miller-Fisher syndrome or polyneuritis cranialis, both had rapidly resolving symptoms.
In conclusion, nervous system symptoms can be observed during SARS-CoV2 infection of which headache and smell and taste disturbance are the main symptoms reported.
Cerebrovascular complications can complicate the course of COVID-19 in apparently low-risk patients. GBS is a life-threatening manifestation of COVID-19.
COVID-19 and pregnancy: a review of current knowledge
Maleki Dana Parisa,
Kolahdooz Fariba,
Sadoughi Fatemeh,
Moazzami Bahram,
Chaichian Shahla,
Asemi Zatollah
Background: Since December 2019, coronavirus disease 2019 (COVID-19) has become a major health problem that is spreading all over the world. Several viral infections such as SARS, MERS, and influenza have been associated with adverse pregnancy outcomes. The question arises whether pregnant women are at greater risk of complications related to COVID-19 compared to other people What complications should we expect in the fetuses whose mothers were infected?
Aims: This review aims to provide a summary of studies on symptoms of COVID-19 and the possible risks of COVID-19 among pregnant women, as well as complications in fetuses and neonates whose mothers were infected with COVID-19.
Methods: The included data were provided from Web of Science, Cochrane, PubMed, and Scopus which are extracted from the published studies in English until April 2nd, 2020 that contained data on the risk of COVID-19 in pregnancy.
Results: The early symptoms of patients with COVID-19 were fever, cough, dyspnea, myalgia, and fatigue; while production of sputum, headache, hemoptysis, and diarrhea were other symptoms which were less common. There is no evidence of vertical maternal-fetal transmission in pregnant women with COVID-19.
Conclusions: The clinical findings in pregnant women with COVID-19 are not significantly different compared to other patients, and pregnant women with COVID-19 are not at a higher risk of developing critical pneumonia compared to non-pregnant women. Although, there has been no sign of vertical infection in infants, but maternal infection can cause serious problems such as preterm labour and fetal distress.
The rationale for Low-Molecular Weight Heparin (LMWH) use in SARS-CoV-2 infection
Di Perri Giovanni
In spite of many ongoing attempts to repurpose existing antivirals, no drugs have emerged yet with the desirable activity against SARS-CoV-2. Hydroxychloroquine, lopinavir/ritonavir, remdesivir, umifenovir, favipiravir, ribavirin and -interferon-1 gave rise to variable but still inconsistent proof of clinical efficacy in the treatment of COVID-19. Pathogenetic studies have shown significant differences between commonly defined viral pneumonia and COVID-19 pulmonary disease. In severe forms, immune/inflammatory alterations reminiscent of disease forms like Macrophage Activation Syndrome (MAS) have been described, and therapeutic options other than anti-infective have been proposed and implemented, such as anti-inflammatory and anticoagulative agents. The thrombotic phenomena described in the pulmonary vascular bed of patients with severe COVID-19 suggest the administration of low-molecular weight heparin (LMWH) as standard measure in hospitalized patients with COVID-19.
Comprehensive review of mask utility and challenges during the COVID-19 pandemic.
Tirupathi Raghavendra,
Bharathidasan Kavya,
Palabindala Venkataraman,
Salim Sohail Abdul,
Al-Tawfiq Jaffar A.
Masks are widely discussed during the course of the ongoing COVID-19 pandemic. Most hospitals have implemented universal masking for their healthcare workers, and the Center for Disease Control currently advises even the general public to wear cloth masks when outdoors. The pertinent need for masks arises from plausible dissemination of the SARS-CoV-2 through close contacts, as well as the possibility of virus transmission from asymptomatic, pre-symptomatic, and mildly symptomatic individuals. Given current global shortages in personal protective equipment, the efficacy of various types of masks: N95 respirators, surgical masks, and cloth masks are researched. To accommodate limited supplies, techniques for extended use, reuse, and sterilization of masks are strategized. However, masks alone may not greatly slow down the COVID-19 pandemic unless they are coupled with adequate social distancing, diligent hand hygiene, and other proven preventive measures.
Preparing for Emerging Respiratory Pathogens such as SARS-CoV, MERS-CoV, and SARS-CoV-2.
