Impact of coronavirus disease 2019 on patients with primary adrenal insufficiency: a cross-sectional study

Objective

Patients with primary adrenal insufficiency (PAI) are thought to be particularly vulnerable to coronavirus disease 2019 (COVID-19); however, little is known about its true impact on this group. We assessed morbidity and health promotion attitudes during the pandemic amongst a large cohort of patients with PAI.

Design

Cross-sectional, single-centre study.

Methods

In May 2020, COVID-19 advice on social distancing and sick-day rules was distributed to all patients with PAI registered with a large secondary/tertiary care centre. A semi-structured questionnaire was used to survey patients in early 2021.

Results

Of 207 contacted patients, 162 responded (82/111 with Addison's disease, AD; 80/96 with congenital adrenal hyperplasia, CAH). Patients with AD were older than those with CAH (median age 51 vs 39 years; P < 0.001) and had more comorbidities (Charlson comorbidity index ≥2 47.6% vs 10.0%; P< 0.001). By the time of the survey, 47 patients (29.0%) had been diagnosed with COVID-19, the second commonest cause of sick-day dosing during the study and the leading trigger of adrenal crises (4/18 cases). Patients with CAH had a higher risk of COVID-19 compared to AD (adjusted odds ratio 2.53 (95% CI 1.07-6.16), P= 0.036), were less inclined to have the COVID-19 vaccine (80.0% vs 96.3%; P = 0.001), and were less likely to have undergone hydrocortisone self-injection training (80.0% vs 91.5%; P = 0.044) or wear medical alert jewellery (36.3% vs 64.6%; P = 0.001).

Conclusions

COVID-19 was a principal trigger for adrenal crises and sick-day dosing in patients with PAI. Despite a higher risk of COVID-19, patients with CAH showed less engagement with self-protective attitudes.

Significance statement

We conducted a cross-sectional study on a large and well-characterised group of patients with PAI and demonstrated that COVID-19 was a leading cause of morbidity during the early phases of the pandemic. Patients with AD were older and had a greater burden of comorbidity than those with CAH, including non-adrenal autoimmune disorders. However, patients with CAH were more likely to develop COVID-19 and demonstrated reduced engagement with healthcare services and health promotion strategies.

Intensive care clincians' information acquisition during the first wave of the Covid 19 pandemic

Introduction

The global pandemic caused by novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has led to an unprecedented demand on critical care resources. The United Kingdom experienced its 'first wave' of Coronavirus-19 (Covid-19) disease in Spring 2020. Critical care units had to make major changes to their working practices in a short space of time and faced multiple challenges in doing so, including the challenge of caring for patients in multiple organ failure secondary to Covid-19 infection in the absence of an established evidence base of best practice. We undertook a qualitative investigation of the personal and professional challenges faced by critical care consultants in one Scottish health board in acquiring and evaluating information to guide clinical decision making during the first wave of the SARS-CoV-2 pandemic.

Methods

Critical care consultants in NHS Lothian working in critical care from March to May 2020 were eligible to participate in the study. Participants were invited to take part in a one-to-one semi structured interview conducted using Microsoft Teams videoconferencing software. Reflexive thematic analysis was used as the method for data analysis using qualitative research methodology informed by a subtle realist position.

Results

Analysis of the interview data generated the following themes: The Knowledge Gap; Trust in Information; and Implications for Practice. Illustrative quotes are presented in the text and thematic tables.

Discussion

This study explored the experiences of critical care consultant physicians in acquiring and evaluating information to guide clinical decision making during the first wave of the SARS CoV2 pandemic. This study revealed that clinicians were profoundly affected by the pandemic and the ways in which it changed how they could access information to guide clinical decision making. The paucity of reliable information on SARS-CoV-2 posed a significant threat to the clinical confidence of participants. Two strategies were adopted to ease mounting pressures - an organised approach to data collection and the establishment of a local community of collaborative decision-making. These findings contribute to the wider literature by describing health care professionals' experiences in unprecedented times and could inform recommendations for future clinical practice. This could include governance around responsible information sharing in professional instant messaging groups, and medical journal guidelines on suspension of usual peer review and other quality assurance processes during pandemics.

