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Management of corona virus disease-19 (COVID-19): the Zhejiang experience
Abstract
The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.
... In addition, emerging data is linking worse outcomes with factors associated with less-favourable gut microflora (dysbiosis) [1][2][3]. Gut dysbiosis can cause impaired gut wall integrity, reduced immunosurveillance, excessive inflammation and impaired oxidative pathways, all of which are very relevant following COVID-19 infection [1,[4][5][6][7][8][9][10][11][12][13][14][15][16]. An exaggerated release of inflammatory cytokines triggers an influx of innate immune cells into tissues, causing collateral damage and excess pulmonary exudates which block pulmonary airways, both features of acute respiratory distress syndrome (ARDS) [4,5,13,[17][18][19][20][21][22]. ...
... Dysbiosis has been reported in the majority of patients with COVID-19, particularly those expressing gastrointestinal (GI) symptoms. This is thought, in part, to be attributed to an increased susceptibility of individuals with dysbiosis to contract COVID-19, but also the ability of the virus in the gut to directly cause gut inflammation which can upset microfloral balance [6][7][8]10,11,14,[23][24][25][26]. Previous studies have highlighted that patients with GI symptoms at presentation had worse non-GI symptoms, particularly fatigue, during COVID-19 infection, and had a greater risk of chronic symptom burden [6,[11][12][13]27]. ...
... Among the cohort (126) given the Lactobacillus probiotic and inulin, there was a clear improvement in CFS, CSS and SWB scores over the 30 days. For patients within the acute phase of an infection this result would have been expected, as most patients are likely to improve within this time frame [7,[116][117][118]. The same, however, cannot be said for participants with chronic, persistent COVID-19-related symptoms. ...
Gut microflora dysbiosis affects the majority of individuals after COVID-19, contributing to both gastro-intestinal (GI) and non-GI symptoms. Natural phytochemicals have reported anti-viral properties and favourable effects on inflammatory and oxidative pathways, both important for tissue damage post-viral pneumonia. This study involved 147 participants with symptomatic COVID-19, randomised to receive a placebo (P) or a phytochemical-rich concentrated food capsule (PC) in addition to a pre/probiotic lactobacillus capsule. Participants taking the PC had an almost two-fold reduction in mean fatigue scores compared to P [p = 0.02], a three-fold reduction in cough score and more than a double improvement in overall well-being scores [p = 0.02]. Two (1.5%) participants reported mild, increased bloating which they felt was attributable to the capsules, although GI symptoms improved in 25 of 31 participants (82%) who reported them at baseline. Sedentary, older, previously hospitalised men with GI symptoms had a statistically significantly improvement among those given the probiotic. Although some participants with early disease would have improved spontaneously, such a rapid improvement observed in the majority of participants, who had been suffering for an average of 108 days, was clinically relevant and welcomed, especially among those more likely to have pre-existing gut dysbiosis. We are now evaluating whether this blend could also enhance antibody titres post-COVID-19 vaccination.
... Based on the data from COVID19 Vaccine Tracker website, there are 38 approved vaccines [10]. A research reported that 76 total vaccine candidates dominantly exist from protein subunit among other molecular platforms such as non-replicating viral (31) vector, RNAbased (31), replicating viral vector (21), DNAbased (19), inactivated virus (14), virus-like particle (13), and live attenuated virus (4) platforms [11]. On the other hand, there is a considerable amount of 3D protein structures for SARS-CoV-2, generally related to its main protease structure resolved by mostly X-ray diffraction crystallography, available in Protein Data Bank (RCSB PDB). ...
... Traditional herbal medicines are known to be used and it was recently reported that these medicines have been used in China from the beginning of the outbreak and they were seen to recover of 90% of the 214 patients treated [17,18]. Some promising results were also published by Xu et al. in Zhejiang Province-China [19]. Chinese traditional medicines, Shu Feng Jie Du and Lianhuaqingwen, were recommended because of their efficiency against previous influenza A (H1N1) or SARS-CoV-1 [20]. ...
... and Lactobacillus spp. [230]. Initially, the treatment option applied for coronavirus disease 2019 (COVID-19) included artificial ventilation and antiviral agents. ...
... Similarly, patients suffering from other complications like antibiotic-related diarrhea showed a higher proportion of COVID-19 infection. These recent findings further indicate that there is a requirement for microbiota balance in patients suffering from COVID-19 infection using some probiotics [230]. COVID-19 infection also causes severe hypoxia, whereas a reduction in probiotic species leads to an increase in the number of pathogens like Actinobacteria spp., Corynebacterium spp., and Ruthenibacterium spp. ...
Consumption of live microorganisms “Probiotics” for health benefits and well-being is increasing worldwide. Their use as a therapeutic approach to confer health benefits has fascinated humans for centuries; however, its conceptuality gradually evolved with methodological advancement, thereby improving our understanding of probiotics-host interaction. However, the emerging concern regarding safety aspects of live microbial is enhancing the interest in non-viable or microbial cell extracts, as they could reduce the risks of microbial translocation and infection. Due to technical limitations in the production and formulation of traditionally used probiotics, the scientific community has been focusing on discovering new microbes to be used as probiotics. In many scientific studies, probiotics have been shown as potential tools to treat metabolic disorders such as obesity, type-2 diabetes, non-alcoholic fatty liver disease, digestive disorders (e.g., acute and antibiotic-associated diarrhea), and allergic disorders (e.g., eczema) in infants. However, the mechanistic insight of strain-specific probiotic action is still unknown. In the present review, we analyzed the scientific state-of-the-art regarding the mechanisms of probiotic action, its physiological and immuno-modulation on the host, and new direction regarding the development of next-generation probiotics. We discuss the use of recently discovered genetic tools and their applications for engineering the probiotic bacteria for various applications including food, biomedical applications, and other health benefits. Finally, the review addresses the future development of biological techniques in combination with clinical and preclinical studies to explain the molecular mechanism of action, and discover an ideal multifunctional probiotic bacterium.
... Obesity and chronic age-related illnesses are associated with an aberrant gut flora, known as dysbiosis. It's worth noting that Xu and his co-authors mention that some Chinese patients with COVID-19 had dysbacteriosis, with low quantities of lactobacilli and bifidobacteria (Xu et al., 2020). The intestinal microbiota should considerably affect the development of the innate and adaptive immune system (Negi et al., 2019). ...
The COVID-19 outbreak is a worldwide hazard and a pandemic. It affects primarily the respiratory system of the infected persons. The severity of infection depends on various factors such as individual health, age, lifestyle, gender, dietary habits, environment, and medications. COVID-19's catastrophic results are exacerbated by a high BMI and chronic conditions. The study's goal was to look at the effects of antioxidant foods on immune function and their possible involvement in the treatment of COVID-19 infection. The human immune cell is always active, and the activity of the immune system is improved when there is an infection requiring energy sources and substrates taken from the food. A range of vitamins and trace minerals has been found to have crucial functions in enhancing immune function and decreasing the chance of infection. The gut microbiota strives to empower and regulate the immune system. Dietary methods for achieving a healthy microbiome can also improve the immune system. According to worldwide standards, the best way to maintain the immune system is to consume a healthy balanced diet rich in plant and animal foods, as well as appropriate prebiotic and probiotic prophylactic supplements.
... When COVID-19 progresses from severe to terminally ill, patients may develop extreme cytokine storm, secondary ARDS, followed by shock, tissue perfusion disorders, and even multi-organ collapse [11]. In SARS-CoV-2 patients with a poor prognosis, IL-6, IL-10, and TNF-α rapidly rise and reach high levels. ...
With the increased number of cases of coronavirus disease 2019 (COVID-19) all over the world which was discovered in December 2019 in Wuhan city of China, there are more positive rates and deaths encountered during the second wave due to this dreadful infection mainly focusing on youngsters diagnosed with COVID-pneumonia. Amidst this devastating situation, there is ray of hope by the emerging clinical trials on Tocilizumab, a potent interleukin-6 (Il-6) inhibitor which likely reduces the mortality of those patients having severe COVID-19 pneumonia as a result of Cytokine Release Syndrome. This syndrome is triggered by burst of inflammatory markers secondary to COVID-19 which is characterized by decrease in T-cells and Natural Killer cells, an increase in IL-6, fever, organ and tissue dysfunction, and an abnormal coagulation function eventually leading to death.
... To ensure the patient's recovery, oxygen therapy, mechanical ventilation, antibiotics, and plasma therapies are the primary treatment methods and antibiotics to prevent secondary infections [18]. In an endeavor to manage immunodeficiency, immunotherapy hasbeen depicted as a supportive treatment. ...
