Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Candida infections in COVID-19 patients: A review of prevalence, risk factors, and mortality

BACKGROUND

Candida spp. infections have increasingly been reported among COVID-19 patients, yet the epidemiological factors, diagnostic methods, and outcomes associated with these infections remain poorly understood. These infections, particularly in ICU settings, present significant challenges due to high mortality rates and rising antifungal resistance. This study aimed to investigate the occurrence, risk factors, treatment, and outcomes of Candida albicans and non-albicans Candida in COVID-19 patients, providing clinical and epidemiological insights.

METHODS

A review following PRISMA guidelines was conducted. Searches were performed in PubMed, Embase, and BVS databases, covering articles published from January 2020 to May 2024. Inclusion criteria included case reports or case series providing detailed information on Candida spp. in COVID-19 patients. Data extraction focused on patient demographics, underlying diseases, antifungal and antibiotic therapies, antifungal susceptibility, resistance profiles, and outcomes. Statistical analyses were conducted using SPSS software.

RESULTS

The review included 67 studies, totaling 223 COVID-19 patients. Male patients were predominant. Common comorbidities included hypertension, cancer, and dyslipidemia. Echinocandins were the primary antifungal treatment. Non-albicans Candida exhibited a higher resistance rate (47.10 %) compared to C. albicans (2.35 %). Overall mortality rates were high, at 60.50 % for C. albicans and 62.30 % for non-albicans. Significant risk factors for mortality included age, central venous catheter use, ICU admission, and corticosteroid therapy.

CONCLUSIONS

The study identified critical risk factors and clinical characteristics in COVID-19 patients with Candida infections. The high incidence of antifungal resistance among non-albicans and high mortality rates highlight the need for vigilant monitoring and targeted antifungal strategies to improve outcomes.

The Effect of Naturally Acquired Immunity on Mortality Predictors: A Focus on Individuals with New Coronavirus

Background/Objectives: The spread of the COVID-19 pandemic has spurred the development of advanced healthcare tools to effectively manage patient outcomes. This study aims to identify key predictors of mortality in hospitalized patients with some level of natural immunity, but not yet vaccinated, using machine learning techniques. Methods: A total of 363 patients with COVID-19 admitted to Río Hortega University Hospital in Spain between the second and fourth waves of the pandemic were included in this study. Key characteristics related to both the patient's previous status and hospital stay were screened using the Random Forest (RF) machine learning technique. Results: Of the 19 variables identified as having the greatest influence on predicting mortality, the most powerful ones could be identified at the time of hospital admission. These included the assessment of severity in community-acquired pneumonia (CURB-65) scale, age, the Glasgow Coma Scale (GCS), and comorbidities, as well as laboratory results. Some variables associated with hospitalization and intensive care unit (ICU) admission (acute renal failure, shock, PRONO sessions and the Acute Physiology and Chronic Health Evaluation [APACHE-II] scale) showed a certain degree of significance. The Random Forest (RF) method showed high accuracy, with a precision of >95%. Conclusions: This study shows that natural immunity generates significant changes in the evolution of the disease. As has been shown, machine learning models are an effective tool to improve personalized patient care in different periods.

Natural Infection of Omicron BA.5.2 in Patients Provides Broad Immune Responses Against SARS-CoV-2

The implementation of COVID-19 policy and the rapid development of SARS-CoV-2 vaccines in the early pandemic significantly contained numerous outbreaks and reduced the severity and mortality of COVID-19. However, the population immunity induced by existing vaccines was insufficient to prevent SARS-CoV-2 outbreaks. The host immunity induced by the wide spread of Omicron variants and its influence on emerging SARS-CoV-2 variants are attracting broad attention. In this study, a clinical data analysis of the patients indicated that pre-vaccination reduced inflammatory responses and mitigated the severity of COVID-19 cases caused by natural infection with Omicron BA.5.2. The analysis of adaptive immune responses indicated that natural infection with BA.5.2 induced robust and broad immune responses, including both humoral and T cell-mediated immune responses (IFN-γ) against highly conserved viral antigens, and provided cross-reactive neutralization against various viral variants. Collectively, we report that the natural infection with Omicron BA.5.2 induced broad cross-reactive immunity against SARS-CoV-2 variants, which suggests that the development of a live attenuated SARS-CoV-2 vaccine with desired safety, high efficacy, broad spectrum, and long-term immune persistence is feasible. Therefore, we suggest that herd immunity, achieved through vaccination with attenuated vaccines, combined with booster doses of existing vaccines and antiviral therapy for people with high viral loads, may contribute to the eradication of this virus.

Deep neural networks excel in COVID-19 disease severity prediction-a meta-regression analysis

COVID-19 is a disease in which early prognosis of severity is critical for desired patient outcomes and for the management of limited resources like intensive care unit beds and ventilation equipment. Many prognostic statistical tools have been developed for the prediction of disease severity, but it is still unclear which ones should be used in practice. We aim to guide clinicians in choosing the best available tools to make optimal decisions and assess their role in resource management and assess what can be learned from the COVID-19 scenario for development of prediction models in similar medical applications. Using the five major medical databases: MEDLINE (via PubMed), Embase, Cochrane Library (CENTRAL), Cochrane COVID-19 Study Register, and Scopus, we conducted a comprehensive systematic review of prediction tools between 2020 January and 2023 April for hospitalized COVID-19 patients. We identified both the relevant confounding factors of tool performance using the MetaForest algorithm and the best tools-comparing linear, machine learning, and deep learning methods-with mixed-effects meta-regression models. The risk of bias was evaluated using the PROBAST tool. Our systematic search identified eligible 27,312 studies, out of which 290 were eligible for data extraction, reporting on 430 independent evaluations of severity prediction tools with ~ 2.8 million patients. Neural Network-based tools have the highest performance with a pooled AUC of 0.893 (0.748-1.000), 0.752 (0.614-0.853) sensitivity, 0.914 (0.849-0.952) specificity, using clinical, laboratory, and imaging data. The relevant confounders of performance are the geographic region of patients, the rate of severe cases, and the use of C-Reactive Protein as input data. 88% of studies have a high risk of bias, mostly because of deficiencies in the data analysis. All investigated tools in use aid decision-making for COVID-19 severity prediction, but Machine Learning tools, specifically Neural Networks clearly outperform other methods, especially in cases when the basic characteristics of severe and non-severe patient groups are similar, and without the need for more data. When highly specific biomarkers are not available-such as in the case of COVID-19-practitioners should abandon general clinical severity scores and turn to disease specific Machine Learning tools.

M, Gowda MAS. A Cross-Sectional Study on Post-COVID-19 Menstrual Abnormalities in Women of Reproductive Age Group at a Tertiary Care Hospital

Purpose: This study aimed to evaluate the effect of COVID-19 infection and vaccination on all the menstrual cycle parameters in the women of reproductive age group, 18-45 years, at a tertiary care hospital. Methods: A single-center, descriptive cross-sectional study was done from January 2, 2023, to June 24, 2023. Sampling was nonprobabilistic and purposeful. Participants were recruited via calls, in-person interviews, and online surveys. A total of 931 participants were recruited, of which 141 participants were eligible for the study. Descriptive statistics were performed for all variables. Pearson's chi-square test was done to compare categorical variables among different groups, and the Wilcoxon matched pair signed-rank test was done to compare the menstrual cycle patterns before and after COVID-19 infection and vaccination. Simple linear regression and multiple linear regression analysis were done wherever necessary. p < 0.05 was considered statistically significant. Results: A total of 931 participants were recruited, of which 141 participants were eligible for the study. The median age was 29 years. Those who reported menstrual abnormalities were mainly of the age group 18-27 (n = 62, 44.0%), resided in an urban locality (n = 123, 87.2%), and were employed (full-time/part-time) (n = 57, 40.4%). Of the 42 participants with menstrual changes, 27 (64.3%) participants experienced changes post-COVID-19 infection before their first vaccination dose and 15 (35.7%) after the first vaccination dose. In this group, 15 (35.7%) continue to experience abnormalities in their cycles. Analysis showed that participants having severe COVID-19 symptoms were more likely to have an earlier onset of menstrual abnormalities (beta = -2.072, p=0.040). Participants with an above-normal BMI were more likely to have increased pain/cramps during menses (beta = 0.236, p=0.0.013). Participants who were students/employed (beta = -0.365, p=0.001) with an above-normal BMI (beta = 0.182, p=0.024) were more likely to experience increased mood swings/tension/irritability. On comparing the onset and duration of menstrual abnormalities in the post-COVID-19 infection and postvaccination groups, it was found that the latter group had a late-onset and short-term effect, while the former group had an early-onset and long-term effect on menses. Conclusion: Our study shows that there is evidence of the onset of menstrual irregularities following COVID-19 infection and vaccination. The study revealed COVID-19 infection and vaccination influence menstrual cycles, the former posing a higher risk, but their effects on menstruation independent of one another are to be studied further.

Structural and virological identification of neutralizing antibody footprint provides insights into therapeutic antibody design against SARS-CoV-2 variants

Medical treatments using potent neutralizing SARS-CoV-2 antibodies have achieved remarkable improvements in clinical symptoms, changing the situation for the severity of COVID-19 patients. We previously reported an antibody, NT-108 with potent neutralizing activity. However, the structural and functional basis for the neutralizing activity of NT-108 has not yet been understood. Here, we demonstrated the therapeutic effects of NT-108 in a hamster model and its protective effects at low doses. Furthermore, we determined the cryo-EM structure of NT-108 in complex with SARS-CoV-2 spike. The single-chain Fv construction of NT-108 improved the cryo-EM maps because of the prevention of preferred orientations induced by Fab orientation. The footprints of NT-108 illuminated how escape mutations such as E484K evade from class 2 antibody recognition without ACE2 affinity attenuation. The functional and structural basis for the potent neutralizing activity of NT-108 provides insights into the rational design of therapeutic antibodies.

