Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Bronchoalveolar lavage single-cell transcriptomics reveals immune dysregulations driving COVID-19 severity

The continuous threats posed by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, including the emergence of potentially more infectious and deadly variants, necessitate ongoing studies to uncover novel and detailed mechanisms driving disease severity. Using single-cell transcriptomics, we conducted a secondary data analysis of bronchoalveolar lavage fluid (BALF) from COVID-19 patients of varying severities and healthy controls to comprehensively examine immune responses. We observed significant immune cell alterations correlating with disease severity. In severe cases, macrophages showed upregulation of pro-inflammatory genes TNFα and IL1β, contributing to severe inflammation and tissue damage. Neutrophils exhibited increased activation, marked by S100A8, CXCL8, and IL1β expression, with extended viability and reduced phagocytosis. Genes such as MCL1 and HIF1α supported extended viability, while MSR1 and MRC1 indicated reduced phagocytosis. Enhanced formation of neutrophil extracellular traps (NETs) and reduced clearance, indicated by NET-associated markers, were linked to thrombo-inflammation and organ damage. Both macrophages and neutrophils in severe cases showed impaired efferocytosis, indicated by decreased expression of MSR1 and TREM2 in macrophages and downregulation of FCGR3B in neutrophils, leading to the accumulation of apoptotic cells and exacerbating inflammation. Severe cases were characterized by M1 macrophages with high TNFα and IL1β, while milder cases had M2 macrophages with elevated PPARγ. Dendritic cells (DCs) in severe cases exhibited reduced proportions and attenuated expression of MHC class I genes (HLA-A, HLA-B, HLA-C) and co-stimulatory molecules (CD80, CD86), alongside increased cytochrome c expression, indicating impaired antigen presentation and enhanced apoptosis. NK and T cells in severe cases demonstrated altered receptor and gene expression, with increased activation markers IFNγ and ISG15, suggesting a paradoxical state of activation and exhaustion. This analysis highlights the critical role of dysregulated neutrophil, macrophage, dendritic cell, NK, and T cell responses in severe COVID-19, identifying potential therapeutic targets and providing novel insights into the disease.

Prognostic Value of Neutrophil/Lymphocyte, Lymphocyte/C-reactive protein, Platelet/ Lymphocyte Rates in Covid-19 Cases Monitored in the Intensive Care Unit

Coronavirus 2019 (COVID-19) infection has a significant mortality rate. Despite the disease's extensive effects, little is known about the prognostic indicators that can be used. We aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR) and platelet-to- lymphocyte ratio (PLR) in predicting mortality of intensive care unit (ICU) patients. Demographic data, underlying diseases, laboratory parameters were evaluated. The study included 222 cases. The mortality rate was 57.65%. No significant differences in terms of sex, age, or underlying disease were observed between the two groups with and without mortality. Obesity, oxygen therapy, invasive mechanical ventilation (IMV) rates and high SOFA (Sequential Organ Failure Assessment) scores were found to be significantly higher in the group with a mortal course. The mortality rate was significantly higher in patients with lung involvement over 50%, with a low lymphocyte count at ICU admission. In this patient group, NLR was found to be higher, and LCR was found to be lower (P = .001). Although there was no significant difference in PLR between the two groups in univariate analysis, multivariate analysis revealed that PLR was independently associated with mortality. High NLR and low LCR values at ICU admission might serve as early warning signs for healthcare providers, allowing them to identify patients at higher risk of mortality.

A novel method for detecting SARS-CoV-2 IgM and IgG based on the gold immune chromatography assay

A novel method was proposed based on gold immune chromatography assay (GICA) including the detection of antibodies targeting different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epitopes to improve the SARS-CoV-2 IgM and IgG detection performance. Sera from 282 confirmed Coronavirus Disease 2019 (COVID-19) patients were obtained at different times as the SARS-CoV-2 IgM or IgG experimental group. Sera from 148 uninfected and unvaccinated individuals were used as the control. The serum single-epitope IgM and IgG antibodies against SARS-CoV-2 were detected via GICA; the two epitope antibodies with high detection performance were used to construct a novel method, and then compared with the chemiluminescence immunoassay (CLIA). The diagnostic specificity and screening sensitivity of S2-IgM and N-IgM combined detection of serum SARS-CoV-2 IgM antibodies based on GICA were 99.32% and 98.81%, respectively, which were higher than those of the CLIA test (83.78% and 82.14%; P < 0.001). The diagnostic specificity of RBD-IgG and N-IgG combined detection in the serum was 100.00%, the same as that of CLIA. The novel method showed excellent screening sensitivity and diagnostic specificity for serum SARS-CoV-2 IgM and IgG, effectively avoiding omissions and misdiagnoses in the early clinical stages of screening and diagnosing COVID-19.

Unsupervised machine learning clustering approach for hospitalized COVID-19 pneumonia patients

BACKGROUND

Identification of distinct clinical phenotypes of diseases can guide personalized treatment. This study aimed to classify hospitalized COVID-19 pneumonia subgroups using an unsupervised machine learning approach.

METHODS

We included hospitalized COVID-19 pneumonia patients from July to September 2021. K-means clustering, an unsupervised machine learning method, was performed to identify clinical phenotypes based on clinical and laboratory variables collected within 24 hours of admission. Variables were normalized before clustering to ensure equal contribution to the analysis. The optimal number of clusters was determined using the elbow method and Silhouette scores. Cox proportional hazard models were used to compare the risk of intubation and 90-day mortality across the identified clusters.

RESULTS

Three clinically distinct clusters were identified among 538 hospitalized COVID-19 pneumonia patients. Cluster 1 (N = 27) consisted predominantly of males and showed significantly elevated serum liver enzymes and LDH levels. Cluster 2 (N = 370) was characterized by lower chest x-ray scores and higher serum albumin levels. Cluster 3 (N = 141) was characterized by older age, diabetes mellitus, higher chest x-ray scores, more severe vital signs, higher creatinine levels, lower hemoglobin levels, lower lymphocyte counts, higher C-reactive protein, higher D-dimer, and higher LDH levels. When compared to cluster 2, cluster 3 was significantly associated with increased risk of 90-day mortality (HR, 6.24; 95% CI, 2.42-16.09) and intubation (HR, 5.26; 95% CI 2.37-11.72). In contrast, cluster 1 had a 100% survival rate with a non-significant increase in intubation risk compared to cluster 2 (HR, 1.40, 95% CI, 0.18-11.04).

CONCLUSIONS

We identified three distinct clinical phenotypes of COVID-19 pneumonia patients, with cluster 3 associated with an increased risk of respiratory failure and mortality. These findings may guide tailored clinical management strategies.

H, Figueira FAMDS, Andrade RLM, de Abreu LC. Evolution of COVID-19 in the State of São Paulo: Analysis of Incidence, Mortality and Lethality from 2020 to 2023

INTRODUCTION

COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, which belongs to the coronavirus family. SARS-CoV-2 is related to other viruses that cause severe acute respiratory syndrome. The emergence of cases of pneumonia of unknown origin triggered the largest viral pandemic in modern times, presenting major challenges to global public health.

OBJECTIVE

To analyze the evolution of the COVID-19 pandemic in the state of São Paulo from 2020 to 2023, focusing on trends in incidence, mortality, and lethality.

METHODS

Ecological study of time series of incidence, mortality and lethality by COVID-19 in the state of São Paulo using Prais-Winsten regression considering the Weekly Percentage Change (WPC) and probability values (p), considering a significance level of 95% (95% CI). To ensure the reliability of the entered data, double-blind typing was performed by different researchers in the same database extracted from the 2024 Ministry of Health Coronavirus dashboard.

RESULTS

From February 2020 and the end of December 2023, 6,763,310 accumulated cases and 182,254 deaths were recorded. Stationary trends were observed for the year 2022, with a reduction in incidence and mortality in the year 2023. However, the epidemiological variable lethality showed a stationary trend.

