COVID-19: what has been learned and to be learned about the novel coronavirus disease

The chimera of S1 and N proteins of SARS-CoV-2: can it be a potential vaccine candidate for COVID-19?

INTRODUCTION

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as one of the biggest global health issues. Spike protein (S) and nucleoprotein (N), the major immunogenic components of SARS-CoV-2, have been shown to be involved in the attachment and replication of the virus inside the host cell.

AREAS COVERED

Several investigations have shown that the SARS-CoV-2 nucleoprotein can elicit a cell-mediated immune response capable of regulating viral replication and lowering viral burden. However, the development of an effective vaccine that can stop the transmission of SARS-CoV-2 remains a matter of concern. Literature was retrieved using the keywords COVID-19 vaccine, role of nucleoprotein as vaccine candidate, spike protein, nucleoprotein immune responses against SARS-CoV-2, and chimera vaccine in PubMed, Google Scholar, and Google.

EXPERT OPINION

We have focussed on the use of chimera protein, consisting of N and S-1 protein components of SARS-CoV-2, as a potential vaccine candidate. This may act as a polyvalent mixed recombinant protein vaccine to elicit a strong T and B cell immune response, which will be capable of neutralizing the wild and mutated variants of SARS-CoV-2, and also restricting its attachment, replication, and budding in the host cell.

A Double-blind Multicenter Two-arm Randomized Placebo-controlled Phase-III Clinical Study to Evaluate the Effectiveness and Safety of Thymosin α1 as an Add-on Treatment to Existing Standard of Care Treatment in Moderate-to-severe COVID-19 Patients

Background

From an epidemic outbreak, coronavirus disease-2019 (COVID-19) has quickly developed. Thymosin α1 (Tα1) has the ability to boost the T-cell numbers, support T-cell differentiation, maturation, and reduce cell apoptosis. In this study, we have investigated the efficacy and safety of Tα1 in moderate-to-severe COVID-19 patients.

Patients and methods

In this double-blind, multicenter, two-arm, randomized, placebo-controlled, phase III clinical study, patients were randomized to receive either Tα1 or placebo in combination with standard of care (SOC). The data on all-cause mortality, clinical progression/deterioration, duration of hospital/intensive care unit (ICU) stay, and safety data were collected. The patients were telephonically followed up on Day 28.

Results

A total of (n = 105) COVID-19 patients were included in the study, of which 40 and 65 were severe and moderate, respectively. Thymosin arm (11.1%) had a statistically lower death rate in comparison to the placebo arm (38.5%). A total of 67 adverse events were reported in 42 patients among 105 dosed patients during the study. Among them, 43 adverse events were of mild in nature, 16 adverse events were of moderate in nature, and 8 serious adverse events (death) occurred during the study.

Conclusion

This study provides evidence that Tα1 can lower death rate in severe COVID-19 patients, reduce the load on hospitals by shortening the required number of days of hospitalization and help in abbreviating the requirement of oxygen support by positively impacting the recovery rate and time taken for recovery.

How to cite this article

Shetty A, Chandrakant NS, Darnule RA, Manjunath BG, Sathe P. A Double-blind Multicenter Two-arm Randomized Placebo-controlled Phase-III Clinical Study to Evaluate the Effectiveness and Safety of Thymosin α1 as an Add-on Treatment to Existing Standard of Care Treatment in Moderate-to-severe COVID-19 Patients. Indian J Crit Care Med 2022;26(8):913–919.

Revealing the mystery of persistent smell loss in Long COVID patients

COVID-19 is hopefully approaching its end in many countries as herd immunity develops and weaker strains of SARS-CoV-2 dominate. However, a new concern occurs over the long-term effects of COVID-19, collectively called "Long COVID", as some symptoms of the nervous system last even after patients recover from COVID-19. This review focuses on studies of anosmia, i.e., impairment of smell, which is the most common sensory defect during the disease course and is caused by olfactory dysfunctions. It remains mysterious how the olfactory functions are affected since the virus can't invade olfactory receptor neurons. We describe several leading hypotheses about the mystery in hope to provide insights into the pathophysiology and treatment strategies for anosmia.

Corticosteroids showed more efficacy in treating hospitalized patients with COVID-19 than standard care but the effect is minimal: A systematic review and meta-analysis

Background

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, the use of corticosteroids for COVID-19 has ignited worldwide debate. Previous systematic reviews, including randomized controlled trials (RCTs) and retrospective observational studies, found that corticosteroids have beneficial effects in treating COVID-19.

Aim

This systematic review and meta-analysis only included RCTs to assess the effectiveness and safety of corticosteroids in hospitalized patients with COVID-19.

Methods

Comprehensive research strategies (PubMed, Embase, MEDLINE, and Coherence Library) were used to search for RCTs from December 2019 to January 2021.

Results

Five RCTs were included with 7,235 patients, of which 2,508 patients were receiving corticosteroid treatments (dexamethasone or methylprednisolone), and 4,727 received standard care. The primary outcome was mortality within 28 days. The use of corticosteroids decreased the 28-day mortality of patients with COVID-19, but the findings were not statistically significant (RR, 0.91; 95% CI, 0.78–1.06, p = 0.24). The secondary outcome was the duration of hospitalization; no differences were found between the corticosteroid and standard care groups. However, corticosteroids were associated with a higher hospital discharge rate than standard treatment, but the result was not statistically significant (RR, 1.36; 95% CI, 0.95–1.96, p = 0.09).

Conclusions

The results suggest that corticosteroids are comparable to standard care in terms of safety in treating COVID-19. Corticosteroids showed greater efficacy than standard care; however, the effect was minimal.

An update on the impact of SARS-CoV-2 pandemic public awareness on cancer patients' COVID-19 vaccine compliance: Outcomes and recommendations

Background:

Aside from the pandemic's negative health effects, the world was confronted with public confusion since proper communication and favorable decisions became an ongoing challenge. As a result, the public's perceptions were influenced by what they knew, the many sources of COVID-19 information, and how they interpreted it. With cancer patients continuing to oppose COVID-19 vaccines, we sought to investigate the COVID-19 pandemic and vaccine sources of this information in adult cancer patients, which either helped or prevented them from taking the vaccine. We also assessed the relevance and impact of their oncologists' recommendations in encouraging them to take the vaccine.

Methods

From June to October 2021, an online survey was conducted at King Hussein Cancer Center. A total of 441 adult cancer patients took part in the study. Patients who had granted their consent were requested to complete an online questionnaire, which was collected using the SurveyMonkey questionnaire online platform. Descriptive analysis was done for all variables. The association between categorical and continuous variables was assessed using the Pearson Chi-square and Fisher Exact.

Results

Our results showed that 75% of the patients registered for the COVID-19 vaccine, while 12% refused vaccination. The majority of participants acquired their information from news and television shows, whereas (138/441) got their information through World Health Organization websites. Because the SARS-CoV-2 vaccines were made in such a short period, 54.7 % assumed the vaccines were unsafe. Only 49% of the patients said their oncologists had informed them about the benefits of SARS-CoV-2 vaccines.

Conclusions

We found that SARS-CoV-2 vaccine hesitancy in cancer patients might be related to misinformation obtained from social media despite the availability of supportive scientific information on the vaccine's benefits from the physicians. To combat misleading and unreliable social media news, we recommend that physicians use telehealth technology to reach out to their patients in addition to their face-to-face consultation, which delivers comprehensive, clear, and high-quality digital services that guide and help patients to better understand the advantages of COVID-19 vaccines.

