Current epidemiological and clinical features of COVID-19; a global perspective from China

Obesity-dependent molecular alterations in fatal COVID-19: A retrospective postmortem study of metabolomic profile of adipose tissue

We investigated the effects of obesity on metabolic, inflammatory, and oxidative stress parameters in the adipose tissue of patients with fatal COVID-19. Postmortem biopsies of subcutaneous adipose tissue were obtained from 25 unvaccinated inpatients who passed from COVID-19, stratified as nonobese (N-OB; body mass index [BMI], 26.5 ± 2.3 kg m-2) or obese (OB BMI 34.2 ± 5.1 kg m-2). Univariate and multivariate analyses revealed that body composition was responsible for most of the variations detected in the metabolome, with greater dispersion observed in the OB group. Fifteen metabolites were major segregation factors. Results from the OB group showed higher levels of creatinine, myo-inositol, O-acetylcholine, and succinate, and lower levels of sarcosine. The N-OB group showed lower levels of glutathione peroxidase activity, as well as higher content of IL-6 and adiponectin. We revealed significant changes in the metabolomic profile of the adipose tissue in fatal COVID-19 cases, with high adiposity playing a key role in these observed variations. These findings highlight the potential involvement of metabolic and inflammatory pathways, possibly dependent on hypoxia, shedding light on the impact of obesity on disease pathogenesis and suggesting avenues for further research and possible therapeutic targets.

Exploring new avenues of health protection: plant-derived nanovesicles reshape microbial communities

Symbiotic microbial communities are crucial for human health, and dysbiosis is associated with various diseases. Plant-derived nanovesicles (PDNVs) have a lipid bilayer structure and contain lipids, metabolites, proteins, and RNA. They offer unique advantages in regulating microbial community homeostasis and treating diseases related to dysbiosis compared to traditional drugs. On the one hand, lipids on PDNVs serve as the primary substances that mediate specific recognition and uptake by bacteria. On the other hand, due to the multifactorial nature of PDNVs, they have the potential to enhance growth and survival of beneficial bacterial while simultaneously reducing the pathogenicity of harmful bacteria. In addition, PDNVs have the capacity to modulate bacterial metabolism, thus facilitating the establishment of a harmonious microbial equilibrium and promoting stability within the microbiota. These remarkable attributes make PDNVs a promising therapeutic approach for various conditions, including periodontitis, inflammatory bowel disease, and skin infection diseases. However, challenges such as consistency, isolation methods, and storage need to be addressed before clinical application. This review aims to explore the value of PDNVs in regulating microbial community homeostasis and provide recommendations for their use as novel therapeutic agents for health protection.

Impact of Telemedicine on Blood Glucose Control and Ophthalmic Screenings for Patients with Diabetes in Remote Areas During the COVID-19 Pandemic: A Real-World Study in Northern Taiwan

Introduction: The purpose of this study was to assess the impact of telemedicine on ophthalmic screening and blood glucose control for patients with diabetes in remote areas of Northern Taiwan during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Telemedicine was implemented in Shiding and Wanli Districts using a 5G platform from April 2021 to December 2022. Patients with poorly controlled diabetes received real-time consultations from endocrinologists at Far Eastern Memorial Hospital, 50 km away, for medication adjustment, diet control, and lifestyle recommendations. The study also provided cloud-upload blood glucose meters for self-monitoring and regular medical advice from hospital nurses. Ophthalmic screenings included fundus imaging, external eye image, and intraocular pressure measurement, with instant communication and diagnosis by ophthalmologists through telemedicine. A satisfaction questionnaire survey was conducted. Results: The study enrolled 196 patients with diabetes. Blood glucose and glycosylated hemoglobin levels were significantly reduced after applying telemedicine (p = 0.01 and p = 0.005, respectively). Ophthalmic screenings led to hospital referrals for 16.0% with abnormal fundus images, 15.6% with severe cataract or anterior segment disorders, and 27.9% with ocular hypertension or glaucoma. Fundus screening rates remained high at 86.3% and 80.4% in 2022, mainly using telemedicine, comparable with the traditional screening rate in the past 5 years. The overall satisfaction rate was 98.5%. Conclusions: Telemedicine showed effectiveness and high satisfaction in managing diabetes and conducting ophthalmic screenings in remote areas during the COVID-19 pandemic. It facilitated early diagnosis and treatment of ocular conditions while maintaining good blood glucose control and fundus screening rates.

Severe acute respiratory syndrome Coronavirus-2 GenoAnalyzer and mutagenic anomaly detector using FCMFI and NSCE

In order to deepen our understanding of the virus and help guide the creation of efficient therapies, this study uses artificial intelligence tools to thoroughly explore the genetic sequences of the SARS-CoV-2 virus. The process starts by using the Fuzzy Closure Miner for Frequent Itemsets (FCMFI) on a large corpus of SARS-CoV-2 genomic sequences to reveal hidden patterns, including nucleotides base sequences, repeating motifs, and corresponding interchanges. Then, using the Nucleotide Sequence Comprehension Engine (NSCE) technique, we were able to precisely define the genomic areas for mutation analysis. Structured and unstructured proteins are both strongly impacted by virus mutations, with spike proteins that are linked to the severity of COVID-19 pneumonia being particularly affected. Notably, the Mutagenic Anomaly Detector shows a 65 % efficiency boost in computing genome mutation rates compared to conventional point mutation analysis, while GenoAnalyzer offers a remarkable 93.33 % improvement over existing approaches in recognizing common genomic sequence patterns. These results highlight the potential of FCMFI to reveal complex genomic patterns and significant insights in COVID-19 genetic sequences when combined with mutation analysis. The Mutagenic Anomaly Detector and GenoAnalyzer show promise for revealing hidden genomic patterns and precisely estimating the SARS-CoV-2 mutation rate.

Impact of the COVID-19 Pandemic on the Professional Attitudes of Medical Students: A Pre-Post-Like Study

OBJECTIVE

This study assesses the difference in professional attitudes among medical students, both before and after coronavirus disease 2019 (COVID-19), and identifies the determinants closely associated with it, while providing precise and scientific evidence for implementing precision education on such professional attitudes.

METHODS

A pre-post-like study was conducted among medical students in 31 provinces in mainland China, from March 23, to April 19, 2021.

RESULTS

The proportion of medical students whose professional attitudes were disturbed after the COVID-19 pandemic, was significantly lower than before the COVID-19 pandemic (χ2 = 15.6216; P < 0.0001). Compared with the "undisturbed -undisturbed" group, the "undisturbed-disturbed" group showed that there was a 1.664-fold risk of professional attitudes disturbed as grade increased, 3.269-fold risk when others suggested they choose a medical career rather than their own desire, and 7.557-fold risk for students with COVID-19 in their family, relatives, or friends; while the "disturbed-undisturbed" group showed that students with internship experience for professional attitudes strengthened was 2.933-fold than those without internship experience.

CONCLUSIONS

The professional attitudes of medical students have been strengthened during the COVID-19 pandemic. The results provide evidence of the importance of education on professional attitudes among medical students during public health emergencies.

Using text mining to glean insights from COVID-19 literature

The purpose of this study is to develop a text clustering-based analysis of COVID-19 research articles. Owing to the proliferation of published COVID-19 research articles, researchers need a method for reducing the number of articles they have to search through to find material relevant to their expertise. The study analyzes 83,264 abstracts from research articles related to COVID-19. The textual data are analysed using singular value decomposition (SVD) and the expectation-maximisation (EM) algorithm. Results suggest that text clustering can both reveal hidden research themes in the published literature related to COVID-19, and reduce the number of articles that researchers need to search through to find material relevant to their field of interest.

Effects of COVID-19 event intensity on college students' health lifestyles: time perspective mediating model and its gender difference

The pandemic of COVID-19 had not only led to healthy-damage behaviors, but also raised people's attention to health and generated health-promoting behaviors. However, little is known about the mechanism underlying how the perception of COVID-19 intensity affects health behaviors. The present study investigated the mediating effect of DBTP between event intensity and health behaviors and the moderating role of gender in this relation. Nine hundred and twenty-four Chinese college students (348 males and 576 females) completed a battery of self-report questionnaires, including COVID-19 Event Intensity Scale, Chinese version of Zimbardo Time Perspective Inventory (ZTPI) and Healthy Lifestyle Scale. Moderated mediation analysis was performed using conditional process analysis. The results showed that COVID-19 intensity had a positive predictive effect on college students' health behaviors. DBTP played a partial mediating role in the relationship between COVID-19 intensity and health behaviors for male and not female. In female group, COVID-19 intensity and DBTP was significantly linked with health behaviour; however, COVID-19 intensity and DBTP were not significantly linked. The findings indicated that COVID-19 intensity perceived by college students could increase their health behaviors, and intervention focus on BTP may contribute to health behaviors only in male. Practical implications were discussed in this academic research.

Health literacy affected the residents' knowledge, attitude, practice for prevention and control of COVID-19 in Shanxi Province, China

Multistage stratified random sampling was used to explore the relationship of health literacy with novel coronavirus disease 2019 (COVID-19) prevention and control knowledge, attitude and practice (KAP) in residents aged 15-69 years old in Shanxi Province. The questionnaire, which was issued by the Chinese Center for Health Education, consisted of a health literacy questionnaire and a COVID-19 prevention and control KAP questionnaire. According to the national unified scoring method, the participants were divided into two groups: those who with adequate health literacy and those who with inadequate health literacy. The results of the answer to each KAP question were compared between the two groups by Chi-square test or Wilcoxon rank sum test. Binary logistic regression was used to control confounding effects of socio-demographic characteristics to draw relatively reliable conclusions. A total of 2700 questionnaires were distributed, and 2686 valid questionnaires were returned, with an efficiency rate of 99.5%. Health literacy qualified was identified for 18.32% (492/2686) in Shanxi Province. Compared with the inadequate health literacy group, people with adequate health literacy had a higher corrected answer rate in 11 knowledge-related questions (all P < 0.001); showed more positive answer to each attitude-related question in the three aspects, namely, responsibility for the prevention and control of infectious disease transmission, evaluation for COVID-19-related information release and reporting, and evaluation for the government's COVID-19 prevention and control results (all P < 0.001); and acted more actively in the practice concerning appropriate self-prevention and control behaviors during the COVID-19 outbreak (all P < 0.001). Logistic regression analyses confirmed that with adequate health literacy played a positive role in each of the contents of COVID-19 prevention and control KAP (ORs were between 1.475 and 4.862, all P < 0.001). Health literacy is closely related to COVID-19 prevention and control KAP in the general population of Shanxi Province. People with high score of health literacy were generally better able to grasp COVID-19 prevention and control knowledge, have more positive attitudes toward prevention and control, and perform better prevention and control behaviors. Promoting residents' health literacy by targeted health education can play an important and positive role in dealing with the threat of major infectious diseases outbreaks.

Neurological Manifestations and Clinical Outcomes of Patients with COVID-19 in the Aseer Region, Saudi Arabia

COVID-19 patients also present with rheumatological problems, cardiac problems, and even neurological manifestations. However, the data are still insufficient at present to fill the gaps in our understanding of the neurological presentations of COVID-19. Therefore, the present study was undertaken to reveal the various neurological manifestations of patients with COVID-19 and to find the association between neurological manifestations and the clinical outcome. This cross-sectional study was conducted in Abha, in the Aseer region of the Kingdom of Saudi Arabia, among COVID-19 patients aged 18 years or older who were admitted with the neurological manifestations of COVID-19 to the Aseer Central Hospital and Heart Center Hospital Abha. Non-probability convenient sampling was used. All the information was gathered by the principal investigator using a questionnaire including sociodemographic information, disease characteristics of COVID-19, neurological manifestations, and other complications. Data were analyzed using the Statistical Package for Social Sciences, version 16.0 (SPSS, Inc., Chicago, IL, USA). A total of 55 patients were included in the present study. About half of the patients were admitted to the ICU, and 18 (62.1%) patients died after 1 month of follow-up. Patients aged over 60 years had a 75% mortality rate. About 66.66% of patients with pre-existing neurological disorders died. Statistically significant associations were found between neurological symptoms such as cranial nerve symptoms and a poor outcome. A statistically significant difference was also found between laboratory parameters such as the absolute neutrophil count (ANC), activated partial thromboplastin time (aPTT), total cholesterol (TC), creatinine, urea, and lactate dehydrogenase (LDH) level and the outcome. A statistically significant difference was also found between the use of medications such as antiplatelets, anticoagulants, and statins at the baseline and after a 1-month follow-up. Neurological symptoms and complications are not uncommon among COVID-19 patients. Most of these patients had poor outcomes. Further studies are required to provide more data and knowledge about this issue, including the possible risk factors and the long-term neurological consequences of COVID-19.

Willingness to receive the COVID-19 vaccine among HIV positive men who have sex with men in China: a cross-sectional study

BACKGROUND

People living with HIV(PLWH) are deemed more vulnerable to the SARS-CoV-2 infection than the uninfected population. Vaccination is an effective measure for COVID-19 control, yet, little knowledge exists about the willingness of men who have sex with men (MSM) living with HIV in China to be vaccinated.

METHODS

This cross-sectional study evaluated the willingness of MSM living with HIV to receive COVID-19 vaccination in six cities of Guangdong, China, from July to September 2020. Factors associated with willingness to receive COVID-19 vaccination using multivariable logistic regression.

RESULTS

In total, we recruited 944 HIV-positive MSM with a mean age of 29.2 ± 7.7 years. Of all participants, 92.4% of them were willing to receive the COVID-19 vaccine. Participants who were separated, divorced, or widowed (adjusted OR: 5.29, 95%CI: 1.02-27.48), had an annual income higher than 9,000 USD (adjusted OR: 1.70, 95%CI: 1.01-2.86), had ever taken an HIV self-test (adjusted OR: 1.78, 95%CI: 1.07-2.95), had ever disclosed sexual orientation to a doctor/nurse (adjusted OR: 3.16, 95%CI: 1.33-7.50), had ever disclosed sexual orientation to others besides their male partners (adjusted OR: 2.18, 95%CI: 1.29-3.69) were more willing to receive the vaccine. Sex with a female partner in the past six months decreased the likelihood of willingness to receive the vaccine (adjusted OR: 0.40, 95%CI: 0.17-0.95). Economic burden, worry that my health condition could not bear the risk of receiving COVID-19 vaccines, and concern that the vaccination would affect the immune status and antiretroviral therapy were the main reasons for unwillingness to receive vaccination.

CONCLUSION

Our study showed that HIV-positive MSM had a high willingness to receive the COVID-19 vaccination. Targeted interventions such as health education should be conducted among MSM with HIV infection to enhance COVID-19 vaccine uptake.

Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19?

OBJECTIVE

To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer.

METHODS

We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis.

RESULTS

A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744).

CONCLUSION

The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.

The role of hypoxia and inflammation in the regulation of iron metabolism and erythropoiesis in COVID-19: The IRONCOVID study

Coronavirus Disease (COVID-19) can be considered as a human pathological model of inflammation combined with hypoxia. In this setting, both erythropoiesis and iron metabolism appear to be profoundly affected by inflammatory and hypoxic stimuli, which act in the opposite direction on hepcidin regulation. The impact of low blood oxygen levels on erythropoiesis and iron metabolism in the context of human hypoxic disease (e.g., pneumonia) has not been fully elucidated. This multicentric observational study was aimed at investigating the prevalence of anemia, the alterations of iron homeostasis, and the relationship between inflammation, hypoxia, and erythropoietic parameters in a cohort of 481 COVID-19 patients admitted both to medical wards and intensive care units (ICU). Data were collected on admission and after 7 days of hospitalization. On admission, nearly half of the patients were anemic, displaying mild-to-moderate anemia. We found that hepcidin levels were increased during the whole period of observation. The patients with a higher burden of disease (i.e., those who needed intensive care treatment or had a more severe degree of hypoxia) showed lower hepcidin levels, despite having a more marked inflammatory pattern. Erythropoietin (EPO) levels were also lower in the ICU group on admission. After 7 days, EPO levels rose in the ICU group while they remained stable in the non-ICU group, reflecting that the initial hypoxic stimulus was stronger in the first group. These findings strengthen the hypothesis that, at least in the early phases, hypoxia-driven stimuli prevail over inflammation in the regulation of hepcidin and, finally, of erythropoiesis.