CONCLUSION

The analysis of the trends in incidence, mortality, and lethality revealed variable dynamics over time, with emphasis on the significant reduction of these indicators in 2023.

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

BACKGROUND/OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Biofilm Formation and Plasmid-Mediated Quinolone Resistance Genes at Varying Quinolone Inhibitory Concentrations in Quinolone-Resistant Bacteria Superinfecting COVID-19 Inpatients

The likelihood of antimicrobial failure in COVID-19 patients with bacterial superinfection arises from both phenotypic (biofilms) and genotypic mechanisms. This cross-sectional study aimed to determine the inhibitory concentrations of quinolones-nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin, and levofloxacin-in biofilm formers (minimum biofilm inhibitory concentration [MBIC]) and nonformers (minimum inhibitory concentration [MIC]) and correlate inhibitory concentrations with plasmid-mediated quinolone resistance (PMQR) genes in quinolone-resistant bacteria isolated from COVID-19 inpatients. Quinolone-resistant bacteria (n = 193), verified through disc diffusion, were tested for quinolone inhibitory concentrations using broth microdilution and biofilm formation using microtiter plate methods. The polymerase chain reaction was used to detect PMQR genes. Study variables were analyzed using SPSS v.17.0, with a significance level set at P <0.05. MIC-to-MBIC median fold increases for ciprofloxacin, ofloxacin, and levofloxacin were 128 (2-8,192), 64 (4-1,024), and 32 (4-512) in gram-positive cocci (GPC, n = 43), respectively, whereas they were 32 (4-8,192), 32 (4-2,048), and 16 (2-1,024) in fermentative gram-negative bacilli (F-GNB, n = 126) and 16 (4-4,096), 64 (2-64), and 16 (8-512) in nonfermentative gram-negative bacilli (NF-GNB, n = 24). In biofilm-forming F-GNB and NF-GNB, qnrB (10/32 versus 3/10), aac(6')-Ib-cr (10/32 versus 4/10), and qnrS (9/32 versus 0/10) genes were detected. A 32-fold median increase in the MIC-to-MBIC of ciprofloxacin was significantly (P <0.05) associated with qnrA in F-GNB and qnrS in NF-GNB. Biofilms formed by F-GNB and NF-GNB were significantly associated with the aac(6')-Ib-cr and qnrS genes, respectively. Nearly one-third of the superinfecting bacteria in COVID-19 patients formed biofilms and had at least one PMQR gene, thus increasing the need for quinolones at higher inhibitory concentrations.

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

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

DATA EXTRACTION

Two reviewers independently extracted data and assessed study quality.

DATA ANALYSIS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022385036.

The prevalence of thromboembolic events among COVID-19 patients admitted to a single centre intensive care unit (ICU): an epidemiological study from a Malaysian population

Introduction

Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear.

Objectives

This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored.

Methods

In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism.

Results

Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; p = 0.013), PE (47.5% vs 34.0%; p = 0.006), stroke (12.3% vs. 1.5; p<0.001) and MI (16.4% vs. 4.6%; p<0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)].

Conclusion

In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.

Comparison of Platelet Indices, Lymphocyte, and Systemic Inflammation Indices on Days 1 and 8 in Surviving and Non-Surviving COVID-19 Patients at Hasan Sadikin General Hospital, Bandung, Indonesia

Purpose

This study aimed to compare platelet count, platelet indices, lymphocyte, and systemic inflammation indices between surviving and non-surviving COVID-19 patients, measured at admission and on the eighth day of hospitalization.

Patients and Methods

A retrospective cohort study was conducted on COVID-19 patients hospitalized at Hasan Sadikin General Hospital, Bandung, from March to December 2020. Patient characteristics and laboratory data were sourced from medical records and the Clinical Pathology Laboratory. Bivariate analysis was performed to determine the comparison of platelet indexes between Surviving and Non-Surviving COVID-19 patients depending on data distribution. Significantly correlated variables in Bivariate analysis were included in the ROC analysis, with the AUC used to identify optimal threshold values for laboratory parameters.

Results

Data from 132 patients were analyzed, with 106 (80.3%) surviving and 32 (19.7%) not surviving. Non-surviving patients had lower platelet count, PLTCT, and lymphocyte levels but higher MPV and PDW compared to survivors. Receiver operating characteristic (ROC) analysis revealed that on day 1, lymphocytes had a higher area under the curve (AUC) than MPV. On day 8, lymphocytes had the highest AUC, followed by platelet count, MPV, PLTCT, and PDW.

Conclusion

Platelet indices, lymphocyte counts, and systemic inflammation index have the potential to distinguish the severity of COVID-19.

Ocular neuroinflammatory response secondary to SARS-CoV-2 infection-a review

With the consistent occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the prevalence of various ocular complications has increased over time. SARS-CoV-2 infection has been shown to have neurotropism and therefore to lead to not only peripheral inflammatory responses but also neuroinflammation. Because the receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), can be found in many intraocular tissues, coronavirus disease 2019 (COVID-19) may also contribute to persistent intraocular neuroinflammation, microcirculation dysfunction and ocular symptoms. Increased awareness of neuroinflammation and future research on interventional strategies for SARS-CoV-2 infection are important for improving long-term outcomes, reducing disease burden, and improving quality of life. Therefore, the aim of this review is to focus on SARS-CoV-2 infection and intraocular neuroinflammation and to discuss current evidence and future perspectives, especially possible connections between conditions and potential treatment strategies.

Antibody-dependent enhancement of coronaviruses

The COVID-19 pandemic presents a significant challenge to the global health and the world economy, with humanity engaged in an extended struggle against the virus. Notable advancements have been achieved in the development of vaccines and therapeutic interventions, including the application of neutralizing antibodies (NAbs) and convalescent plasma (CP). While antibody-dependent enhancement (ADE) has not been observed in human clinical studies related to SARS-CoV-2, the potential for ADE remains a critical concern and challenge in addressing SARS-CoV-2 infections. Moreover, the causal relationship between ADE and viral characteristics remains to be clearly elucidated. Viruses that present with severe clinical manifestations of ADE have demonstrated the capacity to replicate in macrophages or other immune cells, or to alter the immunological status of these cells, which induces abortive infections characterized by systemic inflammation. In this review, we summarize experimental observations and clinical evidence concerning the ADE effect associated with coronaviruses. We critically examine the potential mechanisms through which coronaviruses mediate ADE, and propose strategies to mitigate this phenomenon in the context of viral infection treatment. Our aim is to offer informed recommendations for the containment of the COVID-19 pandemic and to strengthen the response to SARS-CoV-2, as well as to prepare for potential future coronavirus threats.

[The social representations of COVID-19 by users of primary health care services in context of the pandemic]

The scope of this study was to identify and analyze the social representations of Primary Health Care users of the SUS in the Federal District (FD) with respect to COVID-19 in the context of the Pandemic. It involved a qualitative study based on Social Representation Theory (SRT) that analyzed 1,713 interviews with Iramuteq software users. The Descending Hierarchical Classification (DHC) procedure distributed 85.79% of the word sets associated with COVID-19 into five lexical groupings. The main representations of the COVID-19 pandemic for PHC users in the FD are fear and death. The lack of coordination of the health system, which required governance by the State, made it difficult for people to receive care in a timely manner. Historically excluded social segments, particularly the black, mixed-race and economically vulnerable population, experienced the most severe impact, including loss of life. Overcoming the conflict between an austere and minimally effective State prevailing at the time of the pandemic, and the need to build a solidarity-based health system in a society with major socio-economic disparities, was crucial in ensuring that health in the post-COVID-19 era, as a human right and value, remained at the center of the debate on the Bioethics of Intervention.

