Thromboembolic disease in COVID-19 patients: A brief narrative review

Abstract Corona virus 2 (SARS-CoV2/ Severe Acute Respiratory Syndrome Corona Virus 2) infection has emerged as a global health crisis. Incidence of thromboembolic disease is reported to be high in SARS-CoV2 disease and is seen in a multitude of organ systems ranging from cutaneous thrombosis to pulmonary embolism, stroke or coronary thrombosis sometimes with catastrophic outcomes. Evidence points towards a key role of thromboembolism, hypercoagulability and over production of proinflammatory cytokines mimicking a “cytokine storm” which leads to multiorgan failure. This brief narrative review highlights the pathophysiology and risk factors of thromboembolic disease and provides a framework for management of anticoagulation based on the current evidence.

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The application of virtual reality in health professions� digital education: a narrative review (Preprint)

10.2196/preprints.12220 ◽

2018 ◽

Author(s):

Lorraine Tudor Car ◽

Bhone Myint Kyaw ◽

Josip Car

Keyword(s):

Virtual Reality ◽

Professional Education ◽

Health Professions ◽

Health Professions Education ◽

Narrative Review ◽

Current Evidence ◽

Future Research ◽

Educational Content ◽

Potential Applications

BACKGROUND Digital technology called Virtual Reality (VR) is increasingly employed in health professions’ education. Yet, based on the current evidence, its use is narrowed around a few most applications and disciplines. There is a lack of an overview that would capture the diversity of different VR applications in health professions’ education and inform its use and research. OBJECTIVE This narrative review aims to explore different potential applications of VR in health professions’ education. METHODS The narrative synthesis approach to literature review was used to analyse the existing evidence. RESULTS We outline the role of VR features such as immersion, interactivity and feedback and explain the role of VR devices. Based on the type and scope of educational content VR can represent space, individuals, objects, structures or their combination. Application of VR in medical education encompasses environmental, organ and micro level. Environmental VR focuses on training in relation to health professionals’ environment and human interactions. Organ VR educational content targets primarily human body anatomy; and micro VR microscopic structures at the level of cells, molecules and atoms. We examine how different VR features and health professional education areas match these three VR types. CONCLUSIONS We conclude by highlighting the gaps in the literature and providing suggestions for future research.

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Therapeutic Role of Tocilizumab in SARS-CoV-2-Induced Cytokine Storm: Rationale and Current Evidence

International Journal of Molecular Sciences ◽

10.3390/ijms22063059 ◽

2021 ◽

Vol 22 (6) ◽

pp. 3059

Author(s):

Corrado Pelaia ◽

Cecilia Calabrese ◽

Eugenio Garofalo ◽

Andrea Bruni ◽

Alessandro Vatrella ◽

...

Keyword(s):

Review Article ◽

Lung Damage ◽

Current Evidence ◽

Therapeutic Effects ◽

Cytokine Storm ◽

Future Perspectives ◽

Pathogenic Role ◽

Refractory Rheumatoid Arthritis ◽

Life Threatening

Among patients suffering from coronavirus disease 2019 (COVID-19) syndrome, one of the worst possible scenarios is represented by the critical lung damage caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-induced cytokine storm, responsible for a potentially very dangerous hyperinflammatory condition. Within such a context, interleukin-6 (IL-6) plays a key pathogenic role, thus being a suitable therapeutic target. Indeed, the IL-6-receptor antagonist tocilizumab, already approved for treatment of refractory rheumatoid arthritis, is often used to treat patients with severe COVID-19 symptoms and lung involvement. Therefore, the aim of this review article is to focus on the rationale of tocilizumab utilization in the SARS-CoV-2-triggered cytokine storm, as well as to discuss current evidence and future perspectives, especially with regard to ongoing trials referring to the evaluation of tocilizumab’s therapeutic effects in patients with life-threatening SARS-CoV-2 infection.

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Use of Thiols in the Treatment of COVID-19: Current Evidence

Lung ◽

10.1007/s00408-021-00465-3 ◽

2021 ◽

Author(s):

Mario Cazzola ◽

Paola Rogliani ◽

Sundeep Santosh Salvi ◽

Josuel Ora ◽

Maria Gabriella Matera

Keyword(s):