Identification of Kaempferol as viral entry inhibitor and DL-Arginine as viral replication inhibitor from selected plants of Indian traditional medicine against COVID-19: An in silico guided in vitro approach

BACKGROUND

Indian traditional medicinal plants are known for their great potential in tackling viral diseases. Previously, we reported a systematic review approach of seven plausible traditional Indian medicinal plants against SARS CoV 2.

METHODS

Molecular docking was conducted with Biovia Discovery Studio. Three binding domains for Spike glycoprotein (PDB IDs: 6LZG, 6M17, 6M0J) and one binding domain of RdRp (PDB ID: 7BTF) were used. Among 100 phytoconstituents listed from seven plants by IMPPAT Database used for virtual screening, the best six compounds were again filtered using Swiss ADME prediction and Lipinski's rule. Additionally, a Pseudovirion assay was performed to study the interaction of SARS CoV 2 S1-protein with the ACE 2 receptor for further confirming the effect.

RESULTS

Chebulagic acid (52.06 Kcal/mol) and Kaempferol (48.84 Kcal/mol) showed an increased interaction energy compared to Umifenovir (33.68 Kcal/mol) for the 6LZG binding domain of Spike glycoprotein. Epicatechin gallate (36.95 Kcal/mol) and Arachidic acid (26.09 Kcal/mol) showed equally comparable interaction energy compared to Umifenovir (38.20 Kcal/mol) for 6M17 binding domain of Spike glycoprotein. Trihydroxychalcone (35.23 Kcal/mol) and Kaempferol (36.96 Kcal/mol) showed equally comparable interaction energy with Umifenovir (36.60 Kcal/mol) for 6M0J binding domain of Spike glycoprotein. On analyzing the phytoconstituents against RdRp binding domain, DL-Arginine (41.78 Kcal/mol) showed comparable results with the positive control Remdesivir (47.61 Kcal/mol). ADME analysis performed using Swiss ADME revealed that Kaempferol and DL Arginine show drug-like properties with appropriate pharmacokinetic parameters. Further in vitro analysis of Kaempferol by Pseudo virion assay confirmed an acceptable decrease of the lentiviral particles on transfected HEK293T-hACE2 cells.

CONCLUSION

The study highlights that Kaempferol and DL-Arginine could be the significant molecules to exhibit potent action against SARS CoV 2 and its variants.

Proteomic analysis identifies a signature of disease severity in the plasma of COVID-19 pneumonia patients associated to neutrophil, platelet and complement activation

Most patients infected with SARS-CoV-2 display mild symptoms with good prognosis, while 20% of patients suffer from severe viral pneumonia and up to 5% may require intensive care unit (ICU) admission due to severe acute respiratory syndrome, which could be accompanied by multiorgan failure.Plasma proteomics provide valuable and unbiased information about disease progression and therapeutic candidates. Recent proteomic studies have identified molecular changes in plasma of COVID-19 patients that implied significant dysregulation of several aspects of the inflammatory response accompanied by a general metabolic suppression. However, which of these plasma alterations are associated with disease severity remains only partly characterized.A known limitation of proteomic studies of plasma samples is the large difference in the macromolecule abundance, with concentration spanning at least 10 orders of magnitude. To improve the coverage of plasma contents, we performed a deep proteomic analysis of plasma from 10 COVID-19 patients with severe/fatal pneumonia compared to 10 COVID-19 patients with pneumonia who did not require ICU admission (non-ICU). To this aim, plasma samples were first depleted of the most abundant proteins, trypsin digested and peptides subjected to a high pH reversed-phase peptide fractionation before LC-MS analysis.These results highlighted an increase of proteins involved in neutrophil and platelet activity and acute phase response, which is significantly higher in severe/fatal COVID-19 patients when compared to non-ICU ones. Importantly, these changes are associated with a selective induction of complement cascade factors in severe/fatal COVID-19 patients. Data are available via ProteomeXchange with identifier PXD036491. Among these alterations, we confirmed by ELISA that higher levels of the neutrophil granule proteins DEFA3 and LCN2 are present in COVID-19 patients requiring ICU admission when compared to non-ICU and healthy donors.Altogether, our study provided an in-depth view of plasma proteome changes that occur in COVID-19 patients in relation to disease severity, which can be helpful to identify therapeutic strategies to improve the disease outcome.

