Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

SARS-CoV-2 epidemiology, kinetics, and evolution: A narrative review

Since winter 2019, SARS-CoV-2 has emerged, spread, and evolved all around the globe. We explore 4 y of evolutionary epidemiology of this virus, ranging from the applied public health challenges to the more conceptual evolutionary biology perspectives. Through this review, we first present the spread and lethality of the infections it causes, starting from its emergence in Wuhan (China) from the initial epidemics all around the world, compare the virus to other betacoronaviruses, focus on its airborne transmission, compare containment strategies ("zero-COVID" vs. "herd immunity"), explain its phylogeographical tracking, underline the importance of natural selection on the epidemics, mention its within-host population dynamics. Finally, we discuss how the pandemic has transformed (or should transform) the surveillance and prevention of viral respiratory infections and identify perspectives for the research on epidemiology of COVID-19.

Mathematical modelling for vaccine efficacy trials during the future epidemics of emerging respiratory infections

Assessing vaccine efficacy (VE) during emerging epidemics is challenging due to unpredictable disease transmission dynamics. We aimed to investigate the impact of vaccine randomized controlled trials (RCTs) timing on estimates of VE and sample sizes during future epidemics of emerging respiratory diseases. We developed an age-structured susceptible-exposed-infected-asymptomatically infected-removed (SEIAR) compartment models using 2022 Korean population, and COVID-19 and 2009 A/H1N1 pandemic influenza parameters. Various RCT scenarios were tested to calculate VE estimates, sample size and power by varying RCT timings (using the epidemic peak as the base, ± 10%, ± 20%, ± 30% relative to the time of peak) with follow-up durations (4 weeks as the base, and 8 and 12 weeks), recruitment durations (4 weeks as the base, and 2, 8, and 12 weeks), and non-pharmaceutical intervention (NPI) levels in reducing R0 by 10% and 20%. Additionally, assumptions regarding baseline cumulative incidences were evaluated for sample size calculations. The results showed that VE remained relatively stable across trial timings; however, required sample sizes varied significantly with timing. Sample size requirements initially decreased after a peak and then increased steeply as the epidemic progressed. Initiating RCTs 30% earlier than the peak, along with extended recruitment duration, could reduce sample sizes without compromising VE. NPIs effectively extended the feasible timeframe for RCTs. Sample size estimates based on simulated case numbers in the placebo group were slightly underestimated, with power consistently above 85%. In contrast, calculations using cumulative incidence over the 4 weeks pretrial or the entire study duration could lead to overpowered or underpowered studies.

A detailed examination of coronavirus disease 2019 (COVID-19): Covering past and future perspectives

The COVID-19 disease has spread rapidly across the world within just six months, affecting 169 million people and causing 3.5 million deaths globally (2021). The most affected countries include the USA, Brazil, India, and several European countries such as the UK and Russia. Healthcare professionals face new challenges in finding better ways to manage patients and save lives. In this regard, more comprehensive research is needed, including genomic and proteomic studies, personalized medicines and the design of suitable treatments. However, finding novel molecular entities (NME) using a standard or de novo strategy to drug development is a time-consuming and costly process. Another alternate strategy is discovering new therapeutic uses for old/existing/available medications, known as drug repurposing. There are a variety of computational repurposing methodologies, and some of them have been used to counter the coronavirus disease pandemic of 2019 (COVID-19). This review article compiles recently published data on the origin, transmission, pathogenesis, diagnosis, and management of the coronavirus by drug repurposing and vaccine development approach. We have attempted to screen probable drugs in clinical trials by using literature survey. This systematic review aims to create priorities for future research of drugs repurposed and vaccine development for COVID-19.

Performance of Subgenomic RT-PCR for Predicting SARS-CoV-2 Infectivity Compared to Genomic RT-PCR and Culture Isolation

SARS-CoV-2 clinical samples can be detected as positive for a long period of time using real-time RT-PCR, even when patients are no longer infectious. Viral culture is the gold standard for assessing a patient's infectivity, but it is a time-consuming technique and lacks sensitivity. SARS-CoV-2 subgenomic RNA (sgRNA) detection has been used as a proxy for assessing the infectivity but only a limited number of studies have described its use in vitro and in clinical samples. This study aimed to evaluate the correlation between results from viral culture, genomic RT-PCR (gRT-PCR), and subgenomic RT-PCR (sgRT-PCR) during in vitro infection and in clinical samples. In vitro viral replication kinetics showed that both genomic RNA (gRNA) and subgenomic RNA (sgRNA) levels remained stable up to 21 days in the absence of replication-competent virus. Using clinical samples, sgRNA was detected in 87.5% of culture-positive samples, demonstrating better performances than gRT-PCR (Positive predictive value (PPV) 93.3% and Negative predictive value (NPV) of 87.5%) and an almost perfect agreement with culture results (Cohen κ = 0.81 [95% CI: 0.66-0.95]). These findings suggest that testing for sgRNA and/or using a gRNA Ct cut-off of 21.2 could be used as a proxy to determine the presence of SARS-CoV-2 replication-competent virus.

Rerouting therapeutic peptides and unlocking their potential against SARS-CoV2

The COVID-19 pandemic highlighted the potential of peptide-based therapies as an alternative to traditional pharmaceutical treatments for SARS-CoV-2 and its variants. Our review explores the role of therapeutic peptides in modulating immune responses, inhibiting viral entry, and disrupting replication. Despite challenges such as stability, bioavailability, and the rapid mutation of the virus, ongoing research and clinical trials show that peptide-based treatments are increasingly becoming integral to future viral outbreak responses. Advancements in computational modelling methods in combination with artificial intelligence will enable mass screening of therapeutic peptides and thereby, comprehending a peptide repurposing strategy similar to the small molecule repurposing. These findings suggest that peptide-based therapies play a critical and promising role in future pandemic preparedness and outbreak management.

EIDD-2801 resists to infection and co-infection of SARS-CoV-2 and influenza virus

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has exerted a catastrophic impact on public health. Meanwhile, the seasonal influenza outbreak overlaps with the current pandemic wave. There is still an urgent need to develop effective therapeutic agents for the treatment of co-infection of multiple respiratory viruses. This study aimed to investigate antiviral effects of EIDD-2801, an orally bioavailable ribonucleoside analog, and its potent therapeutic effects in co-infection of multiple respiratory viruses.

METHODS

BALB/c mice and hamsters were infected with IFV or SARS-CoV-2, then were dosed orally with EIDD-2801 to measure the antiviral effects of EIDD-2801. Viral replication and mRNA transcription were evaluated by quantitative polymerase chain reaction (qPCR) and protein expression by Western Blot. Influenza viral titer was assessed using EID50 assay.

RESULTS

EIDD-2801 was found to be significantly effective against influenza A virus and influenza B virus. The antiviral activity against SARS-CoV-2 and further co-infection with influenza virus was also distinct. EIDD-2801 had potent antiviral effects against multiple respiratory viruses both in vitro and in vivo.

CONCLUSION

This study demonstrated that the small-molecule compound EIDD-2801, an orally available broad-spectrum antiviral agent, significantly inhibited the infection of influenza virus and SARS-CoV-2 and effectively protected animals from lethal influenza virus co-infection.

Clinical pharmacy as a guarantee of safety in times of crisis: evolution and relevance of the continued presence of clinical pharmacists in frontline medical units during the first wave of COVID-19

BackgroundThe COVID-19 pandemic has had a major impact on the organisation of health services worldwide. In the first wave, many therapeutic options were explored, exposing patients to significant iatrogenic risk. In a context in which patient management was not well defined by clear recommendations and in which healthcare professionals were under great stress, was it still relevant to maintain pharmaceutical care or did it bring an additional factor of disorganisation?

OBJECTIVE

The aim of our study was to compare the relevance of pharmaceutical care practices before and during the COVID-19 crisis.

METHODS

A retrospective, comparative, observational analysis was conducted in two medical units in a French university hospital that were receiving patients with COVID-19 and benefiting from pharmaceutical care prior to the crisis. This study compared clinical pharmacy performance between two 1.5-month periods before and during the COVID-19 crisis. Performance was assessed according to the CLEO scale, rating the clinical, economic and organisational impacts of the accepted pharmaceutical interventions (PIs) performed in these units.

RESULTS

Of the 675 accepted PIs carried out in the two medical units over the entire study period, PIs performed during the COVID-19 period had a greater significant clinical impact (72% vs 56%, p˂0.0001), a more positive economic impact (38% vs 23%, p˂0.0001) and a more favourable organisational impact (52% vs 20%, p˂0.0001) than those performed prior to the COVID-19 period.

CONCLUSIONS

The health crisis generated important changes in care practices. Our study demonstrates the sustained relevance of pharmaceutical care during a health crisis. This local experience confirms the major interest in improving the integration of pharmaceutical expertise within French healthcare teams.