Global burden, subtype, risk factors and etiological analysis of enteric infections from 1990-2021: population based study

Background

Enteric infections represent a prevalent global health issue and contribute significantly to the global disease burden. This study aims to investigate the patterns and trends of enteric infections from 1990 to 2021, providing valuable insights for health policy formulation, medical resource allocation, and the optimization of patient management plans.

Methods

We analyzed the Global Burden of Disease (GBD) 2021 for 21 regions and 204 countries to understand better the health burden using prevalence, incidence, mortality, and disability-adjusted life years (DALYs), subtype, risk factors, and etiology. We tested correlations with the Socio-demographic Index (SDI), and using decomposition analysis to dissect the reasons behind changes in epidemiological indicators of the disease.

Results

In 2021, the age-standardized rates of prevalence, incidence, deaths, and DALYs per 100,000 population for enteric infections were 879.58, 577.21, 17.83, and 1020.15, respectively. Compared to 1990, these rates exhibited -0.18, -0.12, -0.73, and -0.72 changes. Gender and age analyses revealed a higher burden among females, those under 15 years old, and the elderly. Regions with low SDI had higher epidemiological indicators. The burden of Typhoid fever declines in high-development regions. Unsafe water sources were identified as the primary risk factor globally in both 1990 and 2021. Rotavirus was the leading cause of deaths and DALYs.

Conclusion

This study highlights the complex epidemiological landscape of enteric infections, revealing variations in burden, risk factors, and etiological characteristics across age, gender, and geographical regions. It underscores the urgent need for healthcare professionals and policymakers to develop innovative prevention and healthcare strategies based on the current and evolving burden of enteric infections, to alleviate the global disease burden.

Development of the TSR-based computational method to investigate spike and monoclonal antibody interactions

Introduction

Monoclonal antibody (mAb) drug treatments have proven effective in reducing COVID-19-related hospitalizations or fatalities, particularly among high-risk patients. Numerous experimental studies have explored the structures of spike proteins and their complexes with ACE2 or mAbs. These 3D structures provide crucial insights into the interactions between spike proteins and ACE2 or mAb, forming a basis for the development of diagnostic tools and therapeutics. However, the field of computational biology has faced substantial challenges due to the lack of methods for precise protein structural comparisons and accurate prediction of molecular interactions. In our previous studies, we introduced the Triangular Spatial Relationship (TSR)-based algorithm, which represents a protein's 3D structure using a vector of integers (keys). These earlier studies, however, were limited to individual proteins.

Purpose

This study introduces new extensions of the TSR-based algorithm, enhancing its ability to study interactions between two molecules. We apply these extensions to gain a mechanistic understanding of spike - mAb interactions.

Method

We expanded the basic TSR method in three novel ways: (1) TSR keys encompassing all atoms, (2) cross keys for interactions between two molecules, and (3) intra-residual keys for amino acids. This TSR-based representation of 3D structures offers a unique advantage by simplifying the search for similar substructures within structural datasets.

Results

The study's key findings include: (i) The method effectively quantified and interpreted conformational changes and steric effects using the newly introduced TSR keys. (ii) Six clusters for CDRH3 and three clusters for CDRL3 were identified using all-atom keys. (iii) We constructed the TSR-STRSUM (TSR-STRucture SUbstitution Matrix), a matrix that represents pairwise similarities between amino acid structures, providing valuable applications in protein sequence and structure comparison. (iv) Intra-residual keys revealed two distinct Tyr clusters characterized by specific triangle geometries.

Conclusion

This study presents an advanced computational approach that not only quantifies and interprets conformational changes in protein backbones, entire structures, or individual amino acids, but also facilitates the search for substructures induced by molecular binding across protein datasets. In some instances, a direct correlation between structures and functions was successfully established.

A flexible transoral swab sampling robot system with visual-tactile fusion approach

A significant number of individuals have been affected by pandemic diseases, such as COVID-19 and seasonal influenza. Nucleic acid testing is a common method for identifying infected patients. However, manual sampling methods require the involvement of numerous healthcare professionals. To address this challenge, we propose a novel transoral swab sampling robot designed to autonomously perform nucleic acid sampling using a visual-tactile fusion approach. The robot comprises a series-parallel hybrid flexible mechanism for precise distal posture adjustment and a visual-tactile perception module for navigation within the subject's oral cavity. The series-parallel hybrid mechanism, driven by flexible shafts, enables omnidirectional bending through coordinated movement of the two segments of the bendable joint. The visual-tactile perception module incorporates a camera to capture oral images of the subject and recognize the nucleic acid sampling point using a deep learning method. Additionally, a force sensor positioned at the distal end of the robot provides feedback on contact force as the swab is inserted into the subject's oral cavity. The sampling robot is capable of autonomously performing transoral swab sampling while navigating using the visual-tactile perception algorithm. Preliminary experimental trials indicate that the designed robot system is feasible, safe, and accurate for sample collection from subjects.

Dynamic biomarkers and Cox regression with time-dependent covariate for mortality prediction in severe fever with thrombocytopenia syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is a fatal tick-borne infectious disease that lacks effective treatments. Dynamic analysis that reflects changes in the SFTS patient's condition is needed. This study aimed to evaluate the time-dependent predictive performance of key biomarkers using a time-dependent Cox regression model. A retrospective multicenter cohort study was conducted on 440 SFTS patients hospitalized in South Korea between 2013 and 2024. Time-dependent Cox regression and time-dependent receiver operating characteristic (ROC) analyses were applied to assess the prognostic value of Blood Urea Nitrogen (BUN), Prothrombin Time (PT), and Activated Partial Thromboplastin Time (aPTT). Missing data were handled using multiple imputation. aPTT consistently demonstrated high predictive accuracy (AUC > 0.90) throughout the disease course, indicating its sustained role in coagulopathy. PT exhibited strong early-stage predictive power (AUC = 0.86 on day 2) but declined over time, reflecting its utility for early monitoring. BUN showed a progressive increase in predictive performance (AUC = 0.70 on day 2 to AUC = 0.78 on day 8), supporting its relevance in later stages of disease progression. Non-survivors exhibited significantly higher levels of BUN, PT, and aPTT compared to survivors. This study demonstrates the utility of time-dependent analysis for evaluating dynamic biomarker changes in SFTS patients. aPTT is a robust predictor throughout the disease course, while PT is valuable for early-stage assessment and BUN for later-stage management. These findings suggest the importance of integrating dynamic biomarker monitoring into clinical decision-making to improve prognosis in SFTS patients.

Identification of potential hub genes and drugs in septic kidney injury: a bioinformatic analysis with preliminary experimental validation

Background

Sepsis-associated kidney injury (SAKI) is a prevalent complication in intensive care unit (ICU) patients with sepsis. Diagnosis currently relies on clinical assessment, urine output, and serum creatinine levels, yet effective clinical treatments remain scarce. Our objectives are to explore prospective, targeted medications for the treatment of septic kidney injury and to employ bioinformatics to identify key genes and pathways that may be implicated in the pathogenesis of SAKI.

Methods

We utilized the GEO database for differential gene screening. Related genes of septic kidney injury were identified through Pubmed2Ensembl, followed by annotation and visualization of gene ontology biological processes and KEGG pathways using DAVID. Protein-protein interactions were analyzed with the STRING database, and hub genes were identified using Cytoscape software. Candidate genes were further validated through Metascape. The CTD database was employed to uncover the relationship between hub genes and acute kidney injury (AKI). CIBERSORT was applied to evaluate the infiltration of immune cells and their association with hub genes. Hub genes were experimentally verified through qPCR detection. Lastly, the Drug-Gene Interaction Database (DGIdb) was utilized to identify drug-gene interactions.

Results

Six genes, including TNF, CXCL8, IL-6, IL-1β, IL-2, and IL-10, were associated with three major signaling pathways: the COVID-19 adverse outcome pathway, an overview of pro-inflammatory and pro-fibrotic mediators, and the interleukin-10 signaling pathway. Additionally, 12 targeted drugs were identified as potential therapeutic agents.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL TRIAL NUMBER

Not applicable.

Design, synthesis, and antiviral activity of fragmented-lapatinib aminoquinazoline analogs towards SARS-CoV-2 inhibition

The severe impact of COVID-19 on global health and economies highlights the critical need for innovative treatments. Recently, lapatinib, a drug initially used for breast cancer, has been identified as a potential inhibitor of the main protease (Mpro) of SARS-CoV-2, meriting further investigation. Utilizing rational design strategies and guided by MD simulations, we developed novel aminoquinazoline analogs based on fragmented lapatinib's structure. Preliminary computational screenings identified promising candidates, which were synthesized using a concise 3-4 step process. In vitro assays demonstrated notable antiviral efficacy against SARS-CoV-2-infected cells for all analogs, with Bb1 showing an EC50 of 1.10 μM and significantly lower toxicity (13.55 % at 50 μM) compared to lapatinib. Further studies confirmed that these analogs effectively inhibit SARS-CoV-2 Mpro, with Bb7 displaying the highest activity. MD simulations revealed that Bb7 achieves stability within the Mpro binding pocket through interactions with specific residues. These findings indicate that aminoquinazoline analogs hold significant promise as therapeutic candidates for COVID-19.

Severely Ill COVID-19 Patients May Exhibit Hypercoagulability Despite Escalated Anticoagulation

Introduction: Severely ill COVID-19 patients receiving prophylactic-dose anticoagulation exhibit high rates of thrombosis and mortality. The escalation of anticoagulation also does not reduce mortality and has an uncertain impact on thrombosis rates. The reasons why escalated doses fail to outperform prophylactic doses in reducing risks of thrombosis and death in severely ill COVID-19 patients remain unclear. We hypothesized that escalated anticoagulation would not effectively prevent hypercoagulability and, consequently, would not reduce the risk of thrombosis and death in some severely ill patients. Methods: We conducted a prospective multicenter study that enrolled 3860 COVID-19 patients, including 1654 severely ill. They received different doses of low-molecular-weight or unfractionated heparin, and their blood coagulation was monitored with activated partial thromboplastin time, D-dimer, and Thrombodynamics. A primary outcome was hypercoagulability detected by Thrombodynamics. Blood samples were collected at the trough level of anticoagulation. Results: We found that escalated anticoagulation did not prevent hypercoagulability in 28.3% of severely ill patients at the trough level of the pharmacological activity. Severely ill patients with such hypercoagulability had higher levels of inflammation markers and better creatinine clearance compared to severely ill patients without it. Hypercoagulability detected by Thrombodynamics was associated with a 1.68-fold higher hazard rate for death and a 3.19-fold higher hazard rate for thrombosis. Elevated D-dimer levels were also associated with higher hazard rates for thrombosis and death, while shortened APTTs were not. The simultaneous use of Thrombodynamics and D-dimer data enhanced the accuracy for predicting thrombotic events and fatal outcomes in severely ill patients. Conclusions: Thrombodynamics reliably detects hypercoagulability in COVID-19 patients and can be used in conjunction with D-dimer to assess the risk of thrombosis and death in severely ill patients. The pharmacological effect of LMWH at the trough level might be too low to prevent thrombosis in some severely ill patients with severe inflammation and better creatinine clearance, even if escalated doses are used.

Knowledge mapping of Guillain-Barré syndrome from January 2013 to October 2023: A bibliometric analysis

BACKGROUND

With the COVID-19 pandemic and the serious sequelae, foreign factor-induced Guillain-Barré syndrome (GBS) has become a research focus in autoimmune peripheral neuropathies. The study employs a bibliometric system to illustrate the research hotspots and trends in GBS based on pertinent literature from January 2013 to October 2023.

METHODS

The Web of Science Core Collection retrieved articles on GBS from January 1, 2013, to October 28, 2023. These articles were then visualized and statistically evaluated using VOSviewer, CiteSpace software, R version 4.2.1, and Microsoft Office Excel 2019.

RESULTS

A total of 4269 articles on GBS were gathered. The United States of America produced the most publications (28.55%, 1219/4269), followed by China (14.22%, 607/4269). The world's leading country was the United States of America, with the most publications, the most substantial international cooperation, and the highest centrality (0.17). Union of French Research Universities (UDICE)-French Research Universities in France was the most productive organization (189 articles). Lancet was the highest cocited journal (2428), and Professor Jacobs, Bart C., was the most prolific author (93). The most significant increases were shown for the keywords coronavirus, respiratory failure, and coronavirus disease 2019. The novel coronavirus is an emerging virus that may cause GBS, indicating a promising area of research.

CONCLUSIONS

The study on GBS was illustrated using bibliometrics, and it covers trends in international collaboration, publications, and research hotspots. These findings allow the scientific community to pinpoint the novel ideas and directions that will drive future GBS research.

A questionnaire-based survey on the epidemiological and clinical characteristics of SARS-CoV-2 infection in patients with chronic HBV infection and HIV infection

Background and aims

Traditional observational studies have yielded inconsistent findings regarding the association between COVID-19 and HBV/HIV infections, as well as the protective effects of antiviral therapy against severe COVID-19. This study aimed to investigate the potential links between the current use of antiviral therapy and the rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and symptoms of infection in patients with SARS-CoV-2 and HBV/HIV.

Methods

Using a questionnaire-based survey, we recorded whether participants had been infected with SARS-CoV-2, and the symptoms and severity of COVID-19 after the illness.

Results

Among 756 participants, chi-square tests showed a higher incidence of COVID-19 in the HBV infection group (75.6%, p = 0.047) and the HIV infection group (77.6%, p = 0.036). These two groups exhibited fewer symptoms than the control group (p < 0.001). The differences in the prevalence of most symptoms were also significant.

Conclusion

Our findings suggest that patients with HBV or HIV infection have a higher risk of contracting SARS-CoV-2 than the general population; however, antiviral treatment relieves the symptoms of COVID-19.

Combination of fibrosis-4 score and D-dimer: a practical approach to identify poor outcome in COVID-19

AIM

Fibrosis-4 (FIB-4) score and D-dimer (DD) have emerged as prognostic markers in coronavirus disease 2019 (COVID-19). However, precise cutoff points remain undefined, and their combined use has been scarcely studied. We aimed to analyze FIB-4 and DD performance, individually and combined, to predict outcomes among COVID-19 patients.

METHODS

From March to December 2020, hospitalized COVID-19 patients were evaluated based on clinical and laboratory tests from their first day of hospitalization. Primary outcome was inhospital mortality, and secondary outcomes included hospital stay length, ICU admission and duration, need for hemodialysis, ventilatory support, and extent of lung involvement. Optimal FIB-4 and DD cutoff points to predict mortality were established to maximize sensitivity and specificity. A sequential diagnostic strategy using both markers was subsequently evaluated.

RESULTS

Among 518 patients (61 ± 16 years, 64% men), the inhospital mortality rate was 18%. FIB-4 outperformed DD in predicting mortality (area under the receiver operating characteristic curve: 0.76 vs. 0.65, P = 0.003) and was chosen as the first step in sequential analysis. Mortality was higher in patients with FIB-4 ≥1.76 vs. FIB-4 <1.76 (26 vs. 5%, P < 0.001) and DD ≥2000 ng/ml vs. DD <2000 ng/ml (38 vs. 16%, P < 0.001). Using FIB-4 as a screening test (cutoff = 1.76, 90% sensitivity) followed by DD (cutoff = 2000 ng/ml; 90% specificity) identified a subgroup with higher mortality when compared with FIB-4 alone (48 vs. 26%, P < 0.001), missing the identification of only 2% of deaths.

CONCLUSION

Sequential use of FIB-4 and DD represents a comprehensive strategy to identify high-risk COVID-19 patients at hospital admission, potentially minimizing unnecessary DD tests in those deemed low-risk by FIB-4.

Epidemiological and clinical characteristics of COVID-19 mortality: a retrospective study

Background

The global impact of SARS-CoV-2 and its associated coronavirus disease (COVID-19) has necessitated urgent characterization of prognostic biomarkers. This study aimed to delineate the epidemiological and clinical predictors of mortality among hospitalized COVID-19 patients.

Methods

A retrospective cohort study was conducted on 123 patients with laboratory-confirmed COVID-19 admitted to Huoshenshan Hospital (Wuhan, China) from 1 February 2020 to 30 April 2020. Kaplan-Meier curve and multivariate Cox regression were used to assess the independent factors with survival time. Statistical significance was set at a p-value of <0.05.

Results

The cohort exhibited a mortality rate of 49.6% (61/123), with the critical clinical type (HR = 7.970, p = 0.009), leukocytosis (HR = 3.408, p = 0.006), and lymphopenia (HR = 0.817, p = 0.038) emerging as independent predictors of reduced survival. Critical-type patients demonstrated significantly elevated inflammatory markers (neutrophils: 10.41 ± 6.23 × 109/L; CRP: 104.47 ± 29.18 mg/L) and coagulopathy (D-dimer: 5.21 ± 2.34 μg/ml) compared to non-critical cases. Deceased patients exhibited pronounced metabolic derangements, including hyperglycemia (9.81 ± 2.07 mmol/L) and hepatic dysfunction (ALP: 174.03 ± 30.13 U/L).

Conclusion

We revealed the epidemiological and clinical features of different clinical types of SARS-CoV-2 as summarized in this paper. We found that critical type, leukocyte, and lymphocyte are risk factors that affect survival time, which could be an early and helpful marker to improve management of COVID-19 patients.

Temporal Radiographic Trajectory and Clinical Outcomes in COVID-19 Pneumonia: A Longitudinal Study

BACKGROUND

Currently, little is known about the relationship between the temporal radiographic latent trajectories, which are based on the extent of coronavirus disease 2019 (COVID-19) pneumonia and clinical outcomes. This study aimed to elucidate the differences in the temporal trends of critical laboratory biomarkers, utilization of critical care support, and clinical outcomes according to temporal radiographic latent trajectories.

METHODS

We enrolled 2,385 patients who were hospitalized with COVID-19 and underwent serial chest radiographs from December 2019 to March 2022. The extent of radiographic pneumonia was quantified as a percentage using a previously developed deep-learning algorithm. A latent class growth model was used to identify the trajectories of the longitudinal changes of COVID-19 pneumonia extents during hospitalization. We investigated the differences in the temporal trends of critical laboratory biomarkers among the temporal radiographic trajectory groups. Cox regression analyses were conducted to investigate differences in the utilization of critical care supports and clinical outcomes among the temporal radiographic trajectory groups.

RESULTS

The mean age of the enrolled patients was 58.0 ± 16.9 years old, with 1,149 (48.2%) being male. Radiographic pneumonia trajectories were classified into three groups: The steady group (n = 1,925, 80.7%) exhibited stable minimal pneumonia, the downhill group (n = 135, 5.7%) exhibited initial worsening followed by improving pneumonia, and the uphill group (n = 325, 13.6%) exhibited progressive deterioration of pneumonia. There were distinct differences in the patterns of temporal blood urea nitrogen (BUN) and C-reactive protein (CRP) levels between the uphill group and the other two groups. Cox regression analyses revealed that the hazard ratios (HRs) for the need for critical care support and the risk of intensive care unit admission were significantly higher in both the downhill and uphill groups compared to the steady group. However, regarding in-hospital mortality, only the uphill group demonstrated a significantly higher risk than the steady group (HR, 8.2; 95% confidence interval, 3.08-21.98).

