Perfect storm: a rheumatologist's point of view on COVID-19 infection

2020 ◽  
Vol 16 ◽  
Author(s):  
Senol Kobak
Keyword(s):  
Distress Syndrome ◽  
Recent Literature ◽  
Point Of View ◽  
High Morbidity ◽  
Rheumatologic Diseases ◽  
Immunological Mechanisms ◽  
Severe Clinical Picture ◽  
Risk Of Disease ◽  
Disease Reactivation ◽  
Perfect Storm

: New corona virus infection (Covid-19) is a pandemic that affects the whole world and progresses with high morbidity and mortality. It has a high contagion rate and a course capable of rapidly lung involvement with severe acute respiratory distress syndrome (ARDS) and pulmonary insuficiency. Severe clinical picture develops as a result of a “perfect cytokin storm” as a result of possible immunological mechanisms triggered by viral infection. Immun system disregulation and possible autoinflammatory and autoimmune mechanisms are responsible for higher amount cytokines release from immune cells. Although there is no clear treatment of Covid-19 infection yet, it is argued that some disease modifying anti-rheumatic drugs (DMARDs) may be effective in addition to anti-viral treatments. These drugs (antimalarial drugs, colchicum dispert, biologics) have been well known to rheumatologists for years, because they have been used in the treatment of many inflammatory rheumatologic diseases, so now all eyes are on rheumatologists. Another important issue is whether DMARDs, which can cause severe immunosuppression, pose a risk for Covid-19 infection and whether they are discontinued beforehand. Although there are insufficient data on this subject, considering the risk of disease reactivation, patients may continue their DMARDs treatment under the supervision of the rheumatologist. In this article, the possible immunological mechanisms in the pathogenesis of Covid-19 infection and the efficacy and safety of various DMARDs used in the treatment have been discussed with a rheumatologist perspective in the light of recent literature data.

scholarly journals Mesenchymal Stromal Cells for the Treatment of Interstitial Lung Disease in Children: A Look from Pediatric and Pediatric Surgeon Viewpoints

Cells ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 3270
Author(s):  
Gloria Pelizzo ◽  
Serena Silvestro ◽  
Maria Antonietta Avanzini ◽  
Gianvincenzo Zuccotti ◽  
Emanuela Mazzon ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Age Of Onset ◽  
Point Of View ◽  
High Morbidity ◽  
Severe Toxicity ◽  
Adult Age ◽  
Pulmonary Parenchyma

Mesenchymal stromal cells (MSCs) have been proposed as a potential therapy to treat congenital and acquired lung diseases. Due to their tissue-regenerative, anti-fibrotic, and immunomodulatory properties, MSCs combined with other therapy or alone could be considered as a new approach for repair and regeneration of the lung during disease progression and/or after post- surgical injury. Children interstitial lung disease (chILD) represent highly heterogeneous rare respiratory diseases, with a wild range of age of onset and disease expression. The chILD is characterized by inflammatory and fibrotic changes of the pulmonary parenchyma, leading to gas exchange impairment and chronic respiratory failure associated with high morbidity and mortality. The therapeutic strategy is mainly based on the use of corticosteroids, hydroxychloroquine, azithromycin, and supportive care; however, the efficacy is variable, and their long-term use is associated with severe toxicity. The role of MSCs as treatment has been proposed in clinical and pre-clinical studies. In this narrative review, we report on the currently available on MSCs treatment as therapeutical strategy in chILD. The progress into the therapy of respiratory disease in children is mandatory to ameliorate the prognosis and to prevent the progression in adult age. Cell therapy may be a future therapy from both a pediatric and pediatric surgeon’s point of view.

scholarly journals Aurones: A Golden Resource for Active Compounds

Molecules ◽  
2021 ◽  
Vol 27 (1) ◽  
pp. 2
Author(s):  
Ilaria Mazziotti ◽  
Giovanni Petrarolo ◽  
Concettina La Motta
Keyword(s):  
Functional Properties ◽  
Scientific Community ◽  
Recent Literature ◽  
Biological Pathways ◽  
Point Of View ◽  
Drug Candidates ◽  
The Past ◽  
Comprehensive Picture ◽  
Functional Point ◽  
Chemical Strategies

Deemed as poorly represented in nature, aurones have been often overlooked by researchers compared to other members of the flavonoid superfamily. However, over the past two decades, they have been reassessed by the scientific community, who are increasingly appreciating their ability to modulate several biological pathways. This review summarizes the recent literature on this class of compounds, which has been analyzed from both a chemical and a functional point of view. Original articles, reviews and editorials featured in Pubmed and Scifinder over the last twenty years have been taken into account to provide the readers with a view of the chemical strategies to obtain them, their functional properties, and their potential of technological use. The resulting comprehensive picture aims at raising the awareness of these natural derivatives as effective drug candidates, fostering the development of novel synthetic analogues.

Managing a patient exposed to a teratogenic drug at different stages of pregnancy

2021 ◽  
pp. 85-92
Author(s):  
Christof Schaefer
Keyword(s):  
Pregnancy Outcomes ◽  
Drug Exposure ◽  
Unplanned Pregnancy ◽  
Related Information ◽  
Drug Risk ◽  
Developmental Risks ◽  
Risk Of Disease ◽  
Disease Reactivation ◽  
Adverse Pregnancy ◽  
Prescribing Information

Pregnancy-related information provided by leaflets usually contains inadequate data to interpret risks of teratogenicity; and in the absence of data, prescribing information often recommends discontinuing use in anticipation of and during pregnancy. In contrast, individual information on drug risk assessment addresses three different clinical perspectives: 1) looking for drugs of choice or planning pregnancy under medication; 2) assessment of drugs’ risk after exposure during an unplanned pregnancy; 3) assessment of causality in cases of adverse pregnancy outcomes in association with drug exposure. Unfortunately, for many women with chronic rheumatic diseases, discontinuation of all medication leaves an unacceptable risk of disease reactivation. Although, for the majority of drugs, human data are still insufficient to rule out developmental risks it is possible to distinguish antirheumatic drugs of choice with apparently low or negligible risks from those with scarce data or controversies on their safety and those with evidenced risk for the unborn.

scholarly journals The drivers of omni-channel shopping intention: a case study for fashion retailing sector in Danang, Vietnam

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Thi Hieu Hanh Truong
Keyword(s):  
Design Methodology ◽  
Recent Literature ◽  
Theoretical Perspective ◽  
Point Of View ◽  
Content Type ◽  
Customer Perception ◽  
Channel Strategy ◽  
Retail Setting ◽  
Managerial Perspective

PurposeThe purpose of this paper is to look into the mechanism in which customers involve themselves in omni-channel retail setting and use its advantages.Design/methodology/approachVia an empirical analysis through surveying customers, this paper assesses and confirms the drivers of omni-channel shopping intention within the context of fashion retailing sector in Danang.FindingsThe findings highlight the significance of customer perception of research shopping (including showrooming and webrooming) behaviours, compatibility and risk to their intention towards omni-channel shopping, implying profound understanding of designing effective omni-channel retailing strategy.Originality/valueFrom a theoretical perspective, comprehending customer perception of the omni-channel concept has emerged as an important theme in recent literature as well as in practitioners' reports. Hence, the meaningful contribution of this study is the involvement in the attractive steam of study. From a managerial perspective, this study could offer guidance to retailers or managers about developing a successful omni-channel strategy from a customer point of view.

Switching to ocrelizumab in RRMS patients at risk of PML previously treated with extended interval dosing of natalizumab

2020 ◽  
pp. 135245852094601
Author(s):  
Chiara Rosa Mancinelli ◽  
Cristina Scarpazza ◽  
Cinzia Cordioli ◽  
Nicola De Rossi ◽  
Sarah Rasia ◽  
...  
Keyword(s):  
At Risk ◽  
Resonance Imaging ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Patients At Risk ◽  
Risk Of Disease ◽  
Previously Treated ◽  
Disease Reactivation ◽  
Magnetic Resonance Imaging Mri ◽  
Relapsing Remitting Multiple Sclerosis

Discontinuation of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) at risk of progressive multifocal leukoencephalopathy (PML) is associated with disease reactivation. Forty-two RRMS patients, who switched from an extended interval dose (EID) of natalizumab to ocrelizumab, underwent magnetic resonance imaging (MRI) and clinical monitoring during washout and after ocrelizumab starting. During the first 3 months, disease reactivation was observed in five (12%) patients; 6 months after ocrelizumab starting, no further relapses were recorded, and Expanded Disability Status Scale (EDSS) remained stable in 38 (90%) patients. In conclusion, ocrelizumab could be considered a choice to mitigate the risk of disease reactivation in patients previously treated with natalizumab-EID.

scholarly journals Targeting the Heme-Heme Oxygenase System to Prevent Severe Complications Following COVID-19 Infections

Antioxidants ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 540 ◽  
Author(s):  
Frank A. D. T. G. Wagener ◽  
Peter Pickkers ◽  
Stephen J. Peterson ◽  
Stephan Immenschuh ◽  
Nader G. Abraham
Keyword(s):  
Critically Ill ◽  
Heme Oxygenase ◽  
Heme Proteins ◽  
Distress Syndrome ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Proof Of Concept ◽  
Effector Molecules ◽  
Free Heme ◽  
Anti Inflammatory