The Conditions of Survival of Patients with a SARS-CoV-2 Infection Burdened by Cardiovascular Pathologies in a Temporary Hospital in Gdańsk in 2021 and 2022

A detailed analysis was carried out on the impact of cardiovascular disease on the risk of death of patients hospitalized at a temporary hospital in Gdańsk during the third and fifth waves of the COVID-19 pandemic (in 2021 and 2022, respectively). Background/Objectives: The documentation of 1244 patients was analyzed, of which 701 were hospitalized in 2021 (the Delta variant) and 543 in 2022 (the Omicron variant). The aim of this study was to assess the risk of death of patients with COVID-19 depending on the co-existence of cardiovascular diseases. Methods: A model of logistic regression was used to identify the impact of the patients' age, the coexistence of cardiovascular disease, and the length of hospitalization on the risk of death. Results: In 2021, patients were younger (median of 66 years) than in 2022 (median of 74 years), the length of hospitalization was shorter in 2022 (9 days) than in 2021 (11 days), and there was a higher proportion of patients with cardiovascular and respiratory diseases and a medical history of cancer in 2022. The odds of death were also observed to be higher in older patients with cardiovascular disease, particularly those under 73 years of age. In older patients (over 73 years), the odds were paradoxically reduced. Conclusions: The age of the patient, cardiovascular disease, and duration of hospitalization affect the risk of death. The Delta variant (2021) was more virulent than Omicron (2022). Cardiovascular disease significantly increases the risk of death in patients with COVID-19. The comprehensive diagnosis and treatment of patients with these conditions may reduce mortality. Further studies are needed on the long-term effects of COVID-19 on the cardiovascular system.

Is it Curbing-spread of SARS-CoV-2 Variants by Considering Non-linear Predictive Control?

Although SARS-COV-2 started in 2019, its losses are still significant, and it takes victims. In the present study, the epidemic patterns of SARS-COV-2 disease have been investigated from the point of view of mathematical modeling. Also, the effect of quarantine has been considered. This mathematical model is designed in the form of fractional calculations along with a model predictive control (MPC) to monitor this model. The fractional-order model has the memory and hereditary properties of the system, which can provide more adjustable parameters to the designer. Because the MPC can predict future outputs, it can overcome the conditions and events that occur in the future. The results of the simulations show that the proposed nonlinear model predictive controller (NMPC) of fractional-order has a lower mean squared error in susceptible people compared to the optimal control of fractional-order (~3.6e-04 vs. 47.4). This proposed NMPC of fractional-order can be used for other models of epidemics.

Hematological and biochemical markers and cytokine levels in hospitalized psychiatric patients with COVID-19

Background

Multiple lines of evidence indicate a connection between the pathogenesis of coronavirus disease 2019 (COVID-19) and psychiatric diseases (PDs). To improve the treatment and management of individuals with psychosis and COVID-19, we evaluated biomarkers of PD patients, including those with schizophrenia (SCZ), bipolar disorder (BD), and major depression (MDD), along with the biomarkers of COVID-19.

Methods

In this study, 104 inpatients with concurrent PD and COVID-19 (PD+), the same 104 PD patients after they had recovered from COVID-19 (PD-), and 97 healthy controls (HCs) were evaluated. We analyzed the peripheral blood hematological parameters, serum biochemical parameters, and cytokine levels of the participants and compared the results among the three groups.

Results

The monocyte count; neutrophil-to-lymphocyte ratio (NLR); monocyte-to-lymphocyte ratio (MLR); systemic immune-inflammation index (SII); and C-reactive protein (CRP), serum CK isoenzyme MB (CK-MB), glucose (GLU), and interleukin (IL)-6 levels were significantly greater (P < 0.05), whereas the magnesium (Mg) level was lower (P < 0.05) in both the PD+ and PD- groups than in the HC group. Moreover, the above indicators were significantly different between the PD+ and PD- groups (P < 0.05).

Conclusion

Neutrophil count, monocyte count, NLR, MLR, SII, CRP, CK-MB, GLU and IL-6 levels were positively correlated with COVID-19 and PD. The Mg level was negatively correlated with COVID-19 and PD. Our findings suggest that Mg supplementation might be considered a potential treatment approach for PD patients with COVID-19. Despite these insights, the underlying pathophysiological mechanisms remain unclear, highlighting the vital need for further research to validate and build upon these findings.

The immunopathogenesis of SARS-CoV-2 infection: Overview of lessons learned in the first 5 years

This review provides a broad overview of lessons learned in the five years since COVID-19 was identified. It is a bimodal disease, starting with an initially virus-driven phase, followed by resolution or ensuing inappropriate immune activation causing severe inflammation that is no longer strictly virus dependent. Humoral immunity is beneficial for preventing or attenuating the early stage, without benefit once the later stage begins. Neutralizing antibodies elicited by natural infection or vaccination are short-lived and highly vulnerable to viral sequence variation. By contrast, cellular immunity, particularly the CD8+ T cell arm, has a role in preventing or attenuating severe disease, is far less susceptible to viral variation, and is longer-lived than antibodies. Finally, an ill-defined phenomenon of prolonged symptoms after acute infection, termed "long COVID," is poorly understood but may involve various immunologic defects that are hyperactivating or immunosuppressive. Remaining issues include needing to better understand the immune dysregulation of severe disease to allow more tailored therapeutic interventions, developing antibody strategies that cope with the viral spike sequence variability, prolonging vaccine efficacy, and unraveling the mechanisms of long COVID to design therapeutic approaches.

Interferon-I modulation and natural products: Unraveling mechanisms and therapeutic potential in severe COVID-19

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to pose a significant global public health threat, particularly to older adults, pregnant women, and individuals with underlying chronic conditions. Dysregulated immune responses to SARS-CoV-2 infection are believed to contribute to the progression of COVID-19 in severe cases. Previous studies indicates that a deficiency in type I interferon (IFN-I) immunity accounts for approximately 15 %-20 % of patients with severe pneumonia caused by COVID-19, highlighting the potential therapeutic importance of modulating IFN-I signals. Natural products and their derivatives, due to their structural diversity and novel scaffolds, play a crucial role in drug discovery. Some of these natural products targeting IFN-I have demonstrated applications in infectious diseases and inflammatory conditions. However, the immunomodulatory potential of IFN-I in critical COVID-19 pneumonia and the natural compounds regulating the related signal pathway remain not fully understood. In this review, we offer a comprehensive assessment of the association between IFN-I and severe COVID-19, exploring its mechanisms and integrating information on natural compounds effective for IFN-I regulation. Focusing on the primary targets of IFN-I, we also summarize the regulatory mechanisms of natural products, their impact on IFNs, and their therapeutic roles in viral infections. Collectively, by synthesizing these findings, our goal is to provide a valuable reference for future research and to inspire innovative treatment strategies for COVID-19.

Variations in Food Safety Concerns, Hygiene Practices, and Purchasing Behaviors During Pandemic Era: What We Learnt from Coronavirus Disease 2019

The purpose of the study is to evaluate the food safety concerns, purchasing behaviors, and hygiene practices of individuals who contracted and did not contract the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. A total of 2393 individuals 18-65 years years of age, 760 who contracted and 1633 who did not contract SARS-CoV-2 infection, participated in the study. Participants were administered a questionnaire to assess demographic information, food safety concerns, hygiene practices, purchasing behavior, and fear of the coronavirus disease 2019 (COVID-19). Results indicated that 56.3% of participants expressed concern about food safety, and 67% were concerned about infected individuals while shopping. Participants who did not contract COVID-19 had higher levels of food safety concerns and generally adhered to better hygiene practices such as handwashing, hygienic food preparation, sanitizer use, and cleaning and disinfection practices (p < 0.05). Overall, purchasing behaviors did not significantly differ by the infection status, except for a significant difference in reduced purchase frequency (p < 0.001). In addition, purchasing behavior varied in relation to fear levels (p < 0.05). As the pandemic appears to be increasingly controlled, the insights gained from managing outbreaks might contribute to improved understanding and preparedness for global pandemics and food safety education in the future.

Oral Health Status and Dental Services Utilisation Among a Vulnerable Sample of Pregnant Women

INTRODUCTION AND AIMS

Oral health conditions during pregnancy can negatively impact both mother and fetus, highlighting the importance of maintaining dental care. In Canada, significant disparities exist between general and dental healthcare access, with limited evidence on oral health status and dental care utilisation among pregnant women. This study aimed to provide initial insights into self-perceived oral health status and dental utilisation patterns among a vulnerable sample of pregnant women in southwestern Ontario.

METHODS

This cross-sectional study recruited a convenient sample of pregnant women referred to the Family Medicine and Obstetrics Clinic, serving those without a family physician. Data were collected using a self-administered questionnaire adapted from the Canadian Health Measure Survey, the Canadian Community Health Survey, and the Survey of Maternal Health. Andersen and Newman's framework for health service utilisation was used as the theoretical framework. Descriptive and univariable analyses were conducted, followed by a forward stepwise selection of variables with p-values < 0.1 from the univariable analyses.

RESULTS

One-hundred-fifty patients were approached and 130 (86.7%) completed the questionnaire. Of these, 96 (73.9%) reported their oral health as good/excellent while 34 (26.2%) reported having poor/fair oral health. Education level and quality of life were the strongest predictors of oral health status. While 101 (77.7%) visited a dentist within the last 2 years, only 35 (26.9%) had a dental visit during pregnancy. Toothbrushing frequency was the main predictor of time since last dental visit, with no other predictive factors once toothbrushing was considered.