CONCLUSION

Stratified pneumonia trajectories, identified through serial chest radiographs, are linked to different patterns of temporal changes in BUN and CRP levels. These changes can predict the need for critical care support and clinical outcomes in COVID-19 pneumonia. Appropriate therapeutic strategies should be tailored based on these disease trajectories.

Impact of single nucleotide polymorphism of IL-27P28 rs153109 and IFITM3 rs12252 on susceptibility and severity of COVID-19 in Egyptian patients: a case control study

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus disease 2019 (COVID-19), which is a huge global health threat. Interleukin27 (IL-27) gene is a cytokine that produces antiviral proteins in an IFN-independent manner and stimulates both pro- and anti-inflammatory responses. Interferon induced transmembrane protein 3 (IFITM3) inhibits SARS-CoV2 infection by blocking SARSCoV-2 spike proteins which facilitate viral entrance and cell-to-cell fusion. The association between genetic variants and COVID-19 in Egyptians is still unclear. Hence, we sought to investigate the impact of the single nucleotide polymorphism of IL-27P28 rs153109 and IFITM3 rs12252 on the susceptibility and severity of SARS-CoV-2 in Egyptian patients.

METHODS

Our study included 242 SARS-CoV-2 patients were recruited from Main University Hospital, Alexandria University, Egypt, and 187 healthy controls. We subdivided the patient group into two subgroups: group A comprised mild/moderate cases (N = 42) (17.4%), and group B included severe/critical cases (N = 200) (82.6%). Genomic DNA was extracted from blood samples using the QIAamp DNA Blood Mini kit, then the PCR products of IL27 and IFITM3 were cut by FastDigest XhoI and MScI, respectively, for detection of SNPs of IL-27P28 rs153109 (-964A/G) and IFITM3 rs12252 (T>C).

RESULTS

The present study found a significant association between IL27 rs153109 (-964A/G) and SARS-CoV-2 infection susceptibility after adjusting for the risk factor (advanced age), IL27 rs153109 (-964A/G) AG genotype (OR = 2.791, 95% CI: 1.237-6.295, P = 0.013), AA genotype (OR = 2.385, 95% CI: 1.075-5.291, P = 0.033), and (AG+AA vs. GG) genotypes (OR = 2.558, 95% CI: 1.186-5.517, P = 0.017). On the other hand, the IFITM3 rs12252(T>C) CT genotype (OR = 1.419, 95% CI: 0.843-2.391, P = 0.188), CC genotype (OR = 2.132, 95% CI: 0.436-10.415, P = 0.350), and (C/T+C/C vs. TT) genotypes (OR = 1.466, 95% CI: 0.884-2.432, P = 0.138) did not show a statistically significant association with either susceptibility or the severity of SARS-CoV-2.

CONCLUSION

IL27P28 rs153109 AG and AA genotypes of IL27 may be associated with the susceptibility of SARS-CoV-2 infection but not the severity. Concerning the IFITM3 rs12252 SNP, we could not confirm its influence on either susceptibility or the severity of SARS-CoV-2 in this Egyptian population.

Determining the best mathematical model for implementation of non-pharmaceutical interventions

At the onset of the SARS-CoV-2 pandemic in early 2020, only non-pharmaceutical interventions (NPIs) were available to stem the spread of the infection. Much of the early interventions in the US were applied at a state level, with varying levels of strictness and compliance. While NPIs clearly slowed the rate of transmission, it is not clear how these changes are best incorporated into epidemiological models. In order to characterize the effects of early preventative measures, we use a Susceptible-Exposed-Infected-Recovered (SEIR) model and cumulative case counts from US states to analyze the effect of lockdown measures. We test four transition models to simulate the change in transmission rate: instantaneous, linear, exponential, and logarithmic. We find that of the four models examined here, the exponential transition best represents the change in the transmission rate due to implementation of NPIs in the most states, followed by the logistic transition model. The instantaneous and linear models generally lead to poor fits and are the best transition models for the fewest states.

Post-COVID metabolic enzyme alterations in K18-hACE2 mice exacerbate alcohol-induced liver injury through transcriptional regulation

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a significant threat to global public health. Despite reports of liver injury during viral disease, the occurrence and detailed mechanisms underlying the development of secondary exogenous liver injury, particularly in relation to changes in metabolic enzymes, remain to be fully elucidated. Therefore, this study was aimed to investigate the mechanisms underlying SARS-CoV-2-induced molecular alterations in hepatic metabolism and the consequent secondary liver injury resulting from alcohol exposure. We investigated the potential effects of SARS-CoV-2 infection on alcohol-induced liver injury in Keratin 18 promoter-human angiotensin converting enzyme 2 (K18-hACE2) transgenic mice. Mice were intranasally infected with 1 × 102 PFU of SARS-CoV-2. Following a 14 d recovery period from infection, the recovered mice were orally administered alcohol at 6 g/kg. Prior SARS-CoV-2 infection aggravated alcohol-induced liver injury based on increased alanine aminotransferase levels and cytoplasmic vacuolation. Interestingly, infected mice exhibited lower blood alcohol levels and higher levels of acetaldehyde, a toxic alcohol metabolite, compared to uninfected mice after the same period of alcohol consumption. Along with alterations of several metabolic process-related terms identified through RNA sequencing, notably, upregulation of cytochrome P450 2E1 (CYP2E1) and CYP1A2 was observed in infected mice compared to control value prior to alcohol exposure, with no significant impact of SARS-CoV-2 on intestinal damage. Tumor necrosis factor-alpha persistently showed upregulated expression in the infected mice; it also enhanced aryl hydrocarbon receptor and Sp1 expressions and their binding activity to Cyp1a2 and Cyp2e1 promoters, respectively, in hepatocytes, promoting the upregulation of their transcription. Our findings suggest that SARS-CoV-2 infection exacerbates alcohol-induced liver injury through the transcriptional activation of Cyp1a2 and Cyp2e1, providing valuable insights for the development of clinical recommendations on long COVID.

Campesterol and dithymoquinone as a potent inhibitors of SARS cov-2 main proteases-promising drug candidates for targeting its novel variants

The sudden outbreak of the COVID-19 pandemic has currently taken approximately 2.4 million lives, with no specific medication and fast-tracked tested vaccines for prevention. These vaccines have their own adverse effects, which have severely affected the global healthcare system. The discovery of the main protease structure of coronavirus (Mpro/Clpro) has resulted in the identification of compounds having antiviral potential, especially from the herbal system. In this study, the computer-associated drug design tools were utilised to analyze the reported phytoconstituents of Nigella sativa for their antiviral activity against the main protease. Fifty-eight compounds were subjected to pharmacological parameter analysis to determine their lead likeness in comparison to the standard drugs (chloroquine and nirmatrelvir) used in the treatment of SARS-CoV-2. Nearly 31 compounds were docked against five different SARS-CoV-2 main proteases, and all compounds showed better binding affinity and inhibition constant against the proteases. However, dithymoquinone and campesterol displayed the best binding scores and hence were further subjected to dynamics and MMPBSA study for 100 ns. The stability analysis shows that dithymoquinone and campesterol show less variation in fluctuation in residues compared to standard complexes. Moreover, dithymoquinone exhibited higher binding affinity and favorable interaction followed by campesterol as compared to the standard drug. The in silico computational analysis provides a promising hit for regulating the main proteases activity.

Prevalence and Clinical Features of Pulmonary Embolism in Pregnancy and Puerperium in the Post-COVID-19 Era

OBJECTIVE

Interest in pulmonary embolism (PE) has undergone a renaissance since the emergence of COVID-19 pandemic, but PE researches among pregnant mothers in this post-COVID-19 era remains scarce. This study was conducted to (a) determine PE prevalence rate among pregnant and post-partum women with suspected PE after the COVID 19 pandemic, (b) compare the clinical characteristics, laboratory findings and CT features between the PE and non-PE cohorts, and (c) validate the Pregnancy-Adapted Geneva (PAG) score in our population.

METHODS

This retrospective cross-sectional study involved the review of all maternal cases with suspected PE who underwent diagnostic CTPA in year 2022.

RESULTS

A total of 120 patients represented by 90 pregnant patients and 30 post-partum patients were included in the analysis. The prevalence rate of PE was 22.5% (27/120) and gestational diabetes mellitus prevalence rate was significantly higher (48.1% vs. 26.9%; p = 0.037) in PE cohort. Besides, the proportion of patients with moderately and extremely raised peak D-dimer levels were significantly higher among the PE cohort. In patients with PE, the position of the most proximal clot was identified as subsegmental (n = 6, 22.2%) and segmental (n = 21; 77.8%). The predicted PE risk based on PAG score demonstrated poor calibration with the observed PE risk across all three groups, namely low-risk group (2.3% vs. 15.4%), intermediate-risk group (11.6% vs. 26.3%) and high-risk groups (61.5% vs. 0.0%).

CONCLUSION

Overall, PE among pregnant and post-partum populations remain a convoluted disease without distinctive clinical features. There is a need for a prospectively validated PE risk scores to guide its clinical diagnostic pathway.

"Everything has been Dramatically Changed Since The Outbreak Began": A Descriptive Qualitative Study of Cancer Care Experiences of Patients and Oncology Nurses during the COVID-19 Pandemic

Background

Cancer during the novel coronavirus disease 2019 (COVID-19) pandemic has changed, leading to challenges in the management of the two serious health conditions of cancer and COVID-19. This study was conducted to explore the experiences of cancer care among hospitalized patients with cancer and oncology nurses in the COVID-19 pandemic environment.

