Understanding of COVID-19 based on current evidence

Use of NIR in COVID-19 Screening: Proof of Principles for Future Application

The COVID-19 pandemic that affected the world between 2019 and 2022 showed the need for new tools to be tested and developed to be applied in global emergencies. Although standard diagnostic tools exist, such as the reverse-transcription polymerase chain reaction (RT-PCR), these tools have shown severe limitations when mass application is required. Consequently, a pressing need remains to develop a rapid and efficient screening test to deliver reliable results. In this context, near-infrared spectroscopy (NIRS) is a fast and noninvasive vibrational technique capable of identifying the chemical composition of biofluids. This study aimed to develop a rapid NIRS testing methodology to identify individuals with COVID-19 through the spectral analysis of swabs collected from the oral cavity. Swab samples from 67 hospitalized individuals were analyzed using NIR equipment. The spectra were preprocessed, outliers were removed, and classification models were constructed using partial least-squares for discriminant analysis (PLS-DA). Two models were developed: one with all the original variables and another with a limited number of variables selected using ordered predictors selection (OPS-DA). The OPS-DA model effectively reduced the number of redundant variables, thereby improving the diagnostic metrics. The model achieved a sensitivity of 92%, a specificity of 100%, an accuracy of 95%, and an AUROC of 94% for positive samples. These preliminary results suggest that NIRS could be a potential tool for future clinical application. A fast methodology for COVID-19 detection would facilitate medical diagnoses and laboratory routines, helping to ensure appropriate treatment.

Implementation of an Immunoassay Based on the MVA-T7pol-Expression System for Rapid Identification of Immunogenic SARS-CoV-2 Antigens: A Proof-of-Concept Study

The emergence of hitherto unknown viral pathogens presents a great challenge for researchers to develop effective therapeutics and vaccines within a short time to avoid an uncontrolled global spread, as seen during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, rapid and simple methods to identify immunogenic antigens as potential therapeutical targets are urgently needed for a better pandemic preparedness. To address this problem, we chose the well-characterized Modified Vaccinia virus Ankara (MVA)-T7pol expression system to establish a workflow to identify immunogens when a new pathogen emerges, generate candidate vaccines, and test their immunogenicity in an animal model. By using this system, we detected severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) nucleoprotein (N)-, and spike (S)-specific antibodies in COVID-19 patient sera, which is in line with the current literature and our observations from previous immunogenicity studies. Furthermore, we detected antibodies directed against the SARS-CoV-2-membrane (M) and -ORF3a proteins in COVID-19 patient sera and aimed to generate recombinant MVA candidate vaccines expressing either the M or ORF3a protein. When testing our candidate vaccines in a prime-boost immunization regimen in humanized HLA-A2.1-/HLA-DR1-transgenic H-2 class I-/class II-knockout mice, we were able to demonstrate M- and ORF3a-specific cellular and humoral immune responses. Hence, the established workflow using the MVA-T7pol expression system represents a rapid and efficient tool to identify potential immunogenic antigens and provides a basis for future development of candidate vaccines.

The effect of physiotherapy intervention on functional outcomes among COVID-19 patients: Clinical experimental study

BACKGROUND

COVID-19 is a highly contagious virus that causes pneumonia, which quickly progresses to acute respiratory distress. In the case of COVID-19, physiotherapy is critical in non-invasive support management, postural changes, chest physiotherapy (CPT), and bed mobility. This study aims to look into the effects of physiotherapy intervention on functional outcome levels in COVID-19 patients in the acute stage.

METHODS

A total of 60 severe COVID-19 patients (54 males and 6 females) with a mean age of 50 years were studied. The intervention group (n = 30) had two daily physiotherapy sessions that included positioning, CPT, cardio exercises, breathing exercises, and early mobility, whereas the control group (n = 30) received only standard medical care. Patients were tested twice at the baseline and discharge using peripheral oxygen saturation, respiratory rate (RR) test, dyspnea rate, two-min walk test, and spirometer scores, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).

RESULTS

The two groups improved significantly between the baseline and discharge ratings. The intervention group, on the other hand, significantly improved all outcome indicators at discharge (p-value = 0.00). This study found that physiotherapy management improved oxygen saturation, RR, dyspnea, and lung function tests in COVID-19 patients except in FVC (p-value = 0.402) and FEV1(p-value = 0.114).

CONCLUSION

Physiotherapist interventions with COVID-19 patients increase respiratory function and treatment time.

Effects of the combination of bone marrow stromal cells and exercise on corticosterone, BDNF, IGF-1, and anxiety-like behaviour in a rat model of post-traumatic stress disorder: Comparable effects of exercise

AIM

Post-traumatic stress disorder (PTSD) requires more effective treatment options with fewer side effects. Stem cell therapy, as a novel approach, has been investigated in the treatment of various diseases, including brain disorders. This study investigated the effects of bone marrow stromal cells (BMSCs) and the combination of BMSCs with exercise on corticosterone, BDNF and IGF-1, and anxiety-like behaviours in a male rat model of PTSD.

METHODS

Male adult Wistar rats were subjected to PTSD induced by the single prolonged stress (SPS) model. 7 days after SPS, BMSCs were injected intravenously. The exercise started on day 11 and continued for 4 weeks. On day 40th, anxiety behaviour, corticosterone, BDNF, and IGF-1 were tested. p < 0.05 was considered as a significant level.

RESULTS

The study showed that a combination of BMSCs and exercise significantly reduced anxiety-related behaviours, and alterations in BDNF, IGF-1, and corticosterone levels. Also, BMSCs alone significantly reduced some of the PTSD-induced impairments. However, exercise alone showed greater efficiency in comparison with BMSCs alone.

CONCLUSION

According to the results, although combination therapy effectively improved PTSD-related complications, exercise had relatively comparable effects on PTSD. Exercise has the potential to enhance the efficacy of BMSC therapy. Further research is required to determine whether BMSC therapy is sufficiently efficacious and safe in clinical settings.

Examining the long-term effects of COVID-19 in surgical nurses: Case of Aegean Region

PURPOSE

To examine the long-term effects of COVID-19 on surgical nurses.

BACKGROUND

Individuals contaminated with COVID-19 may face several metabolic or psychological issues, primarily in the respiratory, cardiovascular, nervous, musculoskeletal and renal systems during the late period. However, the long-term epidemiology is still not clear.

DESIGN

Descriptive cross-sectional study.

METHODS

The study included nurses (n = 509) who had been diagnosed with COVID-19 at least 12 weeks before and worked in surgical departments. We collected the study data via an online survey using the snowball sampling method between December 2021 and May 2022. This study followed the Reporting of Observational Studies in Epidemiology Guideline.

RESULTS

The mean age of the nurses was 31.66 ± 8.74 years. Nurses stated that they were diagnosed with COVID-19 approximately 36 weeks before participating in this study. We found that the nurses mostly experienced palpitation (83.5%), headache (73.5%), dyspnea (64.1%), anosmia (57.6%), arthralgia (55.7%) and burnout (58.4%) during the late period after COVID-19.

CONCLUSION

The long-term effects of COVID-19 were related to multiple organ dysfunctions.

NO PATIENT OR PUBLIC CONTRIBUTION

Since the study was conducted with healthy individuals who had previously experienced COVID-19, there is no patient contribution.

RELEVANCE TO CLINICAL PRACTICE

This study focuses on the long-term effects of COVID-19 on nurses. The results support the long-term effects of COVID-19 and are thought to contribute to the literature.

Clinical-Epidemiological Profile of COVID-19 Patients Admitted during Three Waves of the Pandemic in a Tertiary Care Center, in Belém, Pará, Amazon Region of Brazil

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a disease with a broad clinical spectrum, which may result in hospitalization in healthcare units, intensive care, and progression to death. This study aimed to describe and compare the clinical and epidemiological profile of COVID-19 during the three waves of the disease, in patients admitted to a public hospital in the city of Belém, Pará, in the Amazon region of Brazil.

METHODS

This descriptive, observational, and cross-sectional study was population-based on individuals who were hospitalized with a diagnosis of COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR), and who were interviewed and monitored at the public hospital, from February 2020 to April 2022.

RESULTS

The prevalence was male patients, older than 60 years. The most frequent symptoms were dyspnea, cough, and fever. Systemic arterial hypertension was the most prevalent comorbidity followed by diabetes mellitus. Less than 15% of patients were vaccinated. The nasal oxygen cannula was the most used oxygen therapy interface followed by the non-rebreathing reservoir mask. Invasive mechanical ventilation predominated and the median time of invasive mechanical ventilation ranged from 2 to 6 days among waves. As for the hospital outcome, transfers prevailed, followed by deaths and discharges.

CONCLUSION

The presence of comorbidities, advanced age, and male sex were important factors in the severity and need for hospitalization of these patients, and the implementation of the vaccination policy was an essential factor in reducing the number of hospital admissions.

Exploring ways to support patients with noncommunicable diseases: A pilot study in Nepal during the COVID-19 pandemic

Global healthcare systems have faced unprecedented strain due to the COVID-19 pandemic, with a profound impact on individuals with non-communicable diseases (NCDs), a scenario particularly pronounced in low-income countries like Nepal. This study aimed to understand the experiences of and challenges faced by patients with NCDs in Nepal during the pandemic, focusing on healthcare service availability and identifying factors affecting healthcare use, with the goal of being prepared for future emergencies. This study utilized a telephonic survey of 102 patients with NCDs and 10 qualitative interviews with healthcare providers in the Kavrepalanchok and Nuwakot districts of Nepal. We used mixed methods, with both qualitative and quantitative approaches. Specifically, multiple correspondence analysis, hierarchical cluster analysis, and classification tree analysis were used as exploratory methods. The study revealed that while 69.6% of the participants reported no difficulty in obtaining medication, other questions revealed that 58.8% experienced challenges in accessing routine medical care. Major barriers, such as fear of infection, unavailability of medicine in rural areas, and lack of transportation, were found through the qualitative interviews. Meanwhile, participants identified innovative strategies, such as telemedicine and community-based awareness programs, as potential facilitators for addressing barriers that arise during pandemic situations such as COVID-19. The COVID-19 pandemic exacerbated challenges in accessing healthcare services for patients with NCDs in Nepal. Our findings suggest the need to design and implement telemedicine services for patients with NCDs, as well as community-based programs that aim to improve health literacy, encourage healthy behavior, prevent development of NCDs, and ensure continuity of care during such crises, especially in countries with limited resources.

Comparison of pre-hospital management of out-of-hospital cardiac arrest and its outcomes between the COVID-19 and pre-COVID-19 periods

Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency that needs immediate interventions. COVID-19 affected the performance of the emergency medical service (EMS) system in pre-hospital care, including the management of cardiac arrest. This study aimed to identify the impact of the COVID-19 pandemic on pre-hospital management of out-of-hospital cardiac arrest and its outcome in Qom City, Iran. In this descriptive-analytical study, the data were collected from the electronic registration system of the EMS center in Qom, Iran. All OHCA patients who received resuscitation during COVID-19 and before COVID-19 were enrolled in the study. Data consisted of the characteristics of OHCA patients, EMS interventions and response times, and the outcome of OHCA. A P-value of <0.05 was deemed statistically significant. 630 OHCA patients in the COVID-19 period and 524 OHCA patients in the pre-COVID-19 period were included in the study. Endotracheal intubation and defibrillation were done more in the COVID-19 period than in the pre-COVID-19 period (50.2 % vs. 17 %, p<0.001 %, and 40.1 % vs. 22.5 %, p < 0.001, respectively). The EMS response time was longer during the COVID-19 pandemic (9.1 ± 3.9 min vs. 7.6 ± 1.4 min, p < 0.001). The rate of pre-hospital return of spontaneous circulation (ROSC) was lower in the COVID-19 period (15.6 % vs. 8.4 %, p < 0.001). According to univariate analysis, ROSC was predicted by COVID-19 (p < 0.001). However, COVID-19 was not the statistically significant independent predictor after multivariate analysis (p < 0.67). The COVID-19 pandemic period influenced OHCA and ROSC. Also, it affected pre-hospital management in the OHCA situation. The negative impact of COVID-19 on the EMS response reflected the need to know and remove barriers to managing crises such as COVID-19.

Healthcare Providers' Adherence to COVID-19 Prevention and Control Practices in Health Records and Information Management, Ghana

Background

The impact of contracting coronavirus on healthcare providers (HCPs) affects their ability to combat the infection. The virus can be transmitted through droplets from sneezing, coughing, and yelling, making it essential for HCPs to plan ahead when dealing with patients with respiratory symptoms. The need to assess healthcare providers' perceived adherence to COVID-19 Prevention and Control Practices (PCP) in Health Records and Information Management is vital for optimizing healthcare operations and ensuring the safety of both patients and providers. This study assesses healthcare providers' perceived adherence to COVID-19 PCP in Health Records and Information Management. Subjects and Method. A cross-sectional survey was conducted to collect data from 1268 HCPs working in eight randomly selected hospitals across five regions in Ghana. The survey was carried out from May 15, 2022, to August 13, 2022. Simple random sampling was used to choose these eight facilities from a total of 204 hospitals. Within each facility, HCPs from various departments were selected using simple random sampling. The EpiInfo 7 software's StatCalc tool was used to choose a total sample size of 1268 from an estimated 4482 HCP-PR from the eight hospitals. Compliance with COVID-19 PCP was assessed using a 3-point scale, ranging from one (Yes always) to three (No). Cronbach's alpha reliability coefficient was used to examine the statistical reliability of the variables in the dataset. Cronbach's alpha was 0.73 overall, suggesting strong reliability. Bartlett's test for equal variances was used for comparative analysis of health facility and overall mean COVID-19 PCP in different areas of health facilities. IBM SPSS (version 23) statistical software was used for the data analysis process.

Results

A total of 1268 HCP-PR participated in the survey, resulting in a 99.6% response rate. Findings reveal that 760 healthcare professionals who handle patients' records (HCP-PR), constituting 60%, consistently followed COVID-19 protocols in the registration and clinic preparation zones. Another 390 individuals (30.7%) adhered to these protocols occasionally, while 119 (9.4%) failed to comply. Similarly, in the filing area, 739 respondents (58.3%) consistently adhered to COVID-19 protocols, 358 (28.3%) occasionally did so, and 170 (13.4%) did not follow the protocols at all. Regarding handling health records cautiously, 540 participants (42.5%) always did, 448 (35.3%) did so sometimes, and 280 (22.2%) neglected these precautions. Additionally, 520 respondents (41.0%) consistently followed COVID-19 precautions when handling computers and other equipment, 393 (31.0%) did so occasionally, and 355 (28.0%) did not adhere to these precautions.

Conclusion

The majority of respondents showed good compliance with COVID-19 protocol in the registration and clinic preparation areas. However, in the filing area, just over four out of every seven respondents consistently adhered to COVID-19 PCP. Additionally, four out of every seven participants did not comply with COVID-19 PCP when handling patients' records. Analysis reveals diverse adherence to COVID-19 PCP, and statistical tests show variable performance, highlighting standout health facilities.

Occupational Stress and Professional Quality of Life Among Community Health Nurses During the COVID-19 Pandemic

Purpose: This study aimed to identify the correlation between occupational stress and professional quality of life (Pro-QOL) among community nurses during the pandemic COVID-19. Design: This study was conducted with a correlational design of 120 community health nurses. The research sample was obtained using a nonprobability purposive sampling technique following the research inclusion criteria. Expanded Nursing Stress Scale and Pro-QOL were used in this study. The research hypothesis: there is a correlation between occupational stress and the Pro-QOL of community health nurses. Methods: Pearson's correlation coefficient was used to analyze the correlation between occupational stress and Pro-QOL. Findings: The results of correlation analysis showed that there was a statistically significant positive correlation between occupational stress and Pro-QOL. Despite being in a difficult situation due to the pandemic and vulnerable to occupational stress, nurses significantly had high compassion satisfaction. Conclusions: Occupational stress affects nurses' Pro-QOL, it can be considered for public healthcare organizations to promote healthcare workers' well-being. Mobilizing the existing workforce, changing work patterns, support from colleagues and supervisors, clear communication of directives, and precautionary measures can reduce psychiatric symptoms.

Communal conflicts in Nigeria: Assessment of the impacts on internally displaced persons and settlements amidst COVID-19 pandemic

Acknowledging that violent communal conflicts can lead to increased displacement and overcrowding in IDP camps, this study investigates the impact of such conflicts on internally displaced persons (IDPs) and their camps in Benue State, Nigeria, amid the COVID-19 pandemic. Employing a mixed-method approach, 386 IDPs and 20 stakeholders were purposively selected. Based on the research objectives, descriptive and inferential statistics were employed to analyze the research objectives. Employing logistics and multi-linear regressions, the data reveal that unregulated access to IDP camps resulted in overcrowding, straining resources like food and shelter. The study identifies economic losses and various challenges stemming from communal conflict and COVID-19, causing chaos, anxiety, and uncertainty in the IDP camps. These findings highlight the urgent need for ongoing humanitarian assistance to alleviate the precarious conditions faced by IDPs and their camps nationwide and recommend that the IDPs camps across the country need constant humanitarian aid to mitigate the various precarious conditions in the camps.

Clinical characteristics of COVID-19 patients treated in emergency COVID-19 hospitals in Vietnam: Experience from Phutho province, Vietnam

Background: This study aimed to evaluate the clinical characteristics, patient's management approaches, and outcomes of the COVID-19 patients in Phu Tho Province, Vietnam. Methods: A retrospective, multicenter study of 2166 COVID-19 patients in 13 hospitals in Phutho Province, Vietnam. The subjects were divided into 3 groups based on vaccination status: unvaccinated group, 1st dose of vaccine group, 2nd dose of vaccine group. The clinical characteristics, management approaches, and outcomes were collected and compared between the 3 groups. Results: The hospitalization rate of the 3 groups decreased from the unvaccinated group, the 1st dose of vaccinated group, to the 2nd dose of vaccinated group, 42.61%; 30,24% and 27,15% respectively. The 19-40 years old group had the highest hospitalization rate (38,1%) together with the group that had not accepted the full COVID 19 vaccination dose (57,64%). The 2nd dose of vaccinated group had the lowest percentages of high temperature, cough, dyspnea, chest pain and sore throat. The unvaccinated group had the highest heart rate, respiratory rate and SpO2 compared to the two other groups. The percentage needing Immunomodulation and Anticoagulant Therapy was highest (6.8% and 1.4 % respectively) in the unvaccinated group. The percentage receiving Antiviral Therapy was highest (42,5%) in those who had received the 2nd dose of vaccine. Conclusions: COVID-19 vaccination improved the symptoms of the patients and should be accepted in all ages.

Current Progress, Challenges and Prospects in the Development of COVID-19 Vaccines

The COVID-19 pandemic has resulted in over 772 million confirmed cases, including nearly 7 million deaths, according to the World Health Organization (WHO). Leveraging rapid development, accelerated vaccine approval processes, and large-scale production of various COVID-19 vaccines using different technical platforms, the WHO declared an end to the global health emergency of COVID-19 on May 5, 2023. Current COVID-19 vaccines encompass inactivated, live attenuated, viral vector, protein subunit, nucleic acid (DNA and RNA), and virus-like particle (VLP) vaccines. However, the efficacy of these vaccines is diminishing due to the constant mutation of SARS-CoV-2 and the heightened immune evasion abilities of emerging variants. This review examines the impact of the COVID-19 pandemic, the biological characteristics of the virus, and its diverse variants. Moreover, the review underscores the effectiveness, advantages, and disadvantages of authorized COVID-19 vaccines. Additionally, it analyzes the challenges, strategies, and future prospects of developing a safe, broad-spectrum vaccine that confers sufficient and sustainable immune protection against new variants of SARS-CoV-2. These discussions not only offer insight for the development of next-generation COVID-19 vaccines but also summarize experiences for combating future emerging viruses.

The Distinct Regulation of the Vitamin D and Aryl Hydrocarbon Receptors in COVID-19

(1) Background: SARS-CoV-2 affects several immune pathways, including the vitamin D (VDR) and the aryl hydrocarbon receptor pathways (AhR). The aim of the study was the evaluation of the VDR and AhR pathways in the blood of COVID-19 patients with regard to the severity of disease. (2) Methods: Observational, single-center, case-control design. A total of 240 samples were selected for exploration. Patients who tested negative for SARS-CoV-2 but suffered from other respiratory infections (ORIs) served as a control group. (3) Results: VDR-specific mRNA in the blood of patients with mild symptoms (131.2 ± 198.6) was significantly upregulated relative to the VDR expression of the ORI group (23.24 ± 42.60; p < 0.0001); however, VDR expression of critically ill patients showed an impaired upregulation (54.73 ± 68.34; p < 0.001). CYP27B1 expression was not significantly regulated during SARS-CoV-2 infection. There was a downregulation of VDR and CYP27B1 compared to survivors. There was no significant difference in 25(OH)-vitamin D3 levels between critically ill patients with regard to survival (24.3 ± 9.4 vs. 27.1 ± 11.3; p = 0.433). (4) Conclusion: The VDR and AhR pathways are distinctively regulated in patients suffering from COVID-19 depending on the severity of disease. A combination treatment of antiviral drugs and vitamin D substitution should be evaluated for potentially improved prognosis in COVID-19.

Knowledge, Attitude, and Practice of Physiotherapists in COVID-19 ICUs: A National Survey

Background

COVID-19 belongs to the beta-corona cluster that spreads enormously via aerosols. Physiotherapists must be knowledgeable about the symptoms, mode of transmission, risk mitigation strategies, and practice guidelines for COVID-19.

Objective

This study aimed to assess physiotherapists' knowledge of COVID-19 guidelines, their attitude toward this new evolving field, and their practice routines in India's COVID-19 ICUs.

Methods

It was a cross-sectional study. A total of 600 questionnaires were distributed through e-mail and WhatsApp to physiotherapists using Google Forms between February 2022 and January 2023. The questionnaires consisted of demographics and 23 questions in three sections about the knowledge, attitude, and practice of physiotherapists working in the COVID-19 ICU. Data analysis was carried out using Jamovi.

Results

A total of 136 responses were obtained from 18 states of India. Of 136 participants, 89 were female (65.4%) and 47 were male (34.6%). The highest level of qualification was BPT (n = 69 (50.7%)), followed by MPT (n = 62 (45.6%)) and Ph.D. (3 (3.7%)). The knowledge about COVID-19 guidelines is fair. Only 21.3% of the physiotherapists received training before being deployed in COVID-19 ICUs, and the CARP protocol was well known by only as few as 10.3%. The criteria advised for close monitoring of patients during treatment was aware by 29.4%. Most physiotherapists have a good attitude toward treating COVID-19 patients; 70.63% strongly agree that physiotherapy is vital in these patients despite the risk of self-exposure, and 64.7% agree that physiotherapy should be initiated during all phases of COVID-19. Physiotherapists follow good practices for COVID-19 patients in the ICU, which is as per the guideline recommendation.

Conclusion

Physiotherapists working in COVID-19 ICUs have a fair knowledge of the existing physiotherapy guidelines for COVID-19, and they exhibit good attitudes and practice patterns.

Trend of viral load during the first, second, and third wave of COVID-19 in the Indian Himalayan region: an observational study of the Uttarakhand state

India had faced three waves throughout the Coronavirus disease 2019 (COVID-19) pandemic, which had already impacted economic lives and affected the healthcare setting and infrastructure. The widespread impacts have inspired researchers to look for clinical indicators of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prognosis. Cyclic threshold values have been used to correlate the viral load in COVID-19 patients and for viral transmission. In light of this correlation, a retrospective study was conducted to assess the trend of viral load in clinical and demographic profiles across the three waves. Data of a total of 11,125 COVID-19-positive patients were obtained, which had a Ct value of <35. We stratified Ct values as follows: under 25 (high viral load), 25-30 (moderate viral load), and over 30 (low viral load). We found a significantly high proportion of patients with high viral load during the second wave. A significantly high viral load across the symptomatic and vaccinated populations was found in all three waves, whereas a significantly high viral load across age groups was found only in the first wave. With the widespread availability of real-time PCR and the limited use of genomic surveillance, the Ct value and viral load could be a suitable tool for population-level monitoring and forecasting.

A Qualitative Study of the Experience of COVID-19 Patients in Burkina Faso

In Burkina Faso, the health system is characterized by systemic insufficient and antiquated health-care infrastructures. Consequently, few health-care establishments have the required resources to diagnose and manage patients with COVID-19, and fewer still have intensive care facilities for severely ill patients with COVID. Furthermore, there is a widespread scarcity of qualified health-care staff. The aim of this study was to explore the experiences of patients with COVID-19 who recovered after being cared for in Bobo Dioulasso and Ouagadougou. Using individual semistructured interviews, we performed a cross-sectional qualitative, descriptive study from June 12 to 30, 2020 with the aid of 13 well-educated patients who had survived COVID-19. The results reveal that prior to hospital admission, the main reason that prompted patients to seek care was onset of symptoms of COVID-19, regardless of whether they had been in contact with suspected or confirmed cases. Transmission was mainly believed to have occurred in the community, in the hospital, and during travel. Patient management was punctuated by frequent self-medication with medicinal plants or pharmaceutical drugs. The participants reported a negative perception of hospitalization or home-based management, with several forms of stigmatization, but a positive perception influenced by the satisfactory quality of management in health-care centers. This report of patient experiences could be helpful in improving the management of COVID-19 in Burkina Faso, both in the health-care setting and in home-based care.

Role of Natural Products against the Spread of SARS-CoV-2 by Inhibition of ACE-2 Receptor: A Review

A unique extreme acute breathing syndrome emerged in China and spread rapidly globally due to a newly diagnosed human coronavirus and declared a pandemic. COVID-19 was formally named by WHO, and the Global Committee on Taxonomy referred to it as extreme Acute respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Currently there is no efficient method to control the extent of SARS-CoV-2 other than social distancing and hygiene activities. This study aims to present a simple medicinal strategy for combating fatal viral diseases like COVID-19 with minimum effort and intervention. Different Ayurveda medicines (Curcuma longa, green tea, and Piper nigrum) inhibit virus entrance and pathogen transmission while also enhancing immunity. Piperine (1-piperoylpiperidine), as well as curcumin, combine to create an intermolecular complex (π- π) that improves curcumin bioavailability by inhibiting glucuronidation of curcumin in the liver. The receptor- binding domains of the S-protein and also the angiotensin-converting enzyme 2 receptor of the recipient organism are directly occupied by curcumin and catechin, respectively, thereby preventing viruses from entering the cell. As a result, the infection will be tolerated by the animal host.