The Relation Between Fear of COVID-19, Burnout Levels of Intensive Care Nurses

We aimed to examine the relation between the fear of COVID-19 and depression, anxiety and burnout of intensive carenurses. This cross-sectional and descriptive research was conducted with 116 intensive care nurses. The data were obtained with a web-based questionnaire created with the "Descriptive Information Form", "COVID-19 Fear Scale", "Depression, Anxiety and Stress Scale Short Form" and "Burnout Short Version". A significant positive correlation was found between depression (r = 0.498, p < .001), anxiety (r = 0.633, p < .001), stress (r = 0.589, p < .001) and burnout (r = 0.299, p = .001) levels of intensive care nurses with a mean age of 30.18 ± 6.55 with the help of the "COVID-19 Fear Scale". It was determined that the mental health of intensive care nurses was at risk and they reached the level of burnout. Intensive care nurses should be supported in understanding the symptoms of psychological problems and in stress management, personal and professional self-care. Receiving professional mental health support when necessary.

Factors associated with the effectiveness of high-flow therapy in patients with acute hypoxemic respiratory failure: An observational study

BACKWARD

The COVID-19 pandemic has severely tested global health systems. Non-invasive respiratory support, especially combining high-flow nasal cannula (HFNC) and continuous positive airway pressure, has effectively treated COVID-19 induced Acute Hypoxemic Respiratory Failure and reduced mortality. However, HFNC alone is more comfortable, better tolerated, and less costly than non-invasive ventilation. Understanding which patients benefit from HFNC monotherapy versus combined therapies is essential.

METHODS

This observational study included patients admitted to the intermediate respiratory care unit of a COVID-19 hospital between December 2020 and September 2021. All patients treated with HFNC were included (n = 1301). HFNC failure was defined as the need for escalated therapy (non-invasive ventilation, intubation) or death. Epidemiological, clinical, non-invasive respiratory support parameters, and laboratory data were collected, and a multivariable analysis identified key determinants.

RESULTS

HFNC was successful in 39.9 % of patients. (n = 511) Risk factors for HFNC failure included increased age, male gender, obesity, obstructive sleep apnea, higher respiratory rate, initial SpO2/FiO2 ≤ 148, and initial PaO2/FiO2 ≤ 100. An increase in the ROX Index at 24 h and slower disease progression were associated with successful treatment. These findings led to the developmet of an index to identify patients who benefit most from HFNC monotherapy.

CONCLUSIONS

HFNC monotherapy can be effective for a specific profile of patients with Acute Hypoxemic Respiratory Failure due to COVID-19. This tool may help manage these patients more appropriately. Further studies are needed to determine if these findings can be applied to Acute Hypoxemic Respiratory Failure caused by other pathologies.

IMPLICATIONS FOR CLINICAL PRACTICE

This study underscores the importance of early identification and management of patients at risk of HFNC failure in intermediate respiratory care units. By recognizing factors such as age, comorbidities, and respiratory indices, healthcare providers can implement targeted strategies to enhance HFNC success. These strategies may include more stringent monitoring, tailored respiratory support, and timely escalation to more intensive therapies if needed. Our findings highlight the need for a comprehensive approach to managing severe respiratory failure in critical care settings, ultimately improving patient outcomes and reducing the burden on healthcare systems.

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin + , age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID -/comorbidity + , 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.

A theoretical systems chronopharmacology approach for COVID-19: Modeling circadian regulation of lung infection and potential precision therapies

The COVID-19 pandemic, caused by SARS-CoV-2, has underscored the urgent need for innovative therapeutic approaches. Recent studies have revealed a complex interplay between the circadian clock and SARS-CoV-2 infection in lung cells, opening new avenues for targeted interventions. This systems pharmacology study investigates this intricate relationship, focusing on the circadian protein BMAL1. BMAL1 plays a dual role in viral dynamics, driving the expression of the viral entry receptor ACE2 while suppressing interferon-stimulated antiviral genes. Its critical position at the host-pathogen interface suggests potential as a therapeutic target, albeit requiring a nuanced approach to avoid disrupting essential circadian regulation. To enable precise tuning of potential interventions, we constructed a computational model integrating the lung cellular clock with viral infection components. We validated this model against literature data to establish a platform for drug administration simulation studies using the REV-ERB agonist SR9009. Our simulations of optimized SR9009 dosing reveal circadian-based strategies that potentially suppress viral infection while minimizing clock disruption. This quantitative framework offers insights into the viral-circadian interface, aiming to guide the development of chronotherapy-based antivirals. More broadly, it underscores the importance of understanding the connections between circadian timing, respiratory viral infections, and therapeutic responses for advancing precision medicine. Such approaches are vital for responding effectively to the rapid spread of coronaviruses like SARS-CoV-2.

The Effects of COVID-19 in Kidney Transplantation: Evidence From Tissue Pathology

BACKGROUND

The biological effects of SARS-CoV-2 infection in transplanted kidneys are uncertain with little pathological information.

METHODS

This single-center, prospective observational study evaluated kidney transplant biopsies from recipients of deceased donors with COVID-19, current recipients contracting SARS-CoV-2 Omicron variant in 2022, against prior BK virus (BKV) infection and uninfected (without SARS-CoV-2 or BKV) samples, as respective positive and negative comparators (n = 503 samples).

RESULTS

We demonstrated nonvirus tubular injury in implanted tissue from infected donors and prevalent recipients with mild acute COVID-19 and acute kidney injury, excluding direct viral infection as a cause of kidney damage. COVID particles were absent in 4116 ultrastructural images of 295 renal tubules from 4 patients with acute COVID-19. No viral cytopathic effect, viral allograft nephropathy, or SARS-CoV-2 RNA was detected in acute tissues, nor in 128 sequential samples from infected donors or recipients with COVID-19. Following recipient COVID-19 (mean 16.8 ± 12.0 wk post-infection), the biopsy-prevalence of rejection was 33.0% (n = 100 biopsies) versus 13.4% for contemporaneous uninfected controls (n = 337; P  < 0.001). Prior COVID-19 was an independent risk factor for incident rejection using multivariable generalized estimating equation adjusted for competing risks (odds ratio, 2.195; 95% confidence interval, 1.189-4.052; P  = 0.012). Landmark and matched-pair analyses confirmed an association of SARS-CoV-2 with subsequent transplant rejection, with a similar pattern following BKV infection.

CONCLUSIONS

Transplantation from COVID-19+ deceased donors yielded good recipient outcomes without evidence of viral tissue transmission. Acute kidney injury during COVID-19 was mediated by archetypical tubular injury and infection correlated with an increased risk of subsequent rejection.

Development of a Preoperative Screening Tool to Reduce Morbidity and Mortality of COVID-19-positive Hepatobiliary Patients

PURPOSE

This study aimed to create a preoperative risk assessment form for COVID-19-positive hepatobiliary patients to guide further prevention of complications after surgery and reduce morbidity and mortality.

DESIGN

Based on the literature, focus groups, and case studies, a multidisciplinary panel of 15 experts conducted three rounds of a Delphi study that resulted in the development of a preoperative risk assessment form to be used by healthcare professionals in the treatment of COVID-19-positive hepatobiliary patients.

METHODS

A preoperative risk assessment form for health professionals to use among COVID-19-positive hepatobiliary patients was developed based on literature, focus groups, and case studies. A 3-round Delphi study was conducted to validate and revise the risk assessment form using a multidisciplinary panel of 15 experts involved in hepatobiliary surgery.

FINDINGS

The experts demonstrated high cooperation and familiarity with the research topic, with positive coefficients ranging from 93.33% to 100% and authority coefficients ranging from 0.83 to 0.86. The coordination coefficients were 0.33, 0.26, and 0.22, respectively, indicating good coordination among expert opinions. The final risk assessment form included 9 primary (first-level) indicators, 38 secondary (second-level) indicators, and 122 tertiary (third-level) indicators.

CONCLUSIONS

The preoperative risk assessment form for hepatobiliary surgery patients infected with COVID-19 is scientifically rigorous, reliable, and valid. This screening tool may be used by health providers to identify high-risk patients, prevent postoperative complications, and reduce morbidity and mortality.