Materials and Methods

This descriptive qualitative study included interviews with patients with cancer and oncology nurses. Observations and field notes were recorded. In this study, we purposively recruited 11 patients and 10 oncology nurses from a tertiary referral hospital affiliated with the Tabriz University of Medical Sciences, northwest Iran. Face-to-face interviews were conducted between June and July 2021. The interviews were recorded, transcribed verbatim, open-coded, and analyzed thematically. All these steps were managed using MAXQDA 10.

Results

Three themes were generated regarding patients' and nurses' experiences of cancer care during the COVID-19 pandemic: 1) feeling scared and neglected, 2) appearance of fundamental changes in all aspects of life, and 3) facing challenges beyond routine cancer care.

Conclusions

This study demonstrates the experiences of a "vulnerable" population during the COVID-19 pandemic. Understanding the experiences of patients with cancer and frontline healthcare providers during this unprecedented time of COVID-19 can help provide guidance and support for health policymakers in evidence-informed decision-making for cancer care beyond the COVID-19 pandemic era.

Clinical, epidemiological, and molecular characteristics of SARS-CoV-2 Infections among healthcare workers at a research center in the amazon region of BRAZIL from 2020 to 2022

The coronavirus disease-2019 (COVID-19) pandemic has affected different sectors of society, and healthcare workers have been particularly impacted. This study aimed to describe the clinical, epidemiological, and molecular characteristics of SARS-CoV-2 infections among healthcare workers in Evandro Chagas Institute, a research reference center in Brazil, from October 2020 to July 2022. 845 samples were collected from individuals who presented clinical symptoms of respiratory infection. Nasopharyngeal positive samples were submitted through genome sequencing. Clinical, epidemiological, and the SARS-CoV-2 lineages (or variants) were analyzed. SARS-CoV-2 positivity was detected in 31.8% (269/845) of samples with a higher prevalence of females (60.2%). The highest SARS-CoV-2 positivity rates were reported in March 2021 (39%), January 2022 (65%), and July 2022 (56%). On clinical symptoms, arthralgia, chills, and diarrhea were statistically significantly detected in 2020; fever, runny nose, and arthralgia in 2021; runny nose, and cough in 2022. On molecular analysis of SARS-CoV-2, 66 samples (25.3%, 66/269) were sequenced and the most prevalent lineage was the Omicron, representing 57.6%. Studies on the epidemiological and clinical characteristics of HCW are essential to propose control measures and work management since research centers play a major role in surveillance to identify and monitor infectious diseases.

Investigating DNA damage caused by COVID-19 and influenza in post COVID-19

The SARS-CoV-2 virus (termed COVID-19) was responsible for over 34 million global deaths. Although the COVID-19 pandemic has subsided, infection by emerging mutant variants of SARS-CoV-2 poses a continuing threat to public health. COVID-19 infection has been associated with the development of cytokine storm syndrome, hypercoagulability, immunological dysregulation and direct viral invasion of organs, and the long-term consequences for the health of COVID-19 survivors are currently unknown. Our research focuses on the possible mutagenic aspects of infection by COVID-19 and measures their harmful effects on DNA composition. DNA damage was investigated, using the comet assay method, during two periods: in the epidemic peak of COVID-19 and during the post-COVID-19 period, both in patients infected with COVID-19 and in those with influenza. During the epidemic peak, the levels of DNA damage ranged from the highest to the lowest levels in the following groups, respectively: intubated-ICU, non-intubated-ICU, non-ICU, and influenza, with a discernible increase in DNA damage in ICU-treated patients. The levels of DNA damage in the post-COVID-19 period were significantly lower compared to those in the epidemic peak period but there was still a discernible increase in DNA damage in the ICU group. Our results indicate that levels of DNA damage may be an effective indicator in prognostic decision-making and may therefore help to reduce mortality. Given that DNA damage and impaired repair processes can contribute to chronic diseases like diabetes, cancer, and neurodegenerative conditions, it will be crucial to investigate potential similar effects in patients with COVID-19.

IL-37 possesses both anti-inflammatory and antiviral effects against Middle East respiratory syndrome coronavirus infection

BACKGROUND

The aim was to elucidate the function of IL-37 in middle east respiratory syndrome coronavirus (MERS-CoV) infection, thereby providing a novel therapeutic strategy for managing the clinical treatment of inflammatory response caused by respiratory virus infection.

METHODS

We investigated the development of MERS by infecting hDPP4 mice with hCoV-EMC (107 TCID50 [50% tissue culture infectious dose]) intranasally. We infected A549 cells with MERS-CoV, which concurrently interfered with IL-37, detecting the viral titer, viral load, and cytokine expression at certain points postinfection. Meanwhile, we administered IL-37 (12.5 μg/kg) intravenously to hDPP4 mice 2 h after MERS-CoV-2 infection and collected the serum and lungs 5 days after infection to investigate the efficacy of IL-37 in MERS-CoV infection.

RESULTS

The viral titer of MERS-CoV-infected A549 cells interfering with IL-37 was significantly reduced by 4.7-fold, and the viral load of MERS-CoV-infected hDPP4 mice was decreased by 59-fold in lung tissue. Furthermore, the administration of IL-37 suppressed inflammatory cytokine and chemokine (monocyte chemoattractant protein 1, interferon-γ, and IL-17A) expression and ameliorated the infiltration of inflammatory cells in hDPP4 mice.

CONCLUSION

IL-37 exhibits protective properties in severe pneumonia induced by MERS-CoV infection. This effect is achieved through attenuation of lung viral load, suppression of inflammatory cytokine secretion, reduction in inflammatory cell infiltration, and mitigation of pulmonary injury.

Emerging and re-emerging viral infections of the central nervous system in Australasia and beyond

Viral infections of the central nervous system (CNS) have been emerging and re-emerging worldwide, and the Australasia region has not been spared. Enterovirus A71 and enterovirus D68, both human enteroviruses, are likely to replace the soon-to-be eradicated poliovirus to cause global outbreaks associated with neurological disease. Although prevalent elsewhere, the newly emergent orthoflavivirus, Japanese encephalitis virus (genotype IV), caused human infections in Australia in 2021, and almost certainly will continue to do so because of spillovers from the natural animal host-vector life cycle endemic in the country. Another orthoflavivirus, Murray Valley encephalitis virus, has re-emerged in Australia. The Hendra henipavirus together with Nipah henipavirus ​are listed as high-risk pathogens by the World Health Organization because both can cause lethal encephalitis. The former remains a health threat in Australasia because bats may still be able to spread the infection to unvaccinated Australian horses and other animals acting as intermediate hosts, and thence to humans. The global COVID-19 pandemic, caused by the emerging severe acute respiratory syndrome coronavirus-2, a virus transmitted from animals to humans that was first described and first arose in China, is associated with acute and long-lasting CNS pathology. Fortunately, the pathology and pathogenesis of these important neurotropic viruses are now better understood, leading to better management protocols and prevention strategies. Pathologists are in a unique position to contribute to the diagnosis and advancement in our knowledge of infectious diseases. This review summarises some of the current knowledge about a few important emerging and re-emerging CNS infections in Australasia and beyond.

The predictive value of the LDH-albumin ratio on poor clinical course and mortality in COVID-19 patients: A single-center study

There are studies evaluating the association of serum lactate dehydrogenase (LDH) and albumin levels with mortality in COVID-19 patients. The aim of our study was to evaluate the predictive effect of the LDH/albumin ratio (LAR) on mortality and poor clinical course in COVID-19 patients. A total of 2093 patients for whom LDH and albumin tests were available were included in the study. Demographic data, length of hospitalization, and signs of poor clinical course were recorded and compared with the LAR value at the time of hospitalization. The study included 1010 female (48.3%) and 1083 male (51.7%) patients. Notably, 1408 (67.3%) of the patients had at least 1 comorbidity. Oxygen was required in 860 patients (41.1%) and intensive care unit was required in 215 patients (10.3%). The mortality rate was 8.1% (n: 170). The median LAR value was 8.05. A positive correlation was observed between LAR and length of hospitalization. The LAR value was significantly higher in patients who died compared with those who survived, in patients who required intensive care compared with those who did not, and in patients who required oxygen compared to those who did not. The cutoff value for LAR in predicting mortality was calculated as 10.48. The sensitivity and specificity were determined as 73.5% and 73.7%. In conclusion, serum LAR at the time of admission is predictive of poor clinical course and mortality in COVID-19 patients. Patients with LAR values higher than the cutoff value should be closely monitored for poor clinical course.

COVID-19 caused by the Omicron variant in lung transplant recipients: a single center case series

Background

Although coronavirus disease 2019 (COVID-19) is no longer classified as a Public Health Emergency of International Concern by World Health Organization, its global impact persists. Data on its impact in lung transplant recipients (LTRs) from China remain limited. This study aims to share clinical experiences and provide insights into managing LTRs with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods

We conducted a study on LTRs with COVID-19 caused by the Omicron variant from November 17, 2022, to May 1, 2023. Clinical information was gathered retrospectively through electronic medical records, questionnaires, or follow-up telephone calls.

