Research Plan

RESEARCH PLAN FOR LITERATURE SUMMARY

MAIN ASPECTS OF THE REVIEW OF THE BIBLIOGRAPHY

Problem solving, background topic selection

a brief summary of the reasons

The global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a major impact on the mortality rate of a human.  

The virus was originated in China and within a couple of months, it spread all over the world. According to WHO, several mutant forms of these viruses are reported. Among different modes of transmission of the virus such as a droplet, airborne, fomite, faecal-oral, bloodborne, mother-to-child, and animal-to-human transmission, it has been evident that the spread through the dissemination of droplet nuclei (aerosol) seek more attention due to its havoc infection rate. The most affected organ due to COVID infection is the lungs, which plays a crucial role in respiration. There is a high chance of a perfect storm from the immunological perspective in the respiratory system with co-infection by pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB). Several case reports elucidate the higher chance of respiratory infection with this type of co-infections. (1)

In this retrospective study, I want to illustrate a possible connection between TB and SARS-CoV-2 co-infection cohorts.  From a clinical and public health perspective, it is important, as both tuberculosis and SARS-COV-2 are significant contagious airborne diseases. (2), (3) SARS-COV-2 is a rapidly developing and frequently fatal viral infection, which can cause hospitalizations and fatalities. Many patients with SARS-COV-2 suffer from chronic diseases which significantly contribute to the development of complications such as pneumonia, acute respiratory distress syndrome (ARDS), septic shock, etc. (4) Both the immune system and body conditions are directly impacted and disrupted by SARS-CoV-2.

Leukopenia, lymphopenia, and an inflammatory cytokine storm are some of the

immunological alterations in the patient, which in some cases, immunosuppressive drugs have been used during detoxification. (5) There are a large number of studies, showing a correlation between SARS/MTB and coinfections of the Middle East respiratory syndrome-CoV/MTB which can cause other infections to increase. (6) As we know that Tuberculosis is a global public health concern, with an estimated 10 million people worldwide becoming ill with tuberculosis in 2019. (WHO) (7) Medical therapy of tuberculosis, commonly including the accurate diagnosis, represents a base in the management and control of it.  A long treatment regimen associated with high pill-load, numerous adverse drug reactions, was implicated in tuberculosis. (8)  MTB infection may increase susceptibility

and severity of SARS-COV-2. Patients with prior lung disease, such as treated

or untreated TB can affect the prognosis of SARS-COV-2 patients, requiring greater caution during outpatient follow-up. (9) As a treatment for the patient with acute hypoxemic respiratory failure, enhanced respiratory support include HFNC, NIPPV, intubation and invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) over conventional oxygen therapy. If tracheal intubation is problematic, this should be managed according to standard rescue algorithms simplified by the COVID patients' DAS guideline for tracheal intubation. (10)

This further makes me more excited to study techniques used in mechanical ventilation, the most significant method of treating respiratory disease. 

The results and knowledge generated with this retrospective study will result in mechanistic data on the impact of TB/ SAR-COV2 infection in health care.

1. Mousquer, G. T., Peres, A., & Fiegenbaum, M. (2021). Pathology of TB/COVID-19 Co-Infection: The phantom menace. Tuberculosis (Edinburgh, Scotland), 126, 102020. doi:10.1016/j.tube.2020.102020

2. Sotgiu, G., Centis, R., D'ambrosio, L., & Migliori, G. B. (2015). Tuberculosis treatment and drug regimens. Cold Spring Harbor perspectives in medicine, 5(5), a017822. doi:10.1101/cshperspect.a017822

3. Takahashi H. (2020). Role of latent tuberculosis infections in reduced COVID-19 mortality: Evidence from an instrumental variable method analysis. Medical hypotheses, 144, 110214. doi:10.1016/j.mehy.2020.110214

4. Yi, Y., Lagniton, P., Ye, S., Li, E., & Xu, R. H. (2020). COVID-19: what has been learned and to be learned about the novel coronavirus disease. International journal of biological sciences, 16(10), p.1753–1766. doi:10.7150/ijbs.45134

5. Tang, Y., Liu, J., Zhang, D., Xu, Z., Ji, J., & Wen, C. (2020). Cytokine Storm in COVID-19: The Current Evidence and Treatment Strategies. Frontiers in immunology, 11, 1708. doi:10.3389/fimmu.2020.01708

6. Alfaraj, S. H., Al-Tawfiq, J. A., Altuwaijri, T. A., & Memish, Z. A. (2017). Middle East Respiratory Syndrome Coronavirus and Pulmonary Tuberculosis Coinfection: Implications for Infection Control. Intervirology, 60(1-2), 53–55. doi:10.1159/000477908

7. WHO, Tuberculosis. [Online] 14 October 2020 [Retrieved:17 january 2021] https://www.who.int/news-room/fact-sheets/detail/tuberculosis#:~:text=Worldwide%2C%20TB%20is%20one%20of,all%20countries%20and%20age%20groups

