Insight into 2019 novel coronavirus - An updated interim review and lessons from SARS-CoV and MERS-CoV

Attitudes, Anxiety, and Behavioral Practices Regarding COVID-19 among University Students in Jordan: A Cross-Sectional Study

The COVID-19 pandemic represents a major public health, economic, political, and scientific concern in most countries around the globe where COVID-19 cases and deaths have been confirmed. This study assessed the attitudes, anxiety, and behavioral practices of university students in Jordan regarding COVID-19 during the early period of the infection (March 19-21, 2020) using a validated, self-administered survey questionnaire. Positive attitudes or low-risk practices were given 1 point, whereas negative attitudes or high-risk practices were scored 0. Percentages of the total score were used for categorizing data into negative attitudes or high-risk practices (≤ 60%), moderate attitudes or moderate-risk practices (60.01-80%), and positive attitudes or low-risk practices (> 80%). Generally, the university students displayed positive attitudes and low-risk practices toward preventing COVID-19, with an average score of 81.1% and 84.3%, respectively. Approximately two-thirds (69.1%) of the students showed a positive attitude toward COVID-19 seriousness, concern of contracting the virus, and the appropriate prevention measures, and low-risk practices (67.6%) toward preventing COVID-19 including implementation of social distancing and good hygiene. Female, older, medical, or postgraduate students practiced significantly more (P ≤ 0.05) appropriate hygiene and social distancing behaviors toward COVID-19 than their counterparts of each group. More than two-thirds (69.2%) of the students were anxious that they might become infected with COVID-19. These results are important for health authorities to develop appropriate educational programs and protective health measures including good respiratory etiquette and handwashing practices, to enhance safer lifestyles and prevent COVID-19 transmission.

Novel coronavirus disease 2019 (COVID-19) pandemic: Considerations for the biomedical waste sector in India

In late December 2019, the world woke to a truth of a pandemic of Coronavirus Disease (COVID-19), inspired by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which has a place with a gathering of beta-coronavirus. As of July 21 India is still fighting to survive against the SARS-CoV-2 as called coronavirus disease. The contaminations, first constrained in the Kerala state, have inevitably spread to every single other area. The possibility to cause dangerous respiratory disappointment and quick transmission puts COVID-19 in the rundown of the Public Health Emergency of International Concern (PHEIC). There is a flow overall break out of the novel coronavirus Covid-19, which started from Wuhan in China and has now spread to more than 212 countries including 14,753,034 cases, as of 12:20 AM on July 21, 2020. Governments are feeling the squeeze to prevent the outbreak from spiralling into a worldwide wellbeing crisis. At this stage, readiness, straightforwardness, and sharing of data are vital to hazard evaluations and starting explosion control exercises. Since the episode of serious intense respiratory disorder (SARS) 18 years back, an enormous number of SARS-related coronaviruses (SARSr-CoVs) have been found in their regular repository have, bats. During this epidemic condition, expulsion of biomedical waste created from crisis facilities treating COVID-19 patients in like manner demands unprecedented thought as they can be potential bearers of the disease SARS-CoV-2. This article discusses the potential consequences of the COVID-19 pandemic on biomedical waste administrations, concentrating on basic focuses where option working methodology or extra moderation measures might be fitting.

COVID-19 pneumonia and immune-related pneumonitis: critical issues on differential diagnosis, potential interactions, and management

INTRODUCTION

The COVID-19 pandemic occurred amid the cancer immunotherapy revolution. Immune checkpoint inhibitors (ICIs) have become the standard of care for several solid cancers and are associated with peculiar toxicities, including pneumonitis which has similar features to COVID-19 pneumonia.

AREAS COVERED

We summarize the main hallmarks of lung injury induced by ICIs and severe acute respiratory syndrome coronavirus 2 and discuss the critical aspects for differential diagnosis and management. Symptoms and radiological findings are often similar; conversely, treatments are quite different. Furthermore, we focus on potential interactions generating hypotheses that need confirmatory studies.

EXPERT OPINION

All cancer patients treated with immunotherapy should receive screening for SARS-CoV-2. This would improve the diagnosis and management of pneumonia and guide therapeutic choices. Furthermore, clinicians could estimate the risk/benefit of continuing ICI treatment in COVID-19 positive patients. Temporary withdrawal of the immunotherapy treatment pending resolution of viral infection may be a reasonable option in long-responders patients.

The SARS-CoV-2 main protease as drug target

The unprecedented pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is threatening global health. The virus emerged in late 2019 and can cause a severe disease associated with significant mortality. Several vaccine development and drug discovery campaigns are underway. The SARS-CoV-2 main protease is considered a promising drug target, as it is dissimilar to human proteases. Sequence and structure of the main protease are closely related to those from other betacoronaviruses, facilitating drug discovery attempts based on previous lead compounds. Covalently binding peptidomimetics and small molecules are investigated. Various compounds show antiviral activity in infected human cells.

