The epidemiology, diagnosis and treatment of COVID-19

Determining the predictors of preventive behaviors adopted by pregnant women against COVID-19 based on the Health Belief Model constructs: a cross sectional study

BACKGROUND

Pregnant women face great challenges during the coronavirus disease 2019(COVID-19) pandemic. The purpose of this study was to explain the main dimensions of adoption of self-care behaviors against COVID-19 based on the health belief model(HBM) in pregnant women.

METHODS

This cross-sectional and analytical study was conducted in Iran, at the end of the third wave of the COVID-19 pandemic, between January and April 2021. Two hundred and thirty pregnant women who referred to Urmia health centers were selected using multi-stage random sampling. The data were collected using an online questionnaire including items that measured the participants' demographic characteristics, the knowledge questionnaire, the HBM items, and questions assessing the adoption of self-care behaviors against COVID-19. The data were analyzed using SPSS software version 20. Descriptive statistics, bivariate Pearson's correlation test, and multiple linear regression were used to analyze the data.

RESULTS

The results of this study showed that the rate of self-care behaviors against COVID-19 in the pregnant women participating in the present study was not very favorable. It was also shown that among the constructs of the HBM, knowledge, self-efficacy, and perceived barriers were the most important predictors of adopting self-care behaviors with a variance of 24% change among the pregnant women.

CONCLUSION

Knowledge, self-efficacy, and perceived barriers were found in this study as the strongest predictors of self-care behaviors among pregnant women. Thus, it is suggested to implement interventions commensurate with the results of this study.

A comprehensive review on the biomedical frontiers of nanowire applications

This comprehensive review examines the immense capacity of nanowires, nanostructures characterized by unbounded dimensions, to profoundly transform the field of biomedicine. Nanowires, which are created by combining several materials using techniques such as electrospinning and vapor deposition, possess distinct mechanical, optical, and electrical properties. As a result, they are well-suited for use in nanoscale electronic devices, drug delivery systems, chemical sensors, and other applications. The utilization of techniques such as the vapor-liquid-solid (VLS) approach and template-assisted approaches enables the achievement of precision in synthesis. This precision allows for the customization of characteristics, which in turn enables the capability of intracellular sensing and accurate drug administration. Nanowires exhibit potential in biomedical imaging, neural interfacing, and tissue engineering, despite obstacles related to biocompatibility and scalable manufacturing. They possess multifunctional capabilities that have the potential to greatly influence the intersection of nanotechnology and healthcare. Surmounting present obstacles has the potential to unleash the complete capabilities of nanowires, leading to significant improvements in diagnostics, biosensing, regenerative medicine, and next-generation point-of-care medicines.

A hybridized feature extraction for COVID-19 multi-class classification on computed tomography images

COVID-19 has killed more than 5 million individuals worldwide within a short time. It is caused by SARS-CoV-2 which continuously mutates and produces more transmissible new different strains. It is therefore of great significance to diagnose COVID-19 early to curb its spread and reduce the death rate. Owing to the COVID-19 pandemic, traditional diagnostic methods such as reverse-transcription polymerase chain reaction (RT-PCR) are ineffective for diagnosis. Medical imaging is among the most effective techniques of respiratory disorders detection through machine learning and deep learning. However, conventional machine learning methods depend on extracted and engineered features, whereby the optimum features influence the classifier's performance. In this study, Histogram of Oriented Gradient (HOG) and eight deep learning models were utilized for feature extraction while K-Nearest Neighbour (KNN) and Support Vector Machines (SVM) were used for classification. A combined feature of HOG and deep learning feature was proposed to improve the performance of the classifiers. VGG-16 + HOG achieved 99.4 overall accuracy with SVM. This indicates that our proposed concatenated feature can enhance the SVM classifier's performance in COVID-19 detection.

The prevalence and risk of depression in aged COVID-19 survivors: a bibliometric and meta-analysis

To explore depression prevalence and related risk factors among elderly coronavirus disease 2019 (COVID-19) survivors, while also evaluating research characteristics. We searched Web of Science, PubMed, Embase, Scopus, CNKI and Wanfang Data for studies that reported COVID-19 and depression in older adults. 'Bibliometrix' facilitated bibliometric analysis and information visualisation. Random-effects models merged depression prevalence and relevant risks. Publication bias and its impact were examined using funnel plots, Begg's test, Egger's linear regression, and trim-and-fill method. Meta-regression, bubble plots, and Baujat plots probed heterogeneity. Sensitivity analysis applied the leave-one-out method. The study is registered with PROSPERO, CRD42023417706. The bibliometric analysis comprised 138 studies. Publication frequency peaked in the US, China, and Italy, reflecting significant growth. The meta-analysis comprised 43 studies. Elderly COVID-19 patients exhibit 28.33% depression prevalence (95% CI: 21.24-35.97). Severe cases (43.91%, 95% CI: 32.28-55.88) experienced higher depression prevalence than mild cases (16.45%, 95% CI: 11.92-21.50). Sex had no depression prevalence impact based on bubble plots. Notably, depression risk did not significantly differ between elderly and young COVID-19 patients (odds ratio (OR) = 1.1808, 95% CI: 0.7323-1.9038). However, COVID-19 infection emerged as a substantial elderly depression risk factor (OR = 1.8521, 95% CI: 1.2877-2.6639). Sensitivity analysis confirmed result robustness. Elderly COVID-19 survivors are likely to develop depression symptoms with regional variations. Severe cases are associated with heightened depression prevalence. COVID-19 infection stands out as a key elderly depression risk factor, while sex does not influence prevalence. The field's expansion necessitates sustained collaboration and extensive research endeavours.

COVID-19 in patients with anemia and haematological malignancies: risk factors, clinical guidelines, and emerging therapeutic approaches

Extensive research in countries with high sociodemographic indices (SDIs) to date has shown that coronavirus disease 2019 (COVID-19) may be directly associated with more severe outcomes among patients living with haematological disorders and malignancies (HDMs). Because individuals with moderate to severe immunodeficiency are likely to undergo persistent infections, shed virus particles for prolonged periods, and lack an inflammatory or abortive phase, this represents an overall risk of morbidity and mortality from COVID-19. In cases suffering from HDMs, further investigation is needed to achieve a better understanding of triviruses and a group of related variants in patients with anemia and HDMs, as well as their treatment through vaccines, drugs, and other methods. Against this background, the present study aimed to delineate the relationship between HDMs and the novel COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides, effective treatment options for HDM cases were further explored to address this epidemic and its variants. Therefore, learning about how COVID-19 manifests in these patients, along with exploiting the most appropriate treatments, may lead to the development of treatment and care strategies by clinicians and researchers to help patients recover faster. Video Abstract.

Exploring the Midwives' Experiences of Providing Delivery Care for Women with Suspected or Confirmed COVID-19 Infection: A Qualitative Study

Introduction

Midwives were at the forefront of caring for pregnant women during the COVID-19 pandemic, therefore, the present study was conducted with the purpose of exploring midwives' experiences of providing delivery care for women with suspected or confirmed COVID-19 infection.

Methods

In this qualitative study, 18 midwives working in the public hospitals affiliated with Guilan University of Medical Sciences (Iran). Who had experience in providing delivery care to women with suspected or confirmed COVID-19 infection were selected using purposive sampling. Data were collected via individual semi-structured interviews until reaching data saturation, and analyzed through conventional content analysis.

Results

Data analysis led to the extraction of three main categories and six sub-categories. The main categories included "COVID-19 and organizational support" with two sub-categories including lack of resources/neglecting the role of midwives, "COVID-19 and positive achievements" with two sub-categories including professional resilience/turning threats into opportunities, "COVID-19 and informational support" with two sub-categories, including up-to-date training/empowering pregnant women.

Conclusion

According to the findings, to realize and guarantee the provision of high-quality maternity care to pregnant women in dealing with epidemic diseases such as COVID-19 in the future, the attention of policymakers and healthcare service officials to the physical and psychological needs of midwives is necessary. Also, organizational and informational support, improving job satisfaction, and paying attention to the importance of midwives' role in the medical team are recommended. Moreover, empowering pregnant women during epidemic diseases is essential.

RNA Analysis Using Immunoassay Detection Format

Oligonucleotide probe tagging and reverse transcriptase polymerase-chain reaction (RT-PCR) are the most widely used techniques currently used for detecting and analyzing RNA. RNA detection using labeled oligonucleotide probe-based approaches is suitable for point-of-care (POC) applications but lacks assay sensitivity, whereas RT-PCR requires complex instrumentation. As an alternative, immunoassay detection formats coupled with isothermal RNA amplification techniques have been proposed for handheld assay development. In this chapter, we describe a robust technique comprising of: (a) target RNA tagging with a complementary oligonucleotide probe labeled with a hapten moiety to form a DNA/RNA duplex hybrid; (b) complexing the DNA/RNA duplex with a pre-coated antibody (Ab) directed at the hapten moiety; (c) sandwich complex formation with an Ab that selectively recognizes the DNA/RNA structural motif; and (d) detection of the sandwich complex using a secondary Ab enzyme conjugate targeting the anti-DNA/RNA Ab followed by standard enzyme-linked immunosorbent assay (ELISA) visualization.

The effect of corticosteroids, antibiotics, and anticoagulants on the development of post-COVID-19 syndrome in COVID-19 hospitalized patients 6 months after discharge: a retrospective follow up study

To assess the effect of pharmacotherapeutic interventions commonly employed in the management of COVID-19 hospitalized patients on the development of post-COVID-19 syndrome. This study employed two distinct databases, the Medisch Spectrum Twente (MST) clinical database comprising electronic health records of COVID-19 patients hospitalized at MST, and the Post-COVID cohort database which contains follow-up information on the same patients. These databases were integrated to establish the potential relationship between the administration of corticosteroids, antibiotics, or anticoagulants during hospitalization and the occurrence of post-COVID-19 syndrome after a 6-month interval following discharge. A total of 123 patients who were hospitalized due to COVID-19 infection were included in this study. Among these patients, 33 (26.8%) developed post-COVID-19 syndrome which persisted even 6 months after hospital discharge. Multivariate analysis revealed that patients who received treatment with corticosteroids had a significantly lower likelihood (OR 0.32, 95% CI 0.11-0.90) of developing post-COVID-19 syndrome, while no significant association was observed for treatment with antibiotics (OR 1.26, 95% CI 0.47-3.39) or anticoagulants (OR 0.55, 95% CI 0.18-1.71). The findings of this study indicate that corticosteroids exert a significant protective effect against the development of post-COVID-19 syndrome in patients who were hospitalized due to COVID-19 infection. Although a trend towards a protective effect of anticoagulants was observed, it did not reach statistical significance. On the contrary, patients treated with antibiotics were shown to have increased chances of developing post-COVID-19 syndrome, although this effect was also not statistically significant.

Passive antibody therapy in emerging infectious diseases

The epidemic of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 and its variants of concern (VOCs) has been ongoing for over 3 years. Antibody therapies encompassing convalescent plasma, hyperimmunoglobulin, and neutralizing monoclonal antibodies (mAbs) applied in passive immunotherapy have yielded positive outcomes and played a crucial role in the early COVID-19 treatment. In this review, the development path, action mechanism, clinical research results, challenges, and safety profile associated with the use of COVID-19 convalescent plasma, hyperimmunoglobulin, and mAbs were summarized. In addition, the prospects of applying antibody therapy against VOCs was assessed, offering insights into the coping strategies for facing new infectious disease outbreaks.

Susceptibility of bovine to SARS-CoV-2 variants of concern: insights from ACE2, AXL, and NRP1 receptors

The possibilities of cross-species transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between humans and important livestock species are not yet known. Herein, we used the structural and genetic alignment and surface potential analysis of the amino acid (aa) in angiotensin-converting enzyme 2 (ACE2), tyrosine kinase receptor UFO (AXL), and neuropilin 1 (NRP1) in different species with substantial public health importance. The residues interfacing with the N-terminal domain (NTD) or receptor-binding domain (RBD) of S were aligned to screen the critical aa sites that determined the susceptibility of the SARS-CoV-2 to the host. We found that AXL and NRP1 proteins might be used as the receptors of SARS-CoV-2 in bovines. However, ACE2 protein may not be considered to be involved in the cross-species transmission of SARS-CoV-2 VOCs in cattle because the key residues of the ACE2-S-binding interface were different from those in known susceptible species. This study indicated that emerging SARS-CoV-2 variants potentially expand species tropism to bovines through AXL and NRP1 proteins.

Assessing risk of major adverse cardiac event among COVID-19 patients using HEART score

Coronavirus disease 2019 (COVID-19) is known to be associated with cardiovascular complications, but whether the current validated HEART score for chest pain is still applicable for these patients is unknown. This study aims to identify the impact and association of COVID-19 co-infection in patients presenting with chest pain and a calculated HEART score to the emergency departments (ED) with 30-day of major adverse cardiac event (MACE). This is a multicenter, retrospective observational study that included adult (age ≥ 18 years) patients visiting 13 different EDs with chest pain and evaluated using a HEART score. The primary outcome was the percentage of 30-day MACE, which included acute myocardial infarction, emergency percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or death among patients who presented with chest pain and had COVID-19 co-infection. The sensitivity and specificity of the HEART score among COVID-19 co-infection for MACE were assessed by the receiver operating curve (ROC). We analyzed records of 46,210 eligible patients, in which 327 (0.7%) patients were identified as infected with COVID-19. Patients with COVID-19 had higher mean total HEART score of 3.3 (1.7), compared to patients who did not have COVID-19 (3.1, SD 1.8, P = 0.048). The rate of MACE was similar between both groups. There were only 2 (0.6%) COVID-19 patients who had MACE, compared to 504 (1.1%) patients in control group. Total HEART score was associated with an area under the ROC (AUROC) of 0.99, while the control group's was 0.78. History was associated with high AUROC in both COVID-19 (0.74) and control groups (0.76). Older age in COVID-19 had higher AUROC (0.89) than control patients (0.63). Among patients presenting to the ED with chest pain and having COVID-19 infection, HEART score had predictive capability for MACE, similar to patients without COVID-19 infection. Further studies with more COVID-19 patients are still necessary to confirm our observation.

COVID-19 knowledge, attitude, and preventive practices among government and private bank workers in Ethiopia

Background

Bank workers are among the many service-sector employees who are at risk of COVID-19 infection. Individual's adherence to control measures is affected by their COVID-19 knowledge, attitudes, and practices (KAP). Since KAP is an important cognitive key in public health prevention and promotion, this study aimed to identify COVID-19 KAP-related gaps among bank workers in Dessie City, Ethiopia and to guide banks and health authorities in taking corrective actions.

Methods

An institution-based cross-sectional study was conducted from January 1st to 30th, 2021 among 413 bank workers. A binary logistic regression was applied to determine association of independent variables with outcome variables using three different models. Variables at 95% confidence interval (CI) with a p < 0.25 from bivariate analysis were transported to three different multivariable logistic regression models and then variables with a p-value of 0.05 from the multivariable analysis of each model were declared as significantly associated with the outcome variables.

Results

The results of this study show that 84.7% [95% CI: 81.1-88.1] of bank workers had good knowledge, 50.4% positive attitude, and 50.6% [95% CI: 45.8-55.0] good practice towards prevention of COVID-19. The only variable significantly associated with knowledge in this study was positive attitude (AOR = 8.89; 95%CI: 3.34-23.64). Being ≥35 years old (AOR = 2.46; 95%CI: 1.25-4.84) and getting information on COVID-19 (AOR = 3.81; 95%CI: 1.84-7.91) were among factors significantly associated with attitude towards COVID-19 prevention, whereas being female and ≥ 35 years old (AOR = 2.56; 95%CI: 1.29-5.06) and (AOR = 2.73; 95% CI: 1.15-6.51), respectively were factors associated with good preventive practice towards COVID-19.

Conclusion and recommendation

Considering those significant factors responsible for determining COVID-19 KAP level of respondents, health education program and information dissemination are recommended, including appropriate strategies by policy makers and bank managers to develop effective interventions for COVID-19 transmission in banks.

Metal Oxide Nanostructures Enhanced Microfluidic Platform for Efficient and Sensitive Immunofluorescence Detection of Dengue Virus

Rapid and sensitive detection of Dengue virus remains a critical challenge in global public health. This study presents the development and evaluation of a Zinc Oxide nanorod (ZnO NR)-surface-integrated microfluidic platform for the early detection of Dengue virus. Utilizing a seed-assisted hydrothermal synthesis method, high-purity ZnO NRs were synthesized, characterized by their hexagonal wurtzite structure and a high surface-to-volume ratio, offering abundant binding sites for bioconjugation. Further, a comparative analysis demonstrated that the ZnO NR substrate outperformed traditional bare glass substrates in functionalization efficiency with 4G2 monoclonal antibody (mAb). Subsequent optimization of the functionalization process identified 4% (3-Glycidyloxypropyl)trimethoxysilane (GPTMS) as the most effective surface modifier. The integration of this substrate within a herringbone-structured microfluidic platform resulted in a robust device for immunofluorescence detection of DENV-3. The limit of detection (LOD) for DENV-3 was observed to be as low as 3.1 × 10-4 ng/mL, highlighting the remarkable sensitivity of the ZnO NR-integrated microfluidic device. This study emphasizes the potential of ZnO NRs and the developed microfluidic platform for the early detection of DENV-3, with possible expansion to other biological targets, hence paving the way for enhanced public health responses and improved disease management strategies.