Issues related to post-COVID-19 syndrome

The pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in 2019-2022 leads to a multisystem illness that results in damage to numerous organ systems. In this review, our goal was to assess current research on long-term respiratory, cardiac, neurological, digestive, rheumatological, urogenital, and dermatological system complications of coronavirus disease 2019 (COVID-19). Bibliographic searches were conducted in December 2021 using PubMed and Google Scholar, retrospectively, covering all COVID-19 literature to determine the consequences of the disease. This review may help to determine the prospects for new studies and predict the upcoming aspects requiring assessment in post-COVID-19 syndrome.

Smart Healthcare System for Severity Prediction and Critical Tasks Management of COVID-19 Patients in IoT-Fog Computing Environments

COVID-19 has depleted healthcare systems around the world. Extreme conditions must be defined as soon as possible so that services and treatment can be deployed and intensified. Many biomarkers are being investigated in order to track the patient's condition. Unfortunately, this may interfere with the symptoms of other diseases, making it more difficult for a specialist to diagnose or predict the severity level of the case. This research develops a Smart Healthcare System for Severity Prediction and Critical Tasks Management (SHSSP-CTM) for COVID-19 patients. On the one hand, a machine learning (ML) model is projected to predict the severity of COVID-19 disease. On the other hand, a multi-agent system is proposed to prioritize patients according to the seriousness of the COVID-19 condition and then provide complete network management from the edge to the cloud. Clinical data, including Internet of Medical Things (IoMT) sensors and Electronic Health Record (EHR) data of 78 patients from one hospital in the Wasit Governorate, Iraq, were used in this study. Different data sources are fused to generate new feature pattern. Also, data mining techniques such as normalization and feature selection are applied. Two models, specifically logistic regression (LR) and random forest (RF), are used as baseline severity predictive models. A multi-agent algorithm (MAA), consisting of a personal agent (PA) and fog node agent (FNA), is used to control the prioritization process of COVID-19 patients. The highest prediction result is achieved based on data fusion and selected features, where all examined classifiers observe a significant increase in accuracy. Furthermore, compared with state-of-the-art methods, the RF model showed a high and balanced prediction performance with 86% accuracy, 85.7% F-score, 87.2% precision, and 86% recall. In addition, as compared to the cloud, the MAA showed very significant performance where the resource usage was 66% in the proposed model and 34% in the traditional cloud, the delay was 19% in the proposed model and 81% in the cloud, and the consumed energy was 31% in proposed model and 69% in the cloud. The findings of this study will allow for the early detection of three severity cases, lowering mortality rates.

Clinical efficacy of SARS-CoV-2 vaccination in hemodialysis patients

Introduction

The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population.

Methods

A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined.

Results

A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8–23.8%), and prevention of death was 66.0% (95% CI:60.6–70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac.

Conclusion

The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

Vacunación contra SARS-COV-2: un año después de iniciada en Colombia

Introducción: el 17 de febrero 2021 se inició el programa de vacunación masiva en Colombia contra el COVID-19, al 17 de febrero 2022 se han aplicado 75’732.846 de dosis en todo el país. El mejor momento de la vacunación se dio el 6 de agosto 2021 cuando se aplicaron 594.933 dosis. Objetivo: mostrar el comportamiento del plan de vacunación contra el SARS-COV-2 en el periodo comprendido entre el 17 de febrero 2021 al 17 de febrero 2022. Metodología: estudio transversal con fuente de información del plan de vacunación nacional contra el COVID-19 de la página web del Ministerio de Salud y Protección Social. Resultados: en noviembre 2021 se evidenció el mayor número de aplicaciones (10’117.202), en junio el mayor número de segunda dosis (3’469.508), en julio el mayor de monodosis (2’322.994), en julio el de esquemas completos (5’282.778) y el mayor número de dosis de refuerzo se presentó en enero 2022 (2’390.185). Conclusión: es de transcendental   importancia   realizar   el   seguimiento   al   proceso de vacunación para comprender su eficacia, la posible disminución de la respuesta inmune con el tiempo y los posibles efectos adversos.  También es fundamental hacer el seguimiento a las mutaciones del virus que se presenten en el país y que afecten la inmunidad proporcionada por las vacunas.

Combining the advantages of AlexNet convolutional deep neural network optimized with anopheles search algorithm based feature extraction and random forest classifier for COVID-19 classification

In this article, COVID-19 detection and classification framework based on anopheles search optimized AlexNet convolutional deep neural network for random forest classifier is implemented. Here, the COVID-19 dataset is taken from Joseph Paul Cohen database. Then, the input images are preprocessed with the help of fuzzy gray level difference histogram equalization technique (FGLHE) and fuzzy stacking technique for color enhancement and noise elimination in the input images. The FGLHE technique and fuzzy stacking technique are combined together and forms into stacked dataset image. This stacked dataset are trained with AlexNet convolutional deep neural network model and the feature packages acquired via the models are processed by the anopheles search algorithm. Subsequently, the efficient features are combined and delivered to random forest (RF) classifier. The proposed approach is implemented in MATLAB. The proposed ADCNN-ASA-RFC provides 91.66%, 69.13%, 34.86%, and 70.13% higher accuracy, 79.13%, 60.33%, and 63.34% higher specificity and 77.13%, 58.45%, 25.86%, and 55.33%, higher sensitivity compared with existing algorithms. At last, the simulation outcomes demonstrate that the proposed system can be able to find the optimal solutions efficiently and accurately with COVID-19 diagnosis.

Percutaneous Auricular Vagus Nerve Stimulation Reduces Inflammation in Critical Covid-19 Patients

Covid-19 is an infectious disease associated with cytokine storms and derailed sympatho-vagal balance leading to respiratory distress, hypoxemia and cardiovascular damage. We applied the auricular vagus nerve stimulation to modulate the parasympathetic nervous system, activate the associated anti-inflammatory pathways, and reestablish the abnormal sympatho-vagal balance. aVNS is performed percutaneously using miniature needle electrodes in ear regions innervated by the auricular vagus nerve. In terms of a randomized prospective study, chronic aVNS is started in critical, but not yet ventilated Covid-19 patients during their stay at the intensive care unit. The results show decreased pro-inflammatory parameters, e.g. a reduction of CRP levels by 32% after 1 day of aVNS and 80% over 7 days (from the mean 151.9 mg/dl to 31.5 mg/dl) or similarly a reduction of TNFalpha levels by 58.1% over 7 days (from a mean 19.3 pg/ml to 8.1 pg/ml) and coagulation parameters, e.g. reduction of DDIMER levels by 66% over 7 days (from a mean 4.5 μg/ml to 1.5 μg/ml) and increased anti-inflammatory parameters, e.g. an increase of IL-10 levels by 66% over 7 days (from the mean 2.7 pg/ml to 7 pg/ml) over the aVNS duration without collateral effects. aVNS proved to be a safe clinical procedure and could effectively supplement treatment of critical Covid-19 patients while preventing devastating over-inflammation.

Acceptance of COVID-19 vaccination among maintenance hemodialysis patients: an Egyptian survey study

Background

Coronavirus disease 2019 (COVID-19) is a contagious disease that is associated with significant morbidity and mortality especially among maintenance hemodialysis (MHD) patients. COVID-19 vaccination is important to decrease risk and severity of COVID-19 infection. However, vaccine hesitancy is a significant barrier to vaccination. Thus, the aim of this study was to investigate the vaccine acceptability among Egyptian MHD patients.

Methods

We conducted a paper-based survey on 237 MHD patients in 2 tertiary Egyptian hemodialysis (HD) centers. The survey consisted of a questionnaire that addressed demographic and clinical data, knowledge and attitudes towards COVID-19 infection and vaccines, beliefs regarding both conventional and COVID-19 vaccines, intention of COVID-19 vaccination together with motivators for and barriers against vaccination, sources of information regarding COVID-19 vaccines.