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

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

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

Background

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

Methods

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

Results

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

Conclusion

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

Ovarian function after COVID-19: long-term effects and vaccine safety in ART patients

PURPOSE

This study aimed to evaluate the long-term impact of mild COVID-19 infection and COVID-19 vaccination on ovarian function in patients undergoing assisted reproductive technology (ART). Specifically, we assessed ovarian outcomes between 9 and 18 months post-infection and investigated the effects of COVID-19 vaccines (inactivated virus and adenovirus) on reproductive parameters.

METHODS

The study included two objectives: (a) examining ovarian function in post-COVID-19 patients (9-18 months post-infection) compared to a control group and (b) comparing reproductive outcomes in vaccinated versus unvaccinated patients. According to the study objectives, ART patients were divided into the following groups: a control group (n = 30), a post-COVID-19 group (n = 55), an unvaccinated group (n = 70), and a vaccinated group (n = 55). Findings revealed a reduction in the number of retrieved and mature oocytes in patients over 36 years in the post-COVID-19 group. Lower IL-1β levels were found in follicular fluid (FF) of post-COVID-19 patients, while VEGF levels were reestablished between 9 and 18 months post-infection. Although cell migration was reduced in endothelial cells incubated with post-COVID-19 FF, angiogenic factor levels and DNA integrity remained stable. No significant differences in retrieved or mature oocytes were observed between vaccinated and unvaccinated patients.

CONCLUSIONS

VEGF levels and DNA integrity in FF from post-COVID-19 patients were normalized between 9 and 18 months post-infection. Additionally, COVID-19 vaccination did not negatively impact ovarian response in ART patients, supporting vaccine safety in reproductive contexts.

Damage mechanisms of bisphenols on the quality of mammalian oocytes

The extensive use of bisphenols in the plastics industry globally is a major growing concern for human health. Bisphenol compounds are easily leached out from plastic containers to food, beverages, and drinking water and contaminate the natural environment. Daily exposure of bisphenol compounds increases their load and impairs various organs, including the reproductive system. Bisphenol compounds directly or indirectly affect ovarian functions, such as folliculogenesis, steroidogenesis, oogenesis, and thereby oocyte quality. Bisphenol A (BPA) and its structural analogues act as endocrine disruptors and induce generation of reactive oxygen species (ROS) within the ovary. Excess levels of ROS induce death pathways in follicular steroidogenic cells and affect ovarian steroidogenesis. The reduced level of estradiol-17β impairs follicular growth and development that reduces the number and quality of oocytes. In addition, excess levels of ROS in follicular fluid trigger meiotic instability, which further deteriorates oocyte quality. The high level of ROS generates oxidative stress that triggers various death pathways in germ cells as well as in oocytes, induces follicular atresia, and depletes ovarian reserve. Although growing evidence indicates the destructive effects of bisphenol compounds at the level of ovary, potential effects and underlying mechanisms that deteriorate oocyte quality remain poorly understood. Therefore, this review summarizes the mechanisms by which bisphenols cause damage to the ovary, impair oocyte quality, and affect women's fertility.

Circulating inflammatory markers predict depressive symptomatology in COVID-19 survivors

Growing evidence suggests the neurobiological mechanism upholding post-COVID-19 depression mainly relates to immune response and subsequent unresolved low-grade inflammation. Herein we exploit a broad panel of cytokines serum levels measured in COVID-19 survivors at one- and three-month since infection to predict post-COVID-19 depression. 87 COVID survivors were screened for depressive symptomatology at one- and three-month after discharge through the Beck Depression Inventory (BDI-13) and the Zung Self-Rating Depression Scale (ZSDS) at San Raffaele Hospital. Blood samples were collected at both timepoints and analyzed through Luminex. We entered one-month 42 inflammatory compounds into two separate penalized logistic regression models to evaluate their reliability in identifying COVID-19 survivors suffering from clinical depression at the two timepoints, applied within a machine learning routine. Delta values of analytes lowering between timepoints were entered in a third model predicting presence long-term depression. 5000 bootstraps were computed to determine significance of predictors. The cross-sectional model reached a balance accuracy (BA) of 76 % and a sensitivity of 70 %. Post-COVID-19 depression was predicted by high levels of CCL17, CCL22. On the other hand, CXCL10, CCL2, CCL3, CCL8, CXCL5, CCL15, CCL23, CXCL13, and GM-CSF showed protective effects. The longitudinal model obtained good performance as well (BA = 74 % and sensitivity = 68 %), revealing CXCL16 and CCL25 as additional drivers of clinical depression. Moreover, dynamic changes of analytes over time accurately predicted long-term depression (BA = 76 % and sensitivity = 75 %). Our findings unveil a putative immune profile upholding post-COVID-19 depression, thus reinforcing the need to deepen molecular mechanisms to appropriately target depression.

Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19

OBJECTIVE

We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.

DESIGN

Single center prospective observational longitudinal cohort study (February-November 2021).

SETTING

Patients admitted to the ICU of a University Hospital.

PARTICIPANTS

Patients with severe COVID-19 pneumoniae.

INTERVENTIONS

Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.

MAIN VARIABLES OF INTEREST

Target: thomboembolic events.

PREDICTORS

demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events.

RESULTS

Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.

CONCLUSIONS

Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.

Bulk and Single-Cell Transcriptomic Reveals Shared Key Genes and Patterns of Immune Dysregulation in Both Intestinal Inflammatory Disease and Sepsis

Inflammatory bowel disease (IBD) and Sepsis are both characterised by immune dysregulation. Notably, IBD is a factor in the increase in septic infections. However, these two conditions' shared molecular and pathophysiological mechanisms remain unclear. We used 'limma' and 'WGCNA' analyses to identify common DEGs between these two conditions. Single-cell RNA sequencing further assessed immune cell heterogeneity. We used machine learning algorithms to construct and identify diagnostic markers for Sepsis, which we then validated using receiver operating characteristic curve (ROC) analysis. A mouse model of IBD combined with Sepsis was constructed, and real-time PCR and western blot validated the expression of BCL2A1 and CEBPB. It was found that 58 shared DEGs identified in both IBD and Sepsis were highly enriched in immune and inflammation-related pathways. Single-cell analysis revealed that CD14+ monocytes (or IL1B+ macrophages) primarily express these hub genes. Both conditions significantly increased the proportion of this cell type compared to healthy controls. Finally, BCL2A1 and CEBPB were identified as potential biomarkers that have strong diagnostic potential. Furthermore, we confirmed that levels of BCL2A1 and CEBPB were elevated in mice with IBD complicated by Sepsis through real-time PCR and observed that IBD exacerbates the progression of Sepsis. We conclude that IL1B+ macrophages expressing high levels of these hub genes play a key role in the immune dysregulation associated with both IBD and Sepsis. The overlapping gene expression and pathway alterations in these cells indicate shared common molecular mechanisms, suggesting new strategies for targeted therapeutic interventions.

[Prevalence and prognostic role of thoracic lymphadenopathy in Covid-19]

PURPOSE

The prevalent coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world and is considered a serious threat to global health. The prognostic role of thoracic lymphadenopathy in COVID-19 is unclear. The aim of the present meta-analysis was to analyze the prognostic role of thoracic lymphadenopathy for the prediction of 30-day mortality in patients with COVID-19.

MATERIALS AND METHODS

The MEDLINE library, Cochrane, and SCOPUS databases were screened for associations between CT-defined features and mortality in COVID-19 patients up to June 2021. In total, 21 studies were included in the present analysis. The quality of the included studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using RevMan 5.3. Heterogeneity was calculated by means of the inconsistency index I2. DerSimonian and Laird random-effect models with inverse variance weights were performed without any further correction.

RESULTS

The included studies comprised 4621 patients. The prevalence of thoracic lymphadenopathy varied between 1 % and 73.4 %. The pooled prevalence was 16.7 %, 95 % CI = (15.6 %; 17.8 %). The hospital mortality was higher in patients with thoracic lymphadenopathy (34.7 %) than in patients without (20.0 %). The pooled odds ratio for the influence of thoracic lymphadenopathy on mortality was 2.13 (95 % CI = [1.80-2.52], p < 0.001).

