Causes of Death in COVID-19: A Minireview

Background: More than two million people have died worldwide as a result of the new corona strain virus SARS-CoV-2 and the associated COVID-19 syndrome. Older patients with pre-existing health problems are more likely to die from their illness. We found that septic shock and multiple failures were the most common causes of death, mainly due to inflammation of the lungs, although there was no definitive study on the causes of death and the role of pre-existing conditions. In a few cases, respiratory failure caused by excessive alveolar injury was the cause of immediate death. Comorbidities such as asthma, heart disease, and obesity were present in most cases. Conclusion: Our findings indicate that COVID-19 was related to death in the majority of decedents, rather than being a direct product of pre-existing health conditions and comorbidities. As a result, we conclude that COVID-19 killed most patients, with pre-existing health issues playing only a minor role in the death mechanism.

Pneumonia Detection from Chest X-Rays using Neural Networks

Pneumonia is one of the most serious diseases which cause the most deaths in the world. Viruses, bacteria, and fungi can cause pneumonia. The infection from spreading to the lungs in the human body. In order to diagnose this infection, a chest x-ray is carried out. The doctor uses X-ray image in order to diagnose or monitor the treatment of states in which inflammation of the lungs. X-rays are also used in the diagnosis of diseases such as emphysema, lung cancer, cancer of the line, and pipe, and tuberculosis (tb). However, a diagnosis of pneumonia requiring medical experts to comment on its presence felt in the chest x-ray. For decades, the auto- diagnosis (CAD) systems have been used for the respiratory disease based on chest X-ray images. Deep learning allows machines can quickly extract and classify objects from a photo. Ilham, with the great success of deep learning, we use a deep learning approach to detection of pneumonia into the work. Convolutional neural network that was developed for this study is the inflammation of the lungs. Supervised learning is ANCHORED to the use of features and functions. In general, the data of 5826 images with the help of one of the Kaggle.com. The CNN training and testing, that is, an open set of data. In the proposed method, the high success rate of accurate classification is achieved.

A case of occult colon cancer with sepsis as the primary manifestation guided by bone marrow puncture

Background: Bone marrow metastasis is common in liver cancer and lung cancer, but there are few reports on bone marrow metastasis of colon cancer. So far, there are no research reports from mainland China; especially reports of bone marrow metastasis combined with septic shock as the main manifestation are even rarer. Case presentation: A 71-year-old elderly woman with sepsis as the first symptom, mainly manifested as high fever, low blood pressure, high inflammation indicators, etc. CT examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture culture suggested Escherichia coli and Aeromonas hydrophila/caviae. After anti-infective treatment, the patient's sepsis symptoms improved significantly, but after repeated platelet transfusion, he still could not correct hypothrombosis. Finally, a large number of malignant cells were found through a bone marrow puncture smear, and further PET-CT examination confirmed that the ascending colon malignant tumor was accompanied by multiple metastases such as the liver and bones. The patient was eventually unable to tolerate surgery due to bone marrow failure and liver failure and died 3 weeks after admission.Conclusions: We hope that this case report can raise people’s awareness of the insidiousness of colon cancer and the possibility of metastasis to the bone marrow, especially for patients with progressive thrombocytopenia that is difficult to correct. Thrombocytopenia needs to be treated differently from sepsis.

VEXAS: A Non - Systematic Literature Review

Aim: Through this review, the authors intend to accumulate existing knowledge of VEXAS for referral, and to serve as an inspiration for further discovery, funding and research into the discipline. Methods: The non systematic literature review was conducted in January 2021, using Google Scholar and PubMed as the major extensive search engines. The keyword ‘VEXAS’ was used to narrow search results, and data was restricted to only those articles published in English. Results: The search, followed by the selection for relevancy led to a total of 5 pieces of literature being used for the purpose of this review; the lack of a huge number of results arises from the fact that the disease has been recently discovered. Discussion: Adult-onset inflammatory conditions are of increasing interest to medical professionals, and a number of patients with these conditions present with symptoms for which a concrete diagnosis is difficult to establish. In recent times, using an unconventional, yet remarkably effective genotype – based approach, researchers at the NIH have been able to discover a number of somatic mutations in UBA 1, which give rise to a unique disease. The disease, which has been named VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic syndrome) by the founders, arises from specific somatic mutations in the UBA 1 gene, and patients presenting with VEXAS have clinical manifestations - as sporadic fevers, chronic inflammation of the lungs and cartilage, and atypical vacuoles in myeloid cells, venous thromboembolism, ear and nose chondritis and macrocytic anaemia. VEXAS stems from accumulated somatic mutations in UBA 1, typically manifesting in three major variants, severely impairing the natural ubiquitylation process in cells, and shows no observable pattern of inheritance, according to the preliminary research conducted at NIH. Conclusion: Further study into VEXAS is needed for a better understanding of the syndrome.