Curcumin Transferosome-Loaded Thermosensitive Intranasal in situ Gel as Prospective Antiviral Therapy for SARS-Cov-2

Purpose

Immunomodulatory and broad-spectrum antiviral activities have motivated the evaluation of curcumin for Coronavirus infection 2019 (COVID-19) management. Inadequate bioavailability is the main impediment to the therapeutic effects of oral Cur. This study aimed to develop an optimal curcumin transferosome-loaded thermosensitive in situ gel to improve its delivery to the lungs.

Methods

Transferosomes were developed by using 33 screening layouts. The phospholipid concentration as well as the concentration and type of surfactant were considered independent variables. The entrapment efficiency (EE%), size, surface charge, and polydispersity index (PDI) were regarded as dependent factors. A cold technique was employed to develop thermosensitive in-situ gels. Optimized transferosomes were loaded onto the selected gels. The produced gel was assessed based on shape attributes, ex vivo permeability enhancement, and the safety of the nasal mucosa. The in vitro cytotoxicity, antiviral cytopathic effect, and plaque assay (CV/CPE/Plaque activity), and in vivo performance were evaluated after intranasal administration in experimental rabbits.

Results

The optimized preparation displayed a particle size of 664.3 ± 69.3 nm, EE% of 82.8 ± 0.02%, ZP of -11.23 ± 2.5 mV, and PDI of 0.6 ± 0.03. The in vitro curcumin release from the optimized transferosomal gel was markedly improved compared with that of the free drug-loaded gel. An ex vivo permeation study revealed a significant improvement (2.58-fold) in drug permeability across nasal tissues of sheep. Histopathological screening confirmed the safety of these preparations. This formulation showed high antiviral activity against SARS-CoV-2 at reduced concentrations. High relative bioavailability (226.45%) was attained after the formula intranasally administered to rabbits compared to the free drug in-situ gel. The curcumin transferosome gel displayed a relatively high lung accumulation after intranasal administration.

Conclusion

This study provides a promising formulation for the antiviral treatment of COVID-19 patients, which can be evaluated further in preclinical and clinical studies.

The Protective Effects of Moisturizer Containing Potentilla anserina Extract in the Topical Treatment of Skin Damage Caused by Masks

The use of face masks during the COVID-19 pandemic resulted in significant societal changes, particularly for individuals with sensitive skin. To address this issue, the researchers explored traditional medicine and identified Potentilla anserina extract as a potential solution due to its anti-inflammatory and moisturizing effects. This research investigated how this extract influences skin hydration, barrier function, and itching. The findings revealed that the extract had a hydrating effect by elevating Aquaporin-3 (AQP3) expression. Additionally, the study demonstrated that the extract improved skin barrier function, with Filaggrin (FLG) expression being approximately three times higher (p < 0.001) in the Potentilla-anserina-extract-treated group compared to the control group and the genes associated with itching being reduced. In this process, we researched and developed HPβCD (hydroxypropyl-β-cyclodextrin)-Liposome containing Potentilla anserina extract, gradually and sustainably releasing the active components of the Potentilla anserina extract. During four weeks of clinical trials involving individuals wearing masks for over 6 h a day, a moisturizer containing Potentilla anserina extract demonstrated a notable reduction in skin redness. Hemoglobin values (A.U.), which serve as indicators of skin redness, showed decreases of 5.06% and 6.74% in the test area inside the mask after 2 and 4 weeks, respectively, compared to the baseline measurements. Additionally, the moisturizer containing Potentilla anserina extract notably decreased Trans Epidermal Water Loss (TEWL), with reductions of 5.23% and 9.13% observed in the test area inside the mask after 2 and 4 weeks, respectively. The moisturizer, especially in the test area treated with the extract-containing moisturizer, significantly enhanced skin hydration compared to the control group. The Corneometer values (A.U) exhibited notable increases of 11.51% and 15.14% in the test area inside the mask after 2 and 4 weeks, respectively. These discoveries emphasize the potential of Potentilla anserina extract and its utility in tackling skin issues caused by mask wearing, including enhancing moisture, fortifying the skin's barrier, and alleviating itching. These results indicate that moisturizers incorporating specific ingredients provide greater benefits compared to conventional moisturizers.

The promising approach of MSCs therapy for COVID-19 treatment

Several ongoing investigations have been founded on the development of an optimized therapeutic strategy for the COVID-19 virus as an undeniable acute challenge for human life. Cell-based therapy and particularly, mesenchymal stem cells (MSCs) therapy has obtained desired outcomes in decreasing the mortality rate of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), mainly owing to its immunoregulatory impact that prevents the overactivation of the immune system. Also, these cells with their multipotent nature, are capable of repairing the damaged tissue of the lung which leads to reducing the probability of acute respiratory distress syndrome (ARDS). Although this cell-based method is not quite cost-effective for developing countries, regarding its promising results in order to treat SARS-COV-2, more economical evaluation as well as clinical trials should be performed for improving this therapeutic approach. Here in this article, the functional mechanism of MSCs therapy for the treatment of COVID-19 and the clinical trials based on this method will be reviewed. Moreover, its economic efficiency will be discussed.

The Effect of the COVID-19 Pandemic on Emergency Department (ED) Admissions in the Only Hospital of City Center ED

AIM

This study aimed to examine the effect of the pandemic on emergency service visits, together with the pre- and post-pandemic period data.

MATERIAL AND METHODS

The charts of patients who applied to the emergency department between 2019 and 2021 were included in the study. We analysed patients' charts from the pre-pandemic period (January 1, 2019-February 29, 2020), the pandemic period (March 1, 2020-June 30, 2021; from the date of detection of the first COVID-19 case to the date of the second dose of the vaccine), and normalisation period (July 1, 2021-December 31, 2021; the date from the completion of vaccination to the end of the year). Demographic characteristics, triage codes, diagnoses, hospitalisation or referral status, population ratio, admission rate, and mortality were examined in these data.

RESULTS

In total, 529,706 patient charts were examined. When the pre-pandemic period (15,983.29±1,493.19) was compared with the pandemic period (11,342.94±2,350.15), it was observed that there was a decrease in the number of visit period. In the post-pandemic period, patients coming to the hospital decreased following vaccination. It was determined that there were more visits (20742.17±967.61) compared to the pre-pandemic period.

CONCLUSION

The data demonstrate that, during the pandemic period, visits decreased in general, and the rate of critical patients increased gradually. Accordingly, there are unnecessary visits and inappropriate use of emergency services.

COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development

The world is presently in crisis facing an outbreak of a health-threatening microorganism known as COVID-19, responsible for causing uncommon viral pneumonia in humans. The virus was first reported in Wuhan, China, in early December 2019, and it quickly became a global concern due to the pandemic. Challenges in this regard have been compounded by the emergence of several variants such as B.1.1.7, B.1.351, P1, and B.1.617, which show an increase in transmission power and resistance to therapies and vaccines. Ongoing researches are focused on developing and manufacturing standard treatment strategies and effective vaccines to control the pandemic. Despite developing several vaccines such as Pfizer/BioNTech and Moderna approved by the U.S. Food and Drug Administration (FDA) and other vaccines in phase 4 clinical trials, preventive measures are mandatory to control the COVID-19 pandemic. In this review, based on the latest findings, we will discuss different types of drugs as therapeutic options and confirmed or developing vaccine candidates against SARS-CoV-2. We also discuss in detail the challenges posed by the variants and their effect on therapeutic and preventive interventions.

An Efficient Electrochemical Sensor Based on NiCo2O4 Nanoplates and Ionic Liquid for Determination of Favipiravir in the Presence of Acetaminophen

Based on the modification of carbon paste electrode with NiCo2O4 nanoplates and 1-hexyl-3-methylimidazolium tetrafluoroborate, a new electrochemical sensing platform for the sensing of favipiravir (a drug with potential therapeutic efficacy in treating COVID-19 patients) in the presence of acetaminophen was prepared. For determining the electrochemical behavior of favipiravir, cyclic voltammetry, differential pulse voltammetry, and chronoamperometry have been utilized. When compared to the unmodified carbon paste electrode, the results of the cyclic voltammetry showed that the proposed NiCo2O4 nanoplates/1-hexyl-3-methylimidazolium tetrafluoroborate/carbon paste electrode had excellent catalytic activity for the oxidation of the favipiravir in phosphate buffer solution (pH = 7.0). This was due to the synergistic influence of 1-hexyl-3-methylimidazolium tetrafluoroborate (ionic liquid) and NiCo2O4 nanoplates. In the optimized conditions of favipiravir measurement, NiCo2O4 nanoplates/1-hexyl-3-methylimidazolium tetrafluoroborate/carbon paste electrode had several benefits, such as a wide dynamic linear between 0.004 and 115.0 µM, a high sensitivity of 0.1672 µA/µM, and a small limit of detection of 1.0 nM. Furthermore, the NiCo2O4 nanoplates/1-hexyl-3-methylimidazolium tetrafluoroborate/carbon paste electrode sensor presented a good capability to investigate the favipiravir and acetaminophen levels in real samples with satisfactory recoveries.

