COVID-19 pathophysiology: A review

Inhaled nitric oxide: can it serve as a savior for COVID-19 and related respiratory and cardiovascular diseases?

Nitric oxide (NO), as an important gaseous medium, plays a pivotal role in the human body, such as maintaining vascular homeostasis, regulating immune-inflammatory responses, inhibiting platelet aggregation, and inhibiting leukocyte adhesion. In recent years, the rapid prevalence of coronavirus disease 2019 (COVID-19) has greatly affected the daily lives and physical and mental health of people all over the world, and the therapeutic efficacy and resuscitation strategies for critically ill patients need to be further improved and perfected. Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator, and some studies have demonstrated its potential therapeutic use for COVID-19, severe respiratory distress syndrome, pulmonary infections, and pulmonary hypertension. In this article, we describe the biochemistry and basic characteristics of NO and discuss whether iNO can act as a "savior" for COVID-19 and related respiratory and cardiovascular disorders to exert a potent clinical protective effect.

Hypothalamic-Pituitary Adrenal Axis Status 3 Months After Recovery From COVID-19 Infection

CONTEXT

Coronavirus disease 2019 (COVID-19) predominantly involves the lungs, albeit many other organ systems, including the hypothalamic-pituitary-adrenal (HPA) axis, can be affected due to the expression of the angiotensin-converting enzyme 2 (ACE2) binding receptor. Few studies have reported the involvement of adrenal gland and the HPA axis during the acute phase of COVID-19; however, the data on the long-term effect of COVID-19 on the HPA axis after acute infection is scarce.

OBJECTIVE

To assess and compare the changes in HPA axis in mild, moderate and severe COVID-19 categories at ≥ 3 months after acute infection.

METHODS

A prospective, observational study was conducted to assess the HPA axis status among COVID-19 subjects at least 3 months after recovery from acute infection. The study was conducted from June 2021 to May 2022. Subjects visited the hospital in the fasting state (8.00-9.00am), serum cortisol levels were measured at baseline, 30 and 60 minutes after a 1-μg short Synacthen test (SST).

RESULTS

A total of 66 subjects ≥ 18 years of age were included in the study. The mean age (SD) was 49.13 ± 11.9 years, 45(68.18%) were male and 21 (31.81%) were female subjects. The mean BMI in the study was 25.91 ± 4.26 kg/m2. Seventeen (25.8%) subjects had mild, twelve (18.2%) had moderate and thirty-seven (56.1%) subjects had severe COVID-19 infection. Out of the sixty-six subjects with COVID-19, nine subjects (9/66, 13.63%) had peak serum cortisol < 496.62 nmol/L suggestive of adrenal insufficiency (AI). SST peak serum cortisol levels did not differ significantly across the disease severity [Mild, (628.50 ± 214.65 nmol/L) vs moderate, [603.39 ± 161.95 nmol/L) vs severe, (597.59 ± 163.05 nmol/L), P = 0.617]. Six subjects with AI came for follow-up at 12 months, and all had normal HPA axis.

CONCLUSION

HPA axis is affected in 13.63% (9/66) of subjects at least 3 months after recovery from COVID-19 infection. AI in COVID-19 might be transient and would recover spontaneously. These findings have important implications for the clinical care and long-term follow-up of subjects after COVID-19 infection.

Anti-inflammatory effect of 3-fluorophenyl pyrimidinylimidazo[2,1-b]thiazole derivatives as p38α inhibitors

In the present work, the anti-inflammatory effect of 30 compounds containing 3-fluorophenyl pyrimidinylimidazo[2,1-b]thiazole was investigated. All final target compounds showed significant Inhibitory effect on p38α. P38α is considered one of the key kinases in the inflammatory process due to its regulatory effect on pro-inflammatory mediators. The final target compounds divided into four group based on the type of terminal moiety (amide and sulfonamide) and the linker between pyrimidine ring and terminal moiety (ethyl and propyl). Most compounds with terminal sulfonamide moiety and propyl linker between the sulfonamide and pyrimidine ring were the most potent among all synthesized final target compounds with sub-micromolar IC50s. Compound 24g (with p-Cl benzene sulfonamide and propyl linker) exhibited the highest activity over P38α with IC50 0.68 µM. All final target compounds were tested for their ability to inhibit nitric oxide release and prostaglandin E2 production. Compounds having amide terminal moiety with ethyl linker showed higher inhibitory activity for nitric oxide release and compound 21d exhibited the highest activity for nitric oxide release with IC50 1.21 µM. Compounds with terminal sulfonamide moiety and propyl linker showed the highest activity for inhibiting PGE2 production and compounds 24i and 24g had the lowest IC50s with value 0.87 and 0.89 µM, respectively. Compounds 21d, 22d and 24g were tested for their ability to inhibit over expression of iNOS, COX1, and COX2. In addition the ability of compounds 21d, 22d and 24g to inhibit inflammatory cytokines were determined. Finally molecular docking of the three compounds were performed on P38α crystal structure to expect their mode of binding.

Efficacy of Licorice as Adjunctive Therapy in Critically Ill Patients with COVID-19: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Objective

There is no definitive pharmacological strategy for COVID-19; thus, medicinal herbs can be an appropriate option for COVID-19 management. We investigated the efficacy of a D-reglis® tablet (root extract of licorice) as adjuvant therapy in critically ill patients with COVID-19 at intensive care units (ICUs) of Alzahra Teaching Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.

Methods

In the present double-blind, randomized, placebo-controlled clinical trial, critically ill cases with COVID-19 (n = 52) received a D-reglis® tablet (760 mg) or a placebo tablet for 5 days. The ICU stay length was the primary outcome. The secondary outcome included the changes in oxygen saturation, duration of mechanical ventilation, mortality rate, and Sequential Organ Failure Assessment (SOFA) Score during the study period.

Findings

The ICU stay was significantly lower in the licorice group than in the placebo group (P = 0.015). No significant difference was detected between the groups regarding oxygen saturation, SOFA score, duration of mechanical ventilation, and mortality rate.

Conclusion

The licorice tablet (D-reglis®) as an adjuvant treatment showed promising results regarding the ICU stay length in critically ill COVID-19 patients. However, further clinical trials with larger sample sizes, further duration of intervention, measurement of inflammatory markers, and further study about the molecular mechanism of the effect of licorice on COVID-19 should be done to obtain more conclusive findings.

Complications of COVID-19 on the Central Nervous System: Mechanisms and Potential Treatment for Easing Long COVID

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invades human cells by binding to the angiotensin-converting-enzyme-2 (ACE-2) using a spike protein and leads to Coronavirus disease-2019 (COVID-19). COVID-19 primarily causes a respiratory infection that can lead to severe systemic inflammation. It is also common for some patients to develop significant neurological and psychiatric symptoms. The spread of SARS-CoV-2 to the CNS likely occurs through several pathways. Once spread in the CNS, many acute symptoms emerge, and such infections could also transpire into severe neurological complications, including encephalitis or ischemic stroke. After recovery from the acute infection, a significant percentage of patients develop "long COVID," a condition in which several symptoms of COVID-19 persist for prolonged periods. This review aims to discuss acute and chronic neurological problems after SARS-CoV-2 infection. The potential mechanisms by which SARS-CoV-2 enters the CNS and causes neuroinflammation, neuropathological changes observed in post-mortem brains of COVID-19 patients, and cognitive and mood problems in COVID-19 survivors are discussed in the initial part. The later part of the review deliberates the causes of long COVID, approaches for noninvasive tracking of neuroinflammation in long COVID patients, and the potential therapeutic strategies that could ease enduring CNS symptoms observed in long COVID.

Immune interaction between SARS-CoV-2 and Mycobacterium tuberculosis

SARS-CoV-2 and Mycobacterium tuberculosis (Mtb) are major infectious causes of death, with meta-analyses and population-based studies finding increased mortality in co-infected patients simultaneously diagnosed with COVID-19 and tuberculosis (TB). There is a need to understand the immune interaction between SARS-CoV-2 and Mtb which impacts poor outcomes for those co-infected. We performed a PubMed and preprint search using keywords [SARS-CoV-2] AND [tuberculosis] AND [Immune response], including publications after January 2020, excluding reviews or opinions. Abstracts were evaluated by authors for inclusion of data specifically investigating the innate and/or acquired immune responses to SARS-CoV-2 and Mtb in humans and animal models, immunopathological responses in co-infection and both trials and investigations of potential protection against SARS-CoV-2 by Bacille Calmette Guérin (BCG). Of the 248 articles identified, 39 were included. Incidence of co-infection is discussed, considering in areas with a high burden of TB, where reported co-infection is likely underestimated. We evaluated evidence of the clinical association between COVID-19 and TB, discuss differences and similarities in immune responses in humans and in murine studies, and the implications of co-infection. SARS-CoV-2 and Mtb have both been shown to modulate immune responses, particularly of monocytes, macrophages, neutrophils, and T cells. Co-infection may result in impaired immunity to SARS-CoV-2, with an exacerbated inflammatory response, while T cell responses to Mtb may be modulated by SARS-CoV-2. Furthermore, there has been no proven potential COVID-19 clinical benefit of BCG despite numerous large-scale clinical trials.

Short Survey on the Protein Modifications in Plasma during SARS-CoV-2 Infection

Although the COVID-19 pandemic has ended, it is important to understand the pathology of severe SARS-CoV-2 infection associated with respiratory failure and high mortality. The plasma proteome, including protein modification by lipid peroxidation products in COVID-19 survivors (COVID-19; n = 10) and deceased individuals (CovDeath; n = 10) was compared in samples collected upon admission to the hospital, when there was no difference in their status, with that of healthy individuals (Ctr; n = 10). The obtained results show that COVID-19 development strongly alters the expression of proteins involved in the regulation of exocytosis and platelet degranulation (top 20 altered proteins indicated by analysis of variance; p-value (False Discovery Rate) cutoff at 5%). These changes were most pronounced in the CovDeath group. In addition, the levels of 4-hydroxynonenal (4-HNE) adducts increased 2- and 3-fold, whereas malondialdehyde (MDA) adducts increased 7- and 2.5-fold, respectively, in COVID-19 and CovDeath groups. Kinases and proinflammatory proteins were particularly affected by these modifications. Protein adducts with 15-deoxy-12,14-prostaglandin J2 (15d-PGJ2) were increased 2.5-fold in COVID-19 patients, including modifications of proteins such as p53 and STAT3, whereas CovDeath showed a decrease of approximately 60% compared with Ctr. This study for the first time demonstrates the formation of lipid metabolism products-protein adducts in plasma from survived and deceased COVID-19 patients, significantly distinguishing them, which may be a predictor of the course of SARS-CoV-2 infection.

Unique SARS-CoV-2 Variants, Tourism Metrics, and B.1.2 Emergence in Early COVID-19 Pandemic: A Correlation Analysis in South Dakota

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, which is the source of the coronavirus disease 2019 (COVID-19), was declared a pandemic in the March of 2020. Travel and tourism were severely impacted as restrictions were imposed to help slow the disease spread, but some states took alternative approaches to travel restrictions. This study investigated the spread of COVID-19 in South Dakota during the early pandemic period to better understand how tourism affected the movement of the virus within the region. Sequences from the fall of 2020 were retrieved from public sources. CDC and other sources were used to determine infections, deaths, and tourism metrics during this time. The data were analyzed using correlation and logistic regression. This study found that the number of unique variants per month was positively correlated with hotel occupancy, but not with the number of cases or deaths. Interestingly, the emergence of the B.1.2 variant in South Dakota was positively correlated with increased case numbers and deaths. Data show that states with a shelter-in-place order were associated with a slower emergence of the B.1.2 variant compared to states without such an order, including South Dakota. Findings suggest complex relationships between tourism, SARS-CoV-2 infections, and mitigation strategies. The unique approach that South Dakota adopted provided insights into the spread of the disease in areas without state-wide restrictions. Our results suggest both positive and negative aspects of this approach. Finally, our data highlight the need for future surveillance efforts, including efforts focused on identifying variants with known increased transmission potential to produce effective population health management.

Asthma and COVID-19: a controversial relationship

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection induces a spectrum of clinical manifestations that depend on the immune response of the patient, i.e., from an asymptomatic form to an inflammatory response with multiorgan deterioration. In some cases, severe cases of SARS-CoV-2 are characterized by an excessive, persistent release of inflammatory mediators known as a cytokine storm. This phenomenon arises from an ineffective T helper (Th)-1 response, which is unable to control the infection and leads to a reinforcement of innate immunity, causing tissue damage. The evolution of the disease produced by SARS-CoV2, known as COVID-19, has been of interest in several research fields. Asthma patients have been reported to present highly variable outcomes due to the heterogeneity of the disease. For example, the Th2 response in patients with allergic asthma is capable of decreasing Th1 activation in COVID-19, preventing the onset of a cytokine storm; additionally, IL-33 released by damaged epithelium in the context of COVID-19 potentiates either Th1 or T2-high responses, a process that contributes to poor outcomes. IL-13, a T2-high inflammatory cytokine, decreases the expression of angiotensin converting enzyme-2 (ACE2) receptor, hindering SARS-CoV-2 entry; finally, poor outcomes have been observed in COVID-19 patients with severe neutrophilic asthma. In other contexts, the COVID-19 lockdown has had interesting effects on asthma epidemiology. The incidence of asthma in the most populated states in Mexico, including Tamaulipas, which has the highest asthma incidence in the country, showed similar tendencies independent of how strict the lockdown measures were in each state. As described worldwide for various diseases, a decrease in asthma cases was observed during the COVID-19 lockdown. This decrease was associated with a drop in acute respiratory infection cases. The drop in cases of various diseases, such as diabetes, hypertension or depression, observed in 2020 was restored in 2022, but not for asthma and acute respiratory infections. There were slight increases in asthma cases when in-person classes resumed. In conclusion, although many factors were involved in asthma outcomes during the pandemic, it seems that acute respiratory infection is intimately linked to asthma cases. Social distancing during remote learning, particularly school lockdown, appears to be an important cause of the decrease in cases.

Substances of abuse and their effect on SAR-CoV-2 pathogenesis

Following the emergence of SARS-CoV-2, various reports suggest that there has been a significant increase in substance abuse due to social distancing and related issues. Several reports have suggested the impact of chronic substance use on individuals' physiological and psychological health. Therefore, there is a need to know the impact of SARS-CoV-2 on persons with substance use disorders. Individuals with substance use disorders are the most vulnerable groups and are at a high risk of SARS-CoV-2 infection due to their already existing health issues associated with substance use. This review discusses some of the molecular and systemic/organic effects chronic substance use such as alcohol, nicotine, marijuana (cannabis), opioids, methamphetamine, and cocaine have on SARS-CoV-2 infectivity and its potential cause for worsened disease outcomes in persons with substance use disorder. This will provide healthcare providers, public health policies, and researchers with the needed knowledge to address some of the many challenges faced during the Covid-19 pandemic to facilitate treatment strategies for persons with substance use disorders.

Identification of behavioural changes in reporting adverse events early during COVID-19: An ambulatory care perspective in Israel

This study examined adverse event reporting centred on three significant dates in the months before the pandemic arrived in Israel. On these dates, broad media coverage exposed citizens and health care providers with indications about the forthcoming pandemic. The current study tracked whether parameters related to reporting adverse medical events provided early indications that a large crisis was unfolding. The method for analysing the data was based on a statistical test called Regression Discontinuity Design, which helped identify parameters related to medical reporting patterns which significantly changed. The examination indicated nurses' reports were unique in relation to others and indicated three phases: (1) upon declaration of the upcoming pandemic, there was a rise in reporting; (2) when the disease was named, there was moderation and maintenance in a steady quantity of reports, and finally, (3) when the first case arrived in Israel, a slight decrease in reporting began. Nurses' behaviours manifested as changes in reporting patterns. In this process of increase, moderation and decrease, it can be concluded that these are three stages that may characterise the beginning of a large event. The research method presented reinforces the need for forming tools by which significant events such as the COVID-19 pandemic can be identified quickly, and aid in proper planning of resources, optimise staffing and maximise utilization of the health systems.

Virus infection participates in the occurrence and development of human diseases through monoamine oxidase

Monoamine oxidase (MAO) is a membrane-bound mitochondrial enzyme that maintains the steady state of neurotransmitters and other biogenic amines in biological systems through catalytic oxidation and deamination. MAO dysfunction is closely related to human neurological and psychiatric diseases and cancers. However, little is known about the relationship between MAO and viral infections in humans. This review summarises current research on how viral infections participate in the occurrence and development of human diseases through MAO. The viruses discussed in this review include hepatitis C virus, dengue virus, severe acute respiratory syndrome coronavirus 2, human immunodeficiency virus, Japanese encephalitis virus, Epstein-Barr virus, and human papillomavirus. This review also describes the effects of MAO inhibitors such as phenelzine, clorgyline, selegiline, M-30, and isatin on viral infectious diseases. This information will not only help us to better understand the role of MAO in the pathogenesis of viruses but will also provide new insights into the treatment and diagnosis of these viral diseases.

Comparing the expression of MiR-223-NLRP3-IL-1β axis and serum IL-1β levels in patients with severe COVID-19 and healthy individuals

BACKGROUND AND AIM

The hyperactive nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a key factor for cytokine storm, chronic inflammation, and mortality in infected patients. On the subject of the regulation of the NLRP3-inflammasome activation, micro-ribonucleic acid (RNA)-223 (miR-223), among the major RNA molecules, has been thus far investigated in some inflammatory diseases along with interleukin-1 beta (IL-1β) and NLRP3. Against this background, the present study aimed to compare healthy individuals and patients with severe COVID-19 with reference to the alterations in the expression of the miR-223, NLRP3, and IL-1β axis and the serum IL-1β levels.

METHODS

In total, 40 patients with severe COVID-19, admitted to the Infectious Ward of Razi Hospital, Ahvaz, Iran, who were homogenous in terms of age (40 years old) and gender, were selected based on the inclusion and exclusion criteria. The real-time polymerase chain reaction (RT-PCR) technique was then applied to assess the expression of the miR-223, NLRP3, and IL-1β genes, and enzyme-linked immunosorbent assay (ELISA) was then utilized to evaluate the serum IL-1β levels, using patients' blood samples. Moreover, inflammatory biochemical markers of the participants were collected and recorded RESULTS: According to the study results, the IL-1β expression was 3.9 times higher in the patients with COVID-19, compared with the control group (p = 0.0005). The NLRP3 expression was also 6.04 times greater in the infected patients, compared with the healthy individuals (p < 0.0001). On the other hand, the miR-223 expression was 5.37 times lower in the case group, compared with the controls (p = 0.04).

CONCLUSION

The study findings indicated the potential role of miR-223 and the dysregulation of NLRP3 inflammasome followed by IL-1β, as a regulatory factor in the pathogenesis of COVID-19, like that in other inflammatory diseases.

COVID-19 screening: use of an artificial neural network

OBJECTIVES

COVID-19 is the biggest pandemic of the 21st century. The disease can be influenced by various sociodemographic factors and can manifest as clinical, pulmonary and gastrointestinal symptoms. This study used an artificial neural network (ANN) model with important sociodemographic factors as well as clinical, pulmonary and gastrointestinal symptoms to screen patients for COVID-19. Patients themselves can screen for these symptoms at home.

METHODS

Data on all registered patients were extracted in autumn. The best ANN model was selected from different combinations of connections, some hidden layers and some neurons in each hidden layer. In this study, 70% of the data were used in the network training process and the remaining 30% were used to evaluate the function of the multilayer, feed-forward, back-propagation algorithm.

RESULTS

The sensitivity and specificity of the ANN model in diagnosing patients with COVID-19 were 94.5% and 17.4%. In order of priority, clinical symptoms, sociodemographic factors, pulmonary symptoms and gastrointestinal symptoms were important predictive factors for COVID-19 using the ANN model. Screening patients for COVID-19 using clinical symptoms and sociodemographic factors (80% importance) remains essential.

CONCLUSIONS

Home monitoring of oxygen saturation and body temperature as well as old age and drug addiction can be helpful in self-screening symptoms of COVID-19 at home, thereby preventing unnecessary visits to medical centres and reducing burden on medical services.

Post-COVID-19 Illness Trend in a Local Community in Bangladesh

BACKGROUND

An infection with coronavirus disease 2019 (COVID-19) might show a wide range of symptoms. Many individuals still experience symptoms after a prolonged period of initial COVID-19.

OBJECTIVES

The objective is to find out the prolonged consequences of COVID-19 with their associations.

MATERIALS AND METHOD

Two hundred and eighty-six COVID-19 cases were the subject of this cross-sectional investigation, which was carried out in basic and secondary healthcare facilities in Bangladesh. COVID-19-positive participants with consent were interviewed in person about their sociodemographic traits, the nature of their COVID-19 infection, risk factors, present manifestations, etc. We carried out our statistical exploration by use of IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). To evaluate differences, we utilized the chi-square (χ2) test as well as the unpaired t-test. Our significance threshold level was 0.05.

RESULT

In this study, 18.5% of participants reported having post-COVID-19 symptoms. The four main symptom categories were anorexia (26.4%), myalgia (34.8%), fatigue (41.5%), and palpitations (25.5%). The majority of post-COVID-19 syndrome patients (e.g., 40.0%) were over 50 years old. Severe disease (81.8%) was more likely to develop post-COVID-19 illness.

CONCLUSION

Fifty-three out of 286 participants (or 18.5%) reported having post-COVID-19 symptoms. The main symptom categories included fatigue, myalgia, anorexia, and palpitations. In order to determine the risk variables our data supports, additional investigation is required.

The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation

Introduction

Severe COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-related ARDS but is influenced by a high risk of failure in more severe patients. Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that provides sedative effects with preservation of respiratory function. The aim of this study is to assess how dexmedetomidine influences gas exchange during non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) in moderate to severe ARDS caused by COVID-19 in a non-intensive care setting.

Methods

This is a single center retrospective cohort study. We included patients who showed moderate to severe respiratory distress. All included subjects had indication to NIV and were suitable for a non-intensive setting of care. A total of 170 patients were included, divided in a control group (n = 71) and a treatment group (DEX group, n = 99).

Results

A total of 170 patients were hospitalized for moderate to severe ARDS and COVID-19. The median age was 71 years, 29% females. The median Charlson comorbidity index (CCI) was 2.5. Obesity affected 21% of the study population. The median pO2/FiO2 was 82 mmHg before treatment. After treatment, the increase of pO2/FiO2 ratio was clinically and statistically significant in the DEX group compared to the controls (125 mmHg [97-152] versus 94 mmHg [75-122]; ***p < 0.0001). A significative reduction of NIV duration was observed in DEX group (10 [7-16] days vs. 13 [10-17] days; *p < 0.02). Twenty four patients required IMV in control group (n = 71) and 16 patients in DEX group (n = 99) with a reduction of endotracheal intubation of 62% (OR 0.38; **p < 0.008). A higher incidence of sinus bradycardia was observed in the DEX group.

Conclusion

Dexmedetomidine provides a "calm and arousal" status which allows spontaneous ventilation in awake patients treated with NIV and HFNC. The adjunctive therapy with dexmedetomidine is associated with a higher pO2/FiO2, lower duration of NIV, and a lower risk of NIV failure. A higher incidence of sinus bradycardia needs to be considered.

The Use of Quantitative Electroencephalography (QEEG) to Assess Post-COVID-19 Concentration Disorders in Professional Pilots: An Initial Concept

Announced by WHO in 2020, the global COVID-19 pandemic caused by SARS-CoV-2 has affected many people, leading to serious health consequences. These consequences are observed in the daily lives of infected patients as various dysfunctions and limitations. More and more people are suffering post-COVID-19 complications that interfere with or completely prevent them from working or even functioning independently on a daily basis. The aim of our study was to demonstrate that innovative quantitative electroencephalography (QEEG) can be used to assess cognitive function disorders reported after the COVID-19 pandemic. It is worth noting that no similar study has been conducted to date in a group of pilots. The QEEG method we used is currently one of the basic neurological examinations, enabling easy observation of post-COVID-19 changes in the nervous system. With the innovativeness of this technique, our study shows that the use of quantitative electroencephalography can be a precursor in identifying complications associated with cognitive function disorders after COVID-19. Our study was conducted on twelve 26-year-old pilots. All participants had attended the same flight academy and had contracted SARS-CoV-2 infection. The pilots began to suspect COVID-19 infection when they developed typical symptoms such as loss of smell and taste, respiratory problems, and rapid fatigue. Quantitative electroencephalography (QEEG), which is one of the most innovative forms of diagnostics, was used to diagnose the patients. Comparison of the results between the study and control groups showed significantly higher values of all measurements of alpha, theta, and beta2 waves in the study group. In the case of the sensorimotor rhythm (SMR), the measurement results were significantly higher in the control group compared to the study group. Our study, conducted on pilots who had recovered from COVID-19, showed changes in the amplitudes of brain waves associated with relaxation and concentration. The results confirmed the issues reported by pilots as evidenced by the increased amplitudes of alfa, theta, and beta2 waves. It should be emphasized that the modern diagnostic method (QEEG) presented here has significant importance in the medical diagnosis of various symptoms and observation of treatment effects in individuals who have contracted the SARS-CoV-2 virus. The present study demonstrated an innovative approach to the diagnosis of neurological complications after COVID-19.