... Disbiosis bakteri menguntungkan pertumbuhan patogen oportunistik yang juga telah terbukti berkorelasi dengan tingkat keparahan COVID-19 (Tang et al., 2020). Pasien COVID-19 dapat mengalami disbiosis mikroba usus yang ditandai dengan rendahnya jumlah berbagai spesies probiotik Bifidobacterium dan Lactobacillus, sehingga diperlukan pemberian probiotik untuk mengembalikan keseimbangan flora usus dan mengurangi risiko terkait infeksi SARS-CoV-2 (Xu et al., 2020). Probiotik dapat membantu mencegah dan mengobati COVID-19 dengan memelihara mikrobiotik saluran pencernaan dan mikrobiota paru-paru. ...
Seiring dengan perkembangan kasus COVID-19, upaya pemeliharaan kesehatan untuk menjaga dan meningkatkan daya tahan tubuh sangat penting dilakukan. upaya hidup sehat yang perlu diimplementasikan adalah dengan mengatur asupan suplementasi nutrisi baik makronutrisi maupun mikronutrisi. Salah satu jenis pangan nutrasetikal dengan gizi kompleks yang potensial digunakan sebagai nutrasetikal untuk upaya suplementasi adalah yoghurt. Secara tradisional yoghurt juga disebutkan dalam kearifan pengobatan masyarakat Bali yaitu Usadha. Dalam Usadha, yoghurt dikombinasikan dengan bahan-bahan yang terdapat dalam Lontar Usadha Taru Pramana (Usadha yang memuat tentang berbagai jenis tanaman berkhasiat obat). Metode yang digunakan menyusun artikel ini adalah studi literatur sistematik review. Informasi yang relevan dikumpulkan dari Google Scholar, Science Direct, ProQuest, Pubmed, EBSCO. Dipilih artikel terindeks Scopus, Sinta, atau Garuda yang dipublikasi 5 tahun terakhir. Berdasarkan penelusuran pustaka diketahui bahwa penambahan masing-masing ekstrak kunyit, jahe, secang, dan kayu manis pada yoghurt dapat meningkatkan kualitas fisiko-kimia dan kandungan nutrisi pada yoghurt tersebut utamanya antioksidan sehingga berkontribusi dalam pemeliharaan kesehatan serta mampu menjaga stabilitas probiotik yoghurt. Kombinasi yoghurt rempah dengan penambahan rimpang jahe, kunyit, kayu secang, dan kayu manis berpotensi digunakan sebagai suplementasi probiotik-antioksidan untuk mendukung gaya hidup sehat yang berkaitan dengan terjaganya sistem imun.
... [34] Lanjuan Li academician and her colleagues who have accumulated experience with severe COVID-19 treatment, reminded clinicians should focus on patients' fungal infections, especially severely ill or immunocompromised ones. [35] At the early phase of the disease or with extrapulmonary fungal infections, it may present with atypical chest imaging. Hence, it is necessary for severely ill patients to receive fungal pathogens surveillance, including (i) etiological examination: direct microscopy and culture; (ii) histopathology; (iii) serology: antigen and antibody, (1,3)-b-D-glucan (BDG) 36 and galactomannan (GM) detection by serum are also need to be tested for suspicious patients, while bronchoalveolar lavage fluid(BALF) and tracheal aspirate (TA) sampling for culture and biomarker testing should be performed under well-protected conditions due to the risk of aerosol spreading and health careworker infections [37] ; (iv) PCRbased methods: Real-time polymerase chain reaction (PCR) techniques and molecular identification can be performed to identify pathogens ifnecessary. ...
... Sel epitel alveolus tipe 2 terdapat pada saluran cerna manusia, paru-paru, makrofag, sel T, badai sitokin sistemik, pneumonia dan kerusakan multi-organ. Penelitian Xu et al. (2020) menggambarkan temuan patologis pada SARS-CoV-2 yang parah dan menunjukkan infiltrat sel imun yang menyimpang di paru-paru. Dalam hal ini, pengurangan dan kelelahan fungsional sel T CD8+ ditunjukkan secara paralel dengan peningkatan kadar sitokin inflamasi pada pasien Covid-19 yang parah (Diao et al., 2020). ...
Corona virus disease 2019 (Covid-19) yang disebabkan oleh severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) adalah pandemi global yang sedang berlangsung. Agen SARS-CoV-2 memengaruhi sel-sel epitel saluran pernapasan manusia yang menyebabkan badai sitokin proinflamasi dan peradangan paru-paru secara kronis. Badai sitokin adalah respons inflamasi ofensif akibat infeksi Covid-19 pada beberapa pasien. Badai sitokin ini dapat merusak paru-paru, saluran pencernaan, otak, sistem kardiovaskuler, hati, ginjal, mikrosirkulasi, dan mata. Akibatnya telah sangat banyak pasien yang meninggal setiap hari, berbagai upaya untuk menemukan vaksin dan sediaan obat antivirus khusus saat ini terus dieksplorasi. Mekanisme probiotik, prebiotik, dan diet dengan kekebalan anti-SARS-CoV-2 telah menghadirkan peluang bagi penemuan terapi mikrob untuk mencegah dan mengobati Covid-19. Probiotik adalah mikroorganisme hidup yang bila diberikan dalam jumlah yang tepat dan memadai dapat memberikan manfaat kesehatan bagi saluran pencernaan manusia. Prebiotik adalah bahan pangan selektif yang dibutuhkan oleh mikrob probiotik usus sebagai sumber nutrisi untuk pertumbuhan dan viabilitasnya. Berbagai bukti ilmiah yang muncul mendukung hipotesis bahwa probiotik dan prebiotik berperan sebagai antivirus dan imunomodulator yang dapat meningkatkan sistem imun manusia. Mekanisme prebiotik dalam meningkatkan imunitas untuk melawan Covid-19 adalah dengan mempromosikan pematangan, diferensiasi, dan reproduksi limfosit dan makrofag, mengaktifkan sistem retikulo endotelial, meningkatkan proporsi CD8+ IEL. Mekanisme probiotik dalam meningkatkan imunitas untuk melawan Covid-19 adalah dengan meningkatkan aktivitas sel T (T-supressor, T-helper (CD4+), selsel Natural Killer, meningkatkan nterleukin 10 (IL-10), meningkatkan kapasitas fagositosis selpolimorfonuklear (PMN).
... The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe [1]. ...
Covid 19, the severe Acute Respiratory Syndrome Coronavirus 2, is the highly transmissible "Complex killer". A recent trend in the community is the consumption of herbal medicines containing certain active compounds, which have antimicrobial or antiviral, anti-inflammatory, and immunomodulatory activities. This study aimed to evaluate the effect of three herbs (Rhus Coriaria, thyme and Anise = Covets) on COVID-19 patients. Two groups were included, the first received the protocoled treatment and the CovETS (Covets (study) group= G1) while the second (control group= G2) received the protocoled treatment only. CovETS showed highly significant improvement with highly significant reduction of patient's mortality.
... 129 Studies in hospitalized COVID-19 patients have shown gut microbial dysbiosis consisting of a reduction in probiotic bacteria, increased opportunistic pathogens and reduced beneficial symbionts that persisted even after resolution of respiratory symptoms and predicted infection severity. [130][131][132] Furthermore, studies suggest that a bi-directional cross-talk between the gut and lung inflammatory response in COVID-19 infection may exist, and that their respective microbial composition can be affected by several elements such as lifestyle factors (e.g. diet, smoking and medications). ...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronavirus family that causes the novel coronavirus disease first diagnosed in 2019 (COVID-19). Although many studies have been carried out in recent months to determine why the disease clinical presentations and outcomes can vary significantly from asymptomatic to severe or lethal, the underlying mechanisms are not fully understood. It is likely that unique individual characteristics can strongly influence the broad disease variability; thus, tailored diagnostic and therapeutic approaches are needed to improve clinical outcomes. The circadian clock is a critical regulatory mechanism orchestrating major physiological and pathological processes. It is generally accepted that more than half of the cell-specific genes in any given organ are under circadian control. Although it is known that a specific role of the circadian clock is to coordinate the immune system's steady-state function and response to infectious threats, the links between the circadian clock and SARS-CoV-2 infection are only now emerging. How inter-individual variability of the circadian profile and its dysregulation may play a role in the differences noted in the COVID-19-related disease presentations, and outcome remains largely underinvestigated. This review summarizes the current evidence on the potential links between circadian clock dysregulation and SARS-CoV-2 infection susceptibility, disease presentation and progression, and clinical outcomes. Further research in this area may contribute towards novel circadian-centred prognostic, diagnostic and therapeutic approaches for COVID-19 in the era of precision health.