Low Baseline Pulmonary Levels of Cytotoxic Lymphocytes as a Predisposing Risk Factor for Severe COVID-19

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and currently has detrimental human health, community, and economic impacts around the world. It is unclear why some SARS-CoV-2-positive individuals remain asymptomatic, while others develop severe symptoms. Baseline pulmonary levels of antiviral leukocytes, already residing in the lung prior to infection, may orchestrate an effective early immune response and prevent severe symptoms. Here, "in silico flow cytometry" was used to deconvolute the levels of all seven types of antiviral leukocytes in 1,927 human lung tissues. Baseline levels of CD8+ T cells, resting NK cells, and activated NK cells, as well as cytokines that recruit these cells, are significantly lower in lung tissues with high expression of the SARS-CoV-2 entry receptor angiotensin-converting enzyme 2 (ACE2). This is observed in univariate analyses, in multivariate analyses, and in two independent data sets. Importantly, ACE2 mRNA and protein levels very strongly correlate in human cells and tissues. The above findings also largely apply to the SARS-CoV-2 entry protease TMPRSS2. Both SARS-CoV-2-infected lung cells and COVID-19 lung tissues show upregulation of CD8+ T cell- and NK cell-recruiting cytokines. Moreover, tissue-resident CD8+ T cells and inflammatory NK cells are significantly more abundant in bronchoalveolar lavage fluids from mildly affected COVID-19 patients compared to severe cases. This suggests that these lymphocytes are important for preventing severe symptoms. Elevated ACE2 expression increases sensitivity to coronavirus infection. Thus, the results suggest that some individuals may be exceedingly susceptible to develop severe COVID-19 due to concomitant high preexisting ACE2 and TMPRSS expression and low baseline cytotoxic lymphocyte levels in the lung.IMPORTANCE COVID-19 is caused by the highly contagious coronavirus SARS-CoV-2 and currently has detrimental human health, community, and economic impacts around the world. It is unclear why some SARS-CoV-2-positive individuals develop severe COVID-19 symptoms, which can be fatal, while others only develop mild symptoms. In the absence of an effective and widely available vaccine, it is of paramount importance that we identify risk factors for development of severe symptoms to be able to improve treatment approaches. The ACE2 gene encodes the receptor on human cells that the virus uses to infect these cells. This study finds that if the lungs of healthy individuals have high levels of ACE2, they typically have low levels of the immune cells that eliminate viruses. Therefore, some individuals may develop severe COVID-19 due to simultaneous high levels of the virus receptor and low levels of immune cells that eradicate the virus in their lungs.

Principles of Rajayakshma management for COVID-19

The pandemic spread of corona virus disease 2019 (COVID-19) has become a global threat. No cure is available for this condition till date. Ayurveda, may come to rescue in these times of COVID-19 spread. In this review we have analyzed that the COVID-19 has analogy with the Rajayakshma (∼a wasting disease indicating suboptimum immune response) and the established treatment of Rajayakshma disease can be proposed for preventive as well as curative purpose.

Structure-Altering Mutations of the SARS-CoV-2 Frame Shifting RNA Element

With the rapid rate of Covid-19 infections and deaths, treatments and cures besides hand washing, social distancing, masks, isolation, and quarantines are urgently needed. The treatments and vaccines rely on the basic biophysics of the complex viral apparatus. While proteins are serving as main drug and vaccine targets, therapeutic approaches targeting the 30,000 nucleotide RNA viral genome form important complementary approaches. Indeed, the high conservation of the viral genome, its close evolutionary relationship to other viruses, and the rise of gene editing and RNA-based vaccines all argue for a focus on the RNA agent itself. One of the key steps in the viral replication cycle inside host cells is the ribosomal frameshifting required for translation of overlapping open reading frames. The frameshifting element (FSE), one of three highly conserved regions of coronaviruses, includes an RNA pseudoknot considered essential for this ribosomal switching. In this work, we apply our graph-theory-based framework for representing RNA secondary structures, "RAG" (RNA-As Graphs), to alter key structural features of the FSE of the SARS-CoV-2 virus. Specifically, using RAG machinery of genetic algorithms for inverse folding adapted for RNA structures with pseudoknots, we computationally predict minimal mutations that destroy a structurally-important stem and/or the pseudoknot of the FSE, potentially dismantling the virus against translation of the polyproteins. Additionally, our microsecond molecular dynamics simulations of mutant structures indicate relatively stable secondary structures. These findings not only advance our computational design of RNAs containing pseudoknots; they pinpoint to key residues of the SARS-CoV-2 virus as targets for anti-viral drugs and gene editing approaches.

COVID-19 and Genetic Variants of Protein Involved in the SARS-CoV-2 Entry into the Host Cells

The recent global COVID-19 public health emergency is caused by SARS-CoV-2 infections and can manifest extremely variable clinical symptoms. Host human genetic variability could influence susceptibility and response to infection. It is known that ACE2 acts as a receptor for this pathogen, but the viral entry into the target cell also depends on other proteins. The aim of this study was to investigate the variability of genes coding for these proteins involved in the SARS-CoV-2 entry into the cells. We analyzed 131 COVID-19 patients by exome sequencing and examined the genetic variants of TMPRSS2, PCSK3, DPP4, and BSG genes. In total we identified seventeen variants. In PCSK3 gene, we observed a missense variant (c.893G>A) statistically more frequent compared to the EUR GnomAD reference population and a missense mutation (c.1906A>G) not found in the GnomAD database. In TMPRSS2 gene, we observed a significant difference in the frequency of c.331G>A, c.23G>T, and c.589G>A variant alleles in COVID-19 patients, compared to the corresponding allelic frequency in GnomAD. Genetic variants in these genes could influence the entry of the SARS-CoV-2. These data also support the hypothesis that host genetic variability may contribute to the variability in infection susceptibility and severity.

