Role of Nasopharyngeal lactate dehydrogenase as a possible economical mass screening test for the detection and segregation of SARS-CoV-2 (COVID-19) cases in India

Qing-Wen-Jie-Re Mixture Ameliorates Poly (I:C)-Induced Viral Pneumonia Through Regulating the Inflammatory Response and Serum Metabolism

Qing-Wen-Jie-Re mixture (QWJR) has been used in the treatment of the coronavirus disease 2019 (COVID-19) in China. However, the protective mechanisms of QWJR on viral pneumonia remain unclear. In the present study, we first investigated the therapeutic effects of QWJR on a rat viral pneumonia model established by using polyinosinic-polycytidylic acid (poly (I:C)). The results indicated that QWJR could relieve the destruction of alveolar-capillary barrier in viral pneumonia rats, as represented by the decreased wet/dry weight (W/D) ratio in lung, total cell count and total protein concentration in bronchoalveolar lavage fluid (BALF). Besides, QWJR could also down-regulate the expression of inflammatory factors such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β and IL-6. More M1-type macrophage polarization was detected by calculating CD86+ cells and CD206+ cells and validated by the decline of inducible nitric oxide synthase (iNOS) and elevated arginase-1 (Arg-1) in lung. Finally, serum untargeted metabolomics analysis demonstrated that QWJR might take effect through regulating arginine metabolism, arachidonic acid (AA) metabolism, tricarboxylic acid (TCA) cycle, nicotinate and nicotinamide metabolism processes.

Plasma LDH: A specific biomarker for lung affectation in COVID-19?

Objectives

We aimed to determine whether the plasma profile of lactate dehydrogenase (LDH) isoenzymes is altered in patients with COVID-19, and whether this is attributable to a specific release of LDH-3, the main LDH isoenzyme expressed in lungs.

Design

We collected fresh plasma aliquots from 17 patients (LDH range, 281–822 U/L) and seven controls (LDH ​< ​230 U/L). In-gel relative activity of the different LDH isoenzymes was determined by electrophoresis and densitometric analysis.

Results

Despite the expected higher total LDH activity levels in patients (p ​< ​0.001), the in-gel relative activities of LDH isoenzymes did not differ between patients and controls (all p ​> ​0.05). We found no correlation between total plasma LDH activity and the in-gel relative activities of the different LDH isoenzymes, including LDH-3. Likewise, there was no correlation between LDH-3 and various routine haematological and serum parameters that have been previously reported to be altered in COVID-19 (such as lymphocyte count, albumin, alanine and aspartate aminotransferase, creatinine, C-reactive protein, or ferritin).

Conclusions

Our findings suggest that elevation of plasma LDH activity in patients with COVID-19 is not associated to a specific release of LDH-3 into the bloodstream, and do not support the use of LDH as a specific biomarker for lung affectation in patients with COVID-19.

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Plasma lactate dehydrogenase (LDH) isoenzyme profile is not altered in COVID-19.

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The main lung LDH isoenzyme, LDH3, is not increased in COVID-19.

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There is no association between plasma LDH-3 and COVID-19 biomarkers.

Psychological impact of COVID-19 pandemic on health-care professionals in India – A multicentric cross-sectional study

Objectives:

The world is grappling with an ongoing COVID-19 pandemic that has shaken the mankind to the core and disrupted the lives of everyone. The aim of the study was to assess the presence of psychological distress, depression, anxiety, stress, and insomnia experienced by the Indian healthcare workers.

Material and Methods:

A cross-sectional study was conducted in India among 777 doctors to evaluate the mental health of doctors working in Corona wards from April 2020 to May 2020 using a pre-designed, pre-tested validated, semi-structured DASS-21 questionnaire, and the Insomnia Severity Index. Continuous variables between the groups were measured using the Mann–Whitney U-test and the Kruskal–Wallis H test.

Results:

Among the doctors working for the pandemic, around 55% of medical officers in the study reported having moderate levels of depression. With respect to anxiety, it was found that among men as many as 52% reported experiencing severe anxiety and 24% had moderate levels of anxiety whereas females reported as high as 68% and 48% of moderate and severe anxiety, respectively. In our study, around 30% and 44% of male doctors reported mild and moderate levels of stress, respectively, whereas 70% and 56% of female doctors reported mild and moderate levels of stress, respectively. It was also observed that among female doctors the rates of moderate insomnia were especially high (65%), whereas a high level of male participants reported sub-threshold insomnia (52%).

Conclusion:

Early screening targeting the medical workforce and the implementation of psychological interventions is essential for protecting and maintaining the functionality of the health-care system.

Immunotherapy of COVID-19 with poly (ADP-ribose) polymerase inhibitors: starting with nicotinamide

COVID-19 induces a proinflammatory environment that is stronger in patients requiring intensive care. The cytokine components of this environment may determine efficacy or otherwise of glucocorticoid therapy. The immunity modulators, the aryl hydrocarbon receptor (AhR) and the nuclear NAD+-consuming enzyme poly (ADP-ribose) polymerase 1 (PARP 1) may play a critical role in COVID-19 pathophysiology. The AhR is overexpressed in coronaviruses, including COVID-19 and, as it regulates PARP gene expression, the latter is likely to be activated in COVID-19. PARP 1 activation leads to cell death mainly by depletion of NAD+ and adenosine triphosphate (ATP), especially when availability of these energy mediators is compromised. PARP expression is enhanced in other lung conditions: the pneumovirus respiratory syncytial virus (RSV) and chronic obstructive pulmonary disease (COPD). I propose that PARP 1 activation is the terminal point in a sequence of events culminating in patient mortality and should be the focus of COVID-19 immunotherapy. Potent PARP 1 inhibitors are undergoing trials in cancer, but a readily available inhibitor, nicotinamide (NAM), which possesses a highly desirable biochemical and activity profile, merits exploration. It conserves NAD+ and prevents ATP depletion by PARP 1 and Sirtuin 1 (silent mating type information regulation 2 homologue 1) inhibition, enhances NAD+ synthesis, and hence that of NADP+ which is a stronger PARP inhibitor, reverses lung injury caused by ischaemia/reperfusion, inhibits proinflammatory cytokines and is effective against HIV infection. These properties qualify NAM for therapeutic use initially in conjunction with standard clinical care or combined with other agents, and subsequently as an adjunct to stronger PARP 1 inhibitors or other drugs.