Clinical Characteristics of Coronavirus Disease 2019 in China

The characterization of technical design of a virus-like structure (VLS) nanodelivery system as vaccine candidate against SARS-CoV-2 variants

The constant mutation of SARS-CoV-2 has led to the continuous appearance of viral variants and their pandemics and has improved the development of vaccines with a broad spectrum of antigens to curb the spread of the virus. The work described here suggested a novel vaccine with a virus-like structure (VLS) composed of combined mRNA and protein that is capable of stimulating the immune system in a manner similar to that of viral infection. This VLS vaccine is characterized by its ability to specifically target dendritic cells and/or macrophages through S1 protein recognition of the DC-SIGN receptor in cells, which leads to direct mRNA delivery to these innate immune cells for activation of robust immunity with a broad spectrum of neutralizing antibodies and immune protective capacity against variants. Research on its composition characteristics and structural features has suggested its druggability. Compared with the current mRNA vaccine, the VLS vaccine was identified as having no cytotoxicity at its effective application dosage, while the results of safety observations in animals revealed fewer adverse reactions during immunization.

Safety and immunogenicity of Ad26.COV2.S in adolescents: Phase 2 randomized clinical trial

We conducted a randomized, Phase 2 trial to assess the safety and humoral immunogenicity of reduced doses/dose volume of the standard dose of Ad26.COV2.S COVID-19 vaccine (5 × 1010 viral particles [vp]) in healthy adolescents aged 12-17 years. Participants were randomly assigned to receive Ad26.COV2.S at reduced dose levels of 0.625 × 1010 (0.5 mL), 1.25 × 1010 (0.5 mL) or 2.5 × 1010 (0.5 mL or low volume 0.25 mL) vp in a 1- or 2-dose (56-day interval) primary schedule. Adolescents who received a 1-dose primary schedule received a 2.5 × 1010 vp booster dose 6 months later. Safety and humoral immunogenicity were assessed up to 6 months post-last vaccination. All regimens were well tolerated, with no safety concerns identified. Local and systemic solicited AEs in adolescents were consistent with the known safety profile in adults. All 1- and 2-dose Ad26.COV2.S primary schedules elicited robust peak Spike-binding antibody responses and virus neutralizing titers against the reference strain, in participants with and without preexisting SARS-CoV-2 immunity. Immune responses were durable for at least 6 months. Spike-binding antibody responses were comparable to those elicited in young adults aged 18-25 years who received a standard dose of Ad26.COV2.S in Phase 3 efficacy studies Reduced doses/dose volume of Ad26.COV2.S had an acceptable safety profile and elicited robust humoral immune responses in adolescents aged 12-17 years. All 1- and 2-dose schedules elicited Spike-binding antibody responses that were comparable to an adult population in whom efficacy has been demonstrated using a higher vaccine dose. (clinicaltrials.gov NCT05007080).

Long-term alveolar-capillary diffusion impairments after severe SARS-CoV-2 pneumonia

BACKGROUND

Persistent respiratory symptoms and impaired gas exchange are common in patients recovering from COVID-19 pneumonia. The Lung Diffusing Capacity for Carbon Monoxide (DLCO) and Carbon Monoxide Transfer Coefficient (KCO) do not adequately distinguish alveolar membrane dysfunction from vascular abnormalities. This study aimed to characterize persistent diffusion impairment in post-ICU patients with prior SARS-CoV-2 pneumonia and reduced DLCO.

METHODS

After hospital discharge, patients underwent spirometry, DLCO measurement, and a 6-minute walking test every six months. If DLCO remained impaired at 18-24 months, a combined Lung Diffusing Capacity for Nitric Oxide (DLNO) and DLCO assessment was performed to differentiate alveolar-capillary membrane (DmCO) and pulmonary capillary blood volume (Vc) alterations.

RESULTS

Among 20 patients with persistent DLCO reduction, 3 had an obstructive ventilatory pattern, 6 had restriction, and 12 had low KCO. In restrictive cases, KCO was reduced but remained within normal limits without compensation. The DLNO/DLCO ratio exceeded 113.5% predicted in all patients. DmCO was impaired in 7 patients, while Vc was reduced in 16.

CONCLUSION

Both DLCO determinants were affected, with vascular impairment predominating. Vc reduction was present in most patients, with mean values below the lower limit of normality, whereas DmCO was less affected and often normal. The elevated DLNO/DLCO ratio suggests that persistent DLCO reduction is primarily driven by prolonged pulmonary capillary circulation dysfunction rather than alveolar membrane alterations, highlighting the vascular component as the primary site of long-term impairment.

Human-genetic variants associated with susceptibility to SARS-CoV-2 infection

SARS-CoV-2, the third major coronavirus of the 21st century, causing COVID-19 disease, profoundly impacts public health and workforces worldwide. Identifying individuals at heightened risk of SARS-CoV-2 infection is crucial for targeted interventions and preparedness. This study investigated 35 SNVs within viral infection-associated genes in SARS-CoV-2 patients and uninfected controls from the Basque Country (March 2020-July 2021). Its primary aim was to uncover genetic markers indicative of SARS-CoV-2 susceptibility and explore genetic predispositions to infection. Association analyses revealed previously unreported associations between SNVs and susceptibility. Haplotype analyses uncovered novel links between haplotypes and susceptibility, surpassing individual SNV associations. Descriptive modelling identified key susceptibility factors, with rs11246068-CC (IFITM3), rs5742933-GG (ORMDL1), rs35337543-CG (IFIH1), and GGGCT (rs2070788, rs2298659, rs17854725, rs12329760, rs3787950) variation in TMPRSS2 emerging as main infection-susceptibility indicators for a COVID-19 pandemic situation. These findings underscore the importance of integrated SNV and haplotype analyses in delineating susceptibility to SARS-CoV-2 and informing proactive prevention strategies. The genetic markers profiled in this study offer valuable insights for future pandemic preparedness.

Efficacy and limitations of SARS-CoV-2 vaccines - A systematic review

The emergence of the SARS-CoV-2 virus worldwide led to the call for the development of effective and safe vaccines to contain the spread and effects of COVID-19. Using information from 40 publications, including clinical trials and observational studies from 2019 to 2024, this review assesses the effectiveness, safety, and limitations of four major vaccines: Sinopharm (BBIBP-CorV), Moderna (mRNA-1273), Pfizer-BioNTech (BNT162b2), and CoronaVac. Pfizer-BioNTech and Moderna's mRNA vaccines proved to be more effective than others; Moderna's vaccines showed an efficacy of 94.1 % against symptomatic infection, while Pfizer-BioNTech's vaccines showed an efficacy of up to 95 %, against severe diseases and hospitalization. These vaccinations, which included protection against Omicron and Delta variants, offered notable protection against serious illness, hospitalization, and mortality. Severe adverse events were rare while most adverse events were mild to moderate, such as headaches, fatigue, and localized reactions. In contrast, inactivated virus vaccines such as Sinopharm and CoronaVac with efficacies ranging from 50 to 79 % against symptomatic infection showed lower levels of effectiveness. In Phase 3 trial, Sinopharm showed 72.8 % efficacy, whereas CoronaVac demonstrated roughly 67 % efficacy in population against hospitalization and severe disease. Booster doses were required for adequate immunological response, especially against novel strains, as these vaccinations proved to be less effective in older populations. They showed considerable safety profiles, with mild side effects, but their low immunogenicity is concerning. This review emphasizes the importance of continuously evaluating vaccines in response to the evolving virus, essential for improving international immunization programs.

Oxidative stress and PARP activation in the lungs is an early event in COVID-19 pneumonia

Oxidative stress and poly (ADP-ribosyl)ation (PARylation) leads to tissue damage and inflammation in multiple lung diseases, likely in COVID-19. In a previous study we evidenced PARylation in multiple pulmonary cell types in patients who died of COVID-19, but not in patients who died of non-COVID-19 causes. We extended these observations in this retrospective immunohistochemical study by enlarging and stratifying the study population to identify subpopulations with high expression of the markers assessed in the study. We showed that pulmonary PARylation and oxidative stress peaked in the exudative and then decreased in the proliferative phase. PARylation correlated with viral load and with the oxidative stress in the tissues, however, correlation between viral load and oxidative stress was marginal suggesting that oxidative stress and the presence of SARS-CoV-2 can independently induce PARylation. Pulmonary oxidative stress, PARylation and TNFα expression correlated with the serum markers of liver and kidney damage, oxygen transport, tissue hypoxia, lymphocytopenia, blood clotting and disseminated intravascular coagulation. In males the time of hospitalization (time to death) was inversely correlated with pulmonary PARylation. Furthermore, males, died of COVID-19, were ∼15 years younger than females, however, there was no difference in pulmonary oxidative stress and PARylation between genders at death. Taken together, pulmonary PARylation and oxidative stress manifests early, in the exudative phase of COVID-19 and PARylation contributes to worse clinical outcome for males. These results suggest repurposing pharmacological PARP inhibitors for acute COVID-19 to counteract tissue damage.

COVID-19 pandemic period and adult cardiac arrest: Analysis of clinical and epidemiological changes before and after the pandemic

This study aimed to investigate the impact of the COVID-19 pandemic on the management and outcomes of adult cardiac arrest patients by assessing the incidence, patient outcomes, and influence of comorbidities during the pandemic. This retrospective cross-sectional study analyzed the clinical data of 500 patients who experienced cardiac arrest in the Emergency Department of Esenyurt Necmi Kadioğlu State Hospital between September 1, 2018, and August 31, 2024. Patient data were obtained from the hospital's electronic records and included variables such as age, sex, arrest location, etiology, initial rhythm, intervention time, and outcomes. Data analysis was performed using SPSS version 26. Chi-square tests were used for categorical variables, while independent sample t tests and Mann-Whitney U tests were used for continuous data. The incidence of cardiac arrest increased during the pandemic. COVID-19-positive patients had a lower return of spontaneous circulation (ROSC) rates (30%) compared with negative patients (50%) and suspected cases (40%). Mortality was higher in COVID-19-positive patients (70%) and their discharge rates were lower (20%). Ventricular fibrillation as the initial rhythm was associated with better ROSC rates. Comorbidities such as chronic obstructive pulmonary disease, cancer, and heart failure were associated with lower ROSC rates and higher mortality rates. In conclusion, the COVID-19 pandemic has increased the number of cardiac arrest cases and worsened patient outcomes. Comorbidities significantly affected the prognosis. Future preparedness should focus on reducing intervention time, optimizing resource management, and implementing targeted care plans for high-risk patient groups.