... The risk of Pneumocystis jirovecii pneumonia (PJP) increases significantly with CD4+ lymphocytopenia (<200 cell/L). 54,55 SARS-COV-2 infection in an already immunosuppressed patient, leads to further functional immunosuppression predisposing the patient to PJP. 54 Due to overlapping radiological features of SARS-COV-2 with PJP, the presence of PJP co-infection with SARS-COV-2 may be difficult to diagnose on imaging. The radiologists should approach the CT scan with suspicion for PJP co-infection in an immunocompromised patient with CD4+ lymphocytopenia. ...
Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.
... Mainly, approved anti-viral drugs such as baloxavir marboxil, darunavir, favipiravir, lopinavir, oseltamivir, remdesivir, ritonavir, etc., along with several immune-modulatory, anti-inflammatory remedies such as Fingolimod, Sarilumab and Tocilizumab are used in multiple combinations against COVID-19 [9][10][11]. Even the combined treatment with obsolete anti-malarial quinine derivatives such as hydroxyl-chloroquine with the macrolide (azithromycin) and tetracycline (doxycycline) class of antibiotics is continuously used as an alternative against COVID-19 [11,12]. The COVID-19 is an aggregated form of previously recognized SARS and the Middle East respiratory syndrome (MERS) virus and its genome was found to have >70% genomic similarity with the previous variants. ...
Background: Coronavirus disease-2019 (COVID-19
... A dysbiotic microbiome can actively impact colonization by modifying innate and adaptive gut immune mechanisms. Dysbiosis is also associated with a variety of immune-related human diseases, but it is not always understandable whether dysbiosis is a causative factor or a response to the ailment (Xu, K. H. Cai;Kuba, K., et al., 2005). ACE2 regulates the amino acid transporter B0AT1, which regulates tryptophan absorption in the intestine (Zhao, Y., et al., 2018). ...
Identifying the mechanism of Covid-19 illness and its development can bring the discovery of new
objectives for prevention or therapy. This might be accomplished by preventing viral entrance and
replication, or just by suppressing the immune reaction elicited by the disease. Probiotics are described as
"beneficial microorganisms that impose a health benefit on the host when given in suitable concentrations."
There is strong scientific research to prove the capacity of probiotics in increasing human immune response,
hence avoiding pathogen proliferation and lowering the occurrence and severity of diseases. We report
clinical data on the usefulness of probiotic supplements to protect and cure respiratory system infections in
this paper. The findings suggest that probiotics may be beneficial in lowering the likelihood of coronavirus
infection. Furthermore, this domain needs to be explored to unleash the strength of probiotics and microbiota
in fighting against COVID-19.
... GİRİŞ COVID-19 pandemisi son dönemde tüm dünyayı etkisi altına almış, toplumları biyopsikososyal olarak çok yönlü etkileyen önemli bir durumudur (1,2). Tüm dünya ülkelerinde pandemi ile savaş planı çerçevesinde sağlık sisteminde çeşitli düzenlemeler yapılmıştır. ...
Objectives: The aim of the study was to evaluate the effect of COVID-19 pandemic on family health center admissions within the framework of a primary health care institution. Materials and Methods: The data of this retrospective study were obtained from the patient applications of a two-unit Family Health Center in Ankara (6407 population) between 01/04/2019-01/12/2019 and 01/04/2020-01/12/2020, which registered on the Family Medicine Information System. A total of 12,878 patients were included in our study, 8,315 of whom applied to our family medicine outpatient clinics in 2019 and 4,563 patients who applied in 2020. In the data form, for the specified application years, the total number of applications by years / months, the number of examinations, the number of baby-child, woman, puerperant and pregnant monitoring and immunization services and individually; age, gender, number of applicants, main diagnoses of admission, chronic-psychiatric illnesses status of applicants have been reported. Results: A total of 12,878 patients were included in study, including 8,315 patients who applied to our family medicine outpatient clinics in 2019 and 4,563 patients in 2020. There is a statistically significant difference according to mean age of the applicants between 2019 and 2020 (p
... While one study reported a decline in Lactobacillus spp. in the samples of COVID-19 patients [133]. One similar study conducted in China noted gut dysbiosis among COVID-19 patients with decreased levels of Lactobacillus [134]. It has been shown that gut commensals including lactobacillus release SCFA such as butyrate, propionate, and acetate which attach to dendritic cells and macrophages and regulate the immune system. ...
Introduction: Alteration in humans’ gut microbiota was reported in patients infected with SARS-CoV-2. The gut and upper respiratory tract microbiota harbor a dynamic and complex population of microorganisms and have strong interaction with host immune system homeostasis. However, our knowledge about microbiota and its association with SARS-CoV-2 is still limited. We aimed to systematically review the effects of gut microbiota on the COVID-19 infection and its severity and the impact that SARS-CoV-2 could have on the gut microbiota.
Methods: We searched the keywords in the online databases of Web of Science, Scopus, PubMed, and Cochrane on December 31st, 2021. After duplicate removal, we performed the screening process in two stages; title/abstract and then full-text screening. The data of the eligible studies were extracted into a pre-designed word table. This study adhered to the PRISMA checklist.
Results: Sixty-three publications were included in this review. It appeared that COVID-19 infection could affect the microbiome in patients, particularly in moderate and severe cases. The severity of COVID-19 disease may also be influenced by the microbiota's composition through immunological responses or some other unknown mechanisms.
Conclusion: Our study showed that there was a significant change in the composition of the upper respiratory tract and gut microbiome in patients with COVID-19 compared to healthy individuals. These apparent changes suggested gut and upper respiratory tract microbiota as a possible indicator for diagnosis and strategy for the treatment of COVID-19.
... Fear of COVID-19 has been positively and significantly correlated with general anxiety disorder. Anxiety and fear were predominantly found among COVID-19 patients in China [61]. Results of another study from Pakistan suggest that fear of COVID-19 is associated with anxiety sensitivity [62]. ...
Background: The outbreak of the novel coronavirus disease (COVID-19) has posed multiple challenges to healthcare systems. Evidence suggests that mental well-being is badly affected due to compliance with preventative measures in containing the COVID-19 pandemic. This study aims to explore the role of positive mental health (subjective sense of wellbeing) to cope with fears related to COVID-19 and general anxiety disorder in the Pashtun community in Pakistan.
Methods: A cross-sectional survey was conducted among 501 respondents from Khyber Pakhtunkhwa participating in an online-based study. We performed correlational analysis, hierarchical linear regression and structural equational modeling (SEM) to analyze the role of mental health in reducing fears and general anxiety disorder.
Results: The results of the SEM show that positive mental health has direct effects in reducing the fear related to COVID-19 (β = − 0.244, p < 0.001) and general anxiety (β = − 0.210, p < 0.001). Fears of COVID-19 has a direct effect on increasing general anxiety (β = 0.480). In addition, positive mental health also has an indirect effect (β = − 0.117, p < 0.001) on general anxiety (R 2 = 0.32, p < 0.001) through reducing fear of coronavirus.
Conclusion: Based on these findings, there is a need to develop community health policies emphasizing on promotive and preventive mental health strategies for people practicing social/physical distancing.
... Moreover, no research has claimed the promising role of probiotics and prebiotics in preventing/treating COVID-19. Additionally, various registered clinical trials that endeavor to explore the effectiveness of probiotics in treating COVID-19 patients are still ongoing [125]. Most importantly, a number of patients infected with COVID-19 showed dysbiosis in intestinal microbiota underpinning lower amounts of probiotic species, including Bifidobacterium and Lactobacillus [72], indicating weak immunity of COVID-19-infected patients; thus, patients necessitate nutritional maintenance as well as probiotic/prebiotic supplements to maintain the intestinal flora equilibrium and reduce the chance of infection [126]. ...
The scare of the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), does not seem to fade away, while there is a constant emergence of novel deadly variants including Alpha, Beta, Gamma, Delta and Omicron. Until now, it has claimed approximately 276,436,619 infections, and the number of deaths surpluses to 5,374,744 all over the world. While saving the life has been a priority during the ongoing SARS-CoV-2 pandemic, the post-infection healing and getting back to normalcy has been undermined. Improving general health conditions and immunity with nutritional adequacy is currently of precedence for the government as well as frontline health workers to prevent and assuage infections. Exploring the role of probiotics and prebiotics in managing the after-effects of a viral outbreak could be of great significance, considering the emergence of new variants every now and then. To enhance human immunity, the recent evidence on the connection between gut microbiota and the broad spectrum of the clinical COVID-19 disease is the reason to look at the benefits of probiotics in improving health conditions. This review aims to sketch out the prospective role of probiotics and prebiotics in improving the standard of health in common people.
