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Table of Contents
August 2020
Volume 4 | Issue 5 (Supplement)
Page Nos. 1-109
Online since Thursday, August 13, 2020
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EDITORIAL
Specially inactivation of SARS-CoV-2 (COVID-19) on surgical or homemade masks and medical clothing: Innovative solution attachment
p. 1
Rozhina Ghanavi, Seyed Alireza Nadji, Poopak Farnia, Jalaledin Ghanavi
DOI
:10.4103/bbrj.bbrj_141_20
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REVIEW ARTICLES
Can animals like bats, pangolins, and ticks would be considered as long-term reservoirs of severe acute respiratory syndrome coronavirus 2
p. 3
Jafar Aghajani, Parissa Farnia, Saman Ayoubi, Poopak Farnia, Jalaledin Ghanavi, Ali Akbar Velayati
DOI
:10.4103/bbrj.bbrj_120_20
In December 2019, there was an outbreak of pneumonia with an unknown cause in Wuhan, Hubei province, China. Within less than 3–4 months, the virus has spread to more than 200 countries. The virus rapidly transmitted from different places of the world with various cultural traditions. Thereby, the question is remained to be resolved about the main intermediate carrier of diseases in different animals. Studied showed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was originated from horseshoe bats, but its intermediate hosts are still largely unknown. Therefore, the possibility of horseshoe bat infection by ticks is high during the flight between plants or when resting in these places. Female ticks can either feed on horseshoe bat blood for 5–7 days before shedding or can form large aggregations by laying several thousand eggs in the right places or on them. Once they feed on horseshoe bat blood containing SARS-CoV-2, they can transfer the infection to the next generations without the need to reuse infections from the reservoir host. With all the potential features that this creature has, it is mandatory to investigate the presence or absences of SARS-CoV-2, especially when we know that ticks co-exist with that horseshoe bats. These factors highlight the importance of studying the viral epidemiology in the tick population. Thereby, based on the wide distribution of ticks and their co-existence with horseshoe bat, we suggest further studies on ticks that might act as one of the main intermediate hosts in different animals.
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The importance of genomic changes of SARS-CoV-2 and its comparison with Iranian-reported COVID-19 sequencing; Whether each country has to design its treatment and vaccine production
p. 13
Ali Akbar Velayati, Parissa Farnia, Saeid Besharati, Poopak Farnia, Jalaledin Ghanavi
DOI
:10.4103/bbrj.bbrj_122_20
Coronavirus (COVID-19), a type of RNA virus, has a positive, single, sense stranded RNA. Studies of coronaviruses have shown high mutations in the virus's RNA. The more the virus infects people, the more the genome will mutate. In addition, evolutionary and genetic studies have the potential to recombine and easily jump from one host to another host. This means flexibility to adapt to new conditions and proliferation in new host cells. Examination of the hosts of this virus shows their extent. Studies show that the virus closely resembles hosts such as bats and pangolins. Genomic studies on severe acute respiratory syndrome coronavirus (SARS-CoV)-2 and bat coronavirus (RaTG13) showed 96.2% genetic similarity although there are differences in the nucleotides of different hosts. The importance of examining mutated areas in coronaviruses for diagnosis and treatment is necessary because molecular methods such as RT-PCR, although having a specific probe, may not cause a connection between the primer and the specific probe and cause a false-negative response be reported. This issue has led various countries to sequence SARS-CoV-2 for their own countries, eventually leading to the identification of specific drugs and vaccines for their country.
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Supplementary medicines and antioxidants in viral infections: A review of proposed effects for COVID-19
p. 19
Anmar Al-Taie, Arueyingho Oritsetimeyin Victoria
DOI
:10.4103/bbrj.bbrj_132_20
The use of supplementary medicines and antioxidant drugs is not restricted to just preventing deficiencies or inhibiting the production of free radicals. There are a plethora of indications that supplements and antioxidants may suffice for and they include viral infections. Hence, the importance of understanding the potential efficacy and activity of supplements and antioxidants in the management of viral infections, specifically the coronavirus disease, cannot be overemphasized. This article aims to explain what supplements and antioxidants are, their proven efficacy in the management/treatment of the existing viral infections, and the possibility of their usefulness in the management/treatment of coronavirus disease. The coronavirus pandemic affected almost 10 million people worldwide and has contributed to hundreds of thousands of deaths, while research is ongoing for the development of a vaccine and if possible, a cure, it is important to explore every available option including traditional medicines, antioxidants, and complementary and supplementary medicines. A comprehensive review of this study was achieved by evaluating recent existing literature on the activity of supplements and antioxidants against viral infections and the coronavirus disease. It was discovered that although Vitamins C and D, zinc, and elderberry have antiviral properties and may be effective in managing preexisting viral infections, their activity against COVID-19 is still unknown and speculative. Therefore, there are no recent guidelines provided for the treatment of COVID-19 that recommend dietary supplements and/or antioxidants as pharmacological interventions.