Remote early detection of SARS-CoV-2 infections using a wearable-based algorithm: Results from the COVID-RED study, a prospective randomised single-blinded crossover trial

BACKGROUND

Rapid and early detection of SARS-CoV-2 infections, especially during the pre- or asymptomatic phase, could aid in reducing virus spread. Physiological parameters measured by wearable devices can be efficiently analysed to provide early detection of infections. The COVID-19 Remote Early Detection (COVID-RED) trial investigated the use of a wearable device (Ava bracelet) for improved early detection of SARS-CoV-2 infections in real-time.

TRIAL DESIGN

Prospective, single-blinded, two-period, two-sequence, randomised controlled crossover trial.

METHODS

Subjects wore a medical device and synced it with a mobile application in which they also reported symptoms. Subjects in the experimental condition received real-time infection indications based on an algorithm using both wearable device and self-reported symptom data, while subjects in the control arm received indications based on daily symptom-reporting only. Subjects were asked to get tested for SARS-CoV-2 when receiving an app-generated alert, and additionally underwent periodic SARS-CoV-2 serology testing. The overall and early detection performance of both algorithms was evaluated and compared using metrics such as sensitivity and specificity.

RESULTS

A total of 17,825 subjects were randomised within the study. Subjects in the experimental condition received an alert significantly earlier than those in the control condition (median of 0 versus 7 days before a positive SARS-CoV-2 test). The experimental algorithm achieved high sensitivity (93.8-99.2%) but low specificity (0.8-4.2%) when detecting infections during a specified period, while the control algorithm achieved more moderate sensitivity (43.3-46.4%) and specificity (66.4-65.0%). When detecting infection on a given day, the experimental algorithm also achieved higher sensitivity compared to the control algorithm (45-52% versus 28-33%), but much lower specificity (38-50% versus 93-97%).

CONCLUSIONS

Our findings highlight the potential role of wearable devices in early detection of SARS-CoV-2. The experimental algorithm overestimated infections, but future iterations could finetune the algorithm to improve specificity and enable it to differentiate between respiratory illnesses.

TRIAL REGISTRATION

Netherlands Trial Register number NL9320.

The Effectiveness of Distance Yoga Learning in Improving Maternal Pandemic-Related Depression and Stress During Pregnancy

Background: The aim of this study was to explore the effects of distance yoga learning in improving depression and pregnancy stress in pregnant women during the pandemic. Methods: A preference-based quasi-experimental study design with an experimental group (n = 30) and a control group (n = 31) was used to test both self-reported depression and stress status. The experimental group received a 12-week pregnancy yoga program, including one weekly 60 min distance yoga class followed by two sessions of DVD yoga exercise at home, while the control group received only routine nursing care. Results: There were significant differences in the depression and pregnancy stress indices between the two groups. As the number of weeks of pregnancy increased, both pregnancy depression and stress tended to gradually increase (p < 0.001). However, the experimental group had less pregnancy depression than the control group (p < 0.001), while there was no significant difference between the two groups in stress (p = 0.970). Conclusions: The findings inform clinical practice regarding the use of alternative exercise options such as distance yoga classes for pregnant women's mental health during a pandemic to reduce depression and pregnancy stress.

Comparison of Tomographic Findings in Patients with Influenza A (H1N1) and COVID-19

Objectives: The objective of this study was to identify CT-based predictors of mechanical ventilation and mortality in patients with severe and critical viral pneumonia and to examine the association between imaging severity and outcomes in ventilated patients. Methods: We analyzed pulmonary CT scans from 148 patients with severe or critical pneumonia caused by COVID-19 (n = 98) or influenza A H1N1 (n = 50). Patients were assessed based on tomographic patterns, demographics, clinical severity scores (Charlson Comorbidity Index, SOFA, and APACHE IV), and biomarkers. Survival analyses were performed using Kaplan-Meier curves and multivariable Cox regression. Results: Bilateral, peripheral, and basal lung involvement was common across both groups. Ground-glass opacities (89.62%, p ≤ 0.001) and consolidation (61.54%, p = 0.001) were more prevalent in COVID-19, whereas pleural effusion was significantly more frequent in H1N1 (76.92%, p ≤ 0.001). COVID-19 cases more often presented with bilateral (96.94%) and peripheral lesions (77.87%). H1N1 patients were more likely to develop severe ARDS and require mechanical ventilation. In COVID-19, higher APACHE IV scores and pulmonary damage severity index were independently associated with increased mortality. Conclusions: Radiologic and clinical severity profiles differ between COVID-19 and H1N1 pneumonia. CT-based assessments combined with prognostic scores may aid early risk stratification and guide treatment decisions in patients with severe viral pneumonia.

Vaccination Status is Not Associated With Adverse Postoperative Outcomes Following Total Joint Arthroplasty in Patients With a Preoperative COVID-19 Diagnosis

Background

Previous studies have shown that COVID-19 diagnosis increases rates of perioperative infection, readmission, and other complications following surgery. However, the effect of the COVID vaccine in such patients is unknown. We hypothesized that of the patients with COVID diagnosis, vaccinated patients with COVID-19 diagnosis would have lower rates of adverse complications compared to unvaccinated patients undergoing total joint arthroplasty (TJA).

Methods

Using a national database registry, patients aged less than 85 years undergoing elective primary total knee or total hip arthroplasty with at least 90 days of follow-up were included during the first year of COVID-19 pandemic from April 2020-April 2021. Patients were included in the COVID-19 cohort if they had a diagnosis on the day of surgery or within 30 days prior to surgery. Patients with a history of malignancy, joint injection, femoral neck fractures, tibial fractures, and those undergoing revision arthroplasty were excluded from the study. All comparisons were performed using multivariate logistic regression with significance set at P < .05. Odds ratio and 95% confidence interval were reported for all comparisons.

Results

There were a total of 1280 patients with COVID-19 diagnosis matched with 3831 patients without COVID-19 diagnosis. Patients with a COVID-19 diagnosis were at an increased risk of pneumonia, acute kidney injury, urinary tract infection, and readmission following TJA compared to patients without COVID-19 diagnosis. However, there were no differences in any complications assessed between vaccinated patients and unvaccinated patients with COVID-19 diagnosis following TJA.

Conclusions

This study confirms that patients with a COVID-19 diagnosis in the 30 days prior to TJA, whether vaccinated or not, have increased risks of medical complications and hospital utilization. However, this study demonstrates that vaccination status does not appear to be associated with the incidence of adverse postoperative events in patients with a COVID-19 diagnosis prior to TJA.

NETosis: A key player in autoimmunity, COVID-19, and long COVID

NETosis, the process through which neutrophils release neutrophil extracellular traps (NETs), has emerged as a crucial mechanism in host defense and the pathogenesis of autoimmune responses. During the SARS-CoV-2 pandemic, this process received significant attention due to the central role of neutrophil recruitment and activation in infection control. However, elevated neutrophil levels and dysregulated NET formation have been linked to coagulopathy and endothelial damage, correlating with disease severity and poor prognosis in COVID-19. Moreover, it is known that SARS-CoV-2 can induce persistent low-grade systemic inflammation, known as long COVID, although the underlying causes remain unclear. It has been increasingly acknowledged that excessive NETosis and NET generation contribute to further pathophysiological abnormalities following SARS-CoV-2 infection. This review provides an updated overview of the role of NETosis in autoimmune diseases, but also the relationship between COVID-19 and long COVID with autoimmunity (e.g., latent and overt autoimmunity, molecular mimicry, epitope spreading) and NETosis (e.g., immune responses, NET markers). Finally, we discuss potential therapeutic strategies targeting dysregulated NETosis to mitigate the severe complications of COVID-19 and long COVID.

Clinical Manifestations of SARS-CoV-2 Infection in Immunocompetent Adults in the Era of Widespread Population Immunity and Omicron Sublineage Viruses

While most SARS-CoV-2 infections and reinfections in the era of widespread population immunity with omicron subsub-lineage variants are mild for immunocompetent individuals, any manifestation previously seen during the pandemic phase is still possible. COVID-19 may affect any organ system. Previous infections and prior vaccines protect against symptomatic future SARS-CoV-2 infections, though this protection wanes over time.

Uso de inteligencia artificial en la predisposición genética a enfermedad crítica por COVID-19: evaluación comparativa de modelos de aprendizaje automático

Objetivos

La predicción temprana de enfermedad crítica por COVID-19 es crucial para optimizar el manejo clínico. Este estudio tiene como objetivo optimizar la predicción de enfermedad crítica por COVID-19 mediante la integración de datos clínicos, de laboratorio y polimorfismos genéticos en modelos de inteligencia artificial, evaluando y comparando el rendimiento de distintos algoritmos de aprendizaje automático.

Métodos

Se analizaron 155 pacientes hospitalizados, 23 de los cuales desarrollaron enfermedad crítica. Se realizó un análisis univariante para evaluar la asociación entre siete SNPs y 9 variables clínicas y 10 parámetros de laboratorio en la analítica al ingreso.

Resultados

De los 7 SNPS, solo tres SNPs se asociaron significativamente con enfermedad crítica: rs77534576, rs10774671 y rs10490770. Los modelos de ensemble consiguieron el mejor rendimiento: Random Forest (AUC=0,989), XGBoost (AUC=0,954) y AdaBoost (AUC=0,927). La importancia de las variables varió entre los modelos, destacando la edad, proteína C reactiva, cardiopatías y los tres SNPs en la mayoría de ellos. La incorporación de los SNPs mejoró el poder predictivo en comparación con estudios previos sin datos genéticos. La validación interna confirmó la superioridad y estabilidad de los modelos de ensemble.

Conclusiones

Los modelos de aprendizaje automático pueden ayudar en la predicción por enfermedad crítica por Covid-19. La incorporación de SNPs asociados a gravedad a los datos clínicos y de laboratorio mejora el poder predictivo. Se requieren estudios adicionales con cohortes más grandes y diversas para validar y generalizar estos hallazgos antes de su aplicación clínica.