Histomorphological evaluation of placenta in SARS-CoV-2 patients: A cross-sectional study

BACKGROUND

SARS-CoV-2 has emerged as a major pandemic of the century and little is known about the impact of maternal infection on placental histopathology. Histopathologic examination of placental tissue can contribute to significant information regarding the pathophysiology of the disease and how it affects the fetal outcome.

MATERIALS AND METHODS

This was a cross-sectional study conducted at the Department of Pathology, Government Doon Medical College and Hospital, Dehradun, on the placenta of 50 coronavirus disease 2019 (COVID-19)-positive pregnant females confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) from August 2020 to October 2020. Fifty term historical placentas were taken as control. Placenta sections were fixed in formalin, processed into paraffin blocks, stained with hematoxylin and eosin (H and E) stain, and visualized for any abnormality.

RESULTS

The most prominent histological finding in the placenta of pregnant women affected by COVID-19 was chorangiosis, which is a feature of fetal vascular malperfusion seen in 28 (56%) cases. Other features included maternal vascular malperfusions (MVM) such as villous crowding and agglutination in 12 (24%) cases. Tenney-Parker change was seen in 13 (26%) patients. Intervillous fibrinoid deposition and intervillous hemorrhage were seen in 37 (74%) patients and 7 (14%) patients showed significant calcification. Other findings observed were less common.

CONCLUSION

Infection with SARS-CoV-2 may be associated with a significant impact on fetal and maternal circulation causing features of fetal and maternal malperfusion such as chorangiosis, villous crowding, and agglutination. Indicating that the infection could cause a potential rise in the risk of adverse perinatal outcomes such as intrauterine fetal growth retardation, preterm birth, or stillbirth.

A computational insight on the inhibitory potential of 8-Hydroxydihydrosanguinarine (8-HDS), a pyridone containing analogue of sanguinarine, against SARS CoV2

The unprecedented global pandemic of COVID‐19 has created a daunting scenario urging an immediate generation of therapeutic strategy. Interventions to curb the spread of viral infection primarily include setting targets against the virus. Here in this study we target S protein to obstruct the viral attachment and entry and also the M pro to prevent the viral replication. For this purpose, the interaction of S protein and M pro with phytocompounds, sanguinarine and eugenol, and their derivatives were studied using computational tools. Docking studies gave evidence that 8‐Hydroxydihydrosanguinarine, a derivative of sanguinarine, showed maximum binding affinity with both the targets. The binding energies of the ligand with S protein and M pro scored to be ΔGb ‐9.4 Kcal/mol and ΔGb ‐10.3 Kcal/mol respectively. MD simulation studies depict that the phytocompound could effectively cause structural perturbations in the targets which would affect their functions.8‐Hydroxydihydrosanguinarine distorts the α‐helix in the secondary structure of M pro and RBD site of S protein. Protein‐protein interaction study in presence of 8‐hydroxydihydrosanguinarine (8‐HDS) also corroborate the above findings which indicate that this polyphenol interfere in the coupling of S Protein and ACE2. The alterations in protonation of M pro suggest that the protein structure undergoes significant structural changes at neutral pH. ADME (Physicochemical, Lipophilicity, Water Solubility, Pharmacokinetics, Drug‐likeness) property of 8‐ hydroxydihydrosanguinarine indicates this could be a potential drug. This makes the phyto‐alkaloid a possible therapeutic molecule for antiCOVID‐19 drug design.

Accelerometer-measured physical activity and sedentary time among children and their parents in the UK before and after COVID-19 lockdowns: a natural experiment

BACKGROUND

Restrictions due to the coronavirus disease 2019 (COVID-19) pandemic reduced physical activity provision for both children and their parents. Recent studies have reported decreases in physical activity levels during lockdown restrictions, but these were largely reliant on self-report methods, with data collected via unrepresentative self-report surveys. The post-pandemic impacts on children's activity levels remain unknown. A key question is how active children become once lockdown restrictions are lifted.

