Pathologic changes in patients infected with SARS-CoV-2: a review

Severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2) enters cells using the angiotensin converting enzyme 2 (ACE2), which are expressed by the respiratory tract endothelium, epithelial cells of the stomach, duodenum, ileum, rectum, cholangiocytes, and hepatocytes. Pathological examinations of these organs are not feasible method of diagnosis but can explain pathological changes, pathogenesis of the disease, and the cause of death in COVID-19 cases. In this review, we performed a literature search for COVID-19-related pathological changes seen during post-mortem examinations in different organs of the body including the lungs, gastrointestinal tract, liver, kidney, skin, heart and blood. Our findings showed that SARS-CoV-2 has damaging effects on many organs, probably due to the host immune responses to the presence of the virus. It is recommended that both antiviral and immunomodulatory agents should be considered in the management of COVID-19 patients for better prognosis, and clinical outcome.   French title: Changements pathologiques chez les patients infectés par le SRAS-CoV-2: une revue Le syndrome respiratoire aigu sévère-coronavirus-2 (SARS-CoV-2) pénètre dans les cellules à l'aide de l'enzyme de conversion de l'angiotensine 2 (ACE2), qui est exprimée par l'endothélium des voies respiratoires, les cellules épithéliales de l'estomac, du duodénum, de l'iléon, du rectum, des cholangiocytes, et les hépatocytes. Les examens pathologiques de ces organes ne sont pas une méthode de diagnostic réalisable, mais peuvent expliquer les changements pathologiques, la pathogenèse de la maladie et la cause du décès dans les cas de COVID-19. Dans cette revue, nous avons effectué une recherche bibliographique sur les changements pathologiques liés au COVID-19 observés lors d'examens post-mortem dans différents organes du corps, notamment les poumons, le tractus gastro-intestinal, le foie, les reins, la peau, le coeur et le sang. Nos résultats ont montré que le SRAS-CoV-2 a des effets néfastes sur de nombreux organes, probablement en raison des réponses immunitaires de l'hôte à la présence du virus. Il est recommandé que les agents antiviraux et immunomodulateurs soient pris en compte dans la prise en charge des patients COVID-19 pour un meilleur pronostic et des résultats cliniques. &nbsp

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Multivariate coefficient of variation control charts in phase I of SPC

Multivariate control charts are mostly available for monitoring the process mean vector or the covariance matrix. Recently, work has been done on monitoring the multivariate coefficient of variation (CV) in phase II of the statistical process control (SPC). However, no study has investigated the performance of the multivariate CV charts in phase I. The phase I procedures are more important and involve the estimation of the charts? limits from a historical or reference dataset that represents the in-control state of the process. In real life, contaminations are mostly present in the historical samples; hence, the phase I procedures are mostly adopted to get rid of these contaminated samples. In this study, we investigate the performance of a variety of multivariate CV charts in phase I considering both diffuse symmetric and localized CV disturbance scenarios, using probability to signal as a performance measure. A real-life application, concerning carbon fiber tubing, is also provided to show the implementation of the proposed charts in phase I. The findings of this study will be useful for practitioners in their selection of an efficient phase I control chart for monitoring multivariate CV.The author Nurudeen A. Adegoke acknowledges the support provided by the Institute of Natural and Mathematical Sciences, Massey University Albany, New Zealand, during his Ph.D. The authors also thank the editor and the referees for their constructive comments.Scopu

Effect of malnutrition on diarrhoeal disease in Nigerian children

Background: Good nutrition plays an important role in the prevention of diseases in children. Childhood diarrhoea is commonly associated with under nutrition such that the frequency and severity of diarrhoea are increased with greater severity of under nutrition. Objectives: The study was carried out to assess the nutritional status of children with diarrhoea, and to determine the impact of malnutrition on diarrhoeal characteristics. Methods: The study was a cross-sectional comparative study which involved under-five children with diarrhoea and controls. Socio-demographic details, diarrhoeal characteristics and nutritional parameters, including weight-for-age, height-for-age and weight-for-height, were assessed in the children. Results: Twenty-five (14.7%) of the diarrhoea patients were underweight, 31 (18.2%) stunted, 29 (17.1%) wasted and6 (3.5%) overweight. Wasting and underweight were significantly more prevalent among the children with diarrhoea, compared with the controls (p <0.001 and p = 0.007, respectively). A significantly higher proportion of children who had signs of dehydration were underweight (p <0.001) and wasted (p <0.001). Wasting was also more prevalent among children with higher stool frequency (p = 0.007). Conclusion: Wasting serves as a risk factor for childhood diarrhoea, and also predisposes children to severe episodes of diarrhoea, whereas overweight status offers no protection against diarrhoea. Keywords: Malnutrition, Diarrhoea, Children, Nigeri

Enhancing the performance of the EWMA control chart for monitoring the process mean using auxiliary information

