Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19

Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome

Chronic COVID syndrome is characterized by chronic fatigue, myalgia, depression and sleep disturbances, similar to chronic fatigue syndrome (CFS) and fibromyalgia syndrome. Implementations of mitochondrial nutrients (MNs) with diet are important for the clinical effects antioxidant. We examined if use of an association of coenzyme Q10 and alpha lipoic acid (Requpero®) could reduce chronic covid symptoms. The Requpero study is a prospective observational study in which 174 patients, who had developed chronic-covid syndrome, were divided in two groups: The first one (116 patients) received coenzyme Q10 + alpha lipoic acid, and the second one (58 patients) did not receive any treatment. Primary outcome was reduction in Fatigue Severity Scale (FSS) in treatment group compared with control group. complete FSS response was reached most frequently in treatment group than in control group. A FSS complete response was reached in 62 (53.5%) patients in treatment group and in two (3.5%) patients in control group. A reduction in FSS core < 20% from baseline at T1 (non-response) was observed in 11 patients in the treatment group (9.5%) and in 15 patients in the control group (25.9%) (p < 0.0001). To date, this is the first study that tests the efficacy of coenzyme Q10 and alpha lipoic acid in chronic Covid syndrome. Primary and secondary outcomes were met. These results have to be confirmed through a double blind placebo controlled trial of longer duration.

Cannabidiol As a Treatment for COVID-19 Symptoms? A Critical Review

Background: Severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 has caused >211 million infections and >5.5 million deaths within 24 months globally (WHO). Internationally, a debate emerged about potential benefits of cannabidiol (CBD) as treatment of corona virus disease-19 (COVID-19). Objective: To assess the effects of CBD in the treatment of COVID-19-related inflammatory symptoms from the literature. Methods: We searched Cochrane COVID-19 study register, CENTRAL (PubMed, Embase, CINAHL, ClinicalTrials.gov, and the WHO's International Clinical Trials Registry Platform), for studies testing CBD as inflammation intervention. All types of studies and populations were considered. All pre-clinical, clinical, and pharmacological outcomes were of interest. Results: Of 18 articles found, 9 were included: 5 in vivo animal studies, 3 in vitro human tissue studies and, 1 randomized clinical trial. Outcomes in four in vivo animal studies and three human tissue studies were immune response markers, which decreased. One in vivo study showed enhancement of monocytes. One human study did not show group differences in COVID-19 evolution. There was no information on adverse effects or drug interaction. Conclusion: There is not enough evidence to support or refute CBD as a repurpose drug to treat inflammation and other symptoms of COVID-19. Clinical trials are needed to test its efficacy and adverse effects.

Plasmacytoid dendritic cells during COVID-19: Ally or adversary?

Plasmacytoid dendritic cells (pDCs) are specialized cells of the immune system that are thought to be the main cellular source of type I interferon alpha (IFNα) in response to viral infections. IFNs are powerful antivirals, whereas defects in their function or induction lead to impaired resistance to virus infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. IFN production needs to be controlled, because sustained IFN production can also have detrimental effects on disease outcome. As such, pDCs are likely important for acute antiviral protection against SARS-CoV-2 infection but could potentially also contribute to chronic IFN levels. Here, we provide a historical overview of pDC biology and summarize existing literature addressing their involvement and importance during viral infections of the airways. Furthermore, we outline recent reports focused on the potential role of pDCs during SARS-CoV-2 infection, as well as the potential for this cellular subset to impact COVID-19 disease outcome.

Modeling the effect of random diagnoses on the spread of COVID-19 in Saudi Arabia

Saudi Arabia was among the countries that attempted to manage the COVID-19 pandemic by developing strategies to control the epidemic. Lockdown, social distancing and random diagnostic tests are among these strategies. In this study, we formulated a mathematical model to investigate the impact of employing random diagnostic tests to detect asymptomatic COVID-19 patients. The model has been examined qualitatively and numerically. Two equilibrium points were obtained: the COVID-19 free equilibrium and the COVID-19 endemic equilibrium. The local and global asymptotic stability of the equilibrium points depends on the control reproduction number R_c. The model was validated by employing the Saudi Ministry of Health COVID-19 dashboard data. Numerical simulations were conducted to substantiate the qualitative results. Further, sensitivity analysis was performed on R_c to scrutinize the significant parameters for combating COVID-19. Finally, different scenarios for implementing random diagnostic tests were explored numerically along with the control strategies applied in Saudi Arabia.

Symptoms and psychosocial effects following hospitalization for Covid-19: A sequential, mixed-methods study from northern India

Background It is reported that patients who have recovered from Covid-19 continue to experience various symptoms and adverse outcomes. However, this aspect has not been studied well. We aimed to evaluate these variables and the perceived impact of Covid-19 among patients discharged from a Covid hospital in northern India. Methods We conducted this study among patients discharged from a Covid-19 hospital in northern India in June 2020. As per the official policy at that time, patients detected to have Covid-19 (symptomatically or via contact tracing) were mandatorily admitted. A sequential, mixed-methods design was followed. Patients discharged from the hospital were contacted telephonically, and the cross-sectional prevalence of symptoms, the prevalence of depression and anxiety and the social consequences of admission were assessed. A subgroup of patients was interviewed for qualitative assessment of their experience. Results A total of 274 patients provided consent and were assessed, of which 8 patients underwent detailed interviews. The prevalence of somatic symptoms was 3.4%; 36.2% of the patients had depressive and 12% of the patients had anxiety symptoms. A majority of patients experienced adverse social and economic consequences of hospitalization for Covid-19. These themes were reinforced by a qualitative analysis of in-depth interviews. Conclusions Our study population experienced a high prevalence of adverse psychosocial consequences of Covid-19. These included depression and anxiety symptoms, stigma and economic and occupational consequences. These deserve more recognition and study.

The role of IL-1 family of cytokines and receptors in pathogenesis of COVID-19

A global pandemic has erupted as a result of the new brand coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This pandemic has been consociated with widespread mortality worldwide. The antiviral immune response is an imperative factor in confronting the recent coronavirus disease 2019 (COVID-19) infections. Meantime, cytokines recognize as crucial components in guiding the appropriate immune pathways in the restraining and eradication of the virus. Moreover, SARS-CoV-2 can induce uncontrolled inflammatory responses characterized by hyper-inflammatory cytokine production, which causes cytokine storm and acute respiratory distress syndrome (ARDS). As excessive inflammatory responses are contributed to the severe stage of the COVID-19 disease, therefore, the pro-inflammatory cytokines are regarded as the Achilles heel during COVID-19 infection. Among these cytokines, interleukin (IL-) 1 family cytokines (IL-1, IL-18, IL-33, IL-36, IL-37, and IL-38) appear to have a strong inflammatory role in severe COVID-19. Hence, understanding the underlying inflammatory mechanism of these cytokines during infection is critical for reducing the symptoms and severity of the disease. Here, the possible mechanisms and pathways involved in inflammatory immune responses are discussed.