8. Zaman K. (2010). Tuberculosis: a global health problem. Journal of health, population, and nutrition, 28(2), p. 111–113. doi:10.3329/jhpn.v28i2.4879

9. He, G., Wu, J., Shi, J., Dai, J., Gamber, M., Jiang, X., Sun, W., & Cai, J. (2020). COVID-19 in tuberculosis patients: A report of three cases. Journal of medical virology, 92(10), p. 1802–1806. doi:10.1002/jmv.25943

10. Cook, T. M., El-Boghdadly, K., McGuire, B., McNarry, A. F., Patel, A., & Higgs, A. (2020). Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia, 75(6), p. 785–799. doi: 10.1111/anae.15054

Selection and exclusion criteria for the resources to be selected

Inclusion criteria:

Preferred database - PubMed, Scopus, Google Scholar, Web of Science. The search strategy will be based on the use of the following keywords, combined, or separated, always accompanied by "tuberculosis" and "COVID-19" among them: "immune response", "SARS", "mycobacterium", "coronavirus" and "co-infection ". (11-19) Correlation between universal BCG vaccination. The articles will be from the last 10 years, taken from trustworthy databases. The articles should include the following criteria:

SAR-COV-2

Mycobacterium tuberculosis (MTB) 

Acute Respiratory Distress Syndrome (ARDS)

Bacillus Calmette–Guérin vaccine (BCG)

ventilation protocols

anesthesiology

intensive care 

cytokine storm 

mechanical ventilation

Exclusion criteria:

The articles that use systematic reviews, older than 10 years, and write about pediatric patients and latent tuberculosis will be excluded.

Analysis and processing are key

aspects (if adaptation covers, main elements of project presentation, main aspects of evening study processing, etc.)

The analysis will include the different complications, the different modes of treatments, the mode of artificial ventilation, risks related to artificial ventilation and prone position during non-invasive ventilation, the different nursing aspects related to tuberculosis and SARS-CoV-2 infections. 

11. László I., Molnár Cs., Koszta Gy.,Végh T., Fábián Á.,Berhés M.,Juhász , Fülesdi B. (2020) Légútbiztosítás koronavírus fertőzött betegeknél. Ovosi Hetilap, 161(17) p.: 696–703.

12. Perényi Á., Sztanó B., Bella Zs., Szegesdi I.,Csanády M.,Kelemen É.,Babik B.,Rovó L. (2020): Tracheotomia az új típusú  koronovírus okozta járvány idején. 161.(19), p.: 767–770

13. Babik B., Hankovszki P., Korsós A., Kupcsulik Sz., Lovas A., Molnár T., Szabó Zs., Szalai G. (2020): SARS-CoV-2 fertőzés következtében kialakuló COVID-19 betegek intenzív terápiás ellátására.Szeged, p. 1-20.

14. Fattorini, L., Creti, R., Palma, C., Pantosti, A., (2020): Bacterial coinfections in COVID-19: an underestimated adversary. Annali dell'Istituto superiore di sanita, 56(3), p. 359–364. doi: 10.4415/ANN_20_03_14

15. Crisan-Dabija, R., Grigorescu, C., Pavel, C. A., Artene, B., Popa, I. V., Cernomaz, A., & Burlacu, A. (2020). Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes. Canadian respiratory journal, 2020, 1401053. doi:10.1155/2020/1401053

16. Redelman-Sidi G. (2020). Could BCG be used to protect against COVID-19?. Nature reviews. Urology, 17(6), p. 316–317. doi:10.1038/s41585-020-0325-9/

17. Escobar, L. E., Molina-Cruz, A., & Barillas-Mury, C. (2020). BCG vaccine protection from severe coronavirus disease in 2019 (COVID-19). Proceedings of the National Academy of Sciences of the United States of America, 117(30), p. 17720–17726. doi:10.1073/pnas.2008410117

18. Gupta P. K. (2020). New disease old vaccine: Is recombinant BCG vaccine an answer for COVID-19? Cellular immunology, 356, 104187. doi:10.1016/j.cellimm. 2020.104187

19. Can Sarınoğlu, R., Sili, U., Eryuksel, E., Olgun Yildizeli, S., Cimsit, C., & Karahasan Yagci, A. (2020). Tuberculosis and COVID-19: An overlapping situation during pandemic. Journal of infection in developing countries, 14(7), p.721–725. doi:10.3855/jidc.13152

Possibilities of practical application of research results

Viral respiratory infections and tuberculosis impede the host immune responses with which we can assume or hypothesize that their lethal synergism may contribute to more severe clinical evolution, and which can be further analyzed. What we are learning during the journey of this COVID-19 can help to develop strategies to prevent TB. We will get an idea of techniques for dealing with the coronavirus and the complicated treatment duties of the health care team within the context of anesthesiology by studying the literature and analyzing it.

As an anesthesiology APN I am looking for ways to ventilate acute respiratory patients and the risks and protocols associated with mechanical ventilation as well.