Cranial Nerve Impairment Associated With COVID-19 Infections: A Systematic Review

The COVID-19 pandemic has created huge economic and healthcare burdens. In most cases, the virus affects the lungs and causes respiratory symptoms. Additionally, its impact on the cranial nerves remains unclear. We thus aimed to investigate cranial nerve dysfunction in patients with COVID-19 infection.  We conducted a systematic literature search of relevant and eligible literature in five databases: PubMed, Web of Science, Medline, EBSCO, and Google Scholar.  Our sample included 21 case reports, one case series with 29 patients, and one analytical study with 135 cases. Participant ages ranged from 23 months to 72 years (mean age of 47.5 ± 19.02). The mean time from respiratory symptoms to the onset of neurological signs was (9.6 ± 7.4) days, and the mean recovery time was (16.3 ± 15.3) days.  Cranial nerve impairment associated with COVID-19 infection has affected a large population, from infants to the elderly. Facial and abducent nerves were the most commonly affected cranial nerves with reported good prognosis or complete recovery within a few days to weeks. Olfactory dysfunctions were widely detected among COVID-19 patients.

Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation

Background

COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities.

Objective

We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques.

Methods

We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands.

Results

The final prediction model had an R² of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household.

Conclusions

Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.

An investigation of a hundred COVID-19 cases and close contacts in Ethiopia, May to June, 2020: A prospective case-ascertained study

Background

Corona Virus Disease 2019 is a novel respiratory disease commonly transmitted through respiratory droplets. The disease has currently expanded all over the world with differing epidemiologic trajectories. This investigation was conducted to determine the basic clinical and epidemiological characteristics of the disease in Ethiopia.

Methods

A prospective case-ascertained study of laboratory-confirmed COVID-19 cases and their close contacts were conducted. The study included 100 COVID-19 laboratory-confirmed cases reported from May 15, 2020 to June 15, 2020 and 300 close contacts. Epidemiological and clinical information were collected using the WHO standard data collection tool developed first-few cases and contacts investigation. Nasopharyngeal and Oropharyngeal samples were collected by using polystyrene tipped swab and transported to the laboratory by viral transport media maintaining an optimal temperature. Clinical and epidemiological parameters were calculated in terms of ratios, proportions, and rates with 95% CI.

Result

A total of 400 participants were investigated, 100 confirmed COVID-19 cases and 300 close contacts of the cases. The symptomatic proportion of cases was 23% (23) (95% CI: 15.2%-32.5%), the proportion of cases required hospitalization were 8% (8) (95%CI: 3.5%-15.2%) and 2% (95%CI: 0.24% - 7.04%) required mechanical ventilation. The secondary infection rate, secondary clinical attack rate, median incubation period and median serial interval were 42% (126) (95% CI: 36.4%-47.8%), 11.7% (35) (95% CI: 8.3%-15.9%), 7 days (IQR: 4–13.8) and 11 days (IQR: 8–11.8) respectively. The basic reproduction number (R_O) was 1.26 (95% CI: 1.0–1.5).

Conclusion

The proportion of asymptomatic infection, as well as secondary infection rate among close contacts, are higher compared to other studies. The long serial interval and low basic reproduction number might contribute to the observed slow progression of the pandemic, which gives a wide window of opportunities and time to control the spread. Testing, prevention, and control measures should be intensified.

Knowledge and perception of COVID-19 and its treatment. A community-based survey in South Nigeria

Background

Media channels increased COVID-19 pandemic uncertainty and disputes, hindering dissemination and acceptance of evidence-based health information. Socioeconomic, cultural, and developmental factors affect a community's access to credible health information. This community-based study aims to assess semi-urban residents' understanding of COVID-19.

Methods

This was a cross-sectional study of 384 multistage-sampled residents of the study site. Sociodemographic, psychographic, and COVID-19 and treatment knowledge were obtained using a semistructured questionnaire. Six questions were used to measure knowledge, which was deemed adequate (three or more correct answers) or inadequate (fewer than three correct responses).

Results

54 out of 364 responders (14.8%) knew COVID-19. 68.9% of respondents stated citrus fruits or spices, 46.1% mentioned infection safety, and 13.3% mentioned chloroquine for prevention. Regarding treatment, 55.5% of responders reported chloroquine and 20.9% hydroxychloroquine. 17% chose "none of the above." Class I workers were four times more likely to have adequate knowledge than class V workers (p=0.019), while class III workers were 79% less likely (p=0.046). Males had 68%less knowledge than females (p=0.008). Conclusions: In this study, adequate knowledge of COVID-19 was low and associated with higher socioeconomic class.

The SARS-CoV-2 main protease (Mpro): Structure, function, and emerging therapies for COVID-19

The main proteases (Mpro), also termed 3-chymotrypsin-like proteases (3CLpro), are a class of highly conserved cysteine hydrolases in β-coronaviruses. Increasing evidence has demonstrated that 3CLpros play an indispensable role in viral replication and have been recognized as key targets for preventing and treating coronavirus-caused infectious diseases, including COVID-19. This review is focused on the structural features and biological function of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease Mpro (also known as 3CLpro), as well as recent advances in discovering and developing SARS-CoV-2 3CLpro inhibitors. To better understand the characteristics of SARS-CoV-2 3CLpro inhibitors, the inhibition activities, inhibitory mechanisms, and key structural features of various 3CLpro inhibitors (including marketed drugs, peptidomimetic, and non-peptidomimetic synthetic compounds, as well as natural compounds and their derivatives) are summarized comprehensively. Meanwhile, the challenges in this field are highlighted, while future directions for designing and developing efficacious 3CLpro inhibitors as novel anti-coronavirus therapies are also proposed. Collectively, all information and knowledge presented here are very helpful for understanding the structural features and inhibitory mechanisms of SARS-CoV-2 3CLpro inhibitors, which offers new insights or inspiration to medicinal chemists for designing and developing more efficacious 3CLpro inhibitors as novel anti-coronavirus agents.

Forecasting the spread of SARS-CoV-2 in the campania region using genetic programming

Coronavirus disease 19 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, which is responsible for the ongoing global pandemic. Stringent measures have been adopted to face the pandemic, such as complete lockdown, shutting down businesses and trade, as well as travel restrictions. Nevertheless, such solutions have had a tremendous economic impact. Although the use of recent vaccines seems to reduce the scale of the problem, the pandemic does not appear to finish soon. Therefore, having a forecasting model about the COVID-19 spread is of paramount importance to plan interventions and, then, to limit the economic and social damage. In this paper, we use Genetic Programming to evidence dependences of the SARS-CoV-2 spread from past data in a given Country. Namely, we analyze real data of the Campania Region, in Italy. The resulting models prove their effectiveness in forecasting the number of new positives 10/15 days before, with quite a high accuracy. The developed models have been integrated into the context of SVIMAC-19, an analytical-forecasting system for the containment, contrast, and monitoring of Covid-19 within the Campania Region.

A Culturally and Linguistically Appropriate Telephone Support Intervention for Diverse Family Caregivers of Persons With Dementia During the COVID-19 Pandemic

Caregivers of persons with dementia (PWDs) were socially isolated with little support during the COVID-19 pandemic "Stay-At-Home" order in the United States. To enhance social and emotional connection for diverse caregivers, a culturally/linguistically appropriate telephone intervention provided compassionate listening, mindful breathing, and COVID-19 safety education. The study purpose was to understand caregiving challenges and to evaluate the intervention for caregivers during the early pandemic using a qualitative approach. Twenty-three caregivers participated in the intervention provided by bilingual research assistants for 3 months. Call logs were used to describe the caregivers' dialogue. Thematic analysis identified (a) the challenges, including fear of coronavirus disease, providing around-the-clock care, and forced isolation and negative emotions; and (b) caregivers' experience with the intervention, including connecting with the outside, relief from emotional stress, reliable COVID-19 information, and reinformed caregiving skills. Results suggest that the telephone support was of benefit to diverse caregivers of PWDs during the pandemic by promoting social connection and reducing emotional distress.