Safety of multiple intravenous infusions of adipose-derived mesenchymal stem cells for hospitalized cases of COVID-19: a randomized controlled trial

Objective

The purpose of the study was to assess the safety of allogeneic, Hope Biosciences Adipose Derived Mesenchymal Stem Cells (HB-adMSCs) for the treatment of hospitalized subjects with COVID-19.

Methods

N = 48 patients were randomly assigned to HB-adMSC (100 MM) or placebo group. Four intravenous infusions of HB-adMSCs or saline were administered at days 0, 3, 7, 10. The primary safety endpoint was incidence of adverse and serious adverse events (AE/SAEs); secondary endpoints were incidence of specific AEs and alterations in hematology, biochemistry, and coagulation parameters.

Results

Majority of AEs were mild in severity. HB-adMSC group showed a higher incidence of cardiopulmonary failure, anemia, anxiety, and diarrhea, while placebo group showed a higher incidence of headaches, fatigue, and chest discomfort (posterior probabilities ≥80%). Deaths were attributed to severe complications due to COVID-19 and were unrelated to study drug. No AEs were attributed to the treatment. Hematology and coagulation panel alterations were not associated with HB-adMSCs. Analyses of inflammatory markers showed increased levels of interleukin-6 and C-reactive protein over time in HB-adMSC group (posterior probabilities ≥78%).

Conclusion

Multiple infusions of 100MM allogeneic HB-adMSCs were considered safe for the study population. More research is needed to determine the safety of MSC therapy.

Clinical trial registration

(www.ClinicalTrials.gov) identifier NCT04362189.

Influenza vaccine: a review on current scenario and future prospects

Vaccination is a crucial tool in preventing influenza, but it requires annual updates in vaccine composition due to the ever-changing nature of the flu virus. While healthcare and economic burdens have reduced, the virus remains a challenge. Research conducted over the past decade has revealed pathways for improvement through both basic and clinical studies. Viral surveillance plays a vital role in the better selection of candidate viruses for vaccines and the early detection of drug-resistant strains.This page offers a description of future vaccine developments and an overview of current vaccine options. In the coming years, we anticipate significant changes in vaccine production, moving away from traditional egg-based methods towards innovative technologies such as DNA and RNA vaccines. These newer approaches offer significant advantages over traditional egg-based and cell culture-based influenza vaccine manufacturing.

Immunogenicity and Protective Efficacy of Nucleic Acid-Based Vaccines Against COVID-19: A Systematic Review

To overcome the COVID-19 pandemic, the development of safe and effective vaccines is crucial. With the enormous information available on vaccine development for COVID-19, there are still grey areas to be considered when designing a potential vaccine. The rapid regulatory approval of nucleic acid-based vaccines was unique to the COVID-19; these vaccines were rapidly produced cost-effectively and with lesser risk of infectivity. Additionally, they demonstrated relative stability at room temperature (DNA). However, a comparative understanding of the immunogenic impact and efficacy of these vaccines is lacking. Immunogenicity is essential for developing and maintaining effective and long-lasting post-vaccination immunity to pathogenic microorganisms. This systematic review aims to assess and summarize the immunogenicity and protective efficacy of the nucleic acid-based vaccines against COVID-19. The Preferred Reporting Items for Systematic Reviews (PRISMA) recommendations were followed in this review. CASP tool was used for quality assessment of randomized controlled trials. All included studies employed a randomized control method, and the results demonstrated promising immune responses and effectiveness that provided high-level protection against COVID-19 infection. This study offers vital insights for advancing vaccine technology. Furthermore, it guides formulation, informs personalized vaccination strategies, and enhances global health preparedness, particularly in regions with limited vaccine access.

Bacterial Biomarkers of the Oropharyngeal and Oral Cavity during SARS-CoV-2 Infection

(1) Background: Individuals with COVID-19 display different forms of disease severity and the upper respiratory tract microbiome has been suggested to play a crucial role in the development of its symptoms. (2) Methods: The present study analyzed the microbial profiles of the oral cavity and oropharynx of 182 COVID-19 patients compared to 75 unaffected individuals. The samples were obtained from gargle screening samples. 16S rRNA amplicon sequencing was applied to analyze the samples. (3) Results: The present study shows that SARS-CoV-2 infection induced significant differences in bacterial community assemblages, with Prevotella and Veillonella as biomarkers for positive-tested people and Streptococcus and Actinomyces for negative-tested people. It also suggests a state of dysbiosis on the part of the infected individuals due to significant differences in the bacterial community in favor of a microbiome richer in opportunistic pathogens. (4) Conclusions: SARS-CoV-2 infection induces dysbiosis in the upper respiratory tract. The identification of these opportunistic pathogenic biomarkers could be a new screening and prevention tool for people with prior dysbiosis.

Immune Profile Determines Response to Vaccination against COVID-19 in Kidney Transplant Recipients

BACKGROUND AND AIM

Immune status profile can predict response to vaccination, while lymphocyte phenotypic alterations represent its effectiveness. We prospectively evaluated these parameters in kidney transplant recipients (KTRs) regarding Tozinameran (BNT162b2) vaccination.

METHOD

In this prospective monocenter observational study, 39 adult KTRs, on stable immunosuppression, naïve to COVID-19, with no protective humoral response after two Tozinameran doses, received the third vaccination dose, and, based on their immunity activation, they were classified as responders or non-responders. Humoral and cellular immunities were assessed at predefined time points (T0: 48 h before the first, T1: 48 h prior to the third and T2: three weeks after the third dose).

RESULTS

Responders, compared to non-responders, had a higher total and transitional B-lymphocyte count at baseline (96.5 (93) vs. 51 (52)cells/μL, p: 0.045 and 9 (17) vs. 1 (2)cells/μL, p: 0.031, respectively). In the responder group, there was a significant increase, from T0 to T1, in the concentrations of activated CD4+ (from 6.5 (4) to 10.08 (11)cells/μL, p: 0.001) and CD8+ (from 8 (19) to 14.76 (16)cells/μL, p: 0.004) and a drop in CD3+PD1+ T-cells (from 130 (121) to 30.44 (25)cells/μL, p: 0.001), while naïve and transitional B-cells increased from T1 to T2 (from 57.55 (66) to 1149.3 (680)cells/μL, p < 0.001 and from 1.4 (3) to 17.5 (21)cells/μL, p: 0.003). The percentages of memory and marginal zone B-lymphocytes, and activated CD4+, CD8+ and natural killer (NK) T-cells significantly increased, while those of naïve B-cells and CD3+PD1+ T-cells reduced from T0 to T1.

CONCLUSIONS

Responders and non-responders to the third BNT162b2 dose demonstrated distinct initial immune cell profiles and changes in cellular subpopulation composition following vaccination.

Adipose-derived, autologous mesenchymal stem cell therapy for patients with post-COVID-19 syndrome: an intermediate-size expanded access program

BACKGROUND

Evolving mutations of the novel coronavirus continue to fuel up the pandemic. The virus affects the human respiratory system along with other body systems, causing several sequelae in the survivors of the disease, presented as post-COVID-19 syndrome or long-COVID-19. This protocol utilized Hope Biosciences' autologous, adipose-derived mesenchymal stem cells (HB-adMSCs) to evaluate safety and efficacy of HB-adMSC therapy to improve signs and symptoms associated with post-COVID-19 syndrome.

METHODS

Ten eligible subjects with post-COVID-19 syndrome were enrolled in the program for a duration of 40 weeks who received 5 intravenous infusions of 2 × 108 autologous HB-adMSCs each at week 0, 2, 6, 10 and 14 with a follow-up at week 18 and end of the study at week 40. Safety assessments included incidence of adverse and serious adverse events along with the laboratory measures of hematologic, hepatic, and renal function. Efficacy was examined by quality-of-life assessments, fatigue assessments, Visual analog scale (VAS) of symptoms and monitoring of respiration and oxygen saturation rates.

RESULTS

VAS scores and Fatigue Assessment scores (FAS) showed significant improvements post-treatment (P = 0.0039, ES = 0.91) compared to baseline. Respiration rates and oxygen saturation levels that were within the normal range at the baseline remained unchanged at the end of the study (EOS). Paired comparison between baseline and EOS for short-form-36 health survey questionnaire (SF-36) scores also showed improved quality-of-life with significant improvements in individual SF-36 evaluations. Mostly mild AEs were reported during the study period with no incidence of serious AEs. Also, no detrimental effects in laboratory values were seen.

CONCLUSIONS

The results of the expanded access program indicated that treatment with autologous HB-adMSCs resulted in significant improvements in the signs and symptoms associated with post-COVID-19 syndrome as assessed by VAS and FAS scores. Additionally, improvements in the patients' quality-of-life as demonstrated using SF-36 scores that also showed significant improvements in individual scaled scores. Overall, administration of multiple infusions of autologous HB-adMSCs is safe and efficacious for improvements in the quality-of life of patients with post-COVID-19 syndrome.

TRIAL REGISTRATION

Clinical trial registration number: NCT04798066. Registered on March 15, 2021. ( https://clinicaltrials.gov/ct2/show/NCT04798066?term=hope+biosciences&cond=Post-COVID-19+Syndrome&draw=2&rank=2 ).

The Impact of COVID-19 on the Neck of Femur Fracture Service in a Tertiary Care Hospital in the United Kingdom

Introduction The emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in late 2019 ushered in a global crisis that profoundly impacted healthcare systems worldwide. In the United Kingdom, COVID-19 resulted in a significant toll on public health and the National Health Service (NHS). As the virus surged, the NHS faced unprecedented challenges, including surges in COVID-19 cases, a dire need for medical equipment, and a strain on intensive care units. Simultaneously, stringent nationwide lockdowns were imposed to curb the virus's spread, disrupting daily life and healthcare access. Amid this crisis, the interactions between COVID-19 and other prevalent health conditions came to the forefront of medical research, sparking interest in understanding their connections. This study delves into the intriguing interplay between COVID-19 and neck of femur (NoF) fractures, exploring shared risk factors, resource implications, and potential alterations in patient pathways. Given the severity of both conditions and their impact on the vulnerable elderly population, elucidating these connections is crucial for comprehensive patient care and resource allocation within the healthcare system. Methods This study used data from the National Hip Fracture Audit (NHFA) database, focusing on NoF fracture patients at Wythenshawe Hospital. We examined two cohorts: pre-pandemic (from March 2019 to March 2020) and pandemic (from March 2020 to March 2021). We compared key parameters and incorporated COVID-19 data. Graphs showed trends and cohort similarities. We also analyzed demographic data (age, gender, fracture type, times, COVID-19 status, and mortality), removing outliers for accuracy. Results The data revealed that while certain factors such as patient age and mobilization remained largely unaffected, there was a modest association between COVID-19 incidence and NoF fracture patients. Notably, regional lockdown measures had a substantial impact on patient care. The initial lockdown effectively reduced COVID-19-positive cases upon admission but led to prolonged intervals and surgical delays. However, the second lockdown showed improvements, attributed to lessons learned, increased resource allocation, and better familiarity with hospital-specific lockdown measures. This research sheds light on the intricate relationship between a global pandemic and orthopedic patient care, highlighting the importance of adapting healthcare systems to evolving challenges. Conclusion This study explores the impact of COVID-19 on neck of femur (NoF) fracture patients, highlighting key findings from Wythenshawe Hospital. It uncovers a dynamic relationship between the pandemic and patient care, with increased COVID-19 cases coinciding with reduced NoF fracture rates. Lockdowns influenced outcomes, with the first causing delays and higher post-discharge mortality, while the second improved efficiency and safety. These insights extend beyond Wythenshawe Hospital, offering implications for healthcare practices in the United Kingdom and beyond, especially in countries with limited vaccination resources. This research underscores the need for tailored strategies to optimize NoF fracture patient outcomes during pandemics and lockdowns.

Neuromuscular defects after infection with a beta coronavirus in mice

COVID-19 affects primarily the lung. However, several other systemic alterations, including muscle weakness, fatigue and myalgia have been reported and may contribute to the disease outcome. We hypothesize that changes in the neuromuscular system may contribute to the latter symptoms observed in COVID-19 patients. Here, we showed that C57BL/6J mice inoculated intranasally with the murine betacoronavirus hepatitis coronavirus 3 (MHV-3), a model for studying COVID-19 in BSL-2 conditions that emulates severe COVID-19, developed robust motor alterations in muscle strength and locomotor activity. The latter changes were accompanied by degeneration and loss of motoneurons that were associated with the presence of virus-like particles inside the motoneuron. At the neuromuscular junction level, there were signs of atrophy and fragmentation in synaptic elements of MHV-3-infected mice. Furthermore, there was muscle atrophy and fiber type switch with alteration in myokines levels in muscles of MHV-3-infected mice. Collectively, our results show that acute infection with a betacoronavirus leads to robust motor impairment accompanied by neuromuscular system alteration.

Deciphering data: How should clinical trials change your clinical practice?

INTRODUCTION

The careful consideration of how to apply findings from the scientific literature is important to every physician's clinical practice. This can pose a difficult task, particularly with the increasing speed of technological advances and complexity involved in modern clinical trials. This review introduces a new method, the WHOM criteria (Who, How, Outcomes, Minimizing bias), from which orthopedic surgeons and other physicians can efficiently evaluate novel medical literature for inclusion into their clinical practice.

WHOM CRITERIA

The WHOM framework consists of four steps. The first step, Who, involves confirming whether a sample population studied is similar to one's patient under treatment, in order to ensure the results can be reasonably applied. Second, the How, comprises evaluating the intervention performed and ensuring that it could be reasonably replicated. The third step requires thoroughly evaluating the outcomes used in the study so as to ensure they are clinically meaningful to both the treating physician and the patient. Finally, there must be a careful evaluation of potential sources of bias and the ways in which errors and bias were minimized in all phases of the study.

CONCLUSION

Evidence-based practice should drive clinical decision making whenever the necessary literature is available. This requires the careful evaluation of new literature on a regular basis so that physicians can render safe and effective health care in partnership with their patients. The WHOM criteria are described in order to aid clinicians in navigating published research and change practice when appropriate.

Knowledge, Perception, and Attitudes during the COVID-19 Pandemic in the Peruvian Population

BACKGROUND

Latin American countries have been profoundly affected by COVID-19. Due to the alarming incidence of identified cases, we intended to explore which psychosocial elements may influence poor adherence to the mandatory control measures among the population.

OBJECTIVE

We aimed to assess Peruvians' knowledge, attitudes, and vulnerability perception during the coronavirus outbreak.

METHOD

We collected data from 225 self-selected participants using a web-based cross-sectional survey.

RESULTS

The overall respondents were between 18 and 29 years old (56.8%), female (59.5%), belonged to educated groups, and graduated professionals (69.3%), most of them. Logistic regression showed that Knowledge is highly associated with education (p = 0.031), occupation (p = 0.002), and age (p = 0.016). Our study identified that, although people reported adequate Knowledge by identifying expected symptoms and virus transmission ways in COVID-19 disease. There is a significant perceived susceptibility to contracting the mentioned virus, displaying stigmatized behavior (59.1%) and fear of contracting the virus from others (70.2%). Additionally, it is reported to lack people's confidence in national health authorities regarding sanitary responses (62.7%), preparedness for the disease (76.9%), and the lack of adequate measures to deal with it (51.1%).

CONCLUSION

We found that age, education, and occupation modulate Knowledge. At the same time, only age affected Perception and Attitude. Public policies should consider specific guidelines on knowledge translation and risk communication strategies for both containing psychological responses promptly and ensuring compliance with general control measures by the population.

The Effect of COVID-19 Outbreak and Incidence on the Health-Related Behaviors and Depression of Gyeongnam Residents in Republic of Korea

Background and Objectives: This study aimed to investigate whether the occurrence of COVID-19 brought about changes in the health behaviors and depression levels of residents in Gyeongnam in Republic of Korea, and whether the prevalence of COVID-19 was related to differences in health behaviors and depression levels among different regions. Materials and Methods: The researchers utilized raw data from the 2019-2020 Community Health Survey in Gyeongnam and conducted analyses using SPSS 25.0. The study included a total of 35,880 participants from 18 cities and counties in the Gyeongnam region (17,942 participants in 2019 and 17,938 participants in 2020). Results: The results of the comparative analysis between pre- and post-COVID-19 occurrence showed that, after the occurrence of COVID-19, the smoking cessation rate and monthly alcohol consumption rate among current smokers decreased, while the high-risk drinking rate increased. The rate of physical activity (walking) increased, but the prevalence of depression experiences and depressive symptoms also increased. Furthermore, the comparative analysis between areas with a higher number of COVID-19 cases and those with a lower number of cases revealed that areas with a higher number of cases had higher monthly alcohol consumption rates, as well as a higher prevalence of depression experiences and depressive symptoms. Conclusions: Considering that the occurrence and severity of COVID-19 had significant impacts on the health behaviors and depression levels of residents in Gyeongnam, this highlights the need for active intervention and management by the national and local governments in response to the occurrence and management of infectious diseases, including COVID-19, to address the health status and health behaviors of the local population.

Metabolomic Profile, Plasmatic Levels of Losartan and EXP3174, Blood Pressure Control in Hypertensive Patients and Their Correlation with COVID-19

Systemic arterial hypertension (SAH) is one of the most prevalent chronic diseases worldwide and is related to serious health complications. It has been pointed out as a major risk factor for COVID-19. This study aimed to determine the impact of COVID-19 on the metabolomic profile, the correlation with the plasmatic levels of losartan and its active metabolite (EXP3174), biochemical markers, and blood pressure (BP) control in hypertensive patients. 1H NMR metabolomic profiles of hypertensive and normotensive patients with and without previous COVID-19 diagnosis were identified. Plasmatic levels of LOS and EXP3174 were correlated with BP, biochemical markers, and the metabolomic fingerprint of the groups. Biomarkers linked to important aspects of SAH and COVID-19 were identified, such as glucose, glutamine, arginine, creatinine, alanine, choline, erythritol, homogentisate, 0-tyrosine, and 2-hydroxybutyrate. Those metabolites are indicative of metabolic alterations, kidney damage, pulmonary dysfunction, and persistent inflammation, which can be found in both diseases. Some hypertensive patients did not reach the therapeutic levels of LOS and EXP3174, while the BP control was also limited among the normotensive patients with previous COVID-19 diagnoses. Metabolomics proved to be an important tool for assessing the effectiveness of losartan pharmacotherapy and the damage caused by SAH and COVID-19 in hypertensive patients.

