scholarly journals Feasibility and safety of angiotensin II administration in general ward patients during COVID-19 pandemic: a case series

2020 ◽  
Vol 22 (4) ◽  
pp. 388-390
Author(s):  
Federica Morselli ◽  
◽  
Giordano Vitali ◽  
Elena Brioschi ◽  
Gaetano Di Terlizzi ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Case Series ◽  
Cellular Membrane ◽  
General Ward ◽  
Converting Enzyme ◽  
Angiotensin Converting Enzyme 2 ◽  
Number Of Patients ◽  
Care Systems ◽  
Membrane Bound ◽  
Functional Receptor

From December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of coronavirus disease 2019 (COVID-19) that has frequently overwhelmed health care systems due to the high number of patients requiring admission to an intensive care unit (ICU). Angiotensin-converting enzyme 2 (ACE2) is a cellular membrane-bound vasopeptidase that has been identified as a functional receptor for SARS-CoV-2.

scholarly journals Angiotensin converting enzyme 2 is a novel target of the γ-secretase complex

2020 ◽  
Author(s):  
Alberto Bartolomé ◽  
Jiani Liang ◽  
Pengfei Wang ◽  
David D. Ho ◽  
Utpal B. Pajvani
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Renin Angiotensin System ◽  
Structural Similarity ◽  
Ectodomain Shedding ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Membrane Bound ◽  
Novel Target ◽  
Functional Receptor

AbstractAngiotensin converting enzyme 2 (ACE2) is a key regulator of the renin-angiotensin system, but also the functional receptor of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on structural similarity with other γ-secretase (γS) targets, we hypothesized that ACE2 may be affected by γS proteolytic activity. We found that after ectodomain shedding, ACE2 is targeted for intramembrane proteolysis by γS, releasing a soluble ACE2 C-terminal fragment. Consistently, chemical or genetic inhibition of γS results in the accumulation of a membrane-bound fragment of ectodomain-deficient ACE2. Although chemical inhibition of γS does not alter SARS-CoV-2 cell entry, these data point to a novel pathway for cellular ACE2 trafficking.

scholarly journals Angiotensin converting enzyme 2 is a novel target of the γ-secretase complex

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alberto Bartolomé ◽  
Jiani Liang ◽  
Pengfei Wang ◽  
David D. Ho ◽  
Utpal B. Pajvani
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Renin Angiotensin System ◽  
Structural Similarity ◽  
Ectodomain Shedding ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Membrane Bound ◽  
Novel Target ◽  
Functional Receptor

AbstractAngiotensin converting enzyme 2 (ACE2) is a key regulator of the renin-angiotensin system, but also the functional receptor of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on structural similarity with other γ-secretase (γS) targets, we hypothesized that ACE2 may be affected by γS proteolytic activity. We found that after ectodomain shedding, ACE2 is targeted for intramembrane proteolysis by γS, releasing a soluble ACE2 C-terminal fragment. Consistently, chemical or genetic inhibition of γS results in the accumulation of a membrane-bound fragment of ectodomain-deficient ACE2. Although chemical inhibition of γS does not alter SARS-CoV-2 cell entry, these data point to a novel pathway for cellular ACE2 trafficking.

scholarly journals SARS-CoV-2 and Cytomegalovirus Co-Infections—A Case Series of Critically Ill Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2792
Author(s):  
Patrícia Moniz ◽  
Sérgio Brito ◽  
Pedro Póvoa
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Immune Suppression ◽  
Clinical Course ◽  
Health Care Systems ◽  
Case Series ◽  
Confounding Factors ◽  
Care Systems ◽  
The Impact ◽  
Cmv Reactivation

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.

scholarly journals Community system of social support

2017 ◽  
Vol 127 (1) ◽  
pp. 37-40
Author(s):  
Krzysztof Włoch ◽  
Janusz Jaroszyński ◽  
Ewa Warchoł-Sławińska ◽  
Anna Jurek ◽  
Bartłomiej Drop ◽  
...  
Keyword(s):  
Social Support ◽  
Health Care ◽  
Health Care Systems ◽  
Family Doctors ◽  
Community System ◽  
Modern Health Care ◽  
Number Of Patients ◽  
The World ◽  
Care Systems ◽  
Is Evaluation

Abstract Community System of Social Support is the basis of modern health care systems not only in Poland but all over the world in the prophylaxis-treatment-rehabilitation procedure. In Poland, family doctors, commune councils and territorial self-governments are involved in it. Family doctors perform a substantial function, whereas commune councils and territorial self-governments an administrative one. The principle of the system work is evaluation of its benefits. Its aim is the reduction of the number of patients who abuse alcohol and those who abuse alcohol despite treatment.