SARS-CoV-2 is causing a pandemic resulting in high morbidity and mortality. COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) are often critically ill and show lung injury and hemolysis. Heme is a prosthetic moiety crucial for the function of a wide variety of heme-proteins, including hemoglobin and cytochromes. However, injury-derived free heme promotes adhesion molecule expression, leukocyte recruitment, vascular permeabilization, platelet activation, complement activation, thrombosis, and fibrosis. Heme can be degraded by the anti-inflammatory enzyme heme oxygenase (HO) generating biliverdin/bilirubin, iron/ferritin, and carbon monoxide. We therefore postulate that free heme contributes to many of the inflammatory phenomena witnessed in critically ill COVID-19 patients, whilst induction of HO-1 or harnessing heme may provide protection. HO-activity not only degrades injurious heme, but its effector molecules possess also potent salutary anti-oxidative and anti-inflammatory properties. Until a vaccine against SARS-CoV-2 becomes available, we need to explore novel strategies to attenuate the pro-inflammatory, pro-thrombotic, and pro-fibrotic consequences of SARS-CoV-2 leading to morbidity and mortality. The heme-HO system represents an interesting target for novel “proof of concept” studies in the context of COVID-19.

Mesenchymal Stem/Stromal Cells Therapy for Sepsis and Acute Respiratory Distress Syndrome

2020 ◽  
Author(s):  
Declan Byrnes ◽  
Claire H. Masterson ◽  
Antonio Artigas ◽  
John G. Laffey
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Stromal Cells ◽  
Distress Syndrome ◽  
Immune Cell ◽  
Therapeutic Potential ◽  
Phase Iii ◽  
High Morbidity ◽  
Lung Dysfunction

AbstractSepsis and acute respiratory distress syndrome (ARDS) constitute devastating conditions with high morbidity and mortality. Sepsis results from abnormal host immune response, with evidence for both pro- and anti-inflammatory activation present from the earliest phases. The “proinflammatory” response predominates initially causing host injury, with later-phase sepsis characterized by immune cell hypofunction and opportunistic superinfection. ARDS is characterized by inflammation and disruption of the alveolar-capillary membrane leading to injury and lung dysfunction. Sepsis is the most common cause of ARDS. Approximately 20% of deaths worldwide in 2017 were due to sepsis, while ARDS occurs in over 10% of all intensive care unit patients and results in a mortality of 30 to 45%. Given the fact that sepsis and ARDS share some—but not all—underlying pathophysiologic injury mechanisms, the lack of specific therapies, and their frequent coexistence in the critically ill, it makes sense to consider therapies for both conditions together. In this article, we will focus on the therapeutic potential of mesenchymal stem/stromal cells (MSCs). MSCs are available from several tissues, including bone marrow, umbilical cord, and adipose tissue. Allogeneic administration is feasible, an important advantage for acute conditions like sepsis or ARDS. They possess diverse mechanisms of action of relevance to sepsis and ARDS, including direct and indirect antibacterial actions, potent effects on the innate and adaptive response, and pro-reparative effects. MSCs can be preactivated thereby potentiating their effects, while the use of their extracellular vesicles can avoid whole cell administration. While early-phase clinical trials suggest safety, considerable challenges exist in moving forward to phase III efficacy studies, and to implementation as a therapy should they prove effective.

A Critique of the Practical Contradiction Procedure for Testing Maxims

2005 ◽  
Vol 10 ◽  
pp. 112-127
Author(s):  
Shawn D. Kaplan
Keyword(s):  
Recent Literature ◽  
Full Range ◽  
Categorical Imperative ◽  
Point Of View ◽  
Practical Philosophy ◽  
Distinct Advantage ◽  
Christine Korsgaard ◽  
Consistent Model ◽  
Textual Support

Emerging from the growing swell of recent literature concerning Kant's practical philosophy, one interpretation of his procedure for testing maxims has crested above others. The influential interpretation to which I refer believes that the categorical imperative guides a procedure that finds maxims impermissible when they cannot be universalized without producing a 'practical' contradiction. As a major proponent of the practical contradiction interpretation, Christine Korsgaard claims that, while there is textual support for this point of view, she is more concerned with developing a defensible interpretation of maxim testing for a ‘Kantian’ system of morality. Accordingly, one cannot simply attempt to evaluate such a theory solely by considering its various incongruities with Kant's specific claims and arguments. Instead, my evaluation of the practical contradiction interpretation will examine: (a) whether it is a procedure that is applicable to a full range of maxims; (b) whether it maintains a distinct advantage over the alternative readings; and (c) whether it is an internally coherent and consistent model for testing maxims. I propose, here, that regardless of the practical contradiction test's many advantages, it fails with regard to all three of these questions.

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