Open Access Macedonian Journal of Medical Sciences Open Access Macedonian Journal of Medical Sciences (OAMJMS) is an international peer reviewed journal published four times per year by the ID Design 2012/DOOEL Skopje on behalf of Foundation Macedonian Donor Registry (MKDR), Skopje en-US <p>All rights reserved.</p> (Prof. Dr Mirko Spiroski) (Ivo Spiroski) Thu, 02 Jan 2020 00:00:00 +0000 OJS 60 One-month Progress of COVID-19 Cases in East Kalimantan, Indonesia <p><strong>BACKGROUND: </strong>East Kalimantan, Indonesia, will play a significant geopolitical role as the province has been selected as the location of the future capital city of Indonesia. As a buffer zone to the capital city, there is urgent attention on the preparedness of the cities and regencies in East Kalimantan to respond to emergent infectious disease events such as coronavirus disease-19 (COVID-19).</p> <p><strong>AIM: </strong>The aim of the present study was to descriptively convey information about COVID-19 cases in East Kalimantan during the period of March 18, 2020–April 18, 2020, in terms of the isolation, testing, and tracing mechanisms used.</p> <p><strong>METHODS: </strong>The initial distribution of COVID-19 was identified in 5 of 10 districts and is now present in almost all districts except for one very remote regency.</p> <p><strong>RESULTS: </strong>The tracing performance of the fast response teams in East Kalimantan during this period was considered satisfactory with a mean of 0.7% of people under observation testing positive for severe acute respiratory syndrome coronavirus 2, and a mean of 14.4% patients under investigations testing positive. The use of rapid tests since March 30, 2020 has improved the detection ability, with confirmed positive cases as a percentage of confirmed negatives increasing from 20.2% to 31.8%. The use of the COVID-19 rapid test was cross-checked with a dengue rapid test to prevent false-positive identification. Confirmed clusters were announced to the public, urging people to respond and report.</p> <p><strong>CONCLUSION: </strong>The 1-month progress of COVID-19 cases in East Kalimantan showed a total case fatality rate (CFR) of 1.85%, a closed CFR of 8.3% and a closed case recovery rate of 91.7%.</p> Swandari Paramita, Anton Rahmadi, Ronny Isnuwardana, Rudy Agung Nugroho (Author) Copyright (c) 2020 Swandari Paramita, Anton Rahmadi, Ronny Isnuwardana, Rudy Agung Nugroho (Author) Fri, 15 May 2020 00:00:00 +0000 Azithromycin in Coronavirus Disease-19: What We Know? <p>Azithromycin (AZM) is a broad-spectrum antibiotic with anti-inflammatory and immunomodulatory properties. It is particularly used in chronic lung diseases including chronic obstructive pulmonary disease, asthma, interstitial lung diseases, bronchiectasis, and cystic fibrosis. AZM has not approved for the treatment of viral infections, but some study supported its antiviral activity. Recently, few studies are emphasized used AZM in combination with chloroquine/hydroxychloroquine for the treatment of novel coronavirus disease-2019 (COVID-19). The present review highlighted uses, dosage, and adverse effects of AZM in COVID-19 based on available literature.</p> Ashok Agrawal (Author) Copyright (c) 2020 Ashok Agrawal (Author) Thu, 25 Jun 2020 00:00:00 +0000 Kidney Diseases and COVID-19 Pandemic – A Review Article <p>In December 2019, first cases of a novel coronavirus were identified in Wuhan, China. A state of global pandemic was shortly declared among a very rapid contagious spread of the virus. The causative virus was identified as the SARS-CoV-2 viruses and is genetically related to the previous SARS outbreak in 2003. The virus causes a wide clinical spectrum from mild flu-like symptoms to adult respiratory distress syndrome. Kidney involvement has been reported in several reports in patients with various degrees of severity of SARS-CoV-2 infection. As knowledge is evolving, the accurate incidence of acute kidney injury (AKI) is not known. Many questions are yet to be answered regarding the effect of epidemiological variables and comorbidities on the occurrence of AKI. Some reports have observed the occurrence of hematuria and proteinuria in a percentage of infected patients. Moreover, chronic kidney disease has not been found, in some reports to add to the adverse outcomes, an aspect that merits further exploration. Patients on regular hemodialysis may be vulnerable to coronavirus infection due to the lower status of immunity and the need for frequent attendance at health-care facilities. Due to the previous factors, prevention and mitigation of the SARS-CoV-2 virus, in this vulnerable population, constitutes a major challenge.