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

Risk factors for SARS-CoV-2 pneumonia among renal transplant recipients in Omicron pandemic-a prospective cohort study

BACKGROUND

The coronavirus disease (COVID-19) pandemic is a global health emergency, and SARS-CoV-2 pneumonia poses significant challenges to health systems worldwide. Renal transplant recipients (RTRs) are a special group and are more vulnerable to viral pneumonia. However, few studies have elucidated the risk factors of SARS-CoV-2 pneumonia in RTRs infected with COVID-19. This study aimed to build a risk prediction model for SARS-CoV-2 pneumonia among RTRs based on demographic and clinical information.

METHODS

We conducted a prospective cohort study among 383 RTRs (age ≥ 18 years) diagnosed with COVID-19 from December 21, 2022, to March 26, 2023. Patients' demographic and clinical information was collected through a questionnaire survey combined with electronic medical records. A stepwise logistic regression model was established to test the predictors of SARS-CoV-2 pneumonia. We assessed the diagnostic performance of the model by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) and calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test.

RESULTS

Our study showed that the incidence of SARS-CoV-2 pneumonia among RTRs was 31.1%. Older age (OR = 2.08-3.37,95%CI:1.05-7.23), shorter post-transplantation duration (OR = 0.92,95% CI: 0.87,0.99), higher post-transplant Charlson Comorbidity Index (CCI) (OR = 1.84, 95%CI: 1.14,2.98), pulmonary infection history (OR = 3.44, 95%CI: 1.459, 8.099, P = 0.005), fatigue (OR = 2.11, 95%CI: 1.14, 3.90), cough (OR = 2.03, 95%CI: 1.08, 3.81), and lower estimated glomerular filtration rate (eGFR) at COVID-19 diagnosis (OR = 0.98, 95%CI:0.97,0.99) predicted a higher risk for SARS-CoV-2 pneumonia. The model showed good diagnostic performance with Chi-Square = 10.832 (P > 0.05) and AUC = 0.839 (P < 0.001).

CONCLUSIONS

Our study showed a high incidence of SARS-CoV-2 pneumonia among RTRs, and we built a risk prediction model for SARS-CoV-2 pneumonia based on patients' demographic and clinical characteristics. The model can help identify RTRs infected with COVID-19 at high risk of SARS-CoV-2 pneumonia to inform timely, targeted, and effective prevention and intervention efforts.

Deciphering the lung microbiota in COVID-19 patients: insights from culture analysis, FilmArray pneumonia panel, ventilation impact, and mortality trends

Few studies have analyzed the role of the lung microbiome in the diagnosis of pulmonary coinfection in ventilated ICU COVID-19 patients. We characterized the lung microbiota in COVID-19 patients with severe pneumonia on invasive mechanical ventilation using full-length 16S rRNA gene sequencing and established its relationship with coinfections, mortality, and the need for mechanical ventilation for more than 7 days. This study included 67 COVID-19 ICU patients. DNA extracted from mini-bronchoalveolar lavage fluid and endotracheal aspirates was amplified by PCR with specific 16S primers (27F and 1492R). General and relative bacterial abundance analysis was also conducted. Alpha diversity was measured by the Shannon and Simpson indices, and differences in the microbiota were established using beta diversity. A linear discriminant analysis (LDA) effect size algorithm was implemented to describe biomarkers. Streptococcus spp. represented 51% of the overall microbial abundance. There were no differences in alpha diversity between the analyzed variables. There was variation in bacterial composition between samples that had positive and negative cultures. The genera Veillonella sp., Granulicatella sp., Enterococcus sp. and Lactiplantibacillus sp., with LDA scores > 2, were biomarkers associated with negative cultures. Rothia sp., with an LDA score > 2, was a biomarker associated with mortality.

Global trends in antibiotic consumption during 2016-2023 and future projections through 2030

Antibiotic resistance is a global public health threat. Many factors contribute to this issue, with human antibiotic consumption being significant among them. Analyzing trends and patterns in consumption can aid in developing policies to mitigate the burden of antimicrobial resistance and global disparities in access to antibiotics. Using pharmaceutical sales data licensed from IQVIA, we estimate national-level trends in antibiotic consumption in 67 countries during 2016-2023 and analyze the effects of economic growth and the COVID-19 pandemic. Finally, we estimate global human consumption and project growth through 2030 assuming current trends. We find that estimated antibiotic consumption in reported countries increased 16.3% from 29.5 to 34.3 billion defined daily doses (DDDs) from 2016 to 2023, reflecting a 10.6% increase in the consumption rate from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. Increases were most pronounced in upper-middle- and lower-middle-income countries. While the COVID-19 pandemic significantly reduced consumption globally, this was most pronounced in high-income countries, and in these countries, reductions in antibiotic use in 2020 were sharper, and lasted longer, than in other countries. By 2030, we project that, without reductions in rapidly developing nations, such as investments to improve infrastructure, particularly water and sanitation, along with improved access to vaccination, global antibiotic consumption will increase by 52.3% from an estimated 49.3 billion in 2023 to 75.1 billion DDDs.

Hard Outcomes in Critically Ill Patients with Acute Respiratory Distress Syndrome Caused by SARS-CoV-2 Infection: A Retrospective Cohort Study of 3 Years of Pandemic

Background: The COVID-19 pandemic has exerted immense pressure on healthcare systems, particularly in the management of patients with acute respiratory distress syndrome (ARDS). Identifying predictors of survival in critically ill patients is crucial for optimizing treatment strategies. Methods: A retrospective cohort study was conducted in an Intensive Care Unit (ICU) in Mexico City, spanning from March 2020 to March 2023. This study included patients aged 18 years and older with confirmed COVID-19 who required invasive mechanical ventilation. Logistic regression and Kaplan–Meier analyses were performed to evaluate factors associated with mortality. Results: A total of 157 patients were included, with a mean age of 62.8 years, and 74.5% were male. The 90-day survival rate was 41.4%, with a mortality rate of 58.6%. Acute kidney injury (AKI) (OR = 3.4), hemodynamic failure (OR = 6.5), and elevated lactate levels (OR = 0.201) were significantly associated with increased mortality risk. Kaplan–Meier analysis demonstrated significantly reduced survival among patients with AKI, hemodynamic failure, and hyperlactatemia. Discussion: AKI, hemodynamic instability, and hyperlactatemia emerged as pivotal predictors of mortality. The high incidence of AKI and associated adverse outcomes underscore the urgent need for tailored management strategies in this vulnerable patient cohort. Conclusions: The 90-day survival rate was 41.4%. AKI, hemodynamic failure, and elevated lactate levels were independently associated with increased mortality, highlighting the necessity for focused and strategic interventions.

Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics

BACKGROUND

During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical.

METHODS

We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations.

RESULTS

Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively).

CONCLUSIONS

We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.

Serum endocan (ESM-1) as diagnostic and prognostic biomarker in Multisystem inflammatory syndrome in children (MIS-C)

Endothelial-cell-specific molecule-1 (ESM-1) also called endocan is a well-known biomarker for detecting inflammation, endothelial dysfunction (ED), and cardiovascular (CV) risk in COVID-19 patients. Upon SARS-CoV-2 infection, a small percentage of children develop Multisystem Inflammatory Syndrome in children (MIS-C). Whether endocan can be used as a biomarker of MIS-C is unknown. In this study, we assessed ESM-1 levels in MIS-C (n = 19) and healthy controls (HC; n = 17). We observed a significant increase in serum ESM-1 levels in MIS-C vs HC (p = 0.0074). In addition, ROC curve analysis demonstrated that this factor has a reasonable discriminatory power between MIS-C patients and HC (AUC of 0.7585). Notably, after one week of hospitalization and care, ESM-1 levels decreased, and this reduction was observed also for other inflammatory and pro-thrombotic markers like C-reactive protein, procalcitonin, fibrinogen, D-dimer, and ferritin, suggesting a general recovery trend in MIS-C patients. In fact, we observed that serum ESM-1 levels positively correlated with procalcitonin (PCT) (r = 0.468; p = 0.043). Finally, logistic regression analysis demonstrated an association between endocan levels and cardiac complications like myocarditis. Therefore, this study suggests that ESM-1 is a valuable diagnostic and prognostic biomarker in patients with MIS-C that may help identify those MIS-C patients at higher risk for cardiovascular complications and guide treatment strategies.

Establishment of a human organoid-based evaluation system for assessing interspecies infection risk of animal-borne coronaviruses

The COVID-19 pandemic presents a major threat to global public health. Several lines of evidence have shown that the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), along with two other highly pathogenic coronaviruses, SARS-CoV and Middle East Respiratory Syndrome (MERS-CoV) originated from bats. To prevent and control future coronavirus outbreaks, it is necessary to investigate the interspecies infection and pathogenicity risks of animal-related coronaviruses. Currently used infection models, including in vitro cell lines and in vivo animal models, fail to fully mimic the primary infection in human tissues. Here, we employed organoid technology as a promising new model for studying emerging pathogens and their pathogenic mechanisms. We investigated the key host-virus interaction patterns of five human coronaviruses (SARS-CoV-2 original strain, Omicron BA.1, MERS-CoV, HCoV-229E, and HCoV-OC43) in different human respiratory organoids. Five indicators, including cell tropism, invasion preference, replication activity, host response and virus-induced cell death, were developed to establish a comprehensive evaluation system to predict coronavirus interspecies infection and pathogenicity risks. Using this system, we further examined the pathogenicity and interspecies infection risks of three SARS-related coronaviruses (SARSr-CoV), including WIV1 and rRsSHC014S from bats, and MpCoV-GX from pangolins. Moreover, we found that cannabidiol, a non-psychoactive plant extract, exhibits significant inhibitory effects on various coronaviruses in human lung organoid. Cannabidiol significantly enhanced interferon-stimulated gene expression but reduced levels of inflammatory cytokines. In summary, our study established a reliable comprehensive evaluation system to analyse infection and pathogenicity patterns of zoonotic coronaviruses, which could aid in prevention and control of potentially emerging coronavirus diseases.

