Viral Outbreaks of SARS-CoV1, SARS-CoV2, MERS-CoV, Influenza H1N1, and Ebola in 21st Century; A Comparative Review of the Pathogenesis and Clinical Characteristics

 Throughout the past twenty years, humankind had its fair share of challenges with viral epidemics. In late December 2019, a zoonotic member of the coronaviruses was responsible for the COVID-19 outbreak of viral pneumonia in Wuhan, China. As a worldwide crisis, meanwhile, conclusive prevention or therapy has yet to be discovered, the death toll of COVID-19 has exceeded 278000 by May 11th, 2020. Alike other members of Coronavirus family such as MERS and SARS-CoV-1, SARS-CoV-2 provokes influenza-like syndrome which might further progress to the severe state of acute respiratory disease in some patients. Comparably, in 2009 the H1N1 influenza outbreak affected countless people by manifestations of respiratory system involvement. Additionally, Ebolavirus, as a member of the Filoviridae family, had also made a global catastrophe by causing hemorrhagic diseases in the past twenty years.  The unknown intrinsic nature of SARS-CoV-2, as a great missing piece of this pandemic puzzle, has had physicians to empirically test the possibly efficacious agents of the former viral epidemics on the COVID-19 cases. Here, the current knowledge in SARS-CoV-2 clinical features, transmissibility, and pathogenicity are all summed up as against the other emerging viruses in the last two decades, and the data crucially required for a better management of the illness has been spotlighted

A Rare Case Report of Duodenal Adenocarcinoma Accompanied by Cerebellar Medulloblastoma

A case of a 6-year-old female with a diagnosis of Duodenal Adenocarcinoma is presented by the authors, in which 24 months subsequent to undergoing radiation therapy for a Cerebellar Medulloblastomas, the mentioned diagnosis has been confirmed. Although, the chance of a secondary malignancy has been recognized to be elevated in children formerly undergone radiation therapy, the incidence of duodenal adenocarcinoma is a highly infrequent condition. As a consideration, observing manifestations like weight loss, vomiting, and icterus in a pediatric patient who has been administered earlier on with radiation therapy, must alert physicians that the risk of a gastrointestinal malignancy exists

Therapeutic Options and Critical Care Strategies in COVID-19 Patients; Where Do We Stand in This Battle?

A pandemic of COVID-19 made an appearance in Wuhan, China, in late December 2019 and rapidly became a serious concern worldwide, with killing more than 238000 people until 3rd May 2020. Given the fact that a vaccine against the virus probably won’t be available anytime in the near future, the therapeutic strategies have become more prominent. Many supposedly effective drugs are under evaluation which may hinder the replication of SARS-CoV-2, and subsequently the infection. Lately on 1th may 2020, FDA authorized the use of experimental drug, Remdesivir for "emergency purpose" in COVID-19 cases. Chloroquine and hydroxychloroquine, among the very first under-trial drugs, have been revealed to have promising impacts in treatment of SARS-CoV2. Broad-spectrum antivirals as well as HIV protease-inhibitors are still subject to assessment. Particularly angiotensin-converting enzyme 2 (ACE2) inhibitors are increasingly taken into consideration because of ACE2 being recognized as a host-cell receptor for COVID-19. Immune-Enhancement therapy by Interferons and Intravenous immunoglobulin (IVIG) has been shown to be effective in some cases. Moreover, Convalescent Plasma Therapy and auxiliary blood purification were considered as the treatment of SARS-CoV2 infection. Among the critically ill patients, Oxygen-therapy, timely usage of inflammatory inhibitors, and controlling viral shedding by antivirals may reduce the mortality and morbidity of COVID-19

Urinary c‐peptide creatinine ratio (UCPCR) as a predictor of coronary artery disease in type 1 diabetes mellitus