Effectiveness of Social Measures against COVID-19 Outbreaks in Selected Japanese Regions Analyzed by System Dynamic Modeling

In Japan’s response to the coronavirus disease 2019 (COVID-19), virus testing was limited to symptomatic patients due to limited capacity, resulting in uncertainty regarding the spread of infection and the appropriateness of countermeasures. System dynamic modelling, comprised of stock flow and infection modelling, was used to describe regional population dynamics and estimate assumed region-specific transmission rates. The estimated regional transmission rates were then mapped against actual patient data throughout the course of the interventions. This modelling, together with simulation studies, demonstrated the effectiveness of inbound traveler quarantine and resident self-isolation policies and practices. A causal loop approach was taken to link societal factors to infection control measures. This causal loop modelling suggested that the only effective measure against COVID-19 transmission in the Japanese context was intervention in the early stages of the outbreak by national and regional governments, and no social self-strengthening dynamics were demonstrated. These findings may contribute to an understanding of how social resilience to future infectious disease threats can be developed.

Evaluation of preventive procedures followed by the medical staff against covid-19 in the Syrian Arab Republic: A cross-sectional study

Objectives:

This study was oriented to investigate the current situation of Syrian medical staff working in different fields and their response regarding the preventive procedures.

Material and Methods:

Questionnaire was designed according to the World Health Organization guidelines and recommendations, addressing the preventive measures, which must be followed by healthcare workers to protect themselves and their community against COVID-19. The participation in the study was average as 1339 participants from medical staff (596 males and 743 females) have filled the questionnaire.

Results:

The results displayed high percentages of commitment in general regarding preventive measures followed (health rules, personal protective equipment, and disinfection) for all healthcare workers. The proportions of responses were varied depending on job nature. In addition, the highest range of percentage of self-evaluation was 50–75% for all medical staff.

Conclusion:

Based on the filled information, the study showed relatively good commitment to the preventive procedures by healthcare workers to control COVID-19 and prevents its spread in the community.

Knowledge, Attitude, and Practice of the Lebanese Community Toward COVID-19

Objectives: Distinct measures were adopted in Lebanon to prohibit the spreading of SARS-CoV-2. These actions provide positive results only if the population chooses to be compliant.

Aim: Accordingly, this study aimed to reflect the Lebanese population adherence by determining their level of knowledge and practice during this pandemic.

Method: A cross-sectional online survey was performed in April 2020. It involved 410 volunteers from the main 5 Lebanese districts. The questionnaire was divided into 3 parts; sociodemographic, knowledge, and practice. A score was calculated out of 18 points to evaluate the knowledge of the respondents. The last 8 questions reflected the participants' precautionary methods during the pandemic. Descriptive statistics and one-way analysis of variance tests were conducted using SPSS version 20.

Results: The overall correct rate of the knowledge questionnaire was 75%. Survey completers of extreme age groups (under 18 and >44), elementary education level, and medical occupation displayed the least level of knowledge compared to other groups (p < 0.05). Most of the participants showed proactive practices to protect themselves against COVID-19. They covered their mouths (81.2%), threw the used tissues (93.7%), and washed their hands (66.6%) after sneezing or coughing. Moreover, they wore face masks if they were sick (59%) or in a crowded place (79.3%). Concerning Hydroxychloroquine, 10% claimed that they would take it if they have COVID-19 symptoms.

Conclusion: This survey sheds the light on the fact that one mandatory measure does not fit all the population; there must be a specialized method of prevention for each profession, age group, and area of the country to prevent the outbreak of COVID-19.

Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU

Coronavirus pandemic is the most important public health event in the world currently. Patients with coronavirus disease 2019 (COVID-19) in a critical state are at risk of progressing rapidly into many serve complications; they require a high level of care from ICU nurses. How to avoid the virus to infect health care worker is also a critical issue. Based on the summarized experience of Chinese health workers, literature review and clinical practice, this article introduced donning and doffing of personal protective equipment (PPE) protocol and some keypoints of nursing critical care in patients with coronavirus disease 2019 (COVID-19): caring of patients requiring intubation and ventilation, venous thromboembolism (VTE) prevention, caring of patients on ECMO, caring for patients requiring enteral nutrition, psychological support and nursing management of COVID-19 ICU. This article introduced a useful protocol of donning and doffing personal protective equipment to protect health care workers, and provided key points for the ICU nurses how to take care of COVID-19 patients.

Molecular Pathogenesis, Immunopathogenesis and Novel Therapeutic Strategy Against COVID-19