... The studies reporting negative potential therapeutic activity of garlic against HSV-1 and -2, Para-3, HRV-2, VSV, VV, FCV, and NDV [34,37,38], as well as ginger against Influenza A virus (H3N2), HSV-2, HRSV, and CpHV-1 [44,47,48,51], are indications that the success or failure of garlic and ginger as antiviral therapies may be much dependent on the taxonomic features and pathogenesis of the viruses they are used against [1]. DOI [62][63][64][65]. Based on the findings in literature, there is moderate evidence of the potential prophylactic/therapeutic use of garlic and ginger against viral infections. ...
Garlic (Allium sativum) and Ginger (Zingiber officinale) are globally utilized herbal medicinal spices. This systematic review discussed available evidence on the direct and indirect antiviral activities of garlic and ginger. Studies investigating the antiviral activities of garlic and ginger were searched and retrieved from four databases, including Google Scholar, PubMed, Science direct, and MEDLINE. Data search and retrieval were done up to 15 October 2021. A total of 28 studies were included in this systematic review (garlic = 18 studies; ginger = 10 studies). Fresh garlic aqueous extract and fresh ginger hot water extract were the most investigated forms of garlic and ginger, respectively. There was minimal evidence on the prophylactic antiviral effect of garlic and ginger, moderate evidence on the therapeutic and prophylactic/therapeutic antiviral effects, and minimal evidence on the enhancement of the immune system against viral infections. The low-moderate quality evidence on the direct and indirect antiviral effects of garlic and ginger has provided the necessary background to instigate further high-quality investigations to validate the current information, address the grey areas, and provide valuable insights into the possible utility of garlic and ginger as raw materials in drug development against viral infections.
... These plasma exosomes activated by the immune system may be responsible for, or inhibit, the beneficial effects of immune antibodies beyond those present in plasma. The inhibition of mRNA gene expression and mRNA conversion to a virus are among the applications of smart nanoexosomes [6,[119][120][121]. ...
Smart nanoexosomes are nanosized structures enclosed in lipid bilayers that are structurally similar to the viruses released by a variety of cells, including the cells lining the respiratory system. Of particular importance, the interaction between smart nanoexosomes and viruses can be used to develop antiviral drugs and vaccines. It is possible that nanoexosomes will be utilized and antibodies will be acquired more successfully for the transmission of an immune response if recon-valescent plasma (CP) is used instead of reconvalescent plasma exosomes (CPExo) in this concept. Convalescent plasma contains billions of smart nanoexosomes capable of transporting a variety of molecules, including proteins, lipids, RNA and DNA among other viral infections. Smart nanoexo-somes are released from virus-infected cells and play an important role in mediating communication between infected and uninfected cells. Infections use the formation, production and release of smart nanoexosomes to enhance the infection, transmission and intercellular diffusion of viruses. Cell-free smart nanoexosomes produced by mesenchymal stem cells (MSCs) could also be used as cell-free therapies in certain cases. Smart nanoexosomes produced by mesenchymal stem cells can also promote mitochondrial function and heal lung injury. They can reduce cytokine storms and restore the suppression of host antiviral defenses weakened by viral infections. This study examines the benefits of smart nanoexosomes and their roles in viral transmission, infection, treatment, drug delivery and clinical applications. We also explore some potential future applications for smart nanoexosomes in the treatment of viral infections.
... Sel epitel alveolus tipe 2 terdapat pada saluran cerna manusia, paru-paru, makrofag, sel T, badai sitokin sistemik, pneumonia dan kerusakan multi-organ. Penelitian Xu et al. (2020) menggambarkan temuan patologis pada SARS-CoV-2 yang parah dan menunjukkan infiltrat sel imun yang menyimpang di paru-paru. Dalam hal ini, pengurangan dan kelelahan fungsional sel T CD8+ ditunjukkan secara paralel dengan peningkatan kadar sitokin inflamasi pada pasien Covid-19 yang parah (Diao et al., 2020). ...
Corona virus disease 2019 (Covid-19) caused by the severe acute respiratory syndrome-corona virus (SARS-CoV-2) was an ongoing global pandemic. SARS-CoV-2 affects human respiratory tract epithelial cells causing a pro-inflammatory cytokine stormed and chronic lung inflammation. Cytokine stormed was an offensive inflammatory response to Covid-19 infection in some patients. These cytokine storms could damage the lungs, digestive tract, brain, cardiovascular system, liver, kidneys, microcirculation, and eyes with many patients dying every day, efforts to found vaccines and special antiviral drug preparations were currently being explored. The mechanisms of probiotics, prebiotics, and diets with anti-SARS-CoV-2 immunity had presented opportunities for the discovery of microbial therapies to prevent and treat Covid-19. Probiotics were lived microorganisms which when administered in appropriate and adequate amounts could provided health benefits for the human digestive tract. Prebiotics were selective food ingredients needed by intestinal probiotic microbes as a source of nutrients for their growth and viability. Various emerging scientific evidence supports the hypothesis that probiotics and prebiotics acted as antiviral and immunomodulators that could improved the human immune system. The mechanism of prebiotics in enhancing immunity against Covid-19 was by promoting the maturation, differentiation, and reproduction of lymphocytes and macrophages, activating the reticuloendothelial system, increasing the proportion of CD8+ IEL. The mechanism of probiotics in increasing immunity to fought covid-19 was by increasing the activity of t cells (T-suppressor, T-helper (CD4+), Natural Killer cells, increasing IL-10, increasing the phagocytic capacity of polymorphonuclear (PMN) cells. ABSTRAK Corona virus disease 2019 (Covid-19) yang disebabkan oleh severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) adalah pandemi global yang sedang berlangsung. Agen SARS-CoV-2 memengaruhi sel-sel epitel saluran pernapasan manusia yang menyebabkan badai sitokin proinflamasi dan peradangan paru-paru secara kronis. Badai sitokin adalah respons inflamasi ofensif akibat infeksi Covid-19 pada beberapa pasien. Badai sitokin ini dapat merusak paru-paru, saluran pencernaan, otak, sistem kardiovaskuler, hati, ginjal, mikrosirkulasi, dan mata. Akibatnya telah sangat banyak pasien yang meninggal setiap hari, berbagai upaya untuk menemukan vaksin dan sediaan obat antivirus khusus saat ini terus dieksplorasi. Mekanisme probiotik, prebiotik, dan diet dengan kekebalan anti-SARS-CoV-2 telah menghadirkan peluang bagi penemuan terapi mikrob untuk mencegah dan mengobati Covid-19. Probiotik adalah mikroorganisme hidup yang bila diberikan dalam jumlah yang tepat dan memadai dapat memberikan manfaat kesehatan bagi saluran pencernaan manusia. Prebiotik adalah bahan pangan selektif yang dibutuhkan oleh mikrob probiotik usus sebagai sumber nutrisi untuk pertumbuhan dan viabilitasnya. Berbagai bukti ilmiah yang muncul mendukung hipotesis bahwa probiotik dan prebiotik berperan sebagai antivirus dan imunomodulator yang dapat meningkatkan sistem imun manusia.
... China's experience has shown that the most important way to control the transmission of the virus is social distancing and staying at home. [4] Studies have shown that it is very important for the general population to be aware of the dangers and how to behave in times of pandemics. Also, assessment of public perceptions of risk, protective behaviors, as well as correct knowledge and information are necessary for health education. ...
BACKGROUND: Many measures have been taken so far to minimize the outbreak of COVID-19, but it is still unclear to what extent people have understood the risk. Public participation plays a vital role in better and effective control of the coronavirus, and the importance of risk perception is effective in their preventive behavior. The aim of this study was to investigate the pandemic risk perception of coronavirus disease after began of pandemic in Iranian society.
MATERIALS AND METHODS: This cross-sectional study was conducted in Iran in spring 2020. The data collection tool was a researcher-made questionnaire. The questions were extracted through interviews with experts and summarizing the opinions of public interviews, etc., The questionnaire was made available to the public through social media. The information was collected within 3 months. Quantitative data were reported as mean ± standard deviation and the qualitative data were reported as number and percent. Multiple linear regression and cross were also used to examine the demographic factors associated with risk perception. Data Analysis was performed using the SPSS version 21 statistical software.
