The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned?

The association between excess weight and COVID-19 outcomes: An umbrella review

This umbrella review assessed the association between excess weight and COVID-19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID-19 outcomes. A second-order meta-analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR-2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta-analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID-19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre-infection risk factor for severe COVID-19 outcomes, including death.

Association between ursodeoxycholic acid use and COVID-19 in individuals with chronic liver disease: a nationwide case-control study in South Korea

BACKGROUND

Conflicting evidence exists regarding the effects of ursodeoxycholic acid (UDCA) on coronavirus disease 2019 (COVID-19). This study investigates the association between UDCA administration and COVID-19 infection and its related outcomes in individuals with chronic liver disease (CLD).

METHODS

A customized COVID-19 research database (n = 3,485,376) was created by integrating data from the National Health Insurance Service (NHIS) and the Korea Disease Control and Prevention Agency's COVID-19 databases. The study focused on patients diagnosed with COVID-19 in 2021, using the NHIS data from 365 days before diagnosis. To create comparable groups with and without UDCA administration before COVID-19, we used propensity score matching. The primary endpoint was the first confirmed positive result for severe acute respiratory syndrome coronavirus-2. In addition, we identified severe COVID-19-related outcomes. Subgroup analysis were conducted based on the dose of UDCA exposure.

RESULTS

Data from 74,074 individuals with CLD was analyzed. The participants' average age was 57.5 years, and 52.1% (19,277) of those in each group were male. Those with prior UDCA exposure had a significantly lower risk of COVID-19 infection (adjusted OR: 0.80, 95% CI [0.76-0.85]) compared to the non-UDCA group. Additionally, the UDCA group had a lower risk of severe COVID-19 outcomes (adjusted OR: 0.67, 95% CI [0.46-0.98]). Subgroup analyses indicated that there was a decrease in COVID-19 infection and its related outcomes with increasing UDCA exposure dose.

CONCLUSIONS

Our large observational study highlights the potential use of readily available UDCA as an adjunctive therapy for COVID-19 in individuals with CLD.

The willingness of healthcare workers to be vaccinated against monkeypox and their knowledge about monkeypox: A systematic review and meta-analysis

Background

Vaccination is an important method to address the monkeypox epidemic. We aimed to analyze the knowledge of healthcare workers (HCWs) about human monkeypox and their attitudes toward vaccination.MethodsWe searched PubMed, Embase and Web of Science for articles and performed a meta-analysis using Stata 14.0 with a random-effects model. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results

A total of 34 studies with 43,226 HCWs were included in this meta-analysis. The results showed that 54 % (95 % CI: 0.39-0.69) of the HCWs were willing to be vaccinated against monkeypox, and only 40 % (95 % CI: 0.29-0.50) of the HCWs had good knowledge of monkeypox. By analyzing the vaccination history of HCWs, we found that history of smallpox vaccination did not significantly affect the willingness of HCWs to receive another vaccination (OR = 0.53, 95 % CI: 0.23-1.26), whereas HCWs who had been vaccinated with the influenza vaccine (OR = 2.80, 95 % CI: 1.29-6.11) or COVID-19 vaccine (OR = 3.10, 95 % CI: 2.00-4.81) showed greater willingness to receive the monkeypox vaccine. In terms of income, low-income HCWs were less willing to be vaccinated against monkeypox (OR = 0.69, 95 % CI: 0.54-0.89), whereas middle-income HCWs were more willing (OR = 1.45, 95 % CI: 1.04-2.02). Notably, although HCWs with education related to monkeypox had better knowledge of monkeypox than HCWs without education related to monkeypox, the difference was not statistically significant (OR = 1.83, 95 % CI: 0.80-4.18).

Conclusions

Publicity and education on monkeypox should be strengthened so that more people, especially HCWs, can have a good understanding of monkeypox and be willing to be vaccinated.