Increased risk of arrhythmias, heart failure, and thrombosis in SARS-CoV-2 positive individuals persists at one year post-infection

Risk of cardiovascular events is increased after COVID-19. However, information on cardiovascular risk trends after COVID-19 infection is lacking and estimates by sex are inconsistent. Our aim was to examine cardiovascular outcomes and mortality in a large cohort (164,346 participants) of SARS-CoV-2 positive individuals compared to non-positive individuals, stratified by sex. Data were obtained from the Spanish Health System's electronic medical records. Selected individuals were ≥ 45 years old with/without a positive SARS-CoV-2 test in the period March-May 2020. Follow-up was obtained until January 31, 2021, for cardiovascular events (angina/myocardial infarction, arrhythmias, bypass/revascularization, heart failure, peripheral artery disease, stroke/transient ischemic attack, and thrombosis), and until March 31, 2021, for mortality. Individuals were matched by propensity score. Incidence of cardiovascular events and mortality was compared with accelerated failure time models. The effect of matching and of COVID-19 severity was assessed with sensitivity analyses. In the first 3 months of follow-up, SARS-CoV-2 positive individuals had a higher risk of mortality and of all cardiovascular events. From 4-12 months, there was increased risk of mortality in SARS-CoV-2 positive individuals overall, of heart failure in SARS-CoV-2 positive females (HR= 1.26 [1.11-1.42]), and of arrhythmias and thrombosis in SARS-CoV-2 positive males (HR= 1.29 [1.14-1.47] and HR= 1.35 [1.03-1.77], respectively). When COVID-19 patients admitted to the ICU were excluded, incidence of thrombosis was similar in males regardless of positive/non-positive SARS-CoV-2 status. In the full year of follow-up, increased incidence of heart failure and of arrhythmias and thrombosis was observed in SARS-CoV-2 positive females and males, respectively.

Examination of diet quality and alcohol on serum IgG levels after first and second COVID-19 vaccines

RATIONALE

The change of IgG of COVID-19 vaccine was thought to be an effect of diet quality or daily habits.

AIMS AND OBJECTIVES

This study aimed to correlate diet quality and healthy living factors with serum IgG response in the blood.

METHODS

Participants were selected from volunteers who had their first vaccination and did not have COVID-19 disease (Male = 21 Female = 40). Serum IgG levels were measured on average (avg) 28 days after the COVID-19 vaccine. Information was obtained directly from the participants by questionnaire method (Food consumption record, frequency of food consumption, Diet Quality Index [(DQI], etc.).

RESULTS

A significant difference was observed in the IgG levels of the second measurement of age (young/middle) and gender (male/female) (p < 0.05). A significant difference was found in the first measurement of serum IgG levels and IgG avgs of those with medium diet quality and those who did not drink alcohol (p < 0.05). When the IgG2/1 ratio was examined between alcohol users and nonalcohol, a significant increase was observed about two times in non-alcohol users (p = 0.039). There is a positive significant moderate strength relationship between the second measurements of IgG and anthropometric measurements and the first, second, and avg measurements of IgG with DQI. It was found that there was a negative significant medium-strength relationship between individuals' amount of alcohol consumption and IgG avg (r = -0.535, p = 0.009).

CONCLUSIONS

Medium diet quality has been seen to affect antibody levels positively. At the same time, it is thought that alcohol use negatively affects serum IgG antibody response in the long term. Other than that, there was shown to be a correlation between IgG levels and DQI.

Clonal landscape of autoantibody-secreting plasmablasts in COVID-19 patients

Whereas severe COVID-19 is often associated with elevated autoantibody titers, the underlying mechanism behind their generation has remained unclear. Here we report clonal composition and diversity of autoantibodies in humoral response to SARS-CoV-2. Immunoglobulin repertoire analysis and characterization of plasmablast-derived monoclonal antibodies uncovered clonal expansion of plasmablasts producing cardiolipin (CL)-reactive autoantibodies. Half of the expanded CL-reactive clones exhibited strong binding to SARS-CoV-2 antigens. One such clone, CoV1804, was reactive to both CL and viral nucleocapsid (N), and further showed anti-nucleolar activity in human cells. Notably, antibodies sharing genetic features with CoV1804 were identified in COVID-19 patient-derived immunoglobulins, thereby constituting a novel public antibody. These public autoantibodies had numerous mutations that unambiguously enhanced anti-N reactivity, when causing fluctuations in anti-CL reactivity along with the acquisition of additional self-reactivities, such as anti-nucleolar activity, in the progeny. Thus, potentially CL-reactive precursors may have developed multiple self-reactivities through clonal selection, expansion, and somatic hypermutation driven by viral antigens. Our results revealed the nature of autoantibody production during COVID-19 and provided novel insights into the origin of virus-induced autoantibodies.

The lethal K18-hACE2 knock-in mouse model mimicking the severe pneumonia of COVID-19 is practicable for antiviral development

Animal models of COVID-19 facilitate the development of vaccines and antivirals against SARS-CoV-2. The efficacy of antivirals or vaccines may differ in different animal models with varied degrees of disease. Here, we introduce a mouse model expressing human angiotensin-converting enzyme 2 (ACE2). In this model, ACE2 with the human cytokeratin 18 promoter was knocked into the Hipp11 locus of C57BL/6J mouse by CRISPR - Cas9 (K18-hACE2 KI). Upon intranasal inoculation with high (3 × 105 PFU) or low (2.5 × 102 PFU) dose of SARS-CoV-2 wildtype (WT), Delta, Omicron BA.1, or Omicron BA.2 variants, all mice showed obvious infection symptoms, including weight loss, high viral loads in the lung, and interstitial pneumonia. 100% lethality was observed in K18-hACE2 KI mice infected by variants with a delay of endpoint for Delta and BA.1, and a significantly attenuated pathogenicity was observed for BA.2. The pneumonia of infected mice was accompanied by the infiltration of neutrophils and pulmonary fibrosis in the lung. Compared with K18-hACE2 Tg mice and HFH4-hACE2 Tg mice, K18-hACE2 KI mice are more susceptible to SARS-CoV-2. In the antivirals test, REGN10933 and Remdesivir had limited antiviral efficacies in K18-hACE2 KI mice upon the challenge of SARS-CoV-2 infections, while Nirmatrelvir, monoclonal antibody 4G4, and mRNA vaccines potently protected the mice from death. Our results suggest that the K18-hACE2 KI mouse model is lethal and stable for SARS-CoV-2 infection, and is practicable and stringent to antiviral development.

Elevated serum mtDNA in COVID-19 patients is linked to SARS-CoV-2 envelope protein targeting mitochondrial VDAC1, inducing apoptosis and mtDNA release

Mitochondria dysfunction is implicated in cell death, inflammation, and autoimmunity. During viral infections, some viruses employ different strategies to disrupt mitochondria-dependent apoptosis, while others, including SARS-CoV-2, induce host cell apoptosis to facilitate replication and immune system modulation. Given mitochondrial DNAs (mtDNA) role as a pro-inflammatory damage-associated molecular pattern in inflammatory diseases, we examined its levels in the serum of COVID-19 patients and found it to be high relative to levels in healthy donors. Furthermore, comparison of serum protein profiles between healthy individuals and SARS-CoV-2-infected patients revealed unique bands in the COVID-19 patients. Using mass spectroscopy, we identified over 15 proteins, whose levels in the serum of COVID-19 patients were 4- to 780-fold higher. As mtDNA release from the mitochondria is mediated by the oligomeric form of the mitochondrial-gatekeeper-the voltage-dependent anion-selective channel 1 (VDAC1)-we investigated whether SARS-CoV-2 protein alters VDAC1 expression. Among the three selected SARS-CoV-2 proteins, small envelope (E), nucleocapsid (N), and accessory 3b proteins, the E-protein induced VDAC1 overexpression, VDAC1 oligomerization, cell death, and mtDNA release. Additionally, this protein led to mitochondrial dysfunction, as evidenced by increased mitochondrial ROS production and cytosolic Ca2+ levels. These findings suggest that SARS-CoV-2 E-protein induces mitochondrial dysfunction, apoptosis, and mtDNA release via VDAC1 modulation. mtDNA that accumulates in the blood activates the cGAS-STING pathway, triggering inflammatory cytokine and chemokine expression that contribute to the cytokine storm and tissue damage seen in cases of severe COVID-19.

Placenta a potential gateway of prenatal SARS-CoV-2 infection: A review

SARS-CoV-2, the causative agent of COVID-19, can infect various tissues in the body apart from the lungs. Although placental infection remains controversial, COVID-19-associated placental abnormalities have been reported worldwide. Therefore, COVID-19 poses a significant risk for fetal distress as well. Scientists are currently debating whether such distress results from direct viral induced assault or placental damage caused by the mother's immune response. The placenta develops different histopathological lesions in response to maternal SARS-CoV-2 infection. While some studies support both theories, the transmission rate through the placenta remains low. Therefore, a more in-depth study is necessary to determine the primary cause of maternal SARS-CoV-2-induced fetal distress. This comprehensive review is aimed to shed light on the possible reasons towards fetal distress among mothers with COVID-19. This review describes the various mechanisms of viral entry along with the mechanisms by which the virus could affect the placenta. Reported cases of placental abnormalities and fetal distress symptoms have been collated to provide an overview of the current state of knowledge on vertical transmission of COVID-19.

Viral Rebound After Antiviral Treatment: A Mathematical Modeling Study of the Role of Antiviral Mechanism of Action

The development of antiviral treatments for SARS-CoV-2 was an important turning point for the pandemic. Availability of safe and effective antivirals has allowed people to return back to normal life. While SARS-CoV-2 antivirals are highly effective at preventing severe disease, there have been concerning reports of viral rebound in some patients after cessation of antiviral treatment. In this study, we use a mathematical model of viral infection to study the potential of different antivirals to prevent viral rebound. We find that antivirals that block production are most likely to result in viral rebound if the treatment time course is not sufficiently long. Since these antivirals do not prevent infection of cells, cells continue to be infected during treatment. When treatment is stopped, the infected cells will begin producing virus at the usual rate. Antivirals that prevent infection of cells are less likely to result in viral rebound since cells are not being infected during treatment. This study highlights the role of antiviral mechanism of action in increasing or reducing the probability of viral rebound.