CONCLUSION

The prevalence of thoracic lymphadenopathy in COVID-19 is 16.7 %. The presence of thoracic lymphadenopathy is associated with an approximately twofold increase in the risk for hospital mortality in COVID-19.

KEY POINTS

· The prevalence of lymphadenopathy in COVID-19 is 16.7 %.. · Patients with lymphadenopathy in COVID-19 have a higher risk of mortality during hospitalization.. · Lymphadenopathy nearly doubles mortality and plays an important prognostic role..

CITATION FORMAT

· Bucher AM, Sieren M, Meinel F et al. Prevalence and prognostic role of thoracic lymphadenopathy in Covid-19. Rofo 2025; 197: 163 - 171.

Social inequality and cultural factors impact the awareness and reaction during the cryptic transmission period of pandemic

The World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern on 2020 January 31. However, rumors of a "mysterious virus" had already been circulating in China in 2019 December, possibly preceding the first confirmed COVID-19 case. Understanding how awareness about an emerging pandemic spreads through society is vital not only for enhancing disease surveillance, but also for mitigating demand shocks and social inequities, such as shortages of personal protective equipment and essential supplies. Here we leverage a massive e-commerce dataset comprising 150 billion online queries and purchase records from 94 million people to detect the traces of early awareness and public response during the cryptic transmission period of COVID-19. Our analysis focuses on identifying information gaps across different demographic cohorts, revealing significant social inequities and the role of cultural factors in shaping awareness diffusion and response behaviors. By modeling awareness diffusion in heterogeneous social networks and analyzing online shopping behavior, we uncover the evolving characteristics of vulnerable populations. Our findings expand the theoretical understanding of awareness spread and social inequality in the early stages of a pandemic, highlighting the critical importance of e-commerce data and social network data in effectively and timely addressing future pandemic challenges. We also provide actionable recommendations to better manage and mitigate dynamic social inequalities in public health crises.

Targeting SARS-CoV2 spike glycoprotein: molecular insights into phytocompounds binding interactions - in-silico molecular docking

This study utilized small molecular characterization and docking study to evaluate the binding affinity of seven antiviral phytocompounds with the SARS CoV-2 variants (SARS-CoV-2 Spike Glycoprotein, SARS-CoV-2 Spike Protein Variant in 1-RBD, Alpha Variant SARS-CoV2- Spike Protein). The results revealed that five of seven compounds, possesses excellent drug lead property reveled through in-silico ADMET analysis. In addition, six of seven except D-Glucosamine, exhibited excellent binding affinity. Six ligands possess significant binding affinity towards SARS-CoV-2 variants 6VXX, 7LWV and 7R13, which is certainly greater than Remdesivir. Fagaronine found to be the best drug candidate against SARS-CoV-2 variants, It was found that -7.4, -5.6 and -6.3 is the docking score respectively. Aranotin, Beta aescin, Gliotoxin, and Fagaronine formed hydrogen bonds with specific amino acids and exhibited significant binding interactions. These findings suggest that these phytocompounds could be promising candidates for developing antiviral therapies against SARS-CoV-2. Moreover, the study underscores the importance of molecular docking in understanding protein-ligand interactions and its role in drug discovery. The documented pharmacological properties of these compounds in the literature further support their potential therapeutic relevance in various diseases.

A comparative cohort study of post-COVID-19 conditions based on physical examination records in China

BACKGROUND

Coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2 virus infection, is characterized as a multisystem disease, potentially yielding multifaceted consequences on various organs at multiple levels. At the end of 2022, over 90% of the Chinese population was infected by SARS-CoV-2 within 35 days because of adjustments to epidemic prevention and control policies. This short-term change provides an unprecedented opportunity for comparative studies on COVID-19 infection among large populations.

METHODS

In this study, the physical examination data of 136,713 people in the past three consecutive years was employed to study the impact of COVID-19. Standard physical examination data, comprising evaluations of nearly a hundred indicators, were investigated for a comprehensive assessment of COVID-19's effect on human health.

FINDINGS

The results suggested that most indicators remained stable or changed within a permissible range after the COVID-19 outbreak in December 2022, but several specific indicators presented abnormal patterns of varying durations. There was an observed increase in the fraction of T-wave abnormalities during the outbreak, especially in people with chronic diseases such as hypertension, liver steatosis, and hyperglycemia.

INTERPRETATION

These findings highlighted the impact of COVID-19 on cardiovascular health and its potential interaction with chronic diseases.

FUNDING

This work was supported by the National Key Research and Development Program of China (2019YFE0108100), the National Natural Science Foundation of China General Program (82270159, 82070147).

Cytokine Levels in Mother-infant Pairs at Term and Preterm Delivery

BACKGROUND

Cell-mediated immunity (CMI), in addition to the humoral immune response, is crucial in clearing infections. Cytokines are important mediators of the immune system and play a role during pregnancy and childbirth. This study assesses circulating cytokine levels in peripartum maternal and cord blood samples at term and preterm delivery.

MATERIALS AND METHODS

Samples from 37 mother-infant pairs from a previously conducted maternal immunization study were used to quantify levels of 6 cytokines [interferon (IFN)-γ, interleukin (IL)-10, IL-17A, IL-1β, IL-6 and tumor necrosis factor-α] using the Meso Scale Discovery® ultrasensitive S-plex assay. The effect of various factors on measured cytokine levels was determined.

RESULTS

Weak to moderate correlations between maternal and cord blood cytokine levels were found. A trend for lower cytokine levels for preterm compared with term delivery was observed. The trend for lower cytokine levels was also seen for cesarean section compared with vaginal delivery and multiparous compared with primiparous women, but only in maternal serum samples. After correction for other variables, the effects of gestational age at delivery and parity were only significant for, respectively, IFN-γ and IL-6 in maternal serum.

CONCLUSIONS

The assessment of circulating cytokine levels in mother-infant pairs at term and preterm deliveries provides a unique insight into the presence of cytokines in maternal and cord blood and their interplay at delivery. It also highlights the complexity of the maternal-fetal immune relationship and underscores the need for further investigation into the origin of cytokines in newborns and the impact of vaccination in pregnancy on CMI at delivery.

Decoding SARS-CoV-2 Inhibition: Insights From Molecular Dynamics Simulation of Condensed Amino Thiourea Scaffold Small Molecules

The main protease (Mpro) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) plays a crucial role in viral replication. In this study, the binding modes and inhibitory mechanisms of eight condensed amino thiourea scaffold inhibitors of Mpro in proteins were investigated using a combination of molecular docking, molecular dynamics simulations, and MM/PBSA binding free energy calculations. The results indicated that the para-hydroxyl group on the benzene ring at the head of the inhibitor has a decisive influence on the initial docking pose and binding free energy strength of the inhibitor. Additionally, the position and length of the hydrophobic side chain on the tail six-membered ring significantly impacted the final binding pose of the inhibitor. The presence of a long hydrophobic side chain in the ortho position of this ring, through its interaction with the P4 hydrophobic pocket, led to an opposite binding mode in the protein compared with when it was present with or without the para-side chain. Different lengths of para-substituted side chains affected the positioning of the inhibitors in the enzyme. These different binding modes led to variations in the binding free energy between the inhibitor and the protein, which in turn gave rise to differences in inhibitory capability.