The Effects of Hospitalisation on the Serum Metabolome in COVID-19 Patients

COVID-19, a systemic multi-organ disease resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is known to result in a wide array of disease outcomes, ranging from asymptomatic to fatal. Despite persistent progress, there is a continued need for more accurate determinants of disease outcomes, including post-acute symptoms after COVID-19. In this study, we characterised the serum metabolomic changes due to hospitalisation and COVID-19 disease progression by mapping the serum metabolomic trajectories of 71 newly hospitalised moderate and severe patients in their first week after hospitalisation. These 71 patients were spread out over three hospitals in Switzerland, enabling us to meta-analyse the metabolomic trajectories and filter consistently changing metabolites. Additionally, we investigated differential metabolite-metabolite trajectories between fatal, severe, and moderate disease outcomes to find prognostic markers of disease severity. We found drastic changes in serum metabolite concentrations for 448 out of the 901 metabolites. These results included markers of hospitalisation, such as environmental exposures, dietary changes, and altered drug administration, but also possible markers of physiological functioning, including carboxyethyl-GABA and fibrinopeptides, which might be prognostic for worsening lung injury. Possible markers of disease progression included altered urea cycle metabolites and metabolites of the tricarboxylic acid (TCA) cycle, indicating a SARS-CoV-2-induced reprogramming of the host metabolism. Glycerophosphorylcholine was identified as a potential marker of disease severity. Taken together, this study describes the metabolome-wide changes due to hospitalisation and COVID-19 disease progression. Moreover, we propose a wide range of novel potential biomarkers for monitoring COVID-19 disease course, both dependent and independent of the severity.

Honey as a Natural Nutraceutical: Its Combinational Therapeutic Strategies Applicable to Blood Infections-Septicemia, HIV, SARS-CoV-2, Malaria

Honey is a natural substance that has existed alongside humanity since the time of antiquity, acting then as a source of nutrition, as well as a source of medicinal aid for people. Ancient civilizations from multiple nations of the world, from ancient China to ancient Greece and Egypt, utilized the supposed healing properties of honey to treat lacerations and wounds, as well as for internal pathologies such as intestinal disease. At present, honey has entered the modern scientific research program in search of novel antibiotics. In recent research, honey has demonstrated its potential use for static and/or cidal effects on microbial strains which are becoming resistant to chemical antibiotics. Additionally, the use of honey as an agent of treatment for more severe infections, namely blood infections pertaining to septicemia, HIV, and SARS-CoV-2, as well as parasitic infections such as malaria, have also been investigated in recent years. In this article, the literature has been reviewed on some of the therapeutic properties of natural nutraceutical honey, where it has been observed to act as a potential ameliorating agent; reducing the severity of such conditions that may amplify a disease, as well as reducing the progression of the disease and its symptoms.

The utility of syndecan-1 circulating levels as a biomarker in patients with previous or active COVID-19: a systematic review and meta-analysis

BACKGROUND

With the emergence of coronavirus disease of 2019 (COVID-19), several blood biomarkers have been identified, including the endothelial biomarker syndecan-1, a surface proteoglycan. In the current systematic review and meta-analysis, we aimed to assess the diagnostic and prognostic role of syndecan-1 in COVID-19.

METHODS

PubMed, Embase, Scopus, and Web of Science, as international databases, were searched for relevant studies measuring blood syndecan-1 levels in COVID-19 patients, COVID-19 convalescents, and healthy control subjects, in patients with different COVID-19 severities and/or in COVID-19 patients with poor outcomes. Random-effect meta-analysis was performed using STATA to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for the comparison between COVID-19 patients and healthy control subjects or COVID-19 convalescents and controls.

RESULTS

After screening by title/abstract and full text, 17 studies were included in the final review. Meta-analysis of syndecan-1 levels in COVID-19 compared with healthy control subjects revealed that patients with COVID-19 had significantly higher syndecan-1 levels (SMD 1.53, 95% CI 0.66 to 2.41, P < 0.01). In contrast, COVID-19 convalescent patients did not show significant difference with non-convalescents (SMD 0.08, 95% CI -0.63 to 0.78, P = 0.83). Regarding disease severity, two studies reported that more severe forms of the disease were associated with increased syndecan-1 levels. Moreover, patients who died from COVID-19 had higher syndecan-1 levels compared with survivors (SMD 1.22, 95% CI 0.10 to 2.33, P = 0.03).

CONCLUSION

Circulating syndecan-1 level can be used as a biomarker of endothelial dysfunction in COVID-19, as it was increased in COVID-19 patients and was higher in more severe instances of the disease. Further larger studies are needed to confirm these findings and further enlighten the role of syndecan-1 in clinical settings.

Evaluation of the treatment options for COVID-19 patients using generalized hesitant fuzzy- multi criteria decision making techniques

The breakout of the pandemic COVID-19 has affected numerous countries and territories worldwide. As COVID-19 specific medicines yet to be invented, at present the treatment is case specific, hence identification and evaluation of different prevalent treatment options based on various criteria and attributes are very important not only from the point of view of present pandemic but also for futuristic pandemic preparedness. The present study focuses on identifying, evaluation and ranking of treatment options using Multi Criteria Decision Making (MCDM). In this regard, the existing literature, doctors and scientist were interviewed to know the current treatment options in vogue and the scale of their importance with respect to the criteria. The criteria taken are side effect, regime cost, treatment duration, plasma stability, plasma turnover, time of suppression, ease of application, drug-drug interaction, compliance, fever, pneumonia, intensive care, organ failure, macrophage activation syndrome, hemophagocytic syndrome, pregnancy, kidney problem, age. This study extended Hesitant Fuzzy Set (HFS) to Generalized Hesitant Fuzzy Sets (GHFS). Generalized Hesitant Pentagonal Fuzzy Number (GHPFN) is developed. The properties of GHPFN are demonstrated. Two types of GHPFN has been described. The GHPFN (2nd type) along with MCDM tool Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) has been applied to rank the treatment options. The result of the study ranked 'Hydroxychloroquine' as the first alternative followed by, 'Plasma Exchange', 'Tocilizumab', 'Remdesivir' and 'Favipravir'. To check the robustness and steadiness of the proposed methodology, comparative analysis and sensitivity analysis has been conducted.

Postoperative pulmonary complications in severe acute respiratory syndrome coronavirus 2 infected patients who underwent emergency surgery

BACKGROUND

Recent studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the incidence of postoperative pulmonary complications (PPCs) and mortality. Consequently, patients with SARS-CoV-2 infection undergoing emergency surgery are more vulnerable to PPCs, yet few studies have evaluated PPCs in these patients.

METHODS

A retrospective analysis was conducted between January 2022 and February 2023 on the medical records of patients infected with SARS-CoV-2 who underwent emergency surgery. The study evaluated the incidence of PPCs and 30-day postoperative mortality in all enrolled patients.

RESULTS

A total of 41 patients were enrolled, among whom PPCs occurred in seven patients (17%). The incidence of PPCs was statistically significant in patients with underlying diabetes compared to those without (p = 0.01) and in patients with an American Society of Anesthesiologists (ASA) class 3 or higher compared to those with less than 3 (p = 0.005) (ASA classification uses a grading system of I (one) through V (five)). The 30-day mortality rate was 4.9%.

CONCLUSIONS

Our study demonstrates that the incidence of PPCs and 30-day mortality rates after emergency surgery in patients infected with SARS-CoV-2 are higher compared to prepandemic baseline rates. Given the significant interest and concern worldwide regarding severe infectious respiratory diseases, such as coronavirus disease 2019 (COVID-19), clinicians should focus on conducting research to identify ways to reduce the incidence of PPCs and mortality in patients with severe acute respiratory infections.

Electrochemical aptasensors for pathogenic detection toward point-of-care diagnostics

A biosensor system refers to a biomedical device, which detects biological, chemical, or biochemical components by converting those signals to an electrical signal by utilizing and uniting physical or chemical transducer with biorecognition elements. An electrochemical biosensor is generally based on the reaction of either production or consumption of electrons under a three-electrode system. Biosensor systems are exploited in a wide range of areas, such as medicine, agriculture, husbandry, food, industry, environment protection, quality control, waste disposal, and the military. Pathogenic infections are the third leading cause of death worldwide after cardiovascular diseases and cancer. Therefore, there is an urgent need for effective diagnostic tools to control food, water, and soil contamination result in protecting human life and health. Aptamers are peptide or oligonucleotide-based molecules that show very high affinity to their targets that are produced from large pools of random amino acid or oligonucleotide sequences. Generally, aptamers have been utilized for fundamental sciences and clinical implementations for their target-specific affinity and have been intensely exploited for different kinds of biosensor applications for approximately 30 years. The convergence of aptamers with biosensor systems enabled the construction of voltammetric, amperometric, and impedimetric biosensors for the detection of specific pathogens. In this review, electrochemical aptamer biosensors were evaluated by discussing the definition, types, and production techniques of aptamers, the advantages of aptamers as a biological recognition element against their alternatives, and a wide range of aptasensor examples from literature in the detection of specific pathogens.