CD151 identifies an NK cell subset that is enriched in COVID-19 patients and correlates with disease severity

Severe coronavirus disease 2019 (COVID-19) often leads to acute respiratory distress syndrome and multi-organ dysfunction, driven by a dysregulated immune response, including a cytokine storm with elevated proinflammatory cytokine levels. Natural killer (NK) cells are part of the innate immune system with a fundamental role in the defense against viral infections. However, during COVID-19 acute infection, they exhibit an altered phenotype and impaired functionality contributing to the immunopathogenesis of the disease. In this work, we have studied a cohort of patients with COVID-19 (ranging from mild to severe) by analyzing IL-15, TGF-β, PlGF and GDF-15 plasma levels and performing multiparametric flow cytometry studies. Our results revealed that severe COVID-19 patients exhibited high levels of IL-15, PlGF and GDF-15, along with an enrichment of an NK cell subset expressing the CD151 tetraspanin, which correlated with IL-15 plasma levels and disease severity. In patients, these CD151+ NK cells displayed a more activated phenotype characterized by an increased expression of HLA-DR, CD38 and granzyme B, a distinct receptor repertoire, with lower levels of CD160 and CD31 and higher levels of CD55 and, remarkably, a higher expression of tissue-resident markers CD103 and the NK cell decidual marker CD9. Last of all, in individuals with severe disease, we identified an expansion of a CD151brightCD9+ NK cell subset, suggesting that these cells play a specific role in COVID-19. Altogether, our findings suggest that CD151+ NK cells may have a relevant role in COVID-19 immunopathogenesis.

Pre-infection liver function is associated with all-cause mortality among hemodialysis patients with SARS-CoV-2 Omicron variant infection

BACKGROUND

There is ample evidence to suggest that patients infected with SARS-CoV-2 Omicron variant may experience liver dysfunction. However, the impact of pre-infection liver function on postinfection mortality rates remains inadequately researched.

METHODS

Data from 847 hemodialysis (HD) patients, diagnosed with Omicron across six HD centers between December 2022 and February 2023, were analyzed. Initial liver function assessments were conducted, following which patients were monitored for mortality outcomes. The stepwise multivariable Cox regression analysis and receiver operating characteristic (ROC) curves were utilized to identify the predictors of mortality.

RESULTS

From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month postinfection. The deceased patients were observed to be mostly older males with an increased prevalence of diabetes and tumors, signifying higher AST and C-reactive protein levels. These patients also exhibited lower hemoglobin, albumin, and prealbumin levels. An elevated AST [per 1 IU increment; HR 1.04 (95% CI 1-1.04), p = 0.026], AST/ALT ratio [per 1 increment; HR 1.52 (95% CI 1.27-2.36), p = 0.004], and reduced prealbumin [per 10 mg/L increment; HR 0.93 (95% CI 0.9-0.96), p < 0.001] were discovered to be independent indicators of an increased mortality risk. Notably, AST, AST/ALT ratio, and prealbumin proved significant predictors of mortality (AUC values were 0.59, 0.65, and 0.79 respectively).

CONCLUSIONS

This study underscores that pre-infection liver function, specifically AST, AST/ALT ratio, and prealbumin levels, substantially influence the mortality rates in HD patients following Omicron infection. Therefore, careful consideration of these liver function parameters could guide superior patient management strategies and potentially decrease mortality rates within this at-risk population.

The mental health of first- and second-generation migrant vs. native healthcare workers during the COVID-19 pandemic: The VOICE survey of 7,187 employees in the German healthcare sector

The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, ϕ = .156) (all other ϕs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all ϕs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all βs ≤ |.030|, anxiety: all βs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.

Vaccine challenges in CLL: a comprehensive exploration of efficacy of SARS-CoV-2 immunization for patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is characterized by disease- and treatment-related immunosuppression. Patients with CLL comprise a vulnerable population to coronavirus disease 2019 (COVID-19), while the protective effect of COVID-19 vaccination remains uncertain.We conducted a systematic review to evaluate published data reporting response to COVID-19 vaccination in patients with CLL. The primary outcome was the rate of seropositivity after full primary vaccination, while secondary outcomes were rates of positive neutralizing antibodies, cellular responses, and adverse events. Response after booster doses of vaccination was also evaluated.Twenty-three studies of full primary vaccination (12 CLL-specific with 1747 patients, 11 with mixed hematologic diseases including 1044 patients with CLL) with a total of 2791 patients, and eight studies on booster doses with 389 patients were included in the analysis. The serologic response varied between studies with a median of 55%. Where reported, the median neutralizing antibody response rate was 61.2% and the cellular response rate was 44.2%. Poor serologic response was noted in patients under active treatment with anti-CD20 monoclonal antibodies, BCL2, and BTK inhibitors.The present review highlights the substantially impaired humoral and cellular response to COVID-19 vaccination in patients with CLL with patients under active treatment being the most vulnerable.

Anal fissures in COVID-19 survivors: Incidence, risk factors, and outcomes

Objectives

In spite of COVID-19's typical presentation in the form of fever, cough, myalgia, and pneumonia, other gastrointestinal manifestations have been reported. Among the COVID-19 survivors, anal fissure has been documented. The aim of this study was to report the incidence of anal fissure among those patients, its possible risk factors and outcome.

Material and Methods

This is a retrospective cross-sectional study which was conducted on COVID-19 patients' who were diagnosed with anal fissure. Those who survived and were discharged home safely were contacted to pick up whether they suffered from any symptoms suggesting anal fissure, to identify the risk factors of anal fissure and their outcomes.

Results

A total of 176 COVID-19 patients were enrolled in this study. The incidence of anal fissure among all patients was 36.9%. Patients were categorized into two groups; fissure and non-fissure groups. No significant difference was noted in the demographic data apart from age, which was younger in the fissure group. The majority of anal fissures resolved spontaneously after patients recovered from the COVID-19 symptoms with no specific treatment (43.1%).

Conclusion

Anal fissure is quite a common problem in COVID-19 patients. Young and middle-aged patients are more vulnerable to develop anal fissure after COVID-19 infection.

Clinical, biochemical, and genetic study of TACE/TNF-α/ACE signaling pathway in pediatric COVID-19 infection

BACKGROUND

Pediatric patients infected with coronavirus disease 2019 (COVID-19) have unique clinical characteristics. Tumor necrosis factor (TNF) is a proinflammatory cytokine that greatly contributes to tumor pathogenesis.

PURPOSE

To describe the presenting characteristics of COVID-19 infection among pediatric patients, and investigate the possible role of the TNF-α signaling pathway.

METHODS

This prospective case-control study included 50 Egyptian pediatric patients with COVID-19 and 50 healthy controls. Clinical, laboratory, and radiological assessments were performed. Serum TNF-alpha (TNF-α), TNF-α-converting enzyme (TACE), and angiotensin-converting enzyme 2 (ACE2) were measured using enzyme-linked immunosorbent assay. ACE (I/D) (rs4646994), ACE2 rs2285666, and TNF-α-308G/A single nucleotide polymorphisms (SNPs) were performed using conventional polymerase chain reaction techniques with or without restriction fragment length polymorphism.

RESULTS

The median age was 1 year (interquartile range [IQR], 0.31-2.50 years) in the case group and 1.45 years (IQR, 1.00-3.00) in the control group. The main presenting symptoms were fever (92%), dry cough (74%), and dyspnea (72%). The lymphocytic count was normal in 14 patients (28%), decreased in 16 patients (32%), and increased in 20 patients (40%) of the case group. Positive chest computed tomography finding of COVID-19 infection were demonstrated among 40% of patients using COVID-19 Reporting and Data System categories (ground-glass opacity with or without consolidations in the lungs). There were significant increased serum TACE and TNF-α with decreased ACE2 levels among cases versus controls (P< 0.001). The GG genotype and G allele of the TNF-α-308G/A SNP were significantly higher in patients than in controls (P<0.05 for both), with insignificant differences in genotype and allelic frequencies in the ACE (I/D) (rs4646994) and ACE2 rs2285666 SNPs.

CONCLUSION

The TNF signaling pathway was significantly activated in pediatric COVID-19 infection. Only the TNF-α-308G/A SNP was significantly associated with pediatric COVID-19 infection.

Screening potential biomarkers for acute respiratory infectious diseases from antipyretics, antiviral, and antibiotics in wastewater

Since the onset of COVID-19, respiratory diseases have emerged as a focal concern within the field of public health. This study aims to reveal the prevalence of acute respiratory infectious diseases by screening antipyretic, antiviral, and antibiotic biomarkers through wastewater analysis. Samples were collected over a seven-day period each year in 2022, 2023, and 2024 from a northern city in China, assessing the concentrations of two antipyretics (paracetamol and ibuprofen), one antiviral drug (oseltamivir), eleven antibiotics, and three pathogens (influenza A, influenza B, and Mycoplasma pneumoniae). The usage of most antipyretics and antibiotics was higher in 2023 and 2024, primarily due to the outbreak of COVID-19 in 2023 and the prevalence of influenza A, influenza B, and Mycoplasma pneumoniae in 2024. The prevalence assessed using antipyretics (2.68 %) and pathogens (2.70 %) demonstrated a high degree of consistency, whereas the prevalence estimated using antibiotics and antiviral drugs was only 0.53 % and 0.36 %, respectively. Antibiotics are generally used to treat a broad spectrum of bacterial infections rather than targeting a specific pathogen, so their presence in wastewater may not directly reflect the prevalence of a particular disease. In contrast, antipyretics and specific pathogens exhibit a stronger correlation, suggesting that they may serve as more reliable biomarkers than antiviral and antibiotic drugs. The research findings offer alternative biomarkers, such as antipyretics, aside from pathogens, for the assessment of acute respiratory infectious diseases.

Adherence to COVID-19 preventive measures and associated factors among high school students in Northwest Ethiopia: a cross-sectional study

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) is a respiratory infection that is spreading worldwide. The WHO has recommended public health preventive measures for COVID-19 prevention and control. Adherence to COVID-19 preventive measures is important for disease prevention and control of the disease's spread. So, implementing preventive measures plays an essential role in reducing the spread of COVID-19 infection. This study aimed to assess the adherence status toward COVID-19 preventive measures and associated factors among high school students.

METHODS

528 high school students participated in an institutional-based cross-sectional study. A multistage sampling technique and a systematic random sampling method were applied to select the study participants. The data was entered into EpiData V.3.1 and then exported to SPSS V.23 for analysis. Bivariate and multivariable logistic regressions were computed. The significance of the association was declared by a 95% CI of adjusted OR (AOR) and a p value<0.05 in the multivariate model.