Anti-Arthritic Effect of TLR4 Inhibitor TAK-242 Through the Inhibition of Th1 and Th17 Cell Proliferation in a Curdlan-Induced Spondyloarthritis SKG Mouse Model

Background: Toll-like receptor 4 (TLR4) is involved in the pathogenesis of arthritic diseases. The TLR4 inhibitor TAK-242 has shown potential as a possible treatment for rheumatoid arthritis in an adjuvant-induced arthritis rat model. However, further investigation of the anti-arthritis effect of TAK-242 in other animal models of arthritis disease is required. Objective: This study was conducted to examine the anti-arthritic effects and mechanisms of TAK-242 on curdlan-induced spondyloarthritis in SKG mice. Methods: Curdlan-injected SKG ZAP-70W163C mice were intraperitoneally administered with TAK-242 (3 mg/kg) every other day or anti-IL-23 antibody (100 μg) weekly for 9 weeks. The therapeutic effect of TAK-242 was evaluated in the SKG mice by measuring the inflammation level of foot, ileum, lung and tail by histology, the levels of proinflammatory cytokines in serum, bone mineral density (BMD) in femur and spine, and CD4+T cell subtypes Th1 and Th17 in spleen.Results: TAK-242 treatment significantly reduced clinical score, paw width, and colon length in SKG mice. Consistent with the therapeutic effect, TAK-242 also reduced peripheral arthritis and IL-17 expression in the foot and ileum tissues. It also inhibited inflammation of the lungs, ileum, paws, and tail and reduced serum levels of pro-inflammatory cytokines such as IL-6 and TNF-α. TAK-242 recovered the reduced bone density in the femur but not in the spine. Treatment with TAK-242 also suppressed the populations of Th1 and Th17 cells in the spleen of SKG mice.Conclusions: TAK-242 may show beneficial anti-arthritis effects by inhibiting the proliferation of pro-inflammatory Th1 and Th17 cells. Further research is needed for TAK-242 to be repositioned as a treatment for arthritis disease.

Imaging of stem cell therapy in Acute Respiratory Distress Syndrome in sheep and its relationship with histopathology

Methods: 10 healthy sheep were separated as the control (PBS) and treatment(BM-MSCs). The BM-samples were aspirated in the treatment group and isolation and expansion of BM-MSCs were achieved. 24h after ARDS-induction by E.coli LPS (400 µg/kg), 5×107 BM-MSCs and 1 ml PBS were intrapulmonary infused in the treatment and control groups, respectively. The total lung volume and the Hounsfield unit by CT-scan and the cardiac parameters by echocardiography were calculated before of ARDS (time -24) and cells/PBS infusion time(time 0) and then for 6,12,24,48,72,168h after cells/PBS infusion. At the end, the sheep were sacrificed and the hearts and lungs were macroscopically and microscopically checked.Results: The results showed the total lung volume and the Hounsfield unit increased at time 0, but BM-MSCs declined their amount, so that the changes were significant at 168h compared with time 0 and comparisons between the two-groups represented the significant difference at 72h and 168h. The cardiac parameters did not changes significantly in the two-groups at different times but the comparison between them demonstrated significant difference in LVPWs, IVSs,IVSd,%FS,RVOTVmax,LA(d1) and AO(d2) at 168 h, LVIDs,ESV and %EF at 72h and 168h and LVPWd at 72h. Also, the histopathology findings indicated decline of inflammatory reactions, edema, hemorrhage and hyperemia in the respiratory system and no observation of damage to the heart compared with the control-group. Conclusions: The results determined BM-MSCs in ARDS decrease edema and inflammation of the lungs and increase the alveoli air volume and prevent damage to heart function.