Use of artificial intelligence to assess genetic predisposition to develop critical COVID-19 disease: a comparative study of machine learning models

Objectives

Early prediction of critical COVID-19 disease is crucial for an optimal clinical management. The objective of this study was to optimize predictive models for critical COVID-19 disease. Clinical data, laboratory data and genetic polymorphisms were integrated into AI models to compare the performance of different machine learning algorithms.

Methods

Data from 155 inpatients were analyzed, 23 of whom developed critical disease. A univariate analysis was performed to assess potential correlations between seven SNPs, nine clinical variables and 10 laboratory parameters at admission.

Results

Of the 7 SNPs, only three SNPs demonstrated a significant association with critical disase, namely: rs77534576, rs10774671 and rs10490770. The ensemble models exhibited the best performance: Random Forest (AUC=0.989), XGBoost (AUC=0.954) and AdaBoost (AUC=0.927). Variable importance varied across models, with age, C-reactive protein, heart diseases and the three SNPs being the most influential features. The predictive power of models improved with the integration of the three SNPs, as compared to previous studies where genetic data were not included. Internal validation confirmed the superiority and stability of the ensemble models.

Conclusions

Machine learning models may help predict progression into critical COVID-19-disease. The predictive power of models improves when SNPs associated with COVID-19 severity are integrated with laboratory and clinical data. Prior to implementation in clinical practice, larger studies in different populations are needed to validate and support the generalization of these results.

Altered liver hemodynamics in patients with COVID-19: a cross sectional study

AIMS

Abnormalities in liver biochemistry are common in COVID-19 patients. Hepatic vein Doppler waveform, typically triphasic, may become biphasic or monophasic in cirrhosis, correlating with liver dysfunction, fibrosis, inflammation, and portal hypertension. This study investigates liver ultrasound (US) features in COVID-19 patients, correlating hepatic vein Doppler waveform and portal vein velocity (PVV) with inflammatory indexes and clinical outcomes.

METHODS

Fifty-seven patients with SARS-CoV-2 infection participated in a crosssectional study. Bedside upper abdomen US evaluations, including B-mode and Doppler, were conducted using a convex probe. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic, and the hepatic vein waveform index (HVWI) was calculated. PVV was measured over three cardiac cycles. Tracings were blindly analyzed by three operators to ensure consistency.

RESULTS

Low HVWI and high PVV correlated with elevated LDH, ALT, D-dimer, and ferritin (p < 0.05). HVWI showed significant negative correlations with ferritin, D-dimer, and ALT (p < 0.05). D-Dimer and ferritin were higher in patients with biphasic/monophasic waveforms (p < 0.05). High PVV and larger spleen diameters predicted worse respiratory outcomes, including CPAP and tracheal intubation (p < 0.05). Optimal cut-off values for PVV (21.7 cm/s) and spleen diameter (9.84 cm) maximized sensitivity and specificity for predicting these outcomes. FIB-4 scores did not correlate with respiratory outcomes or hepatic hemodynamics (p > 0.05). Hemodynamic alterations were not significantly influenced by the presence of SLD (Steatotic Liver Disease).

CONCLUSIONS

COVID-19 patients exhibit altered intrahepatic hemodynamics, with hepatic vein waveform abnormalities potentially reflecting liver inflammation and fibrosis. PVV and spleen diameter may serve as non-invasive predictors of respiratory outcomes.

Cytokine immune profiles among COVID 19 patients with different disease severities seeking treatment at Moi teaching and referral hospital, Kenya

BACKGROUND

COVID-19 manifests with a wide range of severities, from asymptomatic to critical conditions. Immunological profiles in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may serve as early indicators of disease severity, aiding in prioritizing patient care.

METHODOLOGY

Archived patient plasma samples were retrieved from the Molecular Lab Bio-repository, ensuring equal representation of males, females, and various disease severities. Socio-demographic and disease severity data were obtained from patient health records. Levels of pro-inflammatory cytokines (interferon-gamma [IFN-γ], tumor necrosis factor-alpha [TNF-α], interleukin-2 [IL-2], and interleukin-17 [IL-17]) and anti-inflammatory cytokines (interleukin-4 [IL-4], interleukin-6 [IL-6], and interleukin-10 [IL-10]) were measured using the BD FACSCalibur flow cytometer. Data analysis involved comparing cytokine levels across different disease severities, with demographic data expressed as means ± standard deviation (SD). Statistical significance was set at P ≤ 0.05.

FINDINGS

The mean ages for males and females were 49.6 ± 22.7 and 48.4 ± 23.7, respectively. Mean ages for disease severity categories were 33 ± 19 (asymptomatic), 45.2 ± 21.5 (moderate), 56.8 ± 18.7 (severe), and 61.95 ± 22 (critical). Comorbidities were present in 25 % of patients, with cardiovascular disease (41 %) and pulmonary disease (31 %) being the most common. Predominant symptoms in critical patients included dyspnea (63 %) and myalgia (60 %), while rhinorrhea (46.2 %) and chest pain (45.7 %) were common in severe cases. Gastrointestinal symptoms were observed only in severe and critical groups. Levels of the pro-inflammatory cytokines (IFN-γ, TNF-α, and IL-17) increased linearly with disease severity. Among anti-inflammatory cytokines, IL-6 and IL-10 levels also rose significantly with increasing severity.

CONCLUSION

Levels of TNF-α, IL-17, and IL-6 correlated with disease severity and may serve as prognostic biomarkers. Advanced age and underlying comorbidities were independently associated with higher disease severity.

A detailed examination of coronavirus disease 2019 (COVID-19): Covering past and future perspectives

The COVID-19 disease has spread rapidly across the world within just six months, affecting 169 million people and causing 3.5 million deaths globally (2021). The most affected countries include the USA, Brazil, India, and several European countries such as the UK and Russia. Healthcare professionals face new challenges in finding better ways to manage patients and save lives. In this regard, more comprehensive research is needed, including genomic and proteomic studies, personalized medicines and the design of suitable treatments. However, finding novel molecular entities (NME) using a standard or de novo strategy to drug development is a time-consuming and costly process. Another alternate strategy is discovering new therapeutic uses for old/existing/available medications, known as drug repurposing. There are a variety of computational repurposing methodologies, and some of them have been used to counter the coronavirus disease pandemic of 2019 (COVID-19). This review article compiles recently published data on the origin, transmission, pathogenesis, diagnosis, and management of the coronavirus by drug repurposing and vaccine development approach. We have attempted to screen probable drugs in clinical trials by using literature survey. This systematic review aims to create priorities for future research of drugs repurposed and vaccine development for COVID-19.

Nirmatrelvir-ritonavir significantly reduces severe COVID-19 outcomes in diverse Taiwanese populations: Comprehensive evidence from a large-scale longitudinal cohort study in Taiwan

BACKGROUND

Nirmatrelvir-Ritonavir (NR) has proven effective for mild to moderate COVID-19 patients at risk of disease progression. Following its emergency use authorization in Taiwan in January 2022, this study aims to evaluate its impact on severe COVID-19 outcomes across different patient demographics in Taiwan.

METHODS

We performed a retrospective analysis of a database that includes data from three hospitals in Northern Taiwan. Patients with COVID-19 in 2022 were paired by propensity score matching based on NR prescription. Cox proportional hazard regression analysis calculated hazard ratios (HR), adjusting for confounding factors. Subgroup analysis determined HRs across patient characteristics.

RESULTS

Among 95,096 patients, 3329 were in the NR group, and 12,807 in the non-NR group. NR users demonstrated significantly better prevention of severe outcomes: intubation (HR=0.296 [95 % CI: 0.187-0.469], p = 0.0482); ICU admission (HR=0.327[0.108-0.991], p < 0.001); mortality (HR=0.195 [0.101-0.378], p < 0.001). Subgroup analysis revealed significantly lower intubation risks for NR users among both sexes, aged 18-65 or ≥ 65 years, BMI < 30, and patients with diabetes mellitus (DM), cardiovascular disease (CVD), or chronic obstructive pulmonary disease (COPD). ICU admission risk was lower for NR users among males, aged ≥ 65 years, and BMI < 30. Mortality risk was lower for NR users among both sexes, aged ≥ 65 years, BMI < 30, and patients with DM, CVD, or COPD.

CONCLUSION

NR significantly reduces the risk of severe COVID-19, particularly among older adults and those with pre-existing conditions, supporting NR as an essential treatment for high-risk COVID-19 patients.

Early suPAR levels as a predictor of COVID-19 severity: A new tool for efficient patient triage

BACKGROUND

Following several waves of the COVID-19 pandemic, we are now facing a lower but persistent rate of SARS-CoV-2 infections, with seasonal resurgences often coinciding with other respiratory tract infections.

OBJECTIVE

We aimed to identify early clinico-biological variables predictive of an unfavorable outcome in patients with primary SARS-CoV-2 infection. We also evaluated the role of suPAR, an innovative biomarker, in predicting disease severity.

METHODS

We included 255 patients with PCR-confirmed primary SARS-CoV-2 infection and with a 30-day follow-up minimum. Blood samples were collected within the first 24 h of hospitalization to measure suPAR levels. Comprehensive data from medical records were analyzed to assess their predictive value in stratifying patients into seven severity groups, with groups 1 to 3 representing severe COVID-19 (death, intubation, ECMO, or non-invasive ventilation).

RESULTS

Early plasma suPAR levels were significantly associated with severe disease progression, as evidenced by ANOVA and logistic regression models, highlighting suPAR as a persistent predictive factor for unfavorable outcomes.

CONCLUSION

Our findings suggest that a single suPAR measurement, performed early after a positive PCR test for SARS-CoV-2, holds strong predictive value for patient outcomes. This biomarker, alongside pulse oximetry and CT scan results, could be instrumental in early patient triage during seasonal COVID-19 resurgences.