Oxidative Stress ◽

Influenza Virus Infection ◽

Current Evidence ◽

Low Molecular Weight ◽

Oxygen Species ◽

Cytokine Storm ◽

Antioxidant Defences ◽

Antioxidant Molecule ◽

Novel Therapeutic

AbstractThere is a possible role for oxidative stress, a state characterized by an altered balance between the production of free radicals or reactive oxygen species (ROS) and antioxidant defences, in coronavirus disease 2019 (COVID-19), the genesis of which is quite complex. Excessive oxidative stress could be responsible for the alveolar damage, thrombosis, and red blood cell dysregulation observed in COVID-19. Apparently, deficiency of glutathione (GSH), a low-molecular-weight thiol that is the most important non-enzymatic antioxidant molecule and has the potential to keep the cytokine storm in check, is a plausible explanation for the severe manifestations and death in COVID-19 patients. Thiol drugs, which are considered mucolytic, also possess potent antioxidant and anti-inflammatory properties. They exhibit antibacterial activity against a variety of medically important bacteria and may be an effective strategy against influenza virus infection. The importance of oxidative stress during COVID-19 and the various pharmacological characteristics of thiol-based drugs suggest a possible role of thiols in the treatment of COVID-19. Oral and intravenous GSH, as well as GSH precursors such as N-acetylcysteine (NAC), or drugs containing the thiol moiety (erdosteine) may represent a novel therapeutic approach to block NF-kB and address the cytokine storm syndrome and respiratory distress observed in COVID-19 pneumonia patients

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Current Evidence for a Role of Neuropeptides in the Regulation of Autophagy

BioMed Research International ◽

10.1155/2017/5856071 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 7

Author(s):

Elisabetta Catalani ◽

Clara De Palma ◽

Cristiana Perrotta ◽

Davide Cervia

Keyword(s):

Molecular Mechanisms ◽

Current Evidence ◽

Pathological Conditions ◽

Organ Systems ◽

Intercellular Signalling ◽

Physiological Homeostasis ◽

Response To Stress ◽

Autophagic Process ◽

Regulatory Functions

Neuropeptides drive a wide diversity of biological actions and mediate multiple regulatory functions involving all organ systems. They modulate intercellular signalling in the central and peripheral nervous systems as well as the cross talk among nervous and endocrine systems. Indeed, neuropeptides can function as peptide hormones regulating physiological homeostasis (e.g., cognition, blood pressure, feeding behaviour, water balance, glucose metabolism, pain, and response to stress), neuroprotection, and immunomodulation. We aim here to describe the recent advances on the role exerted by neuropeptides in the control of autophagy and its molecular mechanisms since increasing evidence indicates that dysregulation of autophagic process is related to different pathological conditions, including neurodegeneration, metabolic disorders, and cancer.

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The Role of MSC Therapy in Attenuating the Damaging Effects of the Cytokine Storm Induced by COVID-19 on the Heart and Cardiovascular System

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.602183 ◽

2020 ◽

Vol 7 ◽

Author(s):

Georgina M. Ellison-Hughes ◽

Liam Colley ◽

Katie A. O'Brien ◽

Kirsty A. Roberts ◽

Thomas A. Agbaedeng ◽

...

Keyword(s):

Cardiovascular System ◽

Cardiovascular Complications ◽

Multiple Organ ◽

Cytokine Storm ◽

Cell Therapies ◽

Tissue Repair And Regeneration ◽

Global Pandemic ◽

Organ Systems

The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has led to 47 m infected cases and 1. 2 m (2.6%) deaths. A hallmark of more severe cases of SARS-CoV-2 in patients with acute respiratory distress syndrome (ARDS) appears to be a virally-induced over-activation or unregulated response of the immune system, termed a “cytokine storm,” featuring elevated levels of pro-inflammatory cytokines such as IL-2, IL-6, IL-7, IL-22, CXCL10, and TNFα. Whilst the lungs are the primary site of infection for SARS-CoV-2, in more severe cases its effects can be detected in multiple organ systems. Indeed, many COVID-19 positive patients develop cardiovascular complications, such as myocardial injury, myocarditis, cardiac arrhythmia, and thromboembolism, which are associated with higher mortality. Drug and cell therapies targeting immunosuppression have been suggested to help combat the cytokine storm. In particular, mesenchymal stromal cells (MSCs), owing to their powerful immunomodulatory ability, have shown promise in early clinical studies to avoid, prevent or attenuate the cytokine storm. In this review, we will discuss the mechanistic underpinnings of the cytokine storm on the cardiovascular system, and how MSCs potentially attenuate the damage caused by the cytokine storm induced by COVID-19. We will also address how MSC transplantation could alleviate the long-term complications seen in some COVID-19 patients, such as improving tissue repair and regeneration.

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Role of Complement in Multiorgan Failure

Clinical and Developmental Immunology ◽

10.1155/2012/962927 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 44

Author(s):

Daniel Rittirsch ◽

Heinz Redl ◽

Markus Huber-Lang

Keyword(s):

Immune Response ◽

Innate Immunity ◽

Inflammatory Response ◽

Complement System ◽

Multiorgan Failure ◽

Severe Trauma ◽

Organ Systems ◽

Activation Products ◽

The Complement System

Multiorgan failure (MOF) represents the leading cause of death in patients with sepsis and systemic inflammatory response syndrome (SIRS) following severe trauma. The underlying immune response is highly complex and involves activation of the complement system as a crucial entity of innate immunity. Uncontrolled activation of the complement system during sepsis and SIRS with in excessive generation of complement activation products contributes to an ensuing dysfunction of various organ systems. In the present review, mechanisms of the inflammatory response in the development of MOF in sepsis and SIRS with particular focus on the complement system are discussed.