Diagnostic Laboratory Characteristics of COVID-19 Patients Infected by Fomites: COVID-19 Outbreak in a South Korean Public Administrative Facility

There is a paucity of data regarding the differentiating characteristics of patients who were infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by fomites around the world. We conducted an event-based outbreak investigation, involving 795 public officers and 277 assistant staff, in the Ministry of Oceans and Fisheries (MOF) or the same building from March 2 to March 18, 2020. The SARS-CoV-2 patients were found to have more frequently touched fomites and used public toilets than those who were tested negative for the virus (cOR, 24.38; 95% CI, 4.95-120.01). Symptoms such as coughing and loss of taste and smell were more frequently found in the office-cleaner group than in the public-officer group. The SARS-CoV-2 office-cleaner patients were more likely to have a high RdRp(Ct) value of PCR (median: 34.17 vs. 24.99; p = 0.035) and E(Ct) value of PCR (median: 32.30 vs. 24.74; p = 0.045). All office cleaner patients (100%) had a ground glass opacity in both lobes. Regarding segmental lung involvement of CT, two patients (100%) had a lesion in the right middle lobe, which invaded the whole lobe later. This implies that the fomite might be a selective risk factor of SARS-CoV-2 infection.

The Prevalence and Pathophysiology of Chemical Sense Disorder Caused by the Novel Coronavirus

Emerging viral infections are a ceaseless challenge and remain a global public health concern. The world has not yet come back to normal from the devastating effects of the highly contagious and pathogenic novel coronavirus, or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Olfactory and taste dysfunction is common in patients infected by the novel coronavirus. In light of the emergence of different coronavirus variants, it is important to update the prevalence and pathophysiology of these side effects. In this review, articles published on the prevalence of olfactory and taste dysfunction from coronavirus disease (COVID-19) and their possible pathophysiologic mechanisms have been reviewed and reported. The modulatory role of different SARS-CoV-2 variants on the chemical senses is then described. The clinical relevance of chemical sense disorder and its long-term morbidity and management is also discussed.

COVID‑19: Main findings after a year and half of unease and the proper scientific progress (Review)

Since the emergence of the disease in late December 2019, numerous studies have been published to date regarding clinical, laboratory and treatment aspects associated with COVID-19. The present study attempts to compare and unify the clinical, para-clinical and therapeutic aspects that have come to light regarding coronavirus disease-19 (COVID 19), mainly in adults. Between April 2020 and September 2021, a comprehensive systematic literature review was performed, which we added to from our own medical experiences. The search was performed on the PubMed, Scopus and Google Scholar databases, comprising studies with analyzable data that were identified alongside studies and documents containing general scientific data. All published studies were written in English, and were from different countries. A 95% confidence interval (CI95) was also calculated for almost each study using the Wilson formula. When compared with preliminary reports between December 2019 and January 2020, the most frequent symptoms were still identified as being fever (68.6%; CI95: 67.5-69.7) and cough (72.7%; CI95: 71.7-73.8). Nevertheless, asymptomatic cases also increased (by 21.4%; CI95: 16.6-27.1). Severe and critical cases accounted for 10.4% (CI95: 9.6-11.1) of all cases. The mean fatality rate was found to be 4% (CI95: 3.6-4.5). The primary co-morbidity found was hypertension (28.9%; CI95: 27-30.8), followed by other underlying cardiovascular diseases (15.4%; CI95: 13.9-16.9) and diabetes (14.5%; CI95: 13.1-16.1). The majority of studies showed lower white blood cell numbers with neutropenia and lymphopenia, and lower platelet levels. The levels of the biomarkers C-reaction protein and erythrocyte sedimentation rate were positive in all studied cases alongside other lab tests, such as examining the D-dimer levels and those of other hepatic, cardiac and renal injury markers. The procalcitonin level was also found to be elevated in many cases, resulting in high usage of antibiotics (83.7%; CI95: 81.2-85.9). Approximately 31.6% (CI95: 29.1-34.1) of the patients required non-invasive ventilation, whereas 9.9% (CI95: 8.1-12.1) of the patients were intubated or placed on extracorporeal membrane oxygenation. The most used antivirals were ribavirin (67.3%; CI95: 63.4-70.9), oseltamivir (52.5%; CI95: 49.4-55.5) and Arbidol™ (34.5%; CI95: 32-37.1). General admittance to the intensive care unit was ~7.2% (CI95: 6.5-7.9) of patients.

Household transmission of COVID-19 according to index case: children, parents, and healthcare workers

The first SARS-CoV-2 intrafamilial transmission was investigated in China. We evaluated the dynamics of SARS-CoV-2 transmission in 242 individuals from 60 family clusters, including 30 healthcare workers (HCW) and 30 patients, in São Paulo city. Sixty index cases with COVID-19 were selected, being 30 HCW index cases from Hospital São Paulo (HSP) and its 93 household contacts and 30 index case patients from Hospital Infantil Sabará (HIS) and its 89 household contacts. Asymptomatic and symptomatic individuals participating were tested for COVID-19. The secondary attack rates in the family clusters of HCW and HIS patients were 37.63% and 68.54%, respectively. Considering all households, the transmission from adults to children was 55.4%, while the transmission from children to children was 37.5%. Children were more infected if the index case was an adult, suggesting that children were less competent to transmit. The average time for a household to be COVID-19 positive was 4 and 3 days for HCW and HIS patients. Although HCW have a higher risk of infection and social vulnerability, the secondary attack rate was lower than that observed for HIS patients, possibly because HCW are more aware of transmission risks than the general community.

Post-COVID-19 Impairment of the Senses of Smell, Taste, Hearing, and Balance

Background: Various symptoms have been associated with COVID-19, but little is known about the impacts of COVID-19 on the sensory system, risk factors, and the duration of symptoms. This study assesses olfactory, gustatory, hearing, and vestibular systems after COVID-19. Methods: This cross-sectional, single-center study involved 50 patients one to six months after COVID-19 and reports their patient records and the extent, onset, and duration of olfactory, gustatory, hearing, and balance disorders using questionnaires during and after COVID-19. Sensory symptoms were objectively studied using the following clinical tests after COVID-19 Sniffin’ Sticks, taste tests, tone/speech audiometry, and video head impulse test. Results: Post-COVID-19-patients were suffering from olfactory and gustatory impairment for up to six months. According to the Dizziness Handicap Inventory, balance disorders were less noticed: Overall, about 40% of the patients during COVID-19 and nearly all patients recovered within six months. After COVID-19, clinical tests revealed that 75% were suffering from hyposomnia/anosmia, and 20% of all patients reported mild hypogeusia for up to six months. Vestibular disorders and hearing impairment rarely/did not occur. Females were significantly more affected by sensory impairments than males. Conclusions: COVID-19 particularly caused olfactory and gustatory impairment; balance disorders were present too; vestibular and auditory symptoms were negligible.

Immune Signature of COVID-19: In-Depth Reasons and Consequences of the Cytokine Storm

In the beginning of the third year of the fight against COVID-19, the virus remains at least still one step ahead in the pandemic "war". The key reasons are evolving lineages and mutations, resulting in an increase of transmissibility and ability to evade immune system. However, from the immunologic point of view, the cytokine storm (CS) remains a poorly understood and difficult to combat culprit of the extended number of in-hospital admissions and deaths. It is not fully clear whether the cytokine release is a harmful result of suppression of the immune system or a positive reaction necessary to clear the virus. To develop methods of appropriate treatment and therefore decrease the mortality of the so-called COVID-19-CS, we need to look deeply inside its pathogenesis, which is the purpose of this review.