Efficacy and safety of acalabrutinib with best supportive care versus best supportive care in patients with COVID-19 requiring hospitalization

The efficacy and safety of acalabrutinib, a Bruton tyrosine kinase (BTK) inhibitor, was evaluated in 2 phase 2 studies in hospitalized patients with coronavirus disease 2019 (COVID-19) who received acalabrutinib + best supportive care (BSC) versus BSC alone (Clinicaltrials.gov: NCT04380688 and NCT04346199). The primary endpoint was the percentage of patients alive and free of respiratory failure on day 14 (rest of the world [RoW] study) and day 28 (US study). In the RoW study, 177 patients were randomized (acalabrutinib + BSC: n = 89; BSC: n = 88); in the US study, 62 patients were randomized (acalabrutinib + BSC: n = 31; BSC: n = 31). The percentage of patients who met the primary endpoint was similar in both studies (RoW study: acalabrutinib + BSC: 83.1%, BSC: 90.9%; US study: acalabrutinib + BSC: 80.6%, BSC: 83.9%). No new safety concerns were reported. Overall, no significant clinical benefit of adding acalabrutinib to BSC in patients hospitalized with COVID-19 was observed.

Hotspots and Trends in Research on Early Warning of Infectious Diseases: A Bibliometric Analysis Using CiteSpace

Background: Emerging and re-emerging infectious diseases (EIDs and Re-EIDs) cause significant economic crises and public health problems worldwide. Epidemics appear to be more frequent, complex, and harder to prevent. Early warning systems can significantly reduce outbreak response times, contributing to better patient outcomes. Improving early warning systems and methods might be one of the most effective responses. This study employs a bibliometric analysis to dissect the global research hotspots and evolutionary trends in the field of infectious disease early warning, with the aim of providing guidance for optimizing public health emergency management strategies. Methods: Publications related to the role of early warning systems in detecting and responding to infectious disease outbreaks from 1999 to 2024 were retrieved from the Web of Science Core Collection (WoSCC) database. CiteSpace software was used to analyze the datasets and generate knowledge visualization maps. Results: A total of 798 relevant publications are included. The number of annual publications has sharply increased since 2000. The USA produced the highest number of publications and established the most extensive cooperation relationships. The Chinese Center for Disease Control & Prevention was the most productive institution. Drake, John M was the most prolific author, while the World Health Organization and AHMED W were the most cited authors. The top two cited references mainly focused on wastewater surveillance of SARS-CoV-2. The most common keywords were "infectious disease", "outbreak", "transmission", "virus", and "climate change". The basic keyword "climate" ranked the first and long duration with the strongest citation burst. "SARS-CoV-2", "One Health", "early warning system", "artificial intelligence (AI)", and "wastewater-based epidemiology (WBE)" were emerging research foci. Conclusions: Over the past two decades, research on early warning of infectious diseases has focused on climate change, influenza, SARS, virus, machine learning, warning signals and systems, artificial intelligence, and so on. Current research hotspots include wastewater-based epidemiology, sewage, One Health, and artificial intelligence, as well as the early warning and monitoring of COVID-19. Research foci in this area have evolved from focusing on climate-disease interactions to pathogen monitoring systems, and ultimately to the "One Health" integrated framework. Our research findings underscore the imperative for public health policymakers to prioritize investments in real-time surveillance infrastructure, particularly wastewater-based epidemiology and AI-driven predictive models, and strengthen interdisciplinary collaboration frameworks under the One Health paradigm. Developing an integrated human-animal-environment monitoring system will serve as a critical development direction for early warning systems for epidemics.

Rapid and highly sensitive immunoassay using an ultra-thin immuno-wall microfluidic device with a sequential fluorescence signal increment method

We present a rapid and highly sensitive immunoassay platform based on an ultra-thin immuno-wall microfluidic device with an easy-to-perform sequential fluorescence signal increment method. The ultra-thin immuno-wall was fabricated using a special type of water-soluble photopolymer mixed with streptavidin via photolithography. During photolithography, the photopolymer formed a three-dimensional cross-linked structure, and streptavidin was immobilized in the cross-linked structure based on the click chemistry reaction. The immobilized streptavidin was used to immobilize biotin-conjugated antibodies on the cross-linked structure to capture biomarkers, forming immune complexes on the surface, known as an "immuno-wall." A sequential fluorescence signal increment method utilizes two different fluorescence-labeled antibodies with high affinity that were incubated several cycles in the immuno-wall to enhance the fluorescence signal. Moreover, an ultra-thin immuno-wall was developed to reduce the nonspecific binding and increase the signal-to-noise ratio. To evaluate the performance of this immunoassay platform, the spike protein from the SARS-CoV-2 virus was selected as the target biomarker. This immunoassay platform exhibited a limit of detection of 0.01 ng/mL, and the detection time was 30 min, which is comparable to rapid antigen tests. This immunoassay platform demonstrates significant potential for early-phase disease diagnosis.

Immunogenicity of COVID-19 Vaccination in Immunocompromised Patients (Auto-COVID-VACC): Protocol for Multicenter Prospective Noninterventional Study

BACKGROUND

Despite the availability of vaccines, immunocompromised patients are still at high risk for severe COVID-19. Vaccination has been proven to be an effective measure in preventing severe SARS-CoV-2 infections; however, data on B- and T-cell responses are lacking. While vaccination schedules for the general population have been defined, achieving immunogenicity in patients who are immunocompromised remains a challenge.

OBJECTIVE

The primary objective is to analyze anti-spike-immunoglobulin G (IgG) titers after repeated messenger ribonucleic acid vaccinations in patients who are immunocompromised. Further objectives are to analyze data on humoral immune responses and to evaluate data on cellular immune responses.

METHODS

This multicenter, prospective, noninterventional study aims to determine the immunogenicity and reactogenicity of an implemented standard-of-care COVID-19 vaccination strategy in patients who are immunocompromised. A total of 100 patients will be recruited at three study sites. Patients are eligible for study inclusion when they are 18 years or older, vaccinated according to the recent version of the COVID-19 vaccination standard, and if the patient is immunocompromised according to stage 3 of the classification "Stages of Immunosuppression." The study analyzes B- and T-cell responses generated within the standard-of-care COVID-19 vaccination strategy. Additional blood samples will be drawn at each scheduled outpatient visit. Study-related blood samples will be used to extract ethylenediaminetetraacetic acid plasma and peripheral blood mononuclear cells for evaluation of B- and T-cell responses to COVID-19 vaccinations. For this study, no additional visits or invasive procedures will be performed in addition to standard care.

RESULTS

As of August 2024, the study has enrolled 32 patients. The recruitment phase is still ongoing.

CONCLUSIONS

Results will be used to optimize vaccination and booster schedules for patients who are immunocompromised and to increase rates of protection against severe SARS-CoV-2 infections. Further, results may identify risk and treatment factors, which lead to low immune responses in patients vaccinated against COVID-19, as well as the impact of repeated vaccination on B- and T-cell responses.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05597761; https://clinicaltrials.gov/study/NCT05597761.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60675.

Evaluation of broad-spectrum protection by novel mRNA vaccines against SARS-CoV-2 variants (Delta, Omicron-BA.5, XBB-EG.5) in the golden hamster model

BACKGROUND

The SARS-CoV-2 virus has continuously evolved, with new variants like Delta, Omicron-BA.5, and XBB-EG.5 posing challenges to vaccine efficacy. mRNA vaccines have emerged as a promising tool due to their rapid development and adaptability. This study evaluates the protective efficacy of six novel mRNA vaccine candidates against these variants using a golden hamster model.

METHODS

Six mRNA vaccines were designed, targeting the spike (S) and nucleocapsid (N) proteins of SARS-CoV-2. The vaccines were tested on golden hamsters, which were immunized and then challenged with Delta, Omicron-BA.5, and XBB-EG.5 variants. Key outcomes measured included body weight, viral RNA loads in various tissues, cytokine levels, and lung tissue pathology.

RESULTS

Hamsters vaccinated with the novel mRNA vaccines showed reduced weight loss, lower viral RNA loads in throat swabs and lung tissues, and reduced levels of pro-inflammatory cytokines compared to control groups. Additionally, vaccinated animals exhibited significantly less lung damage as evidenced by both histological and immunofluorescence analyses, especially in groups vaccinated with RBD-Fe, RE-N, and COVID-19 epitope formulations.

CONCLUSIONS

These mRNA vaccines demonstrated broad protective efficacy against multiple SARS-CoV-2 variants. They elicited immune responses, reduced viral RNA loads, and mitigated inflammatory and pathological damage, highlighting their potential in combating rapidly evolving SARS-CoV-2 variants.

Indirect effect of the COVID-19 pandemic on cardiovascular diseases incidence, mortality, and healthcare use among patients with hypertension but without SARS-CoV-2 infection in Hong Kong: an interrupted time series analysis

This study investigated the effects of the COVID-19 pandemic on cardiovascular disease (CVD) incidence among hypertensive patients without SARS-CoV-2 infection by changes in CVD incidence, all-cause mortality, blood pressure (BP) control, and healthcare utilization rates among this population from Hong Kong. Individuals diagnosed with hypertension from January 2010 to January 2020 were followed up until death, SARS-CoV infection, or April 2022. Interrupted time series analyses on 1,318,907 patients with hypertension, comparing outcomes across four periods: pre-pandemic (January 2012-January 2020), early pandemic (February 2020-February 2021), interwave (March-December 2021), and Omicron outbreak (January-April 2022). A significant increase in out-of-hospital mortality was found when the early pandemic started. Overall all-cause mortality increased progressively during the interwave period. CVD incidence decreased immediately in the early pandemic period, followed by a progressive increase, and surpassed the pre-pandemic level at the beginning of the interwave period. The proportion of patients with office-measured BP ≤ 140/90 mmHg remained below pre-pandemic levels across the pandemic periods. Healthcare utilization declined immediately in February 2020, while most utilization rebounded to the pre-pandemic level after March 2021 and declined again during the Omicron outbreak. Healthcare disruptions during the early pandemic likely delayed CVD diagnosis and treatment, driving an immediate rise in out-of-hospital mortality. When healthcare services gradually recovered in the interwave period, CVD incidence rebounded and both in and out-of-hospital all-cause mortality increased with a lag, possibly related to delayed treatment.

