The perspectives of biomarker-based electrochemical immunosensors, artificial intelligence and the Internet of Medical Things toward COVID-19 diagnosis and management

The World Health Organization (WHO) has declared the COVID-19 an international health emergency due to the severity of infection progression, which became more severe due to its continuous spread globally and the unavailability of appropriate therapy and diagnostics systems. Thus, there is a need for efficient devices to detect SARS-CoV-2 infection at an early stage. Nowadays, the reverse transcription polymerase chain reaction (RT-PCR) technique is being applied for detecting this virus around the globe; however, factors such as stringent expertise, long diagnostic times, invasive and painful screening, and high costs have restricted the use of RT-PCR methods for rapid diagnostics. Therefore, the development of cost-effective, portable, sensitive, prompt and selective sensing systems to detect SARS-CoV-2 in biofluids at fM/pM/nM concentrations would be a breakthrough in diagnostics. Immunosensors that show increased specificity and sensitivity are considerably fast and do not imply costly reagents or instruments, reducing the cost for COVID-19 detection. The current developments in immunosensors perhaps signify the most significant opportunity for a rapid assay to detect COVID-19, without the need of highly skilled professionals and specialized tools to interpret results. Artificial intelligence (AI) and the Internet of Medical Things (IoMT) can also be equipped with this immunosensing approach to investigate useful networking through database management, sharing, and analytics to prevent and manage COVID-19. Herein, we represent the collective concepts of biomarker-based immunosensors along with AI and IoMT as smart sensing strategies with bioinformatics approach to monitor non-invasive early stage SARS-CoV-2 development, with fast point-of-care (POC) diagnostics as the crucial goal. This approach should be implemented quickly and verified practicality for clinical samples before being set in the present times for mass-diagnostic research.

Brief Report: Switching to DOR/3TC/TDF Maintains HIV-1 Virologic Suppression Through Week 144 in the DRIVE-SHIFT Trial

BACKGROUND

In the primary analysis of the DRIVE-SHIFT trial, switching to doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) maintained suppression of HIV-1 through week 48. Here, we present long-term efficacy and safety outcomes through week 144 of the DRIVE-SHIFT trial.

METHODS

This phase 3, randomized, open-label trial evaluated switching from a stable antiretroviral regimen to once-daily DOR/3TC/TDF in adults with HIV-1 suppressed for ≥6 months and no previous virologic failure. Participants switched at day 1 [immediate switch group (ISG); n = 447] or week 24 [delayed switch group (DSG); n = 209]. Nine ISG participants who completed week 48 but did not enter extension-1 were excluded from week 144 efficacy analyses.

RESULTS

At week 144, HIV-1 RNA <50 copies/mL was maintained in 80.1% of the ISG (351/438) and 83.7% of the DSG (175/209), while 2.7% (12/438) and 4.8% (10/209), respectively, had HIV-1 RNA ≥50 copies/mL (Food and Drug Administration Snapshot approach). Protocol-defined virologic failure after switch occurred in 2.1% of ISG (9/438) and 3.3% of DSG (7/209); no viral resistance to doravirine was detected in 4 participants with samples available. Reductions in fasting lipids were observed at 24 weeks after switch and maintained through week 144. The mean weight change from switch to week 144 was +1.4 kg for ISG and +1.2 kg for DSG. The most common adverse events were nasopharyngitis (16.2%), headache (12.3%), and diarrhea (9.1%). Overall, 4.1% discontinued because of adverse events, and no deaths occurred.

CONCLUSIONS

These results confirm that switching to once-daily DOR/3TC/TDF is a generally well-tolerated option for maintaining viral suppression in adults considering a change in therapy.

REGISTRATION

ClinicalTrials.gov NCT02397096.

Linear lesions in dermatology: a clinicoaetiopathological study

BACKGROUND

Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis.

AIMS

To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution.

METHODS

We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis.

RESULTS

Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus).