Results

A total of 227 LTRs were reviewed for infection with Omicron variant. After excluding 49 cases without confirmed SARS-CoV-2 infection, this left a final cohort of 178 infected LTRs, accounting for an infection rate of 78.4% (178/227). Of the patients, 50% (89/178) required hospitalization, with an average hospital stay of 16 days [interquartile range (IQR): 9.5-25.5 days]. Of the 89 hospitalized patients, 41.6% (37/89) eventually progressed to severe or critical disease, forming the severe/critical group (S/C group), while the remaining 58.4% (52/89) had mild or moderate disease (M/M group). In comparison to the M/M group, the S/C group had higher C-reactive protein (CRP) (59.6 vs. 16.8 mg/L, P<0.001), Erythrocyte sedimentation rate (45.5 vs. 22.5 mm/h, P=0.005) and D-dimer level (1.09 vs. 0.65 mg/L, P=0.01), but lower CD4+ T lymphocytes count (217 vs. 427 cells/µL, P=0.004). The S/C group had significantly higher rates of combined pulmonary bacterial infection (67.6% vs. 38.5%, P=0.006) and pulmonary fungal infection (73.0% vs. 38.5%, P=0.001) during the course of COVID-19, nearly double that of the M/M group. In a multivariate logistic analysis, elevated CRP (>41.8 mg/L), combined pulmonary fungal infection, and interstitial lung disease (ILD) as primary disease emerged as high-risk factors for developing the severe disease phenotype following Omicron variant infection in LTRs, with respective odds ORs values of 4.23 [95% confidence interval (CI): 1.68-11.23], 4.76 (95% CI: 1.59-15.64), and 5.13 (95% CI: 1.19-29.17). Receiver operating characteristic (ROC) curve analysis showed that CD4+ T lymphocyte count may be a strong marker for predicting death. At a cutoff of 404 cells/µL, sensitivity was 0.509, specificity 0.999, and area under the curve (AUC) was 0.806 (95% CI: 0.678-0.934). Ultimately, 13 recipients succumbed to COVID-19 related respiratory failure or secondary multiple organ dysfunction, resulting in an overall mortality rate of 7.3% (13/178).

Conclusions

LTRs are at high risk of secondary lung infections after Omicron. Key risk factors for severe disease include CRP >41.8 mg/L, ILD as primary disease, and pulmonary fungal infection. CD4+ T lymphocyte count may predict mortality risk in LTRs with COVID-19.

Examining neuroanatomical correlates of win-stay, lose-shift behaviour

This study aimed to better understand the neuroanatomical correlates of decision-making strategies, particularly focusing on win-stay and lose-shift behaviours, using voxel-based morphometry (VBM) in a large cohort of healthy adults. Participants completed a forced-choice card-guessing task designed to elicit behavioural responses to rewards and losses. Using this task, we investigated the relationship between win-stay and lose-shift behaviour and both grey matter volume (GMV) and white matter volume (WMV). The frequency of win-stay and lose-shift behaviours was calculated for each participant and entered into VBM analyses alongside GMV and WMV measures. Our results revealed that increased lose-shift behaviour was associated with reduced GMV in key brain regions, comprising of the left superior temporal gyrus, right middle temporal gyrus, and the bilateral superior lateral occipital cortices. Interestingly, no significant associations were found between GMV or WMV, and win-stay behaviour. These results suggest that specific regions within the temporal and occipital lobes may be involved in modulating decision-making strategies following negative outcomes. Further analyses revealed that increased lose-shift behaviour was also associated with increased WMV in the left superior temporal gyrus. The absence of significant findings in relation to win-stay behaviour and the differential involvement of brain structures in lose-shift responses indicate that decision-making in the face of losses may involve distinct neuroanatomical mechanisms compared to decision-making following wins. This study advances our understanding of the structural brain correlates linked to decision-making strategies and highlights the complexity of brain-behaviour relationships in choice behaviour.

Exploring Age, Gender and Pandemic Dynamics: A Retrospective Analysis of the Impact of SARS-CoV-2 on Human Health

BACKGROUND

The deaths due to the SARS-CoV-2 virus increased rapidly over a short period of time. From the beginning of the pandemic until September 2024, the number of COVID-19 cases reached 776,205,140 cases, with 7,064,380 deaths worldwide. The total number of deaths recorded from the beginning of the pandemic until September 2024 represents a share of 0.09% of the total world population and 0.91% of the total infected population.

METHODS

The data in this study were collected from the Ministry of Internal Affairs of Romania, Eurostat, NIS and WHO sites, and analyzed using Microsoft Excel and SPSS 22 in order to detect the evolution trends during the state of emergency, the share of infection and deaths among the European countries and worldwide, differences between gender categories or age groups and to identify factors that can be related to the incidence of infection and mortality due to COVID-19.

RESULTS

Males registered a significant higher number of deaths compared to women in Romania, a trend that aligns with global tendencies (p < 0.05). Also, the 70-79 age group had the highest mortality rate, followed by the over 80 age group and the 60-69 age group. Therefore, the risk of death from COVID-19 increases significantly with age. A good health education may be essential in order to promote a high life expectancy. A higher life expectancy correlated with a lower rate of mortality. BMI can be a factor contributing to the increased comorbidities, and may influence the fatality levels of COVID-19.

Secondary Hemophagocytic Lymphohistiocytosis in severe COVID-19 - a retrospective cohort study

Hemophagocytic lymphohistiocytosis (HLH) is an excessive immune activation with cytokine storm und multi-organ dysfunction. It can occur secondarily, especially due to viral infections like COVID-19. Rapid treatment is crucial for favourable outcomes, but diagnosing HLH is challenging. The most common diagnostic instrument is the H-Score. However, the prognostic value of the H-score has not yet been assessed in detail in the spotlight of secondary HLH in severe COVID-19. COVID-19 patients treated between February 2020 and April 2021 at the intensive care unit (ICU) of the Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria, were included in this study. Data were assessed retrospectively by document review, and the follow-up period was at least 90 days. A total of 208 critically ill COVID-19 patients with an age of 61.8 ± 13.6 years were enrolled in this study. We found an average H-Score in the entire study collective of 94 ± 51 points, and 8.7% had a score ≥ 169 testing positive for HLH. A positive score was associated with increased mortality rates at 28 (66.7 vs. 26.3%, p < 0.001) and 90 days (72.2 vs. 27.9%, p < 0.001). In our cohort study, critically ill COVID-19 patients with an H-Score ≥ 169 during their ICU stay had increased mortality rates at 28 and 90 days. Thus, attention should be paid to individuals with rising or high scores. Therapeutic options and their impact on mortality for patients with COVID-19-associated secondary HLH should be evaluated in further studies.

Co-infections exacerbate inflammatory responses in COVID-19 patients, promoting coagulopathy and myocardial injury, leading to increased disease severity

Objectives

Severe COVID-19 infection is characterized by excessive inflammatory responses, hypercoagulation, and microvascular dysfunction. However, limited research has investigated the effects of co-infections on these characteristics in COVID-19 patients. This study aims to explore how co-infections influence inflammation, hypercoagulability, and microvascular dysfunction in hospitalized COVID-19 patients, and to assess their impact on disease progression.

Methods

This was a retrospective cohort study involving 630 COVID-19 inpatients who tested positive for SARS-CoV-2 RNA at Xi'an Ninth Hospital. The patients were categorized into two groups: a severe group (n = 176) and a mild group (n = 454). Additionally, they were further subdivided into a co-infected (n = 106) group and a non-co-infected group (n=524) based on the presence or absence of co-infections. Clinical characteristics and laboratory findings were analyzed and compared between the groups.

Results

In the co-infected group, 60 patients (56.6%) were classified as severe cases, and 15 (14.2%) died. By comparison, in the non-co-infected group, 97 patients (18.5%) were severe cases, with 4 (0.8%) deaths. The severity and mortality rates were significantly higher in co-infected patients compared to those non-co-infections. The severe and co-infected groups exhibited significantly higher levels of inflammatory cells, inflammatory factors, coagulation biomarkers, and myocardial injury markers compared to the mild and non-co-infected groups. Conversely, lymphocyte counts, RBC counts, HGB, HCT, TP, and ALB levels were significantly lower in the severe and co-infected groups than in the mild and non-co-infected groups. Furthermore, a notable positive correlation was observed among inflammatory factors, coagulation function, and myocardial injury biomarkers in COVID-19 patients.

Conclusion

Co-infections in COVID-19 patients can trigger severe inflammatory responses. This excessive inflammation may lead to coagulation disorders and myocardial injury, all of which are key contributors to disease progression and deterioration. Therefore, implementing infection prevention measures to minimize the spread of co-infections among hospitalized COVID-19 patients is crucial.

Exploring Asthma as a Protective Factor in COVID-19 Outcomes

Asthma has long been associated with increased susceptibility to viral respiratory infections, leading to significant exacerbations and poorer clinical outcomes. Contrarily and interestingly, emerging data and research surrounding the COVID-19 pandemic have shown that patients with asthma infected with SARS-CoV-2 experienced decreased severity of disease, lower hospitalization rates, as well as decreased morbidity and mortality. Research has shown that eosinophils could enhance immune defense against viral infections, while inhaled corticosteroids can assist in controlling systematic inflammation. Moreover, reduced ACE-2 expression in individuals with asthma may restrict viral entry, and the Th2 immune response may offset the Th1 response typically observed in severe COVID-19 patients. These factors may help explain the favorable outcomes seen in asthmatic patients during the COVID-19 pandemic. This review highlights potential protective mechanisms seen in asthmatic patients, including eosinophilia, the use of inhaled corticosteroids, reduced ACE-2 expression, and a dominate Th2 immune response. Such a study will be helpful to better manage patients with asthma who have contracted COVID-19.

Angiotensin-converting enzyme 2 and hepatic SARS-CoV-2 infection: Regulation, association, and therapeutic implications

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells via the angiotensin-converting enzyme 2 (ACE2) receptor. Mounting evidence has indicated the presence of hepatic SARS-CoV-2 infection and liver injury in patients with coronavirus disease 2019 (COVID-19). Understanding the mechanisms of hepatic SARS-CoV-2 infection is crucial for addressing COVID-19-related liver pathology and developing targeted therapies. This editorial discusses the significance of ACE2 in hepatic SARS-CoV-2 infection, drawing on the research by Jacobs et al. Their findings indicate that hepatic ACE2 expression, frequency of hepatic SARS-CoV-2 infection, and severity of liver injury are elevated in patients with pre-existing chronic liver diseases. These data suggest that hepatic ACE2 could be a promising therapeutic target for COVID-19.