Covid-19, HLA, and race common link: A novel hypothesis

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) accountable for the coronavirus disease 2019 (Covid-19) prompted a catastrophic pandemic striking millions of people with diverse presentations, from asymptomatic to severe, potentially lethal disease requiring unprecedented levels of specialized care and extraordinary resources that have overwhelmed healthcare systems around the world. In this detailed communication we postulating a novel hypothesis, based on the viral replication and transplantation immunology. This based on reviewing published journal articles and text book chapters to account for variable mortality and degrees of morbidity among various race and origins. Homo sapiens evolution over millions of years, for that the matter the origin of any biologic form of life form initiated by microorganisms. The entire body of a human has several millions of bacterial and viral genomes incorporated over millions of years. Perhaps the answer or a clue lies how compatible a foreign genomic sequence fits into three billion copies of human genome.

Aptamer-Based Strategies to Address Challenges in COVID-19 Diagnosis and Treatments

Coronavirus disease (COVID-19), a highly contagious and rapidly spreading disease with significant fatality in the elderly population, has swept across the world since 2019. Since its first appearance, the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has undergone multiple mutations, with Omicron as the predominant circulating variant of concern at the moment. The gold standard for diagnosis of COVID-19 by real-time polymerase chain reaction (RT-PCR) to detect the virus is laborious and requires well-trained personnel to perform sophisticated procedures. Also, the genetic variants of SARS-CoV-2 that arise regularly could result in false-negative detection. Meanwhile, the current COVID-19 treatments such as conventional medicine, complementary and alternative medicine, passive antibody therapy, and respiratory therapy are associated with adverse effects. Thus, there is an urgent need to discover novel diagnostic and therapeutic approaches against SARS-CoV-2 and its variants. Over the past 30 years, nucleic acid-based aptamers have gained increasing attention and serve as a promising alternative to the antibodies in the diagnostic and therapeutic fields with their uniqueness of being small, nonimmunogenicity, and thermally stable. Aptamer targeting the SARS-CoV-2 structural proteins or the host receptor proteins represent a powerful tool to control COVID-19 infection. In this review, challenges faced by currently available diagnostic and therapeutic tools for COVID-19 are underscored, along with how aptamers can shed a light on the current COVID-19 pandemic, focusing on the critical factors affecting the discovery of high-affinity aptamers and their potential applications to control COVID-19 infection.

Physician's hesitancy in treating COVID-19 patients and its associated occupational risk factors in Indonesia: an online cross-sectional survey

This cross-sectional survey aims to investigate physician hesitancy in treating COVID-19 patients in Indonesia, particularly among those who have already contracted the disease, along with associated occupational risk factors. The study involved distributing a questionnaire to physicians across the country, using contact information from the Indonesian Physician Association database. The results show that out of the 383 participants, 25.6% experienced moderate symptoms of COVID-19, and 2.9% required critical care. The study found that 20.3% of physicians demonstrated hesitancy to treat suspected, probable, or confirmed COVID-19 patients. Interestingly, older physicians and those with less experience in treating COVID-19 patients were found to have a higher hesitancy rate, while specialist trainees and those working in public hospitals demonstrated the lowest hesitancy. These findings highlight the significant hesitancy among physicians who have suffered from COVID-19 and underline the need for management and policymakers to take further action to address this issue. Understanding the effects and benefits of physician hesitancy in treating COVID-19 patients is crucial for ensuring the effective delivery of healthcare services during pandemics like COVID-19.

The Efficacy of Herbs as Complementary and Alternative Therapy in Recovery and Clinical Outcome Among People with COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression

Background

The COVID-19 pandemic continues, and this condition has caused many cases in various countries around the world, resulting in more than 6 million deaths worldwide. Herbal medicines can act as immunomodulators, anti-inflammatories, antioxidants, antimicrobials, and others depending on the type and content of the herbs used. Previous studies have shown that several types of herbs, such as Echinacea purpurea, Curcumin or Turmeric, Nigella sativa, and Zingiber officinale, have proven their effectiveness as herbal plants for COVID-19.

Methods

We conducted a comprehensive literature search through five databases, namely, PubMed, Scopus, Embase, Wiley, and ProQuest to assess the efficacy of phytopharmaceuticals until July 12, 2022. We used the Cochrane RoB 2.0 for the quality assessment of the study.

Results

Phytopharmaceuticals significantly improved patients' recovery rate (OR = 3.54; p < 0.00001) and reduced deaths (OR = 0.24; p < 0.0001) compared to the control group. Phytopharmaceuticals also performed as a protective factor for COVID-19 clinical symptoms, such as dyspnea (OR = 0.42; p < 0.05) and myalgia (OR = 0.31; p = 0.02) compared to the control group. However, there is no statistically significant effect on cough (OR = 0.76; p = 0.61) and fever (OR = 0.60; p < 0.20). The results were not affected by patients' covariates [hypertension, diabetes mellitus, and cardiovascular diseases (meta-regression p > 0.05)].

Conclusion

Herbal medicine has the potential as an adjuvant therapy in the management of COVID-19.

Acute pancreatitis and COVID-19: an integrative review of the literature

The first cases of the COVID-19 disease were identified in late 2019 in China, but it didnt take long for it to become pandemic. At first, it was believed that it was restricted to respiratory symptoms only, until extrapulmonary manifestations were reported worldwide. Acute pancreatitis concomitant with the diagnosis of SARS-CoV-2 infection has been observed in some patients, in the absence of the most common etiologies described in the literature. It is postulated that the presence of the ECA-2 viral receptor in the pancreas is responsible for the direct cellular damage and that the hyperinflammatory state of COVID-19 favors the development of pancreatitis through an immune-mediated mechanism. This study aimed to analyze the correlation between acute pancreatitis and COVID-19 disease as a probable causality factor. An integrative literature review was carried out, including studies published between January 2020 and December 2022 that brought data on patients diagnosed with acute pancreatitis according to the revised Atlanta Classification with a confirmed diagnosis of COVID-19 in the same period. A total of thirty studies were reviewed. Demographic, clinical, laboratory and imaging aspects were analyzed and discussed. It is believed that SARS-CoV-2 was responsible for the development of acute pancreatitis in these patients, due to the absence of other precipitating risk factors, as well as the close temporal relationship between both. Attention should be given to gastrointestinal manifestations in patients affected by COVID-19.

Association of COVID-19 with short- and long-term risk of cardiovascular disease and mortality: a prospective cohort in UK Biobank

AIMS

This study aims to evaluate the short- and long-term associations between COVID-19 and development of cardiovascular disease (CVD) outcomes and mortality in the general population.

METHODS AND RESULTS

A prospective cohort of patients with COVID-19 infection between 16 March 2020 and 30 November 2020 was identified from UK Biobank, and followed for up to 18 months, until 31 August 2021. Based on age (within 5 years) and sex, each case was randomly matched with up to 10 participants without COVID-19 infection from two cohorts-a contemporary cohort between 16 March 2020 and 30 November 2020 and a historical cohort between 16 March 2018 and 30 November 2018. The characteristics between groups were further adjusted with propensity score-based marginal mean weighting through stratification. To determine the association of COVID-19 with CVD and mortality within 21 days of diagnosis (acute phase) and after this period (post-acute phase), Cox regression was employed. In the acute phase, patients with COVID-19 (n = 7584) were associated with a significantly higher short-term risk of CVD {hazard ratio (HR): 4.3 [95% confidence interval (CI): 2.6- 6.9]; HR: 5.0 (95% CI: 3.0-8.1)} and all-cause mortality [HR: 81.1 (95% CI: 58.5-112.4); HR: 67.5 (95% CI: 49.9-91.1)] than the contemporary (n = 75 790) and historical controls (n = 75 774), respectively. Regarding the post-acute phase, patients with COVID-19 (n = 7139) persisted with a significantly higher risk of CVD in the long-term [HR: 1.4 (95% CI: 1.2-1.8); HR: 1.3 (95% CI: 1.1- 1.6)] and all-cause mortality [HR: 5.0 (95% CI: 4.3-5.8); HR: 4.5 (95% CI: 3.9-5.2) compared to the contemporary (n = 71 296) and historical controls (n = 71 314), respectively.

CONCLUSIONS

COVID-19 infection, including long-COVID, is associated with increased short- and long-term risks of CVD and mortality. Ongoing monitoring of signs and symptoms of developing these cardiovascular complications post diagnosis and up till at least a year post recovery may benefit infected patients, especially those with severe disease.

Comprehensive analysis of clinical data for COVID-19 outcome estimation with machine learning models

COVID-19 is a global threat for the healthcare systems due to the rapid spread of the pathogen that causes it. In such situation, the clinicians must take important decisions, in an environment where medical resources can be insufficient. In this task, the computer-aided diagnosis systems can be very useful not only in the task of supporting the clinical decisions but also to perform relevant analyses, allowing them to understand better the disease and the factors that can identify the high risk patients. For those purposes, in this work, we use several machine learning algorithms to estimate the outcome of COVID-19 patients given their clinical information. Particularly, we perform 2 different studies: the first one estimates whether the patient is at low or at high risk of death whereas the second estimates if the patient needs hospitalization or not. The results of the analyses of this work show the most relevant features for each studied scenario, as well as the classification performance of the considered machine learning models. In particular, the XGBoost algorithm is able to estimate the need for hospitalization of a patient with an AUC-ROC of 0 . 8415 ± 0 . 0217 while it can also estimate the risk of death with an AUC-ROC of 0 . 7992 ± 0 . 0104 . Results have demonstrated the great potential of the proposal to determine those patients that need a greater amount of medical resources for being at a higher risk. This provides the healthcare services with a tool to better manage their resources.