Qualitative Research on the Training Experiences and Needs of Intensive Care Unit General Nurses Against the Background of Regular Coronavirus Disease 2019 Prevention and Control

Objective

This study aimed to investigate the training experiences and needs of intensive care unit (ICU) general nurses against a background of regular Coronavirus disease (COVID-19) prevention and control.

Methods

Using the phenomenological method of qualitative research, semi-structured interviews were conducted with 10 ICU nurses. The interview data were analyzed, sorted, summarized, and refined using the content analysis method.

Results

The following five themes were extracted from the interviews, based on the training experiences of the nurses: 1) broadening their thinking; 2) discovering their personal shortcomings; 3) gaining self-confidence; 4) calmly facing frontline work; 5) experiencing high assessment pressure. The training needs of the nurses could be summarized into the following four themes: 1) increased training time; 2) improving the assessment mechanism; 3) establishing a normal rotating-shift training system; 4) balancing the teaching levels.

Conclusion

Against a background of regular epidemic prevention and control, ICU training for general nurses is of high practical significance and value. Thus, active exploration and research should be conducted to establish perfect training and assessment mechanisms for these nurses. Additionally, training methods that are suitable for clinical needs should be formulated and training systematization and standardization must be promoted.

Infection Rate of Respiratory Viruses in the Pandemic SARS-CoV-2 Period Considering Symptomatic Patients: Two Years of Ongoing Observations

BACKGROUND

In the last two years, the SARS-CoV-2 pandemic has determined radical changes in human behaviors and lifestyles, with a drastic reduction in socialization due to physical distancing and self-isolation. These changes have also been reflected in the epidemiological patterns of common respiratory viruses. For this reason, early discrimination of respiratory viruses is important as new variants emerge.

METHODS

Nasopharyngeal swabs of 2554 patients, with clinically suspected Acute Respiratory Infections (ARIs) from October 2019 to November 2021, were collected to detect 1 or more of the 23 common respiratory pathogens, especially viruses, via BioFilmArray RP2.1plus, including SARS-CoV-2. Demographical characteristics and epidemiological analyses were performed as well as a laboratory features profile of positive patients.

RESULTS

An observational study on 2300 patients (254 patients were excluded because of missing data) including 1560 men and 760 women, median age of 64.5 years, was carried out. Considering the respiratory virus research request, most of the patients were admitted to the Emergency Medicine Department (41.2%, of patients), whereas 29.5% were admitted to the Infectious Diseases Department. The most frequently detected pathogens included SARS-CoV-2 (31.06%, 707/2300, from March 2020 to November 2021), InfA-B (1.86%, 43/2300), HCoV (2.17% 50/2300), and HSRV (1.65%, 38/2300). Interestingly, coinfection rates decreased dramatically in the SARS-CoV-2 pandemic period. The significative decrease in positive rate of SARS-CoV-2 was associated with the massive vaccination.

CONCLUSION

This study represents a dynamic picture of the epidemiological curve of common respiratory viruses during the two years of pandemic, with a disregarded trend for additional viruses. Our results showed that SARS-CoV-2 had a preferential tropism for the respiratory tract without co-existing with other viruses. The possible causes were attributable either to the use of masks, social isolation, or to specific respiratory receptors mostly available for this virus, external and internal lifestyle factors, vaccination campaigns, and emergence of new SARS-CoV-2 variants.

Hallazgos histopatológicos pulmonares en COVID-19. Experiencia de autopsias mínimamente invasivas

Introducción: la COVID-19 es causada por el virus SARS-CoV-2. La presentación clínica varía desde pacientes asintomáticos hasta manifestaciones severas. Durante la pandemia se han realizado autopsias que han permitido reconocer los cambios en diferentes órganos, siendo el pulmón el más afectado. El objetivo del presente estudio es informar nuestra experiencia en cuanto a los hallazgos histopatológicos pulmonares, mediante el sistema de autopsia mínimamente invasiva. Metodología: se tomaron muestras a 8 pacientes fallecidos por COVID-19 en la unidad de cuidado intensivo (UCI) confirmado por PCR en el Hospital de San José, Bogotá, Colombia, en la primera hora después de la muerte. Los tejidos fueron analizados por dos patólogos en forma independiente. Resultados: se observó en todos daño alveolar difuso (DAD) en fases exudativa, proliferativa o ambas, además de bronconeumonía y neumonitis intersticial. Discusión: el pulmón es el principal órgano afectado por el SARS-CoV-2 y el hallazgo histopatológico más frecuente es el DAD en fases exudativa y mixta. También se han descrito alteraciones en diferentes sistemas. Conclusiones: el hallazgo histopatológico pulmonar más frecuente es el DAD en diferentes estadios. Se considera que la autopsia mínimamente invasiva es de gran utilidad en escenarios donde la convencional se encuentra limitada, pues no presenta grandes restricciones y permite obtener tejidos viables.

SARS-CoV-2 and Guillain-Barré Syndrome: Lessons from Viral Infections

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the COVID-19 pandemic. COVID-19 has a broad clinical spectrum from asymptomatic patients to multiorgan dysfunction and septic shock. Most of the common symptoms of COVID-19 are classified as respiratory disorders, but some reports show neurological involvements. During the COVID-19 pandemic, a case series of neurological complications, such as Guillain-Barré syndrome (GBS), were reported. GBS is a neuroimmune disorder with acute inflammatory radicular polyneuropathy in different parts of the peripheral nerve. Some studies have reported GBS as an inflammatory neuropathy related to various viral infections, such as cytomegalovirus (CMV), Epstein-Barr Virus (EBV), herpes simplex virus (HSV), human immunodeficiency virus (HIV), influenza, and Zika virus. There are some immunomodulation approaches for the management of GBS. Studies have evaluated the effects of the various therapeutic approaches, including intravenous immunoglobulin (IVIG), plasma exchange (PE), complement inhibitors, and corticosteroids to regulate overactivation of immune responses during GBS in experimental and clinical studies. In this regard, the possible association between GBS and SARS-CoV-2 infection during the outbreak of the current pandemic and also the mentioned therapeutic approaches were reviewed.

COVID-19 and its Cardiac and Neurological Complications among Ontario Visible Minorities

BACKGROUND

Due to lack of data on the epidemiology, cardiac, and neurological complications among Ontario visible minorities (Chinese and South Asians) affected by coronavirus disease (COVID-19), this population-based retrospective study was undertaken to study them systematically.

METHODS

From January 1, 2020 to September 30, 2020 using the last name algorithm to identify Ontario Chinese and South Asians who were tested positive by PCR for COVID-19, their demographics, cardiac, and neurological complications including hospitalization and emergency visit rates were analyzed compared to the general population.

RESULTS

Chinese (N = 1,186) with COVID-19 were found to be older (mean age 50.7 years) compared to the general population (N = 42,547) (mean age 47.6 years) (p < 0.001), while South Asians (N = 3,459) were younger (age of 42.1 years) (p < 0.001). The 30-day crude rate for cardiac complications among Chinese was 169/10,000 (p = 0.069), while for South Asians, it was 64/10,000 (p = 0.008) and, for the general population, it was 112/10,000. For neurological complications, the 30-day crude rate for Chinese was 160/10,000 (p < 0.001); South Asians was 40/10,000 (p = 0.526), and general population was 48/10,000. The 30-day all-cause mortality rate was significantly higher for Chinese at 8.1% vs 5.0% for the general population (p < 0.001), while it was lower in South Asians at 2.1% (p < 0.001).

CONCLUSIONS

Chinese and South Asians in Ontario affected by COVID-19 during the first wave of the pandemic were found to have a significant difference in their demographics, cardiac, and neurological outcomes.