An after-action review of COVID-19 cases and mitigation measures at US Mission India, March 2020-July 2021

Between March 2020-June 2021, over 30 million COVID-19 cases were reported in India. We described the COVID-19 response across the US Mission India (US Embassy New Delhi, US Consulates - Mumbai, Hyderabad, Chennai, and Kolkata) to use the learnings for a possible future pandemic. We reviewed COVID-19 mitigation activities at five US Mission India posts from March 2020-July 2021. We also analyzed case investigation and contact tracing data from Health Units (outpatient clinics), including demographics, clinical findings, test results, contact positivity rate, and compared attack rates across the posts during the same period. The US Mission in India, comprising multiple US Government agencies, initiated COVID-19 mitigation in March 2020 with educational sessions, infection prevention training, health assessments, and standard operating procedures. The Health Unit and US CDC India office initiated COVID-19 case investigations and conducted contact tracing. During the study period, 636 COVID-19 cases (72% males), including 48 clusters (size range 2-10 cases), were reported. Overall case fatality rate was 1.5% (10). Of case patients, 82% (523) were Indians, and 18% (113) were Americans. On presentation, 22% (138/625) of cases were asymptomatic. The median time from symptom onset to notification to the Health Unit was three days (Interquartile range 1-5). The Health Unit identified 2,484 contacts with a 25% positivity rate. The attack rates ranged between 10-19%, with the highest at 19% in Delhi, which was lower compared to the estimated attack rate for respective cities but closely resembled the pattern of COVID-19 waves in India. Collaboration between medical providers and public health specialists during the COVID-19 response in US Mission India led to new organizational capabilities in contact tracing, community education, and workflows. These strategies helped reduce morbidity and mortality within the US Mission during the pandemic.

Integrating multiplex PCR in fever clinics for acute respiratory pathogen-specific diagnosis

The epidemiological patterns of respiratory tract infections (RTIs) have experienced substantial changes due to the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with a particular focus on acute respiratory infections (ARIs). Challenges in early diagnosis, inadequate triage strategies, and the inappropriate use of antimicrobials or antivirals have compounded the difficulties in accurately diagnosing and managing ARIs in the post-pandemic context. This study aimed to investigate the efficacy of fever clinics equipped with nucleic acid testing capabilities in the precise triage of ARIs. In a cohort of 604 individuals presenting with symptoms of ARIs, we utilized real-time reverse transcription polymerase chain reaction (RT-PCR) technology available in the fever clinic to perform nucleic acid testing for SARS-CoV-2, influenza A virus (Flu A), influenza B virus (Flu B), respiratory syncytial virus, adenovirus, human rhinovirus, and Mycoplasma pneumoniae. Subsequently, statistical methods were employed to analyze the distribution and types of ARIs associated with these pathogens. In fever clinics, most patients presenting with respiratory pathogen infections were diagnosed with non-SARS-CoV-2 respiratory pathogens, with a higher incidence noted among pediatric patients compared to adults. In contrast, SARS-CoV-2 primarily affected the adult population and was linked to more severe clinical outcomes. Consequently, the swift triage of patients exhibiting ARI symptoms in a fever clinic equipped with nucleic acid testing enables the rapid identification and precise treatment of pathogens. This approach alleviates patient discomfort and enhances the efficiency of healthcare resource utilization.

Role of Procalcitonin as a Prognostic Biomarker in Hospitalized COVID-19 Patients: A Comparative Analysis

Background

Procalcitonin (PCT) is recognized as an inflammatory biomarker, often elevated in COVID-19 pneumonia alongside other biomarkers. Understanding its association with severe outcomes and comparing its predictive ability with other biomarkers is crucial for clinical management.

Objectives

This retrospective multicenter observational study aimed to investigate the association between PCT levels and adverse outcomes in hospitalized COVID-19 patients. Additionally, it sought to compare the predictive performance of various biomarkers.

Design

The study analyzed data from the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry, comprising COVID-19 patients hospitalized across multiple Mayo Clinic sites between March 2020 and June 2022.

Methods

A total of 7851 adult COVID-19 patients were included. Patients were categorized into 6 groups based on the worst WHO ordinal scale. Multivariate models were constructed using peak biomarker levels within 72 hours of admission, adjusted for confounders.

Results

Elevated PCT levels were independently associated with increased odds of adverse outcomes, including ICU admission (adjusted odds ratio [aOR] 1.32, 95%CI 1.27-1.38), IMV requirement (aOR 1.35, 95%CI: 1.28-1.42), and in-hospital mortality (aOR 1.30, 95%CI: 1.22-1.37). A 3.48-fold increase in IMV requirement and 3.55 times increase in in-hospital mortality were noted with peak PCT ⩾ 0.25 ng/ml. Similar associations were observed with other biomarkers like NLR (AUC 0.730), CRP, IL-6, LDH (AUC 0.800), and D-dimer (AUC 0.719). Models incorporating NLR, LDH, D-dimer, and PCT demonstrated the highest predictive accuracy, with a combined model exhibiting an area under the curve (AUC) of 0.826 (95%CI 0.803-0.849).

Conclusions

Higher PCT levels were significantly linked to worse outcomes in COVID-19 patients, emphasizing its potential as a prognostic marker. Biomarker-based predictive models, particularly those including PCT, showed promising utility for risk assessment and clinical decision-making. Further prospective studies are warranted to validate these findings on a larger scale.

P.1 and P.2 SARS-CoV-2 Brazilian variants activate the unfolded protein response with a time and pathway specificity

COVID-19 is a human respiratory syndrome caused by the infection of the SARS-CoV-2 virus that has a high rate of infection and mortality. Viruses modulate the host machinery by altering cellular mechanisms that favor their replication. One of the mechanisms that viruses exploit is the protein folding and processing of post-translational modifications that occur in the endoplasmic reticulum (ER). When ER function is impaired, there is an accumulation of misfolded proteins leading to endoplasmic reticulum stress (ER stress). To maintain homeostasis, cells trigger an adaptive signaling mechanism called the Unfolded Protein Response (UPR) which helps cells deal with stress, but under severe conditions, can activate the apoptotic cell death mechanism. This study elucidated an activation of a diversity of molecular mechanisms by Brazilian variants of SARS-CoV-2 by a time-resolved and large-scale characterization of SARS-CoV-2-infected cells proteomics and immunoblotting. Furthermore, it was shown that pharmacological UPR modulation could reduce viral release by counteracting the different viral activations of its cellular response. Analysis of human clinical specimens and disease outcomes focusing on ER stress reinforces the importance of UPR modulation as a host regulatory mechanism during viral infection and could point to novel therapeutic targets. SIGNIFICANCE: Since the emergence of SARS-CoV-2 and the consequent COVID-19 pandemic, the rapid emergence of variants of this new coronavirus has been a cause for concern since many of them have significantly higher rates of transmissibility and virulence, being called Variants of Concern (VOC). In this work, we studied the VOCs Gamma (P.1) and Zeta (P.2), also known as Brazilian variants. Constant evidence has reported that there are particularities related to each variant of SARS-CoV-2, with different rates of transmissibility, replication and modulation of host biological processes being observed, in addition to the mutations present in the variants. For this reason, this work focused on infections caused by the Brazilian variants of SARS-CoV-2 in different cell lines, in which we were able to observe that the infections caused by the variants induced endoplasmic reticulum stress in the infected cells and activated the UPR pathways, presenting specific modulations of each variant in this pathway. Furthermore, transcriptome analysis of patients revealed a correlation between ER-related genes and COVID-19 progression. Finally, we observed that the use of UPR modulators in host cells decreased viral release of all variants without affecting cell viability. The data presented in this work complement the observations of other studies that aim to understand the pathogenicity of SARS-CoV-2 VOCs and possible new therapeutic strategies, mainly targeting biological processes related to the endoplasmic reticulum.

Cardiopulmonary function alterations in mild and moderate SARS-CoV-2 patients: a longitudinal comparison of pre-infection and early recovery phases

The purpose of this study is to compare and analyze the changes of CPET and pulmonary function indexes in patients with mild and moderate SARS-CoV-2 before infection and in the early recovery period, and to explore the influence of SARS-CoV-2 on cardiopulmonary fitness and its pathogenesis. Clinical data of 39 cases are collected, and paired analyses of CPET and pulmonary ventilation parameters before and after infection are performed using software SPSS. Bivariate correlations are analyzed for days post-infection, VO2peak decline rate, VO2peak/kg after infection, AHRR decline rate, and residual symptom count. The results show that VO2peak, VO2peak/kg, and AT significantly decreased after infection. The VE/VCO2 slope increased, while PetCO2, VEpeak, and VE/VCO2 minimum showed reductions. FVC, FEV1, and FEV1/FVC remained unchanged. OUES significantly declined, along with AHRR and HRpeak, although no significant differences are observed in HRrest, HRR-1 min, and HRR-2 min. The number of residual symptoms is significantly correlated with VO2peak/kg and its decline rate, but not with infection duration. Additionally, the decline rate of VO2peak/kg is strongly associated with post-infection time and post-infection VO2peak/kg. VO2/HR and power also decreased significantly. Moreover, after SARS-CoV-2 infection, cardiopulmonary function, including cardiac chronotropic and muscle function, is significantly impaired in mild and moderate patients. Residual symptoms are closely linked to cardiopulmonary function. Given the large proportion of mild and moderate cases, these findings offer valuable insights for developing targeted interventions to prevent further symptom progression and improve cardiopulmonary health in this population.

Prognostic Accuracy of Nutritional Assessment Tools in Critically-Ill COVID-19 Patients

Objectives: Critically ill COVID-19 patients are at high risk of malnutrition; however, no study has directly compared the prognostic accuracy of different nutritional assessment tools. This study aimed to determine the optimal cutoff values for the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score, Nutritional Risk Screening 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST) and to evaluate their predictive value for ICU mortality. Method: A retrospective analysis was conducted on patients with laboratory-confirmed COVID-19 admitted to our ICU between 20 March 2020 and 15 June 2021. Clinical and laboratory data, as well as patient outcomes, were retrieved from electronic medical records and patient charts. The mNUTRIC, NRS 2002, and MUST scores were calculated at ICU admission. Results: The study included 397 patients, with 273 survivors and 124 non-survivors. The median age was 65 (55-76) years, and the median BMI was 26.1 (24.0-29.4). Non-survivors had significantly higher median scores in all three nutritional assessment tools compared to survivors (mNUTRIC: 5 vs. 3, NRS 2002: 4 vs. 3, MUST: 2 vs. 2; p < 0.01). At the optimal cutoff values, mNUTRIC ≥ 4 demonstrated the highest prognostic accuracy (sensitivity: 0.77, specificity: 0.74; AUC = 0.75, CI = 0.70-0.81), followed by NRS 2002 ≥ 4 (sensitivity: 0.63, specificity: 0.60; AUC = 0.62, CI = 0.56-0.67) and MUST ≥ 3 (sensitivity: 0.21, specificity: 0.91; AUC = 0.56, CI = 0.50-0.68). Higher scores were associated with increased disease severity, poorer patient performance, prolonged hospital stays, and elevated ICU, 28-day, and overall hospital mortality rates. Among the three assessment tools, only an mNUTRIC score of ≥ 4 was independently associated with ICU mortality (OR = 1.54, CI = 1.21-1.96, p < 0.01). Conclusions: At ICU admission, mNUTRIC ≥ 4, NRS 2002 ≥ 4, and MUST ≥ 3 were identified as the most accurate predictors of mortality in critically ill COVID-19 patients. However, only the mNUTRIC score was an independent predictor of ICU mortality.