CONCLUSION

Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

The Role of Inflammation and Immune Activation on Circulating Endothelial Progenitor Cells in Chronic HIV Infection

Endothelial inflammation and damage are the main drivers of cardiovascular risk/disease. Endothelial repair is mediated in part by recruitment of bone marrow endothelial progenitor/endothelial colony forming cells (EPC/ECFC). People with HIV (PWH) have increased cardiovascular risk and the impact of infection in endothelial repair is not well defined. The low frequencies and challenges to in vitro isolation and differentiation of EPC/ECFC from PBMCs had made it difficult to study their role in this context. We hypothesized that HIV driven inflammation induces phenotypic changes that reflects the impact of infection. To test this hypothesis, we evaluated expression of markers of trafficking, endothelial differentiation, and angiogenesis, and study their association with biomarkers of inflammation in a cohort of PWH. In addition, we investigated the relationship of circulating endothelial progenitors and angiogenic T cells, a T cell subset with angiogenic function. Using a flow cytometry approach, we identified two subsets of circulating progenitors LIN4^-CD45^-CD34⁺ and LIN4^-CD45^dimCD34⁺ in PWH. We found that the phenotype but not frequencies were associated with biomarkers of inflammation. In addition, the percentage of LIN4^-CD45^dimCD34⁺ was associated with serum levels of lipids. This data may provide a new tool to better address the impact of HIV infection in endothelial inflammation and repair.

A strategy to enhance the photocatalytic efficiency of α-Fe2O3

The photocatalytic dye degradation of pure α-Fe₂O₃ and different concentration of Co doped α-Fe₂O₃ is explored. Facile hydrothermal method were employed to prepare pristine, 2% and 4% Co-Fe₂O₃ nanoparticles. Further, synthesized product confirmation studies were employed from X-ray diffraction, UV-vis spectrometry, Fourier-transform infrared, Raman, scanning electron microscope and transmission electron microscope studies. The rhombohedral nanoparticles developed were enhanced photocatalytic action. Photocatalytic dye degradation studies were analyzed for prepared three samples and the photocatalytic efficacy of the obtained photocatalysts was compared experimentally. Methylene blue dye was degraded under UV-light irradiation with 364 nm. The results showed that 4% Co doped α-Fe₂O₃ sample exhibited better dye degradation with 92% efficiency. The 4% doping of cobalt ions enhanced the photocatalytic property of Fe₂O₃ and is a good candidate for methylene blue dye degradation above 90%. In addition, strategy for photocatalytic efficiency enhancement was proposed.

HIV infection drives immune activation of angiogenic T cells

In people living with HIV (PLWH), immune activation and systemic inflammation are associated with cardiovascular risk independently of the traditional risk factors or duration of antiretroviral treatment and CD4 counts. Endothelial inflammation and injury play a critical role in the pathogenesis of cardiovascular risk/disease. Recent reports had shown that T cells can promote vascular repair by secretion of proangiogenic factors. Because of these functional properties these T cells are called angiogenic T cells (Tang) and are defined by expression of CXCR4 and CD31. Accordantly, we found that in vitro, TCR stimulated CD8 Tang from healthy volunteers induced secretion of proangiogenic cytokines including angiopoietin-2, fibroblast growth factor, and vascular endothelial growth factor (VEGF) by HUVECs. Because HIV chronic infection drives T cell immune activation, we hypothesized that HIV infection alters Tang’s proangiogenic function. To address this question, we studied the phenotype and function of Tang in PBMCs from PLWH and healthy volunteers. We found that PLWH had a significant decrease in the proportion of both CD4 and CD8 Tang when compared to healthy controls, and this difference was more striking in the CD8 Tang. CD8 Tang from PLWH had an activated phenotype and showed an increased expression of granzymes (A and B) when compared to healthy controls. In PLWH, the frequency of GZA+GZB+CD8 Tang was positively associated with 10yr cardiovascular risk score. In addition, upon TCR stimulation, CD8 Tang from PLWH showed a diminished ability to secrete VEGF. These results suggest that in the context of HIV infection, CD8 Tang possesses a pro-inflammatory potential and reduced proangiogenic function to promote endothelial repair.

