Priapism in a patient with coronavirus disease 2019 (COVID-19)

Thromboembolic complications related to SARS-CoV-2 have been extensively reported. They include deep vein thrombosis, pulmonary embolism, ischemic stroke, and acute coronary syndrome. Penile thrombosis has not been reported as a thrombotic complication of SARS-CoV-2 infection with hypercoagulability.Here we describe a case of priapism as a thromboembolic complication in a patient with COVID-19 who recovered from acute respiratory distress syndrome (ARDS). We discuss the underlying pathophysiological mechanisms mainly related to an hypercoagulability state. Emergency management consisted on an intracavernosal injection of the sympathomimetic agent ethylephrine and cavernosal blood aspiration. The patient experienced no recurrences under thromboprophylaxis by enoxaparin 40 mg twice daily.     

A coronavirus disease 2019 (COVID-19) patient with bilateral orchitis

During the development of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2), a myriad of complications has emerged and although rare, several genitourinary complications have been reported. The bulk of these complications have been secondary to hypercoagulable states, such as priapism. Previous SARS family infections have caused orchitis, though no adult cases of orchitis have been reported. We describe a novel case of SARS-CoV2 bilateral orchitis in a previously healthy 37-year-old male who presented for testicular pain with constitutional symptoms. Additionally, there was no epididymitis associated with the bilateral orchitis. Based on both data in SARS-CoV2 infected males and previous data from prior SARS infections, spermatocyte function may be compromised secondary to this infection. With the various symptoms associated with this virulent pathogen, we characterize the potential complications and importance of fertility follow up.     

Survey of the current status of subclinical coronavirus disease 2019 (COVID-19)

ObjectivesWe investigated relationships between subclinical COVID-19 (coronavirus disease 2019) and background factors.MethodsWe determined SARS-CoV-2 antibody (IgG) prevalence in 1603 patients, doctors, and nurses in 65 medical institutions in Kanagawa Prefecture, Japan and investigated their background factors. Antibodies (IgG) against SARS-CoV-2 were analyzed by Immunochromatographic test.ResultsThe 39 subjects (2.4%) were found to be IgG antibody-positive: 29 in the patient group (2.9%), 10 in the doctor/nurse group (2.0%), and 0 in the control group. After adjustment for age, sex, and the antibody prevalence in the control group, antibody prevalence was 2.7% in the patient group and 2.1% in the doctor/nurse group. There was no significant difference between the antibody-positive subjects and the antibody-negative subjects in any background factors investigated including overseas travel, contact with overseas travelers, presence/absence of infected individuals in the living area, use of trains 5 times a week or more, BCG vaccination, and use of ACE inhibitor and ARB.ConclusionsAntibody prevalence in the present survey at medical institution is higher than that in Tokyo and in Osaka measured by the government suggesting that subclinical infections are occurring more frequently than expected. No background factor that influenced antibody-positive status due to subclinical infection was identified.     

Potential repurposed SARS-CoV-2 (COVID-19) infection drugs

The global outbreak of COVID-19 viral infection is associated with the absence of specific drug(s) for fighting this viral infection. About 10 million people are already infected, about 500 000 deaths all over the world to date. Great efforts have been made to find solutions for this viral infection, either vaccines, monoclonal antibodies, or small molecule drugs; this can stop the spread of infection to avoid the expected human, economic and social catastrophe associated with this infection. In the literature and during clinical trials in hospitals, several FDA approved drugs for different diseases have the potential to treat or reduce the severity of COVID-19. Repurposing of these drugs as potential agents to treat COVID-19 reduces the time and cost to find effective COVID-19 agents. This review article summarizes the present situation of transmission, pathogenesis and statistics of COVID-19 in the world. Moreover, it includes chemistry, mechanism of action at the molecular level of the possible drug molecules which are liable for redirection as potential COVID-19 therapeutic agents. This includes polymerase inhibitors, protease inhibitors, malaria drugs, lipid lowering statins, rheumatoid arthritis drugs and some miscellaneous agents. We offer research data and knowledge about the chemistry and biology of potential COVID-19 drugs for the research community in this field.

The global outbreak of COVID-19 viral infection is associated with the absence of specific drug(s) for fighting this viral infection.     

Combinatory effect of fluconazole and FDA-approved drugs against Candida albicans

Candida albicans is the primary cause of systemic candidiasis, which has a high mortality rate. Unfortunately, the number of antifungal drugs available for treatment of Candida infections is limited, and there is an urgent need for development of new drugs and alternative therapeutic options. We investigated the combinatory effect of fluconazole (FLCZ) and 640 FDA-approved drugs in vitro. Ten drugs enhanced and 77 drugs attenuated the antifungal activity of FLCZ. Other drugs did not appear to alter the antifungal activity of FLCZ, although 17 drugs displayed potency equivalent to or greater than that of FLCZ. The 10 FLCZ-enhancing drugs included three inhibitors of 3-hydroxy-3-methyl-glutaryl-CoA reductase, whose synergistic activity had been reported previously. However, the antifungal effects of 3 FLCZ enhancers—artesunate, carvedilol, and bortezomib—were previously unknown. In addition, many drugs were found to attenuate the antifungal activity of FLCZ, including 17 cyclooxygenase (COX) inhibitors, 15 estrogen-related agents, vitamin A- and D-related compounds, antihypertensive drugs, and proton pump inhibitors. Although the clinical significance remains to be determined, analyses of molecular events responsible for synergy or antagonism could provide insight into more efficient use of existing antifungals and lead to novel therapies.     