RESULTS: In this study, 402 individuals from 28 provinces (Azarbaijan Gharbi, Azarbaijan Sharghi, Alborz, Ardabil, Bushehr, Chaharmahal and Bakhtiari, Esfahan, Fars, Ghazvin, Gilan, Golestan, Hamedan, Hormozgan, Ilam, Kerman, Kermanshah, Khorasan Razavi, Khorasan Shomali, Khuzestan, Kohgiluyeh and Boyerahmad, Kurdistan, Lorestan, Mazandaran, Semnan, Sistan and Baluchestan, Tehran, Yazd, and Zanjan) of Iran participated. The risk perception score obtained from the sum of the scores of the questions was classified into quartiles. Accordingly, the risk perception score of (22.9) 92 people was very low, (26.6) 107 people low, (26.9) 108 people moderate, and (23.6) 95 people high. The results of multiple linear regression showed that the variables of gender (P = 0.008) and occupation (P = 0.013) had a significant relationship with risk perception. There was no significant relationship between risk perception and variables of age, marital status, and level of education (P > 0.05).
CONCLUSION: The study showed that the risk perception of the people is more in categories of moderate to high. Assessing the risk perception of a pandemic can be helpful for preventive measurements and planning, and also, according to the results of the research, can be done appropriate educational interventions. Given that 47.5% of respondents were employees, of course, it should be noted that in sending a questionnaire virtually, there is usually a lot of loss and this is a limitation of the research. The results of this study can be useful in making prevention decisions and maintaining safety and health in the workplace.
... Some patients with COVID-19 have intestinal microbial dysbiosis with decreased probiotics such as Lactobacillus and Bifidobacterium. 29 Our hypothesis is biologically plausible. The increased severity of COVID-19 in diabetes, hypertension, obese or older individuals may be related to insulin resistance, with oxidative stress as a common pathway. ...
Background: Many foods have an antioxidant activity, and nutrition may mitigate COVID-19. Some countries with a low COVID-19 mortality have a relatively high consumption of cabbage or fermented foods. To test the potential role of fermented foods and cabbage in COVID-19 mortality in Europe, we performed an ecological study. Methods: The EFSA Comprehensive European Food Consumption Database performed an analysis on country food consumption. Fermented foods were analysed in sub-study 1, and cruciferous and other vegetables in sub-study 2. We obtained the COVID-19 mortality per number of inhabitants from the Johns Hopkins Coronavirus Resource Center. EuroStat data were used for data on potential confounders at the country level including Gross Domestic Product, population density, percentage of people older than 64 years, unemployment rate and obesity. Mortality counts were analysed using quasi-Poisson regression models-with log of population as an offset-to model the death rate while accounting for over-dispersion. A hierarchical model was used to account for multiple data. Results: Among the variables considered, only fermented vegetables reached statistical significance concerning COVID-19 death rate in sub-study 1. In sub-study 2, cabbage and cucumber showed significance, although, for cucumber, this was no longer the case after hierarchical assessment. Adjustment did not change the point estimate, and results were still significant. Conclusion: The negative ecological association between COVID-19 mortality and consumption of fermented vegetables or cabbage supports the a priori hypothesis previously reported. This hypothesis needs to be tested in individual studies performed in countries where the consumption of fermented vegetables is common.
... manipulating gut microbial composition with probiotics, prebiotics, fecal microbiota transplantation (FMT), antibiotics, and or a combination of these drugs. The microbial dysbiosis with reduced Lactobacillus and Bifidobacterium was reported in some COVID-19 affected people from China [42]. Another very recent pilot study revealed that fecal microbiomes in COVID-19 cases suffered from symbiont depletion and pathogen enrichment, which even lasted after the virus clearance [43]. ...
It has been very recently suggested that individuals with chronic gut inflammation are highly susceptible to COVID-19. They constitute the serious cases of COVID-19, in which inflammatory cytokine storm is observed. On the contrary, the healthy gut microbiota is linked with low chronic gut and systemic inflammation. This raises the idea that maintenance of the healthy gut microbiota and prevention of gut microbial dysbiosis in COVID-19 patients might avoid the increased cytokine storm, which in turn might reduces the mortality rate. It has been shown that modulation of the gut microbiota is an effective strategy to strengthen immunity and might be a possible treatment for individuals with the viral infection. Currently, there is no clinical data considering the impact of modulation of the gut microbiota on the treatment of COVID-19. We hypothesize that targeting the gut microbiota might be a novel therapeutic approach or at least a supportive therapy. In the present review article, we described the interaction between SARS-CoV-2 and gut microbiota dysbiosis through two possible mechanisms including aberrant immune activation and aberrant mammalian target of rapamycin (mTOR) activation. Further, disruption of Gastrointestinal Renin-Angiotensin System (GI RAS), dysregulation of the coagulation and fibrinolytic systems and the activity of human serine proteases in COVID-19 pathogenesis was addressed. We also provided possible strategies to restore all the discussed aspects via gut microbiota modulation.
... In the current SARS-COV-2 pandemic, anecdotal reports have shown efficacy of convalescent plasma (10)(11)(12). A number of published studies have reported the detection of viral RNA of SARS-COV-2 many weeks after documented recovery (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Clinical significance of persistence or re-emergence of virus is not well understood. ...
Current COVID-19 pandemic has affected the entire globe. While there was no vaccine neither any specific treatment, investigational use of convalescent plasma has been explored in clinical trials. A prospective multicenter study of convalescent plasma was conducted. Donors were tested for total Anti-SARS-CoV-2 antibodies by electrochemiluminescence (ECLIA) and RT-PCR for COVID-19. Enzyme Linked Immunosorbent Assay (ELISA) was used to detect semi-quantitative and quantitative IgG anti-SARS-COV-2 antibodies. IgG Immunofluorescence-based lateral flow immunoassay (LFIA) was used to recheck seronegative donors. A total of 400 donors were enrolled. Twelve donors were SARS-CoV-2 positive by RT-PCR. Nine of 12 donors had developed SARS-CoV-2 IgG antibodies, while in 3 donors antibodies were not developed. A total of 70 donors (17.5%) were deferred due to seronegative status; 64 (16%) of them did not develop antibodies when plasma collection was planned. The IgG semiquantitative ELISA was positive in 282 and quantitative in 284 of 330 donors with a mean value of >1:160 and 44.10±39.22 IU/ml respectively. A total of 116 (29%) donors did not show IgG humoral response to COVID-19 even 28 days from the onset of illness. Subsequently, LFIA method was able to detect IgG antibodies in 20 of 48 (41.6%) seronegative donors and in 20 of 34 (58.8%) ECLIA positive ELISA negative donors. Viral RNA detection in recovered asymptomatic patients with concomitant IgG antibodies indicates recovery. Inability to detect antibodies by different testing kits may be due to their different antigenic targets or sensitivity. Significance of a positive COVID-19 RT-PCR in asymptomatic recovered patients is yet to be determined.
... Intestinal dysbiosis has been implicated in many common diseases such as obesity, type 2 diabetes, hypertension, and congenital heart disease [66,67]. In hospitalized COVID-19 patients, intestinal dysbiosis was noted with decreased probiotics such as Lactobacillus and Bifidobacterium [68]. Several studies have demonstrated the communication between intestinal bacteria and the nervous system known as the microbiome-gut-brain axis [69][70][71][72][73]. Neufeld et. ...
The ongoing pandemic resulting from severe acute respiratory syndrome—caused by coronavirus 2 (SARS-CoV-2)—has posed a multitude of healthcare challenges of unprecedented proportions. Intestinal enterocytes have the highest expression of angiotensin-converting enzyme-2 (ACE2), which functions as the key receptor for SARS-CoV-2 entry into cells. As such, particular interest has been accorded to SARS-CoV-2 and how it manifests within the gastrointestinal system. The acute and chronic alimentary clinical implications of infection are yet to be fully elucidated, however, the gastrointestinal consequences from non-SARS-CoV-2 viral GI tract infections, coupled with the generalized nature of late sequelae following COVID-19 disease, would predict that motility disorders are likely to be seen in these patients. Determination of the chronic effects of COVID-19 disease, herein defined as GI disease which is persistent or recurrent more than 3 months following recovery from the acute respiratory illness, will require comprehensive investigations comprising combined endoscopic- and motility-based evaluation. It will be fascinating to ascertain whether the specific post-COVID-19 phenotype is hypotonic or hypertonic in nature and to identify the most vulnerable target portions of the gut. A specific biological hypothesis is that motility disorders may result from SARS-CoV-2-induced angiotensin-converting enzyme 2 (ACE2) depletion. Since SARS-CoV-2 is known to exhibit direct neuronal tropism, the potential also exists for the development of neurogenic motility disorders. This review aims to explore some of the potential pathophysiologic mechanisms underlying motility dysfunction as it relates to ACE2 and thereby aims to provide the foundation for mechanism-based potential therapeutic options.