Leveraging deep transfer learning and explainable AI for accurate COVID-19 diagnosis: Insights from a multi-national chest CT scan study

The COVID-19 pandemic has emerged as a global health crisis, impacting millions worldwide. Although chest computed tomography (CT) scan images are pivotal in diagnosing COVID-19, their manual interpretation by radiologists is time-consuming and potentially subjective. Automated computer-aided diagnostic (CAD) frameworks offer efficient and objective solutions. However, machine or deep learning methods often face challenges in their reproducibility due to underlying biases and methodological flaws. To address these issues, we propose XCT-COVID, an explainable, transferable, and reproducible CAD framework based on deep transfer learning to predict COVID-19 infection from CT scan images accurately. This is the first study to develop three distinct models within a unified framework by leveraging a previously unexplored large dataset and two widely used smaller datasets. We employed five known convolutional neural network architectures, both with and without pretrained weights, on the larger dataset. We optimized hyperparameters through extensive grid search and 5-fold cross-validation (CV), significantly enhancing the model performance. Experimental results from the larger dataset showed that the VGG16 architecture (XCT-COVID-L) with pretrained weights consistently outperformed other architectures, achieving the best performance, on both 5-fold CV and independent test. When evaluated with the external datasets, XCT-COVID-L performed well with data with similar distributions, demonstrating its transferability. However, its performance significantly decreased on smaller datasets with lower-quality images. To address this, we developed other models, XCT-COVID-S1 and XCT-COVID-S2, specifically for the smaller datasets, outperforming existing methods. Moreover, eXplainable Artificial Intelligence (XAI) analyses were employed to interpret the models' functionalities. For prediction and reproducibility purposes, the implementation of XCT-COVID is publicly accessible at https://github.com/cbbl-skku-org/XCT-COVID/.

Multicentre analysis of severe perioperative adverse events in children undergoing surgery who were infected with SARS-CoV-2: a propensity score-adjusted analysis

BACKGROUND

The incidence of severe adverse events in children with SARS-CoV-2 undergoing anaesthesia has not been well established. We examined the relationship between SARS-CoV-2 infection and severe perioperative adverse events in children.

METHODS

This multicentre (21 North American institutions), retrospective cohort study included children <18 years old, with American Society of Anesthesiologists physical status (ASA PS) of 1-4 and non-severe SARS-CoV-2, who underwent general anaesthesia between April 1, 2020, and March 31, 2021. The primary outcome was the incidence of severe perioperative adverse events (admission to the intensive care unit for escalation of respiratory support, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death) within 7 days of the anaesthetic, assessed using multivariable analysis with inverse probability of treatment weighting by the propensity score. A propensity score mixed-effects model included variables selected a priori. Inverse probability of treatment weighting was used to retain all data while balancing exposure groups on measured confounders.

RESULTS

We matched 1138 patients with SARS-CoV-2 positive testing within 10 days of the anaesthetic to 3396 non-infected controls. The cohort included 56.6% (2568/4534) male patients, 69.9% (2839/4060) White patients, and 63.5% (2879/4533) ASA PS 1-2 patients. General surgery cases comprised 38.4% (1739/4534) of the cohort, followed by orthopaedic surgery at 12.6% (573/4534) and ear, nose, and throat surgery at 8.2% (371/4534). In the overall sample of 4534 patients, 52 had a severe adverse event (0.01%). Children with SARS-CoV-2 had a higher risk of at least one severe adverse event (25/1138 [2.20%] vs 27/3396 [0.80%] in those non-infected; adjusted odds ratio 2.34; 95% confidence interval 1.25-4.39). None of the children with SARS-CoV-2 had a cardiac arrest, required extracorporeal life support, or died.

CONCLUSIONS

In the largest cohort to date of paediatric patients undergoing general anaesthesia, SARS-CoV-2 infection was associated with severe perioperative adverse events, but no children in the infected cohort died.

Religiosity and Health Outcomes in a Cohort of Romanian Patients Hospitalized for COVID-19

There is a growing body of evidence for the interrelation between health status and religious beliefs. Our aim was to evaluate the level of religiosity in patients hospitalized for COVID-19 and to assess the link between religiosity and measurable health outcomes. This was an observational, single-center study which included patients with moderate-to-severe forms of COVID-19. A total of 112 patients were enrolled in the study, of whom 77 were highly religious (CRS-15 score ≥ 4) and 35 non-highly religious (CRS-15 score < 4). There was no difference in demographics or prevalence of comorbidities between the two groups. Furthermore, we found no difference between groups in radiological extension of lung lesions, length of hospital stays, or ICU need; however, in-hospital mortality rate was significantly lower in highly religious group (1% vs. 14%, p = 0.005). Serum ferritin level at admission was significantly lower (p = 0.03) and prevalence of post-COVID-19 pulmonary sequelae significantly higher in highly religious group (p = 0.02).

Impact of SARS-CoV-2 on the male reproductive tract: insights from semen analysis and cryopreservation

PURPOSE

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus behind the COVID-19 pandemic, affects multiple organs, including the male reproductive system. While viral infections can harm male fertility through cytokine storms, the effects of SARS-CoV-2 on fertility are still unclear. Thus, this study aimed to examine the persistence of viral RNA and inflammatory responses in semen following SARS-CoV-2 infection and the safety of conventional freezing and vitrification techniques.

METHODS

Semen samples from 20 patients were collected 3 months post-SARS-CoV-2 infection. Samples underwent freezing and vitrification. Molecular and cellular analysis separated seminal plasma and pellets. Flow cytometry characterized immune cells. Viral RNA was extracted from plasma and sperm, followed by RT-qPCR. Cytometric Bead Array measured cytokine levels.

RESULTS

Angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors were detected in both plasma and sperm fractions. Five patients exhibited viral RNA-dependent RNA polymerase, indicating potential persistence. Elevated inflammatory cytokines in plasma implied persistent inflammation affecting sperm vitality. Immune cells associated with viral clearance were identified in semen, correlating with receptor expression and cytokines. Both conventional freezing and vitrification were found safe procedures for preserving male fertility.

CONCLUSIONS

Our study highlights the impact of SARS-CoV-2 on male reproductive health, emphasizing the persistence of viral entry receptors, potential viral RNA presence, the inflammatory environment, and the involvement of immune populations in the male reproductive tract post-infection. Importantly, we confirm the safety of conventional freezing and vitrification techniques for preserving male fertility in assisted reproductive technology programs amidst the COVID-19 pandemic.

Post-COVID-19 Neutropenia in an Infant With Thalassemia Minor: Case Report

This case of an 11-month-old female who developed severe neutropenia following COVID-19 infection underscores the need for heightened vigilance and monitoring of hematological parameters in infants post-COVID-19. The exact mechanism of COVID-19-induced neutropenia is not fully understood, but it may involve cytokine-induced suppression of hematopoiesis and bone marrow repression due to the inflammatory response. Given the potential for serious clinical implications, including increased susceptibility to infections, it is crucial to effectively identify and manage neutropenia in this vulnerable population. Further research is necessary to elucidate the underlying mechanisms and optimize treatment strategies for COVID-19-related hematological complications in infants.

Airway basal stem cell therapy for lung diseases: an emerging regenerative medicine strategy

Chronic pulmonary diseases pose a prominent health threat globally owing to their intricate pathogenesis and lack of effective reversal therapies. Nowadays, lung transplantation stands out as a feasible treatment option for patients with end-stage lung disease. Unfortunately, the use of this this option is limited by donor organ shortage and severe immunological rejection reactions. Recently, airway basal stem cells (BSCs) have emerged as a novel therapeutic strategy in pulmonary regenerative medicine because of their substantial potential in repairing lung structure and function. Airway BSCs, which are strongly capable of self-renewal and multi-lineage differentiation, can effectively attenuate airway epithelial injury caused by environmental factors or genetic disorders, such as cystic fibrosis. This review comprehensively explores the efficacy and action mechanisms of airway BSCs across various lung disease models and describes potential strategies for inducing pluripotent stem cells to differentiate into pulmonary epithelial lineages on the basis of the original research findings. Additionally, the review also discusses the technical and biological challenges in translating these research findings into clinical applications and offers prospective views on future research directions, therefore broadening the landscape of pulmonary regenerative medicine.