CONCLUSION

The study sample showed relatively positive self-perceived oral health and dental visit patterns. However, the low rate of dental visits during pregnancy highlights the need for better integration of dental care into prenatal care. To ensure maternal and child health, pregnant women should be a high priority in policies aimed at improving access to dental care.

Jerusalem's CoVID-19 Experience-The Effect of Ethnicity on Disease Prevalence and Adherence to Testing

BACKGROUND

The management of the SARS-CoV-2 pandemic depends amongst other factors on disease prevalence in the general population. The gap between the true rate of infection and the detected rate of infection may vary, especially between sub-groups of the population. Identifying subpopulations with high rates of undetected infection can guide authorities to direct resource distribution in order to improve health equity.

METHODS

A cross-sectional epidemiological survey was conducted between April and July 2021 in the Pediatric Emergency Department of the Shaare Zedek Medical Center, Jerusalem, Israel. We compared three categories: unconfirmed disease (UD), positive serology test result with no history of positive PCR; confirmed disease (CD), history of a positive PCR test result, regardless of serology test result; and no disease (ND), negative serology and no history of PCR. These categories were applied to local prevailing subpopulations: ultra-orthodox Jews (UO), National Religious Jews (NRJ), secular Jews (SJ), and Muslim Arabs (MA).

RESULTS

Comparing the different subpopulations groups, MAs and UOs had the greatest rate of confirmed or unconfirmed disease. MA had the highest rate of UD and UO had the highest rate of CD. UD significantly correlated with ethnicity, with a low prevalence in NRJ and SJ. UD was also associated with larger family size and housing density defined as family size per number of rooms.

CONCLUSION

This study highlights the effect of ethnicity on disease burden. These findings should serve to heighten awareness to disease burden in weaker populations and direct a suitable prevention program to each subpopulation's needs. Early awareness and possible intervention may lower morbidity and mortality.

Nasal Spray Disinfectant for Respiratory Infections Based on Functionalized Silver Nanoparticles: A Physicochemical and Docking Approach

Respiratory diseases have presented a remarkable challenge during modern history, contributing to important pandemics. The scientific community has focused its efforts on developing vaccines and blocking the transmission of viruses through the respiratory tract. In this study, we propose the use of stable silver nanoparticles (AgNPs) functionalized with tannic acid (TA) and sodium citrate (SC) as a nasal spray disinfectant (NSD). The non-ionic ethoxylated surfactant Tween 80 (T80) was added to enhance the wetting effect on nasal and oral tissues following spray application. We analyzed the physicochemical properties of the AgNPs and the NSD, including zeta potential, polarity, morphology, composition, particle size, and distribution. The results indicated spherical AgNPs ranging from 3 to 5 nm, stabilized by TA-SC. The addition of T80 resulted in particles with negative polarity, high stability, and improved coverage area. Furthermore, the colloidal stability was monitored over one year, showing no signs of degradation or precipitation. Interestingly, the interaction between the capped AgNP complex, the spike protein, and ACE2 was studied by molecular docking, indicating a strong and thermodynamically favorable complex interaction. These findings hold promise for the development of potential inhibitors, antagonist receptors, Ag-complex agonists (as observed here), and drug development for viral protection.

Pediatric Dental Emergency Visits and Treatment During Lockdown in the COVID-19 Pandemic: A Retrospective Analysis at the Pediatric Emergency Unit of the University Clinic of Dentistry, Vienna, Austria

Background: In the beginning of the COVID-19 pandemic, the Department of Pediatric Dentistry at the University Dental Clinic Vienna switched from routine medical care to emergency operation mode. The study aims to retrospectively compare the characteristics of pediatric patients' emergency visits before, during, and after lockdown. Methods: All pediatric emergencies that presented at the Department of Pediatric Dentistry in the period from the 7 January 2020 to the 31 July 2020 were recorded. Patients were subclassified into three groups with regard to their time of presentation (group 1: before lockdown, group 2: during lockdown, group 3: after lockdown). Then, pediatric patients' purposes for emergency visit, diagnoses, and the treatments practiced were compared. Results: The number of patients was significantly lower during lockdown but increased again afterward. During lockdown, significantly more patients presented with dental pain, the diagnosis "Extraction: tooth not restorable" increased, and extractions were significantly more often the treatment of choice (p < 0.05). Conclusions: The presented study is the first research on pediatric dental emergency visits during the first lockdown of the COVID-19 pandemic in Austria. The results highlight the negative impact of the pandemic on pediatric dental care as the number of treatments decreased, elective treatments were postponed, and the diagnosis and prognosis of teeth deteriorated.

Study on Gender-specific Population at Risk of Developing Dementia, Anxiety and Depression Following Exposure to COVID-19

Background

The identification of COVID-19 first occurred in January 2020. The rapid transmission of this virus across human populations has led to the emergence of a global pandemic known as COVID-19. Dementia, anxiety and depression are neurological disorders that impact several higher cognitive functions, such as memory, cognition, orientation, understanding, computation, learning ability, language and decision-making.

Purpose

This study aims to examine the impact of demographic factors on the occurrence of dementia, anxiety and depression in individuals who have recovered from a COVID-19 infection.

Methods

This study aims to investigate individuals who are at risk of developing dementia, anxiety and depression following exposure to COVID-19. Ethics Committee approval was obtained from hospital (Ethics Committee-Unique Hospital, Surat, India) and University Research Ethics Committee approval was obtained from Dehradun Institute of Technology University, Dehradun, India (DITU/UREC/2022/04/6). Patients willingly participated in the study and signed the ICF as per their preferred language. Patient data was obtained from the hospital with the assistance of medical staff. The study included patients who met the specific criteria for participation, as determined by the inclusion and exclusion criteria. Patients who satisfy the eligibility conditions were obligated to complete the questionnaire. The data was examined based on the subject's responses.

Results

Exposure to COVID-19 has been linked to a heightened susceptibility to developing mental health issues, such as anxiety, depression and even dementia. Studies have demonstrated that persons who have acquired COVID-19 are more prone to developing various psychiatric disorders in comparison to those who have not been infected. Individuals with dementia encountered a decline in cognitive function and a rise in neuropsychiatric symptoms, including restlessness, confusion, irritability and lack of motivation, amidst the epidemic. Research has indicated that persons experiencing mild cognitive impairment or dementia exhibited elevated levels of despair and anxiety amongst the epidemic.

Conclusion

In this research study on the gender-specific effects of COVID-19 exposure on high-risk persons, development of dementia, anxiety and depression offers important new insights into the complex ways that the pandemic has affected mental health in different genders.

COVID-19 and Transplant Patients: Challenges, Risks, and Evolving Strategies

The first cases of COVID-19 were reported in December 2019 in Wuhan, China [...].

The severity of pediatric COVID-19 during hospitalization is not associated with mortality within six months of discharge

BACKGROUND

COVID-19 has become a global pandemic. However, studies examining the outcomes for pediatric patients after hospital discharge, post-COVID-19, and the predictive factors influencing their high mortality rates, are still limited, especially in Indonesia. Therefore, this study aimed to determine the predictor that predict mortality six months after hospitalization for COVID-19.

METHODS

A retrospective cohort study was performed. The participants were children who were admitted to Dr. Sardjito General Hospital from February-April 2022. The inclusion criteria were pediatric patients who were hospitalized in the pediatric ward and discharged after recovering or completing isolation. COVID-19 hospitalization deaths and incomplete medical records were omitted from the study. Bivariate analysis was performed with chi-square log rank test. Kaplan-Meier method was used for calculating the cumulative survival between comparison groups of the predictor variables. Multivariate analysis was performed with a Cox regression. The relationships between the variables are presented as the Hazard ratios (HRs), confidence intervals of 95% (95%CI), and statistical significance levels, with p < 0.05.

RESULTS

Among the 114 patients studied, the mortality rate during the six months after COVID-19 was 29.8%. The multivariate analysis revealed that mortality was correlated with comorbidities (p < 0.021; HR 11.415; CI 95% 1.449-89.912) and obesity (p = 0.032; HR 4.617; CI 95% 1.139-18.721).

CONCLUSION

The presence of comorbidities and obesity are significant predictors of mortality in pediatric patients with COVID-19 within six months following hospital discharge.

CLINICAL TRIAL NUMBER

Not applicable.

Malabaricone C isolated from edible plants as a potential inhibitor of SARS-CoV-2 infection

Although the SARS-CoV-2 epidemic worldwide has gradually decreased, in some areas, the situation has not yet been stamped and has become a global health emergency. It is quite possible that we could again be threatened by a new coronavirus. Therefore, new nucleotide analog drugs and vaccines or using drug repositioning for SARS-CoV-2 still has been developed, yet their safety and efficacy against COVID-19 remains underexplored. Malabaricone C is 2,6-dihydroxyphenyl acylphenol found in edible plants such as the mace spice of nutmeg derived from the seeds of Myristica fragrans. In this study, we identified malabaricone C as the first inhibitor of SARS-CoV-2 from natural food with a safe alternative for drugs. Malabaricone C and its chemical derivatives showed EC50 values of 1-1.5 μM against SARS-CoV-2 (WK-521, ancestral strain) and its variant strains in mammalian cells (HEK293T and Vero E6). In addition, we have successfully established novel evaluation system for the inhibition of SARS virus cell fusion by visualization for providing a versatile tool for study SARS-CoV-2 mediated fusion. Furthermore, our experiments suggested that malabaricone C could affect the distribution of sphingomyelin on the plasma membrane, which involves in viral infections. Thus, in light of the beneficial effect of malabaricone C on viral infection, the nontoxic malabaricone C is a suitable candidate as a drug that can be employed in the treatment and prevention of COVID-19. Moreover, it may potentially be used to treat acute infections of other enveloped viruses.