Results

According to intention to be vaccinated, the patients were divided into vaccine acceptant (VA), hesitant (VH), and resistant (VR) groups who comprised 58.3%, 26.5%, and 15.2%, respectively. Only occupational status and residency were significantly different between the three groups. In 60% of VA group, fear of infection was the main motivator for vaccination. Meanwhile, 40% of VH and VR groups reported that fear of serious side effects of vaccines was the main barrier against vaccination. Television was the primary information source (58.6%) about COVID-19 vaccination while only 18% of patients got their COVID-19 vaccine information from their nephrologists.

Conclusions

More than half of MHD patients accept to receive COVID-19 vaccine. Vaccine acceptability is not associated with age, gender, educational level, but rather with employment status and residency.

Special Issue: 'Pathogenesis of Emerging Zoonotic Viral Infections'

Emerging zoonotic infections present a serious global health threat [...].

The Potential Use of Carnosine in Diabetes and Other Afflictions Reported in Long COVID Patients

Carnosine is a dipeptide expressed in both the central nervous system and periphery. Several biological functions have been attributed to carnosine, including as an anti-inflammatory and antioxidant agent, and as a modulator of mitochondrial metabolism. Some of these mechanisms have been implicated in the pathophysiology of coronavirus disease-2019 (COVID-19). COVID-19 is caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The clinical manifestation and recovery time for COVID-19 are variable. Some patients are severely affected by SARS-CoV-2 infection and may experience respiratory failure, thromboembolic disease, neurological symptoms, kidney damage, acute pancreatitis, and even death. COVID-19 patients with comorbidities, including diabetes, are at higher risk of death. Mechanisms underlying the dysfunction of the afflicted organs in COVID-19 patients have been discussed, the most common being the so-called cytokine storm. Given the biological effects attributed to carnosine, adjuvant therapy with this dipeptide could be considered as supportive treatment in patients with either COVID-19 or long COVID.

Exploring the Role of Heavy Metals and Their Derivatives on the Pathophysiology of COVID-19

Many aspects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease, COVID-19, have been studied to determine its properties, transmission mechanisms, and pathology. These efforts are aimed at identifying potential approaches to control or treat the disease. Early treatment of novel SARS-CoV-2 infection to minimize symptom progression has minimal evidence; however, many researchers and firms are working on vaccines, and only a few vaccines exist. COVID-19 is affected by several heavy metals and their nanoparticles. We investigated the effects of heavy metals and heavy metal nanoparticles on SARS-CoV-2 and their roles in COVID-19 pathogenesis. AgNPs, AuNPs, gold-silver hybrid NPs, copper nanoparticles, zinc oxide, vanadium, gallium, bismuth, titanium, palladium, silver grafted graphene oxide, and some quantum dots were tested to see if they could minimize the severity or duration of symptoms in patients with SARS-CoV-2 infection when compared to standard therapy.

Risk factors for severe COVID-19 disease and death in patients aged 70 and over: a retrospective observational cohort study

OBJECTIVES

The COVID-19 pandemic resulted in rapid reorganisations of hospital care. In our hospital, the geriatrics team introduced the Clinical Frailty Scale (CFS) on the non-ICU COVID-19 units during these reorganisations. A retrospective analysis was performed to investigate the CFS as a risk factor for severe COVID-19 disease and in-hospital death in older patients with COVID-19.

METHODS

In patients aged ≥70 years, an online geriatric assessment questionnaire was launched, from which the CFS was scored by the geriatrics team. Additional clinical data were collected from the electronic medical records. Risk factors related to ageing, such as the CFS, age-adjusted Charlson Comorbidity Index, living situation and cognitive decline, were examined alongside frequently reported risk factors in the general population. Outcomes were in-hospital death (primary outcome) and oxygen need of ≥6 litres and early warning score ≥7, as parameters for severe disease (secondary outcomes). Baseline characteristics were described with descriptive statistics. Associations were analysed with uni- and multivariable analyses.

RESULTS

One hundred and five patients were included, median age 82 years. CFS scores were 1-4 in 43, 5-6 in 45, and 7-9 in 17 patients. In multivariable analysis, CFS and cognitive decline were the only risk factors that were independently associated with in-hospital mortality. Chronic obstructive pulmonary disease, presence of respiratory symptoms on admission and male gender showed and independent association with severe disease.

CONCLUSION

A retrospective analysis shows that CFS and cognitive decline have added value for predicting in-hospital mortality in older patients with COVID-19 disease.

Comparison between Suspected and Confirmed COVID-19 Respiratory Patients: What Is beyond the PCR Test

COVID-19 modified the healthcare system. Nasal-pharyngeal swab (NPS), with real-time reverse transcriptase-polymerase (PCR), is the gold standard for the diagnosis; however, there are difficulties related to the procedure that may postpone it. The study aims to evaluate whether other elements than the PCR-NPS are reliable and confirm the diagnosis of COVID-19. This is a cross-sectional study on data from the Lung Unit of Pavia (confirmed) and at the Emergency Unit of Palermo (suspected). COVID-19 was confirmed by positive NPS, suspected tested negative. We compared clinical, laboratory and radiological variables and performed Logistic regression to estimate which variables increased the risk of COVID-19. The derived ROC-AUCcurve, assessed the accuracy of the model to distinguish between COVID-19 suspected and confirmed. We selected 50 confirmed and 103 suspected cases. High Reactive C-Protein (OR: 1.02; CI95%: 0.11–1.02), suggestive CT-images (OR: 11.43; CI95%: 3.01–43.3), dyspnea (OR: 10.48; CI95%: 2.08–52.7) and respiratory failure (OR: 5.84; CI95%: 1.73–19.75) increased the risk of COVID-19, whereas pleural effusion decreased the risk (OR: 0.15; CI95%: 0.04–0.63). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19 (AUC 0.91). Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently from the NPS result.

Longitudinal links between behavioral activation coping strategies and depressive symptoms of U.S. adults living alone during the COVID-19 pandemic

The COVID-19 pandemic and related physical distancing measures have posed a significant threat to the mental health of adults, particularly those living alone. Accordingly, the World Health Organization implemented the #HealthyAtHome program, encouraging people to keep in regular contact with loved ones, stay physically active, and keep a regular routine. The current study aims to examine a micro-longitudinal link between behavioral activation coping strategies (exercise, meditation, relaxation, and social connection) and depressive symptoms among adults who lived alone during the COVID-19 pandemic. We used 21 biweekly waves of longitudinal data from the Understanding America Study (UAS) collected between April 2020 and February 2021 (N = 1,280). The multilevel models with correlated random effects were estimated to examine lagged effects of coping strategies (t-1) on depressive symptoms (t). The results showed that exercise was predictive of lower depressive symptoms even after controlling for time-invariant and time-varying covariates. The results showed that modifiable lifestyle factors, such as taking time to exercise, may be beneficial for the mental health of Americans living in single-person households.

