Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation?
COVID-19 is novel infectious disease with an evolving understanding of its epidemiology and clinical manifestations. Immunocompromised patients often present atypical presentations of viral diseases. Herein we report a case of a COVID-19 infection in a solid organ transplant recipient, in which the first clinical symptoms were of gastrointestinal viral disease and fever, which further progressed to respiratory symptoms in 48h. In these high risk populations, protocols for screening for SARS-Cov2 may be needed to be re-evaluated.
SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19?
Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2).
Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%-90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%-62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.
Clinical features and dynamics of viral load in imported and non-imported patients with COVID-19.
To compare the clinical characteristics and the dynamics of viral load between the imported and non-imported patients with COVID-19.Data from 51 laboratory-confirmed patients were retrospectively analyzed.
The incubation period in the tertiary group was longer than that in the imported and secondary groups (both P < 0.05). Fever was the most common symptom at the onset of illness (73.33%, 58.82%, and 68.42%, respectively), and half of the patients had a low-grade temperature (<38.0℃) with a short duration of fever (<7 days). The CT scan showed that most patients had bilateral pneumonia in the three groups (80.00%, 76.47%, and 73.68%, respectively). Ct values detected from the tertiary patients were similar to those from the imported and secondary groups at the time of admission (both P > 0.05). For the tertiary group, the viral load was undetectable for half of the patients (52.63%) on day 7, and all patients on day 14. For 1/3rd of the patients in the imported and secondary groups, the viral load remained positive on day 14 after the admission.
COVID-19 can present as pneumonia with less onset of symptoms, and the infectivity of SARS-CoV2 may gradually decrease in the tertiary patients.
Testing the repatriated for SARS-Cov2: Should laboratory-based quarantine replace traditional quarantine?
An ongoing epidemic of respiratory diseases caused by a novel coronavirus (COVID 2019, SARS-CoV2) started in Wuhan, Hubei, in China at the end of December 2019. The French government decided to repatriate the 337 French nationals living in Wuhan and place them in quarantine in their home country. We decided to test them all for SARS-Cov2 twice in order to reduce anxiety among the population and decision-makers.We investigated the presence of SARS-CoV-19 in asymptomatic carriers by testing all repatriated patients within the first 24 h of their arrival in France and at day 5. Viral RNA was extracted from pooled nasal and oropharyngeal swab fluids or sputum in the absence of nasal/oropharyngeal swabs. Detection of SARS-CoV-2 RNA was then carried out using several real-time reverse transcription (RT)-PCR assays.We tested 337 passengers at day 0 and day 5. All the tests for SARS-CoV2 were negative. By optimising the sampling process, sending samples sequentially and reducing the time-scale for biological analysis, we were able to test the samples within 5 h (including sampling, shipment and biological tests).Optimising our procedures reduces anxiety and reassures the population and decision makers.
Recomendaciones sobre el manejo clínico de la infección por el «nuevo coronavirus» SARS-CoV2. Grupo de trabajo de la Asociación Española de Pediatría (AEP).
On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them.
An exclusive 42 amino acid signature in pp1ab protein provides insights into the evolutive history of the 2019 novel human-pathogenic coronavirus (SARS-CoV2).
The city of Wuhan, Hubei province, China, was the origin of a severe pneumonia outbreak in December 2019, attributed to a novel coronavirus (SARS-CoV2), causing a total of 2761 deaths and 81109 cases (February 25, 2020). SARS-CoV2 belongs to genus Betacoronavirus, subgenus Sarbecovirus. The polyprotein 1ab (pp1ab) remains unstudied thoroughly since it is similar to other sarbecoviruses. In this short communication, we performed phylogenetic-structural sequence analysis of pp1ab protein of SARS-CoV2. The analysis showed that the viral pp1ab has not changed in most isolates throughout the outbreak time, but interestingly a deletion of 8 aa in the virulence factor non-structural protein 1 was found in a virus isolated from a Japanese patient that did not display critical symptoms. While comparing pp1ab protein with other betacoronaviruses, we found a 42 amino acid signature that is only present in SARS-CoV2 (AS-SCoV2). Members from clade 2 of sarbecoviruses have traces of this signature. The AS-SCoV2 located in the acidic-domain of papain-like protein of SARS-CoV2 and bat-SL-RatG13 guided us to suggest that the novel 2019 coronavirus probably emerged by genetic drift from bat-SL-CoV-RaTG13. The implication of this amino acid signature in papain-like protein structure arrangement and function is something worth to be explored. This article is protected by copyright. All rights reserved.