METHODS

Active-6 is a repeated cross-sectional natural experiment. Accelerometer data from 1296 children aged 10-11 and their parents were collected in 50 schools in the Greater Bristol area, UK in March 2017-May 2018 (pre-COVID-19 comparator group), and compared to 393 children aged 10-11 and parents in 23 of the same schools, collected in May-December 2021. Mean minutes of accelerometer-measured moderate-to-vigorous physical activity (MVPA) were derived for weekdays and weekend and compared pre- and post-lockdown via linear multilevel models.

RESULTS

After adjusting for seasonality, accelerometer wear time and child/parent demographics, children's mean weekday and weekend MVPA were 7.7 min (95% CI: 3.5 to 11.9) and 6.9 min (95% CI: 0.9 to 12.9) lower in 2021 than in 2018, respectively, while sedentary time was higher by 25.4 min (95% CI: 15.8 to 35.0) and 14.0 min (95% CI: 1.5 to 26.5). There was no evidence that differences varied by child gender or household education. There was no significant difference in parents' MVPA or sedentary time, either on weekdays or weekends.

CONCLUSIONS

Children's MVPA was lower by 7-8 min/day in 2021 once restrictions were lifted than before the pandemic for all groups, on both weekdays and weekends. Previous research has shown that there is an undesirable age-related decline in children's physical activity. The 8-min difference reported here would be broadly comparable to the decline that would have previously been expected to occur over a three-year period. Parents' physical activity was similar to pre-pandemic levels. Our results suggest that despite easing of restrictions, children's activity levels have not returned to pre-pandemic levels. There is an urgent need to understand why these changes have occurred and how long they are maintained.

COVID-19 Vaccine and Fertility: The Male Perspective

Aims The expedited development of multiple COVID-19 vaccines has raised concerns for some, with vaccine hesitancy described in many populations. A U.S. study assessing fertility patients attitudes towards the COVID -19 vaccine revealed that over half were unsure, or would not accept the vaccine if offered. Only 7.4% of participants in this study were male. We therefore sought to assess the perspective of male fertility patients towards COVID-19 vaccination. Methods Men with a fertility appointment were invited to complete an anonymous 21-item questionnaire. Results Willingness to accept the COVID-19 vaccination was influenced by stage of fertility journey. Overall, 76% (n=102) of participants were willing to receive the COVID-19 vaccine. Men with a pregnant partner were most likely to accept or have already accepted the vaccine (97%, 30/31). Conclusion Although concerns around COVID-19 vaccines persist, this study demonstrates the growing rate of acceptance and engagement among the male fertility population.

Community seroprevalence and risk factors for SARS CoV-2 infection in different subpopulations in Vellore, India and its implications for future prevention

Objectives

The aim of this study was to inform public health policy decisions through the assessment of IgG antibody seroprevalence in the population and the risk factors for SARS-CoV-2 infection.

Methods

The seroprevalence of IgG antibodies among different subpopulations at the end of the first and second waves of the pandemic was estimated. Various risk factors associated with seropositivity, including sociodemography, IgG antibodies against endemic human coronavirus, and vaccination status, were also assessed.

Results

For all 2433 consenting participants, the overall estimated seroprevalences at the end of first and second waves were 28.5% (95% CI 22.3–33.7%) and 71.5% (95% CI 62.8–80.5%), respectively. The accrual of IgG positivity was heterogeneous, with the highest seroprevalences found in urban slum populations (75.1%). Vaccine uptake varied among the subpopulations, with low rates (< 10%) among rural and urban slum residents. The majority of seropositive individuals (75%) were asymptomatic. Residence in urban slums (OR 2.02, 95% CI 1.57–2.6; p < 0.001), middle socioeconomic status (OR 1.77, 95% CI 1.17–2.67; p = 0.007), presence of diabetes (OR 1.721, 95% CI 1.148–2.581; p = 0.009), and hypertension (OR 1.75, 95% CI 1.16–2.64; p = 0.008) were associated with seropositivity in multivariable analyses.

Conclusion

Although considerable population immunity has been reached, with more than two-thirds seropositive, improved vaccination strategies among unreached subpopulations and high-risk individuals are suggested for better preparedness in future.