Meta-analysis of Traditional Chinese Medicine Lianhua Qingwen in the Treatment of Coronavirus Disease 2019

The rapid global spread of Coronavirus disease 2019 (COVID-19) has seriously threatened human life and health. Effects of traditional Chinese medicine, Lianhua Qingwen, combined with western medicine remains controversial for treatment of COVID-19. Evidence to support use of Lianhua Qingwen in COVID-19 is lacking. In this study, we systematically reviewed literature on the use of Lianhua Qingwen in COVID-19, and we performed meta-analysis to assess the effect of Lianhua Qingwen in COVID-19 management. We found that when combined with western medicine in the treatment of COVID-19 patients, Lianhua Qingwen may shorten duration of fever, reduce adverse events, decrease rate of conversion to severe disease, and improve symptom recovery and chest radiographic signs of pneumonia.

Living in an untouchable world: Barriers to recreation and tourism for Portuguese blind people during the COVID-19 pandemic

Despite the COVID-19 pandemic having affected the lives of all citizens, some groups, as people with disabilities (PwD), have felt its effects more intensely, specifically due to social distancing measures adopted. However, PwD are a heterogeneous group and the impacts of COVID-19 are, therefore, experienced differently. Blind people (BP) face considerable challenges during the COVID-19 pandemic, since they "access the world" through touch, something strongly discouraged in order to control the spread of the virus. Nevertheless, no studies are known which analyze the constraints experienced by BP during COVID-19 on participating in recreation and tourism activities. To extend knowledge in this field, the intention of this study is to examine the constraints faced by BP during COVID-19 on participation in outdoor recreation and tourism activities and the strategies used to overcome these constraints. A qualitative methodology (in-depth interviews with BP) was used. The results reveal that during the COVID-19 pandemic, BP faced several constraints that made their participation in outdoor recreation and tourism activities difficult. The paper ends with a discussion of the strategies used by BP to overcome these constraints.

Management implications

Understanding the impact of COVID-19 on the recreation and tourism practices of blind people, and the constraints that they face as a consequence of this pandemic, this study provides relevant implications managers for public and private tourism supply agents. Therefore, managers and planners can use the findings of this study to design strategies to overcome the strong constraints faced by blind people due to the COVID-19 pandemic, to minimize risk exposure and to increase their quality of life. Thus, the type of activities offered and the marketing strategy should be rethought to increase the engagement of blind people in recreation and tourism experiences in an "untouchable world."

Factors Influencing Infection Anxiety in Korean Male Firefighters Due to COVID-19 Infection Status

This paper describes descriptive research to identify the effects of job stress, COVID-19 self-care behavior, and COVID-19 vaccination status according to the infection and non-infection of COVID-19 on anxiety about the COVID-19 infection among firefighters in South Korea. Data from 205 firefighters working at 10 fire stations were collected from 26 January to 16 February 2023. The variables used were job stress, COVID-19 self-care behavior, COVID-19 vaccination status, and COVID-19 infection anxiety. The collected data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple linear regression. In subjects who were infected with COVID-19, the factors that significantly affected infection anxiety were job stress (β = 0.247, p = 0.011) and self-care behavior (β = 0.343, p = 0.011). In subjects who were not infected with COVID-19, the factors that significantly affected infection anxiety were marriage status (unmarried) (β = -0.260, p = 0.005) and self-care behavior (β = 0.374, p = 0.001). These results demonstrate that the infection anxiety of firefighters should be prevented, and their physical and mental health should be promoted by considering job stress, self-care behavior, and personal environment.

Efficacy and safety of human umbilical cord-derived mesenchymal stem cells for COVID-19 pneumonia: a meta-analysis of randomized controlled trials

BACKGROUND

Elevated levels of inflammatory factors are associated with poor prognosis in coronavirus disease-19 (COVID-19). However, mesenchymal stem cells (MSCs) have immunomodulatory functions. Accordingly, this meta-analysis aimed to determine the efficacy and safety of MSC-based therapy in patients with COVID-19 pneumonia.

METHODS

Online global databases were used to find relevant studies. Two independent researchers then selected and evaluated the studies for suitability while the Cochrane risk of bias tool determined the quality of all articles and Cochran's Q test and I2 index assessed the degree of heterogeneity in the principal studies. Statistical analysis was performed using Review Manager software, and the effect of each study on the overall estimate was evaluated by sensitivity analysis.

RESULTS

Seven studies were included in the meta-analysis, and all MSCs used in the trials were acquired from the umbilical cord. The results of these studies (n = 328) indicated that patients with COVID-19 pneumonia who received MSCs had a 0.58 risk of death compared with controls (95% CI = 0.38, 0.87; P = 0.53; I2 = 0%). In terms of inflammatory biomarkers, MSCs reduced the levels of C-reactive protein (n = 88; MD =  - 32.49; 95% CI =  - 48.43, - 16.56; P = 0.46; I2 = 0%) and interferon-gamma (n = 44; SMD =  - 1.23; 95% CI =  - 1.89, - 0.57; P = 0.37; I2 = 0%) in severe COVID-19 patients but had no significant effect on interleukin-6 (n = 185; MD =  - 0.75; 95% CI =  - 7.76, 6.27; P = 0.57; I2 = 0%). A summary of the data revealed no significant differences in adverse events (n = 287) or serious adverse events (n = 229) between the MSC and control groups.

CONCLUSIONS

Infusion of umbilical cord-derived MSCs is an effective strategy for treating patients with COVID-19 pneumonia, with no noticeable adverse effects.

Drug-target interaction prediction based on spatial consistency constraint and graph convolutional autoencoder

BACKGROUND

Drug-target interaction (DTI) prediction plays an important role in drug discovery and repositioning. However, most of the computational methods used for identifying relevant DTIs do not consider the invariance of the nearest neighbour relationships between drugs or targets. In other words, they do not take into account the invariance of the topological relationships between nodes during representation learning. It may limit the performance of the DTI prediction methods.

RESULTS

Here, we propose a novel graph convolutional autoencoder-based model, named SDGAE, to predict DTIs. As the graph convolutional network cannot handle isolated nodes in a network, a pre-processing step was applied to reduce the number of isolated nodes in the heterogeneous network and facilitate effective exploitation of the graph convolutional network. By maintaining the graph structure during representation learning, the nearest neighbour relationships between nodes in the embedding space remained as close as possible to the original space.

CONCLUSIONS

Overall, we demonstrated that SDGAE can automatically learn more informative and robust feature vectors of drugs and targets, thus exhibiting significantly improved predictive accuracy for DTIs.

Changes in incidence and mortality trend due to COVID-19 in southern Iran, from 2020 to 2021: based on Cochran-Armitage trend test

Background

In 2020, COVID-19 spread rapidly in Iran and other parts of the world. Some of the epidemiological aspects of this disease remain unknown; therefore, the present study was designed with the aim of determining the trend of incidence and mortality of COVID-19 from February 2020 to July 2021 in southern Iran.

Methods

The present study was a cross-sectional analytical study that included all people who had COVID-19 in the period from February 2020 to July 2021 and whose information had been registered in the Infectious Diseases Center of Larestan city and MCMC unit. The study area included the cities of Larestan, Evaz, and Khonj, located in the south of Fars province in southern Iran.

Results

Since the emergence of COVID-19 until July 2021, a total of 23,246 new cases of infection were reported in the southern region of Fars province. The average age of patients was 39.90±18.30 years and the range of ages varied from 1 to 103 years. The results of the Cochran-Armitage trend test showed that the trend of the disease in 2020 was completely upward. The first positive case of COVID-19 was recorded on February 27, 2020. The incidence curve in 2021 is sinusoidal, but in general, the results of the Cochran-Armitage trend test showed that the incidence of the disease increased significantly (P-trend < 0.001). Most cases were reported in July, April, and the end of March.

