SARS-CoV-2 Interacts with Mucosal Dysbiosis to Cause the Wide Range of Disease Seen in Covid-19

Hypothesis: SARS-CoV-2 amplifies pre-existing dysbiosis induced mucosal inflammation and this can cause a severe systemic inflammatory disease. The microbial flora perturbation can persist long after the virus has been eliminated leading to a wide range of long Covid symptoms. Evidence: Dysbiosis induced mucosal inflammation increases with age and is strongly associated with the metabolic syndrome (obesity, type 2 diabetes mellitus, ischaemic heart disease, hypertension, and depression). These are risk factors for the conversion of mild to severe Covid-19. Certain common strains of Staphylococcus aureus, which is commonly carried in pharyngeal mucosa, can trigger a cytokine cascade as seen in severe Covid-19. Blood group A and vitamin D deficiency, which are risk factors for hospitalisation in Covid-19 are also associated with increased S. aureus pharyngeal carriage rates. Multi-inflammatory syndrome in children is a post Covid condition which resembles toxic shock syndrome and Kawasaki disease (the former is known to be caused by staphylococcal pyrogenic toxins). A number of studies have shown dysbiosis of the oral mucosa and rectal mucosa in patients who progress to severe Covid-19. The wide range of pathology seen during and following SARS-CoV-2 infection is more in keeping with dysbiosis induced inflammation (multiple pathogenic bacteria at multiple sites) than with an otherwise simple viral induced respiratory tract infection. Implication: Optimization of the microbial flora, prior to encountering the virus, could have reduced the severity of the pandemic. The consumption of fermented foods, especially yoghurt, holds the most promise for reducing dysbiosis induced mucosal inflammation and preventing a wide range of complications. Reduced mucosal inflammation brings not only health but also happiness in which oxytocin has a key role

Piloting the Use of Patient-Specific Cardiac Models as a Novel Tool to Facilitate Communication During Cinical Consultations

This pilot study aimed to assess the impact of using patient-specific three-dimensional (3D) models of congenital heart disease (CHD) during consultations with adolescent patients. Adolescent CHD patients (n = 20, age 15-18 years, 15 male) were asked to complete two questionnaires during a cardiology transition clinic at a specialist centre. The first questionnaire was completed just before routine consultation with the cardiologist, the second just after the consultation. During the consultation, each patient was presented with a 3D full heart model realised from their medical imaging data. The model was used by the cardiologist to point to main features of the CHD. Outcome measures included rating of health status, confidence in explaining their condition to others, name and features of their CHD (as a surrogate for CHD knowledge), impact of CHD on their lifestyle, satisfaction with previous/current visits, positive/negative features of the 3D model, and open-ended feedback. Significant improvements were registered in confidence in explaining their condition to others (p = 0.008), knowledge of CHD (p < 0.001) and patients' satisfaction (p = 0.005). Descriptions of CHD and impact on lifestyle were more eloquent after seeing a 3D model. The majority of participants reported that models helped their understanding and improved their visit, with a non-negligible 30% of participants indicating that the model made them feel more anxious about their condition. Content analysis of open-ended feedback revealed an overall positive attitude of the participants toward 3D models. Clinical translation of 3D models of CHD for communication purposes warrants further exploration in larger studies

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The Microbiome and the Entropy Paradox : An Evolutionary Perspective

The mucosal tissue microbiota, measured in millions, cause inflammation which contributes to the pathogenesis of a wide range of disease including neurodegeneration, atherosclerosis, cancer and psychiatric conditions. A broad range of pathological factors, both psychosocial and physical, interact with, amplify and otherwise modify the inflammatory process and thereby contribute to disease in general. In order to diagnose mucosal tissue dysbiosis and assess its severity in individual cases, it will be necessary to measure markers of inflammation and assess bacterial carriage of specific pathogens in faeces, using quantitative polymerase chain reaction (qPCR). Current methods of analysis of the gut microbiome, using 16S rRNA amplicon sequencing and DNA metagenomics, reveal the composition of the trillions of bacteria in the colonic lumen but not the millions in the wall. The relationship between the mucosal luminal microbiota, the mucosal tissue microbiota and the host; its evolutionary origin and importance in disease is analysed, in this paper, using concepts from information theory. The analysis explains the entropy paradox (increased entropy is usually a marker of disease but in the case of the faecal microbiome it is an indicator of health) and the affluence paradox (diseases which are a consequence of affluence disproportionately affect the least affluent members of the population). An increasingly sterile diet in affluent countries is leading to a sub-optimal mucosal luminal microbiota and as a consequence increased mucosal tissue microbiota induced inflammation. A rising tide of illness has followed and we need to give urgent attention to our diet. Increased consumption of milk and yoghurt will provide the diverse but safe supply of bacteria that we need

HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p&lt;0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p&lt;0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p&lt;0.01) and younger age (OR 0.62; CI 0.49-0.90; p&lt;0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p&lt;0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences

Infective Endocarditis in Patients on Chronic Hemodialysis

International audienceInfective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD)