COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications.

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

Polycarbonate membrane impression cytology: evidence for fluorescein staining in normal and dry eye corneas.

BACKGROUND/AIMS: Corneal impression cytology is usually performed with mixed cellulose ester membranes and a limited array of stains. A method using polycarbonate membrane air-dried preparations led to the discovery of fluorescein staining in cells from patients with and without dry eye disease and a membrane-induced defect that was not due to cell removal. METHODS: Impressions after fluorescein installation were performed using polycarbonate and mixed cellulose ester membranes with rapid staining protocols for Diff-Quick as well as haematoxylin and eosin stains. Prior to staining the air-dried material was examined for fluorescence. RESULTS: Epithelia of both normal and dry eye corneas retained fluorescence from clinical instillation of fluorescein. Corneal defects created by the polycarbonate membrane could not be explained by membrane-induced cell removal. After rapid staining, polycarbonate membranes revealed less background, dissolved easily prior to coverslip application, but showed lower cellular yield compared with the mixed cellulose membranes. CONCLUSION: Polycarbonate membrane impression cytology enables immediate assessment with rapid stains. Topically applied fluorescein penetrates corneal epithelial cells in both normal and dry eye patients. Cells fluoresce on the cytology membranes. The impression-induced defect on the cornea is not due to cell stripping and may represent removal of mucins.

Interface fluid syndrome in laser in situ keratomileusis after complicated trabeculectomy.

A 69-year-old man developed stromal edema and a pocket of fluid in the laser in situ keratomileusis (LASIK) interface wound in the left eye after acute endothelial cell loss from complicated trabeculectomy. He eventually required penetrating keratoplasty along with cataract surgery. Histologic examination of the corneal button showed an edematous 720 microm central residual stromal bed, a 54 microm empty space at the level of the central interface wound, and a 154 microm LASIK flap. The endothelial cell count was 0 to 2 cells per high-power field, corresponding to a cell density of 450 to 500 cells/mm(2). Four years after LASIK, the central interface wound was susceptible to forming a pocket of serous fluid after the corneal endothelial function was compromised.

Corneal copper deposition associated with chronic lymphocytic leukemia.

PURPOSE: To report a case of corneal copper deposition associated with chronic lymphocytic leukemia (CLL). DESIGN: Case report. METHODS: A 65-year-old woman with a history of CLL was diagnosed with bilateral corneal opacification. Slit-lamp examination revealed dense, central yellow-brown pigmentation of Descemet's membrane in each cornea. The presence of a bilateral pigmented deposition at the level of Descemet's membrane led to a presumptive clinical diagnosis of corneal copper deposition. RESULTS: Serologic investigations revealed a markedly elevated copper (hypercupremia) and IgG levels with a normal ceruloplasmin. Wilson's disease was excluded as a possible cause based on liver function tests and a liver biopsy. Thus, the patient was diagnosed with corneal copper deposition secondary to hypercupremia associated with CLL. CONCLUSIONS: Corneal copper deposition may be associated with systemic malignancy, most commonly myeloproliferative disorders, including CLL. Recognition of the characteristic clinical features associated with corneal copper deposition allows the clinician to confirm the diagnosis with appropriate serologic studies.