</p> Tarek Abdelaziz (Author) Copyright (c) 2020 Tarek Abdelaziz (Author) Sat, 30 May 2020 00:00:00 +0000 Coronavirus Disease-19 and Cardiovascular Disease <p>&nbsp;We are facing serious coronavirus disease-19 pandemic, caused by the severe acute respiratory syndrome coronavirus-2. Among infected individuals, there is a higher prevalence of the cardiovascular disease, which leads to their poor prognosis. Myocardial injury is present in more than 15% of critical ill patients in the form of acute myocardial dysfunction or subsequent myocardial injury that develops as disease severity. This new virus pandemic is a global challenge for health-care system which was we still have much to learn.</p> Irena Mitevska, Lidija Poposka (Author) Copyright (c) 2020 Irena Mitevska, Lidija Poposka (Author) Mon, 15 Jun 2020 00:00:00 +0000 Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19 <p>The coronavirus disease (COVID-19) has become a global pandemic with a high mortality rate. There has been emerging evidence regarding the presence of thrombosis in patients with severe COVID-19 infection. In addition, prognosis of COVID patients, once they are complicated with DVT or fatal pulmonary emboli, will also significantly decline. Hence, understanding the pathomechanism and prompt treatment of thromboembolism is important in improving the outcome in COVID-19 patients. Prophylaxis anticoagulant was proposed for all hospitalized COVID-19 patients. The aim of this article is to review the current literature regarding pathomechanism, risk assessment, diagnosis, and management of VTE.</p> Dita Aulia Rachmi, Eka Prasetya Budi Mulia, Johanes Nugroho (Author) Copyright (c) 2020 Dita Aulia Rachmi, Eka Prasetya Budi Mulia, Johanes Nugroho (Author) Mon, 15 Jun 2020 00:00:00 +0000 Clinical Features of Patients with Probable 2019 Novel Coronavirus Infected Pneumonia in Rasht, Iran: A Retrospective Case Series <p><strong>BACKGROUND: </strong>Coronavirus disease-19 (COVID-19) is the first pandemic infectious disease caused by a novel coronavirus. Viral pneumonia is a severe complication of COVID-19.</p> <p><strong>AIM: </strong>Due to the high prevalence of this disease globally, especially in Iran, the aim of this study was to determine the clinical features of seven patients with probable COVID-19 infected pneumonia in Rasht, North Iran.</p> <p><strong>MATERIALS AND METHODS: </strong>In this retrospective case series study, we described the clinical, laboratory, and radiological features of seven patients with probable COVID-19 infected pneumonia at Razi Hospital, Rasht, north of Iran, from February 27 to March 16, 2020.</p> <p><strong>RESULTS: </strong>In this study, the most common clinical symptoms during hospitalization in patients with COVID-19 were poor appetite (seven cases), dehydration (seven cases), cough (six cases), dyspnea (six cases), fatigue (six cases), fever above 38°C (five cases), myalgia (five cases), Chills (five cases), feeling fever (five cases), sore throat (five cases), and nausea (five cases), respectively. The average body temperature in these patients was 39.32°C. In laboratory findings, erythrocyte sedimentation rate was elevated in three patients. Contrary to most of the evidence, C-reactive protein was not elevated in five patients. All patients received antibiotic and antiviral medications and received symptomatic treatment. Finally, four patients responded to the treatments and were discharged from the hospital; two patients were still hospitalized and only one patient died.</p> <p><strong>CONCLUSION: </strong>Patients with COVID-19 associated pneumonia can be treated by evaluating and implementing appropriate therapeutic management. However, at the moment the disease progression for patients with COVID-19 cannot be accurately predicted.</p> Samad Karkhah, Mohammad Javad Ghazanfari, Amir Shamshirian, Latif Panahi, Meysam Molai, Amir Emami Zeydi (Author) Copyright (c) 2020 Samad Karkhah, Mohammad Javad Ghazanfari, Amir Shamshirian, Latif Panahi, Meysam Molai, Amir Emami Zeydi (Author) Sun, 10 May 2020 00:00:00 +0000 Subcorneal Pustular Dermatosis with Temporary Autoimmune Features during COVID-19 Pandemic <p>Subcorneal pustular dermatosis, Sneddon-Wilkinson, is an uncommon neutrophilic dermatosis of unknown etiology. We report on a 51-year-old woman who presented with multiple superficial erythematous erosions surrounded by annular arranged sterile pustules concentrated on the trunk, the neck, and the proximal extremities during the coronavirus disease-19 