Clinical characteristics and symptom duration among outpatients with COVID-19

BACKGROUND

Approximately 80% of people with COVID-19 do not require hospitalization. Studies examining the outpatient experience have not tracked symptoms to resolution leading to unknown expected symptom duration. Our objectives were to (1) determine symptom duration among patients with COVID-19 who do not require hospitalization and (2) identify potential risk factors associated with prolonged symptom duration.

DESIGN

This is a retrospective cohort study conducted across an academic healthcare system including adult patients with laboratory-confirmed SARS-CoV-2 infection between March 18th and April 28th, 2020 who were not hospitalized. Symptom duration encompassed time from patient-reported symptom onset as documented in the chart until documented symptom resolution. We calculated the median symptom duration and tested if demographics, comorbidities, or reported symptoms were associated with symptom duration.

KEY RESULTS

Of 294 patients meeting inclusion criteria, 178 (60.5%) had documented symptom resolution. The median [interquartile range (IQR)] symptom duration for included patients was 15 (8-24) days. No associations were found between comorbidities and symptom duration. Factors associated with prolonged symptom duration were presence vs lack of lower respiratory symptoms [median (IQR) 16.5 (10.75-33.5) vs 14.5 (7-21.75) days respectively, P < .001] and neurologic symptoms [median (IQR) 17 (9-28) vs 9.5 (4-17) days, P < .001] at disease onset.

CONCLUSIONS

The median symptom duration in outpatients is 15 days and over 25% of patients have symptoms longer than 21 days.

The role of unconventional T cells in COVID-19

COVID-19 is a respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first documented in late 2019, but within months, a worldwide pandemic was declared due to the easily transmissible nature of the virus. Research to date on the immune response to SARS-CoV-2 has focused largely on conventional B and T lymphocytes. This review examines the emerging role of unconventional T cell subsets, including γδ T cells, invariant natural killer T (iNKT) cells and mucosal associated invariant T (MAIT) cells in human SARS-CoV-2 infection.Some of these T cell subsets have been shown to play protective roles in anti-viral immunity by suppressing viral replication and opsonising virions of SARS-CoV. Here, we explore whether unconventional T cells play a protective role in SARS-CoV-2 infection as well. Unconventional T cells are already under investigation as cell-based immunotherapies for cancer. We discuss the potential use of these cells as therapeutic agents in the COVID-19 setting. Due to the rapidly evolving situation presented by COVID-19, there is an urgent need to understand the pathogenesis of this disease and the mechanisms underlying its immune response. Through this, we may be able to better help those with severe cases and lower the mortality rate by devising more effective vaccines and novel treatment strategies.

Post-COVID-19 Liver Injury: Comprehensive Imaging With Multiparametric Ultrasound

OBJECTIVES

This study aimed to define patterns of liver injury after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using multiparametric ultrasound (mpUS) in a variable patient population with differing severities of COVID-19.

METHODS

Ninety patients were enrolled into the study: 56 had SARS-CoV-2 3-9 months prior to enrolment; 34 served as a clinically healthy control group. All patients underwent an mpUS evaluation of the liver (elastography, dispersion and attenuation imaging). Seventy-six patients had abdominal magnetic resonance (MR) and noncontrast enhanced thoracic computed tomography (CT) scans performed at the same day. All patients were screened for biochemical markers of liver injury.

RESULTS

Liver elasticity, viscosity, and steatosis values were significantly altered in patients after COVID-19, with particularly higher fibrosis scores compared to the control group (P < .001). Increased biochemical markers of liver injury correlated with changes in mpUS (P < .05), but not with findings on CT or MR findings. Seventeen of 34 hospitalized patients had a moderate or severe course of the disease course with more pronounced changes in mpUS. Increased body mass index was found to influence liver injury and correlated with more severe forms of COVID-19 (P < .001).

CONCLUSIONS

COVID-19 can cause liver injury observable using mpUS. More severe forms of COVID-19 and patient obesity are related to increased values of liver damage observed. In comparison to MRI and CT, mpUS appears to be more sensitive to involvement of liver parenchyma. Further research is warranted to establish this promising method for evaluating post-COVID-19 liver involvement in the aftermath of the pandemic.

Association of anti-contagion policies with the spread of COVID-19 in United States

BACKGROUND

The outbreak of a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, raised worldwide concern. The present study investigates the association between anti-contagion policies and the spread of COVID-19 across the United States.

DESIGN AND METHODS

We selected the most frequently implemented COVID-19 anti-contagion policies in all the U.S. states issued from 29 February 2020. Accordingly, we modified an epidemiological model and combined it with a comprehensive statistical analysis to evaluate the policies' individual and overall likely impact.

RESULTS

For the first time, a novel index, evaluates the associations between policy implementation and COVID-19 spread at both statewide and national levels. Our results indicate that governmental policies requiring mask use, businesses social distancing, and quarantining travelers may be most effective for controlling COVID-19 spread. Simultaneously, widespread orders like school closure and safer-at-home that can be particularly disruptive to the economy and social fabric of society may be unnecessary given their lack of association with reducing infection.

CONCLUSIONS

The absence of any COVID-19 vaccines during the first several months of its pandemic necessitated using governmental policies to help stop the spread of this disease. Our index showed the association between implemented policies and COVID-19 spread, highlighting the specific policies with the greatest association - mandatory quarantine upon entering a state, businesses implementing social distancing, and mandatory mask use - and those with less association like school closure and safer-at-home orders. This study provided evidence to inform policy choices for the current global crisis and future pandemics.

Identification of Distinct Immune Cell Subsets Associated With Asymptomatic Infection, Disease Severity, and Viral Persistence in COVID-19 Patients

The cell-mediated protective and pathogenic immune responses to SARS-CoV-2 infection remain largely elusive. Here we identified 76 distinct cell subsets in the PBMC samples that were associated with various clinical presentations of COVID-19 using scRNA-seq technology coupled with a deep and comprehensive analysis of unique cell surface markers and differentially expressed genes. We revealed that (TRAV1-2⁺CD8⁺)MAIT cells and (NCAM1^hiCD160⁺)NK cells significantly enriched in the asymptomatic subjects whereas (LAG3⁺CD160⁺CD8⁺)NKT cells increased in the symptomatic patients. We also observed that (CD68^-CSF1R^-IL1B^hiCD14⁺)classical monocytes were positively correlated with the disease severity. Moreover, (CD33^-HLA-DMA^-CD14⁺)classical monocytes and (CLEC10A^-S100A9^lo)pDC were associated with the viral persistence. The GO and KEGG analyses identified enriched pathways related to immune responses, inflammation, and apoptosis. These findings may enhance our understanding of the immunopathogenesis of COVID-19 and help develop novel strategies against SARS-CoV-2 infection.

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.

Establishment of models for reliability evaluation of 3CLpro ligand-receptor complexes with different binding sites

Aim: Recent research shows that 3CLpro enzyme of SARS-CoV-2 is a significant target against COVID-19. Drug modeling allows the design of inhibitors of 3CLpro, but the accuracy of those methods remains unclear. Therefore, it is important to determine the trustworthiness of the designed ligand-receptor complexes. Method & materials: The authors built models for the reliability evaluation of 3CLpro complexes with ligands using an in-house developed AlteQ approach and complementarity principles. The models were based on 145 experimentally found 3CLpro complexes with ligands for five different binding sites. Result & conclusion: The obtained models correspond to linear regression with high values of correlation coefficients and can be successfully used to determine the reliability of the docked 3CLpro complexes with ligands.