RESULT

A total of 528 respondents participated in the study, with a 100% response rate. The overall adherence level of high school students toward COVID-19 prevention measures was 110 (20.8%, 95% CI: 17.4%, 24.6%). The mean(±SD) age of the respondents was 18 (SD 11±2) years, which ranges from 16 to 24 years, and 387 (73.3%) were in the age group of 19-20 years, The majority of the students (418; 79.2%, 95% CI: 75.4, 82.6) had poor adherence to COVID-19 preventive measures. 345 (65.3%) had good knowledge, 328 (62.1%) had unfavourable attitudes and 390 (73.9%) had poor risk perception for COVID-19 preventive measures. This study revealed that most (89.9%) of the high school students did not maintain a physical distance of 2 m away, 84.4% of the students had no regular handwashing practice, majority 71.4% of the students did not use facemasks/covered their face during coughing and 62.9% of the students had no face mask and 54% of the students did not use sanitiser or alcohol per recommendation. This study revealed that sex (AOR: 2.42, 95% CI: 1.46, 4.02), attitude (AOR: 4.04, 95% CI: 2.45, 6.68) and risk perception (AOR: 7.60, 95% CI: 4.62, 12.54) were significantly associated with poor adherence toward COVID-19 prevention measures.

CONCLUSION

This study's findings revealed that adherence to COVID-19 preventive measures among high school students was very low. Therefore, promoting adherence to COVID-19 preventive measures demands awareness creation and risk communication to build an appropriate level of knowledge, attitude and risk perception.

Difference in the epidemiological and clinical profiles of mortality between the first and second waves of COVID-19 pandemic in a tertiary care hospital of Andaman and Nicobar Islands

BACKGROUND

The Andaman and Nicobar Islands reported the first coronavirus disease 2019 (COVID-19) case on March 26, 2020. This study aimed to describe the epidemiological and clinical profiles of COVID-19 mortality that occurred during the first and second waves of COVID-19 pandemic and to compare the differences between them.

MATERIALS AND METHODS

This was a retrospective cohort study carried out among COVID-19 patients admitted at GB Pant Hospital, Port Blair. Socio-demographic and clinical details were retrieved from the case records using structured proforma. Comparison of the study variables between the first and second waves was done by using Chi-square test using SPSS version 20.

RESULTS

The first wave had total cases of 4994 and 62 deaths, and the second wave had 2734 cases and 67 deaths. The case fatality among COVID-19 cases during the first and second waves of the pandemic was 1.24% and 2.45%, respectively. There was no significant age and gender difference of patients between the two waves. Those who had co-morbidities during the first wave were 52 (83.8%), and those who had co-morbidities during the second wave were 45 (67.2%). The median duration of hospital stay in days during the first and second waves of the pandemic was 4 and 6 days, respectively.

CONCLUSION

There was no significant difference in the age and gender distribution between the two waves; however, those who died during the second wave had a significantly higher percentage of co-morbidities. Therefore, health policy makers should develop a targeted approach to provide appropriate education, support, and awareness of patients with underlying diseases and allocate health care resources accordingly.

Comparative analysis of six nutritional scores in predicting prognosis of COVID-19 patients

Background

Identifying nutritional risk in COVID-19 patients poses a challenge due to the unique qualities of every nutritional screening instrument. The objective was to assess the efficacy of six nutritional scores, including the Nutritional Risk Screening 2002 (NRS-2002) score, the NUTRIC (nutrition risk in the critically ill) score, the modified NUTRIC score, the prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, TCB index (TCBI), predicting prognosis of COVID-19 patients.

Methods

Clinical data were collected from COVID-19 patients admitted to the First Affiliated Hospital of Wenzhou Medical University between December 2022 and February 2023. Participants in this research were divided into two groups: all patients and those specifically from the intensive care unit (ICU). Each group was further stratified into two groups: survivors and non-survivors.

Result

506 COVID-19 patients and 190 COVID-19 patients in intensive care unit (ICU) were evaluated. In all COVID-19 patients, we found that NRS-2002 (p < 0.001) and TCBI (p = 0.002) were statistically significant independent predictors in multivariate analyses, while APACHE II score (p = 0,048) and the mNUTRIC score (p = 0.025) were statistically significant independent predictors in multivariate analyses in ICU patients. The NRS-2002 demonstrated a higher AUC value (0.687) than other nutritional scores in all patients, with an optimum cut-off value of 3, translating into a corresponding sensitivity of 66.2% and specificity of 68.7%. With an optimum cut-off value of 4, the mNUTRIC score demonstrated a higher AUC value (0.884) in ICU patients, resulting in a sensitivity of 88.4% and a specificity of 76.9%. By using the discrimination and clinical application (DCA) curve, NRS-2002 demonstrated the greatest net benefit in all patients, while NUTRIC score and mNUTRIC score offered the more significant overall advantage than other nutritional scores in ICU patients. Kaplan-Meier analyses showed lower survival rates in patients in low nutritional risk.

Conclusion

Malnutrition was common in COVID-19 patients. The mNUTRIC score and NRS-2002 were, respectively, more effctive scoring systems of prognosis in all COVID-19 patients and severe or critical COVID-19 patients of the intensive care unit (ICU).

Serum proteome reveals distinctive molecular features of H7N9- and SARS-CoV-2-infected patients

The coronavirus disease 2019 (COVID-19) pandemic has reminded us of human infections with the H7N9 virus and has raised questions related to the clinical and molecular pathophysiological diversity between the two diseases. Here, we performed a proteomic approach on sera samples from patients with H7N9-virus or SARS-CoV-2-virus infection and healthy controls. Compared to SARS-CoV-2, H7N9-virus infection caused elevated neutrophil concentrations, T cell exhaustion, and increased cytokine/interleukin secretion. Cell-type deconvolution and temporal analysis revealed that T cells and neutrophils could regulate the core immunological trajectory and influence the prognosis of patients with severe H7N9-virus infection. Elevated tissue-enhanced proteins combined with alterations of clinical biochemical indexes suggested that H7N9 infection induced more severe inflammatory organ injury and dysfunction in the liver and intestine. Further mechanical analysis revealed that the high concentration of neutrophils might impact the intestinal enterocyte cells through cytokine-receptor interaction, leading to intestinal damage in patients with H7N9-virus infection.

Dynamics of Biomarkers in COVID-19 Patients Treated with Anakinra

Background: SARS-CoV-2 can trigger hyperinflammation, leading to severe COVID-19, presenting with pneumonia, acute respiratory distress syndrome (ARDS), and multiple organ failure. Specific biomarkers like leukocytes, CRP, NLR, AST, LDH, D-dimer, ferritin, and IL-6 are associated with disease severity. Anakinra, an IL-1 receptor antagonist, has been proposed to mitigate hyperinflammation, but its clinical efficacy remains uncertain. This study aimed to evaluate the effect of Anakinra on inflammatory biomarkers, oxygenation status, and survival outcomes in hospitalized patients with moderate to severe COVID-19 (according to the National Institute of Health severity scale), compared to standard treatment. Methods: A retrospective analysis included 65 patients (mean age 75.51 ± 9.54 years; 58.5% male, 41.5% female) hospitalized with moderate to severe COVID-19. Patients were divided into two groups: a control group receiving standard treatment (n = 24) and a target group treated with Anakinra (n = 41). Biomarkers and oxygenation status were assessed on Days 0, 3, and 7. Statistical analyses compared the groups for changes in leukocytes, NLR, CRP, AST, LDH, D-dimer, ferritin, and IL-6. Results: Anakinra treatment was associated with significant reductions in leukocytes, NLR, D-dimer, ferritin, IL-6, and CRP by Days 3 and 7. Improvements in oxygenation status were observed, although no survival benefits were noted. The control group showed no significant biomarker changes except for AST and LDH on Day 7. Conclusions: Anakinra demonstrated favorable effects on biomarkers and oxygenation in moderate to severe COVID-19 but did not improve survival. Further studies are needed to validate these findings.

Characteristics of cytokines/chemokines associated with disease severity and adverse prognosis in COVID-19 patients

Background

Cytokines and chemokines as crucial participants in innate immune response play significant roles during SARS-CoV-2 infection, yet excessive immune response exacerbates the severity of COVID-19.

Purpose

This study aims to investigate the involvement of which cytokines/chemokines in the cytokine storm of COVID-19, as well as the changes in cytokine/chemokine levels during the course of COVID-19, simultaneously exploring the diagnostic and prognostic value of the relevant cytokines/chemokines for COVID-19.

Methods

Flow cytometry was employed to detect the levels of cytokines and chemokines in the serum of 50 COVID-19 patients.

Results

Compared with severe COVID-19 patients, the levels of cytokines IL-6, IL-8, IL-10, sCD25, and chemokines IP-10 and MIG in the peripheral blood of non-severe patients were significantly reduced, while only IL-6, IL-10, and IP-10 levels were significantly decreased compared to non-survivors of COVID-19. Meanwhile, serum concentrations of IP-10, MCP-1, sTREM-1, IL-10, and the neutrophil-to-lymphocyte ratio (NLR) in peripheral blood could distinguish between COVID-19 survivors and non-survivors and were significantly associated with mortality. Among them, the concentration of IP-10 was shown to be the most powerful indicator for predicting adverse outcomes in COVID-19 patients (AUC: 0.715); however, its combined detection with the conventional inflammatory marker NLR did not improve the predictive value for adverse outcomes in COVID-19 patients. Additionally, serum IP-10 levels were negatively correlated with peripheral blood NK cell count and total lymphocyte count, while sTREM-1 levels were positively correlated with peripheral blood CD4+ T cell count and CD3+ T cell count. Meanwhile, IL-8 levels were positively correlated with total lymphocyte count in peripheral blood. Finally, the serum levels of cytokines/chemokines in non-survivors of COVID-19 increased significantly before death, while in survivors, they returned to normal levels before discharge.

Conclusions

Severely ill and non-surviving COVID-19 patients exhibit compromised immune function, with significantly higher levels of inflammation, cytokine/chemokine storms, and immune dysregulation compared to non-severe patients. Serum concentrations of IP-10, MCP-1, sTREM-1, and IL-10 levels can serve as biomarkers to predict adverse outcomes in COVID-19.