Sera Metabolomics Characterization of Patients at Different Stages in Wuhan Identifies Critical Biomarkers of COVID-19

We have witnessed the 2-year-long global rampage of COVID-19 caused by the wide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, knowledge about biomarkers of the entire COVID-19 process is limited. Identification of the systemic features of COVID-19 will lead to critical biomarkers and therapeutic targets for early intervention and clinical disease course prediction. Here, we performed a comprehensive analysis of clinical measurements and serum metabolomics in 199 patients with different stages of COVID-19. In particular, our study is the first serum metabolomic analysis of critical rehabilitation patients and critical death patients. We found many differential metabolites in the comparison of metabolomic results between ordinary, severe, and critical patients and uninfected patients. Through the metabolomic results of COVID-19 patients in various stages, and critical rehabilitation patients and critical death patients, we identified a series of differential metabolites as biomarkers, a separate queue and precise distinction, and predicted COVID-19 verification. These differentially expressed metabolites, included 1,2-di-(9Z,12Z-octadecadienoyl)-sn-glycero-3-phosphate, propylparaben, 20-hydroxyeicosatetraenoic acid, triethanolamine, chavicol, disialosyl galactosyl globoside, 1-arachidonoylglycerophosphoinositol, and alpha-methylstyrene, all of which have been identified for the first time as biomarkers in COVID-19 progression. These biomarkers are involved in many pathological and physiological pathways of COVID-19, for example, immune responses, platelet degranulation, and metabolism which might result in pathogenesis. Our results showed valuable information about metabolites obviously altered in COVID-19 patients with different stages, which could shed light on the pathogenesis as well as serve as potential therapeutic agents of COVID-19.

Adoption of Preventive Behaviour Strategies and Public Perceptions About COVID-19 in Singapore

BACKGROUND

The unprecedented severity of coronavirus disease 2019 (COVID-19) constitutes a serious public health concern. However, adoption of COVID-19-related preventive behaviours remain relatively unknown. This study investigated predictors of preventive behaviours.

METHODS

An analytical sample of 897 Singaporean adults who were quota sampled based on age, gender, and ethnicity were recruited through a web-enabled survey. Outcomes were adoption of, or increased frequency of preventive behaviours (avoiding social events; avoiding public transport; reducing time spent shopping and eating out; wearing a mask in public; avoiding hospitals/clinics; keeping children out of school, washing hands/using sanitisers; keeping surroundings clean; avoiding touching public surfaces; working from/studying at home). Public perceptions regarding COVID-19 (chances of getting COVID-19; perceived likelihood of COVID-19-related intensive care unit (ICU) admission; government trust; self-efficacy; perceived appropriateness of COVID-19 behaviours; response efficacy), anxiety, and demographic characteristics (age; ethnicity; marital status; education; chronic conditions; current living arrangements) were investigated as predictors of preventive behaviours adopted during COVID-19 in binomial and ordered logistic regressions.

RESULTS

Though adoption of preventive behaviours among Singaporeans varied, it was, overall, high, and consistent with government recommendations. Nearly a quarter reported moderate to severe anxiety (General Anxiety Disorder 7-item - GAD-7 scores). Respondents who perceived higher COVID-19 risks, had higher government trust, higher self-efficacy, and perceived that others acted appropriately reported increased adoption/frequency of preventive measures. The strongest indicator of behavioural change was response efficacy. Respondents who were older, highly educated, anxious and married reported higher adoption/frequency of preventive measures.

CONCLUSION

To successfully influence appropriate preventive behaviours, public health messages should highlight response efficacy, increase self-efficacy, and promote trust in governmental response. Focus should be on demographic segments with low adoptions, such as younger individuals and those with low education.

Rhamnolipid Nano-Micelles versus Alcohol-Based Hand Sanitizer: A Comparative Study for Antibacterial Activity against Hospital-Acquired Infections and Toxicity Concerns

Hospital-acquired infections (HAIs) are considered to be a major global healthcare challenge, in large part because of the development of microbial resistance to currently approved antimicrobial drugs. HAIs are frequently preventable through infection prevention and control measures, with hand hygiene as a key activity. Improving hand hygiene was reported to reduce the transmission of healthcare-associated pathogens and HAIs. Alcohol-based hand sanitizers are commonly used due to their rapid action and broad spectrum of microbicidal activity, offering protection against bacteria and viruses. However, their frequent administration has been reported to be associated with many side effects, such as skin sensitivity, skin drying, and cracks, which promote further skin infections. Thus, there is an essential need to find alternative approaches to hand sanitation. Rhamnolipids are glycolipids produced by Pseudomonas aeruginosa, and were shown to have broad antimicrobial activity as biosurfactants. We have previously demonstrated the antimicrobial activity of rhamnolipid nano-micelles against selected drug-resistant Gram-negative (Salmonella Montevideo and Salmonella Typhimurium) and Gram-positive bacteria (Staphylococcus aureus, Streptococcus pneumoniae). To the best of our knowledge, the antimicrobial activity of rhamnolipid nano-micelles in comparison to alcohol-based hand sanitizers against microorganisms commonly causing HAIs in Egypt—such as Acinetobacter baumannii and Staphylococcus aureus—has not yet been studied. In the present work, a comparative study of the antibacterial activity of rhamnolipid nano-micelles versus alcohol-based hand sanitizers was performed, and their safety profiles were also assessed. It was demonstrated that rhamnolipid nano-micelles had a comparable antibacterial activity to alcohol-based hand sanitizer, with a better safety profile, i.e., rhamnolipid nano-micelles are unlikely to cause any harmful effects on the skin. Thus, rhamnolipid nano-micelles could be recommended to replace alcohol-based hand sanitizers; however, they must still be tested by healthcare workers in healthcare settings to ascertain their antimicrobial activity and safety.

Peptide-Based Vaccines and Therapeutics for COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been prevalent in the humans since 2019 and has given rise to a pandemic situation. With the discovery and ongoing use of drugs and vaccines against SARS-CoV-2, there is still no surety of its complete suppression of this disease or if there is a need for additional booster doses. There is an urgent need for alternative treatment strategies against COVID-19. Peptides and peptidomimetics have several advantages as therapeutic agents because of their target selectivity, better interactions, and lower toxicity. Minor structural alterations to peptides can help prevent their fast metabolism and provide long-action. This comprehensive review provides an overview of different peptide-based vaccines and therapeutics against SARS-CoV-2. It discusses the design and mechanism of action of the peptide-based vaccines, peptide immunomodulators, anti-inflammatory agents, and peptides as entry inhibitors of SARS-CoV-2. Moreover, the mechanism of action, sequences and current clinical trial studies are also summarized. The review also discusses the future aspects of peptide-based vaccines and therapeutics for COVID-19.

Graphical Abstract

Symptoms of COVID-19 contagion in different social contexts in association to self-reported symptoms, mental health and study capacity in Swedish university students

Objective

The present study investigates if symptoms of COVID-19 contagion in different social contexts (cohabitants, family, acquaintances, and others) are associated with university students' own self-reported symptoms of COVID-19 contagion, mental health, and study capacity. This was investigated by a cross-sectional survey administrated in Sweden during the first wave of the COVID-19 pandemic, at the time when universities were locked down to limit viral spread and contagion.

Results

Mild to moderate symptoms of COVID-19 in cohabitants and family members were associated with student’s self-reported symptoms of contagion, while no associations could be seen in relation to mental health and study capacity. Symptoms of COVID-19 contagion in acquaintances and others were not associated with students’ self-reported symptoms, nor with their mental health and study capacity.

To conclude, during the initial lockdown of universities students’ self-reported symptoms of contagion were mainly associated with cohabitants and family members, while symptoms of contagion in different social contexts were not associated with mental health and study capacity. Findings suggest that lockdown of universities may have contributed to limiting infection pathways, while still allowing students to focus on their studies despite significant contagion among others known to the student.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06009-z.

Mortalidad y función renal a largo plazo en pacientes ingresados en UCI por Covid-19 con fracaso renal agudo, terapia continua de reemplazo renal y ventilación mecánica invasiva

Introducción La interacción

de COVID-19, ventilación mecánica invasiva (VMI) y fracaso renal agudo (FRA) con necesidad de terapia continua de reemplazo renal (TCRR) es conocida, pero hay pocos datos publicados sobre el pronóstico a largo plazo de este tipo de FRA.