pandemic. Larges pustules and flaccid bullae showed a hypopyon. There were no fever and no pruritus, general health was unaffected. Laboratory investigations revealed leukocytosis, neutrophilia, lymphopenia, and increased C-reactive protein. Initially, antinuclear antibodies, pemphigoid antibodies, and antibodies to BP 230 were positive, but negative 5 days later. Nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA tested by real-time reverse-transcriptase-polymerase chain reaction. A diagnostic skin biopsy showed epidermal spongiotic vesiculation and subcorneal pustulation with acantholysis and an inflammatory infiltrate composed of neutrophils and lymphocytes. The confirmed diagnosis was subcorneal pustular dermatosis Sneddon-Wilkinson. She was treated by dapsone and corticosteroids with the latter tempered down. Clinical response was rapid. We suggest that the autoimmune features seen on admission may be due to an undefined viral infection, but not SARS-CoV-2.</p> Uwe Wollina, André Koch, Gesina Hansel, Caroline Fürll, Jacqueline Schönlebe (Author) Copyright (c) 2020 Uwe Wollina, André Koch, Gesina Hansel, Caroline Fürll, Jacqueline Schönlebe (Author) Fri, 05 Jun 2020 00:00:00 +0000 Guide to Leading a Patient with Symptoms of an Acute Respiratory Infection during a Coronavirus Pandemic (COVID-19) <p><strong>BACKGROUND: </strong>Over 500 viruses and bacteria primarily cause respiratory infections. During COVID-19 pandemic, these respiratory infections remain; i.e., COVID-19 has no ability to suppress these infections from the circulation. Therefore, it is very important to differentiate respiratory infections from COVID-19. Proving the presence of COVID-19 with polymerase chain reaction (PCR) is not evidence that the disease was caused by this virus. Possible options are: First, a random encounter of the virus in the patient’s upper respiratory tract; second, further possible colonization with a coronavirus (or with COVID-19); the third option is to have an infection; and the fourth possibility is to have a disease or COVID-19 upper respiratory infection. Unfortunately, the method with PCR, although it is with high sensitivity and specificity, does not help us to distinguish which of these four possibilities are in question.</p> <p><strong>AIM: </strong>We aimed to present a guide to leading a patient with symptoms of an acute respiratory infection during a coronavirus pandemic (COVID-19).</p> <p><strong>RESULTS: </strong>A pandemic of COVID-19 shows that many patients get primary viral pneumonia, but people with normal immune system have no problem recovering. People with reduced immunity die from COVID-19, as opposed to the pandemic influenza virus. It is indirectly concluded that COVID-19 in itself is not very virulent, but it weakens the immunity of those infected who already have some condition and impaired immunity. The available scientific papers show that there is no strong cytokine response, patients have leukopenia and lymphopenia, some patients have a decrease in CD4 T-lymphocytes. From the results of the autopsies available so far, it is clear that there are very few inflammatory cells in the lungs and a lot of fluid domination. Hence, SARS-Cov-2 only somehow speeds up the decline in immunity. The previously published radiographic findings of COVID-19 patients, gave a characteristic findings of the presence of multifocal nodules, described as milky glass, very often localized in the periphery of the lung. Whether it is typical pneumonia, atypical, viral, mixed-type pneumonia, or mycotic pneumonia, it can progress to severe pneumonia. The pneumonia becomes severe when breathing is over 30/min; diastolic pressure below 60 mmHg; low partial oxygen pressure in the blood (PaO2/FiO2 &lt;250 mmHg) (1 mmHg = 0.133 kPa); massive pneumonia, bilateral or multilayered lung X-ray; desorientation; leukopenia; and increased urea.</p> <p><strong>CONCLUSION: </strong>Patients with COVID-19 placed in intensive care units should be led by a team of anesthesiologists with an infectious disease specialist or an anesthesiologist with a pulmonologist. Critical respiratory parameters should be peripheral oxygen saturation &lt;90%, PaO2/FiO2 ratio 100 or &lt;100, tachycardia above 110/min.</p> <p>&nbsp;</p> Velo Markovski (Author) Copyright (c) 2020 Velo Markovski (Author) Tue, 30 Jun 2020 00:00:00 +0000 Chest Computed Tomography Findings in COVID-19 Pneumonia from Tehran, Iran <p>From February 24, 2020, to April 2, 2020, this study presents a preliminary report on the chest computed tomography (CT) findings of COVID-19 pneumonia at Baqiyatallah Hospital, Tehran, Iran. This study performed on 70 patients with a final diagnosis of COVID-19.