IL-27 enhances cytokine secretion by TIGIT+ HIVGag-specific T cells

In chronic HIV infection, HIV-specific T cells have diminished effector function and fail to control/eliminate the viral reservoirs. HIV-specific T cells and latently HIV infected T cells express checkpoint receptors suggesting that therapeutic strategies improving T cell function and targeting the reservoir will be required to treat HIV infection. IL-27, a member of the IL-6/IL-12 cytokine superfamily, can be considered as such agent because of its anti-viral properties and immune modulatory functions. IL-27 signaling activates mainly Signal Transducer and Activator of Transcription (STAT) 1 and 3. IL-27 can inhibit HIV replication, however, its immunomodulatory functions in T cells are largely unknown. In this study, we hypothesized that IL-27 promotes pro-inflammatory properties enhancing HIV-specific T cell immunity. We found that IL-27 enhanced STAT1 activation in T cell subsets from people living with HIV (PLWH). Moreover, the RNA-Seq analysis showed that IL-27 stimulation induced global transcriptional changes that overlapped with both IFNα and IL-6 signaling. We also determined that the T cells response to IL-27 stimulation were enriched in genes associated with IFN/STAT1 signaling pathways in PLWH and healthy donors. In addition, overnight in vitro stimulation with IL-27 upregulated expression of CD69 and T-bet in CD4 and CD8 T cells. Accordingly, IL-27 increased IFN-ɣ and TNF-αsecretion by TIGIT+ HIVGag specific CD4 and CD8 T cells. The previously described anti-viral properties and these newly immunomodulatory features of IL-27 in HIV-specific T cell function suggest its potential therapeutic use in HIV cure strategies.

Connectome-based prediction of global cognitive performance in people with HIV

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Networks strengths predicted global cognitive performance in PWH.

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Model generalized to data from an independent PWH sample.

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Network strengths in PWH with HAND were different from either controls or PWH without HAND.

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Network strengths may serve as a potential biomarker to assist HAND diagnosis.

Global cognitive performance plays an important role in the diagnosis of HIV-associated neurocognitive disorders (HAND), yet to date, there is no simple way to measure global cognitive performance in people with HIV (PWH). Here, we performed connectome-based predictive modeling (CPM) to pursue a neural biomarker of global cognitive performance in PWH based on whole-brain resting-state functional connectivity. We built a CPM model that successfully predicted individual differences in global cognitive performance in the training set of 67 PWH by using leave-one-out cross-validation. This model generalized to both 33 novel PWH in the testing set and a subset of 39 PWH who completed a follow-up visit two years later. Furthermore, network strengths identified by the CPM model were significantly different between PWH with HAND and without HAND. Together, these results demonstrate that whole-brain functional network strengths could serve as a potential neural biomarker of global cognitive performance in PWH.

Low CD4+ cell count nadir exacerbates the impacts of APOE ε4 on functional connectivity and memory in adults with HIV

OBJECTIVE

Nearly half of individuals living with HIV in the USA are now 50 or older. This rapidly ageing populace may be at an increasingly greater risk of Alzheimer's disease. However, the potential interaction between HIV-disease and Alzheimer's disease pathogenesis (i.e. Alzheimer's disease genetic risk factors) on brain function remains an open question. The present study aimed to investigate the impact of APOE ε4 on brain function in middle-aged to older people with HIV (PWH), as well as the putative interaction between ε4 and HIV disease severity.

METHODS

Ninety-nine PWH participated in a cross-sectional study (56.3 ± 6.5 years, range 41-70 years, 27 women, 26 ε4 carriers and 73 noncarriers). Structural MRI and resting-state functional MRI were collected to assess alterations in brain structure and functional connectivity, respectively.

RESULTS

APOE ε4 was associated with worse memory performance and reduced functional connectivity in the memory network. The functional connectivity reduction was centred at the caudate nucleus rather than hippocampus and correlated with worse memory performance. In ε4 carriers, low CD4+ cell count nadir was associated with reduced functional connectivity in the memory network, but this association was absent in noncarriers. Furthermore, there was an indirect detrimental impact of ε4 on memory performance through memory network functional connectivity. However, this indirect effect was contingent on CD4+ cell count nadir, that is the indirect effect of ε4 on memory was only significant when CD4+ cell count nadir was low.

INTERPRETATION

APOE ε4 is associated with reduced memory and reduced functional connectivity within the memory network, and low CD4+ cell count nadir -- indicating a history of severe immunosuppression -- may exacerbate the effects of ε4.

Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials

Background

Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings.

Methods

This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings.

Results

Barriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance.

Conclusions

Results suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06214-9.

