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Cytokine Elevation In Severe And Critical Covid-19: A Rapid Systematic Review, Meta-Analysis, And Comparison With Other Inflammatory Syndromes., D. E. Leisman, L. Ronner, R. Pinotti, M. D. Taylor, P. Sinha, C. S. Calfee, A. V. Hirayama, F. Mastroiani, C. J. Turtle, C. S. Deutschman, +2 Additional Authors

Journal Articles

The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonists. However, direct systematic comparisons of COVID-19 with other critical illnesses associated with elevated cytokine concentrations have not been reported. In this Rapid Review, we report the results of a systematic review and meta-analysis of COVID-19 studies published or posted as preprints between Nov 1, 2019, and April 14, 2020, in which interleukin-6 concentrations in patients with severe or critical disease were recorded. 25 COVID-19 studies (n=1245 patients) were ultimately included. Comparator groups included four trials each in sepsis (n=5320), cytokine …

Hrs/Ehra/Aphrs/Lahrs/Acc/Aha Worldwide Practice Update For Telehealth And Arrhythmia Monitoring During And After A Pandemic, N. Varma, N. F. Marrouche, L. Aguinaga, C. M. Albert, E. Arbelo, J. I. Choi, M. K. Chung, G. Conte, L. M. Epstein, P. D. Varosy, +13 Additional Authors

Journal Articles

No abstract provided.

Coagulation Disorders In Coronavirus Infected Patients: Covid-19, Sars-Cov-1, Mers-Cov And Lessons From The Past, D. Giannis, I. A. Ziogas, P. Gianni

Journal Articles

© 2020 Elsevier B.V. Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus strain disease, has recently emerged in China and rapidly spread worldwide. This novel strain is highly transmittable and severe disease has been reported in up to 16% of hospitalized cases. More than 600,000 cases have been confirmed and the number of deaths is constantly increasing. COVID-19 hospitalized patients, especially those suffering from severe respiratory or systemic manifestations, fall under the spectrum of the acutely ill medical population, which is at increased venous thromboembolism risk. Thrombotic complications seem to emerge as an …

Time To Develop Therapeutic Antibodies Against Harmless Proteins Colluding With Sepsis Mediators?, J. Li, G. Bao, H. Wang

Journal Articles

Sepsis refers to a systemic inflammatory response syndrome resulting from microbial infections, and is partly attributable to dysregulated inflammation and associated immunosuppression. A ubiquitous nuclear protein, HMGB1, is secreted by activated leukocytes to orchestrate inflammatory responses during early stages of sepsis. When it is released by injured somatic cells at overwhelmingly higher quantities, HMGB1 may induce macrophage pyroptosis and immunosuppression, thereby impairing the host's ability to eradicate microbial infections. A number of endogenous proteins have been shown to bind HMGB1 to modulate its extracellular functions. Here, we discuss an emerging possibility to develop therapeutic antibodies against harmless proteins that collude …

A Double-Blind, Placebo-Controlled, Phase Ii, Randomized Study Of Lovastatin Therapy In The Treatment Of Mildly Active Rheumatoid Arthritis, C. Aranow, J. Cush, M. B. Bolster, C. C. Striebich, M. Dall'era, M. Mackay, E. Olech, T. Frech, B. Diamond, A. Davidson Mbbs, +14 Additional Authors

Journal Articles

© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. 3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors (statins) are standard treatment for hyperlipidaemia. In addition to lipid-lowering abilities, statins exhibit multiple anti-inflammatory effects. The objectives of this study were to determine whether treatment of patients with RA with lovastatin decreased CRP or reduced disease activity. Methods: We conducted a randomized double-blind placebo-controlled 12 week trial of lovastatin vs placebo in 64 RA patients with mild clinical disease activity but an elevated CRP. The primary efficacy end point was the reduction …

Role Of Nutraceuticals In Covid-19 Mediated Liver Dysfunction., M. Sikander, S. Malik, A. Rodriguez, M. M. Yallapu, A. S. Narula, S. K. Satapathy, V. Dhevan, S. C. Chauhan, M. Jaggi

Journal Articles

COVID-19 is known as one of the deadliest pandemics of the century. The rapid spread of this deadly virus at incredible speed has stunned the planet and poses a challenge to global scientific and medical communities. Patients with COVID-19 are at an increased risk of co-morbidities associated with liver dysfunction and injury. Moreover, hepatotoxicity induced by antiviral therapy is gaining importance and is an area of great concern. Currently, alternatives therapies are being sought to mitigate hepatic damage, and there has been growing interest in the research on bioactive phytochemical agents (nutraceuticals) due to their versatility in health benefits reported …