Ambient air pollution exposure and effects on neutralizing antibody titers following SARS-CoV-2 vaccination in adults

We examined the association between air pollution and neutralizing antibody responses to COVID-19 vaccination in participants enrolled in a phase 3 clinical trial. Seventy-four adults were vaccinated with two doses of the AstraZeneca ChAdOx1 vectored vaccine (AZD1222) (5 x 1010 viral particles) at baseline and day 29, between Aug 28, 2020, to Jan 15, 2021, in Monroe County, NY. SARS-CoV-2 pseudovirus neutralizing ID50 titers (NAb) and total spike protein IgG were assessed at baseline and 15, 29, 43, 57 and 90 days after vaccination. In this pilot study, each participant's dates of neutralization titers were matched to Monroe County ambient concentrations of fine particles (PM2.5; ≤ 2.5 µm), black carbon (BC; marker of traffic), among other particulate and gaseous pollutants. Using linear mixed models, we estimated the association between each interquartile range (IQR) difference in air pollutant concentrations in the 14 days prior to blood collection and antibody responses at each post vaccination timepoint. Though not statistically significant, we observed a 23% reduction in NAb titer (95% CI: -67%, 79%) measured on day 43 (i.e., 14 days after second vaccination) associated with each 0.32 µg/m3 increase in BC concentrations in the prior 14 days. We also observed a 42% increase in spike protein IgG (95% CI: -16%, 141%) measured on day 15 (i.e., 14 days after primary vaccination) associated with each 0.26 µg/m3 increase in BC concentrations in the 14 days prior. A similar pattern for total spike protein IgG was observed at day 29 (42%; 95% CI: -22%, 157%) and 90 (43%; 95% CI: -11%, 127%). Future research will need to explore the possible association between air pollution exposure and antibody response to SARS-CoV-2 vaccination given the potential for compromised vaccine efficacy.

Prognostic Value of the Brixia Radiological Score in COVID-19 Patients: A Retrospective Study from Romania

The novel coronavirus pandemic, SARS-CoV-2, has a variable clinical spectrum, ranging from asymptomatic to critical forms. High mortality and morbidity rates have been associated with risk factors such as comorbidities, age, sex, and virulence factors specific to viral variants. Material and Methods: We retrospectively evaluated imaging characteristics using the Brixia radiological score in relation to favorable or unfavorable outcomes in adult patients. We included COVID-19 cases, admitted between 2020 and 2022, in a specialized pulmonology hospital with no intensive care unit. We analyzed 380 virologically confirmed COVID-19 cases, with a mean age of 52.8 ± 13.02 years. The mean Brixia radiological score at admission was 5.13 ± 3.56, reflecting predominantly mild-to-moderate pulmonary involvement. Multivariate analysis highlighted the utility of this score as a predictive marker for COVID-19 prognosis, with values >5 correlating with other severity biomarkers, NEWS-2 scores, and a lack of vaccination and hospitalization delay of more than 6 days from symptom onset. Summarizing, the Brixia score is itself an effective tool for screening COVID-19 cases at risk of death for early recognition of clinical deterioration and for decisions regarding appropriate care settings. Promoting vaccination can reduce the severity of radiological lesions, thereby decreasing the risk of death. Technologies based on artificial intelligence could optimize diagnosis and management decisions.

A Rare Case of Small Bowel Ulceration Induced by COVID-19

Background

COVID-19 can affect multiple organ systems beyond the respiratory tract, including the gastrointestinal tract, where gastrointestinal symptoms include nausea, vomiting, diarrhea, abdominal pain, and even serious manifestations such as ulcers, perforation, or gastrointestinal bleeding.

Case Presentation

We report a case of a 45-year-old male patient with small bowel ulcers caused by chronic COVID-19 infection. Initially presenting with fever and transient unconsciousness, he developed ischemic necrosis and required a mid-thigh amputation. Despite treatment with anti-infection therapy, extracorporeal membrane oxygenation, and continuous renal replacement therapy, he experienced persistent abdominal pain and gastrointestinal bleeding. Imaging and colonoscopy confirmed partial small bowel obstruction and inflammation. After treatment with methylprednisolone and enteral nutrition, his symptoms improved. However, he suffered a gastrointestinal perforation requiring emergency surgery and later underwent a successful stoma reversal. The patient was subsequently discharged with improvement and was discharged with a primary diagnosis of "enterostomal status, perforation of small intestinal ulcer, viral myocarditis, COVID-19 infection, and post right lower extremity amputation". During the past year of follow-up, the patient has not experienced any recurrence of abdominal pain or rectal bleeding.

Conclusion

Although coronavirus pneumonia combined with small bowel ulcers is rare, it requires emergency treatment and has a high mortality rate. This case highlighted the severe gastrointestinal complications induced by COVID-19 infection and the effectiveness of comprehensive management strategies.

Evaluation of Retinal and Optic Nerve Parameters in Recovered COVID-19 Patients: Potential Neurodegenerative Impact on the Ganglion Cell Layer

Background/Objectives: This study aimed to analyze optic nerve parameters, retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), and subfoveal choroidal thickness (ChT) in patients who have recovered from coronavirus disease 2019 (COVID-19). Methods: This comparative study included 78 recovered COVID-19 patients (16 men, 62 women) and 56 age- and sex-matched healthy controls (18 men, 38 women). COVID-19 was confirmed in all patients, either through the detection of viral RNA in nasopharyngeal swabs via reverse transcriptase polymerase chain reaction or by serological testing for SARS-CoV-2 antibodies. Spectral-domain optical coherence tomography (SD-OCT) was used to assess optic nerve parameters, RNFLT, GCLT, and ChT. Results: The mean age was 35.0 ± 8.3 years in the COVID-19 group and 31.5 ± 8.3 years in the control group, with no statistically significant differences in age or sex distribution between groups (p = 0.41 and p = 0.16, respectively). Optic nerve parameters and RNFLT (overall and across the four peripapillary quadrants) did not differ significantly between the COVID-19 and control groups. However, the mean ganglion cell-inner plexiform layer (GC-IPL) thickness was significantly reduced in all quadrants in the COVID-19 group compared to the controls. No significant difference was observed in mean subfoveal ChT between groups. Conclusions: A significant reduction in ganglion GCLT was observed in recovered COVID-19 patients compared to healthy controls, suggesting a potential neurodegenerative effect of the disease on the optic nerve.

Two-sided effects of neutrophil extracellular traps and changes in the myeloid compartment in acute COVID-19: A histopathological study on autopsy cases from the first and second COVID-19 waves in Switzerland

Severe COVID-19 is characterized by complex immunopathology that involves inflammation, endothelial dysfunction, and immunothrombosis. Neutrophil extracellular traps (NETs) have been recognized as key factors in the severity of the disease, with their emergence correlating to viral load, immmunothrombosis, and organ damage. In this study, we investigated the role of NETosis and macrophage activation in the course of severe COVID-19. We analyzed 23 autopsy samples from patients who died from COVID-19 and performed immunohistochemical staining and stereological point counting to quantify leukocyte infiltration and NET formation among other histopathological parameters. Our results showcase 2 evident immunophenotypes: lowNET and highNET. The lowNET group displayed lower NET formation, higher viral loads, and an increased incidence of secondary infections, as well as shorter survival times. In contrast, the highNET group exhibited increased neutrophil activation, pronounced endothelial damage and thrombotic complications, as well as prolonged survival times. Our data suggest a dual role of NETosis in COVID-19: initially protective, limiting viral replication, but later likely detrimental through immunothrombosis and tissue damage. These findings underline the need for tailored therapeutic actions, with early antiviral and immune-modulating interventions for lowNET patients and strategies aiming to limit excessive NETosis and coagulopathy in highNET patients. Further research is needed to define the timing of interventions based on the dynamics of NETosis.

Genome-wide association study of post COVID-19 syndrome in a population-based cohort in Germany

If health impairments due to coronavirus disease 2019 (COVID-19) persist for 12 weeks or longer, patients are diagnosed with Post-COVID Syndrome (PCS), or Long-COVID. Although the COVID-19 pandemic has largely subsided in 2024, PCS is still a major health burden worldwide, and identifying potential genetic modifiers of PCS remains of great clinical and scientific interest. We therefore performed a case-control type genome-wide association study (GWAS) of three recently developed PCS (severity) scores in 2,247 participants of COVIDOM, a prospective, multi-centre, population-based cohort study of SARS-CoV-2-infected individuals in Germany. Each PCS score originally represented the weighted sum of the binary indicators of all, or a subset, of 12 PCS symptom complexes, assessed six months or later after the PCR test-confirmed SARS-CoV-2 infection of a participant. For various methodical reasons, however, the PCS scores were dichotomized along their respective median values in the present study, prior to the GWAS. Of the 6,383,167 single nucleotide polymorphisms included, various variants were found to be associated with at least one of the PCS scores, although not at the stringent genome-wide statistical significance level of 5 × 10- 8. With p = 6.6 × 10- 8, however, the genotype-phenotype association of SNP rs9792535 at position chr9:127,166,653 narrowly missed this threshold. The SNP is located in a region including the NEK6, PSMB7 and ADGRD2 genes which, however, does not immediately suggest an etiological connection to PCS. As regards functional plausibility, variants of a possible effect mapped to the olfactory receptor gene region (lead SNP rs10893121 at position chr11:123,854,744; p = 2.5 × 10- 6). Impairment of smell and taste is a pathognomonic feature of both, acute COVID-19 and PCS, and our results suggest that this connection may have a genetic basis. Three other genotype-phenotype associations pointed towards a possible etiological role in PCS of cellular virus repression (CHD6 gene region), activation of macrophages (SLC7A2) and the release of virus particles from infected cells (ARHGAP44). All other gene regions highlighted by our GWAS did not relate to pathophysiological processes currently discussed for PCS. Therefore, and because the genotype-phenotype associations observed in our GWAS were generally not very strong, the complexity of the genetic background of PCS appears to be as high as that of most other multifactorial traits in humans.