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Mini-review on recent update on coronavirus disease 2019: Clinical outcome and largest pharmaceutical companies
p. 25
Pooja Shivappa, Ashfaque Hoosain, Padma G.M. Rao
DOI
:10.4103/bbrj.bbrj_67_20
The current worldwide outbreak of the novel coronavirus disease 2019 (COVID-19); the pathogen called SARS-CoV-2; previously 2019-n CoV), which originated from Wuhan in China and has now spread worldwide. This current review includes information regarding treatment and, clinical outcomes of COVID-19 patients with diabetes, liver injury, rheumatic diseases, respiratory issues, kidney problems, and breast malignant growth. The various international companies supporting the findings in the treatment/vaccine for COVID-19. There are currently no specific antiviral drugs, however, several antiviral drugs and repurposed drugs are under serious scrutiny. We encourage all readers to continue to assess clinical data as it emerges and shares their experience within our community in a well-controlled and, adequately powered fashion.
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Renin–Angiotensin system and fibrinolytic pathway in COVID-19: One-way skepticism
p. 33
Hayder Mutter Al-Kuraishy, Nawar Raad Hussien, Marwa Salih Al-Naimi, Ali Kadhem Al-Buhadily, Ali Ismail Al-Gareeb, Claire Lungnier
DOI
:10.4103/bbrj.bbrj_105_20
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is a recent pandemic infectious disease caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). The entry point of SARS-CoV-2 is via angiotensin-converting enzyme 2 (ACE2), which is highly expressed in the alveolar pulmonary cells. Besides, different peptides and co-mediators such as bradykinin (BK), plasmin, and trans-membrane serine protease may modulate the affinity and binding of SARS-CoV-2 to ACE2. Therefore, this study was planned to review the potential link between the pathogenesis, incidence, and severity of SARS-CoV-2 infection regarding the modulation of ACE2 by these mediators. Electronic database searches of Scopus, Web of Science, Medline, Cochrane Central Register of Controlled Trials, and PubMed was made using MeSH terms, keywords, and title words. Renin–angiotensin system inhibitors might be of value in the reduction of acute respiratory distress syndrome (ARDS), respiratory failure, and acute pneumonia that are induced by SARS-CoV-2. SARS-CoV-2 infection leads to noteworthy lung injury via downregulation of ACE2, which is attenuated by the administration of angiotensin receptor blockers (ARBs). In SARS-CoV-2 infection, BK and its metabolites are augmented due to the downregulation of ACE2 by SARS-CoV-2. SARS-CoV-2 pneumonia is also associated with hyperfibrinolysis as evident with high circulating fibrin degradation products, high plasmin, and presence of hemorrhagic spots in multiple organs. ACEIs improve fibrinolysis via inhibition of PAI-1, while ARBs have a neutral effect on both fibrinolysis and PAI-1. Therefore, these findings show ACEIs but not ARBs as a potential risk for the development of SARS-CoV-2 infection as both plasmin and BK facilitate the pathogenesis of SARS-CoV-2 and augment the development of ARDS in SARS-CoV-2 infection.
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Cytokine storm in COVID-19 and the treatment simulacrum
p. 41
Anita Karimi, Seyed Mohammad Reza Hashemian
DOI
:10.4103/bbrj.bbrj_128_20
Following the outbreak of the severe acute respiratory syndrome-coronavirus (SARS-CoV-2) in December 2019 at Wuhan, China, it spread through the world rapidly, and this disease was declared as a pandemic by the World Health Organization on March 11, 2020. A high mortality rate has been detected due to this respiratory involvement; this novel virus like the previous ones, SARS-CoV-1, from this family, can lead to lethal pneumonia, acute lung injury, and eventually acute respiratory distress syndrome (ARDS), which was reported in 20% of patients. Surprisingly, this ARDS can have a mortality rate of 40%–50%. As it is known that infection can manifest in a wide variety of symptoms, from a mild respiratory disease to life-threatening ARDS, multiorgan dysfunction, shock, and death, the exact mechanism of this ARDS in COVID-19 pneumonia is not known completely. There are ongoing studies, but the term “cytokine storm” can be a possible clue of the transformation of a mild disease to a lethal one, and also an explanation of this rapid and deadly inflammatory response which take a place in the lungs. Our goal in this review is to express a better definition of molecular and cellular pathways of cytokine storms and also discuss some recent trials of the effect of different classes of drugs on this immunologic and inflammatory pathway of CoV infection. In this study, we have addressed evidences for more efficient immunomodulatory drugs for this vivid storm.