Clinical outcomes of Omicron infection and vaccine acceptance among pediatric liver transplant recipients: insights from a cross-sectional survey

OBJECTIVES

Our study aims to explore the clinical characteristics of Omicron infection in pediatric liver transplant recipients (PLTRs), after the national COVID-19 outbreak. Additionally, we will investigate changes in vaccine coverage and parental attitudes towards vaccinating their children after this current outbreak.

METHODS

We conducted a web-based questionnaire survey to gather information on Omicron infection, vaccination status, and guardian attitude among PLTRs. Besides, utilized valid questionnaire and long-term follow-up information processing techniques, and performed statistical analysis of relevant parameters.

RESULTS

528 valid questionnaires were collected, among which, 251 responses replied Omicron infection status. The Omicron infection rate in Chinese PLTRs was 56.2% (141/251), similar to the report in the normal population (around 60%). 99.3% of infected PLTRs presented mild symptoms, mostly with fever (78.0%), followed by Cough (76.6%), with a mean RTPCR conversion time of 7 days; the overall PLTRs' vaccination rate in this study was 13.3%, similar to that of our previous study (9.4%). Besides, we found no significant differences of either infection rate or clinical symptoms between the vaccinated and unvaccinated groups. Moreover, the study showed 61.6% of guardians supported COVID-19 inoculation despite the outbreak of Omicron status.

CONCLUSIONS

The symptoms of Omicron infection in Chinese PLTRs were relatively mild, vaccine immunization had a limited effect on PLTRs' defense against Omicron infection, besides, their guardians supported the inoculation policy with a caution.

CLINICAL TRIAL REGISTRATION

http://www.chictr.org.cn , identifier ChiCTR2200055968.

Haplotypic Distribution of SARS-CoV-2 Variants in Cases of Intradomiciliary Infection in the State of Rondônia, Western Amazon

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a high transmissibility profile which favors the accumulation of mutations along its genome, providing the emergence of new variants. In this context, haplotype studies have allowed mapping specific regions and combining approaches and tracking phylogenetic changes. During the COVID-19 pandemic, it was notorious that home environments favored the circulation of SARS-CoV-2, in this study we evaluated 1,407 individuals positive for SARS-CoV-2, in which we located 53 families in the period from June 2021 to February 2023. The epidemiological data were collected in E-SUS notifica and SIVEP-gripe. Then, the genetic material was extracted using the commercial kit and the viral load was evaluated and the viral genomes were sequenced using the Illumina MiSeq methodology. In addition, the circulation of 3 variants and their respective subvariants was detected. The delta variant represented the highest number of cases with 45%, the Omicron variant 43% and the lowest number with 11% of cases the Gamma variants. There were cases of families infected by different subvariants, thus showing different sources of infection. The haplotype network showed a distribution divided into 6 large clusters that were established according to the genetic characteristics observed by the algorithm and 224 Parsimony informative sites were found. In addition, 92% of subjects were symptomatic and 8% asymptomatic. The secondary attack rate of this study was 8.32%. Therefore, we can infer that the home environment favors the spread of SARS-CoV-2, so it is of paramount importance to carry out genomic surveillance in specific groups such as intradomiciliary ones.

A Comparative Study of Clinical Characteristics and COVID-19 Vaccine Effectiveness Against SARS-CoV-2 Variants: Wild-Type, Alpha, Delta, and Omicron in Beijing, China

Background

To compare the clinical characteristics of symptoms and laboratory findings across SARS-CoV-2 variants (Wild-type, Alpha, Delta, Omicron) and assess the effectiveness of COVID-19 vaccines in preventing symptoms and laboratory abnormalities.

Methods

We conducted a retrospective cohort study of individuals with SARS-CoV-2 infection at Beijing Ditan Hospital, Capital Medical University. Patients were grouped by the SARS-CoV-2 variant (Wild-type, Alpha, Delta, Omicron) based on whole-genome sequencing. Thirteen symptoms and 22 laboratory indices were compared across variants, and Omicron patients were further analyzed by vaccination status with generalized estimating equations (GEE) model.

Results

One thousand four hundred and thirteen participants were included for the analysis as following: Wild-type group (N=322), Alpha group (N=67), Delta group (N=98), and Omicron group (N=926). Omicron patients showed the highest proportion (30.1%) of respiratory symptoms across groups. Patients displayed normal laboratory manifestation, except for inflammatory markers, coagulation function index and glucose. Meanwhile, the Omicron variant was featured by higher inflammatory biomarkers (serum amyloid A protein [SAA] and C-reactive protein [CRP]). In addition, Omicron patients with three or more vaccine doses had fewer symptoms and higher values of SAA and CRP compared to those with fewer than three doses. Results of GEE showed, when compared with ≤ 1 vaccine dose, red blood cell count, white blood cell count, neutrophil count, platelet count, haemoglobin, and C-reactive protein in patients with ≥ 3 doses of vaccine significantly increased; while aspartic transaminase, creatine kinase, blood urea nitrogen, activated partial thromboplastin time, prothrombin time and thrombin time dramatically decreased, respectively.

Conclusion

Omicron variant resulted in abnormal inflammatory response. Individuals with three or more vaccine doses are more likely to experience fewer symptoms and have stronger protection against the virus. This study highlights key differences in symptom onset and laboratory profiles across SARS-CoV-2 variants, reinforcing the importance of three vaccine doses in providing strong protection against the Omicron variant.

Characterization of the gut microbiota in patients with SARS-CoV-2 infection during controlled ovarian stimulation

BACKGROUND

The Coronavirus disease 2019 (COVID-19) pandemic has emerged as a global health crisis, with clinical manifestations including those suggesting injury to various organs such as the ovaries, which implies that it extends beyond respiratory infections. Changes in gut microbiota may exhibit correlations with the mechanisms and stages of severity in COVID-19, as well as a link with sex hormones, embryo development, and pregnancy. Controlled ovarian stimulation (COS) is used to induce the development of multiple high-quality follicles during in vitro fertilization (IVF). Our research aimed to investigate whether patients infected with COVID-19 have altered gut microbiota compositions that would affect the outcomes of COS.

METHODS

Twenty-one healthy females and seventeen patients with COVID-19 were enrolled. Samples were sequenced for gut microbiota identification through 16 S rRNA V3-V4 region, including species annotation, community diversity, and community functions.

RESULTS

No significant differences were found between the groups in terms of in IVF cycle outcomes and laboratory parameters. Patients with COVID-19 and healthy women showed no significant difference in the total number of available blastocyst embryos. Furthermore, the gut microbiota alpha diversity index in the COVID-19 group were markedly reduced compared to those of healthy females. Comparing the COVID-19 group to the controls, the gut microbiota dysbiosis decreased levels of Ruminococcus, and Agathobater, and elevated levels of Achromobacter and Raistonia. Finally, we identified a series of microbial functional characteristics, including membrane transport and carbohydrate metabolism, that exhibited significant disparities between the two groups.

CONCLUSIONS

Patients in the COVID-19 group exhibited significant disparities in the gut microbiota composition compared to the healthy women during COS. However, the IVF outcomes did not show any significant differences between the two groups. Collectively, our speculation suggests that SARS-COV-2 infection may alter the gut microbiota without impacting IVF outcomes.

Prone position ventilation-induced oxygenation improvement as a valuable predictor of survival in patients with acute respiratory distress syndrome: a retrospective observational study

BACKGROUND

In patients with severe acute respiratory distress syndrome (ARDS), prolonged and inappropriate use of prone position ventilation (PPV) is a known risk factor for mortality. Hence, it is critical to monitor patients' response to PPV and accurately differentiate responders from non-responders at an early stage. The study aimed to investigate the relationship between oxygenation improvement after three rounds of PPV and survival rate in patients with pulmonary ARDS. Additionally, we sought to identify the earliest turning point for escalation from PPV to extracorporeal membrane oxygenation.

METHODS

We performed a retrospective observational study from 2015 to 2023. We included adult patients who received invasive mechanical ventilation, underwent at least three periods of at least 6 h of PPV after admission to the Intensive Care Unit, and meet the ARDS criteria. The study collected data on each PPV session, including changes in PaCO2, PaO2, pH, FiO2, PaO2:FiO2 ratio, and clinical outcomes.

RESULTS

A total of 104 patients were enrolled in the study. The change in PaCO2 from baseline to the third PPV session (P3) had the highest area under the receiver operating characteristic curve (AUC) of 0.70 (95% CI 0.60-0.80; p < 0.001) for predicting hospital mortality, with an optimal cut-off point of 3.15 (sensitivity 75.9%, specificity 56.0%). The percentage change in PaO2:FiO2 ratio from baseline to P3 also had significant AUC of 0.71 (95% CI 0.61-0.81; p < 0.001) for predicting hospital mortality, with an optimal cut-off value of 99.465 (sensitivity 79.6%, specificity 62.0%). PaCO2 responders were defined as those with an increase in PaCO2 of ≤ 3.15% from baseline to P3, while PaO2:FiO2 responders were defined as those with an increase in PaO2:FiO2 ratio of ≥ 99.465% from baseline to P3. In the multivariable Cox analysis, PaO2:FiO2 responders had a significantly lower 60-day mortality risk (hazard ratio 0.369; 95% CI 0.171-0.798; p = 0.011).

CONCLUSIONS

The percentage change in PaO2:FiO2 ratio from baseline to P3 was a significant predictor of outcomes. The model fit and prediction accuracy were improved by including the variable of PaCO2 responders.

The Value of Common Laboratory Markers in Predicting the Severity of COVID-19 Patients

Purpose

The aim of the present study was to identify more effective laboratory markers to assess the severity of corona virus disease 2019 and predict the progression of the disease by collecting more laboratory markers and variables.

Patients and Methods

In this study, most risk factors, including epidemiological characteristics, blood cell counts, cytokines, and infection markers, were collected from 126 patients with COVID-19 to assess their predictive value.

Results

The area under curve (AUC) of Albumin (Alb) to fibrinogen (Fib) ratio (AFR) (0.791), Lactate dehydrogenase (LDH) (0.792), myoglobin (MYO) (0.795), C-reactive protein (CRP) (0.801) and lymphocyte count (0.859) were higher than other markers to distinguish severe from non-severe patients in receiver operating characteristic (ROC) analysis. In the univariate logistic regression analysis, thirty-six out of 46 risk factors, including 34 laboratory markers, were significantly associated with increased odds of severe patients. Multivariate logistic regression analysis showed that the CD19+ lymphocyte count, MYO, LDH, and AFR were associated with increased odds of severe disease. Moreover, Lymphocyte count and AFR levels increased, LDH and CRP levels decreased during hospitalization in recovered severe patients, whereas severe lymphocytopenia and continuously increasing LDH levels were observed in deteriorated patients. AFR level increased and CRP level decreased before the disease worsened in the deteriorated patients; however, when the patients deteriorated, AFR decreased and CRP increased significantly.