Al-Tawfiq Jaffar A.,
Garout Mohammed A.,
Gautret Philippe
Preparing for emerging respiratory pathogens is a fundamental requirement for enhancements of the safeguard in healthcare settings. We are facing an increasing pressure to be prepared more than before. Healthcare organizations should be ready to deal with such emerging infectious disease. Here, we share some points that are essential to be considered while we prepare our institutions to prevent the transmission of emerging respiratory pathogens such as MERS-CoV and the recently emerging pandemic of SARS-CoV-2, the causative agent of COVID-19.
MERS-CoV and SARS-CoV infections in animals: a systematic review and meta-analysis of prevalence studies
Bonilla-Aldana D. Katterine,
Cardona-Trujillo María C.,
García-Barco Alejandra,
Holguin-Rivera Yeimer,
Cortes-Bonilla Isabella,
Bedoya-Arias Hugo A.,
Patiño-Cadavid Leidy Jhoana,
Tamayo-Orozco Juan David,
Paniz-Mondolfi Alberto,
Zambrano LysienI.,
Dhama Kuldeep,
Sah Ranjit,
Rabaan Ali A.,
Balbin-Ramon Graciela J.,
Rodriguez-Morales. Alfonso J.
Introduction: Coronaviruses are zoonotic viruses that include human epidemic pathogens such as the Middle East Respiratory Syndrome virus (MERS-CoV), and the Severe Acute Respiratory Syndrome virus (SARS-CoV), among others (e.g., COVID-19, the recently emerging coronavirus disease). The role of animals as potential reservoirs for such pathogens remains an unanswered question. No systematic reviews have been published on this topic to date.
Methods: We performed a systematic literature review with meta-analysis, using three databases to assess MERS-CoV and SARS-CoV infection in animals and its diagnosis by serological and molecular tests. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI).
Results: 6,493articles were retrieved (1960-2019). After screening by abstract/title, 50 articles were selected for full-text assessment. Of them, 42 were finally included for qualitative and quantitative analyses. From a total of 34 studies (n=20,896 animals), the pool prevalence by RT-PCR for MERS-CoV was 7.2% (95%CI 5.6-8.7%), with 97.3% occurring in camels, in which pool prevalence was 10.3% (95%CI 8.3-12.3). Qatar was the country with the highest MERS-CoV RT-PCR pool prevalence: 32.6% (95%CI 4.8-60.4%). From 5 studies and 2,618 animals, for SARS-CoV, the RT-PCR pool prevalence was 2.3% (95%CI 1.3-3.3). Of those, 38.35% were reported on bats, in which the pool prevalence was 14.1% (95%CI0.0-44.6%).
Discussion: A considerable proportion of infected animals tested positive, particularly by nucleic acid amplification tests (NAAT). This essential condition highlights the relevance of individual animals as reservoirs of MERS-CoV and SARS-CoV. In this meta-analysis, camels and bats were found to be positive by RT-PCR in over 10% of the cases for both; thus, suggesting their relevance in the maintenance of wild zoonotic transmission.
Original article
Differences among confirmed and not-confirmed COVID-19 patients at “D.Cotugno” hospital, Naples (Italy): what we learned from first suspected cases?
Pisapia Raffaella,
Pisaturo Mariantonietta,
Fusco Francesco Maria,
Parrella Giovanni,
Iodice Valentina,
Tambaro Orsola,
Di Flumeri Giusy,
Viglietti Rosaria,
Palmiero Giulia,
Falco Erasmo,
Raffone Marcello,
Di Martino Filomena,
Maturo Nicola,
Rescigno Carolina,
Sangiovanni Vincenzo
Clinical presentation of COVID-19 is common to other respiratory infections. We compared the characteristics at hospital admission of confirmed and not-confirmed COVID-19 patients, in the early phase of the epidemic. Thirty-seven suspected patients were enrolled, and COVID-19 was confirmed in 17. Confirmed patients are older, have more frequently contact with confirmed cases. Distinctive clinical characteristics among COVID-19 were the grand-glass opacities at CT scan, and a pO2/FiO2 ratio less than 250. In not-confirmed group, Influenza represented the most frequent alternative diagnosis. This study contributes to highlight the characteristics to consider at hospital admission in order to promptly suspect COVID-19.