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Evidence for SARS-CoV-2 circulating among stray dogs and cats: Should we worry about our pets during the COVID-19 Pandemic?
p. 49
Parissa Farnia, Jafar Aghajani, Poopak Farnia, Saman Ayoubi, Jalaledin Ghanavi, Seyed Alireza Nadji, Sven Hoffner, Ali Akbar Velayati
DOI
:10.4103/bbrj.bbrj_130_20
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) causes the COVID-19 infectious disease. Despite the high level of quarantine control in many well-developed countries, the disease has spread to more than 113 countries all over the world, creating a global pandemic. This emerging situation raises many questions. Can the infection be just through human-to-human transmission or are other sources, for example, animal to human or other environmental sources, also involved? We reviewed the previous literature and assessed the potential risk of transmitting the coronavirus from pets to humans. The pets (dogs and cats), especially dogs, have a habit of licking themselves in the buttocks, or smelling others in the buttocks. In such a way, they may get the virus into their respiratory or digestive tract. In return, once they lick people in the face, they may transmit the diseases. In this study, we not only reviewed the literature on pets and their relationship to the coronavirus but we also tested 22 stray dogs and cats, collected from nearby areas that were used for hospitalization of COVID-19 patients. Although no direct connection was found between these pets and the hospital, we found that 14 (63.6%) out of the 22 pets were positive for COVID-19 with the molecular test. Among them, seven (31.8%) had coughing and sneezing symptoms. The studied cases were stray pets, but the question that remains to be clarified is whether home pets are engaged in a chain of transmission or not? This needs further investigation.
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Coronavirus: A potential threat for dental practitioners
p. 56
RH Shilpa, Samarjeet J Pattnaik, Pooja Pani, Nishant Pani, Bhupender Singh Negi
DOI
:10.4103/bbrj.bbrj_61_20
Coronaviruses are large, enveloped RNA viruses composed of few structural proteins and mainly infect birds and mammals including humans. The first case of coronavirus was described in China in December 2019. Novel coronavirus (SARS-CoV-2) infects the human respiratory, nervous, enteric, and hepatic systems. Individuals with a potential SARS-CoV-2 exposure present with the mild symptoms of low-grade fever, dry cough, shortness of breath, nasal congestion, and headache and muscle pain. In the later stages, these symptoms worsen leading to severe pneumonia, acute respiratory distress syndrome, sepsis, and multiple organ failure. These days this pandemic is emerging as a major threat for the health-care professionals including dental surgeons. The dental surgeons are at greater risk of novel coronavirus infections due to direct contact with infected patients and exposure to contaminated blood, saliva, and other body fluids. This article deals with viral structure, methods of detection, and modes of transmission, especially in dental settings.
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Will the current coronavirus disease 2019 affect progress in the attainment of sustainable development goals in Africa?
p. 60
Brian Chanda Chiluba, Fredrick Chitangala, Gugulethu Dube
DOI
:10.4103/bbrj.bbrj_55_20
The global coronavirus pandemic which has already caused unprecedented damage and misery has put an almost complete halt to our way of life. The epidemic will have significant and enduring economic and social implications in every corner of the globe. Only through successful cooperation and coordination between scientists, experts, innovators and policymakers can we solve the COVID-19 pandemic. Sharing observations and perspectives in real time will be crucial to improving the connection between research , policy and community, and leading to the solutions we need. When the Covid-19 pandemic is under control, and the world economy is back on track, it is important to reassess the status and fate of the 2030 Agenda, also known as Sustainable Development Goals ( SDGs). The Decade of Operation was scheduled to kick-off the year 2020. With only 10 years to go, plans have been made to undertake “ambitious global efforts” to deliver the promise of 2030—by mobilizing more governments, civil society, businesses, and calling on all people to make their own the Global Goals.