Conclusion

In general, the incidence rate of COVID-19 has varied sinusoidally from 2020 to mid-2021. Although the incidence of the disease increased, the number of deaths has fallen. It seems that the increase in the number of diagnostic tests and the implementation of the national COVID-19 immunization program have been effective in changing the trend of the disease.

Challenges and Recent Advancements in COVID-19 Vaccines

Vaccination is the most effective method for the prevention of COVID-19 caused by SARS-CoV-2, which is still a global epidemic. However, the evolution of SARS-CoV-2 is so rapid that various variants, including the Alpha, Beta, Gamma, Delta, and Omicron variants, have emerged, lowering the protection rate of vaccines and even resulting in breakthrough infections. Additionally, some rare but severe adverse reactions induced by COVID-19 vaccines may raise safety concerns and hinder vaccine promotion; however, clinical studies have shown that the benefits of vaccination outweigh the risks caused by adverse reactions. Current vaccines approved with emergency use authorization (EUA) were originally adaptive for adults only, and infants, children, and adolescents are not included. New-generation vaccines are needed to overcome the challenges of limited adaptive age population, breakthrough infection (mainly due to virus variant emergencies), and critical adverse reactions. Fortunately, some advances in COVID-19 vaccines have been obtained regarding enlarged adaptive populations for clinical applications, such as the Pfizer/BioNTech vaccine and the Moderna vaccine. In this article, we provide a review on the challenges and recent advancements in COVID-19 vaccines. The development of next-generation COVID-19 vaccines should lay emphasis on the expansion of adaptive age populations in all individuals, the induction of immune responses to viral variants, the avoidance or alleviation of rare but potentially critical adverse reactions, and the discovery of subunit vaccines with adjuvants encapsulated in nanoparticles.

Exploring pandemic preparedness in higher education: lessons learnt from students' lived experiences during a critical time

Background

The COVID-19 pandemic has had a marked impact on educational disruption and progression of students. Linked to this, studies have demonstrated increases in depression, anxiety, and stress, with long-term outcomes yet to be understood. Students in Higher Education (HE) were at particular risk due to circumstances such as financial stress from job loss, shifting to online learning and uncertainties about the future, with many international students isolated from social support networks. This study explored lived experiences of determinants for academic disruption in HE students during the COVID-19 pandemic across Germany and the UK.

Methods

The study used qualitative secondary data collected from extension and mitigation claim forms from 2019 until 2021 from a university with campuses in the UK and Germany. A phenomenological perspective was utilised to draw out experiences and insights into determinants for mitigation from students to enhance our understanding of real problems encountered during a period of crisis. Thematic data analysis was used to create themes of influence for mitigation of assessments.

Results

Themes identified pre and during the COVID-19 pandemic included; pre-COVID: work-related commitments; bereavement; illness of a family member; mental and physical health issues; natural disasters, during 2020/21, themes created were; COVID-19 social impacts; workplace and financial demands; psychological distress; physical illness, with subthemes evolving such as family responsibilities; and caring for others; furlough and its financial impacts; heavy workload for frontline health care workers; mental health impacts; physical abuse and crime, COVID-19 physical symptoms.

Conclusion

We suggest an Integrated 'Determinants of Wellbeing Framework' for supporting HE students during critical times such as a pandemic. Our suggested framework was adapted from determining health inequalities and the concept of the 'flourishing student' that maps the relationship between the student, their environment and well-being. It is hoped the framework will serve to inform future theories around disruption to student progression and to explore the relevant impact on educational outcomes in HE thus assisting in appropriate support planning.

Hybrid feature engineering of medical data via variational autoencoders with triplet loss: a COVID-19 prognosis study

Medical machine learning frameworks have received much attention in recent years. The recent COVID-19 pandemic was also accompanied by a surge in proposed machine learning algorithms for tasks such as diagnosis and mortality prognosis. Machine learning frameworks can be helpful medical assistants by extracting data patterns that are otherwise hard to detect by humans. Efficient feature engineering and dimensionality reduction are major challenges in most medical machine learning frameworks. Autoencoders are novel unsupervised tools that can perform data-driven dimensionality reduction with minimum prior assumptions. This study, in a novel approach, investigated the predictive power of latent representations obtained from a hybrid autoencoder (HAE) framework combining variational autoencoder (VAE) characteristics with mean squared error (MSE) and triplet loss for forecasting COVID-19 patients with high mortality risk in a retrospective framework. Electronic laboratory and clinical data of 1474 patients were used in the study. Logistic regression with elastic net regularization (EN) and random forest (RF) models were used as final classifiers. Moreover, we also investigated the contribution of utilized features towards latent representations via mutual information analysis. HAE Latent representations model achieved decent performance with an area under ROC curve of 0.921 (±0.027) and 0.910 (±0.036) with EN and RF predictors, respectively, over the hold-out data in comparison with the raw (AUC EN: 0.913 (±0.022); RF: 0.903 (±0.020)) models. The study aims to provide an interpretable feature engineering framework for the medical environment with the potential to integrate imaging data for efficient feature engineering in rapid triage and other clinical predictive models.

Understanding Use Intention of mHealth Applications Based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) Model in China

The COVID-19 pandemic has significantly impacted the healthcare industry, especially public health resources and resource allocation. With the change in people's lifestyles and increased demand for medical and health care in the post-pandemic era, the Internet and home healthcare have rapidly developed. As an essential part of Internet healthcare, mobile health (mHealth) applications help to fundamentally address the lack of medical resources and meet people's healthcare needs. In this mixed-method study, we conducted in-depth interviews with 20 users in China (mean age = 26.13, SD = 2.80, all born in China) during the pandemic, based on the unified theory of acceptance and use of technology 2 (UTAUT-2) mode, and identified four dimensions of user needs in mHealth scenarios: convenience, control, trust, and emotionality. Based on the interview results, we adjusted the independent variables, deleted the hedonic motivation and the habit, and added the perceived trust and perceived risk as the variables. Using a structural equation model (SEM), we designed the questionnaire according to the qualitative results and collected data from 371 participants (above 18 years old, 43.9% male) online to examine the interrelationships these variables. The results show that performance expectancy (β = 0.40, p < 0.001), effort expectancy (β = 0.40, p < 0.001), social influence (β = 0.14, p < 0.05), facilitating condition (β = 0.15, p < 0.001), and perceived trust (β = 0.31, p < 0.001) had positive effects on use intention. Perceived risk (β = -0.31, p < 0.001) harmed use intention, and price value (β = 0.10, p > 0.5) had no significant effects on use intention. Finally, we discussed design and development guidelines that can enhance user experience of mHealth applications. This research combines the actual needs and the main factors affecting the use intention of users, solves the problems of low satisfaction of user experience, and provides better strategic suggestions for developing mHealth applications in the future.

Safety and immunogenicity of a recombinant receptor-binding domain-based protein subunit vaccine (Noora vaccine™) against COVID-19 in adults: A randomized, double-blind, placebo-controlled, Phase 1 trial

The development of a safe and effective vaccine is essential to protect populations against coronavirus disease 2019 (COVID-19). There are several vaccine candidates under investigation with different mechanisms of action. In the present study, we have evaluated the safety and immunogenicity of a recombinant receptor-binding domain (RBD)-based protein subunit vaccine (Noora vaccine) against COVID-19 in adults. This Phase 1 trial is a randomized, double-blind, placebo-controlled study to evaluate the safety and immunogenicity of the recombinant RBD-based protein subunit vaccine (Noora vaccine) against COVID-19 in healthy adults volunteers. Eligible participants were included in this study after evaluating their health status and considering the exclusion criteria. They were then randomized into three groups and received three doses of vaccine (80 µg, 120 µg, and placebo) on Days 0, 21, and 35. Primary outcomes including solicited, unsolicited, and medically attended adverse events were recorded during this study. Secondary outcomes including the humoral and cellular immunity (including anti-RBD IgG antibody and neutralizing antibody) were measured on Days 0, 21, 28, 35, 42, and 49 by using the ELISA kit and the Virus Neutralization Test (VNT) was performed on day 49. Totally 70 cases were included in this Phase 1 trial and 60 of them completed the study. Safety assessments showed no severe adverse events. Local pain at the vaccine injection site occurred in 80% of the vaccinated volunteers. Induration and redness at the injection site were the other adverse reactions of this vaccine. There was no significant difference between the studied groups regarding adverse reactions. Anti-RBD IgG antibody and neutralizing antibody assessment showed significant seroconversion in comparison to the placebo group (80%, and 100% respectively, p < 0.001). The cellular immunity panel also showed mild to moderate induction of TH1 responses and the VNT showed 78% of seroprotection. The results of this Phase 1 trial showed acceptable safety without serious adverse events and significant seroconversions in the humoral and cellular immunity panel. The dose of 80 µg is an appropriate dose for injection in the next phases of the trial.