</p> Mohammad Javanbakht, Ramezan Jafari, Mehd Mesri, Morteza Izadi, Seyed Hassan Saadat (Author) Copyright (c) 2020 Mohammad Javanbakht, Ramezan Jafari, Mehd Mesri, Morteza Izadi, Seyed Hassan Saadat (Author) Mon, 25 May 2020 00:00:00 +0000 Do we Trust the Polymerase Chain Reaction Test Result in Children to Diagnose COVID-19? A Case Report of COVID-19 <p><strong>BACKGROUND:</strong> Coronavirus disease-19 (COVID-19) resulted in widespread concern in global public health and has a bad prognosis despite drug therapy.</p> <p><strong>CASE REPORT:</strong> The patient was an 11-year-old girl referred to a children hospital with a dry cough, fever, and headache symptoms, without comorbidity. She was hospitalized following the results of high-resolution computed tomography (HRCT). The patient was treated with ceftriaxone 1 g every 12 h and the oseltamivir capsule 45 mg every 12 h and azithromycin 250 mg tablet once daily and 200 mg hydroxychloroquine tablet every 12 h for a total of 5 days. After 5 days, the patient had suitable chest status and then was discharged. Azithromycin for 5 days and hydroxychloroquine for 10 days were prescribed for the patient to take at home. The patient’s polymerase chain reaction (PCR) was negative at baseline through the nasopharyngeal swap, but HRCT of the patient’s was completely consistent with COVID-19 accompanied by consolidation and ground-glass opacity in the left lower and right upper lobes.</p> <p><strong>CONCLUSION:</strong> The numerous technical errors in taking the nasopharyngeal swap were the main reasons for the negative PCR. The main lesson from this case report is the high sensitivity and specificity of HRCT compared to the PCR.</p> Amir Nasimfar, Rohollah Valizadeh, Mohammad Nanbakhsh (Author) Copyright (c) 2020 Amir Nasimfar, Rohollah Valizadeh, Mohammad Nanbakhsh (Author) Wed, 10 Jun 2020 00:00:00 +0000 General Anxiety Disorder-Related Coronavirus Disease-19 Outbreak in Indonesia: A Case Report <p><strong>BACKGROUND: </strong>The outbreak of coronavirus disease-19 (COVID-19) which is now a pandemic has become a problem that occurs in every area of life. Coronaphobia, a new term in the psychiatry literature referring to excessive fear of being infected by SARS-COV2 or COVID 19. Infected by influenza, having close relatives or friends with this fatal virus, and strong fear of infection have been reported as important predictors of stress posttrauma. We report a case report-related COVID-19 in Indonesia.</p> <p><strong>CASE PRESENTATION: </strong>A 23-year-old female, dentistry student living in a boarding house in East Java, Indonesia, along with her friend and coming from a middle-up income family background, came to psychiatric consultation with complaints of difficulty of breathing for 1 month ago. This anxiety began to get heavy, especially since the severe acute respiratory syndrome coronavirus 2 (COVID 19) outbreak appeared in Indonesia. In addition, she also recently experienced a failure in her final examination so that her study period as a dentistry student must be extended. Exploration of history revealed that the patient initially experience a feeling of heaviness in the chest, difficulty breathing, palpitation, and sometimes feeling sad due to her failure before. She was then given pharmacological interventions in the form of fluoxetine and clobazam and psychotherapy and progressive muscular relaxation through online.</p> <p><strong>CONCLUSION: </strong>General anxiety disorder, especially due to the COVID-19 outbreak, should be managed appropriately and comprehensively. The pandemic situation and widespread spread of the disease cause psychotherapy to be modified in such a way that assistance can be carried out online.</p> Patricia Wulandari, Rachmat Hidayat (Author) Copyright (c) 2020 Patricia Wulandari, Rachmat Hidayat (Author) Wed, 10 Jun 2020 00:00:00 +0000 A Survey of the Knowledge of Surveillance Officers and Outbreak Investigation Team toward COVID-19 in North Sumatera Province, Indonesia <p><strong>BACKGROUND: </strong>Our world is now facing the public health emergency situation. Since early December 2019, COVID-19 emerged the Wuhan City, Hubei Province, China. The disease is still continuing spread to more than 200 countries and territories globally.</p> <p><strong>AIM: </strong>This study aimed to assess the knowledge of COVID-19 among the surveillance officers and outbreak investigation team in North Sumatera, Indonesia.