Presence of hyaluronan in lung alveoli in severe Covid-19: An opening for new treatment options?

Severe coronavirus disease 2019 (Covid-19) is characterized by inflammation of the lungs with increasing respiratory impairment. In fatal Covid-19, lungs at autopsy have been filled with a clear liquid jelly. However, the nature of this finding has not yet been determined. The aim of the study was to demonstrate whether the lungs of fatal Covid-19 contain hyaluronan, as it is associated with inflammation and acute respiratory distress syndrome (ARDS) and may have the appearance of liquid jelly. Lung tissue obtained at autopsy from three deceased Covid-19 patients was processed for hyaluronan histochemistry using a direct staining method and compared with staining in normal lung tissue. Stainings confirmed that hyaluronan is obstructing alveoli with presence in exudate and plugs, as well as in thickened perialveolar interstitium. In contrast, normal lungs only showed hyaluronan in intact alveolar walls and perivascular tissue. This is the first study to confirm prominent hyaluronan exudates in the alveolar spaces of Covid-19 lungs, supporting the notion that the macromolecule is involved in ARDS caused by SARS-CoV-2. The present finding may open up new treatment options in severe Covid-19, aiming at reducing the presence and production of hyaluronan in the lungs.

COVID-19 and immune checkpoint inhibitors: initial considerations

COVID-19 infections are characterized by inflammation of the lungs and other organs that ranges from mild and asymptomatic to fulminant and fatal. Patients who are immunocompromised and those with cardiopulmonary comorbidities appear to be particularly afflicted by this illness. During pandemic conditions, many aspects of cancer care have been impacted. One important clinical question is how to manage patients who need anticancer therapy, including immune checkpoint inhibitors (ICIs) during these conditions. Herein, we consider diagnostic and therapeutic implications of using ICI during this unprecedented period of COVID-19 infections. In particular, we consider the impact of ICI on COVID-19 severity, decisions surrounding continuing or interrupting therapy, diagnostic measures in patients with symptoms or manifestations potentially consistent with either COVID-19 or ICI toxicity, and resumption of therapy in infected patients. While more robust data are needed to guide clinicians on management of patients with cancer who may be affected by COVID-19, we hope this commentary provides useful insights for the clinical community.

Dampak dan Upaya Penggulangan Gangguan Pernapasan Akibat Paparan Debu di PT Bangun Makmur

PT. Bangun Makmur is an industrial company that produces asphalt hotmix. The activities are the solving process of stones, and mixing asphalt and aggregate by using Asphal Mixing Plant (AMP) machine. Dust in the most produce in the process of stone breaking. The purpose of this research is to explain respiration disorders because of dust and afford to cure those disorders. The methods performed are qualitative descriptive with an informer as a worker. Results of this study of respiratory disorders that can occur due to exposure to dust over a long period of time so that it settles in the lungs and causes several diseases and efforts that can be performed is with the provision of counseling to workers about the dangers of dust exposure to allow workers to wear masks when they are in the working environment and to conduct regular employee health checks. Dust-induced illness in the workplace is Influenza and chemical Pneumonitis, which is inflammation of the lungs occurring due to inhaling gases and chemicals.

Dampak dan Upaya Penanggulangan Gangguan Pernafasan Akibat Paparan Debu di PT Bangun Makmur

PT. Bangun Makmur Utama is an industrial company that produces asphalt hotmix. The activities are the solving process of stones, and mixing asphalt and aggregate by using Asphal Mixing Plant (AMP) machine. Dust in the most produce in the process of stone breaking. The purpose of this research is to explain respiration disorders because of dust and afford to cure those disorders. The methods performed are qualitative descriptive with an informer as a worker. Results of this study of respiratory disorders that can occur due to exposure to dust over a long period of time so that it settles in the lungs and causes several diseases and efforts that can be performed is with the provision of counseling to workers about the dangers of dust exposure to allow workers to wear masks when they are in the working environment and to conduct regular employee health checks. Dust-induced illness in the workplace is Influenza and chemical Pneumonitis, which is inflammation of the lungs occurring due to inhaling gases and chemicals