Assessing the impact of vaccination and medical resource allocation on infectious disease outbreak management: a case study of COVID-19 in Taiyuan City

Introduction

Amidst an emerging infectious disease outbreak, the rational allocation of vaccines and medical resources is crucial for controlling the epidemic's progression.

Method

Analysing COVID-19 data in Taiyuan City from December 2022 to January 2023, this study constructed a S V 1 V 2 V 3 E I Q H R dynamics model to assess the impact of COVID-19 vaccination and resource allocation on epidemic trends.

Results

Vaccination significantly reduces infection rates, hospitalisations, and severe cases, while also curtailing strain on medical resources by reducing congestion periods. An early and sufficient reserve of medical resources can delay the onset of medical congestion, and with increased maximum capacity of medical resources, the congestion's end can be accelerated. Stronger resource allocation capabilities lead to earlier congestion resolution within a fixed total resource pool.

Discussion

Integrating vaccination and medical resource allocation can effectively reduce medical congestion duration and alleviate the epidemic's strain on medical resource capacity (CCMR).

The association between potential predictors and death of patients during the COVID-19 pandemic in Shiraz: a hierarchical multiple regression analysis

INTRODUCTION

Identifying clinical factors that increase the risk of mortality in COVID-19 patients is crucial. This enables targeted screening, optimizing treatment, and prevention of severe complications, ultimately reducing death rates. This study aimed to develop prediction models for the death of patients (i.e., survival or death) during the COVID-19 pandemic in Shiraz, exploring the main influencing factors.

METHOD

We conducted a retrospective cohort study using hospital-based records of 1030 individuals diagnosed with COVID-19, who were hospitalized for treatment between March 21, 2021, and March 21, 2022, in Shiraz, Iran. Variables related to the final outcome were selected based on criteria and univariate logistic regression. Hierarchical multiple logistic regression and classification and regression tree (CART) models were utilized to explore the relationships between potential influencing factors and the final outcome. Additionally, methods were employed to identify the high-risk population for increased mortality rates during COVID-19. Finally, accuracy was evaluated the performance of the models, with the area under the receiver operator characteristic curve(AUC), sensitivity, and specificity metrics.

RESULTS

In this study, 558 (54.2%) individuals infected with COVID-19 died. The final model showed that the type of medicine antiviral (OR: 11.10, p = 0.038) than reference (antiviral and corticosteroid), and discharge oxygen saturation(O2) (OR: 1.10, p < 0.001) had a positive association with the chance of survival, but other variables were not considered as predictive variables. Predictive models for the final outcome(death) achieved accuracies ranging from 81 to 87% for hierarchical multiple logistic regression and from 87 to 94% for the CART model. Therefore, the CART model performed better than the hirerical multiple logistic regression model.

CONCLUSION

These findings firstly elucidate the incidence and associated factors of the outcome (death) among patients in Shiraz, Iran. Furthermore, we demonstrated that antiviral medication alone (without corticosteroids) and high O2 increase the survival chances of COVID patients.

A prediction model for secondary invasive fungal infection among severe SARS-CoV-2 positive patients in ICU

Background

The global COVID-19 pandemic has resulted in over seven million deaths, and IFI can further complicate the clinical course of COVID-19. Coinfection of COVID-19 and IFI (secondary IFI) pose significant threats not only to healthcare systems but also to patient lives. After the control measures for COVID-19 were lifted in China, we observed a substantial number of ICU patients developing COVID-19-associated IFI. This creates an urgent need for predictive assessment of COVID-19 patients in the ICU environment for early detection of suspected fungal infection cases.