Novel Coronavirus 2019 (Sars-CoV2): a global emergency that needs new approaches?
The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak.
Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
2019-novel Coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation.
Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients.We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS).Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes.Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.
The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients.
Following the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), another highly pathogenic coronavirus named SARS-CoV-2 (previously known as 2019-nCoV) emerged in December 2019 in Wuhan, China, and rapidly spreads around the world. This virus shares highly homological sequence with SARS-CoV, and causes acute, highly lethal pneumonia (COVID-19) with clinical symptoms similar to those reported for SARS-CoV and MERS-CoV. The most characteristic symptom of COVID-19 patients is respiratory distress, and most of the patients admitted to the intensive care could not breathe spontaneously. Additionally, some COVID-19 patients also showed neurologic signs such as headache, nausea and vomiting. Increasing evidence shows that coronavriruses are not always confined to the respiratory tract and that they may also invade the central nervous system inducing neurological diseases. The infection of SARS-CoV has been reported in the brains from both patients and experimental animals, where the brainstem was heavily infected. Furthermore, some coronaviruses have been demonstrated able to spread via a synapse-connected route to the medullary cardiorespiratory center from the mechano- and chemoreceptors in the lung and lower respiratory airways. In light of the high similarity between SARS-CoV and SARS-CoV2, it is quite likely that the potential invasion of SARS-CoV2 is partially responsible for the acute respiratory failure of COVID-19 patients. Awareness of this will have important guiding significance for the prevention and treatment of the SARS-CoV-2-induced respiratory failure. (229 words) This article is protected by copyright. All rights reserved.
Homogeneous Cobalt/Vanadium Complexes as Precursors for Functionalized Mixed Oxides in Visible-Light-Driven Water Oxidation.
The heterometallic complexes (NH4 )2 [Co(H2 O)6 ]2 [V10 O28 ]⋅4 H2 O (1) and (NH4 )2 [Co(H2 O)5 (β-HAla)]2 [V10 O28 ]⋅4 H2 O (2) have been synthesized and used for the preparation of mixed oxides as catalysts for water oxidation. Thermal decomposition of 1 and 2 at relatively low temperatures (<500 °C) leads to the formation of the solid mixed oxides CoV2 O6 /V2 O5 (3) and Co2 V2 O7 /V2 O5 (4). The complexes (1, 2) and heterogeneous materials (3, 4) act as catalysts for photoinduced water oxidation. A modification of the thermal decomposition procedure allowed the deposition of mixed metal oxides (MMO) on a mesoporous TiO2 film. The electrodes containing Co/V MMOs in TiO2 films were used for electrocatalytic water oxidation and showed good stability and sustained anodic currents of about 5 mA cm-2 at 1.72 V versus relative hydrogen electrode (RHE). This method of functionalizing TiO2 films with MMOs at relatively low temperatures (<500 °C) can be used to produce other oxides with different functionality for applications in, for example, artificial photosynthesis.
Survival analysis in the presence of competing risks.
Survival analysis in the presence of competing risks imposes additional challenges for clinical investigators in that hazard function (the rate) has no one-to-one link to the cumulative incidence function (CIF, the risk). CIF is of particular interest and can be estimated non-parametrically with the use cuminc() function. This function also allows for group comparison and visualization of estimated CIF. The effect of covariates on cause-specific hazard can be explored using conventional Cox proportional hazard model by treating competing events as censoring. However, the effect on hazard cannot be directly linked to the effect on CIF because there is no one-to-one correspondence between hazard and cumulative incidence. Fine-Gray model directly models the covariate effect on CIF and it reports subdistribution hazard ratio (SHR). However, SHR only provide information on the ordering of CIF curves at different levels of covariates, it has no practical interpretation as HR in the absence of competing risks. Fine-Gray model can be fit with crr() function shipped with the cmprsk package. Time-varying covariates are allowed in the crr() function, which is specified by cov2 and tf arguments. Predictions and visualization of CIF for subjects with given covariate values are allowed for crr object. Alternatively, competing risk models can be fit with riskRegression package by employing different link functions between covariates and outcomes. The assumption of proportionality can be checked by testing statistical significance of interaction terms involving failure time. Schoenfeld residuals provide another way to check model assumption.