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Vitamin C to Improve Organ Dysfunction in Cardiac Surgery Patients—Review and Pragmatic Approach

Nutrients ◽

10.3390/nu10080974 ◽

2018 ◽

Vol 10 (8) ◽

pp. 974 ◽

Cited By ~ 17

Author(s):

Aileen Hill ◽

Sebastian Wendt ◽

Carina Benstoem ◽

Christina Neubauer ◽

Patrick Meybohm ◽

...

Keyword(s):

Cardiac Surgery ◽

Vitamin C ◽

Acute Stress ◽

Ischemia Reperfusion Injury ◽

Current Knowledge ◽

Ischemia Reperfusion ◽

Organ Damage ◽

Current Evidence ◽

Organ Systems

The pleiotropic biochemical and antioxidant functions of vitamin C have sparked recent interest in its application in intensive care. Vitamin C protects important organ systems (cardiovascular, neurologic and renal systems) during inflammation and oxidative stress. It also influences coagulation and inflammation; its application might prevent organ damage. The current evidence of vitamin C’s effect on pathophysiological reactions during various acute stress events (such as sepsis, shock, trauma, burn and ischemia-reperfusion injury) questions whether the application of vitamin C might be especially beneficial for cardiac surgery patients who are routinely exposed to ischemia/reperfusion and subsequent inflammation, systematically affecting different organ systems. This review covers current knowledge about the role of vitamin C in cardiac surgery patients with focus on its influence on organ dysfunctions. The relationships between vitamin C and clinical health outcomes are reviewed with special emphasis on its application in cardiac surgery. Additionally, this review pragmatically discusses evidence on the administration of vitamin C in every day clinical practice, tackling the issues of safety, monitoring, dosage, and appropriate application strategy.

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The role of complementary and alternative methods in the treatment of pain in patients with cancer – current evidence and clinical practice: a narrative review

Współczesna Onkologia ◽

10.5114/wo.2021.105969 ◽

2021 ◽

Vol 25 (2) ◽

pp. 88-94

Author(s):

Magdalena Kocot-Kępska ◽

Renata Zajączkowska ◽

Jing Zhao ◽

Jerzy Wordliczek ◽

Przemysław Tomasik ◽

...

Keyword(s):

Clinical Practice ◽

Narrative Review ◽

Alternative Methods ◽

Current Evidence ◽

Patients With Cancer ◽

Complementary And Alternative

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Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312771 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12771

Author(s):

Olivia Rochelle Joseph ◽

Stuart W. Flint ◽

Rianna Raymond-Williams ◽

Rossby Awadzi ◽

Judith Johnson

Keyword(s):

Racial Bias ◽

Narrative Review ◽

Current Evidence ◽

Future Research ◽

Healthcare Education ◽

Attrition Rates ◽

Implicit Racial Bias ◽

Healthcare Students ◽

Healthcare Settings

Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.

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Vitamin D testing and treatment: a narrative review of current evidence

Endocrine Connections ◽

10.1530/ec-18-0432 ◽

2019 ◽

Vol 8 (2) ◽

pp. R27-R43 ◽

Cited By ~ 51

Author(s):

Stefan Pilz ◽

Armin Zittermann ◽

Christian Trummer ◽

Verena Theiler-Schwetz ◽

Elisabeth Lerchbaum ◽

...

Keyword(s):

Public Health ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Human Health ◽

Mineral Metabolism ◽

Narrative Review ◽

Current Evidence ◽

Scientific Debate ◽

Hydroxyvitamin D

Vitamin D testing and treatment is a subject of controversial scientific discussions, and it is challenging to navigate through the expanding vitamin D literature with heterogeneous and partially opposed opinions and recommendations. In this narrative review, we aim to provide an update on vitamin D guidelines and the current evidence on the role of vitamin D for human health with its subsequent implications for patient care and public health issues. Vitamin D is critical for bone and mineral metabolism, and it is established that vitamin D deficiency can cause rickets and osteomalacia. While many guidelines recommend target serum 25-hydroxyvitamin D (25[OH]D) concentrations of ≥50 nmol/L (20 ng/mL), the minimum consensus in the scientific community is that serum 25(OH)D concentrations below 25–30 nmol/L (10–12 ng/mL) must be prevented and treated. Using this latter threshold of serum 25(OH)D concentrations, it has been documented that there is a high worldwide prevalence of vitamin D deficiency that may require public health actions such as vitamin D food fortification. On the other hand, there is also reason for concern that an exploding rate of vitamin D testing and supplementation increases costs and might potentially be harmful. In the scientific debate on vitamin D, we should consider that nutrient trials differ from drug trials and that apart from the opposed positions regarding indications for vitamin D treatment we still have to better characterize the precise role of vitamin D for human health.

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