Métodos

Este estudio analiza los resultados a largo plazo de 30 pacientes ingresados en la UCI por neumonía por COVID-19, con VMI y FRA con TCRR en el pico de máxima incidencia. Comparamos las características basales, la evolución clínica y bioquímica y los diferentes filtros usados en la TCRR para identificar los factores de riesgo asociados a la muerte intrahospitalaria. Se analizaron el filtrado glomerular estimado (FGe), la proteinuria y la hematuria a los 6 meses de seguimiento de los supervivientes.

Resultados

De los 30 pacientes, 19 fallecieron y 11 fueron dados de alta. Los pacientes con peor función renal tuvieron mayor mortalidad (p = 0,009). Los filtros usados con capacidad adsortiva no ofrecieron beneficios en cuanto a la supervivencia. De los 11 supervivientes, ninguno requirió terapia renal sustitutiva (TRS) una vez superada la infección, pero tuvieron una pérdida importante y mantenida en el tiempo de función renal (FGe de 44 ml/min/1,73 m²).

Conclusión

La mortalidad en pacientes con neumonía por COVID-19 que requieren VMI y TCRR es extremadamente elevada (63%). Los filtros con capacidad adsortiva no modificaron la supervivencia. La función renal basal fue un factor predictor de mortalidad. En este tipo de FRA el deterioro de la función renal no se recupera, objetivándose una reducción importante del FGe a los 6 meses.

Structural and Computational Studies of the SARS-CoV-2 Spike Protein Binding Mechanisms with Nanobodies: From Structure and Dynamics to Avidity-Driven Nanobody Engineering

Nanobodies provide important advantages over traditional antibodies, including their smaller size and robust biochemical properties such as high thermal stability, high solubility, and the ability to be bioengineered into novel multivalent, multi-specific, and high-affinity molecules, making them a class of emerging powerful therapies against SARS-CoV-2. Recent research efforts on the design, protein engineering, and structure-functional characterization of nanobodies and their binding with SARS-CoV-2 S proteins reflected a growing realization that nanobody combinations can exploit distinct binding epitopes and leverage the intrinsic plasticity of the conformational landscape for the SARS-CoV-2 S protein to produce efficient neutralizing and mutation resistant characteristics. Structural and computational studies have also been instrumental in quantifying the structure, dynamics, and energetics of the SARS-CoV-2 spike protein binding with nanobodies. In this review, a comprehensive analysis of the current structural, biophysical, and computational biology investigations of SARS-CoV-2 S proteins and their complexes with distinct classes of nanobodies targeting different binding sites is presented. The analysis of computational studies is supplemented by an in-depth examination of mutational scanning simulations and identification of binding energy hotspots for distinct nanobody classes. The review is focused on the analysis of mechanisms underlying synergistic binding of multivalent nanobodies that can be superior to single nanobodies and conventional nanobody cocktails in combating escape mutations by effectively leveraging binding avidity and allosteric cooperativity. We discuss how structural insights and protein engineering approaches together with computational biology tools can aid in the rational design of synergistic combinations that exhibit superior binding and neutralization characteristics owing to avidity-mediated mechanisms.

Clinicopathologic characteristics of severe COVID-19 patients in Mexico City: A post-mortem analysis using a minimally invasive autopsy approach

OBJECTIVE

Describe the histological findings of minimally ultrasound-guided invasive autopsies in deceased patients with severe SARS-CoV-2 and compare the diagnostic yield with open autopsies.

DESIGN

Observational post-mortem cohort study. Minimally invasive ultrasound-guided autopsies were performed in fourteen deceased patients with a confirmed diagnosis of SARS-CoV-2 pneumonia. Histological and clinical findings of lung, kidney, and liver tissue are described and contrasted with those previously reported in the literature.

SETTING

Single-center COVID-19 reference center in Mexico City.

RESULTS

Fourteen minimally invasive autopsies revealed a gross correlation with open autopsies reports: 1) Lung histology was characterized mainly by early diffuse alveolar damage (12/13). Despite low lung compliances and prolonged mechanical ventilation, the fibrotic phase was rarely observed (2/13). 2) Kidney histopathology demonstrated acute tubular injury (12/13), interstitial nephritis (11/13), and glomerulitis (11/13) as the predominant features 3) Liver histology was characterized by neutrophilic inflammation in all of the cases, as well as hepatic necrosis (8/14) despite minimal alterations in liver function testing. Hepatic steatosis was observed in most cases (12/14). SARS-CoV-2 positivity was widely observed throughout the immunohistochemical analysis. However, endothelitis and micro thrombosis, two of the hallmark features of the disease, were not observed.

CONCLUSION

Our data represents the largest minimally invasive, ultrasound-guided autopsy report. We demonstrate a gross histological correlation with large open autopsy cohorts. However, this approach might overlook major histologic features of the disease, such as endothelitis and micro-thrombosis. Whether this represents sampling bias is unclear.

Mesenchymal Stem Cells in the Treatment of New Coronavirus Pandemic: A Novel Promising Therapeutic Approach

After severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks, coronavirus disease 2019 (COVID-19) is the third coronavirus epidemic that soon turned into a pandemic. This virus causes acute respiratory syndrome in infected people. The mortality rate of SARS-CoV-2 infection will probably rise unless efficient treatments or vaccines are developed. The global funding and medical communities have started performing more than five hundred clinical examinations on a broad spectrum of repurposed drugs to acquire effective treatments. Besides, other novel treatment approaches have also recently emerged, including cellular host-directed therapies. They counteract the unwanted responses of the host immune system that led to the severe pathogenesis of SARS-CoV-2. This brief review focuses on mesenchymal stem cell (MSC) principles in treating the COVID-19. The US clinical trials database and the world health organization database for clinical trials have reported 82 clinical trials (altogether) exploring the effects of MSCs in COVID-19 treatment. MSCs also had better be tried for treating other pathogens worldwide. MSC treatment may have the potential to end the high mortality rate of COVID-19. Besides, it also limits the long-term inability of survivors.

COVID-19 pathophysiology and ultrasound imaging: A multiorgan review

COVID-19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID-19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID-19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID-19 in the lungs, heart and liver.

Effects of the COVID-19 Pandemic on Gynecological Health: An Integrative Review

OBJECTIVE

 To analyze the existing scientific literature to find out if the coronavirus disease 2019 (COVID-19) pandemic has an effect on gynecological health.

SEARCH STRATEGY

 We performed an integrative review of articles published between April 2020 and April 2021 on the PubMed, SciELO, and LILACS databases, using COVID-19 and the following relevant terms: Menstrual change; Ovarian function; Violence against women; Contraception; HPV; Mental health; and Urogynecology.

SELECTION CRITERIA

 Among the eligible studies found, editorials and primary research articles, which describe the dynamics between severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection (the cause of the COVID-19 pandemic) and gynecological health, were included.

DATA COLLECTION AND ANALYSIS

 Through qualitative synthesis, data were extracted from the included publications and from guidelines of national and international societies of gynecology.

MAIN RESULTS

 The 34 publications included in the present study showed that some factors of the SARS-CoV-2 infection, and, consequently, the COVID-19 pandemic, might be associated with menstrual abnormalities, effects on contraception, alterations in steroid hormones, changes in urogynecological care, effects on women's mental health, and negative impact on violence against women.

CONCLUSION

 The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic.