</p> <p><strong>METHODS: </strong>A cross-sectional study was performed between March 5, 2020 and April 20, 2020, among the surveillance officers and outbreak investigation team in North Sumatera province, Indonesia. A set of validated, pre-tested questionnaire was used to measure knowledge regarding COVID-19 infection and to collect a range of explanatory variables. Data were collected through a self-administered questionnaire. A two-step logistic regression analysis was employed to assess the association of participants’ demographic data, level of education, surveillance training, length of work, and location of workplace with the knowledge.</p> <p><strong>RESULTS: </strong>A total of 246 participants were collected. We found that 109 out of 246 (44.3%) participants were good knowledge of COVID-19. Multivariate model revealed that surveillance training was the most associated variable with knowledge of COVID-19 (OR = 2.15, 95% CI = 1.09–4.27). In addition, as much as 27 participants (79.4%) have good knowledge and also have received surveillance training expressed a willingness to conduct surveillance (OR = 4.75, 95% CI = 1.98–11.39).</p> <p><strong>CONCLUSIONS: </strong>The knowledge of surveillance officers and outbreak investigation team in North Sumatera regarding COVID-19 is relatively low. Participants who have good knowledge and have received surveillance training expressed a willingness to conduct surveillance of COVID-19 in the community. Therefore, training for surveillance and outbreak investigation team to improve the understanding and skill is a must.</p> Frans Yosep Sitepu, Elpiani Depari, Wiwit Aditama, Rd Halim, Adi Isworo, Bangun Hot Pandapotan Lumbangaol, Muhammad M Fathan, Firman Apul Aritonang, Elinsa Sihotang, Dormani Peronika Napitupulu, Arwan Nofri (Author) Copyright (c) 2020 Frans Yosep Sitepu, Elpiani Depari, Wiwit Aditama, Rd Halim, Adi Isworo, Bangun Hot Pandapotan Lumbangaol, Muhammad M Fathan, Firman Apul Aritonang, Elinsa Sihotang, Dormani Peronika Napitupulu, Arwan Nofri (Author) Sat, 20 Jun 2020 00:00:00 +0000 Common Phobias among Egyptian Primary Schoolchildren: An Emergency Trigger for Panic Disorder due to Corona Pandemic <p><strong>BACKGROUND: </strong>In the wake of the adverse situation we are currently facing globally due to the coronavirus pandemic outbreak, it is normal to feel stressed, confused, and scared but what is abnormal is to turn this to panic. Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger that may be evolved to experience panic attacks.</p> <p><strong>AIM: </strong>Our objective was to identify the prevalence of most common phobias as well as panic disorder (PD) due to the coronavirus pandemic among Egyptian primary schoolchildren and their determinants.</p> <p><strong>METHODS: </strong>A cross-sectional study was conducted among 2015 schoolchildren from 3 to 6 grades in three governorates of Egypt. Seven types of phobias were investigated: Agoraphobia, phobias from darkness, animal, untreatable illness (mainly coronavirus), insects, height, and social phobia. The child’s self-reported PD symptoms were assessed using DSM-IV with psychiatric diagnoses.</p> <p><strong>RESULTS: </strong>Almost two-thirds of the surveyed primary schoolchildren have phobias of the low score (&lt;9) versus one-third who had high phobias score (61.% vs. 35%, respectively) with highly significant difference (p &lt; 0.001). The most prevalent phobias were from heights (66.5%) followed by darkness (60.0%). The important predictors of phobias were: Being a male child, living in an urban area, and studying at governmental school at fifth or sixth-grade residence. The prevalence of PD due to the corona epidemic is very high, it is reported by almost half of the surveyed primary schoolchildren. Fear of losing any of their family members, especially grandparents, was reported to be the highest PD symptom (97%).</p> <p><strong>CONCLUSION AND RECOMMENDATION: </strong>Phobia from heights and darkness was the most common. The prevalence of PD due to the coronavirus epidemic is reported to be very high. Calming down children who might be experienced with a phobia that is triggering their PD is recommended.