Serological response to vaccination against coronavirus disease-19 in patients with inflammatory bowel disease

Vaccination against coronavirus disease-19 (COVID-19) is effective in preventing the occurrence or reduction in the severity of the infection. Patients with inflammatory bowel disease (IBD) are on immunomodulators, which may alter serological response to vaccination against COVID-19. Accordingly, we studied (i) the serological response to vaccination against COVID-19 in IBD patients and (ii) a comparison of serological response in IBD patients with that in healthy controls. A prospective study was undertaken during a 6-month period (July 2021 to January 2022). Seroconversion was assessed among vaccinated, unvaccinated IBD patients and vaccinated healthy controls using anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G (anti-SARS-CoV-2 IgG) antibody detection enzyme-linked immunosorbent assay (ELISA) kit, and optical density (OD) was measured at 450 nm. OD is directly proportional to the antibody concentration. One hundred and thirty-two blood samples were collected from 97 IBD patients (85 [87.6%] ulcerative colitis and 12 [12.4%] Crohn's disease). Forty-one of the seventy-one (57.7%) unvaccinated and 60/61 (98.4%) vaccinated IBD patients tested positive (OD > 0.3) for SARS-CoV-2 IgG antibodies. Fourteen of the sixteen (87.5%) healthy controls tested positive for SARS-CoV-2 IgG antibodies. Vaccinated IBD patients had higher ODs than unvaccinated IBD patients (1.31 [1.09-1.70] vs. 0.53 [0.19-1.32], p < 0.001) and 16 vaccinated healthy controls (1.31 [1.09-1.70] vs. 0.64 [0.43-0.78], p < 0.001). Three of the seventy-one (4.2%) unvaccinated IBD patients reported having recovered from COVID-19. Most IBD patients seroconvert after vaccination against SARS-CoV-2, similar to a healthy population. A large proportion of IBD patients had anti-SARS-CoV-2 antibodies even before vaccination, suggesting the occurrence of herd immunity.

Comparison of ribavirin degradation in the UV/H2O2 and UV/PDS systems: Reaction mechanism, operational parameter and toxicity evaluation

Residues in surface water of ribavirin, which used extensively during the COVID-19 pandemic, have become an emerging issue due to its adverse impact on the environment and human health. UV/H2O2 and UV/peroxydisulfate (PDS) have different degradation effects on ribavirin, and the same operational parameter have different effects on the two processes. In this study, the reaction mechanism and degradation efficiency for ribavirin were studied to compare the differences under UV/H2O2 and UV/PDS processes. We calculated the total rate constants of ribavirin with HO• and SO4 •- in the liquid phase as 2.73 × 108 and 9.39 × 105 M-1s-1. The density functional theory (DFT) calculation results showed that HO• and SO4 •- react more readily with ribavirin via H-abstraction (HAA). The nitrogen-containing heterocyclic ring is difficult to undergo ring-opening degradation. The UV/PDS process was more stable and performed better than the UV/H2O2 for the ribavirin degradation when the same molar oxidant dosage was applied. HO• plays an extremely important role in the degradation of ribavirin by UV/PDS. The reason for this phenomenon is the combination of the higher yield of HO• produced in the UV/PDS process and the faster reaction rate of ribavirin with HO•. The UV/H2O2 process is more sensitive to pH than UV/PDS. Alkaline condition can significantly inhibit the ribavirin degradation. The effects of natural organic matter (NOM) and ribavirin concentration were also compared. Eventually, the toxicity prediction of the product showed that the opening-ring products were more toxic than the parent compound.

Prevalence of Anxiety Symptoms Among Health Care Workers in Colombia During the COVID-19 Pandemic

OBJECTIVE

This study aimed to determine the prevalence of anxiety symptoms in a Colombian HCW sample during the COVID-19 pandemic.

METHODS

A cross-sectional study was carried out by means of an online survey (May-June 2020). Respondents were HCWs in Colombia reached by a nonprobability sample. Zung's self-rating anxiety scale allowed the estimation of prevalence and classification of anxiety symptoms.

RESULTS

A total of 568 HCWs answered the questionnaire, 66.0% were women, the mean age was 38.6±11.4 years. 28.9% presented with anxiety symptoms, of whom 9.2% were moderate-severe. Characteristics such as living with relatives at higher risk of mortality from COVID-19 infection (OR:1.90; 95% CI: 1.308-2.762), female sex (OR:2.16; 95% CI: 1.422-3.277), and personal history of psychiatric illness (OR:3.41; 95% CI: 2.08-5.57) were associated with higher levels of anxiety. Access to sufficient personal protective equipment (OR:0.45; 95% CI: 0.318-0.903) and age >40 years (OR:0.53; 95% CI: 0.358-0.789) were associated with lower anxiety levels.

CONCLUSIONS

Anxious symptoms are common in the population of HCWs faced with patient care during the COVID-19 pandemic. Different strategies are required to intervene with subgroups at risk of developing higher levels of anxiety during the pandemic.[[[es]]]ResumenObjetivo: Determinar la prevalencia de síntomas de ansiedad en una muestra de personal de salud (PDS) colombianos durante la pandemia por COVID-19-.Métodos: Se llevó a cabo un estudio de corte transversal, mediante una encuesta en línea (mayo a junio 2020). Los encuestados fueron PDS en Colombia reclutados mediante una muestra no probabilística. La escala de autoevaluación de ansiedad de Zung permitió la estimación de la prevalencia y clasificación de los síntomas de ansiedad.

RESULTS

Un total de 568 PDS respondieron el cuestionario, 66.0% fueron mujeres, la edad promedio fue 38.6±11.4 años. 28.9% presentaron síntomas de ansiedad, de los cuales 9.2% fueron moderados-severos. Características como vivir con familiares con mayor riesgo de mortalidad por infección por COVID-19 (OR:1.90; 95% IC: 1.308-2.762), sexo femenino (OR:2.16; 95% IC: 1.422-3.277), y la presencia de historia personal de patología psiquiátrica (OR:3.41; 95% IC: 2.08-5.57) se asociaron con mayores niveles de ansiedad. El acceso a elementos de protección personal suficientes (OR:0.45; 95% IC: 0.318-0.903) y las edades >40 años (OR:0.53; 95% IC: 0.358-0.789) se correlacionaron con menores niveles de ansiedad.

CONCLUSIONES

Los síntomas ansiosos son comunes en la población de PDS enfrentados al cuidado de pacientes durante la pandemia por COVID-19. Diferentes estrategias se requieren para intervenir los subgrupos en riesgo de desarrollar mayores niveles de ansiedad durante la pandemia.

Aspects of Nanotechnology for COVID-19 Vaccine Development and Its Delivery Applications

Coronavirus, a causative agent of the common cold to a much more complicated disease such as "severe acute respiratory syndrome (SARS-CoV-2), Middle East Respiratory Syndrome (MERS-CoV-2), and Coronavirus Disease 2019 (COVID-19)", is a member of the coronaviridae family and contains a positive-sense single-stranded RNA of 26-32 kilobase pairs. COVID-19 has shown very high mortality and morbidity and imparted a significantly impacted socioeconomic status. There are many variants of SARS-CoV-2 that have originated from the mutation of the genetic material of the original coronavirus. This has raised the demand for efficient treatment/therapy to manage newly emerged SARS-CoV-2 infections successfully. However, different types of vaccines have been developed and administered to patients but need more attention because COVID-19 is not under complete control. In this article, currently developed nanotechnology-based vaccines are explored, such as inactivated virus vaccines, mRNA-based vaccines, DNA-based vaccines, S-protein-based vaccines, virus-vectored vaccines, etc. One of the important aspects of vaccines is their administration inside the host body wherein nanotechnology can play a very crucial role. Currently, more than 26 nanotechnology-based COVID-19 vaccine candidates are in various phases of clinical trials. Nanotechnology is one of the growing fields in drug discovery and drug delivery that can also be used for the tackling of coronavirus. Nanotechnology can be used in various ways to design and develop tools and strategies for detection, diagnosis, and therapeutic and vaccine development to protect against COVID-19. The design of instruments for speedy, precise, and sensitive diagnosis, the fabrication of potent sanitizers, the delivery of extracellular antigenic components or mRNA-based vaccines into human tissues, and the administration of antiretroviral medicines into the organism are nanotechnology-based strategies for COVID-19 management. Herein, we discuss the application of nanotechnology in COVID-19 vaccine development and the challenges and opportunities in this approach.

Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward

Background: although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. Methods: in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. Results: from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54−76) vs. 65 (52.5−71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2−5) vs. 2 (1−4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p < 0.001, df = 3, X2 = 39.563] and required more oxygen [3 (0−6) vs. 0 (0−2), p < 0.001, r = 0.328]. Conclusion: empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment.