SARS-CoV-2 Dysregulates Neutrophil Degranulation and Reduces Lymphocyte Counts

SARS-CoV-2, the virus that causes COVID-19, has given rise to one of the largest pandemics, affecting millions worldwide. High neutrophil-to-lymphocyte ratios have been identified as an important correlate to poor recovery rates in severe COVID-19 patients. However, the mechanisms underlying this clinical outcome and the reasons for its correlation to poor prognosis are unclear. Furthermore, the mechanisms involved in healthy neutrophils acquiring a SARS-CoV-2-mediated detrimental role are yet to be fully understood. In this study, we isolated circulating neutrophils from healthy donors for treatment with supernates from infected epithelial cells and direct infection with SARS-CoV-2 in vitro. Infected epithelial cells induced a dysregulated degranulation of primary granules with a decrease in myeloperoxidase (MPO), but slight increase in neutrophil elastase release. Infection of neutrophils resulted in an impairment of both MPO and elastase release, even though CD16 receptor shedding was upregulated. Importantly, SARS-CoV-2-infected neutrophils had a direct effect on peripheral blood lymphocyte counts, with decreasing numbers of CD19+ B cells, CD8+ T cells, and CD4+ T cells. Together, this study highlights the independent role of neutrophils in contributing to the aberrant immune responses observed during SARS-CoV-2 infection that may be further dysregulated in the presence of other immune cells.

Biopsychosocial Factors Predicting Pain Among Individuals Experiencing the Novel Coronavirus Disease (COVID-19)

BACKGROUND

Pain is one of the most common symptoms of novel coronavirus disease (COVID-19). Being both a physical and a psychological experience, pain is affected by many factors, including biological, psychological, and social rather than a single variable.

AIMS

To determine the effects of biological, psychological, and social factors on pain level among participants experiencing with the COVID-19.

DESIGN

A web-based, retrospective, and descriptive study SETTING: Social media sources such as Facebook, WhatsApp, Instagram, and E-mail PARTICIPANTS: One hundred forty-nine participants were included.

METHODS

Data were collected based on the biopsychosocial model. Pain level was evaluated using the visual analog scale (VAS). The data were analyzed using descriptive, correlational statistics, and structural equation modeling.

RESULTS

The mean age of participants was 32.87 (SD = 11.32) years. The VAS scores were associated with gender (Z = -2.103, p = .035), and chronic disease status (Z = 3.001, p = .003), and the Chalder Fatigue Scale total score (β = 0.718, p < .001) associated with biological factors. The Coronavirus Anxiety Scale scores among psychological factors showed a direct impact on the VAS scores (β = 0.583, p < .001). The Patterns of Activity Measure-Pain total score examined within social factors directly affected the VAS score. The VAS score did not correlate with age, smoking status, hospitalization status, respiratory support, marital status, education level, employment, and income status.

CONCLUSIONS

The pain level in COVID-19 participants was determined by biological, psychological, and social factors. Females and participants with chronic illness, anxiety, fatigue, and low physical activity were found to experience high levels of pain. Education and counseling programs for pain management should be comprehensively structured and include anxiety reduction programs, and fatigue management.

Calming the cytokine storm of COVID-19 through inhibition of JAK2/STAT3 signaling

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the unprecedented COVID-19 pandemic, which has infected over 178 million people worldwide. Even with new vaccines, global herd immunity will not be reached soon. New cases and viral variants are being reported at an alarming rate. Effective antiviral treatment is urgently needed. Patients with severe COVID-19 suffer from life-threatening respiratory failure due to acute respiratory distress syndrome in their lungs, a leading cause of COVID-19 mortality. This lung hyper-inflammation is induced by virus-caused massive tissue damage that is associated with uncontrolled cytokine release, known as a cytokine storm, through JAK/STAT signaling pathways. Here, we review the FDA-approved JAK inhibitors that are being clinically evaluated and repurposed for the treatment of patients with severe COVID-19 by calming SARS-CoV-2 infection.

Can Nutritional Supports Beneficial in Other Viral Diseases Be Favorable for COVID-19?

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2), has rapidly spread worldwide, causing many deaths, the number of which continues to increase. Global public health organizations and governments have advised on the adoption of various handwashing and hygiene guidelines, use of masks, and social distancing, along with isolation or lockdown protocols to prevent SARS-COV-2 spread. There are vaccines and drugs that are confirmed but still many human suffer from this disease. Important risk factors for SARS-COV-2 infection are similar to other viral infectious diseases as including influenza, hepatitis B, acquired immunodeficiency syndrome, and other lung infections. These diseases might be related to poor nutritional support, affecting the patient outcomes against COVID-19. In this review, we discuss some of the nutritional therapies currently being investigated for infectious diseases. Studies have shown that nutrition has the potential to prevent and mitigate viral infections. Micronutrients (vitamins A, B6, B12, C, D, and E, B9, and trace elements, such as iron, zinc, copper, selenium, magnesium, and polyphenols) and macronutrients (carbohydrates, prebiotics, probiotics, protein [amino acids], and lipids [fatty acids]) affect the whole body, including the immune system, preventing viral entry and modulating clinical symptoms. This review discusses the importance of nutrition as a strategy to understand food groups and key nutrients that may affect the clinical outcomes of COVID-19 patients during the ongoing pandemic. Scientists believe that the likelihood of another pandemic is imminent. COVID-19 remains important and scientists believe it will continue will in the future. We emphasize the lack of studies on the nutritional impact of COVID-19 in terms of nutrition, even though nutritional interventions has been shown to have many advantages during the treatment of viral infections.

An antibody-based proximity labeling map reveals mechanisms of SARS-CoV-2 inhibition of antiviral immunity

The global epidemic caused by the coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in the infection of over 200 million people. To extend the knowledge of interactions between SARS-CoV-2 and humans, we systematically investigate the interactome of 29 viral proteins in human cells by using an antibody-based TurboID assay. In total, 1,388 high-confidence human proximal proteins with biotinylated sites are identified. Notably, we find that SARS-CoV-2 manipulates the antiviral and immune responses. We validate that the membrane protein ITGB1 associates angiotensin-converting enzyme 2 (ACE2) to mediate SARS-CoV-2 entry. Moreover, we reveal that SARS-CoV-2 proteins inhibit activation of the interferon pathway through the mitochondrial protein mitochondrial antiviral-signaling protein (MAVS) and the methyltransferase SET domain containing 2, histone lysine methyltransferase (SETD2). We propose 111 potential drugs for the clinical treatment of coronavirus disease 2019 (COVID-19) and identify three compounds that significantly inhibit the replication of SARS-CoV-2. The proximity labeling map of SARS-CoV-2 and humans provides a resource for elucidating the mechanisms of viral infection and developing drugs for COVID-19 treatment.

Interleukin-37: A Link Between COVID-19, Diabetes, and the Black Fungus

The COVID-19 pandemic involved millions of people and diabetes was identified as an associated comorbidity. Initiation of systemic corticosteroids in patients suffering from severe COVID-19 was associated with lower mortality. A surge of invasive fungal infections of the maxillofacial region, namely mucormycosis, was linked to a deadly infection known as black fungus. Black fungus, diabetes, corticosteroids, and coronavirus disease 2019 (COVID-19) all have a dysregulated immune response in common, which partly could also be attributed to interleukin 37 (IL-37). IL-37, a new cytokine of the IL-1 family, known for broadly reducing innate inflammation as well as acquired immune responses. The use of corticosteroids in diabetic COVID-19 patients, crowded hospitals, and lack of medical oxygen should be carefully considered to reduce COVID-associated secondary infections.