</p> A. M. Metwally, Marwa M. El-Sonbaty, Ghada A. Abdellatif, Lobna A. El-Etreby, Hanan Elsayed, Eman Elsheshtawy, Amal Elsaeid, Nihad A. Ibrahim (Author) Copyright (c) 2020 A. M. Metwally, Marwa M. El-Sonbaty, Ghada A. Abdellatif, Lobna A. El-Etreby, Hanan Elsayed, Eman Elsheshtawy, Amal Elsaeid, Nihad A. Ibrahim (Author) Mon, 11 May 2020 00:00:00 +0000 When Shall Coronavirus Disease-19 Stop? Review of Literature <p>In December 2019, a new coronavirus, now labeled as severe acute respiratory syndrome coronavirus 2, induced an episode of acute atypical respiratory illness started in Wuhan, Province of Hubei, China. The illness triggered by this virus was called coronavirus disease-19 (COVID-19). The infection is spread within humans and has triggered a global pandemic. The amount of death tolls continues to increase and a growing number of countries have been driven to create social barriers and lock-ups. The shortage of tailored counseling remains an issue. Epidemiological researches have shown that elderly patients are more vulnerable to serious diseases, while children tend to have milder symptoms. Here, we checked the latest understanding of this disease and found a possible explanation of the potential sequel and the expectations for the future.</p> Ahmed M. El-Malky, Waad H. Al-Kathiri, Azza A. El Nouman (Author) Copyright (c) 2020 Ahmed M. El-Malky, Waad H. Al-Kathiri, Azza A. El Nouman (Author) Sun, 10 May 2020 00:00:00 +0000 COVID-19 in Children: A Narrative Review <p><strong>BACKGROUND: </strong>In December 2019, coronavirus (CoV) disease 2019 (COVID-19) was detected in Wuhan, China, which is known as severe acute respiratory syndrome CoV 2 (Severe acute respiratory syndrome [SARS]-CoV-2).</p> <p><strong>AIM: </strong>This study attempted a narrative review of the researches about COVID-19 in children.</p> <p><strong>METHODS: </strong>We searched all articles between 2000 and April 2020 in PubMed, Scopus, and ScienceDirect related to COVID-19 in children, using the following terms: “COVID-19,” “coronavirus,” “SARS-CoV-2” in combination with “pediatrics,” or “children.”</p> <p><strong>RESULTS: </strong>The most common method of transmitting the disease to children was through close contact with family members through respiratory droplets. Coinfection is common in pediatric with COVID-19 infection. One of the most important transmission routes is oral feces. The severity of the disease was mild or asymptomatic in most children. The most common clinical symptoms were fever and cough, and gastrointestinal symptoms were more common in children than in adults. Infants and preschoolers had more severe clinical symptoms than older children. The most common radiographic findings from the lungs were bilateral ground-glass opacity. Increased procalcitonin and lactate dehydrogenase should be considered in children. The use of intravenous immunoglobulin, lopinavir/ritonavir, and oseltamivir, along with oxygen therapy, had the greatest effect on improving children’s conditions.</p> <p><strong>CONCLUSIONS: </strong>The most important way to prevent this disease in children is to follow the health tips of family members. Although the number of children with the disease is low, children are vulnerable to infection. Antiviral medications along with the use of muscle relaxants and oxygen therapy have a great impact on children’s condition.</p> Alireza Razavi, Lotfollah Davoodi, Layla Shojaei, Hamed Jafarpour (Author) Copyright (c) 2020 Alireza Razavi, Lotfollah Davoodi, Layla Shojaei, Hamed Jafarpour (Author) Wed, 20 May 2020 00:00:00 +0000 Gastrointestinal Aspects of COVID-19: A Review <p>Coronaviruses commonly cause mild infections, but recently severe acute respiratory syndrome-coronavirus (SARS-CoV)-2 caused a pandemic of coronavirus disease 2019 (COVID-19). A total of 3,181,642 cases were confirmed globally. Gastrointestinal tract may be involved in COVID-19 due to the presence of angiotensin converting enzyme-2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) in small intestine and colon which are mandatory for SARS-CoV-2 invasion. A proportion of patients with COVID-19 had gastrointestinal manifestation without respiratory symptoms. Viable virus can also be isolated from feces of patients. Fecal-oral transmission should be considered in controlling disease spreading. Fecal examination may also be considered to diagnose COVID-19, especially in areas with limited personal protective equipment.</p> Gontar Alamsyah Siregar, Ginanda Putra Siregar, Darmadi Darmadi (Author) Copyright (c) 2020 Gontar Alamsyah Siregar, Ginanda Putra Siregar, Darmadi Darmadi (Author) Sat, 20 Jun 2020 00:00:00 +0000 Public Eye toward COVID-19: A Systematic Review <p><strong>BACKGROUND: </strong>The general public has an important role in controlling the spread of infectious diseases by pursuing prophylactic measures.</p> <p><strong>AIM: </strong>The aim of the present systematic review was to describe public perceptions, knowledge, attitudes, and behaviors toward COVID-19.