Abstract Background Elevated C‐peptide has been suggested as a risk factor for coronary artery disease (CAD). Elevated urinary C‐peptide to creatinine ratio (UCPCR) as an alternative measurement is shown to be related to insulin secretion dysfunction; however, data regarding UCPCR predictive value for CAD in diabetes mellitus (DM) are scarce. Therefore, we aimed to assess the UCPCR association with CAD in type 1 DM (T1DM) patients. Methods 279 patients previously diagnosed with T1DM included and categorized into two groups of CAD (n = 84) and without‐CAD (n = 195). Furthermore, each group was divided into obese (body mass index (BMI) ≥ 30) and non‐obese (BMI < 30) groups. Four models utilizing the binary logistic regression were designed to evaluate the role of UCPCR in CAD adjusted for well‐known risk factors and mediators. Results Median level of UCPCR was higher in CAD group compared to non‐CAD group (0.07 vs. 0.04, respectively). Also, the well‐acknowledged risk factors including being active smoker, hypertension, duration of diabetes, and body mass index (BMI) as well as higher levels of haemoglobin A1C (HbA1C), total cholesterol (TC), low‐density lipoprotein (LDL) and estimated glomeruli filtration rate (e‐GFR) had more significant pervasiveness in CAD patients. Based on multiple adjustments by logistic regression, UCPCR was a strong risk factor of CAD among T1DM patients independent of hypertension, demographic variables (gender, age, smoking, alcohol consumption), diabetes‐related factors (diabetes duration, FBS, HbA1C), lipid profile (TC, LDL, HDL, TG) and renal‐related indicators (creatinine, e‐GFR, albuminuria, uric acid) in both patients with BMI≥30 and BMI < 30. Conclusion UCPCR is associated with clinical CAD, independent of CAD classic risk factors, glycaemic control, insulin resistance and BMI in type 1 DM patients

Risk factors, thromboembolic events, and clinical course of New‐Onset Atrial Fibrillation among COVID‐19 hospitalized patients: A multicenter cross‐sectional analysis in Iran

Abstract Background and Aims We focused on determining the risk factors, thromboembolic events, and clinical course of New‐Onset Atrial Fibrillation (NOAF) among hospitalized coronavirus disease (COVID‐19) patients. Methods This retrospective study was conducted in the major referral centers in Tehran, Iran. Of 1764 patients enrolled in the study from January 2020 until July 2021, 147 had NOAF, and 1617 had normal sinus rhythm. Univariate and multivariate Logistic regressions were employed accordingly to evaluate NOAF risk factors. The statistical assessments have been run utilizing SPSS 25.0 (SPSS) or R 3.6.3 software. Results For the NOAF patients, the age was significantly higher, and the more prevalent comorbidities were metabolic syndrome, heart failure (HF), peripheral vascular disease, coronary artery disease, and liver cirrhosis. The multivariate analysis showed the established independent risk factors were; Troponin‐I (hazard ratio [HR] = 3.86; 95% confidence interval [CI] = 1.89−7.87; p < 0.001), HF (HR = 2.54; 95% CI = 1.61−4.02; p < 0.001), bilateral grand‐glass opacification (HR = 2.26; 95% CI = 1.68−3.05; p = 0.002). For cases with thromboembolic events, NOAF was the most important prognostic factor (odds ratio [OR] = 2.97; 95% CI = 2.03−4.33; p < 0.001). While evaluating the diagnostic ability of prognostic factors in detecting NOAF, Troponin‐I (Area under the curve [AUC] = 0.85), C‐Reactive Protein (AUC = 0.72), and d‐dimer (AUC = 0.65) had the most accurate sensitivity. Furthermore, the Kaplan‐Meier curves demonstrated that the survival rates diminished more steeply for patients with NOAF history. Conclusion In hospitalized COVID‐19 patients with NOAF, the risk of thromboembolic events, hospital stay, and fatality are significantly higher. The established risk factors showed that patients with older age, higher inflammation states, and more severe clinical conditions based on CHADS2VASC‐score potentially need subsequent preventive strategies. Appropriate prophylactic anticoagulants, Initial management of cytokine storm, sufficient oxygen support, and reducing viral shedding could be of assistance in such patients