The coronavirus disease 2019 (COVID-19), is a highly contagious transmittable disease caused by a recently discovered coronavirus, pathogenic SARS-CoV-2. Followed by the emergence of highly pathogenic coronaviruses in 2003 SARS-CoV, in 2012 MERS-CoV, now in 2019 pathogenic SARS-CoV-2, is associated with a global "pandemic" situation. In humans, the effects of these viruses are correlated with viral pneumonia, severe respiratory tract infections. It is believed that interaction between angiotensin converting enzyme 2 (ACE2) cell receptor and viral Spike protein mediates the coronavirus entry into human respiratory epithelial cells and establishes the host tropism. ACE2 receptor is highly expressed in airway epithelial cells. Along with viral-receptor interaction, proteolytic cleavability of S protein has been considered as the determinant of disease severity. Several studies highlight the occurrence of impaired host immune response and expression of excessive inflammatory response especially cytokines against viral infection. The mechanisms of SARS-CoV-2 induced acute lung injury are still undefined; however, the term cytokine storm has now been recognized to be closely associated with COVID-19. The levels of inflammatory mediators from cytokine storm cause damage to the host cells. In particular, the proinflammatory cytokine IL-6 appears to be the key mediator in early phase of virus-receptor interaction; however, secreted IL-6 might not be representative of lung inflammation. Understanding the cellular, and molecular factors involved in immune dysregulation and the high virulence capacity of COVID-19 will help in potential targeted therapy against it. "Drug repurposing" and "molecular docking analysis" is considered as an attractive alternative approach in analyzing suitable drug candidates to combat SARS-CoV-2 infection. Globally, extensive research is in progress to discover a new vaccine for novel COVID-19. Moreover, our review mainly focuses on the most state-of-the-art therapeutic approach mediated by "Mannose-binding lectin (MBL)." One of the most significant molecules of innate immunity is MBL. It plays a major role in the activation of the complement system as an ante-antibody prior to the response of any particular antibody. Recombinant human MBL can be used as immunomodulators against SARS-CoV-2.

Extracorporeal Membrane Oxygenation (ECMO) in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19) Pneumonia and Acute Respiratory Distress Syndrome (ARDS)

Traced back to December 2019, an unexpected outbreak of a highly contagious new coronavirus pneumonia (COVID-19) has rapidly swept around China and the globe. There have now been an estimated 2 580 000 infections and more than 170 000 fatal cases around the world. The World Health Organization (WHO) estimated that approximately 14% of infections developed into severe disease, 5% were critically ill, and the mortality rate of critically ill patients is reported to be over 50%. The shortage of specific anti-viral treatment and vaccines remains a huge challenge. In COVID-19, refractory hypoxemia is common among the critically ill with acute respiratory distress syndrome (ARDS) despite invasive mechanical ventilation, and is further complicated by respiratory and circulatory failure. This difficult situation calls for the use of extracorporeal membrane oxygenation (ECMO) for assisting respiration and circulation if necessary. This article reviews the pertinent clinical literature, technical guidance, and expert recommendations on use of ECMO in critically ill cases of COVID-19. Here, we present basic knowledge and opinions about COVID-19 and ECMO, review the evidence on ECMO use in Middle East Respiratory Syndrome (MERS) and H1N1 influenza, share the technical guidance and recommendations on use of ECMO in COVID-19, summarize the current use of ECMO against COVID-19 in China, and discuss the issues in use of ECMO in COVID-19.

A dissection of SARS‑CoV2 with clinical implications (Review)

We are being confronted with the most consequential pandemic since the Spanish flu of 1918‑1920 to the extent that never before have 4 billion people quarantined simultaneously; to address this global challenge we bring to the forefront the options for medical treatment and summarize SARS‑CoV2 structure and functions, immune responses and known treatments. Based on literature and our own experience we propose new interventions, including the use of amiodarone, simvastatin, pioglitazone and curcumin. In mild infections (sore throat, cough) we advocate prompt local treatment for the naso‑pharynx (inhalations; aerosols; nebulizers); for moderate to severe infections we propose a tried‑and‑true treatment: the combination of arginine and ascorbate, administered orally or intravenously. The material is organized in three sections: i) Clinical aspects of COVID‑19; acute respiratory distress syndrome (ARDS); known treatments; ii) Structure and functions of SARS‑CoV2 and proposed antiviral drugs; iii) The combination of arginine‑ascorbate.

Low baseline pulmonary levels of cytotoxic lymphocytes as a predisposing risk factor for severe COVID-19

COVID-19 is caused by the coronavirus SARS-CoV-2 and currently has detrimental human health, community and economic impacts around the world. It is unclear why some SARS-CoV-2-positive individuals remain asymptomatic, while others develop severe symptoms. Baseline pulmonary levels of anti-viral leukocytes, already residing in the lung prior to infection, may orchestrate an effective early immune response and prevent severe symptoms. Using "in silico flow cytometry", we deconvoluted the levels of all seven types of anti-viral leukocytes in 1,927 human lung tissues. Baseline levels of CD8+ T cells, resting NK cells and activated NK cells, as well as cytokines that recruit these, are significantly lower in lung tissues with high expression of the SARS-CoV-2 entry receptor ACE2. We observe this in univariate analyses, in multivariate analyses, and in two independent datasets. Relevantly, ACE2 mRNA and protein levels very strongly correlate in human cells and tissues. Above findings also largely apply to the SARS-CoV-2 entry protease TMPRSS2. Both SARS-CoV-2-infected lung cells and COVID-19 lung tissues show upregulation of CD8+ T cell-and NK cell-recruiting cytokines. Moreover, tissue-resident CD8+ T cells and inflammatory NK cells are significantly more abundant in bronchoalveolar lavages from mildly affected COVID-19 patients, compared to severe cases. This suggests that these lymphocytes are important for preventing severe symptoms. Elevated ACE2 expression increases sensitivity to coronavirus infection. Thus, our results suggest that some individuals may be exceedingly susceptible to develop severe COVID-19 due to concomitant high pre-existing ACE2 and TMPRSS expression and low baseline cytotoxic lymphocyte levels in the lung.