</p> <p><strong>METHODS: </strong>In this review, articles were extracted from the Google Scholar, Embase, Scopus, Web of Science, and PubMed search engines. The main keywords for the search were coronavirus, COVID-19, public perceptions, knowledge, attitudes, and behaviors.</p> <p><strong>RESULTS: </strong>The knowledge level toward novel coronavirus in different countries was generally high, and it had an increasing pattern during the pandemic phase. Furthermore, the insight self-efficacy, perceived severity of the COVID-19, and intention to meet the needs of preventive measures have increased notably. Furthermore, there are several misconceptions and unconfirmed beliefs in the general public in the case of preventive measures recommended, in particular.</p> <p><strong>CONCLUSIONS: </strong>Health authorities and other disease control centers should monitor public misconceptions and perceptions continuously and manage a trusting platform to be presented to the public, especially in the case of a novel disease outbreak.</p> Behzad Fouladi Dehaghi, Gholamheidar Teimori-Boghsani, Leila Ibrahimi Ghavamabadi, Abbas Mohammadi (Author) Copyright (c) 2020 Behzad Fouladi Dehaghi, Gholamheidar Teimori-Boghsani, Leila Ibrahimi Ghavamabadi, Abbas Mohammadi (Author) Wed, 10 Jun 2020 00:00:00 +0000 Evaluation of Angiotensin-converting Enzyme 2 (ACE2) in COVID-19: A Systematic Review on All Types of Studies for Epidemiologic, Diagnostic, and Therapeutic Purposes <p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the angiotensin-converting enzyme 2 (ACE2) receptor of SARS-CoV for cell entry. We aimed to check the association between ACE2 and COVID-19 (coronavirus disease 2019) in a systematic review. Two databases (PubMed/Medline and Scopus) and bioRxiv were checked for retrieving all types of studies in relation to ACE2 and COVID-19 until March 18, 2020. Forty-one studies were entered to the systematic review. These studies included nineteen original, eight reviews, four letters to the editor, three research papers, one correspondence, one commentary, one mini review, two reports, one opinion, and one perspective. In summary, the results showed that the ACE2 receptor for COVID-19 is similar to that of SARS-CoV. However, its expression was different in various populations as well as in the two genders. ACE2 may be used as a therapeutic target. Patients who take ACE inhibitors may have benefit in severe disease outcomes. Finally, pangolins and snakes and turtles may act as the potential intermediate hosts transmitting disease to humans.</p> Houshang Nemati, Mazaher Ramezani, Farid Najafi, Babak Sayad, Mehri Nazeri, Masoud Sadeghi (Author) Copyright (c) 2020 Houshang Nemati, Mazaher Ramezani, Farid Najafi, Babak Sayad, Mehri Nazeri, Masoud Sadeghi (Author) Wed, 20 May 2020 00:00:00 +0000 Systematic Review with no Meta-analysis of Coronavirus COVID-19 <p><strong>AIMS: </strong>COVID-19 is a new virus which has spread to most countries in the world. Many papers have been published on the clinical manifestations of this virus. This paper concentrates only on the clinical cases and prognosis of COVID-19 presented in the literature.</p> <p><strong>METHODS: </strong>Systematic review is done, and taken into consideration, all published papers in the literature related to COVID-19. Inclusion and exclusion criteria have been applied.</p> <p><strong>RESULTS: </strong>Few papers have been determined after many filtrations of all published papers concerning inclusion and exclusion criteria to assess outcome of existing COVID-19. Most published papers or reports did not provide full details for each case.</p> <p><strong>CONCLUSION: </strong>Most clinical description data in these reports are so limited and missing some of the critical elements such as the date of infection, source of infection, symptoms, diagnostic criteria, incubation of infection, transmission of infection, number of identified cases after contact with infected patients, and health workers are affected or not by treatment of infected patients, patient age, and type of study. No clear evidence of the treatment plan and the prevention and most data in literature depending on personal experience only which is different from country to others.</p> Bassel Tarakji, Faisal Mehsen Alali, Adel Alenzi, Mohammad Zakaria Nassani (Author) Copyright (c) 2020 Bassel Tarakji, Faisal Mehsen Alali, Adel Alenzi, Mohammad Zakaria Nassani (Author) Tue, 30 Jun 2020 00:00:00 +0000 The Need of Non-traditional Techniques to Screen for the Virus <p><strong>BACKGROUND: </strong>At the present moment, the etiological diagnosis of SARS-CoV-2 is based on the polymerase chain reaction (PCR). False negative cases are increasingly reported in several studies using reverse transcription-PCR (RT-PCR). For example, the positive rate of RT-PCR for throat swabs was reported to be about 60% in early stage of COVID-19.