Effectiveness of HIV health education interventions on the MSM population: a meta-analysis

Men who have sex with men (MSM) face a heightened risk of HIV, presenting a significant public health issue. This meta-analysis evaluates the effectiveness of HIV health education for MSM by examining changes in knowledge, attitudes, and behaviors across different cultures and regions. The study also explores heterogeneity sources through subgroup and sensitivity analyses to guide future research. Searches were conducted in databases including China Knowledge, Wipo, Wanfang, PubMed, and Web of Science, covering studies up to December 1, 2023. Included were controlled pre-post trials on HIV education's impact on MSM. Independent data extraction and analysis were completed by two researchers using RevMan 5.7. Pre-registration was done with PROSPERO. Twenty-seven studies met criteria. Post-intervention, significant improvements were noted in HIV knowledge (OR: 0.49; 95% CI: 0.44-0.56), condom use over six months (OR: 0.47; 95% CI: 0.38-0.58), and condom use in recent same-sex encounters (OR: 0.44; 95% CI: 0.29-0.66). Larger samples (>500) or long-term interventions (>1 year) enhanced homogeneity (I2 = 0%). In conclusion, these interventions significantly boost knowledge and condom use, identifying sample size and intervention duration as primary heterogeneity influences, guiding future strategy optimization.

Exploring the Preventive Potential of Solubilized Sturgeon Oil on Acute Infection with Respiratory Viruses

Acute respiratory viral infections (ARIs) represent a significant global health challenge, contributing heavily to worldwide morbidity and mortality rates. Recent efforts to combat ARIs have focused on developing nasal spray formulations that effectively target the nasal mucosa. However, challenges such as irritation, discomfort, and safety concerns highlight the need for natural, eco-friendly ingredients. In this study, we evaluated the efficacy of solubilized sturgeon oil (SSO), prepared as an oil-in-water nanoemulsion from Siberian sturgeon, as an eco-friendly preventive nasal spray agent against ARIs. Intranasal pre-treatment with SSO effectively inhibited respiratory infections caused by SARS-CoV-2, influenza A virus (IAV), and respiratory syncytial virus (RSV). Additionally, it suppressed viral replication in both nasal and lung tissues. This antiviral effect was linked to reduced pulmonary inflammation, characterized by decreased infiltration of Ly-6C+ monocytes and Ly-6G+ neutrophils, along with lower pro-inflammatory cytokine levels. Histopathological analyses confirmed that nasal SSO administration significantly mitigated lung inflammation progression caused by viral infections. Notably, the protective effects of SSO against SARS-CoV-2, IAV, and RSV persisted for at least six hours following nasal application. These findings highlight SSO as a promising eco-friendly and safe candidate for nasal spray formulations, providing a potential frontline defense against ARIs.

Evaluation of the effects of pre-exposure treatment with hydroxychloroquine on the risk of COVID-19 infection and on the efficacy of anti-COVID-19 vaccination during lupus or Gougerot-Sjögren's disease: Prepcov multicentre trial

OBJECTIVES

Some patients with SLE or Gougerot-Sjögren's disease (GSD) receive long-term treatment with hydroxychloroquine (HCQ), sometimes combined with immunosuppressive therapy (IS). This study sought to assess whether long-term HCQ therapy that had been initiated long before the COVID-19 pandemic had a protective or adverse effect on COVID-19 risk, severity of infection or immunity protection.

METHODS

This prospective multicentre study included 547 patients with SLE, GSD, autoimmune hepatitis, primary biliary cholangitis or cured viral hepatitis C divided into four groups according to HCQ (+/-) and IS (+/-) intake prior to the pandemic: HCQ+IS+ (n=112), HCQ+IS- (n=121), HCQ-IS+ (n=115) and HCQ-IS- (n=199). When COVID-19 vaccination was possible, patients were vaccinated as recommended. Vaccination efficacy was prospectively assessed on the basis of the postvaccination antibody titre.

RESULTS

Compared with HCQ+IS+ patients, HCQ-IS+ patients had a decreased risk of COVID-19 infection (p<0.001). Compared with HCQ+IS+ patients, HCQ-IS- patients had a decreased risk of contracting COVID-19 (p<0.001). Patients in the HCQ-IS+ or HCQ-IS- group had a lower risk of symptomatic or severe infection than HCQ+IS+ patients did (p=0.001 and p<0.001, respectively). Only patients who had two or more exposures (to vaccine and/or infection) had an increased likelihood of COVID-19 immunity after the last dose (p<0.001).

CONCLUSIONS

HCQ treatment that was initiated before the pandemic did not protect against COVID-19 infection. Moreover, non-exposure to HCQ treatment (combined or not with IS) was associated with decreased risk of COVID-19 infection and of developing a symptomatic or severe infection. HCQ and IS do not influence the vaccine response. Only two or more doses of vaccine result in a good vaccine response.

TRIAL REGISTRATION NUMBER

NCT04481633.

Thromboembolic Events in the Era of COVID-19: A Detailed Narrative Review

COVID-19, caused by the SARS-CoV-2 virus, is not only characterized by respiratory symptoms but is also associated with a wide range of systemic complications, including significant hematologic abnormalities. This is a comprehensive review of the current literature, using PubMed and Google Scholar, on the pathophysiology and incidence of thromboembolic events in COVID-19 patients and thromboprophylaxis. COVID-19 infection induces a prothrombotic state in patients through the dysregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, elevated von Willebrand factor (vWF), and a dysregulated immune response involving the complement system and neutrophil extracellular traps (NETs). As a result, thromboembolic complications have emerged in COVID-19 cases, occurring more frequently in severe cases and hospitalized patients. These thrombotic events affect both venous and arterial circulation, with increased incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), systemic arterial thrombosis, and myocardial infarction (MI). While DVT and PE are more common, the literature highlights the potential lethal consequences of arterial thromboembolism (ATE). This review also briefly examines the ongoing discussions regarding the use of anticoagulants for the prevention of thrombotic events in COVID-19 patients. While theoretically promising, current studies have yielded varied outcomes: Some suggest potential benefits, whereas others report an increased risk of bleeding events among hospitalized patients. Therefore, further large-scale studies are needed to assess the efficacy and safety of anticoagulants for thromboprophylaxis in COVID-19 patients.

Enterprise-led internet healthcare provision in China: insights from a leading platform

Background

China's healthcare resources are limited and unevenly distributed, with a notable urban-rural gap. Enterprise-led internet healthcare platforms have become an important solution for optimizing resource allocation, improving accessibility, and enhancing efficiency in mainland China. However, detailed analysis of their online consultation services from both healthcare provider and patient perspectives is still lacking.

Objective

The online consultation data of an enterprise-led internet healthcare platform was depicted and analyzed to understand the temporal trend and current situation of enterprise-led internet healthcare development in mainland China, which provided insights for the further development of internet healthcare.

Methods

We gathered information from an enterprise-led internet healthcare platform (i.e., Good Doctor Online) covering the period from January 2008 to December 2022, including the characteristics of doctors, healthcare institutions, and patients. Based on the above data, we sketched and analyzed the situation of online consultation services provided by the enterprise-led internet healthcare platform in mainland China.

Results

A total of 149,890 doctors from 7,584 healthcare institutions provided 40,462,801 online consultations from January 2008 to December 2022. Doctors and healthcare institutions providing online consultation services were primarily distributed in the economically developed eastern and southern provinces of China. Doctors with intermediate (30.15%) and senior titles (58.12%) were the main providers of online consultations and most doctors were from tertiary hospitals (88.18%). The consultation price {median [interquartile range (IQR)]} was 49.00 (15.00, 100.00) RMB. The health issues with the highest consultation frequency included upper respiratory tract infections or fever (16.19%), gynecological disorders (11.98%), and skin diseases (8.65%), with variations in gender and age. The age distribution of patients showed two peaks in age groups <5 years and 20-39 years, with the median age (IQR) 29.00 (19.00-43.00) years.

Conclusions

Enterprise-led internet healthcare platforms enhance access to care and reduce offline resource strain, especially during COVID-19. They mainly address non-urgent conditions but cannot fully replace in-person care. Policies should focus on increasing elderly participation, engaging senior doctors, optimizing male-oriented services, expanding access to underserved areas, standardizing pricing, and broadening insurance reimbursement coverage to improve equity and sustainability.