Asymmetrical Vortex over Slender Body A Computational Approach

Computational investigations were carried out on an ogive-cylinder configuration having a slenderness ratio of 7.5. The geometry of the nose tip was generated based on the physical geometry of the nose tip observed under a scanning electron microscope. Time-dependent simulations were performed on the slender body at a diameter Reynolds number of 3.0×104. Results indicated that the onset of vortex asymmetry was mainly due to the micro-tip imperfection existing at the tip. It was also observed that the variation in the roll angle of the model affected the flow physics largely which has been experimentally observed by several researchers in the past. The computed results were in better agreement with the referenced experimental data.

Optimized LMS algorithm for system identification and noise cancellation

Optimization by definition is the action of making most effective or the best use of a resource or situation and that is required almost in every field of engineering. In this work, the optimization of Least Mean square (LMS) algorithm is carried out with the help of Particle Swarm Optimization (PSO) and Ant Colony Optimization (ACO). Efforts have been made to find out the advantages and disadvantages of combining gradient based (LMS) algorithm with Swarm Intelligence SI (ACO, PSO). This optimization of LMS algorithm will help us in further extending the uses of adaptive filtering to the system having multi-model error surface that is still a gray area of adaptive filtering. Because the available version of LMS algorithm that plays an important role in adaptive filtering is a gradient based algorithm, that get stuck at the local minima of system with multi-model error surface considering it global minima, resulting in an non-optimized convergence. By virtue of the proposed method we have got a profound solution for the problem associated with system with multimodal error surface. The results depict significant improvements in the performance and displayed fast convergence rate, rather stucking at local minima. Both the SI techniques displayed their own advantage and can be separately combined with LMS algorithm for adaptive filtering. This optimization of LMS algorithm will further help to resolve serious interference and noise issues and holds a very important application in the field of biomedical science.

Effect of Bamlanivimab as Monotherapy or in Combination With Etesevimab on Viral Load in Patients With Mild to Moderate COVID-19: A Randomized Clinical Trial

IMPORTANCE

Coronavirus disease 2019 (COVID-19) continues to spread rapidly worldwide. Neutralizing antibodies are a potential treatment for COVID-19.

OBJECTIVE

To determine the effect of bamlanivimab monotherapy and combination therapy with bamlanivimab and etesevimab on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in mild to moderate COVID-19.

DESIGN, SETTING, AND PARTICIPANTS

The BLAZE-1 study is a randomized phase 2/3 trial at 49 US centers including ambulatory patients (N = 613) who tested positive for SARS-CoV-2 infection and had 1 or more mild to moderate symptoms. Patients who received bamlanivimab monotherapy or placebo were enrolled first (June 17-August 21, 2020) followed by patients who received bamlanivimab and etesevimab or placebo (August 22-September 3). These are the final analyses and represent findings through October 6, 2020.

INTERVENTIONS

Patients were randomized to receive a single infusion of bamlanivimab (700 mg [n = 101], 2800 mg [n = 107], or 7000 mg [n = 101]), the combination treatment (2800 mg of bamlanivimab and 2800 mg of etesevimab [n = 112]), or placebo (n = 156).

MAIN OUTCOMES AND MEASURES

The primary end point was change in SARS-CoV-2 log viral load at day 11 (±4 days). Nine prespecified secondary outcome measures were evaluated with comparisons between each treatment group and placebo, and included 3 other measures of viral load, 5 on symptoms, and 1 measure of clinical outcome (the proportion of patients with a COVID-19-related hospitalization, an emergency department [ED] visit, or death at day 29).

RESULTS

Among the 577 patients who were randomized and received an infusion (mean age, 44.7 [SD, 15.7] years; 315 [54.6%] women), 533 (92.4%) completed the efficacy evaluation period (day 29). The change in log viral load from baseline at day 11 was -3.72 for 700 mg, -4.08 for 2800 mg, -3.49 for 7000 mg, -4.37 for combination treatment, and -3.80 for placebo. Compared with placebo, the differences in the change in log viral load at day 11 were 0.09 (95% CI, -0.35 to 0.52; P = .69) for 700 mg, -0.27 (95% CI, -0.71 to 0.16; P = .21) for 2800 mg, 0.31 (95% CI, -0.13 to 0.76; P = .16) for 7000 mg, and -0.57 (95% CI, -1.00 to -0.14; P = .01) for combination treatment. Among the secondary outcome measures, differences between each treatment group vs the placebo group were statistically significant for 10 of 84 end points. The proportion of patients with COVID-19-related hospitalizations or ED visits was 5.8% (9 events) for placebo, 1.0% (1 event) for 700 mg, 1.9% (2 events) for 2800 mg, 2.0% (2 events) for 7000 mg, and 0.9% (1 event) for combination treatment. Immediate hypersensitivity reactions were reported in 9 patients (6 bamlanivimab, 2 combination treatment, and 1 placebo). No deaths occurred during the study treatment.