Virtual screening, ADMET prediction and dynamics simulation of potential compounds targeting the main protease of SARS-CoV-2

The coronavirus disease-2019 caused by a novel SARS CoV-2 virus has emerged as a global threat. Still, no drugs are available for its treatment. The main protease is the most conserved structure responsible for the posttranslational processing of non-structural polyproteins of this virus. Therefore, it can be the potential target for drug discovery against SARS CoV-2. Twenty-one thousand two hundred and seven chemical compounds used for sequential virtual screening studies including coronavirus screening compounds (Life Chemical database) and antiviral compounds (Asinex database). The Schrodinger suite 2019 employed for high throughput screening, molecular docking and MM-GBSA through the Glide module. Subsequently, 23 compounds were selected in the phase first selection criteria for re-docking with AutoDock and iDock followed by ADMET prediction. The drug-likeness predicted through Lipinski’s rule of five, Veber’s rule and Muegge’s rule. Finally, three ligands were selected for molecular dynamics simulation studies over 150 ns against the main protease of the SARS CoV-2. They showed promising docking scores on Glide, iDock and AutoDock Vina algorithms (ligand F2679-0163: −10.75, −10.29 and −9.2; ligand F6355-0442: −9.38, −8.61 and −7.6; ligand 8250: −9.795, −7.94 and −7.5), respectively. The RMSD parameter remained stable at 2.5 Å for all the three ligands for 150 ns. The high RMSF fluctuations, RoG of around 22 Å and the binding free energy were favorable in each case. The hydrogen bond interactions of 8250, F6355-0442 and F2679-0163 were six, five and three, respectively. These compounds can be further explored for in vitro experimental validation against SARS-CoV-2.

Communicated by Ramaswamy H. Sarma

Decrease in Ambient Fine Particulate Matter during COVID-19 Crisis and Corresponding Health Benefits in Seoul, Korea

Both domestic emissions and transported pollutants from neighboring countries affect the ambient fine particulate matter (PM_2.5) concentration of Seoul, Korea. Diverse measures to control the coronavirus disease 2019 (COVID-19), such as social distancing and increased telecommuting in Korea and the stringent lockdown measures of China, may reduce domestic emissions and levels of transported pollutants, respectively. In addition, wearing a particulate-filtering respirator may have decreased the absolute PM_2.5 exposure level for individuals. Therefore, this study estimated the acute health benefits of PM_2.5 reduction and changes in public behavior during the COVID-19 crisis in Seoul, Korea. To calculate the mortality burden attributable to PM_2.5, we obtained residents’ registration data, mortality data, and air pollution monitoring data for Seoul from publicly available databases. Relative risks were derived from previous time-series studies. We used the attributable fraction to estimate the number of excessive deaths attributable to acute PM_2.5 exposure during January to April, yearly, from 2016 to 2020, and the number of mortalities avoided from PM_2.5 reduction and respirator use observed in 2020. The average PM_2.5 concentration from January to April in 2020 (25.6 μg/m³) was the lowest in the last 5 years. At least −4.1 μg/m³ (95% CI: −7.2, −0.9) change in ambient PM_2.5 in Seoul was observed in 2020 compared to the previous 4 years. Overall, 37.6 (95% CI: 32.6, 42.5) non-accidental; 7.0 (95% CI: 5.7, 8.4) cardiovascular; and 4.7 (95% CI: 3.4, 6.1) respiratory mortalities were avoided due to PM_2.5 reduction in 2020. By considering the effects of particulate respirator, decreases of 102.5 (95% CI: 89.0, 115.9) non-accidental; 19.1 (95% CI: 15.6, 22.9) cardiovascular; and 12.9 (95% CI: 9.2, 16.5) respiratory mortalities were estimated. We estimated that 37 lives were saved due to the PM_2.5 reduction related to COVID-19 in Seoul, Korea. The health benefit may be greater due to the popular use of particulate-filtering respirators during the COVID-19 crisis. Future studies with daily mortality data are needed to verify our study estimates.

Drug targets for COVID-19 therapeutics: Ongoing global efforts

The current global pandemic COVID-19 caused by the SARS-CoV-2 virus has already inflicted insurmountable damage both to the human lives and global economy. There is an immediate need for identification of effective drugs to contain the disastrous virus outbreak. Global efforts are already underway at a war footing to identify the best drug combination to address the disease. In this review, an attempt has been made to understand the SARS-CoV-2 life cycle, and based on this information potential druggable targets against SARS-CoV-2 are summarized. Also, the strategies for ongoing and future drug discovery against the SARS-CoV-2 virus are outlined. Given the urgency to find a definitive cure, ongoing drug repurposing efforts being carried out by various organizations are also described. The unprecedented crisis requires extraordinary efforts from the scientific community to effectively address the issue and prevent further loss of human lives and health.

Smoking increases the risk of infectious diseases: A narrative review

Smoking is relevant to infectious diseases resulting in increased prevalence and mortality. In this article, we aim to provide an overview of the effects of smoking in various infections and to explain the potential mechanisms. We searched PubMed and other relevant databases for scientific studies that explored the relationship between smoking and infection. The mechanisms of susceptibility to infection in smokers may include alteration of the structural, functional and immunologic host defences. Smoking is one of the main risk factors for infections in the respiratory tract, digestive tract, reproductive tract, and other systems in humans, increasing the prevalence of HIV, tuberculosis, SARS-CoV, and the current SARS-CoV-2. Smoking cessation can reduce the risk of infection. Smoking increases the incidence of infections and aggravates the progress and prognosis of infectious diseases in a dose-dependent manner. Smoking cessation promotion and education are the most practical and economical preventive measures to reduce aggravation of disease infection owing to tobacco use.