Interleukin-6 Test Strip Combined With a Spectrum-Based Optical Reader for Early Recognition of COVID-19 Patients With Risk of Respiratory Failure

The COVID-19 pandemic has had a globally devastating impact. This highly contagious virus has significantly overburdened and undermined medical systems. While most infected patients experience only mild symptoms, those who are severely affect require urgent medical interventions and some develop acute respiratory failure and require mechanical ventilation. The broad and potentially deadly impact of infection underscores the critical need for early recognition, especially for those at risk for respiratory failure. Those who are severely impacted and at high risk for respiratory failure have been found to present high levels of serum cytokines, such as interleukin-6 (IL-6). Timely diagnosis and management of those at risk for respiratory failure is crucial. Measurement of IL-6 may provide a means for distinguishing such patients. Currently, most serum IL-6 detection relies on the use of laboratory-based conventional enzyme-linked immunosorbent assays. Although some rapid assays have been developed recently, they need to be conducted by specific technicians in central laboratory settings with advanced and expensive equipment. In this study, we propose an IL-6 test strip combined with a spectrum-based optical reader for early recognition of COVID-19-infected patients at imminent risk of acute respiratory failure requiring mechanical ventilator support. For our analyses, clinical demographic data and sera samples were obtained from three medical centers, and test strip specificity and detection performance were analyzed. This would help healthcare personnel stratify the risk of respiratory failure and provide prompt, and suitable management.

An exploration of factors characterising unusual spatial clusters of COVID-19 cases in the East Midlands region, UK: A geospatial analysis of ambulance 999 data

Complex interactions between physical landscapes and social factors increase vulnerability to emerging infections and their sequelae. Relative vulnerability to severe illness and/or death (VSID) depends on risk and extent of exposure to a virus and underlying health susceptibility. Identifying vulnerable communities and the regions they inhabit in real time is essential for effective rapid response to a new pandemic, such as COVID-19. In the period between first confirmed cases and the introduction of widespread community testing, ambulance records of suspected severe illness from COVID-19 could be used to identify vulnerable communities and regions and rapidly appraise factors that may explain VSID. We analyse the spatial distribution of more than 10,000 suspected severe COVID-19 cases using records of provisional diagnoses made by trained paramedics attending medical emergencies. We identify 13 clusters of severe illness likely related to COVID-19 occurring in the East Midlands of the UK and present an in-depth analysis of those clusters, including urban and rural dynamics, the physical characteristics of landscapes, and socio-economic conditions. Our findings suggest that the dynamics of VSID vary depending on wider geographic location. Vulnerable communities and regions occur in more deprived urban centres as well as more affluent peri-urban and rural areas. This methodology could contribute to the development of a rapid national response to support vulnerable communities during emerging pandemics in real time to save lives.

Epidemic Spreading in Trajectory Networks

Epidemics of infectious diseases, such as the one caused by the rapid spread of the coronavirus disease 2019 (COVID-19), have tested the world's more advanced health systems and have caused an enormous societal and economic damage. The mechanism of contagion is well understood. As people move around, over time, they regularly engage in social interactions. The spatiotemporal network representing these interactions constitutes the backbone on which an epidemic spreads, causing outbreaks. At the same time, advanced technological responses have claimed some success in controlling the epidemic based on digital contact tracing technologies. Motivated by these observations, we design, develop and evaluate a stochastic agent-basedSEIRmodel of epidemic spreading in spatiotemporal networks informed by mobility data of individuals (trajectories). The model focuses on individual variation in mobility patterns that affects the degree of exposure to the disease. Understanding the role that individual nodes play in the process of disease spreading through network effects is fundamental as it allows to (i) assess the risk of infection of individuals, (ii) assess the size of a disease outbreak due to specific individuals, and (iii) assess targeted intervention strategies that aim to control the epidemic spreading. We perform a comprehensive analysis of the model employing COVID-19 as a use case. The results indicate that simple individual-based intervention strategies that exhibit significant network effects can effectively control the spread of an epidemic. We have also demonstrated that targeted interventions can outperform generic intervention strategies. Overall, our work provides an evidence-based data-driven model to support decision making and inform public policy regarding intervention strategies for containing or mitigating the epidemic spread.

Gustatory and Saliva Secretory Dysfunctions in COVID-19 Patients with Zinc Deficiency

Given the ever-progressing studies on coronavirus disease 2019 (COVID-19), it is critical to update our knowledge about COVID-19 symptomatology and pathophysiology. In the present narrative review, oral symptoms were overviewed using the latest data and their pathogenesis was hypothetically speculated. PubMed, LitCovid, ProQuest, and Google Scholar were searched for relevant studies from 1 April 2021 with a cutoff date of 31 January 2022. The literature search indicated that gustatory dysfunction and saliva secretory dysfunction are prevalent in COVID-19 patients and both dysfunctions persist after recovery from the disease, suggesting the pathogenic mechanism common to these cooccurring symptoms. COVID-19 patients are characterized by hypozincemia, in which zinc is possibly redistributed from blood to the liver at the expense of zinc in other tissues. If COVID-19 induces intracellular zinc deficiency, the activity of zinc-metalloenzyme carbonic anhydrase localized in taste buds and salivary glands may be influenced to adversely affect gustatory and saliva secretory functions. Zinc-binding metallothioneins and zinc transporters, which cooperatively control cellular zinc homeostasis, are expressed in oral tissues participating in taste and saliva secretion. Their expression dysregulation associated with COVID-19-induced zinc deficiency may have some effect on oral functions. Zinc supplementation is expected to improve oral symptoms in COVID-19 patients.

Artificial Intelligence for Detecting COVID-19 With the Aid of Human Cough, Breathing and Speech Signals: Scoping Review

Goal: Official tests for COVID-19 are time consuming, costly, can produce high false negatives, use up vital chemicals and may violate social distancing laws. Therefore, a fast and reliable additional solution using recordings of cough, breathing and speech data for preliminary screening may help alleviate these issues. Objective: This scoping review explores how Artificial Intelligence (AI) technology aims to detect COVID-19 disease by using cough, breathing and speech recordings, as reported in the literature. Here, we describe and summarize attributes of the identified AI techniques and datasets used for their implementation. Methods: A scoping review was conducted following the guidelines of PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Electronic databases (Google Scholar, Science Direct, and IEEE Xplore) were searched between 1st April 2020 and 15th August 2021. Terms were selected based on the target intervention (i.e., AI), the target disease (i.e., COVID-19) and acoustic correlates of the disease (i.e., speech, breathing and cough). A narrative approach was used to summarize the extracted data. Results: 24 studies and 8 Apps out of the 86 retrieved studies met the inclusion criteria. Half of the publications and Apps were from the USA. The most prominent AI architecture used was a convolutional neural network, followed by a recurrent neural network. AI models were mainly trained, tested and run-on websites and personal computers, rather than on phone apps. More than half of the included studies reported area-under-the-curve performance of greater than 0.90 on symptomatic and negative datasets while one study achieved 100% sensitivity in predicting asymptomatic COVID-19 from cough-, breathing- or speech-based acoustic features. Conclusions: The included studies show that AI has the potential to help detect COVID-19 using cough, breathing and speech samples. The proposed methods (with some time and appropriate clinical testing) could prove to be an effective method in detecting various diseases related to respiratory and neurophysiological changes in the human body.