When using control charts to monitor manufacturing processes, the exponentially weighted moving average (EWMA) control chart is useful for detecting persistent shifts in the process parameter. This paper proposes enhancements to the applications of the EWMA control chart for those scenarios where the exact measurement of process units is difficult and expensive, but the visual ordering of the units can be done easily. The proposed charts use an auxiliary variable that is correlated with the process variable to provide efficient monitoring of shifts in the process mean and are formulated based on ranked set sampling (RSS) and median RSS schemes (MRSS). Simulation results showed that the proposed charting schemes are more efficient in detecting a shift in the process mean than the classical EWMA control chart and its modification. An example is provided to show the application of the proposed charts using a simulated benchmark process: the continuous stirred tank reactor (CSTR)

Resposta das aves à administração aquosa de extrato de abóbora manchada

Este estudo foi conduzido para avaliar a resposta ao crescimento, o teor de lipoproteínas do sangue, os índices do fígado e do rim e a resposta humoral de extratos aquosos administrados por polpa de Lagenaria breviflora Robert. Um total de noventa (90) quatorze (14) dias de idade pintainhos castanhos de Yaffa foram utilizados para esta experiência. Os pássaros foram distribuídos aleatoriamente em três (3) grupos de tratamento, contendo três (3) repetições de dez (10) aves cada. Os extratos aquosos de Lagenaria breviflora foram administrados no controle, 100 e 150 g/litro, respectivamente. A aquoso da administração de Lagenaria breviflora Robert não teve efeito (P<0,05) nos índices de crescimento considerados. A lipoproteína de alta densidade (HDL) foi significativamente (P<0,05) influenciada em grupos de 100 e 150 g / litro apenas às 16 semanas de idade. Os índices de fígado (Alanina Aminotransferase e Aspartato Aminotransferase) foram estatisticamente (P<0,05) mais elevados em aves administradas com 150 g/litro de grupo às 16 semanas de idade, enquanto o teor sérico de cálcio foi maior no grupo de 100 g. O valor do título de anticorpo foi mais elevado a 100 g/litro do extrato enquanto os 150 g/litro foram reduzidos. Pode recomendar-se que os extratos aquosos sejam administrados a 150g/litro devido à sua capacidade de baixar o nível de lipídios e reduzir a quantidade de material derramado no produto e capaz de melhorar o estado imune das aves. A administração aquosa de 100 e 150 g/litro de forma significativa (P<0,05) efetiva no aprimoramento da resposta imune humoral das frangas em comparação com o grupo controle. Pode ser recomendado que os extratos aquosos possam ser administrados a 100 g / litro para melhorar a condição de saúde e o estado imunológico das aves

Shrinkage estimates of covariance matrices to improve the performance of multivariate cumulative sum control charts

Multivariate cumulative sum control charts require knowledge of the in-control process covariance parameters. Here, we show that the performance of the multivariate cumulative sum control charts for individual-observation monitoring is affected by the estimation of parameters unless the Phase I sample size is large. When only a small Phase I sample size is available, we propose the use of a shrinkage estimate. The average run length performance of multivariate cumulative sum control charts obtained using the shrinkage estimate is superior to the other methods examined in this study. The improved performance of the control charts using the shrinkage estimate is also demonstrated via an illustrative case study of Bimetal data, in which measurements of four properties of bimetal brass and steel thermostats are monitored, and a shift in the multivariate centroid is detected earlier using the shrinkage-based method. - 2018 Elsevier LtdScopu

Inhibition of lipid peroxidation and free radical scavenging activities of methanolic leaf extract of Psidium guajava

Objectives: Studies have linked the generation of free radicals with the incidence of degenerative diseases. Antioxidants from plant origin have been proved to play a major role in mitigating against free radicals-induced oxidative damage. This study aimed at assessing the in-vitro and in-vivo antioxidant capability of Psidium guajava leafMethods: The leaves were collected and extracted with 70% methanol. Total phenolic, and flavonoids contents, 2,2-diphenyl-1-picrylhydrazyl and Hydroxyl radicals scavenging activities, and inhibition of lipid peroxidation potential of the extract were assessed. Furthermore, rats (n=21) randomized into three groups were exposed to 50, 150, and 250 mg/kg body weight of the extract for 30 days. Control animals (n=7) received corn oil, after which blood and liver were excised for antioxidant assay.Results: The extract is rich in phenolic and flavonoid compounds. It scavenged DPPH and hydroxyl radicals and inhibits lipid peroxidation in-vitro. In-vivo, it increased the activities of hepatic superoxide dismutase, catalase, glutathione peroxidase, and plasma paraoxonase, and the concentration of hepatic reduced glutathione and MDA.Conclusion: Psidium guajava leaf extract is a potential source of natural antioxidant compounds, capable of supplementing the body's antioxidant defense system