Prognosis of COVID-19: Changes in laboratory parameters
Lagadinou Maria,
Solomou Elena E,
Zareifopoulos Nicholas,
Marangos Markos,
Gogos Charalambos,
Velissaris Dimitrios
Introduction: Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome - Coronavirus 2 (SARS-CoV-2) emerged in China and has become a global threat. Comparison of hematological parameters between mild and severe cases of SARS-CoV 2 is so far limited, but significant differences in parameters such as interleukin-6, d-dimers, glucose, fibrinogen and C-reactive protein have been already reported.
Purpose: In this study we analyzed the changes observed in easily measured blood biomarkers in the patients and provided evidence of how these markers can be used as prognostic factors of the disease.
Methods: Demographic characteristics, detailed medical history, and laboratory findings of all enrolled SARS-CoV 2 infection positive patients who were referred to Patras University Hospital from the period of March 4th 2020 (when first confirmed case in Greece appeared in our hospital) until April 4th 2020 were extracted from electronic medical records and analyzed.
Results: We provided evidence that some very common laboratory values can be used as independent predictive factors in SARS-CoV 2 infection. Despite the retrospective nature of this study and the small number of subjects analyzed, we showed that NLR, LDH, d-dimers, CRP, fibrinogen and ferritin can be used early at the patient’s first visit for SARS-CoV 2 infection symptoms and can predict the severity of infection. Conclusion: More studies are warranted to further objectively confirm the clinical value of prognostic factors related to SARS-CoV 2 and establish an easy-to-get panel of laboratory findings for evaluating the disease severity.
Risk of hepatic failure in COVID-19 patients: A systematic review and meta-analysis
Samidoust Pirouz,
Samidoust Aryan,
Samadani Ali Akbar,
Khoshdoz Sara
Liver injury has been reported to occur during the disease in severe cases. Therefore, this meta-analysis study aims to investigate the incidence of liver injury among published literature from 2019-Jan-01 to 2020-April-03 to provide an outline for further studies on the liver injury of COVID-19.
Four databases including Pubmed, Embase, Web of Science, and the Scopus were searched for studies published from 2019-Jan-01 to 2020-April-03. Data analysis and drawing of charts were performed using the Comprehensive Meta-Analysis Software Version 2.2 (Biostat, USA).
The search yielded 450 publications, of which 64 potentially eligible studies were identified for full-text review and 21 studies fulfilling the inclusion criteria remained. A total of 4191 COVID-19 patients were included in our meta-analysis. The pooled prevalence of liver injury was 19.5% (95% CI: 14.3-26.1). According to our results, there was significant heterogeneity among the 19 studies (X2 = 738.5; p < 0.001; I2 = 94.34%). Among 288 death cases, the pooled prevalence of liver injury was 22.8% (95% CI: 11.7-39.8).
In summary, the COVID-19 disease itself can result in severe and even fatal respiratory diseases and even may lead to ARDS and multiple organ failure. The results of this systematic review highlight the importance of liver injury that may assist clinicians anywhere in the globe in controlling COVID-19-related infection and complications. Moreover, the prevalence of liver injury can be higher in severe cases than in mild cases
CT features of coronavirus disease 2019 (COVID-19) pneumonia: experience of a single center in Southern Italy
Martino Alberigo,
Fiore Emilio,
Mazza Emerico Maria,
Minichiello Stefana,
Brogna Barbara,
Petronilla Salvatore,
Megliola Antonia,
Musto Lanfranco
Purpose. The aim of this study was to report the radiological features of chest CT scan of patients with coronavirus disease 2019 (COVID-19) living in a town in Southern Italy where a significant outbreak of the disease occurred.
Methods. We revised the CT scan of 62 patients (34 male, 28 female, mean age 71 +/- 14 years) with clinical and laboratory signs of COVID-19, as assessed by positive SARS-CoV-2 RT-PCR testing. All patients underwent chest CT at the time of admission to the hospital. A semi-quantitative scoring system was used to evaluate the extension of the disease.