COVIDiagnosis-Net: Deep Bayes-SqueezeNet based diagnosis of the coronavirus disease 2019 (COVID-19) from X-ray images

The Coronavirus Disease 2019 (COVID-19) outbreak has a tremendous impact on global health and the daily life of people still living in more than two hundred countries. The crucial action to gain the force in the fight of COVID-19 is to have powerful monitoring of the site forming infected patients. Most of the initial tests rely on detecting the genetic material of the coronavirus, and they have a poor detection rate with the time-consuming operation. In the ongoing process, radiological imaging is also preferred where chest X-rays are highlighted in the diagnosis. Early studies express the patients with an abnormality in chest X-rays pointing to the presence of the COVID-19. On this motivation, there are several studies cover the deep learning-based solutions to detect the COVID-19 using chest X-rays. A part of the existing studies use non-public datasets, others perform on complicated Artificial Intelligent (AI) structures. In our study, we demonstrate an AI-based structure to outperform the existing studies. The SqueezeNet that comes forward with its light network design is tuned for the COVID-19 diagnosis with Bayesian optimization additive. Fine-tuned hyperparameters and augmented dataset make the proposed network perform much better than existing network designs and to obtain a higher COVID-19 diagnosis accuracy.

Mechanism of inflammatory response in associated comorbidities in COVID-19

BACKGROUND AND AIMS

The outbreak of the new coronavirus, SARS-CoV-2, causes a respiratory disease and individuals with pre-existing cardiometabolic disorders display worse prognosis through the infection course. The aim of this minireview is to present epidemiological data related to metabolic comorbidities in association with the SARS-CoV-2.

METHODS

This is a narrative mini-review with Pubmed search until April 23, 2020 using the keywords COVID-19, SARS-CoV-2, treatment of coronavirus and following terms: diabetes mellitus, obesity, arterial hypertension, ACE-inhibitors, cytokine storm, immune response and vitamin D.

RESULTS

Studies indicate that obese individuals are more likely to develop infections, and that adipose tissue serves as a pathogen reservoir. In diabetic individuals higher rate of inflammatory processes is seen due to constant glucose recognition by C type lectin receptors. Hypertensive individuals, usually grouped with other conditions, are treated with drugs to reduce blood pressure mostly through ACEi and ARB, that leads to increased ACE2 expression, used by SARS-CoV-2 for human's cell entry. Until now, the studies have shown that individuals with those conditions and affected by COVID-19 present an uncontrolled release of pro-inflammatory cytokines and an unbalanced immune response, leading to the cytokine storm phenomenon. Vitamin D is highlighted as a potential therapeutic target, because in addition to acting on the immune system, it plays an important role in the control of cardiometabolic diseases.

CONCLUSION

Currently, since there is no proven and effective antiviral therapy for SARS-CoV-2, the efforts should focus on controlling inflammatory response and reduce the risks of associated complications.

Imaging findings in COVID-19 pneumonia

The coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan city and was declared a pandemic in March 2020. Although the virus is not restricted to the lung parenchyma, the use of chest imaging in COVID-19 can be especially useful for patients with moderate to severe symptoms or comorbidities. This article aimed to demonstrate the chest imaging findings of COVID-19 on different modalities: chest radiography, computed tomography, and ultrasonography. In addition, it intended to review recommendations on imaging assessment of COVID-19 and to discuss the use of a structured chest computed tomography report. Chest radiography, despite being a low-cost and easily available method, has low sensitivity for screening patients. It can be useful in monitoring hospitalized patients, especially for the evaluation of complications such as pneumothorax and pleural effusion. Chest computed tomography, despite being highly sensitive, has a low specificity, and hence cannot replace the reference diagnostic test (reverse transcription polymerase chain reaction). To facilitate the confection and reduce the variability of radiological reports, some standardizations with structured reports have been proposed. Among the available classifications, it is possible to divide the radiological findings into typical, indeterminate, atypical, and negative findings. The structured report can also contain an estimate of the extent of lung involvement (e.g., more or less than 50% of the lung parenchyma). Pulmonary ultrasonography can also be an auxiliary method, especially for monitoring hospitalized patients in intensive care units, where transfer to a tomography scanner is difficult.

COVID-19: challenges affecting the uptake of e-learning in pharmacy education in Africa

The effort by countries and relevant stakeholders to improving the quality of pharmacy education globally is being countered by the outbreak of infectious diseases. In order to curtail the spread of the coronavirus, unprecedented measures such as total/partial lockdowns and ban on public gatherings have been put in place by several governments. These measures implemented have put a halt on academic activities and schooling and have invariably affected the delivery of pharmacy education globally and Africa is no exception. In order to ensure the continuity of pharmacy education, the e-learning strategy has been utilized by several countries in the world today and Africa should not be left out. There is an urgent need for Africa to meet up with the present education demands by adopting the e-learning strategy but this is not without challenges. We examine the impact of these measures on pharmacy education as well as the challenges affecting the uptake and applicability of the e-learning strategy in pharmacy education in Africa. It is therefore essential for the government and relevant stakeholders in the pharmacy education sector to address the numerous challenges that may hinder its uptake in Africa.