Rescuing emergency cases of COVID-19 patients: An intelligent real-time MSC transfusion framework based on multicriteria decision-making methods

Mesenchymal stem cells (MSCs) have shown promising ability to treat critical cases of coronavirus disease 2019 (COVID-19) by regenerating lung cells and reducing immune system overreaction. However, two main challenges need to be addressed first before MSCs can be efficiently transfused to the most critical cases of COVID-19. First is the selection of suitable MSC sources that can meet the standards of stem cell criteria. Second is differentiating COVID-19 patients into different emergency levels automatically and prioritising them in each emergency level. This study presents an efficient real-time MSC transfusion framework based on multicriteria decision-making(MCDM) methods. In the methodology, the testing phase represents the ability to adhere to plastic surfaces, the upregulation and downregulation of specific surface protein markers and finally the ability to differentiate into different kinds of cells. In the development phase, firstly, two scenarios of an augmented dataset based on the medical perspective are generated to produce 80 patients with different emergency levels. Secondly, an automated triage algorithm based on a formal medical guideline is proposed for real-time monitoring of COVID-19 patients with different emergency levels (i.e. mild, moderate, severe and critical) considering the improvement and deterioration procedures from one level to another. Thirdly, a unique decision matrix for each triage level (except mild) is constructed on the basis of the intersection between the evaluation criteria of each emergency level and list of COVID-19 patients. Thereafter, MCDM methods (i.e. analytic hierarchy process [AHP] and vlsekriterijumska optimizcija i kaompromisno resenje [VIKOR]) are integrated to assign subjective weights for the evaluation criteria within each triage level and then prioritise the COVID-19 patients on the basis of individual and group decision-making(GDM) contexts. Results show that: (1) in both scenarios, the proposed algorithm effectively classified the patients into four emergency levels, including mild, moderate, severe and critical, taking into consideration the improvement and deterioration cases. (2) On the basis of experts' perspectives, clear differences in most individual prioritisations for patients with different emergency levels in both scenarios were found. (3) In both scenarios, COVID-19 patients were prioritised identically between the internal and external group VIKOR. During the evaluation, the statistical objective method indicated that the patient prioritisations underwent systematic ranking. Moreover, comparison analysis with previous work proved the efficiency of the proposed framework. Thus, the real-time MSC transfusion for COVID-19 patients can follow the order achieved in the group VIKOR results.

COVID-19 pandemic: A pragmatic plan for ayurveda intervention

World community is facing an unprecedented pandemic of novel corona virus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV- 2). The disease has spread globally with more than 1.43 million confirmed cases and 82,100 deaths as of April 8, 2020. Despite worldwide efforts to contain it, the pandemic is continuing to spread for want of a clinically-proven prophylaxis and therapeutic strategy. The dimensions of pandemic require an urgent harnessing of all knowledge systems available globally. Utilization of Traditional Chinese Medicine in Wuhan to treat COVID-19 cases sets the example demonstrating that traditional health care can contribute to treatment of these patients successfully. Drawing on the Ayurveda classics, contemporary scientific studies, and experiential knowledge on similar clinical settings, here we propose a pragmatic plan for intervention in India. We provide a plan for graded response, depending on the stage of infection among individuals, in a population. Notwithstanding the fact that no system of medicine has any evidence-based treatment for COVID-19 as yet, clinical interventions are required to be put in place. Therefore, pragmatic strategy proposed here for Ayurveda system of medicine requires immediate implementation. It will facilitate learning, generate evidence and shall be a way forward.

The Relationship Between Community Adherence to COVID-19 Containment Measures and the Wellbeing of Older Adults in Rural Kenya

The COVID-19 pandemic has disrupted lives globally but disproportionately affected older adults due to their increased vulnerability to severe illness and higher mortality. To protect older adults from infection, community members in rural Kenya have ensured enhanced adherence to COVID-19 containment measures. However, while restricted social contact is highly recommended in the control of COVID-19 infection, limited research exists on its effect on the psychosocial wellbeing of older adults. This study therefore assessed the relationship between community adherence to COVID-19 containment measures and the overall wellbeing of older adults. Nyeri County in Central Kenya was selected for the study and all adults aged 70 years and above targeted. Snowball sampling was used to collect data from a sample of 360 respondents. Both descriptive and inferential statistics were used in data analysis. The study established a significant inverse relationship between the level of community adherence to COVID-19 protocols and the wellbeing of older adults. Furthermore, the wellbeing of most older adults had deteriorated during the pandemic, with older married women with higher incomes being less affected. The study concluded that although the COVID-19 pandemic had affected everyone, effective containment is a multi-dimensional issue that requires targeted interventions.

Impact of SARS-CoV-2 on Saliva: TNF-⍺, IL-6, IL-10, Lactoferrin, Lysozyme, IgG, IgA, and IgM

Objectives

Understanding the role of certain salivary components, such as TNF-⍺, IL-6, IL-10, lactoferrin, lysozyme, IgG, IgA, and IgM, in airway defense during the ongoing SARS-CoV-2 pandemic is essential. The salivary immune barrier of patients with COVID-19 may play a role in their prognosis. The present study aims to evaluate the impact of SARS-CoV-2 on saliva composition.

Methods

A longitudinal study was carried out with male and female firefighters aged 24–48 years. The study sample (n = 34) was divided into 3 groups: asymptomatic volunteers with a negative polymerase chain reaction (PCR) test for SARS-CoV-2 (group 1, Control, n = 21); patients with symptoms of COVID-19 of less than 7 days’ duration and a diagnosis of SARS-CoV-2 infection by PCR (group 2, COVID-19, n = 13); and recovered patients from group 2 who were free of COVID-19 symptoms for at least 2 months (group 3, post-COVID-19 recovery, n = 13). All groups underwent real-time PCR to detect the presence of SARS-CoV-2, as well as analysis of the salivary concentrations of TNF-⍺, IL-6, IL-10, lactoferrin, lysozyme, IgG, IgA, and IgM by the ELISA method.

Results

Lactoferrin concentrations were significantly decreased in the infected group (COVID-19) when compared to those not infected by SARS-CoV-2 (control) (p = 0.032). IgA concentrations were decreased in the COVID-19 and post-COVID-19 groups compared to the control group (p = 0.005 and p = 0.016, respectively). Comparison of the COVID-19 and post-COVID-19 groups also revealed an increase in IgM concentrations during acute SARS-CoV-2 infection (p = 0.010).

Conclusion

SARS-CoV-2 alters the composition of the salivary immune barrier.

Impact of non-pharmaceutical interventions during the COVID-19 pandemic on common childhood respiratory viruses - A epidemiological study based on hospital data

Considering common childhood respiratory viruses and SARS-CoV-2 share similar transmission routes, non-pharmaceutical interventions (NPIs) to prevent SARS-CoV-2 may affect the epidemiology of respiratory viruses. Therefore, our study aimed to observe the epidemiologic characteristics of common childhood respiratory viruses in 2020 (after the pandemic) compared with 2019 (before the pandemic) in Hangzhou, China. The data were compared between 2019 and 2020 based on age and month, respectively. One or more viruses were detected in 3135/21452 (14.61%) specimens in 2019, which was significantly lower in 1110/8202 (13.53%) specimens in 2020. Respiratory syncytial virus (RSV) was the most commonly detected virus in 2019 and 2020. The positive rate of adenovirus (ADV), parainfluenza virus (PIV)1, PIV2, and PIV3 in 2020 was significantly decreased in 2019. In 2020, RSV replaced ADV as the most predominant virus in children aged 1–6 years, and the positive rate of influenza virus A (FluA), influenza virus B (FluB), PIV1, and PIV2 was not correlated to age. FluA, FluB, and PIV2 were not almost detected from February 2020. The positive rates of ADV and PIV1 were uncorrelated to the month in 2020. By strict NPIs, besides controlling the COVID-19 pandemic, incredible progress has been made to reduce the prevalence of common childhood respiratory viruses.