Conclusion

CD19+ lymphocyte count, MYO, LDH, and AFR are independent biomarkers for early identification of severe COVID-19. Lymphocyte count, AFR, LDH, and CRP levels were helpful in predicting the clinical progression of the disease.\.

HIV and SARS-CoV-2 Coinfections in Brazil in 2020: Epidemiological, Sociodemographic, and Clinical Characteristics of 36,746 Cases

BACKGROUND

This study aimed to identify COVID-19 cases among people living with HIV (PLWH) in Brazil in 2020, describe their clinical, sociodemographic, and epidemiological profiles, and evaluate the factors associated with disease severity.

METHODS

This cross-sectional study used secondary data obtained from the Brazilian healthcare system. Probabilistic and deterministic data linkage methods were used to identify coinfected patients. Descriptive statistical analysis was conducted, and factors associated with severe cases were evaluated using Pearson's chi-squared test, Student's t-test, and logistic regression.

RESULTS

In 2020, 36,746 coinfections were identified, making it one of the largest coinfection databases described worldwide. In total, 4,502 (12.25%) patients had severe cases and 32,244 (87.75%) had non-severe cases. The covariates age (OR=1.05; 95% CI: 1.05-1.06), nonwhite ethnicity (OR=1.68; 95% CI: 1.56-1.81), history of AIDS diagnosis (OR=1.17; 95% CI: 1.08-1.28), recent HIV diagnosis (OR=5.47; 95% CI: 4.25-7.02), absence of antiretroviral therapy (OR=1.70; 95% CI: 1.57-1.84), CD4+ < 200 (OR=6.41; 95% CI: 5.09-8.08), detectable HIV viral load (OR=2.61; 95% CI: 2.21-3.05), ≥ 1 comorbidity (OR=4.09; 95% CI: 3.79-4.41), and ≥ 4 symptoms were associated with increased severity.

CONCLUSIONS

Multiple factors were linked to severe COVID-19, including uncontrolled HIV infection, age > 50 years, comorbidities, and racial disparities. This study reinforces the importance of maintaining public policies focused on early HIV diagnosis, access and adherence to treatment, especially for minority ethnic groups, and focusing on premature aging in PLWH.

Correlation between oxygenation function and laboratory indicators in COVID-19 patients based on non-enhanced chest CT images and construction of an artificial intelligence prediction model

Objective

By extracting early chest CT radiomic features of COVID-19 patients, we explored their correlation with laboratory indicators and oxygenation index (PaO2/FiO2), thereby developed an Artificial Intelligence (AI) model based on radiomic features to predict the deterioration of oxygenation function in COVID-19 patients.

Methods

This retrospective study included 384 patients with COVID-19, whose baseline information, laboratory indicators, oxygenation-related parameters, and non-enhanced chest CT images were collected. Utilizing the PaO2/FiO2 stratification proposed by the Berlin criteria, patients were divided into 4 groups, and differences in laboratory indicators among these groups were compared. Radiomic features were extracted, and their correlations with laboratory indicators and the PaO2/FiO2 were analyzed, respectively. Finally, an AI model was developed using the PaO2/FiO2 threshold of less than 200 mmHg as the label, and the model's performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. Group datas comparison was analyzed using SPSS software, and radiomic features were extracted using Python-based Pyradiomics.

Results

There were no statistically significant differences in baseline characteristics among the groups. Radiomic features showed differences in all 4 groups, while the differences in laboratory indicators were inconsistent, with some PaO2/FiO2 groups showed differences and others not. Regardless of whether laboratory indicators demonstrated differences across different PaO2/FiO2 groups, they could all be captured by radiomic features. Consequently, we chose radiomic features as variables to establish an AI model based on chest CT radiomic features. On the training set, the model achieved an AUC of 0.8137 (95% CI [0.7631-0.8612]), accuracy of 0.7249, sensitivity of 0.6626 and specificity of 0.8208. On the validation set, the model achieved an AUC of 0.8273 (95% CI [0.7475-0.9005]), accuracy of 0.7739, sensitivity of 0.7429 and specificity of 0.8222.

Conclusion

This study found that the early chest CT radiomic features of COVID-19 patients are strongly associated not only with early laboratory indicators but also with the lowest PaO2/FiO2. Consequently, we developed an AI model based on CT radiomic features to predict deterioration in oxygenation function, which can provide a reliable basis for further clinical management and treatment.

Risk factors affecting the development of pneumothorax in patients followed up in intensive care with a diagnosis of COVID-19

BACKGROUND

Pneumothorax is a little known and reported complication of COVID-19. These patients have poorer general outcomes and greater respiratory support requirements, longer hospitalization times, and higher mortality rates. The purpose of this study was to determine which factors predict mortality in patients with tube thoracostomy diagnosed with COVID-19, admitted to the COVID-19 intensive care unit (ICU), and developing pneumothorax.

METHODS

This respective, observational study was conducted in all COVID-19 ICUs at the Marmara University Pendik Training and Research Hospital, Türkiye. Patients admitted to the ICU with diagnoses of COVID-19 pneumonia and with chest tubes inserted due to pneumothorax were investigated retrospectively.

RESULTS

One hundred patients with tube thoracostomy were included in the study. Their median age was 68 (57-78), and 63% were men. The median follow-up time was 20 [10-29] days, and the median time from initial reverse transcriptase polymerase chain reaction (RT-PCR) results to tube thoracostomy was 17 [9-23] days. Initial RT-PCR results were positive in 90% of the patients, while 8% were negative, and 2% were unknown. Half the patients exhibited pulmonary involvement at thoracic computed tomography (CT) (n = 50), while 22 patients had COVID-19 reporting and data system (CO-RADS) scores of 5 (22%). Sixty-two patients underwent right tube thoracostomy, 24 left side placement, and 14 bilateral placement. The patients' mean positive end expiratory pressure (PEEP) level was 10.31 (4.48) cm H2O, with a mean peak inspiratory pressure (PIP) level of 26.69 (5.95) cm H2O, a mean fraction of inspired oxygen (FiO2) level of 80.06 (21.11) %, a mean respiratory rate of 23.71 (5.62) breaths/min, and a mean high flow nasal cannula (HFNC) flow rate of 70 (8.17) L/min. Eighty-seven patients were intubated (87%), six used non-rebreathable reservoir masks, four HFNC, two non-invasive mechanical ventilation (NIV), and one a simple face mask. Comorbidity was present in 70 patients, 25 had no comorbidity, and the comorbidity status of five was unknown. Comorbidities included hypertension (38%), diabetes mellitus (23%), cardiovascular disease (12%), chronic obstructive pulmonary disease (5%), malignancy (3%), rheumatological diseases (3%), dementia (2%) and other diseases (9%). Twelve of the 100 patients survived. The median survival time was 20 (17.82-22.18) days, and the median 28-day overall survival rate was 29% (20-38%). The multivariate Cox proportional hazards model indicated that age over 68 (HR = 2.23 [95% CI: 1.39-3.56]; p = 0.001), oxygenation status other than by intubation (HR = 2.24 [95% CI: 1.11-4.52]; p = 0.024), and HCO3- below 22 compared with a normal range of 22 to 26 (HR = 1.95 [95% CI: 1.08-3.50]; p = 0.026) were risk factors associated with mortality in patients in the ICU.

CONCLUSIONS

Age over 68, receipt of oxygenation other than by intubation, and HCO3- values lower than 22 in patients with COVID-19 pneumonia emerged as prognostic factors associated with mortality in terms of pneumothorax.

Immunopathological markers and cell types linked to COVID-19 symptom manifestation

BACKGROUND

Numerous studies have investigated the molecular properties that contribute to the symptoms of COVID-19, such as the virus's genetic makeup, its replication mechanisms, and how it interacts with host cells. However, identifying the immunopathological properties, such as the immune system's response, cytokine levels, and the presence of specific biomarkers, that are associated with the severity of the infection remains crucial for developing effective treatments and preventions.

METHODS

We analyzed blood protein factor profiles from 420 individuals to identify features differentiating between test-negative healthy, asymptomatic, and symptomatic individuals using statistical comparison and the least absolute shrinkage and selection operator (i.e., LASSO) algorithm. Additionally, we examined single-cell RNA sequencing data from 141 individuals to identify specific cell types associated with the COVID-19 symptoms.

RESULTS

Healthy individuals who tested negative had distinct blood protein factor levels compared to asymptomatic individuals. We identified two key protein factors, Serpin A10 and Complement C9, that differentiate between asymptomatic and symptomatic patients. Symptomatic patients showed lower levels of CD4+ T naïve, CD4+ T effector & memory, and CD8+ T naïve cells, along with higher levels of CD14+ classical monocytes compared to asymptomatic patients. Additionally, CD16+ non-classical monocytes, major producers of C1QA/B/C, appeared to contribute to the observed Complement C9 levels.

CONCLUSIONS

These findings advance our understanding of the immunopathological mechanisms underlying COVID-19 and may inform the development of targeted therapies and preventative measures. Future research should focus on further elucidating these mechanisms and exploring their potential clinical applications in managing COVID-19 severity.