Methods

This study is a single-center, retrospective research endeavor. We conducted a case-control study on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients. The cases consisted of patients who developed any secondary IFI during their ICU stay at Jilin University China-Japan Union Hospital in Changchun, Jilin Province, China, from December 1st, 2022, to August 31st, 2023. The control group consisted of SARS-CoV-2 positive patients without secondary IFI. Descriptive and comparative analyses were performed, and a logistic regression prediction model for secondary IFI in COVID-19 patients was established. Additionally, we observed an increased incidence of COVID-19-associated pulmonary aspergillosis (CAPA) during this pandemic. Therefore, we conducted a univariate subgroup analysis on top of IFI, using non-CAPA patients as the control subgroup.

Results

From multivariate analysis, the prediction model identified 6 factors that are significantly associated with IFI, including the use of broad-spectrum antibiotics for more than 2 weeks (aOR=4.14, 95% CI 2.03-8.67), fever (aOR=2.3, 95%CI 1.16-4.55), elevated log IL-6 levels (aOR=1.22, 95% CI 1.04-1.43) and prone position ventilation (aOR=2.38, 95%CI 1.15-4.97) as independent risk factors for COVID-19 secondary IFI. High BMI (BMI ≥ 28 kg/m2) (aOR=0.85, 95% CI 0.75-0.94) and the use of COVID-19 immunoglobulin (aOR=0.45, 95% CI 0.2-0.97) were identified as independent protective factors against COVID-19 secondary IFI. The Receiver Operating Curve (ROC) area under the curve (AUC) of this model was 0.81, indicating good classification.

Conclusion

We recommend paying special attention for the occurrence of secondary IFI in COVID-19 patients with low BMI (BMI < 28 kg/m2), elevated log IL-6 levels and fever. Additionally, during the treatment of COVID-19 patients, we emphasize the importance of minimizing the duration of broad-spectrum antibiotic use and highlight the potential of immunoglobulin application in reducing the incidence of IFI.

Mathematical assessment of control strategies against the spread of MERS-CoV in humans and camels in Saudi Arabia

A new mathematical model for the transmission dynamics and control of the Middle Eastern respiratory syndrome (MERS), a respiratory virus caused by MERS-CoV coronavirus (and primarily spread to humans by dromedary camels) that first emerged out of the Kingdom of Saudi Arabia (KSA) in 2012, was designed and used to study the transmission dynamics of the disease in a human-camel population within the KSA. Rigorous analysis of the model, which was fitted and cross-validated using the observed MERS-CoV data for the KSA, showed that its disease-free equilibrium was locally asymptotically stable whenever its reproduction number (denoted by $ {\mathbb R}_{0M} $) was less than unity. Using the fixed and estimated parameters of the model, the value of $ {\mathbb R}_{0M} $ for the KSA was estimated to be 0.84, suggesting that the prospects for MERS-CoV elimination are highly promising. The model was extended to allow for the assessment of public health intervention strategies, notably the potential use of vaccines for both humans and camels and the use of face masks by humans in public or when in close proximity with camels. Simulations of the extended model showed that the use of the face mask by humans who come in close proximity with camels, as a sole public health intervention strategy, significantly reduced human-to-camel and camel-to-human transmission of the disease, and this reduction depends on the efficacy and coverage of the mask type used in the community. For instance, if surgical masks are prioritized, the disease can be eliminated in both the human and camel population if at least 45% of individuals who have close contact with camels wear them consistently. The simulations further showed that while vaccinating humans as a sole intervention strategy only had marginal impact in reducing the disease burden in the human population, an intervention strategy based on vaccinating camels only resulted in a significant reduction in the disease burden in camels (and, consequently, in humans as well). Thus, this study suggests that attention should be focused on effectively combating the disease in the camel population, rather than in the human population. Furthermore, the extended model was used to simulate a hybrid strategy, which combined vaccination of both humans and camels as well as the use of face masks by humans. This simulation showed a marked reduction of the disease burden in both humans and camels, with an increasing effectiveness level of this intervention, in comparison to the baseline scenario or any of the aforementioned sole vaccination scenarios. In summary, this study showed that the prospect of the elimination of MERS-CoV-2 in the Kingdom of Saudi Arabia is promising using pharmaceutical (vaccination) and nonpharmaceutical (mask) intervention strategies, implemented in isolation or (preferably) in combination, that are focused on reducing the disease burden in the camel population.

