الفهرس 
COVID-19 Virus
Clinical presentation of COVID-19 infectionOnly 14 pages are availabe for public view
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Abstract
COVID-19 is a highly contagious respiratory illness, caused by SARS-CoV-2 that can affect any system in human body, and rapidly reached pandemic proportions. Although most patients infected with SARS-CoV-2 develop only mild symptoms like fever& dry cough and fatigue, a minority of patients require hospitalization and intensive care as they have severe symptoms and may develop even multiple organ failure (MOF). The cascade of events leading to MOF includes an early phase of endothelial damage, extravasation of inflammatory cells and release of mediators (cytokines), and a later phase that includes amplification of inflammation and cell damage, which could affect various organs. MOF is considered as late-stage in COVID-19 which often have very limited options and is refractory to most available treatments. As the number of COVID-19 patients is increasing dramatically worldwide and treatment in ICU has become a major challenge, the early recognition of severe forms of COVID19 is essential. Some people especially the elderly may have dysfunctional immune systems that fail to keep the response to certain pathogens in check. This could cause an uncontrolled immune response, triggering an overproduction of immune cells and their signaling molecules leading to a cytokine storm. Toll-like receptors (TLRs), a subfamily of pattern recognition receptors (PRRs), can recognize “danger signals” such as SARS-CoV-2 viruses in the extracellular milieu and endosomes and mediate the inflammatory signaling cascade that leads to the activation and production of inflammatory cytokines TLR activation following a viral infection can induce the production of IL-6 by monocytes and macrophages. TLRs, TNFα, and IL-1β are known as the main stimulators for the synthesis of IL-6, it is the main regulator of T cells. It can promote the development and function of Th17 cells (a population of CD4+ T helper cells), which may serve as pro-inflammatory self-reactive T cells. In addition, IL-6 can induce the production of some acute phase proteins such as CRP The two most extensively studied IL-6 gene promoter variant, 174G/C (rs1800795) and 572C/G (rs1800797) have been shown to affect both the transcription and secretion level of IL-6. The present study aimed to find out the association between IL-6 and its IL- 6 gene (174G/C) single nucleotide polymorphism with the pathogenesis of COVID-19 severity in Egyptian patients. Accordingly, the study was performed on 135 Patients with COVID19 positive from hospitals of Tanta university (inpatients and outpatients) (chest department, isolation hospital). Patients were subjected to the following: 1. Clinical evaluation: History taking Clinical examination Demographic parameters as age and gender 2. CT chest with Categorical CT Assessment Scheme for COVID 19 Patients (CO-RADS) Routine laboratory investigation: complete blood count (CBC), liver function, renal function, CRP, and coagulation profile. Serum ferritin, Ddimer, procalcitonin, and lactate dehydrogenase (LDH) were performed also. 4. Laboratory tests for COVID diagnosis: PCR for COVID – 19 or rapid COVID – 19 antigen detection. 5. Specific laboratory investigations: Detection of serum interleukin 6 (IL-6) level using ELISA method. Detection of IL-6 gene (174G/C) polymorphism using restriction fragment length polymorphism (RFLP) method. The studied patients were classified into 3 groups: group I (Mild): 45 COVID-19 patients with mild criteria they were 15 female patients (33.3%), and 30 male patients (66.6 %)with age ranged from 18 to 78 years old group II (Moderate): 45 COVID-19 patients with moderate criteria they were 13 females (28.8%), and 32 males (71.2%) with age ranged from 19 to 75 years old group III (Severe & Critical): 45 COVID-19 patients with severe and critical criteria they were 19 females (42.3%), and 26 males (57.7%) with age ranged from 19 to 80 years old The findings of this study could be summarized as following: Regarding age and gender, there were no statistically significant differences in the comparison of mean values of the different groups. As regard the distribution of CORAD scores in the three groups there was statistically significant difference.