Asymptomatic infection and transmission of COVID-19 among clusters: systematic review and meta-analysis

OBJECTIVES

Countries throughout the world are experiencing COVID-19 viral load in their populations, leading to potential transmission and infectivity of asymptomatic COVID-19 cases. The current systematic review and meta-analysis aims to investigate the role of asymptomatic infection and transmission reported in family clusters, adults, children and health care workers, globally.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

An online literature search of PubMed, Google Scholar, medRixv and BioRixv was performed using standard Boolean operators and included studies published up to 17 August 2021. For the systematic review, case reports, short communications and retrospective studies were included to ensure sufficient asymptomatic COVID-19 transmission data were reported. For the quantitative synthesis (meta-analysis), participant data from a collection of cohort studies focusing on groups of familial clusters, adults, children and health care workers were included. Inconsistency among studies was assessed using I2 statistics. The data synthesis was computed using the STATA 16.0 software.

RESULTS

This study showed asymptomatic transmission among familial clusters, adults, children and health care workers of 15.72%, 29.48%, 24.09% and 0%, respectively. Overall, asymptomatic transmission was 24.51% (95% confidence interval [CI]: 14.38, 36.02) among all studied population groups, with a heterogeneity of I2 = 95.30% (P < 0.001). No heterogeneity was seen in the population subgroups of children and health care workers. The risk of bias in all included studies was assessed using the Newcastle Ottawa Scale.

CONCLUSIONS

For minimising the spread of COVID-19 within the community, this study found that following the screening of asymptomatic cases and their close contacts for chest CT scan (for symptomatic patients), even after negative nucleic acid testing, it is essential to perform a rigorous epidemiological history, early isolation, social distancing and an increased quarantine period (a minimum of 14-28 days). This systematic review and meta-analysis supports the notion of asymptomatic COVID-19 infection and person-to-person transmission and suggests that this is dependent on the varying viral incubation period among individuals. Children, especially those of school age (i.e. <18 years), need to be monitored carefully and follow mitigation strategies (e.g. social distancing, hand hygiene, wearing face masks) to prevent asymptomatic community transmission of COVID-19.

Differential COVID-19 Symptoms Given Pandemic Locations, Time, and Comorbidities During the Early Pandemic

BACKGROUND

COVID-19 pandemic is disaster to public health worldwide. Better perspective on COVID's features early in its course-prior to the development of vaccines and widespread variants-may prove useful in the understanding of future pandemics. Ontology provides a standardized integrative method for knowledge modeling and computer-assisted reasoning. In this study, we systematically extracted and analyzed clinical phenotypes and comorbidities in COVID-19 patients found at different countries and regions during the early pandemic using an ontology-based bioinformatics approach, with the aim to identify new insights and hidden patterns of the COVID-19 symptoms.

RESULTS

A total of 48 research articles reporting analysis of first-hand clinical data from over 40,000 COVID-19 patients were surveyed. The patients studied therein were diagnosed with COVID-19 before May 2020. A total of 18 commonly-occurring phenotypes in these COVID-19 patients were first identified and then classified into different hierarchical groups based on the Human Phenotype Ontology (HPO). This meta-analytic approach revealed that fever, cough, and the loss of smell and taste were ranked as the most commonly-occurring phenotype in China, the US, and Italy, respectively. We also found that the patients from Europe and the US appeared to have more frequent occurrence of many nervous and abdominal symptom phenotypes (e.g., loss of smell, loss of taste, and diarrhea) than patients from China during the early pandemic. A total of 22 comorbidities, such as diabetes and kidney failure, were found to commonly exist in COVID-19 patients and positively correlated with the severity of the disease. The knowledge learned from the study was further modeled and represented in the Coronavirus Infectious Disease Ontology (CIDO), supporting semantic queries and analysis. Furthermore, also considering the symptoms caused by new viral variants at the later stages, a spiral model hypothesis was proposed to address the changes of specific symptoms during different stages of the pandemic.

CONCLUSIONS

Differential patterns of symptoms in COVID-19 patients were found given different locations, time, and comorbidity types during the early pandemic. The ontology-based informatics provides a unique approach to systematically model, represent, and analyze COVID-19 symptoms, comorbidities, and the factors that influence the disease outcomes.

SARS-CoV-2 epidemic after social and economic reopening in three U.S. states reveals shifts in age structure and clinical characteristics

State-level reopenings in late spring 2020 facilitated the resurgence of severe acute respiratory syndrome coronavirus 2 transmission. Here, we analyze age-structured case, hospitalization, and death time series from three states-Rhode Island, Massachusetts, and Pennsylvania-that had successful reopenings in May 2020 without summer waves of infection. Using 11 daily data streams, we show that from spring to summer, the epidemic shifted from an older to a younger age profile and that elderly individuals were less able to reduce contacts during the lockdown period when compared to younger individuals. Clinical case management improved from spring to summer, resulting in fewer critical care admissions and lower infection fatality rate. Attack rate estimates through 31 August 2020 are 6.2% [95% credible interval (CI), 5.7 to 6.8%] of the total population infected for Rhode Island, 6.7% (95% CI, 5.4 to 7.6%) in Massachusetts, and 2.7% (95% CI, 2.5 to 3.1%) in Pennsylvania.

Olfactory and Gustatory Dysfunction in 2019 Novel Coronavirus: An Updated Systematic Review and Meta-analysis

Background:

Evidence showed that partial or complete loss of smell and taste might be a possible primary symptom of the 2019 novel coronavirus (COVID-19). This study aimed to systematically review and pool all available evidence on the olfactory and gustatory dysfunction in COVID-19 patients.

Methods:

In this systematic review, a comprehensive search was carried out systematically through e-databases including PubMed, EMBASE, Scopus, and Web of Science (WoS); that was limited to English-language studies published from 2019 up to 6^th May 2020. Afterward, all studies reported the taste and smell dysfunction in the COVID-19 patients were included. The quality of the studies was assessed by the Mixed Methods Appraisal Tool (MMAT). The pooled prevalence of olfactory and gustatory dysfunction was estimated using the random effects meta-analysis method.

Results:

Among 28 eligible included studies in this systematic review, finally, 22 studies met the eligibility criteria and were included in the meta-analysis. According to the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of any olfactory dysfunction, anosmia, and hyposmia was 55% (40%-70%), 40% (22%-57%), and 40% (20%-61%) respectively. The pooled estimated prevalence of any gustatory dysfunction, ageusia, and dysgeusia was 41% (23%-59%), 31% (3%-59%), and 34% (19%-48%) respectively.

Conclusions:

Olfactory and gustatory dysfunction is prevalent among COVID-19 patients. Therefore, olfactory and gustatory dysfunction seems to be part of important symptoms and notify for the diagnosis of COVID-19, especially in the early phase of the infection.