Long COVID Symptoms and Five Dimensions of HRQoL: A Retrospective Regional Study of Patients Recovered from COVID-19 Infection in Saudi Arabia

Background/Aim

10-20% of people infected with the coronavirus infection have long COVID symptoms, therefore, current research is the first regional assessment in Saudi Arabia to determine the relationship between long-term health complaints of COVID-19 survivors and health-related quality of life (HRQoL).

Methods

The study population comprised COVID-19 infection cases registered in the Ha'il region of Saudi Arabia from the beginning of the COVID-19 pandemic until September 2022. A retrospective research design was employed, and 295 participants completed a self-report questionnaire to assess long COVID symptoms and the Arabic version of the European 5-Dimensional Quality of Life (EQ-5D). Multiple linear regression was used to evaluate the predictive role of long COVID symptoms on the HRQoL of patients by choosing (p-value < 0.05).

Results

The mean (SD) age of the participants was 38 years, (67.1%) were male and (58.6%) were married. On the long COVID-19 symptoms, the highest mean values were fatigue (M=2.3; 95% CI 2.1-2.4) followed by headache (M=2.1; 95% CI 2.0-2.3) and persistent cough (M=1.9; 95% CI 1.8-2.1). Findings show that HRQoL was problematic in domains of pain/discomfort as depicted by a highest mean score on this domain (M=4.24; 95% CI 4.14-4.33) followed by anxiety/depression (M=4.17: 95% CI 4.08-4.27). Multiple regression analysis showed that marital status (p=0.05), irregular exercise (p<0.01), duration of hospitalization (p<0.01), and oxygen therapy (p<0.05) were the independent background factors affecting HRQoL post-COVID-19. Among the long-COVID-19 symptoms, fatigue (p=0.05), persistent cough (p=0.001), dyspnea (p=0.02), and sexual dysfunction (p<0.001) were the independent factors that impacted the HRQoL after controlling for background variables.

Conclusion

The study has significant implications for Saudi Arabia's Health Sector Transformation Program that could achieve its goals of human centric care and patient satisfaction though addressing the negative impacts of specific long-COVID symptoms such as fatigue, persistent cough, dyspnea and sexual dysfunction and improving the HRQoL in domains of pain/discomfort and anxiety/depression.

[Atypical clinical and mortality in older adults hospitalized with COVID-19 pneumonia]

Background

Pneumonia caused by SARS-CoV-2 is a public health problem. Older adults are vulnerable and the atypical presentation delays diagnosis and increases mortality. In this group the atypical clinical manifestations are more frequent.

Objective

To identify the clinical manifestations and mortality of COVID-19 pneumonia in hospitalized older adults.

Material and methods

A comparative cross-sectional observational study was carried out, from July 1, 2020, to December 31, 2021, in a general hospital of Mexico City. Patients aged 60 years or more who were hospitalized with a diagnosis of COVID-19 were included.

Results

267 older adults participated; 53.9% were men, with a median age of 74 years. The most frequent comorbidities in this population were type 2 diabetes mellitus (T2DM), hypertension and chronic obstructive pulmonary disease (COPD). 41.2% showed atypical presentation of the disease; mortality in the studied population was 53.5%.

Conclusions

The atypical presentation of COVID-19 pneumonia is common in adults over 60 years of age and it increases significantly as they become older. The absence of typical symptoms of pneumonia and the ignorance of the most common signs could delay diagnosis and timely care in this age group, which may increase complications and mortality.

Longitudinal Assessment of Pulmonary Involvement and Prognosis in Different Subtypes of COVID-19 Patients After One Year Using Low-Dose CT: A Prospective Observational Study

RATIONALE AND OBJECTIVES

Severe COVID-19 typically results in pulmonary sequelae. However, current research lacks clarity on the differences in these sequelae among various clinical subtypes. This study aimed to evaluate the changing lung imaging features and predictive factors in patients with COVID-19 pneumonia in northern China over a 12-month follow-up period after the relaxation of COVID-19 restrictions in 2022.

MATERIALS AND METHODS

Imaging and clinically relevant data from three groups (moderate, severe, and critical) of patients with varying severity were prospectively analyzed. Low-dose CT scans were conducted at 3, 6, and 12 months after discharge, with chest CT images evaluated at baseline and each follow-up using qualitative and quantitative analyses. Clinical symptoms and pulmonary function recovery at 12 months were documented. The correlation between lung function and CT results was analyzed. Univariate and multivariable logistic regression analyses were employed to examine factors influencing prognosis, while a post-hoc analysis model was utilized to investigate the relationships among different groups, time points, and chest CT findings.

RESULTS

Among the 103 hospitalized patients with COVID-19 pneumonia, 64 completed the 12-month evaluation. The median age was 63.70 ± 12.15%, and 62.5% (40/64) were men. During the follow-up period, while 67.19% (43/64) showed abnormalities, including fibrotic changes in 9.38% (6/64). Multivariable logistic regression identified age ≥ 65 (OR: 8.66; 95% CI: 1.86, 40.34; P = 0.006), length of hospital stays (OR: 1.23; 95% CI: 1.03, 1.47; P = 0.022), and baseline consolidation volume as a percentage of the whole lung (OR: 56.95; 95% CI: 1.198, 2706.782; P = 0.04) as independent risk factors for persistent CT lung abnormalities at 1 year. After 1 year, 34.38% (22/64) of patients still had abnormal lung function, and 9.38% (6/64) had pulmonary fibrosis and restrictive ventilatory dysfunction. The relationship between lung function and CT findings is weak correlation. The mixed model analysis revealed significant differences between groups, particularly between the moderate and severe groups, and significant changes in CT values over time.

CONCLUSION

One year after infection, more than one third of even moderate patients with mild symptoms had persistent pulmonary abnormalities. In our study, fibrotic changes were seen in severe and critically ill patients and remained stable 6 months after discharge from hospital. Imaging parameters can predict the prognosis. The larger the extent of baseline consolidation, the worse the prognosis of elderly patients.

Ocular hemodynamics in multisystem inflammatory syndrome in children: A cross-sectional study

PURPOSE

To evaluate retinal vascular changes by optical coherence tomography angiography (OCTA) in multisystem inflammatory syndrome in children (MIS-C).

METHODS

This cross-sectional study included 21 patients who were diagnosed with MIS-C and had a history of hospitalization, 20 pediatric outpatients with a coronavirus disease 2019 (COVID-19) diagnosis, and 26 healthy children. All patients underwent a detailed ophthalmologic examination and OCTA. In the MIS-C and pediatric COVID-19 groups, these evaluations were made 6 months after diagnosis. The vascular density values of the superficial, deep, and radial peripapillary capillary plexuses (SCP, DCP, and RPCP, respectively), foveal avascular zone (FAZ) parameters (area, perimeter, acircularity index, and foveal density), and outer retinal and choriocapillaris flow area values were recorded using OCTA.

RESULTS

No pathology was detected in the ophthalmologic examinations of the three groups with similar age and gender distributions. Although the vascular density values of SCP, DCP, and RPCP were found to be higher in most quadrants in the MIS-C group, there was no statistically significant difference among the three groups ( P > 0.05 for all). FAZ parameters and flow area measurements were similar in all three groups ( P > 0.05 for all).

CONCLUSION

This is the first study to evaluate relatively long-term outcomes in patients with MIS-C and pediatric COVID-19 together. This study shows no changes in the SCP and DCP parameters in pediatric age group, which shows that ocular hemodynamic changes may not be reflected on OCTA after 6 months.

HLA Polymorphisms and COVID-19 Susceptibility and Severity: Insights From an Iranian Patients Cohort

The HLA system is a crucial immune response component against infectious agents, including SARS-CoV-2. Certain polymorphisms may impart varying levels of protection or vulnerability to COVID-19. This research aims to understand the possible relationship between HLA polymorphisms and the susceptibility to COVID-19 and its severity. We recruited 290 hospitalised Iranian COVID-19 patients (130 severe and 160 moderate). Using PCR-SSP methods, we conducted a detailed analysis of polymorphisms in HLA class I (HLA-A, HLA-B, and HLA-C) and II (HLA-DRB1 and HLA-DQB1) molecules at low resolution. The study found that certain HLA alleles, including HLA-B*49, HLA-B*52, HLA-C*12, HLA-DRB1*04, and HLA-DQB1*05, were associated with disease susceptibility. Additionally, HLA-A*23, DRB1*10, and DRB1*13 were indicators of disease severity. The study also noted that individuals carrying the HLA-A*23 allele showed a significant decrease in lymphocyte levels and an elevated likelihood of developing thrombosis. We hypothesise that a maladaptive immune response may occur based on these findings. This might be due to the strong affinity of the HLA-A*23 allele group for presenting a wide range of SARS-CoV-2 peptides. Such a presentation possibly leads to a cytokine storm, followed by lymphocyte apoptosis and an increase in platelet count.

SARS-CoV-2 Infection Risk and COVID-19 Prevalence and Mortality in Cancer Patients During the First Wave of COVID-19 Pandemic in a Virus Epicenter in Northern Italy

Background/objectives: Cancer patients are more vulnerable to SARS-CoV-2 infection and COVID-19 due to their immunocompromised status. This study aims to evaluate the risk of SARS-CoV-2 infection, as well as COVID-19 prevalence and mortality, in cancer patients during the first wave of the COVID-19 pandemic in a virus epicenter of Northern Italy. Methods: This retrospective analysis included 40,148 prevalent cancer patients from the province of Parma, Italy, between February and June 2020. Patients were identified from health system records and classified by cancer subtype, treatment status, and COVID-19 diagnosis. The risk of infection and mortality was analyzed using odds ratios (OR) and hazard ratios (HR). Results: Among cancer patients, those on active cancer treatment had a higher cumulative risk of all-cause death (HR 1.83, p < 0.000268). Cancer subtype significantly impacted COVID-19 outcomes, with breast cancer patients showing lower incidence and mortality compared to those with lung, colorectal, or bladder cancers. Conclusions: Cancer patients, especially those on active treatment, are at increased risk of COVID-19 infection and death. Tailored prevention strategies, including prioritization of vaccination and careful management of cancer treatments, are crucial to mitigate risks during pandemics. These findings provide valuable insights for clinical decision-making in oncological care during public health crises.