COVID-19 hastalarında koagülopati için C-reaktif protein/albumin oranının tanısal doğruluğu

Amaç: Bu çalışma, COVİD-19'da D-dimer yüksekliğini öngörmede C-reaktif proteinin (CRP) albümine oranının (CAR) tanısal faydasını değerlendirmek amaçlamıştır. Gereç ve Yöntem: Bu retrospektif kohort çalışmasında, bir üniversite hastanesinde COVID-19 olduğu doğrulanmış 145 yatan hastadan veri topladık. Hastalar D-dimer düzeylerine göre D-dimer düzeyi yüksek olanlar ve D-dimer düzeyi normal olanlar olarak iki gruba ayrıldı. Hastaların tıbbi kayıtlarından demografik veriler, komorbiditeler, klinik semptomlar, CAR ve laboratuvar sonuçları elde edildi ve gruplar arasında kıyaslamalar yapıldı. Bulgular: Hastaların yaş ortalaması 52,9±17,9 yıl olup, 76'sı erkek idi. CAR medyanı, D-dimer değeri yüksek olanlarda anlamlı olarak daha yüksekti (134,1'e karşı 20,7,). D-dimeri yüksek hastalarda CRP, prokalsitonin, lökosit, nötrofil, laktat dehidrojenaz, ferritin ve fibrinojen daha yüksekti. CAR ve D-Dimer arasında oldukça anlamlı pozitif korelasyon vardı. Lojistik regresyon analizi, CAR'ın D-dimer yüksekliği için önemli bir belirleyici olduğunu ortaya koydu. ROC eğrisi altında kalan alan (AUC) CAR için 0,741 idi. COVİD-19 hastalarında D-dimer yüksekliğini öngörmek için CAR'ın doğrulanmış eşik değeri, %58 duyarlılık ve %70 özgüllük ile 81,8 idi. Sonuç: Çalışmamız, CAR'ın D-dimer ile önemli ölçüde korele olduğunu ve COVİD-19’u olan hastalarda D-dimer yüksekliğini öngörmek için kullanılabileceğini göstermiştir.

The Acoustic Dissection of Cough: Diving Into Machine Listening-based COVID-19 Analysis and Detection

OBJECTIVES

The coronavirus disease 2019 (COVID-19) has caused a crisis worldwide. Amounts of efforts have been made to prevent and control COVID-19's transmission, from early screenings to vaccinations and treatments. Recently, due to the spring up of many automatic disease recognition applications based on machine listening techniques, it would be fast and cheap to detect COVID-19 from recordings of cough, a key symptom of COVID-19. To date, knowledge of the acoustic characteristics of COVID-19 cough sounds is limited but would be essential for structuring effective and robust machine learning models. The present study aims to explore acoustic features for distinguishing COVID-19 positive individuals from COVID-19 negative ones based on their cough sounds.

METHODS

By applying conventional inferential statistics, we analyze the acoustic correlates of COVID-19 cough sounds based on the ComParE feature set, i.e., a standardized set of 6,373 acoustic higher-level features. Furthermore, we train automatic COVID-19 detection models with machine learning methods and explore the latent features by evaluating the contribution of all features to the COVID-19 status predictions.

RESULTS

The experimental results demonstrate that a set of acoustic parameters of cough sounds, e.g., statistical functionals of the root mean square energy and Mel-frequency cepstral coefficients, bear essential acoustic information in terms of effect sizes for the differentiation between COVID-19 positive and COVID-19 negative cough samples. Our general automatic COVID-19 detection model performs significantly above chance level, i.e., at an unweighted average recall (UAR) of 0.632, on a data set consisting of 1,411 cough samples (COVID-19 positive/negative: 210/1,201).

CONCLUSIONS

Based on the acoustic correlates analysis on the ComParE feature set and the feature analysis in the effective COVID-19 detection approach, we find that several acoustic features that show higher effects in conventional group difference testing are also higher weighted in the machine learning models.

Analysis on the medication rule of traditional Chinese medicine in the treatment of COVID-19 patients

Objective

To describe patterns of utilization of traditional Chinese medicine (TCM) in the treatment of patients with coronavirus disease 2019 (COVID-19).

Methods

Adult patients with COVID-19 who received TCM treatment were divided into a non-serious group (mild and moderate types) and a serious group (severe and critical types) according to their admission conditions. The medical records and prescriptions of these patients were investigated to determine their TCM utilization patterns.

Results

In all, 3,872 COVID-19 patients were included. Oral Chinese traditional patent medicine (CPM) was the most commonly used type of TCM, followed by decoction. The proportion of multi-drug combinations was higher than single drug use (55.0% vs. 45.0%). Decoction combined with oral CPM was the most common combination (39.1%, 1,514/3,872). Orally administered, injected, and externally applied CPM were significantly more common in the serious group than in the non-serious, while decoction and non-drug TCM treatments were more common in the non-serious than in the serious group. Multi-drug combinations were used for the majority of patients in both groups, mainly in the form of decoctions combined with oral CPM. Among the serious patients, injected CPM was more often used in patients who died during treatment (35.0%, 36/103). The two most common medication patterns were decoction combined with oral CPM and oral CPM alone in the two finally discharged groups. Oral CPM alone or used in combination with injected CPM were seen most commonly in the death group. Significant differences were established in TCM utilization and medication patterns among patients in three groups who had different prognoses and outcomes.

Conclusions

The treatment measures and medication patterns of TCM commonly used in COVID-19 patients with the range of conditions found in this study should be further explored in the future to provide a more complete reference for COVID-19 treatment.

COVID-19 Vaccination Willingness Among People Living With HIV in Wuhan, China

Vaccination is essential to controlling the pandemic of coronavirus disease 2019 (COVID-19). People living with HIV (PLWH) were considered more vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection compared with the general population. Therefore, it is urgent to protect PLWH from SARS-CoV-2 infection. For PLWH, vaccine hesitancy could be more common and may compromise vaccine coverage. Our study aimed to investigate the willingness to receive the COVID-19 vaccination among PLWH and associated factors. A cross-sectional online survey was performed among PLWH and the general population from 4 April to 18 April 2021 in Wuhan, China. The multivariable logistic regression was used to analyze associated factors for COVID-19 vaccination willingness among PLWH. A total of 556 PLWH and 570 individuals from the general population were enrolled. The COVID-19 vaccine willingness among PLWH was 60.8%, which was relatively lower than that in the general population (80.9%) (P &lt; 0.001). The results of multivariable analysis indicated that PLWH with comorbidities (OR = 2.07, 95% CI: 1.25–3.45), those who had idea about PLWH would be more serious if they were infected with SARS-CoV-2 (OR = 1.67, 95% CI: 1.11–2.51) and those who thought their antiretroviral therapy (ART) would be affected by COVID-19 epidemic (OR = 2.04, 95% CI: 1.22–3.42) had higher willingness to receive COVID-19 vaccination. PLWH who had a monthly income over 5,000 RMB (OR = 0.64, 95% CI: 0.45–0.92) and had a sex orientation as non-homosexual (OR = 0.67, 95% CI: 0.47–0.96) were associated with lower willingness for COVID-19 vaccination. Our findings showed that the PLWH had a lower willingness for COVID-19 vaccination compared with the general population in Wuhan. Targeted interventions such as health education should be conducted to increase the willingness for COVID-19 vaccination among PLWH, thus enhancing COVID-19 vaccine uptake among PLWH.

Anticoagulation in COVID-19: current concepts and controversies

Rising incidence of thromboembolism secondary to COVID-19 has become a global concern, with several surveys reporting increased mortality rates. Thrombogenic potential of the SARS-CoV-2 virus has been hypothesised to originate from its ability to produce an exaggerated inflammatory response leading to endothelial dysfunction. Anticoagulants have remained the primary modality of treatment of thromboembolism for decades. However, there is no universal consensus regarding the timing, dosage and duration of anticoagulation in COVID-19 as well as need for postdischarge prophylaxis. This article seeks to review the present guidelines and recommendations as well as the ongoing trials on use of anticoagulants in COVID-19, identify discrepancies between all these, and provide a comprehensive strategy regarding usage of these drugs in the current pandemic.

Epidemiological Study of Infection and Death Due to COVID-19 in Fars Province, Iran, From February to September 2020

Background

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has entered our lives with the fear of outbreak, death, and recurrence. Our objective in this study is to evaluate the epidemiological features of Coronavirus Disease 2019 (COVID-19) infection and death in Fars province, Iran.

Methods

A cross-sectional study was conducted from February 18^th to September 30^th, 2020, where age, history of underlying diseases, sex, community-wide quarantine, nationality, close contact, pregnancy, medical staff job, traveling , and residency were compared between alive and deceased groups. Data were analyzed using IBM SPSS software, version 22.0, and the significance level was set at 0.05.

