Pathophysiology of coronavirus disease 2019 for wound care professionals

Mining the potential therapeutic targets for COVID-19 infection in patients with severe burn injuries via bioinformatics analysis

The Coronavirus Disease-19 (COVID-19) pandemic is posing a serious challenge to human health. Burn victims are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leading to delayed recovery and even profound debilitation. Nevertheless, the molecular mechanisms underlying COVID-19 and severe burn are yet to be elucidated. In our work, the differentially expressed genes (DEGs) were identified from GSE157852 and GSE19743, and the common DEGs between COVID-19 and severe burn were extracted. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein-protein interactions (PPI), gene coexpression network, and multifactor regulatory network analysis of hub genes were carried out. A total of 44 common DEGs were found between COVID-19 and severe burn. Functional analyses indicated that the pathways of immune regulation and cytokine response participated collectively in the development of severe burn and progression of COVID-19. Ten significant hub genes were identified, including MERTK, SIRPA, TLR3, ITGB1, DPP4, PTPRC, LY75, IFIT1, IL4R, and CD2. In addition, the gene coexpression network and regulatory network were constructed containing 42 microRNAs (miRNAs) and 2 transcription factors (TFs). Our study showed the shared pathogenic link between COVID-19 and severe burn. The identified common genes and pivotal pathways pave a new road for future mechanistic researches in severe burn injuries complicated with COVID-19.

Examining trends in the evidence base for the treatment of burns and a quality assessment of randomised controlled trials over an 11-year period

BACKGROUND

Previous articles assessed the evidence-base for the treatment of burns, but the latest was published in 2010, examining data up to and inclusive of 2008. The aim of this article is to examine the trend in the number of high-evidence publications over the subsequent 11-year period and quality-assess RCTs within this timeframe.

MATERIALS AND METHODS

All articles published in Burns and Journal of Burn Care and Research (JBCR) were identified using PubMed Search Tools and its Single Citation Matcher function. These journals were manually screened from 01/01/2009-01/06/2020 inclusive. Additionally, a PubMed search was conducted searching for RCTs and meta-analyses in English with the MESH term burns to identify meta-analyses and RCTs in all other journals. The reporting of RCTs was assessed using a modified CONsolidated Standards of Reporting Trials (CONSORT) checklist.

RESULTS

A total of 5145 articles were evaluated from Burns and JBCR, with 3230 (62.78%) from Burns and 1915 (37.22%) from JBCR. 0.012% were meta-analyses of RCTs, 0.30% were other meta-analyses, and 2.52% were initially identified as RCTs. Whilst a significant increase in the number of high-evidence publications is observed, these represent 2.83% (n = 237) of the total. An additional 95 RCTs were identified in other journals, 58 being included in quality-analysis. A total 128 RCTs were thus eligible for quality-assessment, the most popular individual topic being wound healing (n = 28; 21.88%). The most highly reported criterion was listed inclusion and exclusion criteria (n = 111; 86.72%) and the least reported criterion was allocation concealment (n = 22; 13.92%).

CONCLUSIONS

This study observes a positive trend in high-evidence publications. The reporting of several CONSORT criteria in RCTs remains poor. Observation to standard reporting guidelines is advocated to improve the quality of reporting.

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

The coronavirus disease 2019 (COVID-19) is a novel, rapidly changing pandemic. It has affected specialized medical services in unprecedented ways. Surgical decision making, always the most important aspect of care has taken on an added layer of complexity in the face of the COVID-19 pandemic. Therefore, recommendations for breast reconstruction during COVID-19 remain challenging and unclear. This article reviews the impact of the COVID-19 pandemic and suggests potential approaches that could be considered in the absence of validated strategies in breast reconstruction.

Angiotensin-converting enzyme 2 gene expression in human male urological tissues: implications for pathogenesis and virus transmission pathways

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection occurs through binding and internalization of the viral spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor on the host cell membrane. Pathological changes are caused by damage and failure of vital organs that express high levels of ACE2, including the lungs, the heart and the kidneys. The aim of this study was to investigate ACE2 gene expression in the human male urogenital tract using a public database.