Decoding the SARS-CoV-2 infection process: Insights into origin, spread, and therapeutic approaches

Globally, over 768 million confirmed cases and 6.9 million deaths had been documented as of July 17, 2023. Coronaviruses have a relatively large RNA genome. As with other viruses, SARS-CoV-2 does have an envelope film produced from host cells that are assisted by virally encoded glycoproteins that are required for infectivity, immunological assault, and viral particle production. Although the intermediate source of origin and transmission to humans is unexplained, rapid transmission from human to human has been established. This review focuses on the mechanistic framework for understanding the SARS-CoV-2 viral infection. Additionally, it discusses the origins and implications of COVID-19 using direct quotations from the published scientific literature to avoid misinterpretation of this catastrophic event that resulted in a massive loss of human life and impact on the global economy. The current available information unfolds large number of topics related with COVID-19 and/or the coronavirus (SARS-CoV-2) responsible of the disease. This review article also delves into the multifaceted aspects of COVID-19 and SARS-CoV-2, with a specific focus on a controversial yet essential issue: the possible association between SARS-CoV-2's origin and aldose reductase, an enzyme known for its role in diabetic retinopathy. Exploring this connection holds utmost significance, offering valuable insights into COVID-19's pathogenesis and unlocking new avenues for therapeutic interventions. It is important to trace back the evolution of coronaviruses and reveal the possible origin of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19).

Investigation of the mutated antimicrobial peptides to inhibit ACE2, TMPRSS2 and GRP78 receptors of SARS-CoV-2 and angiotensin II type 1 receptor (AT1R) as well as controlling COVID-19 disease

SARS-CoV-2 is a global problem nowadays. Based on studies, some human receptors are involved in binding to SARS-CoV-2. Thus, the inhibition of these receptors can be effective in the treatment of Covid-19. Because of the proven benefits of antimicrobial peptides (AMPs) and the side effects of chemical drugs, they can be known as an alternative to recent medicines. RCSB PDB to obtain PDB id, StraPep and PhytAMP to acquire Bio-AMPs information and 3-D structure, and AlgPred, Toxinpred, TargetAntiAngio, IL-4pred, IL-6pred, ACPred and Hemopred databases were used to find the best score peptide features. HADDOCK 2.2 was used for molecular docking analysis, and UCSF Chimera software version 1.15, SWISS-MODEL and BIOVIA Discovery Studio Visualizer4.5 were used for mutation and structure modeling. Furthermore, MD simulation results were achieved from GROMACS 4.6.5. Based on the obtained results, the Moricin peptide was found to have the best affinity for ACE2. Moreover, Bacteriocin leucocin-A had the highest affinity for GRP78, Cathelicidin-6 had the best affinity for AT1R, and Bacteriocin PlnK had the best binding affinity for TMPRSS2. Additionally, Bacteriocin glycocin F, Bacteriocin lactococcin-G subunit beta and Cathelicidin-6 peptides were the most common compounds among the four receptors. However, these peptides also have some side effects. Consequently, the mutation eliminated the side effects, and MD simulation results indicated that the mutation proved the result of the docking analysis. The effect of AMPs on ACE2, GRP78, TMPRSS2 and AT1R receptors can be a novel treatment for Covid-19.Communicated by Ramaswamy H. Sarma.

Early Identification of Severe COVID-19 Cases and the Need for ICU Care Based on Clinical and Laboratory Risk Factors

Background and objective Treatment in ICUs became extremely difficult due to the growing number of coronavirus disease 2019 (COVID-19) patients at the height of the pandemic. Consequently, prompt patient triage depends on the early categorization of severe cases in such scenarios. This study aimed to provide an evidence-based strategy to ensure the best use of resources by triaging patients based on objective risk factors. Methods This retrospective observational study comprised 500 inpatients (>age 18 years) who were hospitalized between March 20 and April 19, 2020, at the Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC) in Peshawar, Pakistan. The clinical, laboratory, and radiological parameters were assessed. Real-time polymerase chain reaction (RT-PCR) findings were used to confirm the diagnosis of COVID-19. Results A total of 19 potential clinical and laboratory risk factors associated with ICU admissions were identified. At least one comorbidity among chronic lung disease, cardiovascular disease (CVD), and diabetes was the factor with the strongest association with ICU admission with a univariable odds ratio (OR) of over 27, followed by renal disease and other COVID-19 sequelae such as diarrhea, respiratory rate (>24 breaths/minute), and positive RT-PCR (vs. negative) with an univariable OR between 9 and 15. Furthermore, a multivariate logistic regression model was further developed with five risk factors, including comorbidity, presence of chronic lung disease, presence of diabetes, and RT-PCR (positive vs. negative), male sex (vs. female), and older age (65.0-80.5 years), suggesting a good fit of the model to the data shown by the area under the receiver operator characteristic curve (AUC) of 0.943 (95% CI: 0.917, 0.969). Additionally, a chest CT scan showed the typical COVID-19 pneumonia with pulmonary involvement of 30-40%, which was further evaluated by the COVID-19 Reporting and Data System (CO-RADS). The typical COVID-19 pneumonia was on a scale of four (15/25) or five (19/25) lung lesions. Conclusions Based on our findings, this approach could be used to screen the severe cases of COVID-19 patients and help them to be treated in ICUs on time while preventing others from unnecessarily using ICUs in the setting of limited medical resources, such as the outbreak of a pandemic.

Insights into the epidemiology and clinical aspects of post-COVID-19 conditions in adult

ObjectivesWhile most individuals infected with COVID-19 recover completely within a few weeks, some continue to experience lingering symptoms. This study was conducted to identify and describe the clinical and subclinical manifestations of adult patients from the long-term effects of COVID-19.MethodsThe study analyzed 205 medical records of inpatients (age ≥ 16 years, ≥ 4 weeks post-COVID-19 recovery, and a negative SARS-CoV-2 status at enrollment) at Thong Nhat Hospital, Vietnam, from 6 September 2021 to 26 August 2022, using R language software.ResultsThe majority of patients hospitalized with long COVID-19 symptoms (92.68%) had normal consciousness. The most common symptoms on admission were fatigue (59.02%), dyspnea (52.68%), and cough (42.93%). In total, 80% of patients observed respiratory symptoms, primarily dyspnea, while 42.44% reported neurological symptoms, with sleep disturbance being the most common. Noticeably, 42.93% of patients experienced respiratory failure in the post-COVID-19 period, resembling acute respiratory distress syndrome.DiscussionThese findings provide crucial insights into the epidemiology, clinical, and subclinical aspects of post-COVID-19 conditions, shedding light on the prevalence of common symptoms and the demographic distribution of affected patients. Understanding these manifestations is vital for patient well-being, improved clinical practice, and targeted healthcare planning, potentially leading to better patient care, management, and future interventions.

Analysis of inoculation strategies during COVID-19 pandemic with an agent-based simulation approach

BACKGROUND

The severity of recent Coronavirus (COVID-19) pandemics has revealed the importance of development of inoculation strategies in case of limited vaccine availability. Authorities have implemented inoculation strategies based on perceived risk factors such as age and existence of other chronic health conditions for survivability from the disease. However, various other factors can be considered for identifying the preferred inoculation strategies depending on the vaccine availability and disease spread levels. This study explores the effectiveness of inoculating different groups of population in case of various vaccine availabilities and disease spread levels by means of some performance metrics namely: Attack Rate (AR), Death Rate (DR) and Hospitalization Rate (HR).

METHOD

In this study we have implemented a highly detailed Agent-Based Simulation (ABS) model that extends classical SEIR Model by including five more additional states: Asymptomatic (A), Quarantine (Q), Hospitalized (H), Dead (D) and Immune (M) which can be used as a decision support tool to prioritize the groups of the population inoculated. The approach employs the modelling of daily mobility of individuals, their interactions and transmission of virus among individuals. The population is heterogeneously clustered according to age, family size, work status, transportation and leisure preferences with 17 different groups in order to find the most appropriate one to inoculate. Three different Disease Spread Levels (DSL) (low, mid, high) are experimented with four different Vaccine Available Percentages (VAP) (25%, 50%, 75% and 85%) with a total of 84 scenarios.

RESULTS

As the benchmark, under the No Vaccine case Attack Rate, Hospitalization Rate, and Death Rate goes as high as 99.53%, 16.96%, and 1.38%, respectively. Corresponding highest performance metrics (rates) are 72.33%, 15.95%, and 1.35% for VAP = 25%; 50.25%, 9.55%, and 0.94% for VAP = 50%; 24.53%, 2.62%, and 0.25% for VAP = 75%; and 11.51%, 0.002%, and 0.08% for VAP = 85%. The results of our study shows that the common practice of inoculation based on the age of individual does not yield the best outcome in terms of performance metrics across all DSL and VAP values. The groups containing workers and students that represent highly interactive individuals, i.e. Group (9, 10), Group (9, 11, 10‾) and Group (9, 10, 11, 12‾) emerge as a commonly recommended choice for inoculation in the majority of cases. As expected, we observe that the higher is the VAP levels the more is the number of alternative inoculation groups.

CONCLUSIONS

Findings of this study present that: (i) inoculation considerably decreases the number of infected individuals, the number of deaths and the number of hospitalized individuals due to the disease, (ii) the best inoculation group/groups with respect to performance metrics varies depending on the vaccine availability percentages and disease spread levels, (iii) simultaneous implementation of both inoculation and precautions like lock-down, social distances and quarantines, yields a stronger impact on disease spread and its consequences.