The role of CT-scan in the diagnosis and prognosis of COVID-19 in a sample of Iraqi patients referred to Al-Diwaniyah Teaching Hospital, Iraq

The respiratory system is the primary target of the SARS-CoV-2 virus, leading to clinical manifestations such as dry cough, fever, and shortness of breath. Other reported manifestations include generalized weakness, dizziness, headache, vomiting, and diarrhea. A chest CT scan is one of the best imaging tools to screen and diagnose COVID-19. This prospective observational study was conducted at Al-Diwaniyah Teaching Hospital in the mid-Euphrates region of Iraq to assess the prognostic role of chest CT examinations in COVID-19 patients between February 2020 and July the 15th, 2020. The study included 100 patients suspected of COVID-19 based on clinical features and microbiological investigations, comprising 72 males and 28 females aged between 30 and 55. All patients were SARS-CoV-2 PCR positive and had no history of chronic lung disease. We categorized patients into two groups based on changes in density and lesion area: patients with changes (n=55) and patients without changes (n=45). Furthermore, we divided all patients into three groups according to treatment requirements and symptom severity: group 1 included patients with severe symptoms who required CPAP and admission to the Respiratory Care Unit, group 2 consisted of patients with moderate symptoms who needed oxygen therapy and hospital admission, and group 3 comprised patients with mild symptoms who were treated as outpatients with medication. Upon correlating the change in density and lesion area with these groups, we observed that most patients with no changes were in group 1, while patients with changes were predominantly seen in group 2. Additionally, the ratio of lesion area in the mediastinal CT window to lung CT was identified as a potential prognostic factor for COVID-19 patients.

Myocarditis related SARS-CoV-2 infection or vaccination: an expert consensus statement on its diagnosis and management

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revealed several cardiovascular complications, including myocarditis caused by SARS-CoV-2 infection (COVID-19) or after messenger RNA vaccine administration. Because of the high prevalence of COVID-19, the expansion of vaccination programs, and the appearance of new information on myocarditis in these contexts, there is a need to condense the knowledge acquired since the start of the pandemic. To meet this need, this document was drafted by the Myocarditis Working Group of the Heart Failure Association of the Spanish Society of Cardiology, with the collaboration of the Spanish Agency for Medicines and Health Products (AEMPS). The document aims to address the diagnosis and treatment of cases of myocarditis associated with SARS-CoV-2 infection or messenger RNA vaccine administration.

Clinical and radiographic assessment of periodontal status among patients with post-COVID mucormycosis: A cross-sectional study

Background

An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals.

Materials and Methods

This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done.

Results

An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%-40% of patients had Miller's Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss.

Conclusion

The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.

Assessment of Anxiety among People with Various Physical Activity Levels during Lockdown in Karachi, Pakistan

Background  The purpose of this study is to make it easier to counsel the general public on how to promote their psychological health and better lifestyle by boosting their physical activity in the event of more devastating future waves of coronavirus disease 2019. Coronavirus disease is a viral infection first reported in Wuhan, China, which led to a worldwide pandemic and lockdown. In addition to physical health, the uncertainty of situation and fear of infection have further affected the mental health of the individuals. Lockdown has also halted the physical activity of people further adding into the stress and anxiety. Methods  A sample size of 376 was required, but a convenient sampling technique collected 400 responses due to overwhelming Participation. A well-structured questionnaire was used for data collection, which contained sections such as a demographics section. We used the International Physical Activity Questionnaire scale to measure various physical activity levels and the generalized anxiety disorder scale to measure anxiety levels, because of their considerate validity and feasibility. Later both of our variables were compared to find out the correlation of anxiety levels with different physical activity levels. Results  Mean Anxiety and its prevalence rates in the sample were 7.32 ± 5.767 and 33%. On performing Pearson correlation, increasing age was found to be a risk factor for Anxiety. One-way analysis of variance showed a significant difference between Physical Activity and Anxiety. In the post-hoc Tukey test, a considerable difference in anxiety level was found between people with no physical activity and vigorous physical activity. Conclusion  During the lockdown period, the mean anxiety was found to be 7.0 ± 5.56 with prevalence rate of 33% among the people with no, low, moderate or vigorous physically active levels was found to be associated with better perceived mental health status which suggests the need to promote physically active style to cope with anxiety and awareness sessions to be conducted especially among those who could not maintain a physically active lifestyle. Also, among the general population e-Health programs could provide an appropriate way to promote a physically active lifestyle.

A typology of healthcare pathways after hospital discharge for adults with COVID-19: the evolution of UK services during pandemic conditions

Introduction

Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways.

Methods

In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study. The online survey explored the availability of proactive follow-up, patient selection, involvement of multidisciplinary teams, investigations, assessment and access to mental health and rehabilitation interventions. The typology was defined by a three-stage process: 1) using the survey results to develop a bespoke algorithm to inform a draft classification, 2) a stakeholder event for refinement and 3) finalisation between the Project Advisory Group and research team. The bespoke algorithm was used to map each site onto the classification with further mapping by level of mental health and rehabilitation provision.

Results

70% of hospital sites (45 out of 64) responded to the survey. 82% (37 out of 45) reported delivering a follow-up service after hospital discharge during the first few months of the pandemic. Only 13 out of 37 services (35%) were delivered by permanent staff. The final typology of five categories included no proactive follow-up, and a matrix of four groups based on patient selection (prespecified subgroup/all patients) and complexity of assessment (low/high). The complexity of assessment, rehabilitation and mental health interventions was variable within sites.

Discussion

We describe the first typology of post-hospitalisation COVID-19 healthcare pathways to enable modelling of clinical effectiveness and cost-effectiveness to inform future policy. Our results highlight the heterogeneity and vulnerability of healthcare services after COVID-19 hospitalisation.

[Myocarditis related SARS-CoV-2 infection or vaccination: an expert consensus statement on its diagnosis and management]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revealed several cardiovascular complications, including myocarditis caused by SARS-CoV-2 infection (COVID-19) or after messenger RNA vaccine administration. Because of the high prevalence of COVID-19, the expansion of vaccination programs, and the appearance of new information on myocarditis in these contexts, there is a need to condense the knowledge acquired since the start of the pandemic. To meet this need, this document was drafted by the Myocarditis Working Group of the Heart Failure Association of the Spanish Society of Cardiology, with the collaboration of the Spanish Agency for Medicines and Health Products (AEMPS). The document aims to address the diagnosis and treatment of cases of myocarditis associated with SARS-CoV-2 infection or messenger RNA vaccine administration.

Evaluation of Maternal and Fetal Outcomes in Pregnant Women with COVID-19 based on Different Trimesters

Background

COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters.

Materials and Methods

This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection.

Results

The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester (P = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women (P = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester (P = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%).

Conclusion

We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.

The response of CD59 NK cell and IL-6 level in Cynomolgus macaque immunized with inactivated SARS-CoV-2 vaccine candidate

Vaccination is deemed the best approach against the COVID-19 pandemic. In regard of safety and protectivity, the whole inactivated vaccine platform is advantageous and widely used. Whole inactivated vaccine provides broader protection against various antigenic components of SARS-CoV-2. This study aims to analyze the immune response of cynomolgus macaques (Macaca fascicularis) following inactivated SARS-CoV-2 vaccine administration. The analysis utilized the flow cytometry and enzyme-linked immunosorbent assay to evaluate CD59 NK cell expression and serum IL-6 level. This research used 6 macaques which were divided into 2 groups: Adult and Adolescence. Each group was consisted of 3 macaques. The macaques received two doses of 3 µg of inactivated SARS-CoV-2 vaccine with 21 days interval between first and second dose. CD59 and IL-6 level were measured before the first vaccination (D0), 21 days post-vaccination but before second dose (D21), and 14 days after the second dose (D35). The result showed significant escalation (p ≤ 0.05) of CD59 NK cell expression between D0, D21, and D35 in both adult and adolescence macaques. Higher expression of CD59 NK cell was found in adult macaques compared to adolescence macaques. Meanwhile, the level of IL-6 remained constant (p > 0.05) throughout D0, D21, and D35 in both groups. In conclusion, the inactivated SARS-CoV-2 vaccine candidate can increase CD59 NK cell expression significantly, while IL-6 level was mildly elevated although the differences were insignificant.