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A comparative study between the severe acute respiratory syndrome–Coronavirus-2, severe acute respiratory syndrome coronavirus, and the middle east respiratory syndrome coronavirus
p. 65
Syed Abdullah Ibn Asaduzzaman, Amayna Zakaria, Ilora Shabnam Kheya, Nazmul Fahad, Yusra Binte Sikandar, Rashed Noor
DOI
:10.4103/bbrj.bbrj_99_20
The ongoing COVID-19 pandemic caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is of public health emergency of international concern. Within the last two decades, the prevalence of the epidemics by the acute respiratory syndrome coronavirus (SARS-CoV) and by the Middle East respiratory syndrome coronavirus has also been observed. Therefore, regarding these three coronaviruses, certain critical issues have been focused in the current review concerning their evolution and transmission, genomic influence on the corresponding virulence, immunopathogenesis, and the preventive measures including the vaccination strategies and the antiviral therapies.
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ORIGINAL ARTICLES
COVID-19-Related severe heterogeneous acute respiratory distress syndrome: A therapeutic challenge
p. 75
Hamidreza Jamaati, Lida Fadaizadeh, Batoul Khoundabi, Seyed Mohammad Hashemian, Fatemeh Monjazabi, Alireza Jahangirifard, Mohammad Taghi Beigmohammadi, Behrooz Farzanegan, Seyedpouzhia Shojaei, Payam Tabarsi, Farzaneh Dastan, Seyed Ali Reza Nadji, Mihan Pourabdollah Toutkaboni, Majid Malekmohammad, Abdolreza Mohamadnia, Esmail Mortaz, Maryam Mirenayat, Fatemeh Yassari, Jalal Heshmatnia, Alireza Eslaminejad, Ali Akbar Velayati
DOI
:10.4103/bbrj.bbrj_133_20
Background:
A heterogeneous pattern was detected in COVID-19 severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to define special features and individualized treatment modalities for this fatal infectious disease.
Methods:
Thirty-six patients diagnosed as COVID-19 severe ARDS were chosen. Lung mechanics (compliance), the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI), and serum concentrations of immunology markers (interleukin [IL]-1β, IL-6, IL-8, ferritin, and C-reactive protein) were measured. Accordingly, individualized treatment consisting of Actemra, hemoperfusion (HP), continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) was implemented for each patient.
Results:
Patients were categorized according to the lung compliance: 18 in “L type” with compliance >40 cc/cmH2O and 18 in “H type” with compliance ≤40 cc/cmH
2
O. In 16 patients, standard mechanical ventilation management and antiviral therapy were unsuccessful; therefore, hemodynamic and immunity responses were evaluated. Results of transpulmonary thermodilution in L-type patients surprisingly showed EVLWI = 8.8 ± 1.3 (6.9–9.7) and PVPI = 2.4 ± 0.1 (2.2–2.6). In the H-type patients, five cases showed EVLWI = 8.7 ± 0.8 (7.5–9.8) and PVPI = 2.6 ± 0.3 (2.1–2.8) which were subclassified as “Ha type” and five cases with EVLWI = 17.5 ± 1.9 (15.7–20.6) and PVPI = 3.9 ± 0.4 (3.5–4.5) were named “Hb type”. By measuring immunologic markers, these two groups were subdivided into high and low marker groups. Individualized treatment resulted in 2 survivals with Actemra, 1 with HP, 2 with HP + CRRT, and 1 with ECMO.
Conclusion:
According to the heterogeneity of COVID-19 severe ARDS presentation, which is due to various immunologic and hemodynamic responses, a systematic approach is an important and relatively successful strategy in choosing the appropriate treatment modality.
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A multipronged strategy operationalized to combat the COVID-19 pandemic in India
p. 83
Vikas Bhatia, Neeraj Agarwal, Bijit Biswas
DOI
:10.4103/bbrj.bbrj_138_20
Background: COVID-19 is an ongoing largest public health emergency of the 21
st
century. India is effectively controlling the pandemic by taking bold and stringent steps right from the beginning of the pandemic. This article aimed to formulate a multipronged strategy to combat the COVID-19 pandemic in India. Method: We have gone through websites of World Health Organization, Centers for Disease Control and Prevention, Indian Council of Medical Research, and Ministry of Health and Family Welfare of Government of India to avail updated information on COVID-19. Result: We found that there may be three pillars of this COVID-19 pandemic management, namely public health measures, diagnostic and testing, and hospital and health care. These pillars should be aimed to achieve three primary goals, namely containment, capacity building, and recovery. For India, gradual relaxation in lockdown with social distancing and personal and environmental hygiene measures must be the more suitable exit plan.