Perception of Risk for Developing Severe Illness or Complications from COVID-19 in Brazil: Focus on Factors Linked to Socially Vulnerable Populations, 2020-2023

In this study, the aim was to comparatively examine the perception of risk for developing severe illness or complications due to COVID-19 among the general population and socially vulnerable populations in Brazil, focusing on uncovering the associated factors that disproportionately impacted people experiencing homelessness and slum dwellers. This study is part of the project "Social Thermometer-COVID-19 in Brazil", which employed a hybrid approach, combining a national online survey with field research in state capitals and the Federal District. Data collection took place from August 2020 to October 2023, and the data were analyzed using descriptive statistics and logistic regression. A total of 5094 participants were included in this study, with 2363 from the general population and 2731 from the socially vulnerable population. Among the general population, the majority of participants were women, white individuals, those with higher incomes, formal employment, and higher education levels. Concerning the vulnerable population, most were men, Black individuals, those with lower incomes, unemployment, and lower education levels. It was observed that 87% of the general population perceived a risk of severe COVID-19, compared to 74% of the vulnerable population. Slum dwellers who received emergency aid (ORa = 1.39; 95% CI: 1.02-1.91), adhered to mask-wearing practices (ORa = 1.93; 95% CI: 1.39-2.66), used COVID-19-related medications (ORa = 2.13; 95% CI: 1.31-3. 64), and those with pre-existing conditions, such as high blood pressure (ORa = 1.86; 95% CI: 1.20-2.98), demonstrated a heightened perception of risk for severe COVID-19 complications. Among the homeless population, individuals who wore masks (ORa = 1.67; 95% CI: 1.26-2.20 and had been vaccinated (ORa = 1.44; 95% CI: 1.04-1.98) were also more likely to perceive a high risk. In conclusion, in this study, significant disparities are revealed in the perception of COVID-19 risk between the general and socially vulnerable populations in Brazil. Factors such as receiving emergency aid, adherence to mask-wearing, use of COVID-19-related medications, and pre-existing health conditions were associated with increased risk perception. Despite facing greater socioeconomic challenges, vulnerable groups, particularly those experiencing homelessness and slum dwellers, showed a lower perception of the risk for severe COVID-19 complications.

Risk factors for relapse and aggravation in membranous nephropathy after COVID-19 infection

BACKGROUND

Relapse of membranous nephropathy (MN) and other glomerular diseases has been observed after COVID-19 infection. The risk factors contributing to disease progression in MN patients after contracting COVID-19 remain unclear.

METHODS

This retrospective study included 656 consecutive patients with biopsy-proven primary MN who received treatment and were regularly followed up for over six months. Logistic regression analyses were conducted to identify risk factors for disease progression.

RESULTS

Among the cohort, 555 patients (84.6%) contracted COVID-19 from November 11th, 2022, to February 22nd, 2023. Of them, 112 patients (20.2%) experienced a > 50% increase in proteinuria, including 30 patients (5.4%) who experienced nephrotic syndrome relapse. Sixteen patients (2.9%) showed immune aggravation with elevated anti-PLA2R antibody levels, and five patients (0.9%) had immune relapse characterized by antibody reoccurrence. Kidney dysfunction, defined as an eGFR reduction > 30% from baseline, occurred in 10 patients (1.8%), with two patients (0.4%) progressing to ESKD. Four patients (0.7%) died of respiratory failure. Overall, 132 patients (24.0%) experienced disease progression after COVID-19 infection. Multivariate logistic regression identified longer fever duration (OR 1.118, 95% CI 1.029-1.356, P = 0.018), withdrawal of immunosuppressants and/or steroids (OR 2.571, 95% CI 1.377-4.799, P = 0.003) and extended drug cessation (OR 1.113, 95% CI 1.045-1.186, P = 0.001) as independent risk factors for MN progression.

CONCLUSIONS

These findings suggest prompt antiviral treatment and minimizing the duration of immunosuppressant withdrawal to optimize kidney outcomes in MN patients with COVID-19.

Severity Matters: How COVID-19 Severity Impacts Long-Term Effects on Symptoms, Physical Activity and Functionality-An Observational Study

BACKGROUND/OBJECTIVES

The existing literature has described the common symptoms and long-term effects of coronavirus disease (COVID-19). However, there is a lack of detailed information on how different degrees of disease severity affect survivors differently. This study aims to fill that gap by evaluating the symptoms, physical activity, and functionality of COVID-19 survivors across a spectrum of severity levels, comparing them with those of healthy individuals.

METHODS

An observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria and checklist. Participants were divided into 5 groups based on COVID-19 severity according to the World Health Organization classification: healthy (COVID-19-negative), mild (symptomatic without pneumonia or dyspnoea), moderate (pneumonia and dyspnoea without hospitalisation), severe (severe pneumonia requiring hospitalisation), and critical (severe pneumonia with admission to the intensive care unit). Descriptive variables, symptoms (Fatigue Borg Scale, Fatigue Impact Scale, Fatigue Severity Scale, Dyspnoea Borg Scale, Visual Analogue Scale, Hospital Anxiety and Depression Scale, and European Quality of Life-5 Dimensions), physical activity (the International Physical Activity Questionnaire) and functionality (Patient-Specific Functional Scale, Short Physical Performance Battery, Arm Curl test, and 2 min step test) were measured.

RESULTS

A total of 304 participants were included: healthy (n = 42), mild (n = 143), moderate (n = 49), severe (n = 52), and critical (n = 18) COVID-19 patients. The impact of COVID-19 on surviving patients varies significantly with the severity of the disease. The results show that the hospitalisation time, age, and comorbidities of the patients are greater in those with a greater severity of the disease. Patients with more severe COVID-19 also experience greater frailty, dysphagia, fatigue, dyspnoea, and pain. Additionally, those with severe cases have poorer overall health, reduced physical activity, and diminished functionality. No evidence of post-COVID-19 anxiety or depression is found in the sample, even considering the timeframe between the negative test and the assessment.

CONCLUSIONS

Patients with higher COVID-19 severity (severe or critical) experience more symptoms than those with lower COVID-19 severity (mild or moderate). Additionally, those with severe cases have poorer overall health, reduced physical activity and diminished functionality. Register: Clinicaltrials.gov: NCT05731817.

Increased Risk of Influenza-Like Illness Clusters in Schools, Taiwan from 2011 to 2020: A Retrospective Study

Acute influenza-like illnesses (ILIs) are primarily caused by influenza type A or type B viruses. Several factors influence the risk of the spread of ILIs. The present study investigated the epidemiological characteristics, differences, and epidemiological trends of influenza viruses, noninfluenza respiratory pathogens, and locations where clusters occurred in Taiwan between 2011 and 2020. The study analyzed publicly available data on 1,545 confirmed ILI clusters, with the data obtained from the Taiwan Centers for Disease Control. In total, 1,334 ILI clusters were caused by influenza virus infection, 11 ILI clusters were caused by noninfluenza respiratory pathogens, and 78 ILI clusters were caused by pathogens not detected in routine testing. Additionally, for 122 ILI clusters, no pathogen detection was initiated. Significant differences were observed (p < 0.001) in the number of ILI clusters between influenza and noninfluenza respiratory pathogens in 2011-2020. In addition, significant differences were observed (p < 0.001) in the number of ILI clusters between locations in 2011-2020. In terms of specific pathogens within ILI clusters, single infections with influenza A virus accounted for the highest number of cases (69.6%, 1076/1358, odds ratio: 1.740-2.957, p < 0.001-0.012), followed by adenovirus infections among noninfluenza respiratory pathogens (58.3%, 7/12). Schools had the highest number of ILI clusters (47.3%, 731/1545) among the investigated institutions (odds ratio: 1.438-1.556, p < 0.001-0.012). This study provides valuable insights into ILI cluster transmission patterns in Taiwan over a 10-year period and highlights the importance of long-term studies covering a wide geographic area as a means of understanding the implications of such patterns.

Association Between Vitamin D and COVID-19-Related Outcomes: An Umbrella Review of Meta-Analyses

CONTEXT

COVID-19 remains globally pandemic, and although several meta-analyses have explored the association between vitamin D and COVID-19 relative to clinical outcomes, a unified view has not yet emerged.

OBJECTIVE

To summarize the evidence for associations between vitamin D levels and COVID-19-related clinical outcomes and to assess the strength and validity of these associations.

DATA SOURCES

PubMed, Embase, Web of Science, Scopus, and the Cochrane Database of Systematic Reviews databases were searched from January 1, 2020, to June 15, 2024.

DATA EXTRACTION

Two reviewers independently extracted data and assessed study quality.

DATA ANALYSIS

Low vitamin D levels increased the risk of infection by 1.26- to 2.18-fold, the risk of severe illness by 1.50- to 5.57-fold, the risk of intensive care unit (ICU) admission by more than 2-fold, and the risk of death by 1.22- to 4.15-fold. In addition, patients with vitamin D deficiency had an average increase in length of hospital stay of 0.54 days compared with patients with high vitamin D levels. Overall, vitamin D supplementation may reduce severity (eg, ICU admissions, need for mechanical ventilation) and shorter length of hospital stay but has a nonsignificant effect on infection and mortality rates. In addition, there were significant differences in vitamin D levels between individuals testing positive for COVID-19 and those testing negative (mean difference [MD] = -3.22 ng mL-1; 95% CI, -5.18 to -1.25), those with severe cases and those with mild cases (MD = -4.60 ng mL-1; 95% CI, -5.49 to -3.71), and nonsurvivors and survivors of COVID-19 infection (MD = -6.59 ng mL-1; 95% CI: -8.94 to -4.24).

