ACE2 expression and localization are regulated by CFTR: implications beyond cystic fibrosis

As an inherited disorder characterized by severe pulmonary disease, cystic fibrosis (CF) could be considered a comorbidity for coronavirus disease 2019 (COVID-19)1. Instead, CF seems to constitute an advantage in COVID-19 infection2-5. To clarify whether host factors expressed by the CF epithelia may influence COVID-19 progression, we investigated the expression of SARS-CoV-2 receptor and coreceptors in primary airway epithelial cells. We found that angiotensin converting enzyme 2 (ACE2) expression and localization are regulated by cystic fibrosis transmembrane conductance regulator (CFTR) channels. Consistently, our results indicate that dysfunctional CFTR channels alter susceptibility to SARS-CoV-2 infection, resulting in reduced viral infection in CF cells. Depending on the pattern of ACE2 expression, the SARS-CoV-2 spike (S) protein induced high levels of Interleukin (IL)-6 in healthy donor-derived primary airway epithelial cells but a very weak response in primary CF cells. Collectively, these data support the hypothesis that CF condition is unfavorable for SARS-CoV-2 infection.

Endovascular thrombectomy for critical lower limb ischaemia in a patient with COVID-19

Hypercoagulable and proinflammatory states induced by the novel coronavirus (SARS-CoV-2) lead to thrombotic and embolic events. In this case report, the authors describe how they successfully managed acute critical limb ischaemia in a patient of COVID-19 illness with severe pulmonary disease and high thrombus burden in the infrapopliteal arteries.

Vaping and alternative smoking methods – a new risk of toxicity in children and adolescents

The children’s use of e-cigarettes has increased as many view them as a safer alternative to smoking during the past few years. In e-cigarettes, tobacco combustion is replaced by e-liquid heating, but the heating process can lead to new decomposition compounds of questionable toxicity. In addition, children exposure to e-cigarette liquids, whether intentional or accidental, may lead to specific adverse events of various types and severity from acute nicotine poisoning to an e-cigarette or vaping use-associated lung injury (EVALI), a severe pulmonary disease with public health implications. Therefore ongoing surveillance of poisoning exposure cases involving e-cigarettes and informing and educating the receptive population, especially adolescents and young people, on the risks they are exposed to by using these alternative smoking methods acquires special importance.

A review of COVID-19: a threat to pregnant women?

The outbreak of Coronavirus disease-2019 (COVID-19) has widely spread worldwide. While, mild symptoms have been observed in a majority but on the other hand, the virus may cause severe pulmonary disease. The major concern has been the pregnant women. In this review, we have tried to cover COVID-19 infections transmission, diagnosis, management, prognosis during pregnancy. The evidence on vertical transmission has been lacking. However, physiological changes during pregnancy, make women more vulnerable to this COVID-19. The problem of anxiety also flares up the disease in pregnancy.

Neonatal Acute Respiratory Distress Syndrome (Nrds) Secondary to Sars-Cov-2 Virus- Beneficial Role of Surfactant

We describe a preterm neonate with SARS-CoV-2-related neonatal acute respiratory distress syndrome (NRDS) in the second week of life with apneas and progressed to severe pulmonary disease requiring mechanical ventilation. He was administered surfactant therapy along with the other supportive care and had successful outcome. A recognition that these high-risk neonates could deteriorate, and as long as we do not have specific antiviral therapies against SARS-CoV-2, early patho-physiology based supportive therapy is the mainstay to prevent the progression of pulmonary failure, the most common cause of COVID-19 mortality. .

Tocilizumab in Severe Covid-19 Infection, Early Experiences at a Community Hospital

The COVID-19 global pandemic has resulted in more than 118 million cases and more than 2.5 million deaths. Most fatalities are related to severe pulmonary disease caused by a severe inflammatory response to the virus in the lungs. As yet there is no uniformly successful therapeutic agent. Tocilizumab is a monoclonal antibody that binds to IL-6 receptor thus inhibiting IL-6 mediated signaling of the inflammatory cascade. Early trials did not show a mortality benefit in patients treated with this agent. Newer studies have shown a benefit when Tocilizumab is used in conjunction with corticosteroids. This is a brief report on 7 patients with severe COVID-19 infection who received Tocilizumab therapy at our community hospital in the early period of the pandemic.

Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab

COVID-19 is characterized by a severe pulmonary disease due to severe acute respiratory syndrome (SARS)-CoV-2 infection. For clinicians involved in the management of patients with chronic autoimmune diseases the risk linked to the conditions itself and to drug-induced immunosuppression during the COVID-19 pandemic is a major topic. Pemphigus is a rare autoimmune blistering disease (AIBD) of the skin and mucous membranes caused by autoantibodies to desmosomal components, desmoglein 1 and 3. Among immunosuppressant therapies, rituximab (RTX) is considered a highly effective treatment with a favorable safety profile, but it induces a prolonged B-cell depletion that can lead to higher susceptibility to infections. For this reason, concerns about its use during the pandemic have been raised. We describe a case of a pemphigus patient in which RTX-induced B cell depletion led to the severe inflammatory phase, whereas corticosteroid treatment allowed a favorable outcome.

Humoral responses to SARS-CoV-2 by healthy and sick dogs during the COVID-19 pandemic in Spain

COVID-19 is a zoonotic disease caused by SARS-CoV-2. Infections of animals with SARS-CoV-2 have recently been reported, and an increase of severe lung pathologies in domestic dogs has also been detected by veterinarians in Spain. Therefore, further descriptions of the pathological processes in those animals that show symptoms similar to those described in humans affected by COVID-19 would be highly valuable. The potential for companion animals to contribute to the continued transmission and community spread of this known human-to-human disease is an urgent issue to be considered. Forty animals with pulmonary pathologies were studied by chest X-ray, ultrasound analysis, and computed tomography. Nasopharyngeal and rectal swabs were analyzed to detect canine pathogens, including SARS-CoV-2. An additional twenty healthy dogs living in SARS-CoV-2-positive households were included. Immunoglobulin detection by several immunoassays was performed. Our findings show that sick dogs presented severe alveolar or interstitial patterns with pulmonary opacity, parenchymal abnormalities, and bilateral lesions. The forty sick dogs were negative for SARS-CoV-2 but Mycoplasma spp. was detected in 26 of 33 dogs. Five healthy and one pathological dog presented IgG against SARS-CoV-2. Here we report that despite detecting dogs with α-SARS-CoV-2 IgG, we never obtained a positive RT-qPCR for SARS-SoV-2, not even in dogs with severe pulmonary disease; suggesting that even in the case of canine infection, transmission would be unlikely. Moreover, dogs living in COVID-19-positive households could have been more highly exposed to infection with SARS-CoV-2.

Comparing the novel microstream and the traditional mainstream method of end-tidal CO2 monitoring with respect to PaCO2 as gold standard in intubated critically ill children

The objective of this study was to evaluate a novel microstream method by comparison with PaCO2 and the more standard mainstream capnometer in intubated pediatric patients. We hypothesized that the novel microstream method would superior compared to the traditional mainstream method in predicting PaCO2. This was a prospective single-center comparative study. The study was carried out on 174 subjects with a total of 1338 values for each method. Data were collected prospectively from mainstream and microstream capnometer simultaneously and compared with PaCO2 results. Although both mainstream PetCO2 (mainPetCO2) and microstream PetCO2 (microPetCO2) were moderately correlated (r = 0.63 and r = 0.68, respectively) with PaCO2 values, mainPetCO2 was in better agreement with PaCO2 in all subjects (bias ± precision values of 3.8 ± 8.9 and 7.3 ± 8.2 mmHg, respectively). In those with severe pulmonary disease, the mainPetCO2 and microPetCO2 methods were highly correlated with PaCO2 (r = 0.80 and r = 0.81, respectively); however, the biases of both methods increased (14.8 ± 9.1 mmHg and 16.2 ± 9.0 mmHg, respectively). In cases with increased physiologic dead space ventilation, the agreement levels of mainPetCO2 and microPetCO2 methods became distorted (bias ± precision values of 20.9 ± 11.2 and 25.0 ± 11.8 mm Hg, respectively) even though mainPetCO2 and microPetCO2 were highly correlated (r = 0.78 and r = 0.78, respectively). It was found that the novel microstream capnometer method for PetCO2 measurements provided no superiority to the traditional mainstream method. Both capnometer methods may be useful in predicting the trend of PaCO2 due to significant correlations with the gold standard measurement in cases with severe pulmonary disease or increased physiological dead space –despite reduced accuracy.