Hmgb1 As A Potential Biomarker And Therapeutic Target For Severe Covid-19, R. Chen, Y. Huang, J. Quan, J. Liu, H. Wang, T. R. Billiar, M. T. Lotze, H. J. Zeh, R. Kang, D. Tang

Journal Articles

© 2020 The Author(s) HMGB1; COVID-19; Cell culture; Cell death; Inflammation; Infectious disease; Immunology; Microbiology; Virology

Dedicated Area Within The Emergency Department Versus An Outside Dedicated Area For Evaluation And Management Of Suspected Coronavirus Disease 2019., G. Garra, S. Gupta, S. Ferrante, W. Apterbach

Journal Articles

Background

The circumstances of the coronavirus disease 2019 pandemic necessitated an alternate operations strategy for efficient patient management. Alternate care sites were a viable option for managing emergency department (ED) surge in previous epidemics and disasters.

Objective

This study describes the development of an alternate care site and evaluates efficiency by comparing key performance indicators between an ad hoc nested respiratory evaluation unit (NRU) within the ED and an alternate care site outside the ED.

Methods

This was a cohort study of 2 care models in the same ED during 2 different time periods. As coronavirus disease 2019 surged in …

Liver Injury In Covid-19: The Hepatic Aspect Of The Respiratory Syndrome — What We Know So Far, P. Anirvan, P. Bharali, M. Gogoi, P. J. Thuluvath, S. P. Singh, S. K. Satapathy

Journal Articles

© 2020. All Rights Reserved. The 2019 novel coronavirus disease (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a serious threat to global public health. Although primarily, the infection causes lung injury, liver enzyme abnormalities have also been reported to occur during the course of the disease. We conducted an extensive literature review using the PubMed database on articles covering a broad range of issues related to COVID-19 and hepatic injury. The present review summarizes available information on the spectrum of liver involvement, the possible mechanisms and risk factors of liver injury due to SARS-CoV-2 …

Clinical Characteristics And Outcomes Of Critically Ill Patients With Covid-19 Admitted To An Intensive Care Unit In London: A Prospective Observational Cohort Study, R. J. Thomson, J. Hunter, J. Dutton, J. Schneider, M. Khosravi, A. Casement, K. Dhadwal, D. Martin

Journal Articles

© 2020 Thomson et al. Background Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection. Methods We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from …

Identification Of A Brainstem Locus That Inhibits Tumor Necrosis Factor., A. M. Kressel, T. Tsaava, Y. A. Levine, E. H. Chang, M. E. Addorisio, Q. Chang, B. J. Burbach, V. A. Pavlov, S. S. Chavan, K. J. Tracey, +4 Additional Authors

Journal Articles

In the brain, compact clusters of neuron cell bodies, termed nuclei, are essential for maintaining parameters of host physiology within a narrow range optimal for health. Neurons residing in the brainstem dorsal motor nucleus (DMN) project in the vagus nerve to communicate with the lungs, liver, gastrointestinal tract, and other organs. Vagus nerve-mediated reflexes also control immune system responses to infection and injury by inhibiting the production of tumor necrosis factor (TNF) and other cytokines in the spleen, although the function of DMN neurons in regulating TNF release is not known. Here, optogenetics and functional mapping reveal cholinergic neurons in …

The Value Proposition For Pathologists: A Population Health Approach, B. S. Ducatman, A. M. Ducatman, J. M. Crawford, M. Laposata, F. Sanfilippo

Journal Articles

© The Author(s) 2020. The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of …

Molecular Pathology Economics 101: An Overview Of Molecular Diagnostics Coding, Coverage, And Reimbursement A Report Of The Association For Molecular Pathology, A. N. Sireci, J. L. Patel, L. Joseph, M. C. Hiemenz, O. C. Rosca, S. K. Caughron, S. A. Thibault-Sennett, T. L. Burke, D. L. Aisner

Journal Articles

No abstract provided.

Hrs/Ehra/Aphrs/Lahrs/Acc/Aha Worldwide Practice Update For Telehealth And Arrhythmia Monitoring During And After A Pandemic., N. Varma, N. F. Marrouche, L. Aguinaga, C. M. Albert, E. Arbelo, J. Choi, M. K. Chung, G. Conte, L. M. Epstein, P. D. Varosy, +13 Additional Authors

Journal Articles

No abstract provided.

Hrs/Ehra/Aphrs/Lahrs/Acc/Aha Worldwide Practice Update For Telehealth And Arrhythmia Monitoring During And After A Pandemic., N. Varma, N. F. Marrouche, L. Aguinaga, C. M. Albert, E. Arbelo, J. Choi, M. K. Chung, G. Conte, L. M. Epstein, P. D. Varosy, +13 Additional Authors

Journal Articles

No abstract provided.