COVID-19 and cardiovascular complications: updates of emergency medicine

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyper-inflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2 induced cardiac injury remains unknown and under-investigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in Emergency Medicine.

Role of toll-like receptors in the pathogenesis of COVID-19: Current and future perspectives

The coronavirus disease 2019 (COVID-19) pandemic underlines a persistent threat of respiratory tract infectious diseases and warrants preparedness for a rapid response. At present, COVID-19 has had a serious social impact and imposed a heavy global burden on public health. The exact pathogenesis of COVID-19 has not been fully elucidated. Since the outbreak of COVID-19, a renewed attention has been brought to Toll-like receptors (TLRs). Available data and new findings have demonstrated that the interaction of human TLRs and SARS-CoV-2 is a vital mediator of COVID-19 immunopathogenesis. TLRs such as TLR2, 4, 7 and 8 are potentially important in viral combat and activation of immunity in patients with COVID-19. Therapeutics targeting TLRs are currently considered promising options against the pandemic. A number of TLR-targeting immunotherapeutics are now being investigated in preclinical studies and different phases of clinical trials. In addition, innovative vaccines based on TLRs under development could be a promising approach for building a new generation of vaccines to solve the current challenges. In this review, we summarize recent progress in the role of TLRs in COVID-19, focusing the new candidate drugs targeting TLRs, the current technology and potential paths forward for employing TLR agonists as vaccine adjuvants.

Diagnostic techniques for critical respiratory infections: Update on current methods

Respiratory infections, whether chronic or acute, are frequent in both children and adults and result in an economic burden in health care systems. In particular, for an immunocompromised patient, respiratory infection leads to acute hypoxemic respiratory failure, a leading cause of intensive care unit (ICU) admission. Most respiratory infections are caused by bacteria, viruses, parasites, smoking, or air pollution. Over the last two decades, considerable improvements have been made in understanding and identifying respiratory infections. Various biosensing techniques have been developed with a range of targets to identify the infection at earlier stages. Recently, nanomaterials have been effectively applied to improve biosensors and their analytical performances. This review discusses recent biosensor developments for identifying respiratory infections caused by viruses and bacteria assisted by different types of nanomaterials and target molecules.

Drawing Parallels between SARS, MERS, and COVID-19: A Comparative Overview of Epidemiology, Pathogenesis, and Pathological Features

Background

Since November 2019, when the novel coronavirus arose in Wuhan City, over 188 million people worldwide have been infected with COVID-19. It is the third coronavirus outbreak in the twenty-first century. Until now, practically all coronavirus epidemics have occurred due to zoonotic spread from an animal or transitional host or through the consumption of their products. Coronaviruses can infect humans and cause severe illness and even death.

Material and Methods

This review was designed to help us recognize and harmonize the similarities and differences between these three coronaviridae family members.

Result

Measures aimed at containing the epidemic should be emphasized in this circumstance. Prioritizing and planning these activities require an understanding of the particulars of these three viruses. Given the pandemic's enormous death toll and rapid spread, we should be cognizant of the parallels and differences between these three viruses. Additionally, this pandemic warns us to be cautious against the possibility of a future pandemic.

Conclusion

We highlight the fundamental characteristics of coronaviruses that are critical for recognizing coronavirus epidemiology, pathogenesis, and pathological features that reveal numerous significant pathological attributes and evolutionary patterns in the viral genome that aid in better understanding and anticipating future epidemics.

Gender differences in comorbidities of patients with COVID-19: An Italian local register-based analysis

In the current COVID-19 pandemic scenario, it is still necessary to understand if differences exist between genders in terms of patients' characteristics and clinical outcomes. For this reason, we retrospectively analyzed data obtained from a local register-based dataset of all SARS-CoV-2 positive patients diagnosed in the province of Catania (Italy). The main aim of this analysis was to understand any differences between genders in the distribution of previous medical conditions, and to evaluate which of them posed individuals at higher risk of death. With this purpose, we analyzed data from 1424 patients with at least one underlying medical condition, who were tested positive for SARS-CoV-2 infection from February 2020 to December 2021. Overall, males were 59.5% of the total population and significantly younger than females (median ages: 68 years vs. 72 years; p = 0.011). The age distribution of cases by gender confirms that individuals from 70 to 79 years were the most affected in both genders. The comparison of underlying comorbidities by gender shows significant differences for diabetes (p < 0.001), other metabolic diseases (p = 0.006), and obesity (p = 0.019). Accordingly, multivariable logistic regression analysis confirmed that diabetes was more likely to be present in males than in females (p = 0.001), while other metabolic diseases and obesity were less likely to be present (p = 0.003 and p = 0.005, respectively). Although no difference in mortality was evident between genders (p = 0.141), both male and female COVID-19 patients had a significantly higher risk of death if they had comorbidities such as CVDs, kidney diseases, or chronic neurological diseases. Moreover, diabetes and chronic respiratory diseases were significant risk factors for COVID-19 mortality among men, whereas cancer was a significant contributor among women. Our findings confirm gender-differences in pre-existing medical conditions of COVID-19 patients, which may influence the risk of death. Further studies, however, are needed to understand physiological and pathological mechanisms underpinning these differences.

Deep learning for deterioration prediction of COVID-19 patients based on time-series of three vital signs

Unrecognized deterioration of COVID-19 patients can lead to high morbidity and mortality. Most existing deterioration prediction models require a large number of clinical information, typically collected in hospital settings, such as medical images or comprehensive laboratory tests. This is infeasible for telehealth solutions and highlights a gap in deterioration prediction models based on minimal data, which can be recorded at a large scale in any clinic, nursing home, or even at the patient's home. In this study, we develop and compare two prognostic models that predict if a patient will experience deterioration in the forthcoming 3 to 24 h. The models sequentially process routine triadic vital signs: (a) oxygen saturation, (b) heart rate, and (c) temperature. These models are also provided with basic patient information, including sex, age, vaccination status, vaccination date, and status of obesity, hypertension, or diabetes. The difference between the two models is the way that the temporal dynamics of the vital signs are processed. Model #1 utilizes a temporally-dilated version of the Long-Short Term Memory model (LSTM) for temporal processes, and Model #2 utilizes a residual temporal convolutional network (TCN) for this purpose. We train and evaluate the models using data collected from 37,006 COVID-19 patients at NYU Langone Health in New York, USA. The convolution-based model outperforms the LSTM based model, achieving a high AUROC of 0.8844-0.9336 for 3 to 24 h deterioration prediction on a held-out test set. We also conduct occlusion experiments to evaluate the importance of each input feature, which reveals the significance of continuously monitoring the variation of the vital signs. Our results show the prospect for accurate deterioration forecast using a minimum feature set that can be relatively easily obtained using wearable devices and self-reported patient information.

Real-time face mask position recognition system based on MobileNet model

COVID-19 is a highly contagious disease that was first identified in 2019, and has since taken more than six million lives world wide till date, while also causing considerable economic, social, cultural and political turmoil. As a way to limit its spread, the World Health Organization and medical experts have advised properly wearing face masks, social distancing and hand sanitization, besides vaccination. However, people wear masks sometimes uncovering their mouths and/or noses consciously or unconsciously, thereby lessening the effectiveness of the protection they provide. A system capable of automatic recognition of face mask position could alert and ensure that an individual is wearing a mask properly before entering a crowded public area and putting themselves and others at risk. We first develop and publicly release a dataset of face mask images, which are collected from 391 individuals of different age groups and gender. Then, we study six different architectures of pre-trained deep learning models, and finally propose a model developed by fine tuning the pre-trained state of the art MobileNet model. We evaluate the performance (accuracy, F1-score, and Cohen's Kappa) of this model on the proposed dataset and MaskedFace-Net, a publicly available synthetic dataset created by image editing. Its performance is also compared to other existing methods. The proposed MobileNet is found as the best model providing an accuracy, F1-score, and Cohen's Kappa of 99.23%, 99.22%, and 99.19%, respectively for face mask position recognition. It outperforms the accuracy of the best existing model by about 2%. Finally, an automatic face mask position recognition system has been developed, which can recognize if an individual is wearing a mask correctly or incorrectly. The proposed model performs very well with no drop in recognition accuracy from real images captured by a camera.

Household transmission dynamics of COVID-19 among residents of Delhi, India: a prospective case-ascertained study

Objective

The aim of this study was to observe the secondary infection rate and transmission dynamics of COVID-19 among household contacts, and their associations with various factors across four dimensions of interaction.