Clinical characteristics of the coronavirus disease 2019 (COVID-19) outbreak on a cruise ship

BackgroundA large COVID-19 outbreak occurred on the cruise ship Diamond Princess in February 2020. Little information has been reported about the clinical characteristics of the patients.MethodsThis single-center, retrospective, observational study was conducted in Yokohama, Japan. We included symptomatic patients who were infected on the ship and admitted to our hospital between 5 and 19 February 2020. All the cases were confirmed with SARS-CoV-2 infection by polymerase chain reaction (PCR).ResultsWe confirmed 17 cases. The average age was 69 years; 10 patients were Asian and 7 were Caucasian. Eleven patients had one or more chronic diseases. The major symptoms were cough and fever. Chest computed tomography (CT) scans found bilateral ground-glass opacities predominantly in the peripheral area, which were similar to reports from cases in China. C-reactive protein (CRP) levels were higher in severe and critical cases than in mild to moderate cases. The moderate to severe cases reached symptomatic resolution; one of the three critical cases resulted in death due to multiple organ failure. SARS-CoV-2 was detected by PCR at an average of 7 days after symptomatic resolution.ConclusionsCough and fever, increased blood CRP levels, and CT findings of bilateral ground-glass opacities predominantly in the peripheral lung were characteristic of the COVID-19 cases in this study. These findings were compatible with those of previous reports.     

Incubation period of the coronavirus disease 2019 (COVID-19) in Busan,South Korea

The assessment of the incubation period, which is the period between the infection and the illness onset, is essential to identify the sufficient isolation period for infectious diseases. In South Korea, a few cases of the coronavirus disease 2019 (COVID-19) were identified after the 14-day self-quarantine program, and the length of this quarantine has raised controversial issues for the Korean public health professionals.We estimated the COVID-19 incubation period using the log-normal distribution from publicly available data. The data were obtained from the press release of the Busan city department of public health and news reports.We collected and analysed information for 47 patients with a median age of 30. We estimated that the median incubation period was three days (95% Confidence Interval, 0.6–8.2). We also did not find any significant difference in the incubation period between males and females.Our findings indicate that a 14-day self-quarantine program should be sufficient to prevent spreading in the infection of suspected individuals with COVID-19 in the community.     

Myalgia may not be associated with severity of coronavirus disease 2019 (COVID-19)

Dear editor,A recent study based on the use of experimental artificial intelligence(AI)tool showed 70%–80%accuracy in predicting development of severe disease in coronavirus disease 2019(COVID-19)based on predictive parameters alanine aminotransferase(ALT),myalgia and hemoglobin,whilst only 5 of 53 patients developed acute respiratory distress syndrome(ARDS),2 of whom reporting myalgia.     

Early identification of novel coronavirus (COVID-19) pneumonia using clinical and radiographic findings

IntroductionThe Japanese Respiratory Society (JRS) scoring system is a useful tool for identifying Mycoplasma pneumoniae pneumonia. Most COVID-19 pneumonia in non-elderly patients (aged <60 years) are classified as atypical pneumonia using the JRS scoring system. We evaluated whether physicians could distinguish between COVID-19 pneumonia and M. pneumoniae pneumonia using chest computed tomography (CT) findings. In addition, we investigated chest CT findings if there is a difference between the variant and non-variant strain.MethodsThis study was conducted at five institutions and assessed a total of 823 patients with COVID-19 pneumonia (335 had lineage B.1.1.7.) and 100 patients with M. pneumoniae pneumonia.ResultsIn COVID-19 pneumonia, at the first CT examination, peripheral, bilateral ground-glass opacity (GGO) with or without consolidation or crazy-paving pattern was observed frequently. GGO frequently had a round morphology (39.2%). No differences were observed in the radiological findings between the non-B.1.1.7 groups and B.1.1.7 groups. The frequency of pleural effusion, lymphadenopathy, bronchial wall thickening and nodules (tree-in-bud and centrilobular) was low. In contrast to COVID-19 pneumonia, bronchial wall thickening (84%) was observed most frequently, followed by nodules (81%) in M. pneumoniae pneumonia. These findings were significantly higher in M. pneumoniae pneumonia than COVID-19 pneumonia.ConclusionsOur results demonstrated that a combination of the JRS scoring system and chest CT findings is useful for the rapid presumptive diagnosis of COVID-19 pneumonia in patients aged <60 years. However, this clinical and radiographic diagnosis is not adapted to elderly people.     

Successful treatment of a centenarian with coronavirus disease 2019 (COVID-19) using convalescent plasma

BackgroundBecause treatment options for coronavirus disease 2019 (COVID-19) are very limited, the use of convalescent plasma has bee explored.Case presentation and treatmentA male centenarian with cough and dyspnea for 2 months was diagnosed with COVID-19. Without effective treatments and with the increased risks of antiviral therapy for the elderly, this patient was given convalescent plasma. The viral load, complete blood count, inflammatory indicators, vital signs, and clinical symptoms were observed before and after COVID-19 convalescent plasma transfusion.ResultsAfter convalescent plasma transfusion, significant improvement was observed on laboratory indicators and clinical symptoms of the patient. Concurrently, SARS-CoV-2 viral load decreased sharply after the first transfusion (from 2.55 × 104 to 1.39 × 103 copies/mL) and became undetectable after the second transfusion.ConclusionsWith the substantial increase of COVID-19 in recent months,treatment for elderly patients has become restricted in some countries. The successful treatment of this 100-year-old patient using convalescent plasma suggests that we should consider adding convalescent plasma in th management of the elderly.