Ouratein D, a Biflavanone From Ouratea spectabilis, Alleviates Betacoronavirus Infection by Mitigating Inflammation, Lung Damage and Viral Replication

Severe coronavirus outbreaks, including SARS, MERS, and COVID-19, have underscored the urgent need for effective antiviral therapies. This study evaluated the antiviral activity of biflavanones isolated from Ouratea spectabilis-specifically ouratein (Our-) A, B, C, and D-against murine hepatitis virus (MHV-3) and human SARS-CoV-2. Cells infected with MHV-3 or SARS-CoV-2 were treated with ourateins, and viral replication was assessed using plaque assays. Mice infected with MHV-3 were treated with Our-D either orally or intraperitoneally. Key assessments included leukocyte counts, cytokine and chemokine levels, histological analysis, and survival rates. The mechanism of action was explored through in silico and in vitro studies focused on the binding and inhibition of the main protease (Mpro). Our-D significantly inhibited the replication of both viruses, with a selective index of 2.5 for MHV-3 and 14.9 for SARS-CoV-2. In vivo, Our-D reduced leukocyte infiltration in the lungs, decreased CCL2 levels, increased IL-10, and lowered plasma IL-6 and CXCL1 levels. Additionally, Our-D mitigated lung damage, partially restored betacoronavirus-induced lymphopenia, and reduced viral loads in the lungs, heart, and spleen, ultimately improving survival in mice. In silico studies revealed that Our-A and Our-C had strong binding affinity for Mpro, and both significantly inhibited Mpro activity in vitro, unlike Our-D. Our-D protected mice from coronavirus infection by modulating the inflammatory response and reducing viral loads, with minimal effect on Mpro inhibition, suggesting alternative mechanisms for its antiviral activity.

Impact of High-Titer Convalescent Plasma on Clinical and Virologic Outcomes Among Veterans Hospitalized With SARS-CoV-2 Infection: VA CoronavirUs Research and Efficacy Studies-1 (VA CURES-1)

In the initial absence of proven therapies, empirical COVID-19 convalescent plasma (CCP) was rapidly introduced for individuals hospitalized for COVID-19. Seventy-five participants were randomized from November 2020 to June 2021 in a double-blind, multi-site, placebo-controlled, randomized trial (VA CURES-1) evaluating the impact of CCP vs. saline in Veterans hospitalized with COVID-19 with hypoxemia. The composite primary outcome was acute hypoxemic respiratory failure or all-cause death by Day 29. We analyzed clinical outcomes, nasal viral RNA, plasma cytokines and viral evolution over time. Among 40 participants receiving saline and 35 receiving CCP with high neutralizing titers (median 1:1420), the percent reaching the primary outcome was similar (10%), as were time to clinical recovery and to nasal viral clearance. By whole genome sequencing, viral molecular complexity evolved pre- to posttreatment more frequently in recipients of saline vs. CCP (4 of 7 (57.1%) vs. 1 of 4 (25%), respectively), based on numbers of mixed allele positions. Numbers of amino acid-changing, non-synonymous mutations in the spike protein were greater in saline vs. CCP recipients. Both outcomes suggested purifying selection (reduced overall viral infection complexity) following CCP. In conclusion, convalescent plasma showed no significant clinical impact but may influence SARS-CoV-2 complexity. Trial Registration: ClinicalTrials.gov Identifier: NCT04539275.

Translational research on pandemic virus infection using nonhuman primate models

After the COVID-19 pandemic, nonhuman primate (NHP) models, which are necessary for the rapid development of vaccines and new medical therapies, have become important in studies on infectious diseases because of their genetic, metabolic, and immunological similarities to humans. Our group has long been using NHP models in studies on infectious diseases including H1N1 influenza pandemic and COVID-19. Despite limitations such as the limited number of animals and the husbandry requirements, NHP models have contributed to the prediction of the pathogenicity of emerging viruses and the evaluation of the efficacy of vaccines and therapeutics due to the similarity of NHP models to humans before starting clinical trials to select good candidates of vaccines and drugs. In this review, the findings obtained in NHP infectious disease models of influenza and COVID-19 are summarized to clarify the benefits of NHP models for studies on infectious diseases. We believe that this review will support future research in exploring new perspectives for the development of vaccines and therapies targeting influenza, COVID-19, and infectious diseases in future pandemics.

Incidence, pathophysiology, risk factors, histopathology, and outcomes of COVID-19-induced acute kidney injury: A narrative review

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to a significant burden on global healthcare systems. COVID-19-induced acute kidney injury (AKI) is among one of the complications, that has emerged as a critical and frequent condition in COVID-19 patients. This AKI among COVID-19 patients is associated with poor outcomes, and high mortality rates, especially in those with severe AKI or requiring renal replacement therapy. COVID-19-induced AKI represents a significant complication with complex pathophysiology and multifactorial risk factors. Indeed, several pathophysiological mechanisms, including direct viral invasion of renal cells, systemic inflammation, endothelial and thrombotic abnormalities as well as nephrotoxic drugs and rhabdomyolysis are believed to underlie this condition. Moreover, histopathological and immunohistopathological findings commonly observed in postmortem studies include acute tubular necrosis, glomerular injury, and the presence of viral particles within renal tissue and urine. Identified risk factors for developing AKI vary among studies, depending on regions, underlying conditions, and the severity of the disease. Moreover, histopathological and immunohistopathological findings commonly observed in postmortem studies include show acute tubular necrosis, glomerular injury, and viral particles within renal tissue and urine. While, identified risk factors for developing AKI vary among studies, according to regions, underlying conditions, and the gravity of the disease. This narrative review aims to synthesize current knowledge on the incidence, pathophysiology, risk factors, histopathology, and outcomes of AKI induced by COVID-19.

Differences in Clinical and Laboratory Features of Pregnant and Non-Pregnant Female with Hospitalized COVID-19

Background

The impact of COVID-19 on vulnerable populations, including pregnant female, is critical due to higher risks and potential complications. This study aims to compare the clinical and laboratory features of COVID-19 between pregnant and non-pregnant female.

Materials and Methods

This retrospective cohort study included 245 COVID-19 patients admitted to Universitas Sabellas Maret (UNS) Hospital, Indonesia, from March 2020 to May 2022. Among them, 72 were pregnant, and 173 were non-pregnant. Data on demographics, clinical presentations, and laboratory findings were collected from medical records. Statistical analysis utilized Chi-square or Fisher exact tests, Mann-Whitney or independent t-tests, and multiple linear regression.

Results

No significant demographic differences were found, except in hospitalization status. Clinically, pregnant female had a higher prevalence of symptoms such as cough (p = 0.002), fatigue (p = 0.025), and shortness of breath (p = 0.035), with no differences in other symptoms or length of stay. Laboratory findings indicated significant differences in White Cell Count (WCC), Absolute Lymphocyte Count (ALC), High Fluorescence Lymphocyte Count (HFLC), lymphocyte percentage, neutrophil percentage, Neutrophil Lymphocyte Ratio (NLR), Red Cell Count (RCC), Hemoglobin (Hb), Hematocrit (Hct), Platelet Count (PC), Prothrombin Time (PT), International Normalized Ratio (INR), D-Dimer, and Sodium (p values < 0.05). Multivariate analysis identified WCC, lymphocyte percentage, HFLC, neutrophil percentage, PT, INR, D-Dimer, Creatinine, and Potassium as significant predictors of length of stay (R²adj = 0.874, F = 17.979, p < 0.001).

Conclusions

Pregnant female with COVID-19 exhibited distinct laboratory profiles compared to non-pregnant female. These findings highlight the need for tailored management strategies for COVID-19 in pregnant patients and provide a foundation for further research.

Association of the medication protocols and longitudinal change of COVID-19 symptoms: a hospital-based mixed-statistical methods study

The objective of this study was to identify the relationship between hospitalization treatment strategies leading to change in symptoms during 12-week follow-up among hospitalized patients during the COVID-19 outbreak. In this article, data from a prospective cohort study on COVID-19 patients admitted to Khorshid Hospital, Isfahan, Iran, from February 2020 to February 2021, were analyzed and reported. Patient characteristics, including socio-demographics, comorbidities, signs and symptoms, and treatments during hospitalization, were investigated. Also, to investigate the treatment effects adjusted by other confounding factors that lead to symptom change during follow-up, the binary classification trees, generalized linear mixed model, machine learning, and joint generalized estimating equation methods were applied. This research scrutinized the effects of various medications on COVID-19 patients in a prospective hospital-based cohort study, and found that heparin, methylprednisolone, ceftriaxone, and hydroxychloroquine were the most frequently prescribed medications. The results indicate that of patients under 65 years of age, 76% had a cough at the time of admission, while of patients with Cr levels of 1.1 or more, 80% had not lost weight at the time of admission. The results of fitted models showed that, during the follow-up, women are more likely to have shortness of breath (OR = 1.25; P-value: 0.039), fatigue (OR = 1.31; P-value: 0.013) and cough (OR = 1.29; P-value: 0.019) compared to men. Additionally, patients with symptoms of chest pain, fatigue and decreased appetite during admission are at a higher risk of experiencing fatigue during follow-up. Each day increase in the duration of ceftriaxone multiplies the odds of shortness of breath by 1.15 (P-value: 0.012). With each passing week, the odds of losing weight increase by 1.41 (P-value: 0.038), while the odds of shortness of breath and cough decrease by 0.84 (P-value: 0.005) and 0.56 (P-value: 0.000), respectively. In addition, each day increase in the duration of meropenem or methylprednisolone decreased the odds of weight loss at follow-up by 0.88 (P-value: 0.026) and 0.91 (P-value: 0.023), respectively (among those who took these medications). Identified prognostic factors can help clinicians and policymakers adapt management strategies for patients in any pandemic like COVID-19, which ultimately leads to better hospital decision-making and improved patient quality of life outcomes.