Results. Out of the 62 patients the main radiological findings were reticular pattern (29%), ground-glass opacities (24%), crazy paving pattern (11%) and consolidation (35%). Most of the lesions were bilateral (97%), posterior (95%) and located near pleura (50%) or lung fissures (45%), mainly involving the lower right lobe (56%) and lower left lobe (23%). Pleural thickening was observed in 72.6% of patients and pleural effusion in 18%. Median value of the score was 7.0 and was significantly higher in male than female (8.5 vs 6.0, p=0.03) and in patients with pleural thickening compared to those without this finding (8.0 vs 5.0, p=0.03)
Conclusions. We have observed patients with different stages of the disease. Lung score was significantly higher in male than female confirming the clinical observation of a worst prognosis in male subjects. Pleural thickening was frequently observed and significantly associated with a higher lung score suggesting a possible association with a more severe disease .
Cognitive load and performance of health care professionals in donning and doffing PPE before and after a simulation-based educational intervention and its implications during the COVID-19 pandemic for biosafety.
Díaz-Guio Diego Andrés,
Ricardo-Zapata Alejandra,
Ospina-Velez Jeniffer,
Gómez-Candamil Gabriel,
Mora-Martinez Santiago,
Rodriguez-Morales. Alfonso J.
Introduction: The Personal Protective Equipment (PPE) is essential to avoid the COVID-19 spread to health care workers. Its use can be difficult, posing a high risk of contamination, mainly during doffing, then with the risk of becoming infected.
Methods: We conducted a prospective before-and-after design that used clinical simulation as a research methodology in a clinical simulation center of Colombia. A simulation-based educational intervention with two cases related to COVID-19 was proposed in the emergency room and the intensive care unit. We conducted A workshop for donning and doffing of personal protective equipment (PPE) and a debriefing after the first case.
Results: In the pre-test, 100% of participants failed donning and doffing PPE, 98.4% were contaminated, only one-person did not contaminate out of. The mean cognitive load was high (7.43±0.9 points). In the post-test, 100% were successful in donning the PPE and 94.8% in doffing; only 9.8% were contaminated. The mean of the cognitive load was low (4.1±1.4 points), and the performance was high (7.9±1.1). Of the total, 73.8% of participants reported overload in the doffing. The most difficulties were in gown/overall, and N95 mask removal.
Discussion: The PPE donning and doffing is critical and may be changed significantly by active training. In responding to the current COVID-19 pandemic in 2020, activities of training in donning and doffing PPE would provide a means of training personnel, reducing the cognitive load and maybe the risk of contamination and infection of health care workers
Case report
Clinical experience with therapeutic dose of Low-Molecular-Weight Heparin
Viale Pierluigi,
Bartoletti Michele
A 71-year old gentleman with history of arterial hypertension treated with valsartan presented on was hospitalized at the Infectious Diseases Unit, University of Bologna (Italy) for severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) and received treatment with hydroxychloroquine 200mg bid (400 mg bid the first day), azithromycin 400 mg qd, thrombotic prophylaxis with enoxaparin 4000 UI qd and Venturi mask oxygen delivering FiO2 of 31%.
The case highlights the high frequency of coagulopathy in patients with moderate to severe cases of SARS-CoV-2 associated disease (COVID-19). After one week the patient significantly improved and the daily dose of enoxaparin was reduced and definitively discontinued four days later.
The case highlights the high frequency of coagulopathy in patients with moderate to severe cases of SARS-CoV-2 associated disease (COVID-19).
Considering the available information we believe that LMWH may represent a promising treatment for COVID-19 but further well-designed trials are needed to address these points.
Letters to the editor
Vitamin C (ovi) D; An unexplored option!
Ish Pranav,
Agrawal Sumita,
Gupta Nitesh
Abstract not available
Infection prevention and control in blood purification centers during the COVID-19 epidemic: a single institution experience from Zhejiang, China
Yamei Yang,
Yanbo Zhang,
Yuhong Jin,
Xueyan Bian
Abtract not availble