Results

Regarding 57958 new cases of COVID-19, the basic reproduction number (R₀) was estimated as 2.8, requiring a minimum of 65% immunization to reach herd immunity. Moreover, an R₀=0.36 was required to reach the endemic state in the region. The incidence, mortality, fatality, and recurrence rates of COVID-19 were estimated as 1347.9 per 100,000 dwellers, 209.5 per 1000,000 dwellers, 1.6 %, and 3.1 per 100,000 dwellers, respectively. Age, history of underlying diseases, urban residency, and the male sex were significantly higher in the deceased group (OR=1.09, 5.48, 1.24, and 1.32; All Ps<0.001, <0.001, 0.005, and <0.001, respectively). In addition, the recurrence rate among positive cases was estimated as 0.23% with a median±inter-quartile range equal to 84±46.25 days. Community-wide quarantine was shown to be a protective factor for death due to COVID-19 (OR=0.58, P=0.005).

Conclusion

Community-wide quarantine blocks the transmission of COVID-19 effectively. COVID-19 enjoys no solid immunity. History of underlying diseases, the male sex, urban residency, and age were among the most significant causes of death due to COVID-19. Further investigations are recommended on the genetic structure of SARS-CoV-2, treatments, and vaccination.

A Case of Acute Transverse Myelitis in a Mildly Symptomatic Patient: An Emerging and Serious Neurological Manifestation of COVID-19

Coronavirus disease 2019 (COVID-19) is known to have neurological manifestations and one of them is acute transverse myelitis (ATM). Despite being exceedingly rare (1.34-4.6 cases per million/year), COVID-19-associated ATM cases have continuously been reported and have significant health impact to patients. This case report presents a previously healthy, unvaccinated male who developed COVID-19-associated ATM.

Morphological and tissue-based molecular characterization of oral lesions in patients with COVID-19: A living systematic review

OBJECTIVE

This living systematic review aims to integrate the morphological and tissue-based molecular characterization of oral lesions occurring in individuals infected by COVID-19 (OLICs).

MATERIALS AND DESIGN

This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Scopus, Ovid, Embase, and LILACS were searched to identify reports on OLICs with morphological and/or tissue-based molecular data.

RESULTS

Four studies reporting five cases were included. Three patients were male, and the mean age of the individuals was 47.6 years. The most reported anatomical location was the palate (n = 4), whereas ulcers were the most frequent clinical presentation (n = 3). Histopathologically, all cases revealed cell vacuolization and exocytosis in the epithelial layer. In the mesenchymal layer, inflammatory cell infiltrate and thrombi/microvascular thrombosis were observed in three cases. Immunohistochemical reactions were performed in two cases. Both cases were negative for HHV-1, HHV-2, and CMV. One case revealed positivity for SARS-CoV-2 spike protein. No other molecular tests were found for the characterization of OLIC.

CONCLUSIONS

The pathological characteristics of OLICs are still unspecific. However, with the ongoing COVID-19 pandemic and well-documented new cases, whether OLICs are due to coinfections or has a primary origin can be determined.

SARS-CoV-2 triggering autoimmune diseases

Autoimmunity, hyperstimulation of the immune system, can be caused by a variety of reasons. Viruses are thought to be important environmental elements that contribute to the development of autoimmune antibodies. It seems that viruses cause autoimmunity with mechanisms such as molecular mimicry, bystander activation of T cells, transient immunosuppression, and inflammation, which has also been seen in post-Covid-19 autoimmunity. Infection of respiratory epithelium by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dysregulates the immune response, triggers both innate and acquired immunity that led to the immune system's hyperactivation, excessive cytokine secretion known as “cytokine storm,” and finally acute respiratory distress syndrome (ARDS) associated with high mortality. Any factor in the body that triggers chronic inflammation can contribute to autoimmune disease, which has been documented during the Covid-19 pandemic. It has been observed that some patients produce autoantibody and autoreactive CD4⁺ and CD8⁺ T cells, leading to the loss of self-tolerance. However, there is a scarcity of evidence defining the precise molecular interaction between the virus and the immune system to elicit autoreactivity. Here, we present a review of the relevant immunological findings in Covid-19 and the current reports of autoimmune disease associated with the disease.

Diagnostic performance of CO-RADS for COVID-19: a systematic review and meta-analysis

Objectives

To investigate the diagnostic performance of the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) for detecting COVID-19.

Methods

We searched PubMed, EMBASE, MEDLINE, Web of Science, Cochrane Library, and Scopus database until September 21, 2021. Statistical analysis included data pooling, forest plot construction, heterogeneity testing, meta-regression, and subgroup analyses.

Results

We included 24 studies with 8382 patients. The pooled sensitivity and specificity and the area under the curve (AUC) of CO-RADS ≥ 3 for detecting COVID-19 were 0.89 (95% confidence interval (CI) 0.85–0.93), 0.68 (95% CI 0.60–0.75), and 0.87 (95% CI 0.84–0.90), respectively. The pooled sensitivity and specificity and AUC of CO-RADS ≥ 4 were 0.83 (95% CI 0.79–0.87), 0.84 (95% CI 0.78–0.88), and 0.90 (95% CI 0.87–0.92), respectively. Cochran’s Q test (p < 0.01) and Higgins I² heterogeneity index revealed considerable heterogeneity. Studies with both symptomatic and asymptomatic patients had higher specificity than those with only symptomatic patients using CO-RADS ≥ 3 and CO-RADS ≥ 4. Using CO-RADS ≥ 4, studies with participants aged < 60 years had higher sensitivity (0.88 vs. 0.80, p = 0.02) and lower specificity (0.77 vs. 0.87, p = 0.01) than studies with participants aged > 60 years.

Conclusions

CO-RADS has favorable performance in detecting COVID-19. CO-RADS ≥ 3/4 might be applied as cutoff values given their high sensitivity and specificity. However, there is a need for more well-designed studies on CO-RADS.

Key Points

• CO-RADS shows a favorable performance in detecting COVID-19.

• CO-RADS ≥ 3 had a high sensitivity 0.89 (95% CI 0.85–0.93), and it may prove advantageous in screening the potentially infected people to prevent the spread of COVID-19.

• CO-RADS ≥ 4 had high specificity 0.84 (95% CI 0.78–0.88) and may be more suitable for definite diagnosis of COVID-19.

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.

Use of Remdesivir in the treatment of Coronavirus Disease 2019 (COVID-19) infection among Sudanese patients: a case series

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is affecting populations worldwide. Remdesivir is an anti-retroviral agent, with a broad spectrum of usage. Remdesivir usage against COVID-19 had been studied both in vitro and in vivo but is still considered a new treatment for COVID-19 and is not available in all countries. The aim of our study was to report several cases of the use of Remdesivir in Sudanese patients and report the adverse events related to the course of treatment.

Methods: A case series study was conducted in Imperial Hospital, Khartoum, Sudan reporting two cases who received Remdesivir for treating COVID-19 besides other treatments such as steroids and supportive therapy in December 2020. Cases were males aged over 65 years.

Cases presentation: Both patients were severe cases of COVID-19 admitted to the intensive care unit (ICU), who received Remdesivir for treating COVID-19 infection. Several side effects were reported: the first case had increased liver enzymes and then unexpectedly died from severe resistant hypotension; and hypoalbuminemia was noticed in the second case.

Conclusions: Remdesivir use among patients in Sudan must be studied extensively in order to determine the unexpected fatal event and assess the association of this event to Remdesivir use, as well as to report the frequency of the side effects.