Immune Regulatory Circular RNAs, circRasGEF1B and circHIPK3, are Upregulated in Peripheral Blood Mononuclear Cells of COVID-19 Patients

Background: COVID-19 is one of the worst pandemics worldwide, and its diagnosis and treatment are of great importance. Recent evidence has shown that circular RNA (circRNA deregulation is involved in different infectious diseases. In the present study, we tried to investigate the expression of cirRNAs RasGEF1B (hsa_circ_0127052), HIPK3 (hsa_circ_100783), and GATAD2A (hsa_circ_0050236) in COVID-19 patients. Methods: Using quantitative real-time polymerase chain reaction, the expression profiles of candidate circRNAs were detected in 57 COVID-19 patients and 51 healthy controls. As part of the process of identifying a candidate circRNA that is sensitive and specific, receiver operating characteristic (ROC) curves were also utilized. Results: Our results showed higher expression levels of circRasGEF1B and circHIPK3 in COVID-19 patients, however, circGATAD2A showed no statistical difference between patients and controls. ROC curves showed that circRasGEF1B (hsa_circ_0127052), and HIPK3 (hsa_circ_100783) had favorable specificity and sensitivity, whereas GATAD2A (hsa_circ_0050236) did not. Conclusion: In summary, our study highlights the potential of CircRasGEF1B (hsa_circ_0127052) and HIPK3 (hsa_circ_100783) as biomarkers for COVID-19 diagnosis due to their high expression levels and demonstrated diagnostic accuracy. These findings suggest that circRNAs could play a crucial role in the development of diagnostic tools for COVID-19, providing a new avenue for early detection and management of the disease.

Hyperexpression of PTAFR and PF4 as Possible Platelet Risk Biomarkers in Patients With COVID-19

BACKGROUND/AIM

SARS-CoV-2 infection presents different severity levels that suggest the influence of genetic factors on the clinical outcome of the disease. In cases of severe COVID-19, the presence of elevated coagulation markers, increased platelet activation and aggregation and the risk of thrombotic complications are described. Given the participation of these cells in several serious viral infections and their negative role when associated with a prothrombotic response, it is important to understand the mechanistic role of SARS-CoV-2 in platelet physiology. This study evaluated the hyperexpression of platelet-activating factor receptor (PTAFR) and platelet factor 4 (PF4) in unvaccinated and hospitalized patients with COVID-19.

PATIENTS AND METHODS

The study included 43 COVID-19 patients stratified according to WHO guidelines. Subsequently, the expression of the PTAFR and PF4 genes were evaluated using the real-time quantitative PCR and their possible correlation with the severity of the disease and clinical variables including hospitalization, outcome, sex, age and laboratory parameters (platelet count, INR and D-dimer).

RESULTS

The analysis demonstrated a significant (p<0.05) hyperexpression of these genes COVID-19 patients (n=43) compared to healthy controls. Expression of these genes in patients was not statistically significant (p>0.05) different between patients stratified according to clinical variables.

CONCLUSION

The expression of PTAFR and PF4 suggests an important molecular pathway in the pathophysiology of the disease and may be valuable platelet biomarkers to indicate increased risk in patients with COVID-19 who require hospital care, contributing to personalized intervention strategies and improving their clinical management.

Impact of genetic variations of gene involved in regulation of metabolism, inflammation and coagulation on pathogenesis of cardiac injuries associated with COVID-19

BACKGROUND

SARS-CoV-2 infection can result in long-term chronic cardiovascular (CV) damage after the acute phase of the illness. COVID-19 frequently causes active myocarditis, SARS-CoV-2 can directly infect and kill cardiac cells, causing severe pathology and dysfunction across the organs and cells. Till now, the pathogenesis of COVID-19-associated cardiac injuries has not been understood, but there are several factors that contribute to the progression of cardiac injuries, such as genetic, dietary, and environmental. Among them ranges of host genetic factor including metabolizing, inflammation, and coagulation related genes have a role to contribute the cardiac injuries induced by COVID-19. Hereditary DNA sequence variations contribute to the risk of illness in almost all of these diseases. Hence, we comprehended the occurrence of genetic variations of metabolizing, inflammation and coagulation-related genes in the general population, their expression in various diseases, and their impact on cardiac injuries induced by COVID-19.

METHOD

We utilized multiple databases, including PubMed (Medline), EMBASE, and Google Scholar, for literature searches.

DESCRIPTION

The genes involved in metabolism (APOE, MTHFR), coagulation (PAI-1, ACE2), and immune factors (CRP, ESR, and troponin I) may have a role in the progression of COVID-19-associated cardiac injuries. The risk factors for CVD are significantly varied between and within different regions. In healthy individuals, the ACE I allele is responsible for the predisposition to CAD, but the ACE D haplotype is responsible for susceptibility and severity, which ultimately leads to heart failure. Patients who carry the T allele of rs12329760 in the TMPRSS2 gene are at risk for developing the severe form of COVID-19. IL-6 (rs1800796/rs1800795) polymorphism is associated with an increased mortality rate and susceptibility to severe COVID-19 disease. While the putative role of IL-6 associated with chronic, inflammatory diseases like cardiac and cerebrovascular disease is well known.

CONCLUSION

The occurrence of genetic variations in the ACE-2, AGT, DPP-IV, TMPRSS2, FUIRN, IL-4, IL-6, IFN-γ, and CYP2D6 genes is varied among different populations. Examining the correlation between these variations and their protein levels and cardiac injuries induced by COVID-19 may provide valuable insights into the pathogenesis of cardiac injuries induced by COVID-19.

Impact of COVID-19 on the Clinical Characteristics and Outcomes of Patients with Acute Leukaemia: An academic centre experience

Objectives

This study aimed to identify the impact of the COVID-19 pandemic on the frequency, clinical characteristics and outcomes of patients with acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL).

Methods

This retrospective cohort study included all patients treated at Sultan Qaboos University Hospital in Muscat, Oman with AML or ALL from January 2017 to December 2021. Data were obtained from the electronic medical record, and patients diagnosed before the start of the COVID-19 pandemic were compared with those diagnosed during the pandemic using appropriate statistical tests.

Results

A total of 151 patients with ALL (n = 58) and AML (n = 93) were included, of whom 78 were diagnosed before the COVID-19 pandemic and 73 during the pandemic. The rate of acute leukaemia increased during the pandemic (P = 0.039). The clinical characteristics and molecular profiles were similar between the 2 periods, except for platelet count which was higher during the pandemic compared to before the pandemic (median platelet count: 55 × 109/L versus 47 × 109/L; P = 0.02). No significant difference was found in the number of FLT3-positive AML; however, the number of NPM1-mutated AML cases was higher during the pandemic (P = 0.02). The number of Philadelphia-positive ALL cases remained consistent between the 2 time periods. The complete remission (P = 0.48) and the overall survival rates were similar (P >0.05).

Conclusion

Except for an increased rate of acute leukaemia and a lower platelet count, the COVID-19 pandemic did not impact the presentation and outcomes of acute leukaemia.

Phytocompounds as versatile drug-leads targeting mProtease in the SARS-CoV-2 virus: insights from a molecular dynamics study

SARS-CoV-2 is one of the deadly outbreaks in the present era and still showing its presence around the globe. Researchers have produced various vaccines that offer protection against infection, but we have not yet found a cure for COVID-19. Currently, efforts are focused on identifying effective therapeutic approaches to treat this infectious disease. In the present work, we investigated the main protease (Mpro) protein, a crucial component in SARS-CoV-2 viral particle formation, as a drug target and proposed phytocompounds with therapeutic potential against SARS-CoV-2. Initially, several plant-based resources were exploited to screen around one thousand phytocompounds and further their physiochemical characterization and assessment of drug likeliness were performed using SwissADME. Eventually, we screened 95 compounds based on docking analysis using AutoDock Vina. Five compounds were selected having the highest affinity for Mpro for the analysis of ligand-receptor interaction using molecular dynamic (MD) simulation. Docking and MD simulation studies elucidated the promising stable interaction of selected 5 ligands with Mpro. During MD simulation of 100 ns, Abacopterin F showed the lowest binding energy (-37.13 kcal/mol) with the highest affinity towards Mpro and this compound may be proposed as a lead molecule for further investigation. This interaction may result in modulation of the Mpro activity, consequently leading to hindrance in viral particle formation. However, in-vitro and in-vivo experimental validation would be needed to process the selected phytomolecules as a therapeutic lead against SARS-CoV-2.

The effectiveness of vaccination on the COVID-19 epidemic in California

BACKGROUND

The COVID-19 pandemic has caused overwhelming morbidity, mortality, and hospitalization worldwide, including in the state of California. Vaccination efforts have been an important measure in curtailing the adverse outcomes of COVID-19.

METHODS

To quantify the effectiveness of COVID-19 vaccinations in California, we conducted a retrospective cohort study investigating how vaccination has impacted the extent of COVID-19 contraction, hospitalizations, and death totals. We compared outcomes of the Delta Wave, Omicron Wave, and Pre-Delta Period.

RESULTS

Vaccinated individuals have far-lower incidence risk ratio (IRR) of and odds of contracting a COVID-19 case (Delta IRR: 0.197) being hospitalized from COVID-19 (Delta IRR: 0.105), and dying from COVID-19 compared with an unvaccinated individual (Delta IRR: 0.0941). The preventive fraction of the unexposed and population-preventive fractions for cases, deaths, and hospitalizations also showed significant proportions. All tests showed P < .001.

DISCUSSION

Vaccination was most effective in the Delta Wave, then in the Omicron Wave, and least effective in the Pre-Delta Period. Deaths were the most prevented outcome, followed by hospitalizations, then cases.

CONCLUSIONS

This study exposes the massive impact of vaccinations in California in reducing COVID-19 outcomes and the potential for fewer adverse outcomes had there been greater vaccination compliance, demonstrating the need to increase vaccination efforts.

Comparison of Performance Characteristics in Early Warning Scoring Tools for Diagnosis of Intubation and Mortality Among COVID-19 Patients

INTRODUCTION

Early warning scores serve as valuable tools for predicting adverse events in patients. This study aimed to compare the diagnostic performance of National Early Warning Score, Hamilton Early Warning Score, Standardized Early Warning Score, and Triage Early Warning Score in forecasting intubation and mortality among patients with coronavirus disease 2019.

METHODS

This predictive correlation study included 370 patients admitted to the emergency department of 22 Bahman Hospital in Neyshabur, Iran, from December 2021 to March 2022. The aforementioned scores were assessed daily upon patient admission and throughout a 1-month hospitalization period, alongside intubation and mortality occurrences. Data analysis used SPSS 26 and MEDCALC 20.0.13 software. We adhered to the Standards for Reporting of Diagnostic Accuracy Studies guidelines to ensure the accurate reporting of our study.