scholarly journals Assessing Lysosomal Disorders in the NGS Era: Identification of Novel Rare Variants

2020 ◽  
Vol 21 (17) ◽  
pp. 6355
Author(s):  
Marisa Encarnação ◽  
Maria Francisca Coutinho ◽  
Lisbeth Silva ◽  
Diogo Ribeiro ◽  
Souad Ouesleti ◽  
...  
Keyword(s):  
Rare Variants ◽  
Health Care Systems ◽  
Genetic Disorders ◽  
Case Series ◽  
In Silico Analysis ◽  
Analysis Data ◽  
Lysosomal Storage ◽  
Pathogenic Variants ◽  
Number Of Patients

Lysosomal storage diseases (LSDs) are a heterogeneous group of genetic disorders with variable degrees of severity and a broad phenotypic spectrum, which may overlap with a number of other conditions. While individually rare, as a group LSDs affect a significant number of patients, placing an important burden on affected individuals and their families but also on national health care systems worldwide. Here, we present our results on the use of an in-house customized next-generation sequencing (NGS) panel of genes related to lysosome function as a first-line molecular test for the diagnosis of LSDs. Ultimately, our goal is to provide a fast and effective tool to screen for virtually all LSDs in a single run, thus contributing to decrease the diagnostic odyssey, accelerating the time to diagnosis. Our study enrolled a group of 23 patients with variable degrees of clinical and/or biochemical suspicion of LSD. Briefly, NGS analysis data workflow, followed by segregation analysis allowed the characterization of approximately 41% of the analyzed patients and the identification of 10 different pathogenic variants, underlying nine LSDs. Importantly, four of those variants were novel, and, when applicable, their effect over protein structure was evaluated through in silico analysis. One of the novel pathogenic variants was identified in the GM2A gene, which is associated with an ultra-rare (or misdiagnosed) LSD, the AB variant of GM2 Gangliosidosis. Overall, this case series highlights not only the major advantages of NGS-based diagnostic approaches but also, to some extent, its limitations ultimately promoting a reflection on the role of targeted panels as a primary tool for the prompt characterization of LSD patients.

scholarly journals The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19

2020 ◽  
Vol 35 (9) ◽  
pp. 927-932
Author(s):  
Robert Canelli ◽  
Nicole Spence ◽  
Nisha Kumar ◽  
Gerardo Rodriguez ◽  
Mauricio Gonzalez
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Health Care Systems ◽  
Ventilatory Support ◽  
Management Team ◽  
Mechanical Ventilators ◽  
Care Services ◽  
Number Of Patients ◽  
Ventilator Management ◽  
Care Systems

The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.

scholarly journals Big data modeling to predict platelet usage and minimize wastage in a tertiary care system

2017 ◽  
Vol 114 (43) ◽  
pp. 11368-11373 ◽  
Author(s):  
Leying Guan ◽  
Xiaoying Tian ◽  
Saurabh Gombar ◽  
Allison J. Zemek ◽  
Gomathi Krishnan ◽  
...  
Keyword(s):  
Health Care ◽  
Census Data ◽  
Blood Product ◽  
Complete Blood Count ◽  
Health Care Systems ◽  
Tertiary Care ◽  
The United States ◽  
Number Of Patients ◽  
Usage Patterns ◽  
Care Systems

Maintaining a robust blood product supply is an essential requirement to guarantee optimal patient care in modern health care systems. However, daily blood product use is difficult to anticipate. Platelet products are the most variable in daily usage, have short shelf lives, and are also the most expensive to produce, test, and store. Due to the combination of absolute need, uncertain daily demand, and short shelf life, platelet products are frequently wasted due to expiration. Our aim is to build and validate a statistical model to forecast future platelet demand and thereby reduce wastage. We have investigated platelet usage patterns at our institution, and specifically interrogated the relationship between platelet usage and aggregated hospital-wide patient data over a recent consecutive 29-mo period. Using a convex statistical formulation, we have found that platelet usage is highly dependent on weekday/weekend pattern, number of patients with various abnormal complete blood count measurements, and location-specific hospital census data. We incorporated these relationships in a mathematical model to guide collection and ordering strategy. This model minimizes waste due to expiration while avoiding shortages; the number of remaining platelet units at the end of any day stays above 10 in our model during the same period. Compared with historical expiration rates during the same period, our model reduces the expiration rate from 10.5 to 3.2%. Extrapolating our results to the ∼2 million units of platelets transfused annually within the United States, if implemented successfully, our model can potentially save ∼80 million dollars in health care costs.

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