... Some COVID-19 patients showed intestinal microbial dysbiosis characterized by decreased probiotics such as Lactobacillus and Bifidobacterium. Prebiotic or probiotic supplementation, and nutritional support has been recommended to re-normalize the balance of intestinal microbiota and decrease the risk of secondary infection due to bacterial translocation [10]. Probiotic supplementation could be a promising strategy given previous studies of the potential application of probiotics in treatment and prevention of various viral infections [1,11,12]. ...
... By performing a higher ratio TANAFFOS Moradpour Z,et al. 241 of air extractor than air supplier, infection of indoor air is decreased in negative air pressure system (10). Air filtration in the patient room reduces the viral load in the surfaces and airborne (11,12). The HVAC system can also decrease the airborne particles and released contamination from surfaces by continuously ventilating of patient room (9). ...
Background:
Ventilation system besides other prevention strategies such as surface disinfecting and personal protective equipment (PPE) decrease the risk of coronavirus disease 2019 (COVID-19) infection. This study aimed to examine the ventilation system of an intensive care unit (ICU) in a hospital in Tehran, Iran to evaluate the potency of heating, ventilation, and air conditioning system (HVAC) for COVID-19 spread.
Materials and methods:
Contamination of air turnover caves was evaluated in supplier diffuser and extractor grills of negative pressure HVAC by ten samples. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the samples was evaluated by the real time reverse transcription-polymerase chain reaction (PCR). Moreover, air conditioning and sick building syndrome (SBS) was assessed according to MM040EA questioning from health care workers.
Results:
In the health care workers, respiratory effects were more prevalent compared to other signs. Despite suitable air conditioning, this study highlighted carrier potency of ICU workers for SARS-COV-2.
Conclusion:
According to our results, although the HVAC of ICU ward had an appropriate air movement, it was not safe enough for health care workers.
... Furthermore, lactobacillus casei promotes killing and phagocytosis in alveolar macrophages, which increases expressions of IgA, IFN-γ and TNF-α, thereby aiding the hosts battle against influenza virus [120]. Supplementation of probiotics has been proposed as a complementary remedy for gastrointestinal symptoms and to lower secondary COVID-19 infection risks from microbial translocation in acute cases [121]. Direct evidence of probiotics in COVID-19 treatment is yet to be proven; however, it is suggested that probiotics could serve as a complementary treatment to reduce SARS-CoV-2-induced inflammation and repair damaged intestinal mucosa by modulating the gut microbiota [25]. ...
COVID-19, resulting from the SARS-CoV-2 virus, is a major pandemic that the world is fighting. SARS-CoV-2 primarily causes lung infection by attaching to the ACE2 receptor on the alveolar epithelial cells. However, the ACE2 receptor is also present in intestinal epithelial cells, suggesting a link between nutrition, virulence and clinical outcomes of COVID-19. Respiratory viral infections perturb the gut microbiota. The gut microbiota is shaped by our diet; therefore, a healthy gut is important for optimal metabolism, immunology and protection of the host. Malnutrition causes diverse changes in the immune system by repressing immune responses and enhancing viral vulnerability. Thus, improving gut health with a high-quality, nutrient-filled diet will improve immunity against infections and diseases. This review emphasizes the significance of dietary choices and its subsequent effects on the immune system, which may potentially impact SARS-CoV-2 vulnerability.
... Research by Xu et al. demonstrated patients with COVID-19 had a reduction in genera such as Bifidobacterium and Lactobacillus [90]. In another study, Zuo et al. examined the intestinal microbiota of 15 patients with SARS-CoV-2 infection by collecting fecal samples 2-3 times during their hospital stay [91]. ...
Coronavirus disease 2019, or COVID-19, is a major challenge facing scientists worldwide. Alongside the lungs, the system of organs comprising the GI tract is commonly targeted by COVID-19. The dysbiotic modulations in the intestine influence the disease severity, potentially due to the ability of the intestinal microbiota to modulate T lymphocyte functions, i.e., to suppress or activate T cell subpopulations. The interplay between the lungs and intestinal microbiota is named the gut-lung axis. One of the most usual comorbidities in COVID-19 patients is type 2 diabetes, which induces changes in intestinal microbiota, resulting in a pro-inflammatory immune response, and consequently , a more severe course of COVID-19. However, changes in the microbiota in this comorbid pathology remain unclear. Metformin is used as a medication to treat type 2 diabetes. The use of the type 2 diabetes drug metformin is a promising treatment for this comorbidity because, in addition to its hypoglycemic action, it can increase amount of intestinal bacteria that induce regulatory T cell response. This dual activity of metformin can reduce lung damage and improve the course of the COVID-19 disease.
This study aims to explore the experiences of COVID-19 patients treated at the Wisma Atlet COVID-19 Emergency Hospital. The research method used in this study is a qualitative research method with thematic analysis methods. This study showed that there were 2 participants with suspected cases and 5 participants with confirmed cases, while the age of participants was between 26 to 54 years. The participants' occupations are four employees, two medical personnel, and one civil servant with an average quarantine time of 14 to 38 days of care. In conclusion, This study resulted in 6 themes, namely: changes experienced by patients when diagnosed with COVID-19, changes experienced by the family and environment of family members diagnosed with COVID-19, sources of information for treatment, attitudes of health workers who carry out treatment, description of patient feelings. while being treated, the hope of COVID-19 patients being treated at the Wisma Atlet RSDC. Keywords: COVID-19, Wisma Athlete Jakarta Emergency Hospital, Quarantine, Experience
The relationship between excessive sugar consumption and many diseases such as dental caries, obesity, diabetes and coronary heart has been increasing in recent years. In this study, utilization of natural sugar replacer steviol glycosides and bifidogenic effect by Bifidobacterium animalis subsp. lactis was assayed in vitro model system. The basal medium (non-carbohydrate containing MRS, Man, Rogosa and Sharpe Agar) were supplemented with 0.025% and 1% stevia, 0.025% stevia + 1% inulin, %1 stevia + 1% inulin. The medium which contained no carbohydrate was designated as negative control, whereas the medium containing 1% glucose or inulin were evaluated as positive and evaluated on the 0, 12, 24, 36 and 48 h of fermentation. Steviol glycosides in both system significantly stimulated the growth of Bifidobacterium animalis subsp. lactis to varying degrees with highest prebiotic activity score, short chain fatty acid production and growth parameters as much as glucose and prebiotic inulin. The viability of the probiotic bacteria was determined within the bio-therapeutic level with potential prebiotic effects depending on the probiotic bacterial strain growing and the type of carbohydrate source utilized. In the study, stevia at lower concentration showed a higher growth rate of with inulin. In conclusion, stevia can be used as functional ingredients for the modulation of the gut microbiota and design of synbiotic systems as a prebiotic substrate and sugar substitute.
В процессе разработки рекомендаций были проанализированы публикации официальных сайтов Российской Федерации, электронных баз данных РИНЦ, PubMed, MEDLINE, EMBASE и Cochrane Central Register of Controlled Trials (CENTRAL) разработчиками независимо друг от друга. Дата последнего поискового запроса — 1 ноября 2021 г. Для разработки положений рекомендаций были использованы документы непосредственно описывающие особенности ведения пациентов с новой коронавирусной инфекцией (НКИ) COVID-19 (руководства и гайдлайны — 35; рандомизированные клинические исследования и Кокрейновские обзоры — 23; наблюдательные и сравнительные исследования — 134; прочие документы, заметки и комментарии — 72). По сравнению с предыдущей, 5-й, версией рекомендаций скорригированы 35 положений в 10 разделах. Положения текущей версии рекомендаций освещают особенности проведения анестезии, интенсивной терапии, реабилитации, реанимационных мероприятий, проведения манипуляций, транспортировки, предупреждения распространения НКИ COVID-19 при осуществлении данных видов деятельности. Рассмотрены методы защиты персонала от заражения НКИ COVID-19 при проведении манипуляций, анестезии и интенсивной терапии. Описаны особенности респираторной поддержки, экстракорпоральной детоксикации, экстракорпоральной мембранной оксигенации, тромбопрофилактики, лекарственных взаимодействий. Рассмотрены особенности ведения беременных, детей разных возрастных групп, пациентов с сопутствующими заболеваниями, принципы формирования запасов лекарственных препаратов и расходных материалов. Применительно к НКИ CОVID-19 уточнены и дополнены: 1) показания и противопоказания к назначению препаратов (ацетоминофена, глюкокортикостероидов, ремдесевира, тоцилизумаба, барицитинаба, статинов, плазмы реконвалесцентов) в зависимости от тяжести течения заболевания; 2) особенности интенсивной терапии при сопутствующих заболеваниях (сердечно-сосудистой системы, воспалительные заболевания кишечника, онкологические заболевания, нарушения ритма сердца); 3) срок проведения плановых операций у пациентов, перенесших НКИ CОVID-19, и после вакцинации; 4) вопросы тромбопрофилактики и лечения расстройств системы гемостаза; 5) нормативно-правовые документы, касающиеся деятельности медработников в связи с распространением НКИ CОVID-19.