Network pharmacology and bioinformatics analysis identifies potential therapeutic targets of Naringenin against COVID-19/LUSC

Background

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease that has posed a serious threat to people's daily lives and caused an unprecedented challenge to public health and people's health worldwide. Lung squamous cell carcinoma (LUSC) is a common type of lung malignancy with a highly aggressive nature and poor prognosis. Patients with LUSC could be at risk for COVID-19, We conducted this study to examine the potential for naringenin to develop into an ideal medicine and investigate the underlying action mechanisms of naringenin in COVID-19 and LUSC due to the anti-viral, anti-tumor, and anti-inflammatory activities of naringenin.

Methods

LUSC related genes were obtained from TCGA, PharmGKB, TTD,GeneCards and NCBI, and then the transcriptome data for COVID-19 was downloaded from GEO, DisGeNET, CTD, DrugBank, PubChem, TTD, NCBI Gene, OMIM. The drug targets of Naringenin were revealed through CTD, BATMAN, TCMIP, SymMap, Chemical Association Networks, SwissTargetPrediction, PharmMapper, ECTM, and DGIdb. The genes related to susceptibility to COVID-19 in LUSC patients were obtained through differential analysis. The interaction of COVID-19/LUSC related genes was evaluated and demonstrated using STRING to develop a a COX risk regression model to screen and evaluate the association of genes with clinical characteristics. To investigate the related functional and pathway analysis of the common targets of COVID-19/LUSC and Naringenin, KEGG and GO enrichment analysis were employed to perform the functional analysis of the target genes. Finally, The Hub Gene was screened and visualized using Cytoscape, and molecular docking between the drug and the target was performed using Autodock.

Results

We discovered numerous COVID-19/LUSC target genes and examined their prognostic value in LUSC patients utilizing a variety of bioinformatics and network pharmacology methods. Furthermore, a risk score model with strong predictive performance was developed based on these target genes to assess the prognosis of LUSC patients with COVID-19. We intersected the therapeutic target genes of naringenin with the LUSC, COVID-19-related targets, and identified 354 common targets, which could be used as potential target genes for naringenin to treat COVID-19/LUSC. The treatment of COVID-19/LUSC with naringenin may involve oxidative stress, anti-inflammatory, antiviral, antiviral, apoptosis, immunological, and multiple pathways containing PI3K-Akt, HIF-1, and VEGF, according to the results of the GO and KEGG enrichment analysis of these 354 common targets. By constructing a PPI network, we ascertained AKT1, TP53, SRC, MAPK1, MAPK3, and HSP90AA1 as possible hub targets of naringenin for the treatment of COVID-19/LUSC. Last but not least, molecular docking investigations showed that naringenin has strong binding activity in COVID-19/LUSC.

Conclusion

We revealed for the first time the pharmacological targets and potential molecular processes of naringenin for the treatment of COVID-19/LUSC. However, these results need to be confirmed by additional research and validation in real LUSC patients with COVID-19.

Far-field super-resolution chemical microscopy

Far-field chemical microscopy providing molecular electronic or vibrational fingerprint information opens a new window for the study of three-dimensional biological, material, and chemical systems. Chemical microscopy provides a nondestructive way of chemical identification without exterior labels. However, the diffraction limit of optics hindered it from discovering more details under the resolution limit. Recent development of super-resolution techniques gives enlightenment to open this door behind far-field chemical microscopy. Here, we review recent advances that have pushed the boundary of far-field chemical microscopy in terms of spatial resolution. We further highlight applications in biomedical research, material characterization, environmental study, cultural heritage conservation, and integrated chip inspection.

A Comprehensive Survey on Pandemic Patient Monitoring System: Enabling Technologies, Opportunities, and Research Challenges

Sporadic occurrences of transmissible diseases have severe and long-lasting effects on humankind throughout history. These outbreaks have molded the political, economic, and social aspects of human life. Pandemics have redefined some of the basic beliefs of modern healthcare, pushing researchers and scientists to develop innovative solutions to be better equipped for future emergencies. Numerous attempts have been made to fight Covid-19-like pandemics using technologies such as the Internet of Things, wireless body area network, blockchain, and machine learning. Since the disease is highly contagious, novel research in patients' health monitoring system is essential for the constant monitoring of pandemic patients with minimal or no human intervention. With the ongoing pandemic of SARS-CoV-2, popularly known as Covid-19, innovations for monitoring of patients' vitals and storing them securely have risen more than ever. Analyzing the stored patients' data can further assist healthcare workers in their decision-making process. In this paper, we surveyed the research works on remote monitoring of pandemic patients admitted in hospitals or quarantined at home. First, an overview of pandemic patient monitoring is given followed by a brief introduction of enabling technologies i.e. Internet of Things, blockchain, and machine learning to implement the system. The reviewed works have been classified into three categories; remote monitoring of pandemic patients using IoT, blockchain-based storage or sharing platforms for patients' data, and processing/analyzing the stored patients' data using machine learning for prognosis and diagnosis. We also identified several open research issues to set directions for future research.

Evaluation of IL-6, IL-25 & IL-35 in the COVID 19 Patients and their Correlation to Demography Data in the Symptomatic Patients

The severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, was first discovered in Wuhan, Hubei province, China. Cytokines play a critical role in COVID-19 infections through their inflammatory or anti-inflammatory activities. This study aimed to detect the diagnostic value of and the relationship between the interleukins under study, in addition to their relationship with demographic data in COVID-19 patients. Patients with a confirmed diagnosis of COVID-19 based on laboratory (PCR) results and the healthy control group were given their section of this investigation. The patient group had 120 COVID-19 patients, including 62 males and 58 females, while the control group consisted of 32 individuals (22 males and 10 females). The subdivision was then performed according to their vaccination status, chronic diseases, gender, and residence. Cytokine levels were detected using the ELISA technique. The immunological status of COVID-19 patients was determined by measuring interleukin (IL)-6, IL-25, and IL-35. During the research, it was found that IL-6 was highly significant in COVID-19 patients (0.001). However, its level was not significantly different (0.376) in patients regarding the type of chronic diseases, residence (0.353), and gender (0.574), but it was significantly different in vaccinated patients (0.029). It was also found that IL-6 is significantly correlated with IL-25 and IL-35. IL-25 was highly significant in COVID-19 patients (0.007), and there was a significant difference in its level in patients regarding the type of chronic disease (0.049). While there was no difference in terms of residence (0.421) and gender (0.681), corona vaccination showed a significant difference (0.047). IL-25 also had a significant correlation with IL-6 and IL-35. As for IL-35, it was significant in patients with COVID-19 (0.013) but not significantly different regarding chronic diseases (0.344), residence (0.877), or gender (0.800). However, it was significantly different in vaccinated patients, compared to the non-vaccinated ones. IL-35 was found to be significantly correlated with IL-25 and IL-6 (0.000). The examined interleukins increased in COVID-19 individuals. IL-6 remains an excellent marker for determining the immune state of patients with COVID-19. There were also strong correlations between the interleukins under study in COVID-19 patients. However, there was no relationship between age, residence, gender, and the concentration of studied cytokines. IL-25 increases significantly in COVID-19 patients suffering from chronic diseases. Therefore, it is more efficient in the follow-up of patients.

1,4,9,9-tetramethyloctahydro-4,7-(epoxymethano)azulen-5(1H)-one, a natural product as a potential inhibitor of COVID-19: Extraction, crystal structure, and virtual screening approach

In the present work, we describe the extraction of a natural product namely 1,4,9,9-tetramethyloctahydro-4,7-(epoxymethano)azulen-5(1H)-one, and its structure was confirmed by single crystal X-ray diffraction analysis. The conformations of the 5-, 6-, and 7-membered rings in the title compound, C₁₅H₂₄O₂, have been probed by a Cremer-Pople puckering analysis. C-H···O hydrogen bonds generate chains in the crystal that stretch along the c-axis direction. The Hirshfeld surface analysis method was used to stabilize the crystal packing of the natural compound. Accompanied by experimental studies, quantum chemical calculations were also performed to compare the structural elucidation and the results of these geometrical parameters exhibited excellent agreement. The compound was also docked with several drug targets of the SARS-CoV-2 virus and found to show the best binding with the main protease enzyme, having a binding energy of -12.31 kcal/mol and interacting with His41 and Cys145 residues. The dynamic stability deciphered the complex to be stable with an average RMSD of 3.8 Å. The compound dynamics with the enzyme showed the compound conformation to be highly stable. The intermolecular binding free energy determined the compound-main protease enzyme to show high interaction energy of < 40 kcal/mol. Together, these studies demonstrate the compound to be a lead structure against SARS-CoV-2.