Propolis effects in periodontal disease seem to affect coronavirus disease: a meta-analysis

This meta-analysis aimed to investigate the effects of propolis on the severity of coronavirus disease symptoms by reducing periodontal disease. PubMed, EMBASE, SciELO, Web of Science, and SCOPUS databases were systematically searched. Studies have been conducted analyzing propolis's effects on COVID-19 and periodontitis. The study was conducted according to the PRISMA statement and registered in PROSPERO. Risk of Bias (RoB) assessment and meta-analysis of clinical studies were performed (Review Manager 5, Cochrane). The certainty of the evidence was assessed using GradePro (GDT). Studies have shown propolis flavonoids inhibit viral replication in several DNA and RNA viruses, including coronaviruses. Propolis components have an aminopeptidase inhibitor activity that can inhibit the main proteases of SARS viruses and seem to inhibit protein spikes, which are sites of most mutations in SARS-CoV strains. The meta-analysis showed favorable results with the use of propolis on probing depth (95%CI: 0.92; p < 0.001), clinical attachment level (95%CI: 1.48; p < 0.001), gingival index (95%CI: 0.14; p = 0.03), plaque index (95%CI: 0.11; p = 0.23), and blending on probing (95%CI: 0.39; p < 0.001). The antibacterial activity of propolis could be mediated through its direct action on microorganisms or the stimulation of the immune system, activating natural defenses. Thus, propolis inhibits the replication of SARS-CoV-2 as well as its bacterial activity. Treatment with propolis improves general health and facilitates the activation of the immune system against coronavirus.

Endurance of COVID 19 in wastewater, natural prescription and antiviral medication for the analysis of COVID 19 and its effects on the development of new antiseptic strategies

The continuous worldwide pandemic of COVID-19 brought about by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a public health emergency of international concern, which was formally announced by the World Health Organization (WHO). The antivirals utilized to restrict the spread of virus and the procedures for the recognition of SARS-COV-2 in wastewater has been reviewed. A main tool Wastewater-based epidemiology (WBE) played a notable role in tracking the spread of corona virus in large community. This review signifies the upgraded clinical impacts and components of Traditional Chinese Medicine (TCM), the function of various antiviral drugs against COVID 19 and the role of human covid to exist in the habitat and the viability countered; with specific spotlight on the advancement of latest strategies to assess the action of latest antiseptic-disinfectants on infections.

Assessment Model for Rapid Suppression of SARS-CoV-2 Transmission under Government Control

The rapid suppression of SARS-CoV-2 transmission remains a priority for maintaining public health security throughout the world, and the agile adjustment of government prevention and control strategies according to the spread of the epidemic is crucial for controlling the spread of the epidemic. Thus, in this study, a multi-agent modeling approach was developed for constructing an assessment model for the rapid suppression of SARS-CoV-2 transmission under government control. Different from previous mathematical models, this model combines computer technology and geographic information system to abstract human beings in different states into micro-agents with self-control and independent decision-making ability; defines the rules of agent behavior and interaction; and describes the mobility, heterogeneity, contact behavior patterns, and dynamic interactive feedback mechanism of space environment. The real geospatial and social environment in Taiyuan was considered as a case study. In the implemented model, the government agent could adjust the response level and prevention and control policies for major public health emergencies in real time according to the development of the epidemic, and different intervention strategies were provided to improve disease control methods in the simulation experiment. The simulation results demonstrate that the proposed model is widely applicable, and it can not only judge the effectiveness of intervention measures in time but also analyze the virus transmission status in complex urban systems and its change trend under different intervention measures, thereby providing scientific guidance to support urban public health safety.

Rapid utilisation of telehealth services for specialist paediatric general surgery outpatient clinics in response to COVID-19

Background

The COVID-19 pandemic is highly infectious and prompted, amongst other changes, strict social distancing requirements for medical practitioners in Western Australia. Despite significant previous research into telehealth, uptake had been limited beyond servicing rural patients, in spite of numerous purported benefits.

Results

Rapid adoption of telehealth for a majority of outpatient appointments was instituted in the sole tertiary paediatric general surgery with high overall success rates — a satisfactory outcome being achieved without requiring an in-person appointment (97.1% for telephone consults, 93.8% for videoconferencing) during the initial COVID-19 crisis from April to June 2020. Success of appointments was lowest for new referrals for undescended testicles at 81.3%. Operations booked through telehealth consultations were only altered in 1 case (5%), and this was not significantly different to in-person bookings (p > 0.05). No cases of COVID-19 were incurred by the surgical team or patients during the study period.

Conclusions

We found that with existing technology and minimal training, paediatric surgical consultations were able to be performed via telehealth with high success, high accuracy, and without significant adverse outcomes.

The Impact of COVID-19 on the Quality of Life and Happiness of Care Home Residents in Croatia: A Cross-Sectional Study

Care/nursing homes globally have been severely affected by the COVID-19 pandemic and have disproportionately experienced a high rate of mortality which led to the introduction of strict isolation policies. However, while there are studies on the mortality, epidemiology, staffing challenges, and mismanagement in long-term care homes as a result of COVID-19, there appears to be a paucity of information regarding the Quality of Life (QoL), happiness, and associated well-being of the elderly residents of these homes. Therefore, we examined if COVID-19 affected the happiness level, QoL, and financial condition of long-term care home residents in Croatia. To achieve this, a survey of 308 participants in eight long term care homes was conducted. Descriptive analysis was performed to describe the mean of all responses and the Bayesian Integrated Nested Laplace Approximation (INLA) was used to provide a detailed quantitative analysis of the results. We found that the QoL and happiness of residents remained relatively stable during the COVID-19 pandemic. However, the income level, financial outlook, marital status, and vaccination positivity influenced the QoL and happiness of care home residents to a considerable degree. We recommend that policy makers pay attention to these underlying factors.

COVID-19 health policy evaluation: integrating health and economic perspectives with a data envelopment analysis approach

The COVID-19 pandemic is a global challenge to humankind. To improve the knowledge regarding relevant, efficient and effective COVID-19 measures in health policy, this paper applies a multi-criteria evaluation approach with population, health care, and economic datasets from 19 countries within the OECD. The comparative investigation was based on a Data Envelopment Analysis approach as an efficiency measurement method. Results indicate that on the one hand, factors like population size, population density, and country development stage, did not play a major role in successful pandemic management. On the other hand, pre-pandemic healthcare system policies were decisive. Healthcare systems with a primary care orientation and a high proportion of primary care doctors compared to specialists were found to be more efficient than systems with a medium level of resources that were partly financed through public funding and characterized by a high level of access regulation. Roughly two weeks after the introduction of ad hoc measures, e.g., lockdowns and quarantine policies, we did not observe a direct impact on country-level healthcare efficiency, while delayed lockdowns led to significantly lower efficiency levels during the first COVID-19 wave in 2020. From an economic perspective, strategies without general lockdowns were identified as a more efficient strategy than the full lockdown strategy. Additionally, governmental support of short-term work is promising. Improving the efficiency of COVID-19 countermeasures is crucial in saving as many lives as possible with limited resources.

Knowledge, Attitudes, and Practices Toward the Coronavirus Disease 2019 (COVID-19) Pandemic in a Population Under Community-Wide Containment Measures in Southern Thailand

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak has had a significant impact on public health and the socioeconomic system. While governments established community-wide containment measures to prevent further transmission, the number of patients continued to increase. For a better COVID-19 outbreak response, there is a need to better understand communities' knowledge, attitudes and practices toward COVID-19.

OBJECTIVE

Our main objective is to describe knowledge, attitudes, and practices toward COVID-19 in a population under community-wide containment measures.

PARTICIPANTS AND SETTING

Eligible participants affected by community-wide containment measures living in southern Thailand were included. A convenience sampling strategy was used to include the participants.

METHODS

A descriptive cross-sectional survey was used in this study. We developed an online self-administered Thai-language questionnaire that included the respondents' demographic profiles and questions regarding their knowledge, attitudes, and practices toward COVID-19. Piloting the questionnaire was performed in a small sample at Walailak University, Nakhon Si Thammarat.

RESULTS

In total, 717 subjects were included in this study. Regarding the knowledge and practice assessments, most respondents knew about COVID-19 by browsing websites. The respondents were confident in their knowledge, understood the situation causing the COVID-19 outbreak and knew how to prevent it. However, there were still misunderstandings. Regarding the attitude assessment, only 56.4% (405/717) of the subjects scored greater than or equal to 80%.