Characteristics and Outcomes of Children Hospitalized With COVID-19 During Early Pandemic and Delta Variant

Background: Children were less affected by severe illness as compared to adults at the start of the COVID-19 pandemic. As the pandemic progressed and variants emerged, pediatric hospitalizations increased, and some previously healthy children developed multisystem inflammatory disorder. The aim of this study was to describe the characteristics and outcomes of children hospitalized with COVID-19 from the beginning of the pandemic through the Δ variant. Methods: Data were collected retrospectively for children hospitalized during March 2020-November 2021 with a diagnosis of COVID-19. Admissions were classified as early pandemic or during the delta variant, and outcomes were compared between the time periods. Primary outcome measures were hospital length of stay and use of respiratory support. The number of admissions/month was the secondary outcome. Results: There were 784 hospital admissions: 400 during early pandemic and 378 during the Δ period. Forty-four percent had an underlying medical condition, and 78% were not eligible for COVID-19 vaccination. Oxygen was the most common respiratory support modality and was required more often during Δ (P < .001). Hospital stay was longer during the Δ period (P < .001), and the number of monthly admissions was higher. A statistically significant but low correlation was identified between body mass index (BMI) Z score and stay (P < .001, r = 0.19). Conclusions: The Δ variant was associated with increased hospital length of stay and use of respiratory support compared to the early pandemic period. Children with preexisting medical conditions were more likely to require respiratory support and have longer hospitalization than others. Higher BMI Z score was also weakly associated with longer length of stay. The reason for admission was attributed to causes other than COVID-19 for the majority of admissions except during the Δ period.

CT scan-derived pectoralis muscle parameters are closely associated with COVID-19 outcomes: A systematic review and meta-analysis

BACKGROUND

The relationships between pectoralis muscle parameters and outcomes in patients with coronavirus disease 2019 (COVID-19) remain uncertain.

METHODS

We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 1 January 2019 to 1 May 2024 to identify non-overlapping studies evaluating pectoralis muscle-associated index on chest CT scan with clinical outcome in COVID-19 patients. Random-effects and fixed-effects meta-analyses were performed, and heterogeneity between studies was quantified using the I2 statistic. The risk of study bias was assessed using the Newcastle-Ottawa scale. Funnel plots for detecting small-study effects.

RESULTS

A total of 9 studies with 4109 COVID-19 patients were included. The meta-analysis findings revealed a correlation between pectoralis muscle parameters and COVID-19 prognosis. Specifically, patients with higher pectoralis muscle density (PMD) exhibited a lower mortality risk, with an odds ratio (OR) of 0.95 (95% CI: 0.92-0.99). The rate of intubation was lower in COVID-19 patients with a high pectoralis muscle index (PMI) (OR =  0.96, 95% CI: 0.92-1.00).

CONCLUSION

In summary, a low PMD is associated with a marginally elevated risk of mortality, whereas a decreased PMI represents a risk factor for intubation in COVID-19 patients. These findings suggest that pectoralis muscle parameters on chest CT may be a useful prognostic tool for COVID-19 patients.

Respiratory Muscle Dysfunction and Associated Risk Factors Following COVID-19-Related Hospitalisation

BACKGROUND

Studies have highlighted long-term respiratory muscle dysfunction in COVID-19 survivors, although the underlying risk factors remain unclear. This single-centre study assessed respiratory muscle function and individual associated factors at follow-up in patients hospitalised with COVID-19 and related acute respiratory failure.

METHODS

Data were collected for consecutive patients, aged ≥ 18 years, at the post-COVID outpatient service of Hospital Policlinico in Modena (Italy) in the time frame of 3 to 6 months after discharge. Data were analysed using single and multiple logistic regression models. Correlations among MIP/MEP, hand-grip values, and lung function were further explored.

RESULTS

Out of 223 patients (mean age 67 years, 69% male) 121 (54.3%) exhibited MIP or MEP dysfunction, which was found to be associated with the use of non-invasive ventilation (aOR = 1.91 [1.07-3.49], p = 0.04) and female gender (aOR = 1.76 [1.09-4.16], p = 0.03) as independent risk factors. A positive correlation was observed between MIP dysfunction and hand-grip strength (p = 0.03 and 0.01), whereas both MIP and MEP were significantly associated with FEV1, FVC, TLC, and DLCO.

CONCLUSIONS

Respiratory muscle dysfunction is consistently prevalent and parallels peripheral muscle weakness and the lung function level in patients at follow-up after severe COVID-19. The need for non-invasive ventilation during the acute phase and female gender might represent risk factors. MIP/MEP assessment should be recommended to observe respiratory muscle dysfunction in severe post-COVID survivors.

The prevalence and outcomes of viremia in patients with acute respiratory viral infection: a systematic review and meta-analysis

BACKGROUND

Viremia has been detected in a significant proportion of patients with acute respiratory viral infection, yet its clinical value remains underappreciated.

OBJECTIVES

This study synthesized available evidence to comprehensively assess the prevalence of viremia and its impact on clinical outcomes.

METHODS

Data sources: Data were retrieved from Medline (via Ovid), Embase, and the WHO COVID-19 database.

STUDY ELIGIBILITY CRITERIA

This review included original clinical studies analysing the prevalence of viremia in patients with acute respiratory viral infection or its association with clinical outcomes, while excluding non-original research, insufficiently detailed studies, inconsistent pathogen observations, or those with inadequate sample sizes.

PARTICIPANTS

Patients with acute respiratory viral infection.

ASSESSMENT OF RISK OF BIAS

Newcastle-Ottawa scale and an adapted version were used.

EXPOSURE

Respiratory viral infection-related viremia.

METHODS OF DATA SYNTHESIS

Data synthesis utilized random-effects models to pool prevalence and hazard ratio (HR), OR, and adjusted HR/OR for clinical outcomes.

RESULTS

In the comprehensive analysis of viremia prevalence, data were pooled from 101 studies, which included a total of 16,388 non-overlapping patients. Viremia was present in 34% (95% CI, 28-41%) of patients with acute respiratory viral infection. A total of 45 studies provided information on the clinical outcomes of 2002 patients with viremia and 3907 patients without viremia. Viremia was associated with increased risks of mortality (OR, 6.83; 95% CI, 4.92-9.48; adjusted HR, 2.91; 95% CI, 1.87-4.53; adjusted OR, 3.68; 95% CI, 2.37-5.71), intensive care unit admission (OR, 4.74; 95% CI, 2.66-8.46; adjusted OR, 4.89; 95% CI, 1.61-14.91), mechanical ventilation (OR, 4.12; 95% CI, 2.25-7.52), and hepatic complications (OR, 3.10; 95% CI, 1.30-7.40).

CONCLUSIONS

Viremia is prevalent in patients with respiratory viral infection and is associated with elevated risks of adverse clinical outcomes.

Political economics in health and implications for neurosurgery diseases

The field of political economics in health has a significant and far-reaching impact on public health. It encompasses a diverse range of interconnected domains, including the economy, welfare, the environment, food and drug safety, pollution emissions, occupational safety, the quality of medical services, consumer rights, public health policy, healthcare policy, scientific research, and marketing management. In this review, we examine the global influence of political economics on health outcomes and delineate the impact of prevalent neurosurgical conditions on individual and collective healthcare resources. This review will discuss the effects of political-economic factors on the prevalence and treatment of neurosurgical diseases, including stroke, traumatic brain injury (TBI), intracerebral hemorrhage (ICH), and brain malignant tumors. Furthermore, the current challenges and future directions will be discussed. We intend this review to facilitate the exchange and integration of political economics, public health, and neurosurgery, provide a foundation for policy development, enhance the prevention, diagnosis, and treatment of neurosurgical diseases, and ultimately promote public health.

Correlation of diabetes and adverse outcomes in hospitalized COVID-19 patients admitted to a tertiary hospital in China during a small-scale COVID-19 outbreak

Background

The aim of this study was to investigate the impact of diabetes on mortality and adverse outcomes in COVID-19 patients and to analyse the associated risk factors.

Methods

This is a retrospective cohort study in 500 hospitalized patients with COVID-19 infection (214 with diabetes and 286 without diabetes) admitted to a tertiary hospital in China from December 2022 to February 2023. Demographic information, clinical characteristics and outcomes were collected. Survival status was investigated at discharge and at 6 months after discharge.