THE PERFORMANCE OF A RAPID TEST FOR ANTI-HCV SCREENING IN ORAL FLUIDS.
Gingival crevicular fluid (GCF) and saliva samples provide advantages for screening or sero-prevalence studies on HCV using less invasive methods. The study aimed to evaluate the performance of a rapid test for HCV-antibodies (HCV-Ab) screening in oral fluids among high-risk individuals with chronic liver disease.
Chronic liver disease patients attending at the Matei Bals National Instiute for Infectious Diseases were recruited for this study. Plasma, GCF and saliva samples (pair samples) were collected from each patient included in the study. Forty-three sample pairs were tested with Laboquick (Koroglu Medical Devices) rapid test and ELISA (DIA.PRO–Diagnostic Bio-probes) for the detection of anti-HCV antibodies.
Using rapid test, anti-HCV antibodies were detected in 36 GCFs (83.72%) and 24 saliva cases (55.8%) of infected subjects. For a better estimation of oral fluids positivity, the cut-off values were calculated following plotting the ROC curves (COV2). Comparing Laboquick and ELISA (COV2) data, matched results were noted in 95.3 % saliva samples and 93% GCF samples.
Oral fluids could be an alternative to blood for detection of HCV-positive subjects. Anti-HCV rapid test may be useful in routine dental medicine.
[Serum levels of alanine aminotransferase in Chilean population: analysis of results of the national health survey 2009-2010].
Determination of Alanine aminotransferase serum levels ([ALT]s) is a sensitive ana reliable test for liver diseases.
To report the prevalence of abnormal [ALT]s in Chilean population and to identify associated variables.
We analyzed data from a random sub-sample of 2,794 adults surveyed during the second Chilean National Health Survey. Abnormal [ALT]s were defined by using three different cut-off values (COV), two fixed COV (COV1:>> 30 IU/L in men and>> 19 IU/L in women and COV2 pre-defined by the performing laboratory) and a COV adjusted by age, weight and sex (COV3>> 31 IU/L for women and>> 44 IU/L and men>> 42 IU/L and>> 66 IU/L with a BMI>> 23). Logistic regression analysis was performed to determine risk factors for elevated [ALT]s.
Mean [ALT]s values were 30.14 I U/L in men and 22.03 IU/L in women. The observed prevalence of abnormal [ALT]s defined by different COV were 38%, 11.5%, and 8.1% for COV1, COV2 and COV3 respectively. Variables independently associated to abnormal [ALT]s in a multivariate analysis were the following: serum gamma-glutamyl-transpeptidase (OR: 1.055 [95% CI 1.033-1.078]) and body mass index (OR:1.13 [95% CI 1.09-1.17]). Variables inversely associated with abnormal [ALT]s (COV1) were mole gender (OR-.0.976 [95% CI 0.96-0.99) and HDL-cholesterol (OR:0979 [95% CI 0.96-0.99]).
Independently of the COV used, Chilean population exhibits a high prevalence of abnormal [ALT]s which may reflect a significant burden of liver disease. Non-alcoholic fatty liver disease could be a major contributor to elevated [ALT]s considering the association of abnormal [ALT]s and metabolic variables.
The inhibition of Bid expression by Akt leads to resistance to TRAIL-induced apoptosis in ovarian cancer cells.
Epithelial ovarian cancer (EOC) cells often show increased activity of the PI3K/Akt pathway. In addition, we have previously shown that EOC ascites induce Akt activation in the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-sensitive EOC cell line, CaOV3, leading to TRAIL-mediated apoptosis inhibition. In this study, we investigated the role of Akt in intrinsic resistance to TRAIL, which is common in EOC cells. We report that Akt activation reduces the sensitivity of EOC cells to TRAIL. TRAIL-resistant SKOV3ip1 and COV2 cells were sensitized to TRAIL-induced apoptosis by PI3K or Akt inhibitors although inhibition of PI3K/Akt signaling pathway did not interfere with the recruitment and processing of caspase-8 to the death-inducing signaling complex. Conversely, overexpression of Akt1 in TRAIL-sensitive cells promoted resistance to TRAIL. Although the fact that TRAIL-induced caspase-8 activation was observed in both sensitive and resistant cell lines, Bid cleavage occurred only in sensitive cells or in SKOV3ip1 cells treated with LY294002. Bid expression was low in resistant cells and Akt activation downregulated its expression. Depletion of Bid by siRNA in OVCAR3 cells was associated with a decrease in TRAIL-mediated apoptosis. Overexpression of Bid only in SKOV3ip1 cells enhanced TRAIL-induced apoptosis. Simultaneous blockade of Akt pathway further increased TRAIL-induced apoptosis. Thus, Akt acts upstream of mitochondria and inhibits TRAIL-induced apoptosis by decreasing Bid protein levels and possibly inhibiting its cleavage.