Mucus targeting as a plausible approach to improve lung function in COVID-19 patients

COVID-19 (SARS-CoV-2) has emerged as one of the worst pandemics that have tormented the globe due to its highly contagious nature. Even if the disease manifests fever-like symptoms mostly, the disease may progress to the pulmonary-hyper inflammatory phase, with severe pneumonia, hypoxia and subsequent multiple organ infection. This subsequently creates a huge burden to the health care systems across the globe for an immediate arrangement of ventilator facilities, oxygen supply and advanced health care. We evaluated the pathological similarity of COVID-19 with other airway obstructive disorders such as COPD and asthma and found typical mucus hypersecretion and mucus plugging in COVID-19 subjects. From several bronchoscopy and clinical autopsy carried out in COVID-19 patients, the overexpression of mucin gene was evident which play a significant role in mucus hypersecretion and accumulation, leading to airway obstruction and further to respiratory distress. In the present work, we highlight the need for intense research inputs to elucidate the exact role the mucus plays in worsening COVID-19 symptoms. This will further help to find a proper approach to quantify the airway mucus plugging in each patient and to develop an appropriate therapy either to inhibit mucus secretion or to improve mucus clearance through well-designed clinical trials.

Kikuchi-Fujimoto disease following SARS CoV2 vaccination: Case report

Kikuchi's disease (KD) also known as Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis was first described in 1972 independently by Kikuchi and Fujimoto et al. It is a benign self-limited condition of unknown etiology which usually presents with cervical lymphadenopathy or fever of unknown origin. The diagnosis of KFD is based on histopathologic examination of the involved lymph node, showing the presence of well-defined necrosis without granulocytic cells. There is no special treatment for KFD. However non-steroidal anti-inflammatory drugs or corticosteroids are required occasionally to control the associated systemic manifestations. The outcome of the disease is usually favorable with resolution of symptoms in most cases within one to four months. We report a case of Kikuchi-Fujimoto disease that occurred in a young Qatari male patient 10 days following receiving the first dose of BNT162b2 vaccine. Diagnosis was established by lymph node biopsy and recovery was complete after 10 days.

Partial protection of Sinopharm vaccine against SARS COV2 during recent outbreak in Bahrain

Background

In order to impart immunity against SARS COV 2 in the community, the oil rich countries of the Gulf Cooperation Council (GCC) provided citizens and expatriates with free vaccination. Different types of vaccination brands were utilized for this purpose. The purpose of this study is to determine the efficacy of the different types of vaccinations used.

Methods

This is an observational analytical case study of one Bahraini family who were vaccinated with 1st, 2nd or no dose.

Results

Out of 22 double dose recipients of SARS COV2 vaccine, 20 were infected. Those 20 were vaccinated against SARS COV 2 using Sinopharm, the rest (2) were in direct contact with the source but were vaccinated against SARS COV 2 using other type of vaccine. Out of 26 single dose recipients of Sinopharm vaccine, 23 were infected. The other three were not in direct contact with the infected source. Social gathering has been the main source of transmission. The infection has been mild with headache, chest pain. From 20 cases with double dose vaccinations only one had a lung infection and needed hospitalization. Out of 23 cases with single dose vaccinations 10 were hospitalized due to lung infections. All family members who were not vaccinated were infected, three were hospitalized one of which was deceased due to diabetes mellitus complications.

Conlcusion

Sinopharm provides partial protection against SARS COV 2 infection. That might be due to lack of its potential to detect recent variations in the protein structure of spike(S) protein of virus.

Tolerability and usability of 0.5% PVP-I gargles and nasal drops in 6692 patients: Observational study

Objectives

1.

To assess the feasibility and usability of 0.5% PVP-I gargles and nasal drops in patients attending ENT consultations for a period of 5 months as a pre requisite prior to ENT examination.

2.

To assess the tolerance of 0.5% PVP-I in these patients for regular use for a period of 8 days.

Study design

Observational study.

Setting

Secondary care ENT Centre.

Methods

All patients attending the hospital for office ENT consultations from 15th April 2020 to 15th September 2020 were included in the study. A total of 6692 office patients were evaluated for feasibility, usability and tolerability of the 0.5% PVP-I gargles and nasal drops.