Methods

This was a case-ascertained study among unvaccinated household contacts of a laboratory-confirmed COVID-19 case in New Delhi between December 2020 and July 2021. For this study, 99 index cases and their 316 household contacts were interviewed and sampled (blood and oro-nasal swab) on days 1, 7, 14, and 28.

Results

The secondary infection rate among unvaccinated household contacts was 44.6% (95% confidence interval (CI) 39.1-50.1). The predictors of secondary infection among individual contact levels were: being female (odds ratio (OR) 2.13), increasing age (OR 1.01), symptoms at baseline (OR 3.39), and symptoms during follow-up (OR 3.18). Among index cases, age of the primary case (OR 1.03) and symptoms during follow-up (OR 6.29) were significantly associated with secondary infection. Among household-level and contact patterns, having more rooms (OR 4.44) and taking care of the index case (OR 2.02) were significantly associated with secondary infection.

Conclusion

A high secondary infection rate highlights the need to adopt strict measures and advocate COVID-19-appropriate behaviors. A targeted approach for higher-risk household contacts would efficiently limit infections among susceptible contacts.

COVID-19 diagnosis: A comprehensive review of pre-trained deep learning models based on feature extraction algorithm

Due to the augmented rise of COVID-19, clinical specialists are looking for fast faultless diagnosis strategies to restrict Covid spread while attempting to lessen the computational complexity. In this way, swift diagnosis techniques for COVID-19 with high precision can offer valuable aid to clinical specialists. RT- PCR test is an expensive and tedious COVID diagnosis technique in practice. Medical imaging is feasible to diagnose COVID-19 by X-ray chest radiography to get around the shortcomings of RT-PCR. Through a variety of Deep Transfer-learning models, this research investigates the potential of Artificial Intelligence -based early diagnosis of COVID-19 via X-ray chest radiographs. With 10,192 normal and 3616 Covid X-ray chest radiographs, the deep transfer-learning models are optimized to further the accurate diagnosis. The x-ray chest radiographs undergo a data augmentation phase before developing a modified dataset to train the Deep Transfer-learning models. The Deep Transfer-learning architectures are trained using the extracted features from the Feature Extraction stage. During training, the classification of X-ray Chest radiographs based on feature extraction algorithm values is converted into a feature label set containing the classified image data with a feature string value representing the number of edges detected after edge detection. The feature label set is further tested with the SVM, KNN, NN, Naive Bayes and Logistic Regression classifiers to audit the quality metrics of the proposed model. The quality metrics include accuracy, precision, F1 score, recall and AUC. The Inception-V3 dominates the six Deep Transfer-learning models, according to the assessment results, with a training accuracy of 84.79% and a loss function of 2.4%. The performance of Cubic SVM was superior to that of the other SVM classifiers, with an AUC score of 0.99, precision of 0.983, recall of 0.8977, accuracy of 95.8%, and F1 score of 0.9384. Cosine KNN fared better than the other KNN classifiers with an AUC score of 0.95, precision of 0.974, recall of 0.777, accuracy of 90.8%, and F1 score of 0.864. Wide NN fared better than the other NN classifiers with an AUC score of 0.98, precision of 0.975, recall of 0.907, accuracy of 95.5%, and F1 score of 0.939. According to the findings, SVM classifiers topped other classifiers in terms of performance indicators like accuracy, precision, recall, F1-score, and AUC. The SVM classifiers reported better mean optimal scores compared to other classifiers. The performance assessment metrics uncover that the proposed methodology can aid in preliminary COVID diagnosis.

Factors Associated with Turnover Intentions of Nurses Working in Japanese Hospitals Admitting COVID-19 Patients

Three years after the outbreak of the coronavirus disease (COVID-19) pandemic, turnover among frontline nurses has increased. The participants of this study were nurses at two general hospitals in Ishikawa, Japan, receiving COVID-19 patients. An original self-report questionnaire was created based on previous research. The questionnaire was distributed to 400 nurses, and responses were received from 227 nurses (response rate: 56.8%). The factors influencing turnover intention at the facilities were having less time to relax (odds ratio [OR]: 2.88, 95% confidence interval [CI]: 1.12-7.41) and wanting to receive counseling (OR: 5.21, 95% CI: 1.30-20.91). As a strategy to prevent turnover, nurse managers should provide opportunities for nurses to receive counseling during normal working hours and pay particular attention to changes in nurses' daily lives, such as changes in the time available for relaxation.

Effect of COVID-19 on Pregnancy and Neonate's Vital Parameters: A Systematic Review

Background

COVID-19 is a new pandemic, which was declared by the World Health Organization in 2019 as a threat to public health. According to numerous reports, it can have negative consequences for pregnant women, labour, and neonates born to infected mothers. The aim of this paper was to gather the evidence and to present a summary of the results of studies concerning COVID-19 in pregnant women and their neonates.

Methods

Articles from prestigious journals covering the period from 2020 to February 2023, relevant review papers, and original research articles from PubMed were analysed. In order to analyse the available research literature, the Web of Science, Scopus, and PubMed databases were used, in which the search for articles was conducted using terms ("pregnancy," "coronavirus," "SARS-CoV-2," and "newborn") and using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) guidelines for clinical trials. Meta-analyses and systematic reviews (2022-2023) on symptoms, neonatal course, and risk of COVID-19 infection have been summarized. Summary of meta-analyses and systematic reviews (2022-2023) on the effect and adverse reaction of the COVID-19 vaccination is presented.

Results

As a result of the research conducted, it was confirmed that in most pregnant women, no serious signs of the infection were observed, although isolated cases of death related to COVID-19 in pregnant women were reported. Several authors called attention to the more severe course of the infection in pregnant women with obesity. It seemed that no vertical transmission from mother to child was occurring. Nevertheless, the information was not clinching. The condition of the neonates born to mothers with COVID-19 was in most cases described as normal; however, some papers reported deaths of infected neonates.

Conclusions

Due to insufficient data, further research is necessary. Further studies and follow-up are recommended, which would make possible an assessment of remote effects of COVID-19 on pregnancy and vital parameters of the newborn.

Clinical Study on the Emotional Intervention of Patients with Asymptomatic and Mild Novel Coronavirus (COVID-19)

Background and Objectives: The aim was to explore the interventional effect of the traditional Chinese medicine (TCM) exercise of Tian Dan Shugan Tiaoxi on the emotions of patients with mild novel coronavirus (COVID-19). Materials and Methods: A total of 110 asymptomatic and mildly symptomatic COVID-19 patients from Hongkou Memorial Road Temporary Cabin Hospital and South Renji Hospital were selected between April 2022 and June 2022, and randomly divided into two groups: a control group and an intervention group. There were 55 participants in each group. The control group was treated with Lianhua Qingwen granules, and members of the intervention group were made to practice Tian Dan Shugan Tiaoxi (an exercise that soothes the liver and regulates emotions) every day for 5 days. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder questionnaire (GAD-7), and the Symptom Checklist 90 (SCL-90) were used to evaluate the data collected before and after the trial. Results: The incidence of anxiety and depression was high in the patients included in this study, at 73.64% and 69.09%, respectively. After intervention, the scores of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder questionnaire (GAD-7) in the two groups had decreased in comparison with those recorded before intervention (p < 0.05). The PHQ-9 and GAD-7 scores in the intervention group were significantly better than those of the control group (p < 0.05). The factors of somatization, depression, anxiety, hostility, and fear in the SCL-90 in the intervention group were significantly improved after intervention, and generally, better than those in the control group (p < 0.05). Conclusions: Patients infected with novel coronavirus in shelter hospitals have different degrees of emotional abnormalities. Tian Dan Shugan Tiaoxi can reduce the anxiety and depression of people with mild novel coronavirus, and it can be practiced clinically to improve the recovery rate among infected people.

Trajectories of quality of life and mental health during the Covid-19 lockdown and six months after in Italy. A longitudinal exploration

Aim

Covid-19 pandemic and its relative containment measures have affected populations' quality of life and psychological well-being worldwide. The fear related to the pandemic and the imposed containment measures has acted as a trigger causing a global increase in negative mental health states. Thus, we aimed to explore the relationship between fear of covid-19 and mental health via QoL (the first and the second lockdown in Italy, 2020).

Subject and methods

Through a quantitative cross-lagged path model research design, the study investigates people's fear of Covid-19, quality of life, and negative mental states in a population of 444 Italian adults (Mean=40.7; Standard Deviation=16.9; 80% women), in the period between the first and the second waves of the pandemic.

Results

Results show that participants' Covid-19 fear decreased between waves, contributing to a decrease in negative mental states (stress, anxiety and depression), thus improving the perceived quality of life. Furthermore, quality of life emerged as able to buffer the impact of fear of Covid on people's psychological distress in short and medium terms, confirming its central role in regulating mental distress.

Conclusion

The study suggests important guidelines for developing interventions to support the populations' well-being and mental health.

