Clinical manifestation and disease progression in COVID-19 infection.

Coronavirus disease 2019 (COVID-19) is mainly an infectious disease of the respiratory system transmitted through air droplets, and pulmonary symptoms constitute main presentations of this disease. However, COVID-19 demonstrates a clinically diverse manifestation ranging from asymptomatic presentation to critically illness with severe pneumonia, acute respiratory distress syndrome, respiratory failure, or multiple organ failure. Accumulating evidences demonstrated that COVID-19 has extrapulmonary involvement, including neurological, smelling sensation, cardiovascular, digestive, hepatobiliary, renal, endocrinologic, dermatologic system, and others. Over a third of COVID-19 patients manifest a wide range of neurological symptoms involving the central/peripheral nervous system. Underlying cardiovascular comorbidities were associated with detrimental outcomes, meanwhile the occurrence of cardiovascular complications correlate to poor survival. Gastrointestinal symptoms frequently occur and have been associated with a longer period of illness. Impaired hepatic functions were associated with the severity of the disease. Higher rate of acute kidney injury was reported in critically ill patients with COVID-19. Endocrinologic presentations of COVID-19 include exacerbating hyperglycemia, euglycemic ketosis, and diabetic ketoacidosis. The most common cutaneous manifestation was acro-cutaneous (pernio or chilblain-like) lesions, and other skin lesions consist of maculopapular rash, vesicular lesions, livedoid/necrotic lesions, exanthematous rashes, and petechiae. This review article summarized the general clinical signs and symptoms, radiologic features, and disease manifestation with progression in patients with COVID-19.

Acute effect of methylprednisolone on the brain in a rat model of allergic asthma.

Asthma affects not only the airways but also the central nervous system (CNS). Corticosteroids are an effective therapeutic agents for asthma. In our study, we investigated the acute effect of ovalbumin (OVA) on the brain and the effectiveness of methylprednisolone (MP) in both the periphery and CNS in a rat model of allergic asthma. Rats sensitized to OVA and exposed to OVA aerosol challenge to induce allergic asthma were compared with control rats and rats sensitized to OVA and pretreated with MP before OVA exposure. In response to OVA stimulation, the amount of c-Fos and glial fibrillary acidic protein (GFAP) increased, while that of neuronal nitric oxide synthase (nNOS) decreased in the nucleus tractus solitarius (NTS). In addition, the c-Fos, GFAP, and nNOS levels in the hippocampus and the nNOS levels in the olfactory bulb increased. However, the expression of these proteins in the frontal and cerebellar cortices was not affected by OVA stimulation. In contrast, pretreatment with MP before OVA exposure decreased the protein expression of c-Fos in the CA1 area, GFAP in NTS, and nNOS in CA1 and olfactory bulb, and while it increased the nNOS content in the NTS. These findings suggest that the brain responds to OVA stimulation in a rat model of allergic asthma and that MP treatment cannot only ameliorate airway inflammation but also OVA-induced effects.

Clinical manifestations of two cases with severe acute respiratory syndrome (SARS) in I-Lan County.

Severe acute respiratory syndrome (SARS) is a new respiratory tract infectious disease caused by a novel coronavirus. As of this report, there were 3 probable SARS cases in I-Lan County. Of them, 1 was deceased in another hospital and the remaining 2 were cured and discharged. This report describes the clinical manifestations of the 2 surviving probable cases. The first case had a travel history to Guangdong province, China, and the second case probably contracted the disease from a hospital outbreak. They both developed infiltrations over uni- or bilateral lungs but recovered without intubations. Their treatment modalities included empirical antibiotics, steroids, and anti-viral agents. As SARS becomes an emerging infectious disease in the 21st century, its clinical manifestations and treatment will be discussed.