</p> <p><strong>AIM: </strong>We aimed to present metagenomic next-generation sequencing (mNGS) as a potential tool to detect pathogens.</p> <p><strong>METHODS: </strong>In the recent year, mNGS is shown the potential to detect pathogens without the need of hypothesis guided approach and is proven to be highly effective.</p> <p><strong>RESULTS: </strong>A recent prospective study in the United States compared the diagnostic performance of routine diagnostic tests with mNGS and showed that mNGS detected a bacteria or virus in the CSF of 13 of 58 patients presenting with meningoencephalitis who were negative for or not assessed with routine diagnostic test including PCR. NGS also has the advantage to cover entire viral genomes.</p> <p><strong>CONCLUSION: </strong>As viral metagenomics has significantly improved in recent years and become more cost effective, we think that a change in the approach toward a shot-gun metagenomic testing should be explored and could potentially aid the diagnosis of COVID-19 cases and the management of this pandemic.</p> Davide Borroni, Kunal Gadhvi (Author) Copyright (c) 2020 Davide Borroni, Kunal Gadhvi (Author) Tue, 05 May 2020 00:00:00 +0000 COVID-19 from a Perspective of Neuromuscular Diseases: Meeting the Challenges <p>Dear Editor,</p> <p>The new SARS-CoV-2 epidemic is imposing immense strain on the health systems in several countries. The growth of the epidemic has led the WHO to declare the 2019-nCoV disease as a global pandemic (1). COVID-19 pandemic has the potential to affect patients with neuromuscular diseases. The evaluation of the overall risk of COVID-19 in patients with neuromuscular diseases depends on several factors: the specificity of the neuromuscular disease, the general condition, the presence of other comorbidities, age, and the type of immunosuppressive treatment they receive. It is important to emphasize the fact that most patients with neuromuscular disease are not expected to suffer from severe complications due to coronavirus infection. Corona infections can affect certain myopathies. In a recent study published in China, related to COVID-19 is shown that hospitalized patients experienced fatigue and myalgia (44-70%), and increased creatine kinase (33%) in the serum (2). Apart from this, a third of hospitalized patients infected with the coronavirus had rhabdomyolysis (3). All of this points to the fact that coronavirus infection may be responsible for viral myositis. In addition, is the finding that some of the critical cases have developed polyneuropathy or myopathy (4). On the other hand, it is well known that infection is a trigger for exacerbation of certain neuromuscular diseases. There is no data that measured the risk of exacerbation as a result of coronaviruses infection for neuromuscular disorders. However, in one retrospective study, COVID-19 infection was a leading reason for the exacerbation of myasthenia gravis (5). As a result of this, an increased incidence of exacerbations of certain neuromuscular diseases should be expected, as well as the appearance of new clinical presentations during this pandemic. It is important to note that there are still no neuromuscular diseases-specific recommendations for patients who are infected with the coronavirus. Observation is recommended in patients at high and medium risk, especially in those patients where there is a possibility of a decrease in respiratory function. Last but not least, we would like to emphasize the need for reorganization of clinical care for these patients (6). The goal is to reduce exposure of patients to areas where the coronavirus could be found. Moreover, non-urgent or outpatient care is remarkably reduced. In conclusion, we must learn to apply our clinical practices in order to reduce the complications that may occur in patients with neuromuscular disease due to COVID-19. The primary goal is to develop evidence-based medical practices in order to reduce morbidity and mortality. Collaboration among institutions worldwide will be able to give us the data needed for planning management for neuromuscular disorders with COVID-19 and maintain clinical research against strong challenges.</p> <p>&nbsp;</p> <p>&nbsp;</p> Ivan Barbov, Goce Kalcev (Author) Copyright (c) 2020 Ivan Barbov, Goce Kalcev (Author) Tue, 05 May 2020 00:00:00 +0000