Serum Lactate Dehydrogenase Levels Reflect the Lung Injury Extension in COVID-19 Patients at Hospital Admission

BACKGROUND

Several hematological and biochemical parameters have been related to the COVID-19 infection severity and outcomes. However, less is known about clinical indicators reflecting lung involvement of COVID-19 patients at hospital admission. Computed tomography (CT) represents an established imaging tool for the detection of lung injury, and the quantitative analysis software CALIPER has been used to assess lung involvement in COVID-19 patients. Herein, the relationship between the lung involvement expressed by CALIPER interstitial lung disease (ILD) percentage and a set of blood parameters related to tissue oxygenation and damage in COVID-19 patients at hospital admission was evaluated.

METHODS

We performed a retrospective and a prospective study involving 321 and 75, respectively, COVID-19-positive patients recruited from Pisa University Hospital. The association between CALIPER ILD percentages and selected blood parameters was investigated by a regression tree approach, after multiple imputations of the dataset missing values.

RESULTS

High serum lactate dehydrogenase (LDH) values appeared to be predictive of high CALIPER ILD percentages at hospital admission in both retrospective and prospective datasets, even if the predictive performance of the algorithm was not optimal.

CONCLUSIONS

LDH levels could be evaluated as a tool for early identification of COVID-19 patients at risk of extensive lung injury, as well as in fast screening procedures before hospitalization.

[Validated clinical prediction model for mortality from COVID-19 in hospitalized patients. What is truly important?]

OBJECTIVE

To develop and validate a clinical prediction model aimed at improving resource management and determining the prognosis of patients hospitalized with COVID-19.

MATERIALS AND METHODS

A retrospective, single-center cohort study conducted at the University Hospital of Guadalajara, including 1,043 patients hospitalized with COVID-19 between March and May 2020. Data were extracted from hospital records and anonymized. Demographic, clinical, laboratory, radiological, and therapeutic variables were collected, and statistical analysis was performed to identify factors associated with mortality. Logistic regression and Cox models were employed to evaluate mortality predictors. Validation was conducted by comparing ROC curves.

RESULTS

The median age of the patients was 70.4years (P25-P75: 59-84), with 59.2% being male, and a mortality rate of 23.2%. The most common comorbidities were hypertension (54.8%), dyslipidemia (36.3%), and diabetes (27.1%). Independent predictors of mortality included age over 80years (OR: 6.18), chronic obstructive pulmonary disease (OR: 2.35), oxygen saturation <90% (OR: 1.7), multilobar pneumonia (OR: 2.4), and elevated LDH levels (OR: 1.2). The area under the curve (AUC) for the derivation model was 0.805 (P<.001), and for the validation model, the AUC was 0.78 (P<.001).

CONCLUSIONS

Advanced age, chronic obstructive pulmonary disease, low oxygen saturation, multilobar pneumonia, and elevated LDH levels are significantly associated with increased mortality risk. The validated predictive model enables classification of patients into high- or low-risk groups, thereby facilitating improved clinical decision-making and resource management.

Identification of antiviral RNAi regulators, ILF3/DHX9, recruit at ZIKV stem loop B to protect against ZIKV induced microcephaly

Zika virus (ZIKV) is a member of the Flaviviridae family and causes congenital microcephaly and Guillain-Barré syndrome. Currently, there is a lack of approved vaccines or therapies against ZIKV infection. In this study, we profile vRNA‒host protein interactomes at ZIKV stem‒loop B (SLB) and reveal that interleukin enhancer binding factor 3 (ILF3) and DEAH-box helicase 9 (DHX9) form positive regulators of antiviral RNA inference in undifferentiated human neuroblastoma cells and induced pluripotent stem cell-derived human neural stem cells (iPSC-NSCs). Functionally, ablation of ILF3 in brain organoids and Nestin-Cre ILF3 cKO foetal mice significantly enhance ZIKV replication and aggravated ZIKV-induced microcephalic phenotypes. Mechanistically, ILF3/DHX9 enhance DICER processing of ZIKV vRNA-derived siRNAs (vsiR-1 and vsiR-2) to exert anti-flavivirus activity. VsiR-1 strongly inhibits ZIKV NS5 polymerase activity and RNA translation. Treatment with the vsiR-1 mimic inhibits ZIKV replication in vitro and in vivo and protected mice from ZIKV-induced microcephaly. Overall, we propose a novel therapeutic strategy to combat flavivirus infection.

Assessing the causal association between 731 immunophenotypes and the risk of colorectal cancer: a Mendelian randomization study

BACKGROUND

Emerging research suggested a potential role of immune cells in colorectal cancer (CRC) development. However, the causal relationship between immune phenotypes and CRC remains elusive. Hence, this two-sample Mendelian randomization (MR) study aimed to explore the causal association.

METHODS

In this study, a bidirectional, two-sample MR analysis and multivariate MR was conducted, leveraging public genetic data. Four types of immune phenotypes were employed. A comprehensive sensitivity analysis was carried out to validate the robustness, heterogeneity, and horizontal pleiotropy of the results, with Bonferroni correction applied for accurate interpretation.

RESULTS

It was revealed that four immune cell phenotypes were significantly associated with CRC risk. Specifically, lymphocyte % leukocyte in the T-cell/B-cell/NK-cell (TBNK) group (odds ratio (OR) = 1.0013, 95% confidence interval (CI): 1.0005-1.0017, P = 0.0003, PBonferroni = 0.011) and CD3 on CM CD8br in the maturation stages of T cell group (OR = 1.0014, 95% CI: 1.0006-1.0022, P = 0.0007, PBonferroni = 0.023) were positively correlated with the risk of CRC. Conversely, DN (CD4-CD8-) %leukocyte in the TBNK group (OR = 0.9990, 95% CI: 0.9984-0.9997, P = 0.0020, PBonferroni = 0.063) and herpesvirus entry mediator (HVEM) on CD8br in the maturation stages of T cell group (OR = 0.9989, 95% CI: 0.9982-0.9997, P = 0.00431, PBonferroni = 0.137) exhibited a negative association with the risk of CRC. This study did not detect any statistically significant impact of CRC on immune phenotypes.

CONCLUSIONS

This study inferred an association between immune cells and CRC risk. Nevertheless, further clinical and experimental studies are warranted to validate these findings and elucidate the underlying mechanisms.

Long-term outcomes of mesenchymal stem cell therapy in severe COVID-19 patients: 3-year follow-up of a randomized, double-blind, placebo-controlled trial

BACKGROUND

The long-term effects and outcomes of human mesenchymal stem cell (MSC) therapy in patients with severe coronavirus disease 2019 (COVID-19) remain poorly understood. This study aimed to evaluate the extended safety and efficacy of MSC treatment in severe patients with COVID-19 who participated in our earlier randomized, double-blind, placebo-controlled clinical trial, with follow-up conducted over 3 years.

METHODS

One hundred patients with severe COVID-19 were randomized to receive either an MSC infusion (n = 65, 4 × 107 cells/dose, on days 0, 3, and 6) or a placebo, with both groups receiving the standard of care. At 36 months post-MSC therapy, patients were followed up to long-term safety and efficacy, particularly the effects of MSC therapy on persistent COVID-19 symptoms. Evaluated outcomes included lung imaging results, 6-min walking distance (6-MWD), pulmonary function test results, quality of life scores based on the Short Form-36 (SF-36) health survey, Long COVID symptoms, new-onset comorbidities, tumor marker levels, and rates of COVID-19 reinfection.

RESULTS

Three years post-treatment, 46.94% (23/49) of patients in the MSC group and 34.48% (10/29) in the placebo group showed normal findings on computed tomography (CT) images (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 0.65-4.34). The general health (GH) score from the SF-36 was higher in the MSC group (67.0) compared to the placebo group (50.0), with a difference of 12.86 (95% CI: 1.44-24.28). Both groups showed similar results for total lung severity scores (TSS), 6-MWD, pulmonary function tests, and Long COVID symptoms. No significant differences between groups were observed in new-onset complications (including tumorigenesis) or tumor marker levels. After adjusting for China's dynamic zero-COVID-19 strategy, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection rates were 53.06% (26/49) in the MSC group and 67.86% (19/28) in the placebo group (OR = 0.54, 95% CI: 0.20-1.41).

CONCLUSIONS

These findings support the long-term safety of MSC therapy in patients with severe COVID-19 over 3 years. MSC treatment may offer potential benefits for lung recovery and improved quality of life in patients experiencing Long COVID symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04288102. Registered 28 February 2020, https://clinicaltrials.gov/study/NCT04288102 .

modelSSE: An R Package for Characterizing Infectious Disease Superspreading from Contact Tracing Data

Infectious disease superspreading is a phenomenon where few primary cases generate unexpectedly large numbers of secondary cases. Superspreading, is frequently documented in epidemiology literature, and is considered a consequence of heterogeneity in transmission. Since understanding the risks of superspreading became a rising concern from both statistical modelling and public health aspects, the R package modelSSE provides comprehensive analytical tools to characterize transmission heterogeneity. The package modelSSE integrates recent advances in statistical methods, such as decomposition of reproduction number, for modelling infectious disease superspreading using various types and sources of contact tracing data that allow models to be grounded in real-world observations. This study provided an overview of the theoretical background and implementation of modelSSE, designed to facilitate learning infectious disease transmission, and explore novel research questions for transmission risks and superspreading potentials. Detailed examples of classic, historical infectious disease datasets are given for demonstration and model extensions.