[Otorhinolaryngological aspects of the disease course in children infected with SARS-CoV-2 virus]

Recently, almost all over the world attention of doctors and scientists is focused on a new coronavirus infection, the source of which was the causative agent SARS-CoV-2. In this regard, early diagnosis, including on the basis of symptoms from ENT organs, is crucial. A brief analysis of the available literature on the peculiarities of ENT organs manifestations in patients with SARS-CoV-2 is given. It was found out that to date there is very little data on the state of loro organs in patients with SARS-CoV-2 and no data on anosmia in the pediatric population. However, it is in children in the epidemic aspect that early diagnosis of infection and understanding of its key symptoms is of utmost importance.

Possible long-term endocrine-metabolic complications in COVID-19: lesson from the SARS model

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is centralizing the interest of the scientific world. In the next months, long-term consequences on the endocrine system may arise following COVID-19. In this article, we hypothesized the effects of SARS-CoV-2 taking into account what learned from the severe acute respiratory syndrome coronavirus (SARS-CoV) that caused SARS in 2003.

[Appreciating COVID-19 as a child and adolescent psychiatrist on the move]

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.

Coronaviridae-Old friends, new enemy!

Coronaviridae is a family of single‐stranded positive enveloped RNA viruses. This article aimed to review the history of these viruses in the last 60 years since their discovery to understand what lessons can be learned from the past. A review of the PubMed database was carried out, describing taxonomy, classification, virology, genetic recombination, host adaptation, and main symptoms related to each type of virus. SARS‐CoV‐2 is responsible for the ongoing global pandemic, and SARS‐CoV and MERS‐CoV were responsible for causing severe respiratory illness and regional epidemics in the past while the four other strains of CoVs (229‐E OC43, NL63, and HKU1) circulate worldwide and normally only cause mild upper respiratory tract infections. Given the enormous diversity of coronavirus viruses in wildlife and their continuous evolution and adaptation to humans, future outbreaks would undoubtedly occur. Restricting or banning all trade in wild animals in wet markets would be a necessary measure to reduce future zoonotic infections.

A Review on the Novel Coronavirus Disease based on In-silico Analysis of Various Drugs and Target Proteins

Coronavirus Disease (COVID-19) is a new disease that emerged in Wuhan, China which spreads through close contact of people, often by small droplets produced during coughing or sneezing. Detail mechanism by which it spreads between people are under investigation. The World Health Organization (WHO) declared this disease as a pandemic after the severity of the disease increased. Many scientific reports gathered have suggested many drugs that could be potential candidates for the treatment. Although, clinical effectiveness has not been fully evaluated. In this review, we have aggregated the data from few research articles, official news websites and few review papers regarding its phylogenetic relation, genomic constitution, transmission, replication and in-silico analysis done by researchers for few potent drugs that are currently used to cure COVID-19. SARS-CoV-2 belongs to Betacoronavirus genus with Genome structure consists 14 Open Reading Frames (ORFs) that encode 27 proteins. Coronavirus replicates into the host cells having unique mechanisms like ribosome frame-shifting and synthesis of genomic and sub genomic RNAs. In-silico methods have the advantage that they can make fast predictions for a large set of compounds in a high-throughput mode and also make their prediction based on the structure of a compound even before it has been synthesized. In-silico softwares have been used to find or to improve a novel bioactive compound, which may exhibit a strong affinity to a particular target in the drug development process.

The Psychological Impact of Confinement Linked to the Coronavirus Epidemic COVID-19 in Algeria

The COVID-19 pandemic continues to spread in countries around the world. The impact of this virus is very great on populations following the application of total and partial containment measures. Our study aims to study the psychological impact of total and partial containment applied in Algeria, on 23 March 2020, following the spread of the virus COVID-19 and also studied the habits and behaviors of the Algerian population during this new way of life and this through a cross-sectional survey launched after three days from the start of confinement to quickly assess the impacts over the period from 23 March to 12 April 2020, by an online questionnaire which allowed us to obtain 678 responses from Internet users, who live in confinement in Algeria. According to the gender variable, our sample includes 405 men, or 59.7%, and 273 women, representing 40.3%. The results of the statistical analysis carried out using SPSS version 22.0 software showed that 50.3% of the respondents were in an anxious situation during these first three weeks of confinement. In addition, 48.2% feels stressed, 46.6% of the respondents confirmed to be feeling in a bad mood, and 47.4% do not stop thinking throughout the day about this epidemic and how to protect themselves. In addition, the study shows that 87.9% of the respondents in Algeria found it difficult to follow the confinement instructions. A significant change in the habits of the population was noted especially for the time of going to bed, the time of waking up, and the use of the Internet as well as the hours devoted to daily reading.

Early intervention likely improves mortality in COVID-19 infection

While some risk factors have been identified, the reasons for the disparities in disease progression with COVID-19 are unclear, with some patients developing progressive and severe disease while in others the course is benign. Given this sense of randomness, and in the absence of a definitive treatment, medical professionals can feel helpless. It is useful to remember how much can be done to affect the trajectory of illness, even without a 'magic bullet'. With evidence emerging that late presentation is directly associated with increased mortality, we make the case for increased vigilance in the community and earlier intervention.