IL-10/IL-6 ratio from nasal & oral swab samples, acts as an inflammatory indicator for COVID-19 patients infected with the delta variant

Background

Hyper-inflammatory immune response of SARS-CoV-2 is often characterized by the release of multiple pro-inflammatory cytokines with an impact on the expression of numerous other interleukins (ILs). However, from oral and nasal swab samples the specific quantitative association of the different IL-markers with the disease progression and its relationship with the status of vaccination remains unclear.

Materials and methods

Patients' combined oral and nasal swab samples were collected from both non-vaccinated and double-vaccinated individuals with high (Ct value < 25) and low (Ct value > 30) viral loads, along with uninfected donors. None of the patients were critically ill, or needed ICU support. The expression of different cytokines (IL6, IL10, IL1B, IFNG) and mucin (MUC5AC, MUC1) markers were assessed between different groups by qRT-PCR. The important cytokine markers differentiating between vaccinated and non-vaccinated patients were identified by PCA.

Conclusion

IL6 expression was higher in non-vaccinated COVID-19 patients infected with delta-variant irrespective of their viral-load compared to uninfected individuals. However, in double-vaccinated patients, only in high viral-load patients (Ct value < 25), IL6 expression increased. In high viral-load patients, irrespective to their vaccination status, IL10 expression was lower compared to the uninfected control group. Surprisingly, IL10 expression was lower in double-vaccinated patients with Ct value > 30. IL1B, and IFNG expression remained unaltered in uninfected and infected individuals. However, MUC5AC expression was lower in non-vaccinated patients with Ct value < 25 compared to control group. Our study unveiled that IL10/IL6 ratio can be used as a biomarker for COVID-19 patients upon proper establishment of it in a clinical setting.

Using Machine Learning Algorithms to Determine the Post-COVID State of a Person by Their Rhythmogram

This study introduces a novel method for detecting the post-COVID state using ECG data. By leveraging a convolutional neural network, we identify "cardiospikes" present in the ECG data of individuals who have experienced a COVID-19 infection. With a test sample, we achieve an 87 percent accuracy in detecting these cardiospikes. Importantly, our research demonstrates that these observed cardiospikes are not artifacts of hardware-software signal distortions, but rather possess an inherent nature, indicating their potential as markers for COVID-specific modes of heart rhythm regulation. Additionally, we conduct blood parameter measurements on recovered COVID-19 patients and construct corresponding profiles. These findings contribute to the field of remote screening using mobile devices and heart rate telemetry for diagnosing and monitoring COVID-19.

Prognostic value of neutrophil and lymphocyte counts and neutrophil/lymphocyte ratio for predicting death in patients hospitalized for COVID-19

COVID-19 primarily affects the respiratory system and can cause changes in other systems. Early identification of patients with a higher potential for complications is critical to provide the best possible treatment to reduce the disease's lethality. This study aimed to analyze the behavior of hematologic biomarkers in predicting mortality in patients hospitalized with COVID-19. This retrospective cohort study used data from the medical records of patients hospitalized with COVID-19 between March and August 2020 in two referral hospitals for treatment of the disease in the city of Cuiabá (in the state of Mato Grosso, Brazil). Clinical and laboratory characteristics related to cardiovascular involvement and death during hospitalization were evaluated. Neutrophils, lymphocytes, and monocytes, as well as the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MRL), were used as potential biomarkers of death. A total of 199 patients were included (male: 113; mean age: 51.4 years). Leukocyte, neutrophil, and lymphocyte counts showed a statistically significant association with death, as did NLR and MRL. Satisfactory accuracy in predicting death was observed for leukocyte, neutrophil, lymphocyte, NLR, and MLR counts. The hematologic biomarkers studied may be useful for prognosticating hospitalized patients for the possibility of death from COVID-19.

Neurologic Complications of Cardiac and Pulmonary Disease

OBJECTIVE

The heart and lungs work as a functional unit through a complex interplay. The cardiorespiratory system is responsible for the delivery of oxygen and energy substrates to the brain. Therefore, diseases of the heart and lungs can lead to various neurologic illnesses. This article reviews various cardiac and pulmonary pathologies that can lead to neurologic injury and discusses the relevant pathophysiologic mechanisms.

LATEST DEVELOPMENTS

We have lived through unprecedented times over the past 3 years with the emergence and rapid spread of the COVID-19 pandemic. Given the effects of COVID-19 on the lungs and heart, an increased incidence of hypoxic-ischemic brain injury and stroke associated with cardiorespiratory pathologies has been observed. Newer evidence has questioned the benefit of induced hypothermia in patients with out-of-hospital cardiac arrest. Further, global collaborative initiatives such as the Curing Coma Campaign are underway with the goal of improving the care of patients with coma and disorders of consciousness, including those resulting from cardiac and pulmonary pathologies.

ESSENTIAL POINTS

The neurologic complications of cardiorespiratory disorders are common and present in various forms such as stroke or hypoxic and anoxic injury related to cardiac or respiratory failure. With the emergence of the COVID-19 pandemic, neurologic complications have increased in recent years. Given the intimate and interdependent dynamics of the heart, lungs, and brain, it is crucial for neurologists to be aware of the interplay between these organs.

An online survey on clinical characteristics of otologic symptoms linked to COVID-19 infection

Objective

To report the otologic symptoms that present in patients with COVID-19 infection and investigate the pathogenic characteristics during the period of the pandemic.

Materials and methods

This cross-sectional descriptive study included participants with COVID-19 infection. COVID-19 infection was verified in these patients by nucleic acid test or antigen test. An online questionnaire was developed to analyze the association between the COVID-19 pandemic and the characteristics of otologic symptoms.

Results

This study included 2,247 participants, of which nearly half had one or more otologic symptoms. The presents of otologic symptoms were associated with gender (OR = 1.575, p < 0.0001), age (OR = 0.972, p < 0.0001), and occupation (healthcare worker: p < 0.0001; personnel of enterprises or institutions: OR = 1.792, p < 0.0001; student: OR = 0.712, p < 0.044). The otologic symptoms following COVID-19 infection in order were vertigo (25.95%), tinnitus (19.05%), otalgia (19.00%), aural fullness (17.18%), hearing loss (11.62%), otorrhea (1.25%), and facial paralysis (0.27%).

Conclusion

The present study shows that otologic symptoms are common among the COVID-19 infected participants and that these symptoms mostly recover spontaneously. During the corona-virus pandemic, the involvement of the cochleovestibular system and facial nerve should not be overlooked while treating the COVID-19 infected individuals.

The effects of COVID-19 on placental morphology

The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in pregnant women than non-pregnant women. Therefore, a review detailing the morphological alterations and physiological changes associated with COVID-19 during pregnancy and the effect that these changes have on the feto-placental unit is of high priority. This knowledge is crucial for these mothers, their babies and clinicians to ensure a healthy life post-pandemic. Hence, we review the placental morphological changes due to COVID-19 to enhance the general understanding of how pregnant mothers, their placentas and unborn children may have been affected by this pandemic. Based on current literature, we deduced that COVID-19 pregnancies were oxygen deficient, which could further result in other pregnancy-related complications like preeclampsia and IUGR. Therefore, we present an up-to-date review of the COVID-19 pathophysiological implications on the placenta, covering the function of the placenta in COVID-19, the effects of this virus on the placenta, its functions and its link to other gestational complications. Furthermore, we highlight the possible effects of COVID-19 therapeutic interventions on pregnant mothers and their unborn children. Based on the literature, we strongly suggest that consistent surveillance for the mothers and infants from COVID-19 pregnancies be prioritised in the future. Though the pandemic is now in the past, its effects are long-term, necessitating the monitoring of clinical manifestations in the near future.

Platelets and SARS-CoV-2 During COVID-19: Immunity, Thrombosis, and Beyond

COVID-19 is characterized by dysregulated thrombosis and coagulation that can increase mortality in patients. Platelets are fast responders to pathogen presence, alerting the surrounding immune cells and contributing to thrombosis and intravascular coagulation. The SARS-CoV-2 genome has been found in platelets from patients with COVID-19, and its coverage varies according to the method of detection, suggesting direct interaction of the virus with these cells. Antibodies against Spike and Nucleocapsid have confirmed this platelet-viral interaction. This review discusses the immune, prothrombotic, and procoagulant characteristics of platelets observed in patients with COVID-19. We outline the direct and indirect interaction of platelets with SARS-CoV-2, the contribution of the virus to programmed cell death pathway activation in platelets and the consequent extracellular vesicle release. We discuss platelet activation and immunothrombosis in patients with COVID-19, the effect of Spike on platelets, and possible activation of platelets by classical platelet activation triggers as well as contribution of platelets to complement activation. As COVID-19-mediated thrombosis and coagulation are still not well understood in vivo, we discuss available murine models and mouse adaptable strains.