An Overview of COVID-19 and Its Vaccines

Coronavirus pandemic, is a continuing catastrophe (COVID-19) triggered by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The virus passes into the target cells by attaching itself to a receptor i.e., Human Angiotensin-converting enzyme 2 (hACE2). It consists of Spike structures created from glycoproteins that promote the virus entry into the target cells of host. The RBD of the S1 subunit on Spike proteins binds to the hACE2 receptor, which is mostly found in the lungs, particularly type-2 pneumocytes, causing human ACE2 receptors to be downregulated. Apart from nausea, vomiting, and chest tightness, which are unusual symptoms of COVID-19, the most common causes of death and severity are respiratory failure (69.5%), sepsis or multi-organ failure (28%), cardiac failure (14.6%), and renal failure (14.6%). Viral antigen-based or viral nucleic acid-based real-time RT-PCR is recommended for the diagnosis of COVID-19 suspects. Vaccination is essential for antiviral treatment. The study was conducted on viruses based on live-attenuated or non-activated viruses, recombinant viral vectors, DNA, VLPs and soluble proteins. Vaccine from Pfizer and BioNTech was the first that showed promising data on effectiveness. 90% efficacy of the vaccine was reported. BNT-162b2 (Pfizer, BioNTech) & mRNA-1273 (Moderna) are mRNA based; AZD-1222 Ad5‑CoV (AstraZeneca; Oxford University); Ad26.COV2.S (Johnson & Johnson) are viral vector based and other vaccines have been granted emergency use authorization by FDA. Since RNA viruses are able to mutate readily and quickly the mutation in the existing strain can be Variants of concern (VOCs) that might diminish vaccine effectiveness. The latest Delta variant (B.1.671.2) has rapidly spread in India is emerging in the United States in mid-2021. It turns out to be the chief which is 6–8 fold more resistant to neutralization by sera from COVID-19 convalescent and mRNA vaccinated individuals.

Epidemiological approximation of the enteric manifestation and possible fecal-oral transmission in COVID-19: a preliminary systematic review

The recent appearance of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has led to the publication of the first evidence on gastrointestinal symptoms (GIS), the possible enteric involvement of the virus and the detection of RNA in stool, with its possible implication in the fecal-oral transmission of coronavirus disease 2019 (COVID-19). We aimed to conduct a systematic review to describe the epidemiological scientific evidence on GIS, enteric involvement and fecal excretion of SARS-CoV-2 viral RNA and to discuss the possible fecal-oral transmission pathway of COVID-19.

Severe Acute Respiratory Syndrome Coronavirus 2: The Role of the Main Components of the Innate Immune System

At the end of December 2019, the COVID-19 pandemic began in Wuhan of China. COVID-19 affects different people with a wide spectrum of clinical manifestations, ranging from asymptomatic with recovery without hospitalization up to a severe acute respiratory syndrome (SARS). The innate and adaptive immunity appears responsible for the defense against the virus and recovery from the disease. The innate immune system, as the first line of defense, is essential for the detection of virus and subsequent activation of acquired immunity. The innate immune response is carried out by sentinel cells such as monocytes/macrophages and dendritic cells and by receptors known as pattern recognition receptors (PRR). These receptors can recognize various components of the virus, which lead to intracellular signaling and subsequently the synthesis of various cytokines. These cytokines then recruit other immune cells, activate adaptive immune responses, and inhibit viral spreading. The most common receptors include Toll-like receptors, C-type lectin receptors, and RIG-I like receptors. This review describes the current knowledge about the interplay between innate immune responses and SARS-CoV-2 with a focus on the innate immune cells and the role of their receptors in viral RNA recognition, as well as their mechanisms for recognizing SARS-CoV-2.

In silico drug repositioning against human NRP1 to block SARS-CoV-2 host entry

Despite COVID-19 turned into a pandemic, no approved drug for the treatment or globally available vaccine is out yet. In such a global emergency, drug repurposing approach that bypasses a costly and long-time demanding drug discovery process is an effective way in search of finding drugs for the COVID-19 treatment. Recent studies showed that SARS-CoV-2 uses neuropilin-1 (NRP1) for host entry. Here we took advantage of structural information of the NRP1 in complex with C-terminal of spike (S) protein of SARS-CoV-2 to identify drugs that may inhibit NRP1 and S protein interaction. U.S. Food and Drug Administration (FDA) approved drugs were screened using docking simulations. Among top drugs, well-tolerated drugs were selected for further analysis. Molecular dynamics (MD) simulations of drugs-NRP1 complexes were run for 100 ns to assess the persistency of binding. MM/GBSA calculations from MD simulations showed that eltrombopag, glimepiride, sitagliptin, dutasteride, and ergotamine stably and strongly bind to NRP1. In silico Alanine scanning analysis revealed that Tyr²⁹⁷, Trp³⁰¹, and Tyr³⁵³ amino acids of NRP1 are critical for drug binding. Validating the effect of drugs analyzed in this paper by experimental studies and clinical trials will expedite the drug discovery process for COVID-19.

Spike protein multiorgan tropism suppressed by antibodies targeting SARS-CoV-2

While there is SARS-CoV-2 multiorgan tropism in severely infected COVID-19 patients, it's unclear if this occurs in healthy young individuals. In addition, for antibodies that target the spike protein (SP), it's unclear if these reduce SARS-CoV-2/SP multiorgan tropism equally. We used fluorescently labeled SP-NIRF to study viral behavior, using an in vivo dynamic imaging system and ex in vivo tissue analysis, in young mice. We found a SP body-wide biodistribution followed by a slow regional elimination, except for the liver, which showed an accumulation. SP uptake was highest for the lungs, and this was followed by kidney, heart and liver, but, unlike the choroid plexus, it was not detected in the brain parenchyma or CSF. Thus, the brain vascular barriers were effective in restricting the entry of SP into brain parenchyma in young healthy mice. While both anti-ACE2 and anti-SP antibodies suppressed SP biodistribution and organ uptake, anti-SP antibody was more effective. By extension, our data support the efficacy of these antibodies on SARS-CoV-2 multiorgan tropism, which could determine COVID-19 organ-specific outcomes.

Exposure to PM2.5 and PM10 and COVID-19 Infection Rates and Mortality: a one-year observational study in Poland

Background

Atmospheric contamination, especially particulate matter (PM), can be associated viral infections connected with respiratory failure. Literature data indicates that intensity of SARS-CoV-2 infections worldwide can be associated with PM pollution levels.

Objectives

The aim of the study was to examine the relationship between atmospheric contamination, measured as PM2.5 and PM10 levels, and the number of COVID-19 cases and related deaths in Poland in a one-year observation study.

Methods

Number and geographical distribution of COVID-19 incidents and related deaths, as well as PM2.5 and PM10 exposure levels in Poland were obtained from publicly accessible databases. Average monthly values of these parameters for individual provinces were calculated. Multiple regression analysis was performed for the period between March 2020 and February 2021, taking into account average monthly exposure to PM2.5 and PM10, monthly COVID-19 incidence and mortality rates per 100,000 inhabitants and the population density across Polish provinces.

Results

Only December 2020 the number of new infections was significantly related to the three analyzed factors: PM2.5, population density and the number of laboratory COVID-19 tests (R² = 0.882). For COVID-19 mortality, a model with all three significant factors: PM10, population density and number of tests was obtained as significant only in November 2020 (R² = 0.468).

Conclusion

The distribution of COVID-19 incidents across Poland was independent from annual levels of particulate matter concentration in provinces. Exposure to PM2.5 and PM10 was associated with COVID-19 incidence and mortality in different provinces only in certain months. Other cofactors such as population density and the number of performed COVID-19 tests also corresponded with both COVID-19-related infections and deaths only in certain months. Particulate matter should not be treated as the sole determinant of the spread and severity of the COVID-19 pandemic but its importance in the incidence of infectious diseases should not be forgotten.