RNase-resistant virus-like particles containing long chimeric RNA sequences produced by two-plasmid coexpression system.
RNase-resistant, noninfectious virus-like particles containing exogenous RNA sequences (armored RNA) are good candidates as RNA controls and standards in RNA virus detection. However, the length of RNA packaged in the virus-like particles with high efficiency is usually less than 500 bases. In this study, we describe a method for producing armored L-RNA. Armored L-RNA is a complex of MS2 bacteriophage coat protein and RNA produced in Escherichia coli by the induction of a two-plasmid coexpression system in which the coat protein and maturase are expressed from one plasmid and the target RNA sequence with modified MS2 stem-loop (pac site) is transcribed from another plasmid. A 3V armored L-RNA of 2,248 bases containing six gene fragments-hepatitis C virus, severe acute respiratory syndrome coronavirus (SARS-CoV1, SARS-CoV2, and SARS-CoV3), avian influenza virus matrix gene (M300), and H5N1 avian influenza virus (HA300)-was successfully expressed by the two-plasmid coexpression system and was demonstrated to have all of the characteristics of armored RNA. We evaluated the 3V armored L-RNA as a calibrator for multiple virus assays. We used the WHO International Standard for HCV RNA (NIBSC 96/790) to calibrate the chimeric armored L-RNA, which was diluted by 10-fold serial dilutions to obtain samples containing 10(6) to 10(2) copies. In conclusion, the approach we used for armored L-RNA preparation is practical and could reduce the labor and cost of quality control in multiplex RNA virus assays. Furthermore, we can assign the chimeric armored RNA with an international unit for quantitative detection.
Can CO2 sensors in the ventilation system of a pool facility help reduce the variability in the trihalomethane concentration observed in indoor air?
Volatile and hazardous compounds are formed during the chlorination of pool water. Monitoring components in the air, such as the four trihalomethanes; chloroform, dichlorobromomethane, dibromochloromethane and bromoform (tTHM), is challenging. Carbon dioxide (CO2) sensors are used for controlling air quality in different buildings and can be installed in ventilation systems for continuous surveillance and monitoring purposes. However, such sensors are not used in indoor swimming facilities. In this study, samples of tTHM and CO2 were collected and analysed, along with other air and water quality parameters such as combined chlorine, to evaluate whether CO2 sensors could be used to explain the observed variability in the tTHM concentration in an indoor swimming facility and thereby reduce the exposure of individuals utilising the pool to tTHM. Random intercept models were built for the tTHM and CO2 concentrations, respectively, and the results show that the relationships between combined chlorine in the water, CO2 in the air and number of occupants explain 52% of the variability in tTHM. The correlation between occupancy and CO2 concentration (ρ = 0.65, p ≤ 0.01) suggests that CO2 sensors should be used so that the air supply corresponds to the demand of the users.
The Novel Coronavirus (SARS-CoV-2) Epidemic.
In-situ mineral CO2 sequestration in a methane producing microbial electrolysis cell treating sludge hydrolysate.
Microbial electrolysis cell (MEC) has excellent CH4 production performance, however, CO2 still remains in the produced biogas at high content. For achieving in-situ CO2 sequestration and thus upgrading biogas, mineral carbonation was integrated into a MEC treating sludge hydrolysate. With 19 g/L wollastonite addition, in-situ mineral CO2 sequestration was achieved by formation of calcite precipitates. CH4 content in the biogas was increased by 5.1 % and reached 95.9 %, with CH4 production improved by 16.9 %. In addition, the removals of polysaccharide, protein.