High SARS-CoV-2 Prevalence among Healthcare Workers in Cochabamba, Bolivia

Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection. The aim of the study was to estimate the SARS-CoV-2 seroprevalence among HCWs in Cochabamba, Bolivia and to determine the potential risk factors. In January 2021, a cross-sectional SARS-CoV-2 seroprevalence study was conducted in 783 volunteer clinical and non-clinical HCWs in tertiary care facilities. It was based on IgG detection using ELISA, chemiluminiscence, and seroneutralisation tests from dried blood spots. Analysis revealed a high seroprevalence (43.4%) of SARS-CoV-2 IgG antibodies. The combination of anosmia and ageusia (OR: 68.11; 95%-CI 24.83–186.80) was predictive of seropositivity. Belonging to the cleaning staff (OR: 1.94; 95%-CI 1.09–3.45), having more than two children in the same house (OR: 1.74; 95%-CI 1.12–2.71), and having been in contact with a close relative with COVID-19 (OR: 3.53; 95%-CI 2.24–5.58) were identified as risk factors for seropositivity in a multivariate analysis. A total of 47.5% of participants had received medication for COVID-19 treatment or prevention, and only ~50% of symptomatic subjects accessed PCR or antigenic testing. This study confirms a massive SARS-CoV-2 attack rate among HCWs in Cochabamba by the end of January 2021. The main risk factors identified are having a low-skilled job, living with children, and having been in contact with an infected relative in the household.

Facile Fabrication of Multilayer Stretchable Electronics via a Two-mode Mechanical Cutting Process

A time- and cost-effective fabrication methodology via a two-mode mechanical cutting process for multilayer stretchable electronics has been developed without using the conventional photolithography-based processes. A commercially available vinyl cutter is used for defining complex patterns on designated material layers by adjusting the applied force and the depth of the cutting blade. Two distinct modes of mechanical cutting can be achieved and employed to establish the basic fabrication procedures for common features in stretchable electronics, such as the metal interconnects, contact pads, and openings by the "tunnel cut" mode, and the flexible overall structure by the "through cut" mode. Three robust and resilient stretchable systems have been demonstrated, including a water-resistant, omnidirectionally stretchable supercapacitor array, a stretchable mesh applicable in sweat extraction and sensing, and a skin-mountable human breathing monitoring patch. Results show excellent electronic performances of these devices made of multilayer functional materials after repetitive large deformations.

Acupuncture for nasal congestion in COVID-19: A protocol for systematic review and meta-analysis

BACKGROUND

From the end of 2019 to now, coronavirus disease 2019 (COVID-19) has put enormous strain on the world's health systems, causing significant deaths and economic losses worldwide. Nasal congestion, one of the symptoms of COVID-19, poses considerable problems for patients. In China, acupuncture has been widely used to treat nasal congestion caused by COVID-19, but there is still a lack of evidence-based medical evaluation.

METHODS

According to the retrieval strategies, randomized controlled trials on the acupuncture for COVID-19 nasal congestion were obtained from China National Knowledge Infrastructure, WanFang, VIP, PubMed, Embase, and Cochrane Library, regardless of publication date, or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to evaluate the quality of the studies. The meta-analysis was performed using Review Manager (RevMan 5.3) and STATA 14.2 software. Ultimately, the evidentiary grade for the results will be evaluated.

RESULTS

The study will provide a high-quality and convincing assessment of the efficacy and safety of acupuncture in the treatment of COVID-19's nasal congestion and will be published in peer-reviewed journals.

CONCLUSION

Our findings will provide references for future clinical decision and guidance development.

PROSPERO REGISTRATION NUMBER

NO.CRD42021299482.

Clinical study on acupuncture treatment of COVID-19: A protocol for a systematic review and meta-analysis

BACKGROUND

COVID-19 is an acute respiratory infectious disease, which makes people difficult to breathe; in addition, it is often accompanied by headache, olfaction, and taste disorders of the neurological manifestations. Acupuncture has been proved to have a therapeutic effect on various neurologic manifestations. This study is designed to evaluate the effectiveness and safety of acupuncture for the neurologic manifestations in COVID-19.

METHODS

Randomized controlled trials from December 2019 to July 2021 will be included without restrictions on language or publication date. PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database will be searched. Two researchers will independently select studies, extract data, and evaluate study quality. Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias of included studies. Statistical analyses will be performed using the Review Manager V.5.3 and stata 14.0.

ETHICS AND DISSEMINATION

This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal.

PROSPERO TRIAL REGISTRATION NUMBER

CRD42021265699.

Insights Into the Changing Landscape of Coronavirus Disease 2019

Coronavirus disease 2019 (COVID-19) is a highly contagious, infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in late 2019 in Wuhan China. A year after the World Health Organization declared COVID-19 a global pandemic, over 215 million confirmed cases and approximately 5 million deaths have been reported worldwide. In this multidisciplinary review, we summarize important insights for COVID-19, ranging from its origin, pathology, epidemiology, to clinical manifestations and treatment. More importantly, we also highlight the foundational connection between genetics and the development of personalized medicine and how these aspects have an impact on disease treatment and management in the dynamic landscape of this pandemic.

Antiviral activity of 5-aminolevulinic acid against variants of severe acute respiratory syndrome coronavirus 2

BACKGROUND

Genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to emerge in 2020 and have been spreading globally during the coronavirus disease 2019 (COVID-19) pandemic. Despite the presence of different COVID-19 vaccines, the discovery of effective antiviral therapeutics for the treatment of patients infected with SARS-CoV-2 are still urgently needed. A natural amino acid, 5-aminolevulinic acid (5-ALA), has exhibited both antiviral and anti-inflammatory activities. In a previous study, we demonstrated an in vitro antiviral effect of 5-ALA against SARS-CoV-2 infection without significant cytotoxicity. In the present study, we sought to investigate whether 5-ALA with or without sodium ferrous citrate (SFC) can inhibit in vitro both the original SARS-CoV-2 Wuhan strain and its variants, including the Alpha, Beta, Gamma and Delta strains.

METHODS

The antiviral activity of ALA with or without SFC was determined in Vero-E6 cell. The virus inhibition was quantified by real time RT-PCR.

RESULTS

Co-administration of 5-ALA and SFC inhibited the Wuhan, Alpha and Delta variants of SARS-CoV-2 with IC50 values of 235, 173 and 397 µM, respectively, and the Beta and Gamma variants with IC50 values of 1311 and 1516 µM.

CONCLUSION

Our study suggests that 5-ALA with SFC warrants accelerated clinical evaluation as an antiviral drug candidate for treating patients infected with SARS-CoV-2 variants.

Clinical Presentation of the SARS-CoV-2 Virus Infection and Predictive Validity of the PCR Test in Primary Health Care Worker Patients of the Spanish National Health System

Background: Despite the impact that the SARS-CoV-2 virus infection has presented in Spain, data on the diagnostic capacity of the symptoms associated with this infection are limited, especially among patients with mild symptoms and who are detected in the primary care field (PC). The objective of the present study was to know the associated symptoms and their predictive criterial validity in SARS-CoV-2 infection among professionals working in PC. Methods: A cross-sectional, multicenter study was carried out in the Spanish National Health System, through an epidemiological survey directed to patients who underwent the PCR test for SARS-CoV-2 in the PC setting. Results: A total of 1612 patients participated, of which 86.6% were PC healthcare professionals, and of these, 67.4% family doctors. Hyposmia, with a sensitivity of 42.69% (95% CI: 37.30–48.08) and a specificity of 95.91% (95% CI: 94.78–97.03), and ageusia with a sensitivity of 39.47% (34.15–44.80) and a specificity of 95.20% (93.98–96.41) were the symptoms with the highest criteria validity indexes. Conclusions: This study identifies the specific symptoms of loss of smell or taste as the most frequently associated with SARS-CoV-2 infection, essential in the detection of COVID-19 given its high frequency and predictive capacity.

