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Coagulopathy has proven to be a common complication of the novel coronavirus SARS-CoV-2, with evidence of elevated D-dimers and fibrin degradation products associated with an increased incidence of thromboembolism. Despite emerging evidence describing the coagulopathy and its clinical relevance in COVID-19, fewer studies have addressed the potential role of empiric therapeutic anticoagulation in this setting. We report the case of a patient admitted to our intensive care unit (ICU) with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 whose clinical trajectory improved dramatically after initiation of a therapeutic dose of LMWH. The patient showed progressive elevation of fibrinogen and D-dimers despite a prophylactic dose of LMWH during her ICU stay. This was met with a moderate increase of troponin T-hs, an escalating need for vasopressors, and a progressive decrease in her P/F ratio despite preserved lung static compliance. Her platelet count was normal and had an elevated fibrinogen during the first week of ICU stay. The ECG was normal, and a bedside transthoracic echocardiogram showed no evidence of pulmonary embolism and a preserved EF with no regional wall motion abnormalities (RMWA). The chest X-ray was not dissimilar to previous exams, and the ABG showed hypoxia with normal pCO2 values. The decision was made to commence empiric therapeutic enoxaparin. The patient did not experience bleeding complications, and her clinical trajectory appeared to change dramatically. She was successfully extubated three days later and proceeded to clinical recovery and eventual discharge from the ICU. The available evidence shows that there is undoubtedly coagulopathy associated with COVID-19 with various subsequent forms of clinical manifestation described in the literature. Evidence also shows the benefits of heparin as an anticoagulant. From the discussion of this case report, however, it can be concluded that despite the plausible theoretical rationale, studies pertaining to the role of empiric therapeutic anticoagulation in this setting fall short of providing compelling evidence. Subsequently the role of empiric therapeutic anticoagulation in COVID-19 remains unclear with a pressing call for further research.

The ability of B. longum subsp. infantis ATCC15697 in utilizing milk N-glycans to shape an ideal gut microbiota in infants has not been extensively studied. Here we compared N-glycan structures from human and bovine milk using UHPLC and MALDI-TOF-MS/MS. The structural differences between the two were apparent. When being tested as bifidus growth promoting factors, milk N-glycans from both human and bovine showed bifidogenic activity, with a stronger effect from the former. Sequential comparison of glycoprofiles revealed an apparent difference in the bifidobacterial consumption of N-glycans from human and bovine milk, and a general preference for smaller structures. In summary, this work indicates that the consumption of the milk N-glycans by B. infantis ATCC15697 is depending on the glycan composition, and regulating the N-glycome composition of bovine milk through adding exogenous N-glycans favored by B. infantis ATCC15697 might provide improved effect on regulating the microbial composition of the infant gut.