Use Of Teledermatology By Dermatology Hospitalists Is Effective In The Diagnosis And Management Of Inpatient Disease., C. K. Gabel, E. Nguyen, R. Karmouta, K. J. Liu, G. Zhou, A. Alloo, R. Arakaki, Y. Balagula, V. R. Sharon, Daniela Kroshinsky, +25 Additional Authors

Journal Articles

BACKGROUND:Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data. METHODS:This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic. RESULTS:There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis …

Targeting Inflammation Driven By Hmgb1, H. Yang, H. Wang, U. Andersson

Journal Articles

© Copyright © 2020 Yang, Wang and Andersson. High mobility group box 1 (HMGB1) is a highly conserved, nuclear protein present in all cell types. It is a multi-facet protein exerting functions both inside and outside of cells. Extracellular HMGB1 has been extensively studied for its prototypical alarmin functions activating innate immunity, after being actively released from cells or passively released upon cell death. TLR4 and RAGE operate as the main HMGB1 receptors. Disulfide HMGB1 activates the TLR4 complex by binding to MD-2. The binding site is separate from that of LPS and it is now feasible to specifically interrupt …

Epidemiological And Clinical Characteristics Of International Travelers With Enteric Fever And Antibiotic Resistance Profiles Of Their Isolates: A Geosentinel Analysis, S. H. Hagmann, K. M. Angelo, R. Huits, K. Plewes, G. Eperon, M. P. Grobusch, A. Mccarthy, M. Libman, E. Caumes, D. H. Hamer, +15 Additional Authors

Journal Articles

Copyright © 2020 American Society for Microbiology. All Rights Reserved. Enteric fever, caused by Salmonella enterica serovar Typhi (S. Typhi) and S. enterica serovar Paratyphi (S. Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site’s national guidelines. A total of …

Meningococcal Vaccination: Recommendations Of The Advisory Committee On Immunization Practices, United States, 2020, S. A. Mbaeyi, C. H. Bozio, J. Duffy, L. G. Rubin, S. Hariri, D. S. Stephens, J. R. Macneil

Journal Articles

© 2020. This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of meningococcal vaccines in the United States. As a comprehensive summary and update of previously published recommendations, it replaces all previously published reports and policy notes. This report also contains new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. These guidelines will be updated as needed on the basis of availability of new data or licensure of new meningococcal vaccines. ACIP recommends routine vaccination with a quadrivalent …

Clinical Practices For Measles-Mumps-Rubella Vaccination Among Us Pediatric International Travelers., E. P. Hyle, S. R. Rao, A. C. Bangs, P. Gastañaduy, A. P. Fiebelkorn, S. H. F. Hagmann, A. T. Walker, R. P. Walensky, E. T. Ryan, R. C. Larocque

Journal Articles

Importance: The US population is experiencing a resurgence of measles, with more than 1000 cases during the first 6 months of 2019. Imported measles cases among returning international travelers are the source of most US measles outbreaks, and these importations can be reduced with pretravel measles-mumps-rubella (MMR) vaccination of pediatric travelers. Although it is estimated that children account for less than 10% of US international travelers, pediatric travelers account for 47% of all known measles importations.

Objective: To examine clinical practice regarding MMR vaccination of pediatric international travelers and to identify reasons for nonvaccination of pediatric travelers identified as MMR …

Covid-19 Leading To Acute Encephalopathy In A Patient With Heart Transplant., K Jang, A Khatri, Dt Majure

Journal Articles

No abstract provided.

Intensive Care Unit Admissions For Pregnant And Nonpregnant Women With Coronavirus Disease 2019, M J. Blitz, A Grünebaum, A Tekbali, E Bornstein, B Rochelson, M Nimaroff, Fa Chervenak

Journal Articles

No abstract provided.

The Underrecognized Prothrombotic Vascular Disease Of Covid-19., Kp Cohoon, G Mahé, Ac Spyropoulos

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No abstract provided.