Investigation and influencing factors about well-being level of elderly chronic patients during COVID-19 postpandemic period in Beijing

The Corona Virus Disease 2019 (COVID-19) pandemic has huge impacts on the world, including human health and economic decline. The COVID-19 has severe infectivity, especially the elderly with chronic diseases will cause various complications after infection and accelerate the disease process. In addition, COVID-19 will also affect their mental health. Therefore, the mental health of elderly patients with chronic diseases cannot be ignored. The aim of this study was to investigate the well-being level of elderly people with chronic disease during COVID-19 postpandemic period in Beijing and analysis related influencing factors, so as to provide a basis for improving the well-being level of elderly chronic patients during the postpandemic period.Elderly patients with chronic diseases who met the inclusion criteria in 5 different administrative regions in Beijing were selected to carry out a questionnaire survey. The contents of the questionnaire included general data, the Memorial University of Newfoundland Happiness scale and the awareness situation of the COVID-19 pandemic. A total of 500 questionnaires were distributed by WeChat and 486 valid questionnaires were collected. The t test and one-way analysis of variance were used to compare Memorial University of Newfoundland Happiness scores between 2 or more groups, multiple linear regression analysis was used to conduct multiple factor analysis to explore the related factors about well-being level of elderly chronic patients.A total of 109 cases (22.43%) were evaluated high well-being level, 319 cases (65.64%) were evaluated moderate well-being level and 58 cases (11.93%) were evaluated low well-being according to the Memorial University of Newfoundland Happiness (MUNSH) scores rating. The multiple linear regression indicated that the education level, number of chronic diseases, medical expenses, frequency of children's visits, taking care of grandchildren or not, and group activity frequency significantly affected the well-being of patients with chronic diseases during COVID-19 postpandemic period in Beijing (P < .05).Most elderly patients with chronic diseases had moderate or above sense of well-being during postpandemic period, but we should still pay attention to the mental health of those elderly chronic patients with low education level, much comorbidity, more medical expenses, less visits by children, not take care of grandchildren and never participate in group activities.

Autopsy results from a COVID-19 patient treated in a tropical area, and a review of the epidemiological history

Since the start of the COVID-19 pandemic, there has been an urgent need to produce accurate and sensitive tests. However, there have been instances where a positive nucleic acid test turns negative after treatment, and then positive again. This case report describes such an instance from the tropical region of Hainan, China. The patient was a 61-year-old female who went to Hainan on vacation from Wuhan during the COVID-19 pandemic in 2020. Symptoms appeared 9 d after arriving in Hainan, and it was confirmed that the nucleic acid test was positive after 4 repeats. Her condition declined rapidly, her heart stopped beating, and she was admitted in a coma to the ICU. After treatment, the SARS-CoV-2 virus nucleic acid test of several nasopharyngeal swabs were negative, and tests on whole blood, anal swabs, and urine were also negative. Later, however, nucleic acid tests on a lower respiratory tract sputum swab and lower respiratory tract lavage fluid were positive. An autopsy examination was carried out 12 h after her death, and multi-organ secretions were extracted for nucleic acid testing. The SARS-CoV-2 virus nucleic acid was only detected in the swabs from the end of the bronchus, which was confirmed by the visualization of the coronavirus by electron microscopy. Autopsy confirmed that the damage was mainly concentrated in the lungs and immune organs and tissues throughout the body. Epidemiology indicated that none of the people she came into contact with after arriving in Hainan, including close contacts, were infected. This is in sharp contrast to the highly contagious virus in Wuhan in the temperate zone during the same period. This case report indicates: (1) The high temperatures in tropical areas may have an impact on the spread and harm of COVID-19, and (2) The reason why nucleic acid testing for COVID-19 was initially negative and then positive after treatment may be related to the survival of the SARS-CoV-2 virus in deep lung tissues.

Seroprevalence and infection attack rate of COVID-19 in Indian cities

Objectives

Serological surveys were used to infer the infection attack rate in different populations. The sensitivity of the testing assay, Abbott, drops fast over time since infection which makes the serological data difficult to interpret. In this work, we aim to solve this issue.

Methods

We collect longitudinal serological data of Abbott to construct a sensitive decay function. We use the reported COVID-19 deaths to infer the infections, and use the decay function to simulate the seroprevalence and match to the reported seroprevalence in 12 Indian cities.

Results

Our model simulated seroprevalence matchs the reported seroprevalence in most of the 12 Indian cities. We obtain reasonable infection attack rate and infection fatality rate for most of the 12 Indian cities.

Conclusions

Using both reported COVID-19 deaths data and serological survey data, we infer the infection attack rate and infection fatality rate with increased confidence.

Factors Associated with Severe COVID-19 and Post-Acute COVID-19 Syndrome in a Cohort of People Living with HIV on Antiretroviral Treatment and with Undetectable HIV RNA

SARS-CoV-2 can produce both severe clinical conditions and long-term sequelae, but data describing post-acute COVID-19 syndrome (PACS) are lacking for people living with HIV (PLWH). We aimed at assessing the prevalence and factors associated with severe COVID-19 and PACS in our cohort. We included all unvaccinated adult PLWH on antiretroviral treatment and plasma HIV-RNA < 40 cp/mL since at least six months before SARS-CoV-2 infection at the Infectious and Tropical Diseases Unit of Padua (Italy), from 20 February 2020 to 31 March 2021. COVID-19 severity was defined by WHO criteria; PACS was defined as the persistence of symptoms or development of sequelae beyond four weeks from SARS-CoV-2 infection. Demographic and clinical variables were collected, and data were analyzed by non-parametric tests. 123 subjects meeting the inclusion criteria among 1800 (6.8%) PLWH in care at the Infectious and Tropical diseases Unit in Padua were diagnosed with SARS-CoV-2 infection/COVID-19 during the study period. The median age was 51 years (40−58), 79.7% were males, and 77.2% of Caucasian ethnicity. The median CD4+ T-cell count and length of HIV infection were 560 cells/mmc (444−780) and 11 years, respectively. Of the patients, 35.0% had asymptomatic SARS-CoV-2 infection, 48% developed mild COVID-19, 17.1% presented moderate or severe COVID-19 requiring hospitalization and 4.1% died. Polypharmacy was the single independent factor associated with severe COVID-19. As for PACS, among 75 patients who survived SARS-CoV-2 symptomatic infection, 20 (26.7%) reported PACS at a median follow-up of six months: asthenia (80.0%), shortness of breath (50.0%) and recurrent headache (25.0%) were the three most common complaints. Only the severity of the COVID-19 episode predicted PACS after adjusting for relevant demographic and clinical variables. In our study, PLWH with sustained viral suppression and good immunological response showed that the risk of hospital admission for COVID-19 was low, even though the severity of the disease was associated with high mortality. In addition, the likelihood of developing severe COVID-19 and PACS was mainly driven by similar risk factors to those faced by the general population, such as polypharmacy and the severity of SARS-CoV-2 infection.

Stem cell therapy for COVID-19 pneumonia

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus is a highly contagious microorganism, and despite substantial investigation, no progress has been achieved in treating post-COVID complications. However, the virus has made various mutations and has spread around the world. Researchers have tried different treatments to reduce the side effects of the COVID-19 symptoms. One of the most common and effective treatments now used is steroid therapy to reduce the complications of this disease. Long-term steroid therapy for chronic inflammation following COVID-19 is harmful and increases the risk of secondary infection, and effective treatment remains challenging owing to fibrosis and severe inflammation and infection. Sometimes our immune system can severely damage ourselves in disease. In the past, many researchers have conducted various studies on the immunomodulatory properties of stem cells. This property of stem cells led them to modulate the immune system of autoimmune diseases like diabetes, multiple sclerosis, and Parkinson's. Because of their immunomodulatory properties, stem cell-based therapy employing mesenchymal or hematopoietic stem cells may be a viable alternative treatment option in some patients. By priming the immune system and providing cytokines, chemokines, and growth factors, stem cells can be employed to build a long-term regenerative and protective response. This review addresses the latest trends and rapid progress in stem cell treatment for Acute Respiratory Distress Syndrome (ARDS) following COVID-19.

The Positive Rate of Nucleic Acid Testing and the Epidemiological Characteristics of COVID-19 in Chongqing

Objective

The purpose of this study is to analyze the positive rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid testing (NAT), cases of and deaths due to SARS-CoV-2, and the epidemiological characteristics of SARS-CoV-2 to identify high-risk populations.

Methods

A retrospective study in Jiulongpo district of Chongqing was conducted by performing continuous observations of the frequency of SARS-CoV-2 NAT, analyzing the data of close contacts of patients and asymptomatic carriers, and collecting epidemiological data. Data were collected from January 20, 2020, when the first case of SARS-CoV-2 infection was reported, to March 26, 2020. Descriptive statistical analysis and Cochrane–Mantel–Haenszel analysis were used to compare the positive detection rates and positive diagnostic rates of different exposure groups.