Disease characteristics and serological responses in patients with differing severity of COVID-19 infection: A longitudinal cohort study in Dhaka, Bangladesh

BACKGROUND

COVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients.

METHODOLOGY/PRINCIPAL FINDINGS

This longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases. Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases.

CONCLUSION/SIGNIFICANCE

We report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection.

Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis

Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19 taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 241 meeting all inclusion criteria. Drawing on previous studies and guided by early meta-analyses, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct measures of taste are at least as sensitive as those obtained by self-report and that the preponderance of evidence confirms taste loss is a symptom of COVID-19. The meta-analysis showed that, among 138,897 COVID-19-positive patients, 39.2% reported taste dysfunction (95% confidence interval: 35.34%-43.12%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 18) versus self-report (n = 223) methodologies (Q = 0.57, df = 1, P = 0.45). Generally, males reported lower rates of taste loss than did females, and taste loss was highest among middle-aged adults. Thus, taste loss is likely a bona fide symptom of COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.

Hematological changes associated with COVID-19 infection

BACKGROUND

The unresolved COVID-19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID-19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow-up, and outcome prediction.

AIM

This narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID-19 infection, highlighting the diagnostic and prognostic significance.

METHODS

Literature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID-19 using the following key words: "hematological," "complete blood count," "lymphopenia," "blood indices," "markers" "platelet" OR "thrombocytopenia" AND "COVID-19," "coronavirus2019," "2019-nCoV," OR "SARS-CoV-2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included.

RESULTS

Hematological changes are not reported in asymptomatic or presymptomatic COVID-19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D-dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome.

CONCLUSION

Monitoring hematological changes in patients with COVID-19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID-19 as compared to global data.

Sex-Related Factors in Cardiovascular Complications Associated to COVID-19

Coronavirus disease 2019 (COVID-19), the pandemic infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with an extremely heterogeneous spectrum of symptoms and signs. The clinical manifestations seem to be correlated with disease severity. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality compared to women. Such variability can be ascribed to both sex-related biological factors and gender-related behavioral cues. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Cardiovascular diseases play a central role in determining COVID-19 outcome, whether they are pre-existent or arose upon infection. We will pay particular attention to the impact of sex and gender on cardiovascular manifestations related to COVID-19. Finally, we will discuss the sex-dependent variability in some biomarkers for the evaluation of COVID-19 infection and prognosis. The aim of this work is to highlight the significance of gendered medicine in setting up personalized programs for COVID-19 prevention, clinical evaluation and treatment.

The performance of COVID-19 Surveillance System as timely containment strategy in Western Oromia, Ethiopia

BACKGROUND

COVID-19 has been swiftly spreading throughout the world ever since it emerged in Wuhan, China, in late December 2019. Case detection and contact identification remain the key surveillance objectives for effective containment of the pandemic. This study was aimed at assessing performance of surveillance in early containment of COVID 19 in Western Oromia, Ethiopia.

METHODS

A cross-sectional study was conducted from August 1 to September 30, 2020, in the 7 kebeles of Nekemte and 2 kebeles of Shambu Town. Residents who lived there for at least the past six months were considered eligible for this study. Data were collected from community and health system at different levels using semi structured questionnaire and checklist, respectively. Participants' health facility usage (dependent variable) and perceived risk, awareness, Socioeconomic Status, and practices (independent variable) were assessed. Bivariable analysis was computed to test the presence of an association between dependent and independent variables. Independent predictors were identified on multivariable logistic regression using a p-value of (<0.05) significance level. We have checked the model goodness of fit test by Hosmer-lemeshow test.

RESULTS

One hundred seventy-nine (41%) of the participants believe that they have a high risk of contracting COVID-19 and 127 (29%) of them reported they have been visited by health extension worker. One hundred ninety-seven (45.2%) reported that they were not using health facilities for routine services during this pandemic. Except one hospital, all health facilities (92%) were using updated case definition. Three (33%) of the assessed health posts didn't have community volunteers. On multivariable logistic regression analysis, the source of income AOR=0.30, 95% CI (0.11, 0.86), perceived level of risk AOR=3.42, 95% CI (2.04, 5.7) and not visited by health extension workers AOR=0.46, 95% CI (0.29, 0.74) were found to be independent predictors of not using health facilities during this pandemic.

CONCLUSION

Event based surveillance, both at community and health facility level, was not performing optimally in identifying potential suspects. Therefore, for effective early containment of epidemic, it is critical to strengthen event based surveillance and make use of surveillance data for tailored intervention in settings where mass testing is not feasible.

Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study

Objective

To evaluate the association between overweight and obesity on the clinical course and outcomes in patients hospitalized with COVID-19.

Design

Retrospective, observational cohort study.

Methods

We performed a multicenter, retrospective, observational cohort study of hospitalized COVID-19 patients to evaluate the associations between overweight and obesity on the clinical course and outcomes.

Results

Out of 1634 hospitalized COVID-19 patients, 473 (28.9%) had normal weight, 669 (40.9%) were overweight, and 492 (30.1%) were obese. Patients who were overweight or had obesity were younger, and there were more women in the obese group. Normal-weight patients more often had pre-existing conditions such as malignancy, or were organ recipients. During admission, patients who were overweight or had obesity had an increased probability of acute respiratory distress syndrome [OR 1.70 (1.26-2.30) and 1.40 (1.01-1.96)], respectively and acute kidney failure [OR 2.29 (1.28-3.76) and 1.92 (1.06-3.48)], respectively. Length of hospital stay was similar between groups. The overall in-hospital mortality rate was 27.7%, and multivariate logistic regression analyses showed that overweight and obesity were not associated with increased mortality compared to normal-weight patients.

Conclusion

In this study, overweight and obesity were associated with acute respiratory distress syndrome and acute kidney injury, but not with in-hospital mortality nor length of hospital stay.

Acupuncture for headache in COVID-19: A protocol for systematic review and meta-analysis

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease which making people difficult to breathe and often accompanied with headache. Acupuncture have been proved the therapeutic effect on headache, but there has been no high-quality evidence on acupuncture for the headache in COVID-19. This study is designed to evaluate the effectiveness and safety of acupuncture for headache in COVID-19.

METHODS

Randomized controlled trials from December 2019 to July 2021 will be included without restrictions on language or publication date. PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases, China National Knowledge Infrastructure, Wanfang database, and VIP database will be searched. Two researchers will independently select studies, extract data and evaluate study quality. Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias of included studies. Statistical analyses will be performed using the Review Manager V.5.3 and stata 14.0.

ETHICS AND DISSEMINATION

This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal.

PROSPERO TRIAL REGISTRATION NUMBER

CRD42021270722.

Prevalence of COVID-19 in Bangladesh, April to October 2020—a cross-sectional study

•

This was a cross-sectional survey study.

•

The prevalence of COVID-19 in Bangladesh was estimated.

•

The estimated prevalence of COVID-19 was 6.4%.

Objective: The aim of this study was to estimate the proportion of symptomatic and asymptomatic laboratory-confirmed coronavirus disease 2019 (COVID-19) cases among the population of Bangladesh.