Results

Overall practicability of using 0.5% PVP-I gargles and nasal drops at office level was assessed in terms of feasibility and usability. Feasibility and usability was considered in terms of the ease of the dispensing method of the 0.5% PVP-I gargles and nasal drops by the health care workers to the patients prior to ENT examination. Tolerance was assessed in terms of altered taste, staining of teeth or nasal skin or irritation in the nose. None reported any serious reactions or adverse effects following use of 0.5% PVP-I.

Conclusion

The study reports the successful feasibility and usability of 0.5% PVP-I gargles and nasal drops and bears the potential to provide benefits in preventing transmission from the patients to the health care workers and vice versa.

Level of evidence

4.

EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures.

To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic.

The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care.

As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data.

This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic.

Serology in COVID: Light the Lantern and Pave the Way to Unexplored…

International Guidelines have voted for PCR as the Gold Standard in COVID diagnosis. Nasoparyngeal swab is the preferred specimen for PCR. It has a high probability of diagnosing early infection. But the diagnostic sensitivity of nasopharyngeal PCR decreases with increase in lapse between the infection and presentation to hospital. This might lead to dire consequences of labelling these patients as false negative, though such patients have been proved to be potentially infective since viral shedding occurs through other body fluids (stools) for long. COVID infection reveals that the IgM antibodies start to appear as early as 5th day of infection and switches over to IgA within 2–3 days. The aim of the study was to see if COVID antibody testing be coupled with PCR for diagnosis especially in patients presenting late (more than 14 days) of onset of infection? And if the antibodies are giving values, hence can them be reported quantitatively rather than in qualitative fashion? The second objective was to see if the COVID antibody levels be used to monitor the disease severity? And if the antibody levels of SARS CoV 2 be used an indicator to monitor the recovery?

Re-starting elective orthopaedic services in NHS Tayside during the COVID-19 pandemic

Background

Elective orthopaedic operations were suspended at the start of the COVID-19 lockdown. Three pathways were created to allow patients to undergo urgent elective operations in NHS Tayside as soon as it was deemed safe to do so.

Methods

We examined elective orthopaedic activity in NHS Tayside during and immediately after the Scottish lockdown. Elective operations performed between 27 March 2020 and 10 August 2020 were included and compared with cases performed between 27 March and 10 August in both 2018 and 2019. Primary outcomes were 30-day mortality, 30-day complications, and nosocomial infection rates of COVID-19.

Findings

Fewer elective operations were performed in 2020 (258) compared with 2019 (1196) and 2018 (1261). The rate of nosocomial infection in the 2020 cohort was 0%. The 30-day mortality rate was 0%. Over 98% of patients agreed to undergo surgery after a detailed consenting process.

Interpretation

We were able to re-start a safe elective orthopaedic service in the early stages of recovery from the COVID-19 pandemic, compatible with the guidelines set by the Royal College of Surgery of England and the British Orthopaedic Association. Our findings will serve to reassure regions with sufficient resources that it is acceptable to restart elective surgery for urgent priority cases. They may provide a template for planned surgical care in the event of further pandemics.

Tuning Proton Transfer Thermodynamics in SARS-Cov-2 Main Protease: Implications for Catalysis and Inhibitor Design

In this comutational work a hybrid quantum mechanics/molecular mechanics approach, the MD-PMM approach, is used to investigate the proton transfer reaction the activates the catalytic activity of SARS-CoV-2 main protease. The proton transfer thermodynamics is investigated for the apo ensyme (i.e., without any bound substrate or inhibitor) and in the presence of a inhibitor, N3, which was previously shown to covalently bind SARS-CoV-2 main protease.