CONCLUSIONS AND RELEVANCE

Among nonhospitalized patients with mild to moderate COVID-19 illness, treatment with bamlanivimab and etesevimab, compared with placebo, was associated with a statistically significant reduction in SARS-CoV-2 viral load at day 11; no significant difference in viral load reduction was observed for bamlanivimab monotherapy. Further ongoing clinical trials will focus on assessing the clinical benefit of antispike neutralizing antibodies in patients with COVID-19 as a primary end point.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04427501.

Complete genome sequence and genetic organization of a Garlic virus D infecting garlic (Allium sativum) from northern India

The present paper describes first full genome sequence of the Garlic virus D (GarV-D) from northern India with a genome size of 8425 bp long ssRNA. The infected leaves and bulbs of garlic variety Yamuna Safed (G-282) plants suspected for GarV-D infection were collected with the aim to identify contagion virus during March, 2018. The total RNA was extracted from the pooled garlic plants using TRIzol reagent and sequenced using an Illumina HiSeq 2000 platform. BLASTn search in the NCBI database identified contagion as GarV-D (MK518067). It shared 83.63-85.83% nucleotide sequence identities with other (GarV-D) isolates from Argentina (KF550407, KF555653, KR819505) and 83.15% with isolates from China (MF795136, MF363012). Keywords: Allium sativum; Allexivirus; Garlic virus D; India.

Cancer Incidence and Cancer Screening Practices Among a Cohort of Persons Receiving HIV Care in Washington, DC

In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and receipt of screening among persons actively enrolled in the DC Cohort, a longitudinal observational cohort of PLWH, between 2011 and 2017. Cancer screening eligibility was determined based on age, sex, smoking history and co-morbidity data available and published national guidelines. The incidence rate of NADCs was 12.1 (95% CI 10.7, 13.8) and ADCs 1.6 (95% CI 0.6, 4.6) per 1000 person-years. The most common incident NADCs were breast 2.6 (95% CI 0.5,1 2.1), prostate 2.3 (95% CI 1.2, 4.3), and non-melanoma skin 1.2 (95% CI 0.6, 2.3) incident diagnoses/cases per 1000 person-years. Among cohort sites where receipt of cancer screening was assessed, less than 60% of eligible participants had any ascertained anal HPV, breast, cervical, colorectal, hepatocellular carcinoma, or lung cancer screening. In this cohort of PLWH, there were more incident NADCs versus ADCs in contrast to earlier cohort studies where ADCs predominated. Despite a large eligible population there were low rates of screening. Implementation of cancer screening is an important component of care among PLWH.

Alginate-gum acacia based sponges as potential wound dressings for exuding and bleeding wounds

The improper management of wound exudates can expose the wound to bacterial invasion, skin maceration etc. thereby resulting in prolonged wound healing. Biopolymers are characterized by hydrophilic functional groups which when employed for the development of wound dressings promote the wound dressings capability to absorb a high amount of wound exudates. Alginate-gum acacia sponges were prepared from a combination of biopolymers such as sodium alginate and gum acacia in varying amounts with carbopol via crosslinking with 1 and 2% CaCl₂. The prepared sponges were loaded with a combination of ampicillin and norfloxacin. In vitro antibacterial analysis revealed that the antibacterial activity of the loaded antibiotics was retained and the sponges were effective against gram-positive and gram-negative bacteria. The sponges displayed rapid and high absorption capability in the range of 1022-2419% at pH 5.5 simulating wound exudates, and 2268-5042% at pH 7.4 simulating blood within a period of 1-3 h. Furthermore, the whole blood clotting studies further revealed low absorbance values when compared to the control revealing the good clotting capability of the sponges. The unique features of the sponges revealed their potential application for the management of infected, high exuding and bleeding wounds.