Results

A total of 7,118 people received 10,377 SARS-CoV-2 nucleic acid tests in one district, and the SARS-CoV-2 positive rates were 0.40% (18/4446) and 0.15% (4/2672) in people receiving one and ≥ two nucleic acid tests (p = 0.06), respectively. Those with suspected cases (12.35%) and close contacts (8%) had higher positive rates than people tested at fever clinics (0.39%) (p < 0.001). The median latency (range) of cases was 5 (2, 9) days, and the median time from diagnosis to recovery was 22 (14, 25) days. One recovered patient received a positive test result at 28 days after recovery when she attempted to donate blood. Six clustered cases, including one patient who died, indicated persistent human-to-human transmission. One patient who was diagnosed after death was found to have infected 13 close contacts. People working in catering and other public service departments (36.36%) and people who are unemployed and retirees (45.45%) have an increased risk of infection compared with technical staff (9.09%) and farmers (9.09%).

Conclusion

The total positive rate was low in the tested population, and more effective detection ranges should be defined to improve precise and differentiated epidemic control strategies. Moreover, in asymptomatic carriers, SARS-CoV-2 tests were positive after recovery, and patients with suspected SARS-CoV-2 infection who die may pose serious potential transmission threats.

Risk factors of COVID-19 in subjects with and without mental disorders

BACKGROUND

Subjects with mental disorders are at a higher risk of various pandemic, but no specific studies concerning on screening and comparing the risk factors of COVID-19 for subjects with and without mental disorders, and the role of different classes of mental disorders with respect to the COVID-19.

METHODS

This study comprised 42,264 subjects with mental disorders and 431,694 subjects without. Logistic regression was used to evaluate the associations of exposure factors with COVID-19 risk. Interaction terms were employed to explore the potential interaction effect between mental disorders and each exposure factor on COVID-19 risk.

RESULTS

Mental disorders increased 1.45-fold risk of COVID-19 compared with non-mental disorders. There were significant interaction effects between mental disorders and age, sex, ethnicity, health ratings, socioeconomic adversity, lifestyle habits or comorbidities on COVID-19 risk. Subjects with and without mental disorders shared some overlapping risk factors of COVID-19, including the non-white ethnicity, socioeconomic adversity and comorbidities. Subjects without mental disorders carry some specific risk and protective factors. Among subjects with mental disorders, the COVID-19 risk was higher in subjects with a diagnosis of organic/symptomatic mental disorders, mood disorders, and neurotic, stress-related and somatoform disorders than that of their counterparts. Age, amount of alcohol consumption, BMI and Townsend deprivation showed non-linear increase with COVID-19 risk.

LIMITATIONS

Absence of replication.

CONCLUSIONS

Subjects with mental disorders are vulnerable populations to whom more attention should be paid. Public health guidance should focus on reducing the COVID-19 risk by advocating healthy lifestyle habits and preferential policies in populations with comorbidities.

Central Nervous System Lesions in COVID-19

This review discusses current data on CNS lesions in infections with the new coronavirus that causes COVID-19. The pathogenetic mechanisms leading to infection of the brain and spinal cord are presented. Published studies and meta-analyses published by autumn 2020 are assessed. The authors present results from their own clinical observations of various types of CNS infection in COVID-19 virus disease. Particular attention is paid to certain common forms of CNS lesion such as encephalitis, cerebrovascular pathology, and headache. A form of acute hemorrhagic necrotic encephalopathy is identified, which is a quite rare but fatal pathology comorbid with COVID-19. A description of our own clinical observation of acute necrotic encephalopathy is presented. The importance of further studies of the effects of the coronavirus on the CNS and possible approaches to treatment and rehabilitation of this category of patients is emphasized.

Patterns of Otorhinolaryngological Manifestations of Covid-19: A Longitudinal Questionnaire-Based Prospective Study in a Tertiary Hospital in Saudi Arabia

Objective:

Many studied investigated the manifestations of COVID-19, yet few described the pattern and severity of otolaryngological symptoms. We aim to describe the picture of COVID-19-associated otorhinolaryngological manifestations and recovery to explore individualized treatment, onward referral, and complications prevention.

Design:

Prospective longitudinal questionnaire-based study.

Setting:

The online questionnaire was filled 3 times through a remote interview over a period of 1 month from June 2020 to July 2020.

Participants:

Patients with confirmed COVID-19 by RT-PCR who were clinically stable.

Main Outcome Measures:

Date of diagnosis, sociodemographic data, and the presence of predictive factors, such as nasal and paranasal disease, anosmia and dysgeusia. Validated tools were used, such as Sino-nasal Outcome Test (SNOT-22), smell test (medical academy screening tool), Voice Handicap Index (VHI), and Reflux Symptoms Index (RSI).

Result:

The questionnaire was sent to 363 patients and the response rate was 70.80% (n = 257). The mean age was 34.58 years (SD = 11.22) and the rate of male participants was 60.7%. The most common otorhinolaryngological symptoms at the time of enrollment was fever (48.6%), whilst the commonest severe symptom was cough (57%). After 1 month, only 11 participants had persistent severe symptoms, especially sleep and psychological symptoms (73%), and the majority were female (63.6%). All of them had at least 1 comorbidity. There was a significant difference between the mean age of participants with severe symptoms (mean = 27.45, SD = 8.39) and without severe symptoms (mean = 34.90, SD = 2.53, t(255) = 2.17, P = .031).

Conclusion:

COVID-19 has a wide-ranged spectrum of presentations, with otorhinolaryngological symptoms being the commonest and most serious. Studying these symptoms is vital to advance management options.

A Large-Scale Screening Responding Sporadic Epidemic of COVID-19 in China by an Integrated Health-Care System

Introduction

In the post-pandemic period of COVID-19, the majority of cities in China try to balance the normalization of epidemic prevention and social-economic development. However, the appearance of asymptomatic infected patients poses threats to public health, which might be infectious without clinical symptoms and only be detected by testing approaches.

Methods

Along with the appearance of one symptomatic case, a regional large-scale screening program was carried out in Shenzhen City charged by a regionally integrated healthcare system. After describing the screening program, a retrospective cross-sectional study for the screening outcome and efficacy was conducted.

Discussion

According to the screening results, the asymptomatic case was infectious and their close contacts should be quarantined cautiously as the close contacts of symptomatic cases. Besides, after integrating medical resources in Luohu district of Shenzhen, the medical capability of Luohu district improved greatly which could be demonstrated in inspection and organization abilities in this screening program.

Conclusion

The large-scale screening contributed to preventing epidemic transmission. In the post-pandemic period, regular surveillance of asymptomatic cases and rapid response capability for emergent screening program are both crucial for the prevention and control of COVID-19 epidemic. The integrated healthcare system coordinating regional medical institutions and optimizing regional medical recourse has advantages to address public health emergencies.

Household transmission of COVID-19 among the earliest cases in Antananarivo, Madagascar

BACKGROUND

Households are among the highest risk for the transmission of SARS-CoV-2. In sub-Saharan Africa, very few studies have described household transmission during the COVID-19 pandemic. Our work aimed to describe the epidemiologic parameters and analyze the secondary attack rate (SAR) in Antananarivo, Madagascar, following the introduction of SARS-CoV-2 in the country in March 2020.

METHODS

A prospective case-ascertained study of all identified close contacts of laboratory-confirmed COVID-19 infections was conducted in Antananarivo from March to June 2020. Cases and household contacts were followed for 21 days. We estimated epidemic parameters of disease transmission by fitting parametric distributions based on infector-infected paired data. We assessed factors influencing transmission risk by analyzing the SAR.

FINDINGS

Overall, we included 96 index cases and 179 household contacts. Adjusted with the best-fit normal distribution, the incubation period was 4.1 days (95% CI 0.7-7.5]). The serial interval was 6.0 days (95% CI [2.4-9.6]) after adjusting with the best-fit Weibull distribution. On average, each index case infected 1.6 family members (95%CI [0.9-2.3]). The mean SAR among close contacts was 38.8% (95% CI [19.5-58.2]) with the best-fit gamma distribution. Contacts older than 35 years old were more likely to be infected, and the highest SAR was found among them.

CONCLUSION

The results of our study provide key insights into the epidemiology of the first wave of SARS-CoV-2 in Madagascar. High rates of household transmission were found in Antananarivo, emphasizing the need for preventive measures to reduce community transmission.