Iglv3-21∗01 Is An Inherited Risk Factor For Cll Through The Acquisition Of A Single-Point Mutation Enabling Autonomous Bcr Signaling, P. C. Maity, M. Bilal, M. T. Koning, M. Young, C. A. Van Bergen, V. Renna, A. Nicolò, A. N. Mazzarello, N. Chiorazzi, H. Jumaa, +28 Additional Authors

Journal Articles

© 2020 National Academy of Sciences. All rights reserved. The prognosis of chronic lymphocytic leukemia (CLL) depends on different markers, including cytogenetic aberrations, oncogenic mutations, and mutational status of the immunoglobulin (Ig) heavy-chain variable (IGHV) gene. The number of IGHV mutations distinguishes mutated (M) CLL with a markedly superior prognosis from unmutated (UM) CLL cases. In addition, B cell antigen receptor (BCR) stereotypes as defined by IGHV usage and complementaritydetermining regions (CDRs) classify ∼30% of CLL cases into prognostically important subsets. Subset 2 expresses a BCR with the combination of IGHV3-21-derived heavy chains (HCs) with IGLV3- 21-derived light chains (LCs), …

Integrated Urine Proteomics And Renal Single-Cell Genomics Identify An Interferon-Γ Response Gradient In Lupus Nephritis., A. Fava, J. P. Buyon, C. Mohan, T. Zhang, H. M. Belmont, P. Izmirly, A. Arazi, A. Davidson, B. Diamond, M. Petri, +12 Additional Authors

Journal Articles

Lupus nephritis, one of the most serious manifestations of systemic lupus erythematosus (SLE), has both a heterogeneous clinical and pathological presentation. For example, proliferative nephritis identifies a more aggressive disease class that requires immunosuppression. However, the current classification system relies on the static appearance of histopathological morphology which does not capture differences in the inflammatory response. Therefore, a biomarker grounded in the disease biology is needed to understand the molecular heterogeneity of lupus nephritis and identify immunologic mechanism and pathways. Here, we analyzed the patterns of 1000 urine protein biomarkers in 30 patients with active lupus nephritis. We found that …

Aid Overlapping And Polη Hotspots Are Key Features Of Evolutionary Variation Within The Human Antibody Heavy Chain (Ighv) Genes, C. Tang, D. Bagnara, N. Chiorazzi, M. D. Scharff, T. Maccarthy

Journal Articles

© Copyright © 2020 Tang, Bagnara, Chiorazzi, Scharff and MacCarthy. Somatic hypermutation (SHM) of the immunoglobulin variable (IgV) loci is a key process in antibody affinity maturation. The enzyme activation-induced deaminase (AID), initiates SHM by creating C → U mismatches on single-stranded DNA (ssDNA). AID has preferential hotspot motif targets in the context of WRC/GYW (W = A/T, R = A/G, Y = C/T) and particularly at WGCW overlapping hotspots where hotspots appear opposite each other on both strands. Subsequent recruitment of the low-fidelity DNA repair enzyme, Polymerase eta (Polη), during mismatch repair, creates additional mutations at WA/TW sites. Although …

Febrile Infant: Covid-19 In Addition To The Usual Suspects, E Robbins, Z Ilahi, P Roth

Journal Articles

No abstract provided.

Major Thrombotic Event Despite Anticoagulation In A Patient With Covid-19., B. Ataallah, A. Sharma, S. Tamanna, J. Ng, G. Haggerty

Journal Articles

The outbreak of coronavirus disease 2019 (known as COVID-19), which started in Wuhan, China in December 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been associated with both venous and arterial thromboembolism likely secondary to significant cytokine activation and inflammation. Reports on the incidence of thrombotic complications, however, are not well documented. Our case will examine a young man diagnosed with COVID-19 who developed an acute, severe bilateral saddle pulmonary embolism while on prophylactic dose anticoagulation after being admitted to the hospital and treated for two weeks with significant improvement.

Nebulized In-Line Endotracheal Dornase Alfa And Albuterol Administered To Mechanically Ventilated Covid-19 Patients: A Case Series, A. G. Weber, A. S. Chau, M. Egeblad, B. J. Barnes, T. Janowitz

Journal Articles

© 2020 The Author(s). Background: Mechanically ventilated patients with COVID-19 have a mortality of 24-53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods: Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients …

Outcomes Of Patients With End-Stage Kidney Disease Hospitalized With Covid-19., J. H. Ng, J. S. Hirsch, R. Wanchoo, M. Sachdeva, V. Sakhiya, S. Hong, K. D. Jhaveri, S. Fishbane, Northwell Covid-19 Research Consortium, Northwell Nephrology Covid-19 Research Consortium

Journal Articles

Given the high risk of infection-related mortality, patients with end-stage kidney disease (ESKD) may be at increased risk with COVID-19. To assess this, we compared outcomes of patients with and without ESKD, hospitalized with COVID-19. This was a retrospective study of patients admitted with COVID-19 from 13 New York. hospitals from March 1, 2020, to April 27, 2020, and followed through May 27, 2020. We measured primary outcome (in-hospital death), and secondary outcomes (mechanical ventilation and length of stay), Of 10,482 patients with COVID-19, 419 had ESKD. Patients with ESKD were older, had a greater percentage self-identified as Black, and …