Potential treatments of COVID-19: Drug repurposing and therapeutic interventions

The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is caused when Spike-protein (S-protein) present on the surface of SARS-CoV-2 interacts with human cell surface receptor, Angiotensin-converting enzyme 2 (ACE2). This binding facilitates SARS-CoV-2 genome entry into the human cells, which in turn causes infection. Since the beginning of the pandemic, many different therapies have been developed to combat COVID-19, including treatment and prevention. This review is focused on the currently adapted and certain other potential therapies for COVID-19 treatment, which include drug repurposing, vaccines and drug-free therapies. The efficacy of various treatment options is constantly being tested through clinical trials and in vivo studies before they are made medically available to the public.

Automated speech emotion polarization for a distance education system based on orbital local binary pattern and an appropriate sub-band selection technique

The distance education system was widely adopted during the Covid-19 pandemic by many institutions of learning. To measure the effectiveness of this system, it is essential to evaluate the performance of the lecturers. To this end, an automated speech emotion recognition model is a solution. This research aims to develop an accurate speech emotion recognition model that will check the lecturers/instructors' emotional state during lecture presentations. A new speech emotion dataset is collected, and an automated speech emotion recognition (SER) model is proposed to achieve this aim. The presented SER model contains three main phases, which are (i) feature extraction using multi-level discrete wavelet transform (DWT) and one-dimensional orbital local binary pattern (1D-OLBP), (ii) feature selection using neighborhood component analysis (NCA), (iii) classification using support vector machine (SVM) with ten-fold cross-validation. The proposed 1D-OLBP and NCA-based model is tested on the collected dataset, containing three emotional states with 7101 sound segments. The presented 1D-OLBP and NCA-based technique achieved a 93.40% classification accuracy using the proposed model on the new dataset. Moreover, the proposed architecture has been tested on the three publicly available speech emotion recognition datasets to highlight the general classification ability of this self-organized model. We reached over 70% classification accuracies for all three public datasets, and these results demonstrated the success of this model.

Children's Physical Activity During the COVID-19 Lockdown: A Cross Cultural Comparison Between Portugal, Brazil and Italy

The COVID-19 pandemic forced governments to implement measures that disrupted the daily routines of many families worldwide. We studied how the COVID-19 lockdown affected children's routines in Portugal (PT), Brazil (BR), and Italy (IT) to determine if children's age and country impacted their physical activity (PA) and sedentary time. We launched an anonymous online survey to assess how 3-12 years old children adjusted their daily routines to this situation. Parents reported the times each child was engaged in different activities throughout the day, and we used these data to calculate separately overall sedentary and physical activity time. We conducted separate analyses of variance for age and country on the percentage of time spent in the different activities. Results, based on the data from 3045 children in these three countries (PT n = 2044; BR n = 836; IT n = 165), showed that, during lockdown, most children spent most of their awake daily hours in sedentary activities. There was a clear age effect on the way their routines were organized. Percentages of time spent in intellectual activity, playful screen activity, and overall sedentary time were greater in the older age groups, whereas percentages of time spent in play (with and without PA) and in overall PA were greater in the younger groups. We found a main effect of country for all variables except play without PA. The country effect was mainly due to the difference between the routines in BR when compared to PT and IT. Values of playful screen time and overall sedentary activity were higher in BR than in the two European countries. Conversely, values for play with PA, PA, and overall PA (except in the older group) were lower in BR. Patterns of time spent in these activities were similar in IT and PT, but PA and overall PA times were higher in the two younger age groups in IT. In summary, percentage of PA time of confined children was low and decreased with age across all three countries and was particularly low for children in BR relative to those in PT and IT.

A triangulation method on the effectiveness of digital game-based language learning for vocabulary acquisition

This research aimed to explore the views of 8th grade students on digital game-based English language learning as a foreign language (EFL). A total of 69 students between the ages of 12 and 14 participated in the study. Students' vocabulary acquisition skills were tested using a web 2.0 application called "Quizziz." The study utilized a triangulation method in which the results of a quasi-experiment and the metaphorical perceptions of the learners were obtained. The results of the tests were recorded at two-week intervals, and students' reactions to the results were collected using a data collection tool. The study used a pre-test, post-test, and control group design. The experimental and control groups took a pre-test before the study began. The experimental group then practiced vocabulary using Quizziz, while the control group practiced vocabulary by memorizing it in their mother tongue. The post-test results showed significant differences between the control and experimental groups. In addition, content analysis was used to analyse the data, with metaphors being grouped and frequencies calculated. The students generally expressed positive views on digital game-based EFL, stating that it was highly successful and that in-game power-ups, competing with other students, and receiving rapid feedback improved their motivation.

Mathematical modeling and investigation on the role of demography and contact patterns in social distancing measures effectiveness in COVID-19 dissemination

In this article, we investigate the importance of demography and contact patterns in determining the spread of COVID-19 and to the effectiveness of social distancing policies. We investigate these questions proposing an augmented epidemiological model with an age-structured model, with the population divided into susceptible (S), exposed (E), asymptomatic infectious (A), hospitalized (H), symptomatic infectious (I) and recovered individuals (R), to simulate COVID-19 dissemination. The simulations were carried out using six combinations of four types of isolation policies (work restrictions, isolation of the elderly, community distancing and school closures) and four representative fictitious countries generated over alternative demographic transition stage patterns (aged developed, developed, developing and least developed countries). We concluded that the basic reproduction number depends on the age profile and the contact patterns. The aged developed country had the lowest basic reproduction number ($R0=1.74$) due to the low contact rate among individuals, followed by the least developed country ($R0=2.00$), the developing country ($R0=2.43$) and the developed country ($R0=2.64$). Because of these differences in the basic reproduction numbers, the same intervention policies had higher efficiencies in the aged and least developed countries. Of all intervention policies, the reduction in work contacts and community distancing were the ones that produced the highest decrease in the $R0$ value, prevalence, maximum hospitalization demand and fatality rate. The isolation of the elderly was more effective in the developed and aged developed countries. The school closure was the less effective intervention policy, though its effects were not negligible in the least developed and developing countries.

MicroRNAs and cytokines as potential predictive biomarkers for COVID-19 disease progression

Host microRNAs can influence the cytokine storm associated SARS-CoV-2 infection and proposed as biomarkers for COVID-19 disease. In the present study, serum MiRNA-106a and miRNA-20a were quantified by real time-PCR in 50 COVID-19 patients hospitalized at Minia university hospital and 30 healthy volunteers. Profiles of serum inflammatory cytokines (TNF-α, IFN-γ, and IL-10) and TLR4 were analyzed by Eliza in patients and controls. A highly significant decrease (P value = 0.0001) in the expressions of miRNA-106a and miRNA-20a was reported in COVID-19 patients compared to controls. A significant decrease in the levels of miRNA-20a was also reported in patients with lymphopenia, patients having chest CT severity score (CSS) > 19 and in patients having O₂ saturation less than 90%. Significantly higher levels of TNF-α, IFN-γ, IL-10 and TLR4 were reported in patients compared to controls. IL-10 and TLR4 levels were significantly higher in patients having lymphopenia. TLR-4 level was higher in patients with CSS > 19 and in patients with hypoxia. Using univariate logistic regression analysis, miRNA-106a, miRNA-20a, TNF-α, IFN-γ, IL-10 and TLR4 were identified as good predictors of disease. Receiver operating curve showed that the downregulation of miRNA-20a in patients having lymphopenia, patients with CSS > 19 and patients with hypoxia could be a potential biomarker with AUC = 0.68 ± 0.08, AUC = 0.73 ± 0.07 and AUC = 0.68 ± 0.07 respectively. Also, ROC curve showed accurate association between the increase of serum IL-10 and TLR-4 and lymphopenia among COVID-19 patients with AUC = 0.66 ± 0.08 and AUC = 0.73 ± 0.07 respectively. ROC curve showed also that serum TLR-4 could be a potential marker for high CSS with AUC = 0.78 ± 0.06. A negative correlation was detected between miRNA-20a with TLR-4 (r = - 0.30, P value = 0.03). We concluded that, miR-20a, is a potential biomarker of COVID-19 severity and blockade of IL-10 and TLR4 may constitute a novel therapy for COVID-19 patients.

The kidney in COVID-19: protagonist or figurant?

The etiology of injury in COVID-19 patients is diverse and multifactorial. Autopsy and biopsy studies reveal, alongside podocyte and tubular cell anomalies, the presence of virion within the cells. Evidence suggests that, in addition to the direct cytopathic effect of SARS-CoV-2 on the glomeruli and renal tubules, there is also the indirect effect of cell-mediated immunity, the cytokines storm and the cross-talk between organs with possible systemic effects of the disease. These mechanisms are interconnected and have profound therapeutic implications involving extracorporeal removal of inflammatory cytokines. Dialysis patients, and children, in particular, should be classified as "at high risk" of contracting the disease. Infections are one of the most frequent causes of death in children with chronic renal failure who undergo dialysis. The reasons for this particular susceptibility are to be found in the compromised immune system, secondary to chronic malnutrition, immunosuppressive therapy, and uremia, frequent contact with healthcare personnel and other patients attending the dialysis unit and in need of the presence of other family members during treatment.