METHODS

A search of transcriptomic datasets from a database to investigate ACE2 gene expression in human urogenital tract tissue.

RESULTS

The gene expression profile demonstrated that ACE2 gene expression was higher in human kidney cortex and testis than human lung tissue. The gene expression profile demonstrated that ACE2 gene expression in the human bladder and prostate was comparable to human lung tissue.

CONCLUSIONS

Male urogenital tissues are directly susceptible to SARS-CoV-2 infection through the expression of ACE2. Moreover, the SARS-Cov-2/ACE2 interaction may disturb the male genital and reproductive functions.

Angiotensin-Converting Enzyme 2 Gene Expression in Breast Tissue

OBJECTIVE

Binding to angiotensin-converting enzyme 2 (ACE2) receptor is a critical step for severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) to mediate its entry into target cells. ACE2 is expressed in many human tissues, including the lungs. However, no research has demonstrated that SARS-CoV-2 can infect human breast tissue. This study aimed to investigate ACE2 gene expression in human breast tissue using a public database.

MATERIALS AND METHODS

A search of a public gene expression database was performed to investigate ACE2 gene expression in in human breast tissue.

RESULTS

The gene expression profile demonstrated that ACE2 gene expression was higher in human breast tissue than human lung tissue.

CONCLUSION

Our knowledge about coronavirus disease-2019 (COVID-19) is expanding rapidly. Clinicians are eager for vetted information regarding all aspects of this new illness, and this study demonstrates that the level of ACE2 expression in human breast tissue is higher than that in the lung tissue, a major target tissue affected by SARS-CoV-2 infection. This finding strongly suggests that SARS-CoV-2 infection causes breast pathology.

Inflammatory and coagulative pathophysiology for the management of burn patients with COVID-19: systematic review of the evidence

The pathogenesis of coronavirus disease 2019 (COVID-19) involves a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system and acute phase proteins. This hyperinflammatory response predisposes patients to thromboembolic disease, acute lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. In burn injuries, damaged tissues induce a local and systemic inflammatory response through pathways associated to COVID-19. As such, a COVID-19 positive patient sustaining burn injuries may have an amplified response to the burn insult due to their baseline hyperinflammatory and hypercoagulable states. Burn patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. The concurrent pathogenesis of COVID-19 and the inflammatory response in burn injury have serious implications on the management of burn patients.

Protective Measures For Burn Care Professionals During The Coronavirus Disease 2019 Pandemic: Systematic Review

The emergence of a novel human β coronavirus, severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has developed into a global pandemic and public health emergency. The management of patients with burns must be adapted to this context. The aim of this systematic review is to identify the optimal protection measures during the COVID-19 pandemic and provide guidance of protective measures for burn surgeons. A systematic search of PubMed was performed for articles about COVID-19. "Burn units", "burns", "COVID-19", "health personnel", "protective devices", "severe acute respiratory syndrome coronavirus 2", "surgeons" and "telemedicine" were reviewed during the entire diagnosis and management process of burn patients. Eight articles were included, and five articles emphasized that burn care professionals should pay attention to prevent cross-infection. Only three articles reported in detail how burn care professionals should be protected during surgery in the operating room. These experiences and strategies can help burn care professionals work safely and effectively, and prevent both nosocomial infections and burn care professional infections during the global pandemic of COVID-19.

Pathophysiology of coronavirus disease 2019 for wound care professionals

There is pressing urgency to understand the pathogenesis of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) which causes Coronavirus disease 2019 (COVID‐19). The tissue tropism of SARS‐CoV‐2 includes not only the lung but also the vascular and integumentary systems. Angiotensin‐converting enzyme 2 (ACE2) appears to be the key functional receptor for the virus. There is a prominent innate immune response to SARS‐CoV‐2 infection, including inflammatory cytokines, chemokines, the complement system, and acute phase proteins. The pathophysiologic significance of SARS‐COV‐2 and host immune system interaction, and COVID‐19‐associated coagulopathy instigating microvascular injury syndrome mediated by activation of complement pathways, and an associated procoagulant state is important for wound care professionals to understand.