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CASE REPORTS
Lifesaving combined treatment in a rapidly progressive COVID-19 pneumonia case with extensive lung involvement
p. 93
Seyed Mohammad Reza Hashemian, Razieh Farrokhi, Payam Tabarsi, Hamidreza Jamaati, Ali Akbar Velayati
DOI
:10.4103/bbrj.bbrj_134_20
COVID-19 pneumonia has rapid development into a global pandemic. For the infected patients, it is an urgent matter to improve the cure rate and reduce the death rate, but there are no effective antiviral drugs for COVID-19 so far. There is an urgent need for effective treatment. The current focus has been on the development of novel therapeutics, including antivirals and vaccines. One of these drugs, Favipiravir (Avigan), an antiviral agent approved for use in influenza in Japan, is being studied for the treatment of COVID-19. Herein, we report a patient; a 53 Y/O man without any underlying disease, developed COVID19 pneumonia rapidly and well respond to combination treatment including Dexamethasone, Favipiravir, and IFN-β-1a.
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Outcome of COVID-19: A trend analysis
p. 96
Kavitha Chandu, Madhavaprasad Dasari
DOI
:10.4103/bbrj.bbrj_65_20
COVID-19 though originated in China traversed divergently both in magnitude and time line. Outcome is an important indicator of its impact. It is measured in terms of recovery and death rates out of closed cases affected by COVID virus. The study attempts to analyze trends in the outcome of COVID-19. Six countries from Asia, Europe, and North America were selected for the analysis. The study infers that the outcome trend out of closed cases of COVID-19 varied across countries. The recovery rate is higher in Asian countries, while death rate is more in European and North American countries. The panacea for overcoming COVID-19 lies in finding therapeutic solution.
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SHORT COMMUNICATION
Investigation of the hypothesis of biofilm formation in coronavirus (COVID-19)
p. 99
Saeid Besharati, Parissa Farnia, Poopak Farnia, Jalaledin Ghanavi, Ali Akbar Velayati
DOI
:10.4103/bbrj.bbrj_126_20
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BRIEF REPORT
Is ivermectin–Azithromycin combination the next step for COVID-19?
p. 101
Hayder Mutter Al-Kuraishy, Nawar Raad Hussien, Marwa Salih Al-Naimi, Ali Kadhem Al-Buhadily, Ali Ismail Al-Gareeb, Claire Lungnier
DOI
:10.4103/bbrj.bbrj_109_20
Different experimental and approved drugs were tested for coronavirus infection disease (COVID-19) to detect effective one that attenuates or prevents the pathogenesis of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Repurposing of old approved drugs with the potential arrhythmogenic effect such as chloroquine in COVID-19 may increase the risk of sudden cardiac death due to torsadogenic potential. The Food and Drug Administration approved the drugs, such as ivermectin, which can kill SARS-CoV-2 within 48 h. Azithromycin augments the antiviral activity of chloroquine in COVID-19 with a high risk of morbidity and mortality through torsadogenic potential. There were no obvious interactions between ivermectin and azithromycin and without risk of torsadogenic effect despite the prolongation of QT by azithromycin. Therefore, azithromycin–ivermectin is regarded as an effectual combo for COVID-19 in elderly patients with underlying cardiac abnormalities.
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LETTER TO EDITOR
End-of-life guidelines: Iran confronts COVID-19
p. 104
Seyed Mohammad Reza Hashemian, James Miller
DOI
:10.4103/bbrj.bbrj_127_20
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Potential therapeutic effects of pentoxifylline against COVID-19
p. 106
Atefeh Abedini, Faezeh Feizabadi, Arda Kiani, Farzaneh Dastan
DOI
:10.4103/bbrj.bbrj_124_20
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Can Hesperidin be the Key to the Treatment of Severe Acute Respiratory Syndrome COV-2?
p. 108
Atefeh Abedini, Seyed Bashir Mirtajani, Mani Karimzadeh, Alireza Jahangirifard, Arda Kiani
DOI
:10.4103/bbrj.bbrj_131_20
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