A compact, palm-sized isothermal fluorescent diagnostic intelligent IoT device for personal health monitoring and beyond via one-tube/one-step LAMP-CRISPR assay

The demand for accurate, user-friendly, and sensitive at-home nucleic acid testing solutions is rising due to occasional outbreaks of various infectious diseases and a growing desire for an improved quality of life. In response, we developed the WeD-mini, a compact, palm-sized isothermal fluorescent diagnostic IoT device that weighs just 61 g. The WeD-mini features a uniquely designed, highly sensitive optical sensing system, ultra-low power consumption, a minimalist industrial design, and an intelligent operating algorithm. It integrates real-time fluorescence detection and automatic result interpretation via a smartphone, with results seamlessly uploaded to the 'EzDx Cloud' for comprehensive health management and spatio-temporal disease mapping. The device supports various assays that operate at different temperatures and with varying fluorescence emission intensities, such as RPA (39 °C, low intensity), LAMP (65 °C, high intensity), and LAMP-PfAgo (65/95 °C, high intensity), while maintaining precise temperature control and exceptional fluorescence detection sensitivity. Additionally, we engineered a more thermostable AapCRISPR-Cas12b variant that operates effectively at 63 °C, enhancing compatibility with LAMP to create a robust One-Tube/One-Step LAMP-CRISPR assay. Adaptable for at-home testing of SARS-CoV-2 and influenza viruses, the WeD-mini achieved 100% sensitivity and specificity with the newly established One-Tube/One-Step LAMP-CRISPR assay. Furthermore, the WeD-mini shows potential applications in detecting meat adulteration, monitoring respiratory diseases in pets, and conducting wastewater surveillance, making it suitable for a wide range of personal and public health use cases.

Association of Serum Irisin With Severity and Prognosis in Patients With Coronavirus Disease 2019: A Prospective Cohort Study

Background

Irisin is the cleaved form of fibronectin type III domain-containing protein 5 (FNDC5), which can confer antioxidant and anti-inflammatory effects. Several studies have revealed that irisin can alleviate lung injury and affect the pathology of coronavirus disease 2019 (COVID-19). The aim of this study was to assess the relationships of serum irisin with the severity and prognosis of COVID-19.

Methods

A total of 328 COVID-19 patients were recruited. Peripheral blood samples were collected. The level of serum irisin was determined by ELISA. The associations of serum irisin with COVID-19 severity and prognosis were evaluated through linear and logistic regression models on the basis of a prospective cohort study.

Results

Serum irisin levels were lower in severe patients than in mild patients. The level of serum irisin was gradually decreased with the worsening of COVID-19. Spearman correlation analysis revealed that serum irisin concentration was inversely correlated with several clinical characteristics. Moreover, linear and logistic regression analyses revealed that serum irisin concentration was negatively correlated with the severity score. Interestingly, chronic heart and kidney diseases significantly affected the associations between serum irisin and severity scores. The results of the follow-up study suggested that the level of serum irisin upon admission was reduced in patients who died within one month of hospitalization. A lower serum irisin level at admission increased the risk of death within one month.

Conclusion

Serum irisin levels at admission were negatively correlated with disease severity and prognosis, suggesting that irisin is involved in the pathological process of COVID-19. Serum irisin may be used as a biomarker for diagnostic and prognostic assessment of COVID-19.

Analysis of antibacterial drug use and bacterial resistance in psychiatric hospital in the epidemic

Analyze the use of antibacterial drugs and bacterial resistance in psychiatric hospital during the epidemic. Using the hospital information system and the National Antibacterial Drug Clinical Application Monitoring Network, we retrospectively collected data on the use of antibacterial drugs and bacterial resistance in psychiatric hospitals during the 2022 epidemic. During the 2022 epidemic, our hospital had an antibiotic use rate of 5.00%, a usage intensity of 3.07, a combined medication rate of 11.11%, a cumulative DDDs of 12,039.04, and antibiotic costs accounting for 3.95% of total drug costs. These are much lower than the levels in Jiangsu Province and nationwide. However, the rate of microbiological submission for antibacterial drug use was 77.78%, higher than that of Jiangsu Province and nationwide. The main antibiotics used in our hospital were third-generation cephalosporins, penicillins, and quinolone antibiotics, with the most commonly used being cefodizime, amoxicillin, and piperacillin-tazobactam. The results showed that Gram-negative bacteria mainly exhibited resistance to penicillins, cephalosporins, and quinolones, especially ampicillin, amoxicillin-clavulanic acid, ceftazidime, ceftriaxone, amikacin, and ciprofloxacin. Gram-positive bacteria mainly resisted penicillins, macrolides, and quinolones, especially penicillin, benzylpenicillin, erythromycin, levofloxacin, and ciprofloxacin. This study reveals a complex relationship between the rational use of antibacterial drugs and bacterial resistance in the psychiatric hospital. Although antimicrobial usage during the pandemic was generally appropriate, increased use in psychiatric settings correlated with rising bacterial resistance, thereby impacting treatment outcomes and patient prognosis. Therefore, it is recommended to enhance monitoring of bacterial resistance and regularly analyze resistance data to optimize antimicrobial use in psychiatric hospitals. This approach aims to ensure effective treatment while minimizing the development of resistant strains, ultimately improving the overall value of healthcare services.

Psychosocial and mental health status among older adults in China during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. During the virus's spread and subsequent lockdowns, older adults faced heightened risks and significant mental health challenges.

METHODS

A cross-sectional study was conducted in Shandong Province, China, using a custom-designed demographic questionnaire, a COVID-19-related survey, and the Symptom Checklist-90 Revised (SCL-90-R). Correspondence analysis and multiple linear regression models were employed to examine factors influencing the mental health of older adults.

RESULTS

Among 3363 older adults, the total SCL-90-R score was 153.11 ± 36.98, with an average score of 1.70 ± 0.41. Both scores were lower than the Chinese norm and pre-pandemic levels. Factors significantly affecting older adults' mental health included place of residence, age, educational attainment, marital status, fear of COVID-19, understanding of COVID-19 transmission routes, and awareness of preventive measures.

CONCLUSIONS

Greater attention is needed to address the mental health of older adult males, individuals of advanced age, employed individuals, those with lower educational backgrounds, and those without a spouse. Policymakers should implement targeted policies and interventions to enhance mental health support for older adults.

Decarceration and COVID-19 infections in U.S. Immigration and Customs Enforcement detention facilities: a simulation modeling study

Background

U.S. Immigration and Customs Enforcement (ICE) facilities had high rates of COVID-19 infections and mortality during the global pandemic. We sought to quantify how many COVID-19 infections could have been averted through different decarceration strategies.

Methods

We developed a set of stochastic simulation models of SARS-CoV-2 transmission in ICE facilities. Employing incremental mixture importance sampling (IMIS), we calibrated them to empirical targets derived from publicly available case time series for ICE facilities, and publicly available facility population censuses prior to vaccine availability (May 6, 2020 to December 31, 2020). The models included infection importation from extra-facility sources. We evaluated reduction of the incarcerated population by 10-90%. People who were decarcerated faced background cumulative risks of infection and detection based on a weighted average of county-level estimates from the covidestim model, which is a Bayesian evidence synthesis model.

Findings

Without decarceration, the infection rate was 5.05 per 1000 person-days (95% CrI 3.40-6.81) and case rate was 1.53 per 1000 person-days (95% CrI 1.04-2.02). Rates declined linearly when decarceration did not reduce contacts of people remaining in facilities and faster than linearly when it did reduce contacts. At all decarceration levels, rates were substantially higher when contacts were not reduced. Even with 90% decarceration, infection rates for people remaining in facilities were higher than or comparable to otherwise similar free-living people.

Interpretation

The decline in COVID-19 infection rates with decarceration was linear or faster than linear depending on how decarceration was implemented. Our findings highlight infection risks associated with incarceration, which compound other health harms of incarceration.

Funding

Stanford's COVID-19 Emergency Response Fund; the National Institute on Drug Abuse; and the National Institute of Mental Health.

Acidic pH of early endosomes governs SARS-CoV-2 transport in host cells

Endocytosis is a prominent mechanism for SARS-CoV-2 entry into host cells. Upon internalization into early endosomes (EEs), the virus is transported to late endosomes (LEs), where acidic conditions facilitate spike protein processing and viral genome release. Dynein and kinesin motors drive EE transport along microtubules; dynein moves EEs to the perinuclear region, while kinesins direct them towards the plasma membrane, creating a tug-of-war over the direction of transport. Here, we identify that the luminal pH of EEs is a key factor regulating the outcome of this tug-of-war. Among the known endosomal pH regulators, only the sodium-proton exchanger NHE9 has so far been genetically linked to severe COVID-19 risk. NHE9 functions as a proton leak pathway specifically on endosomes. We show that limiting acidification of EEs by increasing the expression of NHE9 leads to decreased infectivity of the SARS-CoV-2 spike-bearing virus in host cells. Our investigation identified the EE membrane lipid phosphatidylinositol-3-phosphate (PI3P) as a link between luminal pH changes and EE transport. Normally, as EEs mature, PI3P depletes. However, in cells with high NHE9 expression, PI3P persists longer on EEs. PI3P plays a pivotal role in the recruitment of motor proteins and the subsequent movement of EEs. Consistently, we observed that NHE9-mediated alkalization of EEs hindered perinuclear movement. Specifically, EE speed and run length were negatively impacted, ultimately leading to EEs falling off microtubules and impairing the delivery of viral cargo to LEs. NHE9 thus offers a unique opportunity as a viable therapeutic target to impede SARS-CoV-2 host cell entry.