Designing novel peptides for detecting the Omicron variant, specifying SARS-CoV-2, and simultaneously screening coronavirus infections

In this study in silico a candidate diagnostic peptide-based tool was designed in four stages including diagnosis of coronavirus diseases, simultaneously identifying of COVID-19 and SARS from other members of this family, specific identification of SARS-CoV2, and diagnosis of COVID-19 Omicron. Designed candidate peptides consist of four immunodominant peptides from the proteins of the SARS-CoV-2 spike (S) and membrane (M). The tertiary structure of each peptide was predicted. The stimulation ability of the humoral immunity for each peptide was evaluated. Finally, in silico cloning was performed to develop an expression strategy for each peptide. These four peptides have suitable immunogenicity, appropriate construct, and the ability to be expressed in E.coli. These results must be experimentally validated in vitro and in vivo to ensure the immunogenicity of the kit.Communicated by Ramaswamy H. Sarma.

Natural linear coumarin-heterocyclic conjugates: A review of their roles in phytotherapy

Heterocycle conjugates provide a fresh investigative scope to find novel molecules with enhanced phytotherapeutic characteristics. Coumarin-based products are widely used in the synthesis of several compounds with biological and medicinal properties since they are naturally occurring heterocycles with a broad dispersion. The investigation of coumarin-based phytochemicals with annulated heterocyclic rings is a promising approach to discovering novel conjugates with significant phytotherapeutic attributes. Due to the applicable coumarin extraction processes, a range of linear coumarin-heterocyclic conjugates were isolated from different natural resources and exhibited remarkable therapeutic efficacy. This review highlights the phytotherapeutic potential and origins of various natural linear coumarin-heterocyclic conjugates. We searched several databases, including Science Direct, Web of Science, Springer, Google Scholar, and PubMed. After sieving, we ultimately identified and included 118 pertinent studies published between 2000 and the middle of 2023. This will inspire medicinal chemists with extremely insightful ideas for designing and synthesizing therapeutically active lead compounds in the future that are built on the pharmacophores of coumarin-heterocyclic conjugates and have significant therapeutic attributes.

Repurposing FDA approved drugs against monkeypox virus DNA dependent RNA polymerase: virtual screening, normal mode analysis and molecular dynamics simulation studies

Zoonotic monkeypox disease, caused by the double-stranded DNA monkeypox virus, has become a global concern. Due to the absence of a specific small molecule drug for the disease, this report aims to identify potential inhibitor drugs for monkeypox. This study explores a drug repurposing strategy using virtual screening to evaluate 1615 FDA approved drugs against the monkeypox virus DNA dependent RNA polymerase subunit A6R. Normal mode analysis and molecular dynamics simulation assessed the flexibility and stability of the target protein in complex with the top screened drugs. The analysis identified Nilotinib (ZINC000006716957), Conivaptan (ZINC000012503187), and Ponatinib (ZINC000036701290) as the most potential RNA polymerase inhibitors with binding energies of - 7.5 kcal/mol. These drugs mainly established hydrogen bonds and hydrophobic interactions with the protein active sites, including LEU95, LEU90, PRO96, MET110, and VAL113, and residues nearby. Normal mode analysis and molecular dynamics simulation confirmed the stability of interactions between the top drugs and the protein. In conclusion, we have discovered promising drugs that can potentially control the monkeypox virus and should be further explored through experimental assays and clinical trials to assess their actual activity against the disease. The findings of this study could lay the foundation for screening repurposed compounds as possible antiviral treatments against various highly pathogenic viruses.