Initially, doctors did not pay much attention to gastrointestinal symptoms in patients with COVID-19. Fever and respiratory syndrome were monitored. A more prolonged observation period revealed gastrointestinal disorders to be an important element of the new coronavirus infection. In scientific publications, a stable term appeared — gastrointestinal coronavirus disease 2019. The tropism of the SARS-CoV-2 virus to the epitheliocytes of the gastrointestinal tract, the presence and long-term persistence of the virus in the feces were found. The frequent detection of gastrointestinal symptoms in infected patients, the frequent involvement of the liver and pancreas in the pathological process determine the importance of clinical and laboratory assessment of the state of the digestive system due to its undoubted impact on the status, course, and the overall disease prognosis. Based on the analysis of scientific publications, the article presents the results of the latest observations regarding the development of a new disease, its diagnosis, treatment options using modern drugs when combined with dyspeptic syndrome and other gastroenterological symptoms. The role of the use of standards, in particular the clinical recommendations of the Ministry of Health of Russia, is emphasized.
Probiotics are the beneficial microorganisms, catalase negative which restore microbial balance inside the gut of humans as well as animals. Lactobacillus the earliest probiotic that have the beneficial impact on health. These “Good Microorganisms” can be obtained not only from various non-dairy products but also from processed dairy products like. Another economically viable method is microencapsulation for preserving probiotics and the stability is improved by glucose. Even the vitamins manufacturer the probiotic bacterial agents. The health benefits of probiotics include increased immunological responses, relief of lactose intolerance symptoms, therapy for diarrhea, reduction in serum of cholesterol, production of vitamin, anticarcinogenic. Probiotics play a wide range in the host body (e.g., decreasing illnesses and stress, enhancing immunity, modulation of gut microbiota, nutritional assistance, improving quality of water, etc.). So, the positive effects of probiotics help to boost animal feed value and growth and improve aquaculture breeding and hatching rates. Probiotics can lower the prevalence and severity of illnesses, showing their promise to cure or prevent COVID-19. Lactobacillus casei also interact with epithelial cells with Toll-like receptors (TLRs) to improve the production of cytokines that are important in the enhancement of cell productivity and prevent apoptosis during restoration, which promote survival and proliferation. The preservation of the human GI or lung microbiota might help prevent COVID-19, as dysbiosis plays an essential role in people’s vulnerability to infectious illnesses. Most of the experimental studies proved that bacteria isolated from processed dairy products belonged to lactic acid bacteria and are declared as probiotic bacteria. In present review, various research studies regarding significance of probiotics as well as their extraction from processed dairy products are discussed.
Длительный COVID представляет собой мультисистемное заболевание с сохраняющейся симптоматикой от 4 недель и более и включает большое разнообразие стойких неврологических, респираторных, сердечно-сосудистых и других симптомов. В механизмах развития длительного COVID и постковидного синдрома, помимо прямого повреждения органов вирусом SARS-CoV-2 и тромбоэмболических осложнений, не менее важны эффекты, опосредованные через иммунную систему в результате воспаления, стойкой иммуносупрессии или аутоиммунитета. Учитывая разнообразие симптомов длительного COVID, их высокую распространенность и существенное влияние на качество жизни, наблюдение за этими пациентами требует междисциплинарного командного подхода с респираторной, нейропсихологической и симптоматической оценкой. Монтелукаст (Синглон) может применяться в постковидном периоде при стойких респираторных симптомах и рассматривается как перспективный препарат для лечения и профилактики COVID-19. Инозин пранобекс (Гроприносин) может влиять одновременно на несколько звеньев патогенеза СOVID-19, оказывая неспецифическое противовирусное, а также иммуномодулирующее действие и уменьшая риск развития вторичных инфекций, что делает его ценным лекарственным препаратом для лечения и профилактики COVID-19, включая пациентов с длительным COVID.
Long COVID is a multisystem disease with symptoms persisting for 4 weeks or more and includes a wide variety of ongoing neurological, respiratory, cardiovascular, and other symptoms. In the mechanisms of long COVID and post-COVID syndrome development, in addition to the direct SARS-CoV-2 organs damage and thromboembolic complications, immune system mediated effects as a result of inflammation, persistent immunosuppression, or autoimmunity are equally important. Given the diversity of long COVID symptoms, their high prevalence, and significant impact on quality of life, follow-up of these patients requires a multidisciplinary team approach with respiratory, neuropsychological, and symptomatic assessment. Montelukast (Singlon) can be used in the post-COVID period for persistent respiratory symptoms and is considered a promising drug for the treatment and prevention of COVID-19. Inosine pranobex (Groprinosin) can simultaneously affect several links in the pathogenesis of COVID-19, providing a non- specific antiviral and immunomodulatory effect, and reducing the risk of developing secondary infections, which makes it a valuable drug for the treatment and prevention of COVID-19, including patients with long COVID.
Introduction
Post-COVID symptoms are the new concern in the COVID-19 pandemic, where recovered patients experience residual symptoms affecting their quality of life. Therefore, it is imperative to evaluate the role of complete vaccination, prescribed medication, and micronutrients during COVID episodes in the occurrence of post-COVID symptoms.
Method
A longitudinal evaluation of Indonesia’s recovered COVID-19 patients was performed using the data collected from July 2021 and extracted in mid-February 2022. All participants were confirmed with a Real-Time Polymerase Chain Reaction test (PCR) and/or antigen test. This study collected demography and comorbidities information, symptoms and treatment of COVID-19, and collection of self-reported post-COVID symptoms every 30 days within 90 days after diagnosis/onset. Exposures of interest include vaccination status, Favipiravir administration, Vitamin C, Vitamin D, and Zinc. A Generalized Estimating Equation (GEE) was used to evaluate the longitudinal effect of exposures, presented with adjusted odds ratios and its 95% confidence interval.
Results
A total of 923 participants (18.2% fully-vaccinated) were involved in the study, with 79.7% being non-hospitalized. Only 25.7% did not develop any residual symptoms within 90 days. Fatigue was the most reported post-COVID symptom in each measurement time (39.5%, 16.3%, and 7.3%). Full-vaccination was effective against chronic cough (aOR 0.527, 95% CI 0.286–0.971), chronic headache (aOR 0.317, 95% CI 0.163–0.616), and chronic arthritis (aOR 0.285, 95% CI 0.116–0.703). The combination of micronutrient supplementations and Favipiravir gave no significant effect on all post-COVID symptoms. However, early initiation of Favipiravir and delaying vitamin D administration were associated with arthritis.
Conclusion
Full vaccination of COVID-19 prevents the disease and the development of residual symptoms when infected with SARS-COV-2. Hence, it is crucial to reconsider the prescription of micronutrient supplementation or adjust the dose of Favipiravir in the current guideline.
Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.
Ivermectin is an anti-parasitic agent that has gained attention as a potential COVID-19 therapeutic. It is a compound of the type Avermectin, which is a fermented by-product of Streptomyces avermitilis. Bifidobacterium is a member of the same phylum as Streptomyces spp., suggesting it may have a symbiotic relation with Streptomyces. Decreased Bifidobacterium levels are observed in COVID-19 susceptibility states, including old age, autoimmune disorder, and obesity. We hypothesize that Ivermectin, as a by-product of Streptomyces fermentation, is capable of feeding Bifidobacterium, thereby possibly preventing against COVID-19 susceptibilities. Moreover, Bifidobacterium may be capable of boosting natural immunity, offering more direct COVID-19 protection. These data concord with our study, as well as others, that show Ivermectin protects against COVID-19.