Results

The mortality rate of COVID-19 patients with diabetes was higher than the rate of non-diabetic COVID-19 patients, both at discharge, and at 6 months after discharge. Body mass index (BMI), C-reactive protein (CRP), pH, D-dimer, blood osmotic pressure, serum creatinine, white blood cell count, creatine kinase and hospitalization expenses were significantly different between diabetic group and non-diabetic group (p < 0.05). Compared with the survivors, non-survived COVID-19 patients with diabetes had worse diabetes control indicators, with random blood glucose increased by 3.58 mmol/L (p < 0.05), and fasting blood glucose increased by 2.77 mmol/L (p < 0.01). In addition, there were significant differences in age, heart rate, CRP, pH, potassium (K+), serum creatinine, white blood cell count, creatine kinase, the proportion with diabetic complications, treatment in ICU and mechanical ventilation between survivors and non-survivors of COVID-19 patients with diabetes. By multivariate logistic regression analysis, the death of COVID-19 patients with diabetes is positively correlated with age and CRP (p < 0.05), and has a trend towards significance with fasting blood glucose (p < 0.1).

Conclusion

Infection with COVID-19 on the basis of diabetes can significantly increase mortality, which was further associated with diabetes control indicators.

Severe central nervous system injury in 9 children with COVID-19

PURPOSE

To investigate the clinical features and prognosis of severe central nervous system (CNS) injury in children caused by coronavirus disease 2019 (COVID-19).

METHOD

We retrospectively studied confirmed pediatric cases of COVID-19 complicated with CNS injury.

RESULTS

Nine patients diagnosed with COVID-19 complicated with severe CNS injury were admitted to the pediatric intensive care unit of the Affiliated Hospital of Jining University from December 1, 2022 to January 12, 2023. Of the nine patients, seven were male (77.78%). Five children were aged ≥ 10 years, and the others were 1-2 years old. All children had fever, eight had convulsions, seven had progressed to multiple organ failure, and all suffered varying degrees of coma. Most of the children had elevated interleukin-6 (100%), lactic acid (100%), alanine transaminase (87.5%), aspartate transaminase (87.5%), creatine kinase MB (87.5%), and lactate dehydrogenase (85.7%) levels. Four children had cerebrospinal fluid proteinnacell separation. The cranial imaging results of five children were abnormal. One child had lost his vital signs when admitted to hospital, and the remaining eight received hormonal shock, human immunoglobulin transfusion, antinainfection, cranial pressure reduction, and tracheal intubation, among others, during hospitalization. Ultimately, eight children died, and the remaining child has serious neurological sequelae and is undergoing rehabilitation.

CONCLUSIONS

Severe CNS injury caused by COVID-19 has an acute onset, rapid progression, high disability rate, and high fatality rate. A low cerebrospinal fluid protein level may be a protective factor for children with severe nervous system injury caused by COVID-19.

Inhaled Aviptadil Is a New Hope for Recovery of Lung Damage due to COVID-19

OBJECTIVE

We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients.

METHODS

A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements.

RESULTS

The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects.

CONCLUSION

Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia.

OBJECTIVE

We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients.

METHODS

A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements.

RESULTS

The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects.

CONCLUSION

Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia.

Risk factors for delirium in patients with COVID-19: A systematic review and meta-analysis

Delirium is one of the serious neurological complications of Coronavirus Disease 2019 (COVID-19) and is associated with significant morbidity and mortality in patients with COVID-19, especially in older patients. There is currently no meta-analysis of risk factors for delirium in patients with COVID-19. This study aimed to identify potential risk factors for delirium in patients with COVID-19 through a meta-analysis of observational clinical studies. In conducting this analysis, literature searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science, and study quality was assessed using the Newcastle-Ottawa Quality Scale (NOS). Data were extracted independently by two reviewers and pooled using either fixed effects or random effects models based on the results of heterogeneity testing. As a result of this meta-analysis, a total of 21 studies were included, including 10,147 patients. The analysis revealed the identification of 26 predisposing factors and 54 precipitating factors associated with COVID-19-related delirium. Notably, the administration of hydrocortisone and azithromycin, among other specific medications designated for COVID-19, exhibited a potential to be positively associated with the incidence of delirium in patients afflicted with COVID-19. In conclusion, the present study identified potential predisposing and precipitating factors linked with delirium in COVID-19 patients. It is anticipated that these results will have a considerable impact on the management and treatment of delirium in COVID-19 patients.

SARS-CoV-2 S, M, and E Structural Glycoproteins Differentially Modulate Endoplasmic Reticulum Stress Responses

We have previously shown that the hepatitis C virus (HCV) E1E2 envelope glycoprotein can regulate HIV-1 long-terminal repeat (LTR) activity through disruption to NF-κB activation. This response is associated with upregulation of the endoplasmic reticulum (ER) stress response pathway. Here, we demonstrate that the SARS-CoV-2 S, M, and E but not the N structural protein can perform similar downmodulation of HIV-1 LTR activation, and in a dose-dependent manner, in both HEK293 and lung BEAS-2B cell lines. This effect is highest with the SARS-CoV-2 Wuhan S strain and decreases over time for the subsequent emerging variants of concern (VOC), with Omicron providing the weakest effect. We developed pseudo-typed viral particle (PVP) viral tools that allowed for the generation of cell lines constitutively expressing the four SARS-CoV-2 structural proteins and utilising the VSV-g envelope protein to deliver the integrated gene construct. Differential gene expression analysis (DGEA) was performed on cells expressing S, E, M, or N to determine cell activation status. Gene expression differences were found in a number of interferon-stimulated genes (ISGs), including IF16, IFIT1, IFIT2, and ISG15, as well as for a number of heat shock protein (HSP) genes, including HSPH1, HSPA6, and HSPBP1, with all four SARS-CoV-2 structural proteins. There were also differences observed in expression patterns of transcription factors, with both SP1 and MAVS upregulated in the presence of S, M, and E but not the N protein. Collectively, the results indicate that gene expression patterns associated with ER stress pathways can be activated by SARS-CoV-2 envelope glycoprotein expression. The results suggest the SARS-CoV-2 infection can modulate an array of cell pathways, resulting in disruption to NF-κB signalling, hence providing alterations to multiple physiological responses of SARS-CoV-2-infected cells.

Selective phosphodiesterase 4 inhibitor roflumilast reduces inflammation and lung injury in models of betacoronavirus infection in mice

OBJECTIVE

We aimed to understand the potential therapeutic and anti-inflammatory effects of the phosphodiesterase-4 (PDE4) inhibitor roflumilast in models of pulmonary infection caused by betacoronaviruses.

METHODS

Mice were infected intranasally with murine hepatitis virus (MHV-3) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Roflumilast was given to MHV-3-infected mice therapeutically at doses of 1 mg/kg or 10 mg/kg, or prophylactically at 10 mg/kg. In SARS-CoV-2-infected mice, roflumilast was given therapeutically at a dose of 10 mg/kg. Lung histopathology, chemokines (CXCL-1 and CCL2), cytokines (IL-1β, IL-6, TNF, IFN-γ, IL-10 and TGFβ), neutrophil immunohistochemical staining (Ly6G+ cells), macrophage immunofluorescence staining (F4/80+ cells), viral titration plaque assay, real-time PCR virus detection, and blood cell counts were examined.

RESULTS

Therapeutic treatment with roflumilast at 10 mg/kg reduced lung injury in SARS-CoV-2 or MHV-3-infected mice without compromising viral clearance. In MHV-3-infected mice, reduced lung injury was associated with decreased chemokines levels, prevention of neutrophil aggregates and reduced macrophage accumulation in the lung tissue. However, the prophylactic treatment strategy with roflumilast increased lung injury in MHV-3-infected mice.

CONCLUSION

Our findings indicate that therapeutic treatment with roflumilast reduced lung injury in MHV-3 and SARS-CoV-2 lung infections. Given the protection induced by roflumilast in inflammation, PDE4 targeting could be a promising therapeutic avenue worth exploring following severe viral infections of the lung.