Outcomes of Ayurvedic care in a COVID-19 patient with hypoxia - A Case Report

This paper reports for the first time, the outcomes of Ayurvedic intervention in a COVID-19 patient with severe hypoxia requiring supportive oxygen therapy. Patient developed fever, severe cough, loss of smell, loss of taste, nasal block, anorexia, headache, body ache, chills, and fatigue and was hospitalised when she developed severe breathing difficulty. Later, she tested positive for COVID-19 by RT PCR. The patient sought Ayurvedic treatment voluntarily when her SPO2 remained at 80% even after being given oxygen support. The patient was administered Ayurvedic medicines while undergoing oxygen therapy at the hospital. The patient refused to take Fabiflu recommended by the treating physician and discontinued other allopathic drugs except for Vitamin C. The patient showed clinical improvement within a day of administration of Ayurvedic medicines and was able to talk, eat, and sit on the bed without breathing difficulty and her SPO2 became stable between 95 and 98%. In the next two days, she was asymptomatic without oxygen support and was discharged from the hospital in the following week. Since obesity and high plasma CRP indicated high risk for progression to severe disease, the favourable outcomes with Ayurvedic treatment in this patient is significant and warrants further studies. Ayurveda care may be considered as first-line cost-effective alternative for COVID-19 patients presenting with symptomatic hypoxia in an integrative setup.

Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic

SARS CoV 2 is very much homologous in structure to SARS CoV. Review of literature suggests the in-vitro virucidal action of povidone iodine in SARS CoV and MERS. The oropharynx and nasopharynx are target sites of SARS CoV 2. A significant proportion of COVID 19 sufferers are asymptomatic, but shedding these viral particles, PVP-I has been shown to be a safe therapy when used as a mouthwash or taken nasally or used during ophthalmic surgeries.

AIMS

MATERIALS AND METHODS: 0.5% PVP-I solution is prepared from commercially available 10% PVP-I solution. Patients were instructed to put 0.5% PVP-I drops in nose and rinse mouth with gargle prior examinations for 30 s. For endoscopic procedure (nasal and throat) nasal douching and gargling to be started one day prior. Douching and rinsing to be repeated just before procedures. Nasal packing with 0.5% PVP-I along with 4% xylocaine/adrenaline solution, tolerability and any allergic reaction noted.

RESULTS

The patient and health care workers tolerated the 0.5%. No allergy was noted.

CONCLUSION

We propose the use of 0.5% PVP-I in healthcare workers and their patients to minimise the risk of spread of the disease in addition to the recommended PPE.

SARS-CoV-2 Transmission and Outcome in Neuro-rehabilitation Patients Hospitalized at Neuroscience Hospital in Italy

ABSTRACT Introduction:  Patients admitted to intensive neurorehabilitation facilities following neurological damage who developed SARS-CoV-2 infection during hospitalization have not yet been reported. Such patients are elderly, with severe disabling neurological syndromes, more likely have significant underlying comorbidities and develop fatal complications during the disease. We reported clinical features, underlying comorbidities, laboratory and radiological findings, treatment and outcome of severely disabled neurological patients with SARS-CoV-2 infection. Methods:  We retrospectively analyzed a group of 14 patients affected by severe neurological damage previously admitted to the Neurorehabilitation Unit of Neuromed Research Institute in Pozzilli, Italy, who developed confirmed COVID-19 during a SARS-CoV-2 outbreak occurred on March, 2020. Results:  One out of 14 patients (7%) died after developing a severe acute respiratory distress. The remaining patients did not present any symptom or laboratory or radiological signs of the disease; neither new neurological deficit nor worsening of the pre-existing clinical manifestations were observed. Thirtheen patients had underlying comorbitidies (93%), the most frequent being hypertension (11 patients, 78.5%) and diabetes mellitus type II (7 patients, 50%). Long before infection, all patients were already under anticoagulant therapy with enoxaparin. Conclusions:  In 13 out of 14 patients, the infection was asymptomatic; this is particularly intriguing considering their severe neurological clinical profile. According to the pivotal role played by inflammation and activation of blood coagulation in the pathogenesis of COVID-19, the anti-inflammatory and anticoagulant properties of enoxaparin, administered much earlier and during infection, could have favored an extremely benign disease course in these patients at high risk of poor outcome. Keywords: SARS CoV 2, neurological patients, neurological damage, Infection, Coronavirus    

COVID-19 versus the 1918 influenza pandemic: different virus, different age mortality patterns

The influenza pandemic of 1918-19 and the SARS-CoV 2 pandemic of 2020 had markedly different age mortality patterns. Influenza in 1918 particularly killed young adults whereas the elderly are most at risk from COVID-19. Mortality depends on complex host-pathogen interactions specific to the viral and human population’s history of infection.