COVID-19 is a global contemporary issue. Acute hypoxic respiratory failure and associated multiple organ dysfunction are the basics of the new disease pathogenesis. An important characteristic of COVID-19 is the damage to the central nervous system, which determines the peculiarities of the clinical course. In the case of vascular complications (ischemic stroke, encephalopathy, delirium) the prognosis of the disease is more severe. The article presents the experience of a large Russian monohospital in observation and treatment of patients with COVID-19 and neurological complications. It also shows the prospect of neuroprotective therapy in this category of patients.
Today, during the SARS-CoV-2 pandemic, when there are no clear therapeutic strategies for prevention and treatment, attention should be paid to alternative treatments, which may include the use of bacteriotherapeutic drugs based on probiotic microorganisms, i.e. representatives of the host normobiota. Experimental data show that changes in immune balance in patients with SARS-CoV-2 may be mediated by corresponding changes in the host intestinal microbiota. This statement is especially significant for the elderly, whose intestinal biota is less diverse. Especially the number of useful representative’s decreases, which leads to greater sensitivity of the older generation to SARS-CoV-2. The composition and function of the intestinal microbiota may be a potential biological mechanism responsible for the diversity of susceptibility of different groups of people to SARS-CoV-2. A bidirectional connection along the intestinelung axis due to soluble microbial metabolites transported by the bloodstream is shown. The intestinal microbiota produces many diffusing metabolites with immunomodulatory properties. Given the potential beneficial effects of bacteriotherapeutic drugs and functional foods enriched with probiotic microbiota during respiratory viral infection, their use as therapeutic agents during SARS-CoV-2 infection can be considered. Since the microbiota can be maintained using adequate, safe, and relatively inexpensive bacteriotherapeutic drugs (pro-, pre-, para-, post-, synbiotics, immunobiotics, functional foods enriched with probiotic microorganisms, etc.), their use should be considered as adjunctive therapy to limit SARS-CoV-2 progression in infected patients or as a prophylactic strategy for uninfected people at risk during the expansion of SARS-CoV-2.
COVID-19 is highly transmissive and contagious disease with a wide spectrum of clinicopathological issues, including respiratory, vasculo-coagulative, and immune disorders. In some cases of COVID-19, patients can be characterized by clinical sequelae with mild-to-moderate symptoms that persist long after the resolution of the acute infection, known as long-COVID, potentially affecting their quality of life. The main symptoms of long-COVID include persistent dyspnea, fatigue and weakness (that are typically out of proportion, to the degree of ongoing lung damage and gas exchange impairment), persistence of anosmia and dysgeusia, neuropsychiatric symptoms, and cognitive dysfunctions (such as brain fog or memory lapses). The appropriate management and prevention of potential long-COVID sequelae is still lacking. It is also believed that long-term symptoms of COVID-19 are related to an immunity over-response, namely a cytokine storm, involving the release of pro-inflammatory interleukins, monocyte chemoattractant proteins, and tissue necrosis factors. Palmitoylethanolamide (PEA) shows affinity for vanilloid receptor 1 and for cannabinoid-like G protein-coupled receptors, enhancing anandamide activity by means of an entourage effect. Due to its anti-inflammatory properties, PEA has been recently used as an early add-on therapy for respiratory problems in patients with COVID-19. It is believed that PEA mitigates the cytokine storm modulating cell-mediated immunity, as well as counteracts pain and oxidative stress. In this article, we theorize that PEA could be a potentially effective nutraceutical to treat long-COVID, with regard to fatigue and myalgia, where a mythocondrial dysfunction is hypothesizable.
The integrity of the gastrointestinal tract structure and function is seriously compromised by two pathological conditions sharing, at least in part, several pathogenetic mechanisms: inflammatory bowel diseases (IBD) and coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. IBD and COVID-19 are marked by gut inflammation, intestinal barrier breakdown, resulting in mucosal hyperpermeability, gut bacterial overgrowth, and dysbiosis together with perturbations in microbial and human metabolic pathways originating changes in the blood and fecal metabolome. This review compared the most relevant metabolic and microbial alterations reported from the literature in patients with IBD with those in patients with COVID-19. In both diseases, gut dysbiosis is marked by the prevalence of pro-inflammatory bacterial species and the shortfall of anti-inflammatory species; most studies reported the decrease in Firmicutes, with a specific decrease in obligately anaerobic producers short-chain fatty acids (SCFAs), such as Faecalibacterium prausnitzii. In addition, Escherichia coli overgrowth has been observed in IBD and COVID-19, while Akkermansia muciniphila is depleted in IBD and overexpressed in COVID-19. In patients with COVID-19, gut dysbiosis continues after the clearance of the viral RNA from the upper respiratory tract and the resolution of clinical symptoms. Finally, we presented and discussed the impact of gut dysbiosis, inflammation, oxidative stress, and increased energy demand on metabolic pathways involving key metabolites, such as tryptophan, phenylalanine, histidine, glutamine, succinate, citrate, and lipids.
Coronavirus disease 2019 (COVID-19) is a threat to patients not only because of its acute course, but also because of various complications occurring in the following period, that is, more than 28 days after the onset of acute infection. The present study identified a total of 121 patients hospitalized 29 or more days after the first positive result of a PCR test for SARS-CoV-2, of whom 98 patients were included in the study. Patients were divided into two groups by the time interval between the positive COVID-19 test result and hospitalization date. The time intervals were week 5–11 in an ongoing-COVID group (57.1% of patients) and 12 or more weeks in a post-COVID-group (42.9%). The most frequent reason for hospitalization was respiratory tract infection (58.2%). Pneumonia accounted for 77.2% of these cases. Other reasons for hospitalization were interstitial lung disease (22.4%), pulmonary embolism (8.2%), and sarcoidosis (6.1%). The study group was further divided according to the causes of hospitalization into subgroups with infections and other causes. In the group with infectious diseases, there was a shorter time period between PCR positivity and hospitalization and there were significantly more frequent non-respiratory complications. In the entire sample, the in-hospital mortality was 5.1%.
Background
Despite a reported cardiac injury in patients with new coronavirus infection, the possibility and specifics of genuine viral myocarditis in COVID-19 remains not fully clear.
Purpose
To study the presence of SARS-CoV-2 in the myocardium and the morphological properties of myocarditis in patients with severe coronavirus infection (COVID-19).
Methods
Autopsy data of eight elderly patients (75.6 ± 7.4 years), four male and four female, with severe new coronavirus infection were studied. The lifetime diagnosis of COVID-19 is based on a positive result of the PCR study. The inclusion criterion was the presence of morphological signs of myocarditis according to the Dallas criteria. A standard histological examination included staining by hematoxylin and eosin, toluidin blue and Van Gieson. An immunohistochemical study was performed using antibodies to CD3, CD 68, CD20, perforin, toll-like receptor (TLR) types 4 and 9. PCR in real-time was performed to determine the viral RNA in the myocardium.
Results
All patients had severe bilateral viral pneumonia. In all cases, myocarditis was not clinically diagnosed. Morphological examination of the heart found signs of active lymphocytic myocarditis. PCR identified the SARS-Cov2 RNA in all cases. There were also signs of destructive coronaritis in all cases, thrombovasculitis, lymphocytic pericarditis (in 3 cases) and endocarditis (in 2 cases). The absence of neutrophils confirms the aseptic nature of inflammation. An immunohistochemical study showed the CD3-positive T lymphocytes in the infiltrates. Increased expression of TLR type 4 and less 9 was also detected.
Conclusion
Morphological and immunohistochemical evidence of myocarditis in COVID-19 was presented. Lymphocytic infiltrations and positive PCR confirm the viral nature of inflammation. Myocarditis in COVID-19 is also characterized by coronaritis with microvascular thrombosis and associated with lymphocytic endo- and pericarditis.
In late December 2019, a novel coronavirus emerged and had a rapid and worldwide spread, resulting in an ongoing pandemic. This virus, designated SARS-CoV-2, causes a respiratory disease named COVID-19 which can range in severity, depending not only on the viral infection but also conditioned by the immune system and the host's response. COVID-19 is often associated with aggressive and uncontrolled inflammation that may lead to acute respiratory distress syndrome (ARDS), multiorgan damage and failure, and death. In this chapter, we review the general characteristics of SARS-CoV-2 infection, its interaction with target cells and the resulting immune response, as well as current and potential therapeutic interventions.
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