SARS-CoV-2 and Dysphagia: A Retrospective Analysis of COVID-19 Patients with Swallowing Disorders

BACKGROUND

COVID-19 can lead to impairment of neural networks involved in swallowing, since the act of swallowing is coordinated and performed by a diffuse brain network involving peripheral nerves and muscles. Dysphagia has been identified as a risk and predictive factor for the severest form of SARS-CoV-2 infection.

OBJECTIVES

To investigate the association between swallowing disorders and COVID-19 in patients hospitalized for COVID-19.

METHODS

We collected demographic data, medical information specific to dysphagia and data on medical treatments of patients with COVID-19.

RESULTS

A total of 43 hospitalized COVID-19 patients were enrolled in the study. Twenty (46%) were evaluated positive for dysphagia and 23 (54%) were evaluated negative. Neurocognitive disorders and diabetes were mostly associated with patients who resulted positive for dysphagia. Respiratory impairment caused by COVID-19 seems to be a cause of dysphagia, since all patients who needed oxygen-therapy developed symptoms of dysphagia, unlike patients who did not. In the dysphagic group, alteration of the swallowing trigger resulted in the severest form of dysphagia. An association was found between the severest form of COVID-19 and dysphagia. This group consisted predominantly of males with longer hospitalization.

CONCLUSIONS

Identification of COVID-19 patients at risk for dysphagia is crucial for better patient management.

Real-world experience of tixagevimab/cilgavimab prophylaxis in Japanese patients with immunodeficiency

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes severe illness and mortality in patients with immunodeficiency. Although vaccination has been recommended, the induction of protective antibodies by immunization, and thus the disease-preventive effect, has proven insufficient in immunodeficient patients, especially in those with predominantly antibody deficiency. A monoclonal antibody combination of tixagevimab and cilgavimab (TIX/CIL) was developed as a pre-exposure prophylaxis (PrEP). In this study, we investigated the post-PrEP increase in antiviral antibody titers and detailed the breakthrough infections that occurred despite PrEP in Japanese immunodeficient patients who had received TIX/CIL.

METHODS

Blood samples were collected before and after TIX/CIL administration between November 2022 and August 2023. Antibody titers against the S-protein of SARS-CoV-2 were measured to evaluate TIX/CIL-induced protection. Information regarding breakthrough infection, as evidenced by positive antigen and/or PCR tests, was collected.

RESULTS

A significant increase in the anti-S antibody titer was observed in all 89 immunodeficient patients who had received TIX/CIL. However, 14 (16 %) patients experienced breakthrough SARS-CoV-2 infections, of which one died of respiratory failure.

CONCLUSION

The shift in the SARS-CoV-2 circulating strain might have reduced the efficacy of TIX/CIL, leading to an increased number of breakthrough infections.

Real-World Treatment Outcomes in the First and Subsequent Coronavirus Disease 2019 (COVID-19) Hospital Clusters

OBJECTIVES

We experienced 10 coronavirus disease 2019 (COVID-19) hospital clusters between November 2020 and September 2023 and retrospectively examined whether the introduction of hospital cluster countermeasures improved patient prognosis.

METHODS

We compared the first hospital cluster, in which infection prevention measures were insufficient, vaccines were not introduced, and antiviral drugs were not available (Phase 1), and the second or subsequent hospital clusters, when the abovementioned measures were improved (Phase 2).

RESULTS

In Phase 2, the number of COVID-19 patient deaths within 30 days, infection rate in patients who shared a room with an infected patient, and infection rate among medical workers were reduced. Survival rates within 30 days did not differ significantly between Phases 1 and 2. In Phase 2, the survival rate was higher in females than in males and in groups treated with ensitrelvir and molnupiravir than in those treated with remdesivir.

CONCLUSIONS

Countermeasures against hospital clusters require comprehensive measures, such as infection prevention, vaccination, rapid diagnosis, and antiviral drug administration. Antiviral drugs may shorten hospital clusters by rapidly suppressing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients.

SAM-dPCR: Accurate and Generalist Nuclei Acid Quantification Leveraging the Zero-Shot Segment Anything Model

Digital PCR (dPCR) has transformed nucleic acid diagnostics by enabling the absolute quantification of rare mutations and target sequences. However, traditional dPCR detection methods, such as those involving flow cytometry and fluorescence imaging, may face challenges due to high costs, complexity, limited accuracy, and slow processing speeds. In this study, SAM-dPCR is introduced, a training-free open-source bioanalysis paradigm that offers swift and precise absolute quantification of biological samples. SAM-dPCR leverages the robustness of the zero-shot Segment Anything Model (SAM) to achieve rapid processing times (<4 seconds) with an accuracy exceeding 97.10%. This method has been extensively validated across diverse samples and reactor morphologies, demonstrating its broad applicability. Utilizing standard laboratory fluorescence microscopes, SAM-dPCR can measure nucleic acid template concentrations ranging from 0.154 copies µL-1 to 1.295 × 103 copies µL-1 for droplet dPCR and 0.160 × 103 to 3.629 × 103 copies µL-1 for microwell dPCR. Experimental validation shows a strong linear relationship (r2 > 0.96) between expected and determined sample concentrations. SAM-dPCR offers high accuracy, accessibility, and the ability to address bioanalytical needs in resource-limited settings, as it does not rely on hand-crafted "ground truth" data.

Chronological trend of social contact patterns in Japan after the emergence of COVID-19

BACKGROUND

The social contact data for Japan as of 2022 showed a substantially decreased number of contacts compared with before the COVID-19 pandemic. However, it is unclear whether social contact continues to be depressed following the end of countermeasures against the pandemic. There is also scarce evidence regarding the influence of influenza-like illnesses (ILIs) on social contacts in Japan. Therefore, this study examined whether the reduction in contact frequency during the pandemic was temporary or persists today and assessed the impact of ILIs on social mixing patterns.

METHODS

We conducted online questionnaire surveys of individuals who experienced symptoms of ILIs periodically from 2022 to 2024 to compare the number of contacts per day during and after their illnesses. Contact matrices were obtained from the survey data. The impacts of the timing of the survey and the ILIs were examined using negative binomial regression analysis.

RESULTS

Contact patterns were generally age-assortative, and the average contact numbers gradually increased from March 2022 to June 2024. Most recently, the median number of contacts per day during illness was 3 (interquartile range [IQR] 2-7) and then rose to 4.5 (IQR 2-11) after recovery. The earlier survey and ILIs showed a negative association with the frequency of social contacts.

CONCLUSION

The frequency of social contacts in Japan tended to rise compared with that in 2021 but has not yet reached pre-pandemic levels. Individuals tended to decrease their contacts when they had symptoms caused by ILIs.

Genomic Epidemiology of the Main SARS-CoV-2 Variants Circulating in Italy During the Omicron Era

Since early 2022 the Omicron variant has rapidly spread worldwide, becoming the dominant variant to date. The study aimed to investigate the clinical and epidemiological characteristics of COVID-19 patients and reconstruct the genomic epidemiology of main SARS-CoV-2 Omicron sublineages in Italy in 2022. A total of 8970 SARS-CoV-2 samples were studied, and phylogenetic analyses were focused on BA.1, BA.2, and BA.5 subvariants. More than half of subjects received three doses of vaccine and experienced a reinfection. A significant larger proportion of unvaccinated subjects presented reinfection compared with vaccinated. Clusters presented a tMRCA between September-November 2021 (BA.1), November 2021-January 2022 (BA.2), and October 2021-May 2022 (BA.5). Re values showed the highest level between September-October, January-February 2022, and May 2022 for BA.1, BA.2 and BA.5, respectively. Limited number of studied variant sequences are included in clusters. The spread rate of the studied variant exceeded its evolutionary rate. No single sublineage had sufficient time to differentiate into large clusters, but only into small and fragmented groups sharing the same recent ancestor. These analyses dissect the epidemiological dynamics of Omicron sublineages in Italy over a period of great epidemiological changes in the COVID-19 epidemic.

The Short and Long of COVID-19: A Review of Acute and Chronic Radiologic Pulmonary Manifestations of SARS-2-CoV and Their Clinical Significance

Coronavirus disease 2019 (COVID-19) pneumonia has had catastrophic effects worldwide. Radiology, in particular computed tomography (CT) imaging, has proven to be valuable in the diagnosis, prognostication, and longitudinal assessment of those diagnosed with COVID-19 pneumonia. This article will review acute and chronic pulmonary radiologic manifestations of COVID-19 pneumonia with an emphasis on CT and also highlighting histopathology, relevant clinical details, and some notable challenges when interpreting the literature.