Microarray expression profiling of long noncoding RNAs in the progesterone-treated lung cancer cells

BACKGROUND

The increasing incidence and unique biological features of lung cancer in women has prompted renewed interest in the role of sex hormones in this disease. We previously showed that progesterone (P4) inhibited lung cancer tumorigenesis and progression. Here, we investigated the effects of P4 on expression of long noncoding RNAs (lncRNAs) and target mRNAs in lung cancer cells.

METHODS

We performed high-throughput microarray and bioinformatics analysis to identify differentially expressed lncRNAs and mRNAs in the untreated and the P4-treated A549 human lung cancer cells.

RESULTS

In total, 692 lncRNAs and 268 mRNAs were significantly differentially expressed in the P4-treated A549 cells compared to the untreated A549 cells (> 2-fold change, p < 0.05). Of the lncRNAs, 82 and 610 were up-regulated and down-regulated, respectively. Gene ontology, pathway and network analyses showed that many of the mRNAs were involved in the regulation of classical pathways, including Notch signaling. Differential expression of a lncRNA signature composed of NONHSAT000264, FR075921, FR324124, linc-TRIM58, RP1-93H18.7, RP11-120 K9.2, RP11-134F2.2 and NONHSAG024980 was validated by quantitatuve reverse transcriptase-polymerase chain reaction analysis.

CONCLUSIONS

This is the first report of differentially expressed lncRNAs in the P4-treated lung cancer cells. The results suggest that lncRNAs could serve as potential therapeutic targets for P4-sensitive lung cancer.

SARS-CoV-2 Inflammatory Syndrome. Clinical Features and Rationale for Immunological Treatment

The current pandemic coronavirus, SARS-CoV-2, is a global health emergency because of its highly contagious nature, the great number of patients requiring intensive care therapy, and the high fatality rate. In the absence of specific antiviral drugs, passive prophylaxis, or a vaccine, the treatment aim in these patients is to prevent the potent virus-induced inflammatory stimuli from leading to the acute respiratory distress syndrome (ARDS), which has a severe prognosis. Here, the mechanism of action and the rationale for employing immunological strategies, which range from traditional chemically synthesized drugs, anti-cytokine antibodies, human immunoglobulin for intravenous use, to vaccines, are reviewed.

SARS-CoV-2 Inflammatory Syndrome. Clinical Features and Rationale for Immunological Treatment

The current pandemic coronavirus, SARS-CoV-2, is a global health emergency because of its highly contagious nature, the great number of patients requiring intensive care therapy, and the high fatality rate. In the absence of specific antiviral drugs, passive prophylaxis, or a vaccine, the treatment aim in these patients is to prevent the potent virus-induced inflammatory stimuli from leading to the acute respiratory distress syndrome (ARDS), which has a severe prognosis. Here, the mechanism of action and the rationale for employing immunological strategies, which range from traditional chemically synthesized drugs, anti-cytokine antibodies, human immunoglobulin for intravenous use, to vaccines, are reviewed.

Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis

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COVID-19 is a new respiratory and systemic disease which needs quick identification of potential critical patients.

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There is a significant reduction of lymphocyte count in the severe COVID-19 group compared to the non-severe group.

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Those with lymphopenia have a 3-fold higher risk of developing severe COVID-19.

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Lymphopenia is a prominent feature of COVID-19 and lymphocyte counts may be a useful, easily available biomarker in predicting the severity and clinical outcomes.

Objectives

Coronavirus Disease 2019 (COVID-19) is a new respiratory and systemic disease which needs quick identification of potential critical patients. This meta-analysis aimed to explore the relationship between lymphocyte count and the severity of COVID-19.

Methods

A comprehensive systematic literature search was carried out to find studies published from December 2019 to 22 March 2020 from five databases. The language of literatures included English and Chinese. Mean difference (MD) of lymphocyte count in COVID-19 patients with or without severe disease and odds ratio (OR) of lymphopenia for severe form of COVID-19 was evaluated with this meta-analysis.

Results

Overall 13 case-series with a total of 2282 cases were included in the study. The pooled analysis showed that lymphocyte count was significantly lower in severe COVID-19 patients (MD -0.31 × 10⁹/L; 95%CI: -0.42 to -0.19 × 10⁹/L). The presence of lymphopenia was associated with nearly threefold increased risk of severe COVID-19 (Random effects model, OR = 2.99, 95% CI: 1.31-6.82).

Conclusions

Lymphopenia is a prominent part of severe COVID-19 and a lymphocyte count of less than 1.5 × 10⁹/L may be useful in predicting the severity clinical outcomes.

Face Masks in the New COVID-19 Normal: Materials, Testing, and Perspectives

The increasing prevalence of infectious diseases in recent decades has posed a serious threat to public health. Routes of transmission differ, but the respiratory droplet or airborne route has the greatest potential to disrupt social intercourse, while being amenable to prevention by the humble face mask. Different types of masks give different levels of protection to the user. The ongoing COVID-19 pandemic has even resulted in a global shortage of face masks and the raw materials that go into them, driving individuals to self-produce masks from household items. At the same time, research has been accelerated towards improving the quality and performance of face masks, e.g., by introducing properties such as antimicrobial activity and superhydrophobicity. This review will cover mask-wearing from the public health perspective, the technical details of commercial and home-made masks, and recent advances in mask engineering, disinfection, and materials and discuss the sustainability of mask-wearing and mask production into the future.