Disruption in Medical Care of Non-COVID Patients in COVID-19 Pandemic

In December 2019, a novel coronavirus (2019-nCoV) was detected in Wuhan Hubei province, China. The virus has caused a global concern because of its high potential for transmission, high morbidity and mortality. COVID-19 spreads so rapidly across an increasing number of countries worldwide that it has been found in more than 200 countries so far. The World Health Organization (WHO) has declared COVID-19 a pandemic and public health threat. In general, COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A case fatality rate of approximately 2.3% has been reported for COVID-19. New fever, cough, lymphopenia and bilateral lung infiltrations are characteristic but not diagnostic for COVID-19. Sore throat, dyspnea, myalgia, diarrhea, and abdominal pain are other presentations of COVID-19. We should also be attentive to the probability of atypical presentations in patients who are immunocompromised. While the majority of cases result in mild respiratory tract symptoms like acute bronchitis, severe cases might end in severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and death due to multiorgan damage, so early recognition of patients with suspected COVID-19 infection is crucial. The burden of the virus is not limited to physical damage, but it also has a significant impact on the mental health of the public. It can lead to generalized anxiety disorders and depression during COVID-19 pandemic. Now many countries are in a state of crisis worldwide. Whenever the living environment changes, people feel unsafe. People's fear of COVID-19 makes them refrain from going to medical centers, which significantly impacts their access to medical care while they require acute treatment. COVID-19 outbreak in countries has pulled essential medical resources away from regular procedures. This has caused complications for patients who need treatment for other medical conditions that require timely and appropriate care. Cancer patients especially still require attention in curative or palliative settings, and women will still be delivering their infants. How can we care for these patients without exposing them to COVID-19

Evaluation of genes and molecular pathway related pathogenesis of endometriosis: A bioinformatics approach

Objective: Although recent studies have focused on the role of genes in the pathogenesis of endometriosis, the investigation of genes and molecular pathways involved in the pathogenesis of endometriosis with a bioinformatics approach has not been addressed yet. Hence, we aimed to investigate this issue in our study. Materials and methods: The gene expression datasets GSE7305 and GSE124010 were obtained from the GEO database, consisting of endometriosis and normal endometrial tissue samples. Differential expression analysis was performed using the R software and LIMMA package, applying cutoff criteria of p-value  1 to identify differentially expressed miRNAs (DEmiRs) and genes (DEGs). The MultiMiR package was used to predict target genes for DEmiRs, considering the overlapping predictions from multiple databases. Venn diagrams were used to establish miRNA-target relationships and identify interactions with DEGs. Functional enrichment analyses were conducted using the Enrichr analysis tool to predict the molecular function, biological processes, cellular components, and pathways associated with the target genes. Protein-protein interaction networks were constructed using the STRING database and visualized in Cytoscape, and hub genes were identified based on their centrality measures. Key hub genes were selected by considering those shared among all three centrality measures. The expression levels of hub genes were validated in endometriosis samples using ROC curves to assess diagnostic accuracy. The AUC was calculated to compare the diagnostic value of the hub genes, using GraphPad Prism version 9.1.0. Result: The analysis identified six hub genes (CCNA2, ESR1, AURKA, MKI67, and VEGFA) in the protein-protein interaction network. Among the miRNAs, hsa-miR-29a-3p showed the highest number of interactions with these hub genes, making it the key miRNA in the study. These findings suggest the potential involvement of hsa-miR-29a-3p in regulating the expression of the identified hub genes in endometriosis. Conclusion: Identifying pathways related to the expression of hub genes can be useful in designing appropriate treatment strategies. On the other hand, examining the pathways activated by hub genes can be effective in preventing of endometriosis progression

Concurrent COVID-19 and pneumocystis carinii pneumonia in a patient subsequently found to have underlying hairy cell leukemia

SARS-CoV-2 infection manifestation has great diversity and it becomes even greater while co-infection occurs or there is a serious underlying disease in an affected patient. In this case report, we present a case of a 71-year-old man who underwent a chest CT scan following the development of fever, weakness, and pulmonary symptoms. Chest CT scan showed segmental consolidation with centrilobular nodular infiltration, ground glass opacifications in the inferior segment of the left upper and lower lobes, and left lung pleural thickening which was atypical for either COVID-19 infection or pneumocystis carinii pneumonia but his SARS-CoV-2 PCR result was positive and he received COVID-19 treatment. His symptoms recurred after a few months with the same chest CT findings and subsequent bronchoalveolar lavage revealed the presence of pneumocystis carinii infection. Consequently, he received cotrimoxazole which caused improvement in symptoms, nonetheless splenomegaly and anemia remained in his clinical and laboratory investigation. Accordingly, bone marrow study and flow cytometry was done and confirmed the previously undiagnosed hairy cell leukemia. This case accentuates the fact that when we face atypical clinical or paraclinical features in a COVID-19 patient, we should explore for coinfection or unknown underlying diseases

Thrombotic thrombocytopenic purpura following ChAdOx1 nCov-19 vaccination: A case report

Vaccine-associated thrombotic thrombocytopenic purpura (TTP) is a rare type of acquired TTP recently reported after COVID-19 vaccination. Merely four cases are ascribed to the ChAdOx1 nCoV-19 vaccine in the medical literature till the preparation of this study. In this case report, we describe a 43-year-old man who developed symptoms of TTP four days after receiving the second dose of the ChAdOx1 nCoV-19 vaccine. Peripheral blood smear demonstrated multiple schistocytes. Given a high plasmic score, he received plasma exchange, corticosteroids, and rituximab, and later, low ADAMTS 13 activity and high-titer ADAMTS inhibition antibody confirmed the diagnosis of COVID-19 vaccine-associated TTP. COVID-19 vaccine-associated TTP is an infrequent consequence of SARS-CoV-2 vaccination but with a substantial mortality rate which must be considered as one of the crucial differential diagnoses of post-COVID-19 vaccine thrombocytopenia besides vaccine-induced immune thrombotic thrombocytopenia and Immune thrombocytopenic purpura