Abstract
Background
Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, previously named 2019-nCov), a novel coronavirus that emerged in ...China in December 2019 and was declared a global pandemic by World Health Organization by March 11th, 2020. Severe manifestations of COVID-19 are caused by a combination of direct tissue injury by viral replication and associated cytokine storm resulting in progressive organ damage.
Discussion
We reviewed published literature between January 1st, 2000 and June 30th, 2020, excluding articles focusing on pediatric or obstetric population, with a focus on virus-host interactions and immunological mechanisms responsible for virus associated cytokine release syndrome (CRS). COVID-19 illness encompasses three main phases. In phase 1, SARS-CoV-2 binds with angiotensin converting enzyme (ACE)2 receptor on alveolar macrophages and epithelial cells, triggering toll like receptor (TLR) mediated nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ƙB) signaling. It effectively blunts an early (IFN) response allowing unchecked viral replication. Phase 2 is characterized by hypoxia and innate immunity mediated pneumocyte damage as well as capillary leak. Some patients further progress to phase 3 characterized by cytokine storm with worsening respiratory symptoms, persistent fever, and hemodynamic instability. Important cytokines involved in this phase are interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α. This is typically followed by a recovery phase with production of antibodies against the virus. We summarize published data regarding virus-host interactions, key immunological mechanisms responsible for virus-associated CRS, and potential opportunities for therapeutic interventions.
Conclusion
Evidence regarding SARS-CoV-2 epidemiology and pathogenesis is rapidly evolving. A better understanding of the pathophysiology and immune system dysregulation associated with CRS and acute respiratory distress syndrome in severe COVID-19 is imperative to identify novel drug targets and other therapeutic interventions.
Checkpoint immunotherapy uses highly selective humanized monoclonal antibodies against checkpoint signals such as programmed cell death receptor (PD-1) and programmed cell death ligand (PD-L1). By ...blocking these receptors and signals, the immune system can be reactivated to fight the tumor. Immunotherapy for advanced non-small cell lung cancer (NSCLC) has resulted in a new paradigm of treatment options resulting in improved survival and response rates and has a less severe yet unique toxicity profile when compared to chemotherapy. PD-1 inhibitors, nivolumab and pembrolizumab, and PD-L1 inhibitor, atezolizumab, are currently approved by regulatory authorities for the treatment of advanced NSCLC. This article provides a detailed review of these newer agents, their mechanism of action, side-effect profile, therapeutic indications and current evidence supporting their use in the management of NSCLC.
Coconut (Cocos nucifera) is extensively cultivated and used as a staple ingredient in Indian cuisines, especially in the South Indian cuisines. In India, other than edible purposes, coconut is widely ...used in religious practices and, it is considered as symbol of prosperity. Despite these facts, several upturns and downturns occurring in the growth trends of coconut in recent periods irrespective of geographical differences. This study attempts to decipher the growth trends in the area, the production and yield of coconut in major coconut producing states in India from 2000–2001 to 2017–2018. Kerala, Tamil Nadu and Karnataka are the states in India where coconut palms are extensively cultivated and produced in large quantities. These states together contribute to approximately 84 per cent of the total area for cultivation of coconut and account for over 87 per cent of total production in the country. We analyse the growth trends in coconut cultivation using appropriate growth equations to estimate the growth rates and instabilities in growth trends. Besides, we use decomposition analysis to find the role of area, price, yield and crop mix effects on coconut production. The results reveal that Karnataka secured high growth in coconut production and its productivity and recorded better acceleration but fluctuated heavily between the phases of years under investigation. It shows that the price effect and yield effect play a crucial role in the total change of coconut production among the selected states. Based on the results, we recommend the local governments and other dedicated authorities to ensure that coconut growers have better access to modern technology, quality inputs, marketing and credit facilities following local necessity. Eventually, these measures can attract and encourage many new farmers into coconut cultivation and thereby achieving better advances in coconut farming.
Multiple synchronous lung nodules are frequently encountered on computed tomography (CT) scanning of the chest and are most commonly either non-neoplastic or metastases from a known primary ...malignancy. The finding may initiate a search for primary malignancy elsewhere in the body. An exception to this rule, however, is a class of rare primary lung neoplasms that originate from epithelial (pneumocytes and neuroendocrine), mesenchymal (vascular and meningothelial) and lymphoid tissues of the lung. While these rare neoplasms also present as multiple synchronous unilateral or bilateral lung nodules on chest CT, they are often overlooked in favour of more common causes of multiple lung nodules. The correct diagnosis may be suggested by a multidisciplinary team and established on biopsy, performed either as part of routine diagnostic work-up or staging for malignancy. In this review, we discuss clinical presentations, imaging features, pathology findings and subsequent management of these rare primary neoplasms of the lung.
Bleeding is one of the most feared complications of flexible bronchoscopy. Although infrequent, it can be catastrophic and result in fatal outcomes. Compared to other endoscopic procedures, the risk ...of morbidity and mortality from the bleeding is increased, as even a small amount of blood can fill the tracheobronchial tree and lead to respiratory failure. Patients using antithrombotic agents (ATAs) have higher bleeding risk. A thorough understanding of the different ATAs is critical to manage patients during the peri-procedural period. A decision to stop an ATA before bronchoscopy should take into account a variety of factors, including indication for its use and the type of procedure. This article serves as a detailed review on the different ATAs, their pharmacokinetics and the pre- and post-bronchoscopy management of patients receiving these medications.
Vessels of the Central Airways Kumar, Anupam, MD; Raju, Shine, MD; Das, Aparna, MD ...
Chest,
March 2016, Letnik:
149, Številka:
3
Journal Article
Recenzirano
Blood supply of the tracheobronchial tree is derived from a dual system involving pulmonary and bronchial circulation. Various primary and secondary abnormalities of central airway vasculature can ...present with patterns that are distinct during bronchoscopy. These patterns maybe visualized during bronchoscopic evaluation of a patient with hemoptysis or as an incidental finding during an airway examination for other indications. Thorough knowledge of airway vasculature abnormalities and recognition of possible underlying pathophysiology is vital for the bronchoscopist. This review is a comprehensive description of vascular anatomy of the airway and the different vascular abnormalities that can be encountered during bronchoscopy.
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