CONCLUSIONS

Low vitamin D levels are associated with higher infection rates, more severe disease, and higher mortality rates among individuals with COVID-19, whereas vitamin D supplementation may reduce patients' disease severity. The beneficial effects on infection rates and mortality remain to be further explored, however, in higher-quality, randomized controlled studies. Nonetheless, caution is warranted because the methodological quality of most meta-analyses and the level of evidence for most outcomes are very low.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022385036.

Iron and ferroptosis in kidney disease: molecular and metabolic mechanisms

Maintaining iron homeostasis is necessary for kidney functioning. There is more and more research indicating that kidney disease is often caused by iron imbalance. Over the past decade, ferroptosis' role in mediating the development and progression of renal disorders, such as acute kidney injury (renal ischemia-reperfusion injury, drug-induced acute kidney injury, severe acute pancreatitis induced acute kidney injury and sepsis-associated acute kidney injury), chronic kidney disease (diabetic nephropathy, renal fibrosis, autosomal dominant polycystic kidney disease) and renal cell carcinoma, has come into focus. Thus, knowing kidney iron metabolism and ferroptosis regulation may enhance disease therapy. In this review, we discuss the metabolic and molecular mechanisms of iron signaling and ferroptosis in kidney disease. We also explore the possible targets of ferroptosis in the therapy of renal illness, as well as their existing limitations and future strategies.

Isolation, identification, and challenges of extracellular vesicles: emerging players in clinical applications

Extracellular vesicles (EVs) serve as critical mediators of intercellular communication, encompassing exosomes, microvesicles, and apoptotic vesicles that play significant roles in diverse physiological and pathological contexts. Numerous studies have demonstrated that EVs derived from mesenchymal stem cells (MSC-EVs) play a pivotal role in facilitating tissue and organ repair, alleviating inflammation and apoptosis, enhancing the proliferation of endogenous stem cells within tissues and organs, and modulating immune function-these functions have been extensively utilized in clinical applications. The precise classification, isolation, and identification of MSC-EVs are essential for their clinical applications. This article provides a comprehensive overview of the biological properties of EVs, emphasizing both their advantages and limitations in isolation and identification methodologies. Additionally, we summarize the protein markers associated with MSC-EVs, emphasizing their significance in the treatment of various diseases. Finally, this article addresses the current challenges and dilemmas in developing clinical applications for MSC-EVs, aiming to offer valuable insights for future research.

Restorative and endodontic clinical strategies during COVID-19 (SARS-CoV-2) pandemic: a revision of the literature

The aim of this study was to analyze clinical strategies supported by validated references during two of the most frequent dental emergencies (i.e. restorative and endodontic treatment) in the COVID-19 pandemic. Coronavirus disease 2019 (COVID-19) was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of an emergency in the health system worldwide and a potentially fatal disease. Person-to-person transmission of SARS-CoV-2 through aerosol and droplets led to extensive preventive measures to contain COVID-19 outbreak. Dental care providers have been exposed to a high risk of SARS-CoV-2 infection, due to the face-to-face communication and the exposure to saliva, blood, and other body fluids during routine interventions; this can also contribute to a high risk for cross-infection, even though dentist usually cope with those situations in everyday practice. Restorative and endodontic emergencies represented a high proportion of dental emergencies, with prolonged exposure time for dentists/endodontists in contact with suspected or confirmed infected patients. Lack of knowledge and undefined progression controlled the decision-making in clinical dentistry. The dynamicity of the situation determined change of views and recommendations in dental setting. The implementation of strict restorative and endodontics protocols are aimed at preventing circumstances similar to those observed with COVID-19.

Therapeutic Versus Non-Therapeutic Dose Anticoagulation in COVID-19 Infection: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Background

Abnormal coagulation and thrombotic complications prompted many guidelines to recommend thromboprophylaxis for patients hospitalised with COVID-19, but the dose required for prophylaxis remains unclear. This systematic review (SR) analyses the safety and efficacy of therapeutic dose anticoagulation (TDA) versus non-therapeutic dose anticoagulation (NDA) in COVID-19 patients.

Methods

According to the Cochrane Handbook of Systematic Review of Interventions, we performed an SR. The protocol is registered in Prospero (CRD42021269197, date 12 August 2021).

Results

In this SR of 18 studies, TDA was shown to reduce all-cause mortality (risk ratio [RR] 0.83; 95% confidence interval [95% CI] 0.70, 0.99) in COVID-19 infection. TDA also reduced thrombosis (RR 0.55; 95% CI 0.48, 0.72) but increased major bleeding (RR 1.87; 95% CI 1.29, 2.69). A stratified analysis according to severity revealed that, in non-critical patients, TDA resulted in mortality benefit (RR 0.79; 95% CI 0.67, 0.94). In critical patients, TDA did not affect all-cause mortality (RR 1.03; 95% CI 0.89, 1.18) but reduced thrombosis (RR 0.65; 95% CI 0.48, 0.86) and increased major bleeding (RR 1.85; 95% CI 1.06, 3.23).

Conclusion

TDA significantly reduced all-cause mortality and thrombosis in non-critical COVID-19 patients at the expense of increased major bleeding. In critical COVID-19, this mortality benefit was not observed.

Analysis of Clinical Characteristics and Risk Factors for Severe Influenza A and Influenza B in Children

PURPOSE

The goal of this study was to develop and validate an online dynamic nomogram system for early differential diagnosis of influenza A and B.

METHODS

Patients with severe influenza A and B admitted to Henan Children's Hospital from January 2019 to January 2022 were used as the modeling group (n = 161), and patients admitted from January to September 2023 were used as the validation group (n = 52). Univariate logistic regression and multivariate logistic regression were used to identify the risk variables of severe influenza A and B in children in the modeling group. The selected variables were used to build the nomogram, and the C-index, decision curve analysis, calibration curves, and receiver operating characteristic curves were used to assess the differentiation, calibration of the models, and external validation of the above models with validation group data.

FINDINGS

Fever for >3 days, vomiting, lymphocyte count (LY), and duration from onset to hospitalization were independent factors for the identification of severe influenza A and B. We created a dynamic nomogram (https://ertong.shinyapps.io/influenza/) that can be accessed online. The C-index was 0.92. In the modeling group, the AUC of the prediction model was 0.92 (95% CI, 0.87-0.98), the calibration curve showed a good fit between the predicted probability and the actual probability, with high comparability, and the decision curve analysis showed that the nomogram model had significant clinical benefits. The application of this model in external verification predicts that the AUC of the verification group is 0.749 (95% CI, 0.61-0.88), and the validation results were in good agreement with reality.

IMPLICATIONS

Fever for >3 days, vomiting, lymphocyte count, and duration from onset to hospitalization have an impact on the differentiation of severe influenza A from severe influenza B. The prediction value and clinical benefit of the nomogram model are satisfactory.

Clinical and Multiorgan Proteomics Characteristics of the Diverse Fatal Phase in Super Elderly Patients With SARS-CoV-2 Infection: A Descriptive Study

This study aims to identify the risk factors associated with clinical outcomes and the proteomic changes in organs related to fatal SARS-CoV-2 infection within the super-elderly population. This retrospective analysis included all elderly individuals with COVID-19 admitted to the Second Medical Center of PLA General Hospital from December 2022 to January 2023. The follow-up period ended on March 30, 2023. During this time, epidemiological, demographic, laboratory, and outcome data were analyzed descriptively. Proteomic sequencing was performed on super-elderly patients who died from COVID-19 at different stages of the disease. A total of 352 elderly COVID-19 patients, with a mean age of 89.84 ± 8.54 years, were included in this study. During a median follow-up period of 98 days, 79 patients died. Deceased patients were older and more likely to have cardiovascular and cerebrovascular diseases, with a lower prevalence of lipid-lowering therapy. The number of deaths in the acute and post-acute phases were 34 and 45, respectively. Proteomics data suggest that the immune systems of patients who died in the acute phase underwent a more rapid and severe onslaught. Patients in the post-acute phase showed higher levels of viral genome replication and a more robust immune response. However, the over-activation of the immune system led to systemic organ dysfunction. Effective management of comorbidities may improve the prognosis of COVID-19 in super-elderly patients. The continuous replication of the SARS-CoV-2 virus and its subsequent impact on the immune system are critical determinants of survival time in this demographic.

Temporal trends in the incidence and case severity of COVID-19 cases among the Syrian refugees in Azraq camp in Jordan: A retrospective observational study

BACKGROUND

Azraq Syrian refugee camp, located in Jordan, is where the challenges of managing the COVID-19 epidemic meet the vulnerabilities of displaced people. This study aimed to investigate the epidemiological characteristics, incidence, risk factors, and outcomes of COVID-19 among Azraq camp residents.

METHODS

COVID-19 data from Azraq camp were collected by International Medical Corps clinics and analyzed retrospectively from August 1, 2020, to August 31, 2022. Data included demographics, risk factors, testing history, contact tracing, and vaccination profiles. We estimated COVID-19 incidence and analyzed risk factors using Poisson and multilevel logistic regression.

RESULTS

A total of 2,468 confirmed COVID-19 cases were identified, with a prevalence of 5.6 per 100 residents. The camp's monthly incidence rate was more than 50% lower than the national rate, with a 1.7% monthly decrease. Females had a higher incidence than males (6.4% vs. 4.9%, p < 0.001), while the elderly bore the greatest disease burden. Home-based isolation was the main strategy, except during the second wave. Vaccination coverage reached 31.6%, primarily with Pfizer (49.8%). Symptomatic cases made up 44.0% of confirmed cases, with 10.4% requiring hospitalization. Factors independently associated with hospitalization included age, comorbidity, and vaccination status.

CONCLUSION

The study highlights the need for robust surveillance, targeted healthcare interventions, equitable resource allocation, and vaccination campaigns to manage COVID-19 and future epidemics in refugee camps.