RESULTS

The patients' mean age was 65.03 ± 18.47 years, with 209 (56.5%) being male. Both Standardized Early Warning Score and Hamilton Early Warning Score demonstrated high diagnostic performance, with area under the curve values of 0.92 and 0.95, respectively. For Standardized Early Warning Score, the positive likelihood ratio was 10.81 for intubation and 17.90 for mortality, whereas for Hamilton Early Warning Score, the positive likelihood ratio was 7.88 for intubation and 10.40 for mortality. The negative likelihood ratio values were 0.23 and 0.17 for Standardized Early Warning Score and 0.21 and 0.18 for Hamilton Early Warning Score, respectively, for the 24-hour period preceding intubation events and mortality.

DISCUSSION

Findings suggest that Standardized Early Warning Score, followed by Hamilton Early Warning Score, has superior diagnostic performance in predicting intubation and mortality in patients with coronavirus disease 2019 within 24 hours before these outcomes. Therefore, serial assessments of Hamilton Early Warning Score or Standardized Early Warning Score may be valuable tools for health care providers in identifying high-risk patients with coronavirus disease 2019 who require intubation or are at increased risk of mortality.

Soluble Urokinase Plasminogen Activator Receptor: A Useful Marker for Predicting Mortality in COVID-19 Patients

Introduction Efficient and practical healthcare based on prognostic indicators can reduce morbidity and mortality in hospitalized COVID-19 patients. Soluble urokinase plasminogen activator receptor (suPAR) predicts clinical outcomes and respiratory failure in SARS-CoV-2 patients, but additional research is needed. Among other characteristics, we aimed to evaluate the predictive value of suPAR in COVID-19 patients. Methods This observational study was conducted at the All India Institute of Medical Sciences in New Delhi between January and April 2022. Patients within the age range from 18 to 85 years with mild, moderate, or severe COVID-19 infections were included in the study. Twenty-one patients (group 1) had positive RT-PCR throat and nasal swabs. Nine patients (group 2) with fever but without COVID-19 were recruited as controls. Ninety patient samples were tested for suPAR on days 1, 5, and 10 utilizing suPARnostic AUTO Flex ELISA kits (ViroGates, Denmark). Results The median age was 59 years in both groups. COVID-19 was mild in six patients (29%), moderate in seven patients (33%), and severe in eight patients (38%). At a median follow-up of 10 days, 8 out of 21 patients (38%) in group 1 died, while none in group 2 died. Patients' median suPAR levels were 4.35 ng/ml on day 1, 4.68 ng/ml on day 5, and 4.37 ng/ml on day 10. In the control group, suPAR levels were 1.6 ng/ml on day 1, 1.7 ng/ml on day 5, and 2.02 ng/ml on day 10. The suPAR levels were statistically significant on day 1 (p = 0.004), day 5 (p = 0.04), and day 10 (p = 0.007) between the patient and the control groups. Conclusion Patients who died had higher suPAR levels on days 1 (p = 0.007), 5 (p = 0.01), and 10 (p = 0.03) than survivors. The suPAR cut-off ≥ 3.64 (AUC = 0.82) predicts mortality with 88% sensitivity and 73% specificity.

Clinical and Epidemiological Features of Pediatric COVID-19: A Retrospective Study

Background and Aims

There is a demand for additional data regarding the impact of coronavirus disease 2019 (COVID-19) on the pediatric population. This study sought to determine the clinical and epidemiological features of pediatric COVID-19 in Iran.

Methods

A retrospective study was performed to assess medical records of children with COVID-19 admitted to Abuzar Hospital in Ahvaz (Iran). Their clinical and demographic data were recorded.

Results

In this study, 600 medical records of pediatric COVID-19 patients were evaluated. Over 50% of them were boys. Mild, moderate, and severe manifestations of COVID-19 were identified in 250, 200, and 150 children, respectively. Patients with severe or moderate COVID-19 had substantially higher levels of various inflammatory markers (C-reactive protein (CRP), fibrinogen, and d-dimer), alanine transaminase (ALT), creatine kinase (CPK), blood urea nitrogen (BUN), neutrophils, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatinine (Cr), bilirubin, and gamma-glutamyl transferase (GGT) compared to children with mild COVID-19 (p < 0.001); they also had lower levels of lymphocytes, hemoglobin (Hb), and vitamin D than patients with mild COVID-19 (p < 0.001). In addition, children with severe or moderate COVID-19 had a notably higher incidence of fever or dry cough and longer hospital stays than those with mild COVID-19 (p < 0.001). The prevalence of malnutrition and anemia in patients was 50.6% and 31.5%, respectively. A significant proportion of children who were underweight and stunted experienced moderate to severe COVID-19. Furthermore, there was a considerably higher prevalence of malnutrition, anemia, and vitamin D insufficiency, or deficiency in children with moderate-to-severe COVID-19 compared to patients with mild COVID-19 (p < 0.001).

Conclusion

The outcomes of this study revealed a significantly higher prevalence of malnutrition, anemia, vitamin D insufficiency or deficiency, elevated liver and kidney function test results, and increased inflammatory markers in children with moderate to severe COVID-19 compared to those with mild COVID-19.

Indeterminate Result of Interferon-γ Release Assay-A Risk Factor of Mortality for COVID-19 and Non-COVID-19 Respiratory Infections

Toward the end of 2022, the cessation of China's "dynamic zero-COVID policy" had led to a notable outbreak of SARS-CoV-2 infections and a substantial number of severe cases and deaths were reported, which raised serious concerns. Concurrently, our study identified a significant increase in the incidence of indeterminate results from the Interferon-γ Release Assay (IGRA) among hospitalized patients during this period. Peripheral T cells from these individuals were unable to produce measurable levels of IFN-γ upon stimulation with the PHA mitogen. This indeterminate IGRA results emerged as a potential risk factor for increased mortality among severely affected elderly COVID-19 patients, contributing to an understanding of the observed excess mortality. The deep serum proteomic analysis elucidated a dysfunctional immune response and defect in cardiac function of those patients. A predictive panel including IGRA results significantly enhanced the accuracy of predicting mortality outcomes in COVID-19 cases (AUC = 0.9762). We also extended the relevance of indeterminate IGRA outcomes as a risk factor for mortality to elderly non-COVID-19 respiratory infections, providing valuable prognostic insights into this type of disease and informing targeted and effective therapeutic interventions for similar outbreaks in the future.

Surfactant-derived protein type B: a new biomarker linked to respiratory failure and lung damage in mild to moderate SARS-CoV-2 pneumonia

Background

The COVID-19 pandemic has led to significant concern due to its impact on human health, particularly through pneumonia-induced lung damage. Surfactant proteins A and D (SP-A and SP-D) are implicated in COVID-19 lung damage, but the role of surfactant protein B (SP-B) remains unclear.

Methods

We conducted a single-centre, prospective observational study involving 73 hospitalised COVID-19 pneumonia patients. SP-B levels were measured within 48 h of admission, alongside SP-A and SP-D in a subset. Clinical data were collected, and follow-up visits were conducted after 6 months.

Results

At hospitalisation, circulating immature SP-B levels measured in 73 patients (median 26.31 arbitrary units (AU) (interquartile range 14.27-41.31)) correlated significantly with lung involvement (r=0.447, p<0.001) and oxygen support requirement (p=0.005). SP-B levels did not predict mechanical ventilation or intensive care unit admission. SP-B decreased significantly (p<0.001) from 25.53 AU (14.36-41.46) at the acute hospitalisation to 12.73 AU (9.12-20.23) at the 6-month follow-up, whereas SP-A and SP-D did not change significantly. Immature SP-B (but not SP-A and SP-D) was confirmed to be significantly associated with the need for oxygen support (n=26, 58%) during the hospitalisation (p<0.05).

Conclusion

Immature SP-B emerges as a potential biomarker for COVID-19 pneumonia severity and prognosis. Its dynamic changes suggest utility in monitoring disease progression and long-term outcomes, despite limitations in predicting hard end-points. Larger studies are needed to validate these findings and understand the underlying mechanisms of surfactant protein dysregulation in COVID-19 pathogenesis.

An in-depth analysis of COVID-19 treatment: Present situation and prospects

Coronavirus disease 2019 (COVID-19) the most contagious infection caused by the unique type of coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), produced a global pandemic that wreaked havoc on the health-care system, resulting in high morbidity and mortality. Several methods were implemented to tackle the virus, including the repurposing of existing medications and the development of vaccinations. The purpose of this article is to provide a complete summary of the current state and future possibilities for COVID-19 therapies. We describe the many treatment classes, such as antivirals, immunomodulators, and monoclonal antibodies, that have been repurposed or developed to treat COVID-19. We also looked at the clinical evidence for these treatments, including findings from observational studies and randomized-controlled clinical trials, and highlighted the problems and limitations of the available evidence. Furthermore, we reviewed existing clinical trials and prospective COVID-19 therapeutic options, such as novel medication candidates and combination therapies. Finally, we discussed the long-term consequences of COVID-19 and the importance of ongoing research into the development of viable treatments. This review will help physicians, researchers, and policymakers to understand the prevention and mitigation of COVID-19.

Advanced federated ensemble internet of learning approach for cloud based medical healthcare monitoring system

Medical image machines serve as a valuable tool to monitor and diagnose a variety of diseases. However, manual and centralized interpretation are both error-prone and time-consuming due to malicious attacks. Numerous diagnostic algorithms have been developed to improve precision and prevent poisoning attacks by integrating symptoms, test methods, and imaging data. But in today's digital technology world, it is necessary to have a global cloud-based diagnostic artificial intelligence model that is efficient in diagnosis and preventing poisoning attacks and might be used for multiple purposes. We propose the Healthcare Federated Ensemble Internet of Learning Cloud Doctor System (FDEIoL) model, which integrates different Internet of Things (IoT) devices to provide precise and accurate interpretation without poisoning attack problems, thereby facilitating IoT-enabled remote patient monitoring for smart healthcare systems. Furthermore, the FDEIoL system model uses a federated ensemble learning strategy to provide an automatic, up-to-date global prediction model based on input local models from the medical specialist. This assures biomedical security by safeguarding patient data and preserving the integrity of diagnostic processes. The FDEIoL system model utilizes local model feature selection to discriminate between malicious and non-malicious local models, and ensemble strategies use positive and negative samples to optimize the performance of the test dataset, enhancing its capability for remote patient monitoring. The FDEIoL system model achieved an exceptional accuracy rate of 99.24% on the Chest X-ray dataset and 99.0% on the MRI dataset of brain tumors compared to centralized models, demonstrating its ability for precision diagnosis in IoT-enabled healthcare systems.