Methods: A cross-sectional survey was conducted in Dhaka City and other districts of Bangladesh between April 18 and October 12, 2020. A total of 32 districts outside Dhaka were randomly selected, and one village and one mahalla was selected from each district; 25 mahallas were selected from Dhaka City. From each village or mahalla, 120 households were enrolled through systematic random sampling.

Results: A total of 44 865 individuals were interviewed from 10 907 households. The majority (70%, n = 31 488) of the individuals were <40 years of age. Almost half of the individuals (49%, n = 21 888) reported more than four members in their household. It was estimated that 12.6% (n = 160) of the households had one or more severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals, among whom 0.9% (n = 404) of individuals had at least one COVID-19-like symptom, at the national level. The prevalence of COVID-19 in the general population was 6.4%. Among the SARS-CoV-2-positive individuals, 87% were asymptomatic.

Conclusions: The substantial high number of asymptomatic cases all over Bangladesh suggests that community-level containment and mitigation measures are required to combat COVID-19. Future studies to understand the transmission capability could help to define mitigation and control measures.

Evaluation of a comprehensive pre-procedural screening protocol for COVID-19 in times of a high SARS CoV-2 prevalence: a prospective cross-sectional study

BACKGROUND

To minimise the risk of COVID-19 transmission, an ambulant screening protocol for COVID-19 in patients before admission to the hospital was implemented, combining the SARS CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) on a nasopharyngeal swab, a chest computed tomography (CT) and assessment of clinical symptoms. The aim of this study was to evaluatethe diagnostic yield and the proportionality of this pre-procedural screeningprotocol.

METHODS

In this mono-centre, prospective, cross-sectional study, all patients admitted to the hospital between 22nd April 2020 until 14th May 2020 for semi-urgent surgery, haematological or oncological treatment, or electrophysiological investigationunderwent a COVID-19 screening 2 days before their procedure. At a 2-week follow-up, the presence of clinical symptoms was evaluated by telephone as a post-hoc evaluation of the screening approach.Combined positive RT-PCR assay and/or positive chest CT was used as gold standard. Post-procedural outcomes of all patients diagnosed positive for COVID-19 were assessed.

RESULTS

In total,528 patients were included of which 20 (3.8%) were diagnosed as COVID-19 positive and 508 (96.2%) as COVID-19 negative. 11 (55.0%) of COVID-19 positive patients had only a positive RT-PCR assay, 3 (15.0%) had only a positive chest CT and 6 (30%) had both a positive RT-PCR assay and chest CT. 10 out of 20 (50.0%) COVID-19 positive patients reported no single clinical symptom at the screening. At 2 week follow-up, 50% of these patients were still asymptomatic. 37.5% of all COVID-19 negative patients were symptomatic at screening. In the COVID-19 negative group without symptoms at screening, 78 (29.3%) patients developed clinical symptoms at a 2-week follow-up.

CONCLUSION

This study suggests that routine chest CT and assessment of self-reported symptoms have limited value in the preprocedural COVID-19 screening due to low sensitivity and/or specificity.

Covid-19: Signs and symptoms related to the feeding behavior

COVID-19 reached pandemic level in March 2020 and the number of confirmed cases continued to increase worldwide. The clinical course of the disease has not yet been fully characterized, and some specific symptoms related to smell, taste, and feeding behavior require further examination. The present study aimed to assess the presence of symptoms related to the feeding behavior occurred during and/or after COVID-19 in adults residing in Portugal and to link them to disease severity using a multivariate approach. Data were collected from May to September 2020, through a questionnaire answered online containing questions about general and specific symptoms before, during and after COVID-19. 362 participants were included: 201 were symptomatic, being 15 hospitalized and 186 non-hospitalized. Cluster analysis grouped the symptomatic non-hospitalized participants as mild and severe cases. For these patients, the most frequent symptoms related to the feeding process were smell disorders in 40% and 62%, taste disorders in 37% and 60%, and dry mouth, in 23% and 48% of the mild and severe cases, respectively. Dry mouth was significantly associated with difficulty to swallow, pain during swallow, choking when eating or drinking, and preference for mushy/pasty foods (p < 0.01; Chi-squared test). Among the severe cases, the incidence of coughing during the meal (31%), difficulty (19%) and pain during swallow (17%), preference for mushy/pasty foods (10%) and choking when eating or drinking (6%) were clinically relevant and may indicate the presence of swallowing disorders. This group also showed a higher frequency of general symptoms, such as fever, headache, abdominal pain, tiredness, diarrhea, nausea, and shortness of breath (p < 0.05; Chi-squared test). Smell disorders, taste disorders and dry mouth were the most frequent symptoms related to the feeding behavior for both mild and severe cases. Dry mouth was significantly associated with swallowing difficulties and future research should investigate it as a frequent symptom and as a predictive of the presence of eating and swallowing disorders in COVID-19 cases.

Epidemiological characteristics and outcomes of COVID-19 in asymptomatic versus symptomatic patients

BACKGROUND

The clinical manifestations of COVID-19 are different, which can be attributed to asymptomatic carriers, acute respiratory disease and pneumonia with different severities. The aim of this study was to compare the epidemiological characteristics and outcomes of COVID-19 in patients with clinical symptoms versus asymptomatic patients.

METHODS

In this retrospective cohort study, the epidemiological characteristics of two groups of patients, with clinical symptoms (n = 38,630) and without clinical symptoms who were definitive cases of COVID-19 (n = 2,327) were investigated in the southwestern of Iran. Chi-square test was used to evaluate the differences between qualitative variables in the two study groups.

RESULTS

Of 40,957 patients with COVID-19, 2,327 (5.68%) were asymptomatic, of whom 1391 (59.77%) were males, 1841 patients (79.11%) had a history of contact with definite or suspected cases of COVID-19. Asymptomatic patients were older than symptomatic cases. Patients with clinical symptoms had higher mortality rate than asymptomatic patients (2.68% in symptomatic patients vs 0% in asymptomatic patients).

CONCLUSION

According to the results of our study, the detected viral load in asymptomatic individuals was similar to that of symptomatic patients, indicating that asymptomatic infections can potentially transmit the disease. Therefore, screening and detection of asymptomatic cases is an important and key measure in prevention and early control of COVID-19 worldwide.

Inflammatory but not respiratory symptoms are associated with ongoing upper airway viral shedding in outpatients with uncomplicated COVID-19

Although the vast majority of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections are uncomplicated, our understanding of predictors of symptom resolution and viral shedding cessation remains limited. We characterized symptom trajectories and oropharyngeal viral shedding among 120 outpatients with uncomplicated Coronavirus Disease of 2019 (COVID-19) enrolled in a clinical trial of Peginterferon Lambda, which demonstrated no clinical or virologic benefit compared with placebo. In the combined trial cohort, objective fever was uncommon, inflammatory symptoms (myalgias, fatigue) peaked at 4 to 5 days postsymptom onset, and cough peaked at 9 days. The median time to symptom resolution from earliest symptom onset was 17 days (95% confidence interval 14-18). SARS-CoV-2 IgG seropositivity at enrollment was associated with hastened resolution of viral shedding (hazard ratio 1.80, 95% confidence interval 1.05-3.1, P = 0.03), but not with symptom resolution. Inflammatory symptoms were associated with a significantly greater odds of oropharyngeal SARS-CoV-2 RNA detection; respiratory symptoms were not. These findings have important implications for COVID-19 screening approaches and trial design.