CONCLUSION

COVID-19 misunderstandings render disease outbreaks more difficult to control. These misunderstandings may result from outdated or inaccurate online information. It is essential to gain knowledge from a reliable source for proper understanding.

Economic Burden of SARS-CoV-2 Patients with Multi-Morbidity: A Systematic Review Protocol

Economic burden issues in SARS-CoV-2 patients with underlying co-morbidities are enormous resources for patient treatment and management. The uncertainty costs for clinical management render the healthcare system catatonic and incurs deficits in national annual budgets. This article focuses on systematic steps towards selecting and evaluating literature to uncover gaps and ways to help healthcare stakeholders optimize resources in treating and managing COVID-19 patients with multi-morbidity. A systematic review of all COVID-19 treatment procedures with co-morbidities or multi-morbidity for the period from 2019 to 2022 was conducted. The search includes studies describing treatment costs associated with multi- or co-morbidity cases for infected patients and, if concurrently reported, determining recurring expenses. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Galbraith plots and I2 statistics will be deployed to assess heterogeneity and to identify potential sources. A backward elimination process will be applied in the regression modelling procedure. Based on the number of studies retrieved and their sample size, the subgroup analysis will be stratified on participant disease category, associated total costs, and degree of freedom in cost estimation. These studies were registered in the PROSPERO registry (ID: CRD42022323071).

Prevalence and Recovery from Newly Onset Anosmia and Ageusia in Covid 19 Patients at our Teritary Care Centre

Anosmia (loss of smell) and Ageusia (loss of taste) are newly presenting independent symptoms in association with multiple symptoms such as Fever, Dry cough and Breathlessness in COVID 19 Patients.The Study of aims is to estimate Prevalence of Anosmia & Ageusia in Confirmed Covid 19 cases and to assess their Recovery rates. A Study conducted between June 2020 and September 2020 at a tertiary care COVID Dedicated hospital. Total 200 patients with age group 12-70 years Confirmed COVID 19 Positive Patients using RTPCR having mild to moderate symptoms were included. Patients were examined Clinically alongwith all safety measures to analyse prevalence & estimate their recoveries from sensory impairement using 10 item based DyNaCHRON questionnaire(concerned with taste and smell) at 10th, 14th & 21st Day. Out of 200 patients, Prevalence of Isolated Ageusia is 7%, Isolated Anosmia 4.5% and with Anosmia and Ageusia 4%. Complete Recovery regained in Ageusia within 14 days, while Rest all patients of Anosmia and both (Anosmia and Ageusia) within 21 days, Except 2 patients where long term Anosmia persists. Newly onset Anosmia and Ageusia are common in early stages of Covid 19 disease. They are Prevalent in mild to moderate symptomatic form of Diseases. Recovery in most cases is rapid and complete.Early Screening tests performed in suspected COVID 19 patients with loss of taste and smell sensation allows early diagnosis and treatment.

An in-silico investigation of potential natural polyphenols for the targeting of COVID main protease inhibitor

The deadliest recent pandemic outbreak of COVID-19 disease has severely damaged the socio-economic health of the people globally. Due to unavailability of any effective vaccine or treatment the human beings are still struggling to overcome the pandemic condition. In an attempt to discover anti-COVID molecule, we used in-silico approach and reported 160 natural polyphenols to identify the most promising druggable HITs that can further used for drug discovery process. The co-crystallized structure COVID protease enzyme (PDB id 6LU7) was used. HTVS, MD simulation, binding energy calculations and in-silico ADME calculation were done and analyzed. Depending upon the scores three compounds galangin, nalsudaldain and rhamnezine were identified and the docking score were found to be -7.704, -6.51, -4.212 respectively. These docked complexes were further subjected to MD simulation runs over a 100 ns time and the RMSD and RMSF values were determined. The RMSD values of three compounds were found to be 2.9 Å, 7.6 Å & 9.5 Å respectively and the lowest RMSF values suggested the steady stability of ligand-protein complexes. The binding free energies (ΔG) of compounds with protein were found to be -49.8, -56.45, -62.87 kJ/mole. Moreover, in-silico ADME calculations indicated the drug likeliness properties of these molecules. By considering all these in-silico results the identified HITs would be the most probable anti-COVID drug molecules that can be further taken in wet lab and can act as lead for development of newer inhibitor of COVID-19 main protease enzyme.

Predicting and preventing COVID-19 outbreaks in indoor environments: an agent-based modeling study

How to mitigate the spread of infectious diseases like COVID-19 in indoor environments remains an important research question. In this study, we propose an agent-based modeling framework to evaluate facility usage policies that aim to lower the probability of outbreaks. The proposed framework is individual-based, spatially-resolved with time resolution of up to 1 s, and takes into detailed account specific floor layouts, occupant schedules and movement. It enables decision makers to compute realistic contact networks and generate risk profiles of their facilities without relying on wearable devices, smartphone tagging or surveillance cameras. Our demonstrative modeling results indicate that not all facility occupants present the same risk of starting an outbreak, where the driver of outbreaks varies with facility layouts as well as individual occupant schedules. Therefore, generic mitigation strategies applied across all facilities should be considered inferior to tailored policies that take into account individual characteristics of the facilities of interest. The proposed modeling framework, implemented in Python and now available to the public in an open-source platform, enables such strategy evaluation.

Impact of COVID-19 pandemic on emergency department length of stay and clinical outcomes of patients with severe pneumonia: A single-center observational study

We examined the impact of COVID-19 pandemic on the emergency department length of stay (EDLOS) and clinical outcomes of patients with severe pneumonia admitted to the intensive care unit (ICU) through the emergency department (ED). This single-center retrospective observational study included adult patients with pneumonia admitted to the ICU through the ED between January and December 2019 (pre-pandemic) and between March 2020 and February 2021 (during-pandemic). We compared and analyzed the EDLOS by dividing it into pre-, mid-, and post-EDLOS and in-hospital mortality of patients with pneumonia admitted to the ICU according to the time of ED visits before and during the COVID-19 pandemic. Risk factors for in-hospital mortality according to the time of ED visits were analyzed using multiple logistic regression analysis. In total, 227 patients (73 patients pre-pandemic and 154 patients during the pandemic) with pneumonia admitted to the ICU through the ED were analyzed. During the COVID-19 pandemic, pre-, mid-, and post-EDLOS increased (P < .05), and the in-hospital mortality rate increased by 10.4%; however, this was not significant (P = .155). Multivariate logistic regression analysis revealed post-EDLOS (ED waiting time after making ICU admission decision) as an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU, pre-pandemic (odds ratio [OR] = 2.282, 95% confidence interval [CI]: 1.367-3.807, P = .002) and during the pandemic (OR = 1.126, 95% CI: 1.002-1.266, P = .047). Mid-EDLOS (ED time to assess, care, and ICU admission decision) was an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU during the COVID-19 pandemic (OR = 1.835, 95% CI: 1.089-3.092, P = .023). During the pandemic of emerging respiratory infectious diseases, to reduce in-hospital mortality of severe pneumonia patients, it is necessary to shorten the ED waiting time for admission by increasing the number of isolation ICU beds. It is also necessary to accelerate the assessment and care process in the ED, and make prompt decisions regarding admission to the ICU.

Use of Drugs Associated with QT Interval Prolongation at the Hospital Level during the COVID-19 Pandemic in Colombia

Background. Many of the therapeutic proposals for COVID-19 have been associated with adverse effects, including the risk of QT interval prolongation and torsades de pointes (TdP). The objective was to determine the use of drugs with a risk of QT interval prolongation in 21 clinics/hospitals in Colombia from January to December 2020. Methods. This cross-sectional study identified drug use according to pharmacological groups with potential risk of QT interval prolongation according to a risk classification: conditional, possible, and known risk of TdP. Descriptive analyses were performed. Results. A total of 355,574 patients who received QT-prolonging drugs were identified (equivalent to 51.4% of all inpatients treated during the study period). Of the group of patients on QT drugs, 54.4% used at least one drug with conditional risk, 52.6% with possible risk, and 40.3% with known risk. The most commonly used belonged to the group of drugs for the nervous system (63.0%), alimentary tract and metabolism (56.8%), anti-infectives for systemic use (13.0%), and the cardiovascular system (11.7%). On average, patients received $2.0\pm 1.5$ risk drugs. Regarding drugs initially considered against COVID-19, 2,120 patients (0.6%) received azithromycin, 802 (0.2%) received chloroquine, 517 received hydroxychloroquine (0.1%), and 265 received lopinavir/ritonavir (0.1%). Conclusion. The high proportion of patients treated at the hospital level who receive drugs with risk of prolonging the QT interval should alert those responsible for their care to avoid fatal outcomes, especially during the COVID-19 epidemic, when some QT drugs are being used more frequently.