4.Epidemiology, pathogenesis, and management of Coronavirus disease 2019-associated stroke.
Lu LIU ; Chenxia ZHOU ; Huimin JIANG ; Huimin WEI ; Yifan ZHOU ; Chen ZHOU ; Xunming JI
Frontiers of Medicine 2023;17(6):1047-1067
The Coronavirus disease 2019 (COVID-19) epidemic has triggered a huge impact on healthcare, socioeconomics, and other aspects of the world over the past three years. An increasing number of studies have identified a complex relationship between COVID-19 and stroke, although active measures are being implemented to prevent disease transmission. Severe COVID-19 may be associated with an increased risk of stroke and increase the rates of disability and mortality, posing a serious challenge to acute stroke diagnosis, treatment, and care. This review aims to provide an update on the influence of COVID-19 itself or vaccines on stroke, including arterial stroke (ischemic stroke and hemorrhagic stroke) and venous stroke (cerebral venous thrombosis). Additionally, the neurovascular mechanisms involved in SARS-CoV-2 infection and the clinical characteristics of stroke in the COVID-19 setting are presented. Evidence on vaccinations, potential therapeutic approaches, and effective strategies for stroke management has been highlighted.
Humans
;
COVID-19/complications*
;
SARS-CoV-2
;
Stroke/therapy*
6.Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review.
Jiacai CHO ; Joanne LEE ; Ching-Hui SIA ; Chieh Sian KOO ; Benjamin Y Q TAN ; Weizhen HONG ; Ellie CHOI ; Xueying GOH ; Louis CHAI ; Nisha Suyien CHANDRAN ; Horng Ruey CHUA ; Bernard P L CHAN ; Mark MUTHIAH ; Ting Ting LOW ; Eng Soo YAP ; Manjari LAHIRI
Singapore medical journal 2023;64(6):349-365
INTRODUCTION:
We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity.
METHODS:
We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January 2020 and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded.
RESULTS:
169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum.
CONCLUSION
Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement; and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
Humans
;
Asian People
;
COVID-19/complications*
;
Inflammation/complications*
;
SARS-CoV-2
;
Thrombosis
8.Weak SARS-CoV-2-specific responses of TIGIT-expressing CD8 + T cells in people living with HIV after a third dose of a SARS-CoV-2 inactivated vaccine.
Junyan JIN ; Xiuwen WANG ; Yongzheng LI ; Xiaodong YANG ; Hu WANG ; Xiaoxu HAN ; Jin SUN ; Zhenglai MA ; Junyi DUAN ; Guanghui ZHANG ; Tao HUANG ; Tong ZHANG ; Hao WU ; Xin ZHANG ; Bin SU
Chinese Medical Journal 2023;136(24):2938-2947
BACKGROUND:
T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domains (TIGIT), an inhibitory receptor expressed on T cells, plays a dysfunctional role in antiviral infection and antitumor activity. However, it is unknown whether TIGIT expression on T cells influences the immunological effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivated vaccines.
METHODS:
Forty-five people living with HIV (PLWH) on antiretroviral therapy (ART) for more than two years and 31 healthy controls (HCs), all received a third dose of a SARS-CoV-2 inactivated vaccine, were enrolled in this study. The amounts, activation, proportion of cell subsets, and magnitude of the SARS-CoV-2-specific immune response of TIGIT + CD4 + and TIGIT + CD8 + T cells were investigated before the third dose but 6 months after the second vaccine dose (0W), 4 weeks (4W) and 12 weeks (12W) after the third dose.
RESULTS:
Compared to that in HCs, the frequency of TIGIT + CD8 + T cells in the peripheral blood of PLWH increased at 12W after the third dose of the inactivated vaccine, and the immune activation of TIGIT + CD8 + T cells also increased. A decrease in the ratio of both T naïve (T N ) and central memory (T CM ) cells among TIGIT + CD8 + T cells and an increase in the ratio of the effector memory (T EM ) subpopulation were observed at 12W in PLWH. Interestingly, particularly at 12W, a higher proportion of TIGIT + CD8 + T cells expressing CD137 and CD69 simultaneously was observed in HCs than in PLWH based on the activation-induced marker assay. Compared with 0W, SARS-CoV-2-specific TIGIT + CD8 + T-cell responses in PLWH were not enhanced at 12W but were enhanced in HCs. Additionally, at all time points, the SARS-CoV-2-specific responses of TIGIT + CD8 + T cells in PLWH were significantly weaker than those of TIGIT - CD8 + T cells. However, in HCs, the difference in the SARS-CoV-2-specific responses induced between TIGIT + CD8 + T cells and TIGIT - CD8 + T cells was insignificant at 4W and 12W, except at 0W.
CONCLUSIONS
TIGIT expression on CD8 + T cells may hinder the T-cell immune response to a booster dose of an inactivated SARS-CoV-2 vaccine, suggesting weakened resistance to SARS-CoV-2 infection, especially in PLWH. Furthermore, TIGIT may be used as a potential target to increase the production of SARS-CoV-2-specific CD8 + T cells, thereby enhancing the effectiveness of vaccination.
Humans
;
Antibodies, Viral
;
CD8-Positive T-Lymphocytes
;
COVID-19/complications*
;
COVID-19 Vaccines/immunology*
;
HIV Infections/complications*
;
Receptors, Immunologic
;
SARS-CoV-2
10.Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore.
Kee Thai YEO ; Agnihotri BISWAS ; Selina Kah YING HO ; Juin Yee KONG ; Srabani BHARADWAJ ; Amutha CHINNADURAI ; Wai Yan YIP ; Nurli Fadhillah AB LATIFF ; Bin Huey QUEK ; Cheo Lian YEO ; Yvonne Peng MEI NG ; Kenny Teong TAI EE ; Mei Chien CHUA ; Woei Bing POON ; Zubair AMIN
Singapore medical journal 2022;63(9):489-496
In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
Infant, Newborn
;
Pregnancy
;
Female
;
Humans
;
Mothers
;
COVID-19/epidemiology*
;
Singapore/epidemiology*
;
COVID-19 Testing
;
Pandemics/prevention & control*
;
Infectious Disease Transmission, Vertical/prevention & control*
;
Pregnancy Complications, Infectious/prevention & control*