A Comparative Study of "Grafting to" and "Grafting from" Conjugation Methods for the Preparation of Antibody-Temperature-Responsive Polymer Conjugates

Early diagnosis of infectious diseases is still challenging particularly in a nonlaboratory environment or limited resources areas. Thus, sensitive, inexpensive, and easily handled diagnostic approaches are required. The lateral flow immunoassay (LFIA) is commonly used in the screening of infectious diseases despite its poor sensitivity, especially with low pathogenic loads (early stages of infection). This article introduces a novel polymeric material that might help in the enrichment and concentration of pathogens to overcome the LFIA misdiagnosis. To achieve this, we evaluated the efficiency of introducing poly(N-isopropylacrylamide) (PNIPAAm) into immunoglobulin G (IgG) as a model antibody using two different conjugation methods: grafting to (GT) and grafting from (GF). The IgG-PNIPAAm conjugates were characterized using SDS-PAGE, DLS, and temperature-responsive phase transition behavior. SDS-PAGE analysis revealed that the GF method was more efficient in introducing the polymer than the GT method, with calculated polymer introduction ratios of 61% and 34%, respectively. The GF method proved to be less susceptible to steric hindrance and more efficient in introducing high-molecular-weight polymers into proteins. These results are consistent with previous studies comparing the GT and GF methods in similar systems. This study represents an important step toward understanding how the choice of polymer incorporation method affects the properties of IgG-PNIPAAm conjugates. The synthesized polymer allowed binding and enrichment of mouse IgG that was used as a model antigen with a clear LFIA band. On the basis of our findings, this system might help in improving the sensitivity of simple diagnostics.

Evaluating infection risks in buses based on passengers' dynamic temporal and typical spatial scenarios: A case study of COVID-19

Conventional buses, as an indispensable part of the urban public transport system, impose cross-infection risks on passengers. To assess differential risks due to dynamic staying durations and locations, this study considered four spatial distributions (i = 1-4) and six temporal scenarios (j = 1-6) of buses. Based on field measurements and a risk assessment approach combining both short-range and room-scale effects, risks are evaluated properly. The results showed that temporal asynchrony between infected and susceptible individuals significantly affects disease transmission rates. The Control Case assumes that infected and susceptible individuals enter and leave synchronously. However, ignoring temporal asynchrony scenarios, i.e., the Control Case, resulted in overestimation (+30.7 % to +99.6 %) or underestimation (-15.2 % to -69.9 %) of the actual risk. Moreover, the relative difference ratios of room-scale risks between the Control Case and five temporal scenarios are impacted by ventilation. Short-range risk exists only if infected and susceptible individuals have temporal overlap on the bus. Considering temporal and spatial asynchrony, a more realistic total reproduction number (R) can be obtained. Subsequently, the total R was assessed under five temporal scenarios. On average, for the Control Case, the total R was estimated to be +27.3 % higher than j = 1, -9.3 % lower than j = 2, +12.8 % higher than j = 3, +33.0 % lower than j = 4, and + 77.6 % higher than j = 5. This implies the need for a combination of active prevention and real-time risk monitoring to enable rigid travel demand and control the spread of the epidemic.

The predictive power of data: machine learning analysis for Covid-19 mortality based on personal, clinical, preclinical, and laboratory variables in a case-control study

BACKGROUND AND PURPOSE

The COVID-19 pandemic has presented unprecedented public health challenges worldwide. Understanding the factors contributing to COVID-19 mortality is critical for effective management and intervention strategies. This study aims to unlock the predictive power of data collected from personal, clinical, preclinical, and laboratory variables through machine learning (ML) analyses.

METHODS

A retrospective study was conducted in 2022 in a large hospital in Abadan, Iran. Data were collected and categorized into demographic, clinical, comorbid, treatment, initial vital signs, symptoms, and laboratory test groups. The collected data were subjected to ML analysis to identify predictive factors associated with COVID-19 mortality. Five algorithms were used to analyze the data set and derive the latent predictive power of the variables by the shapely additive explanation values.

RESULTS

Results highlight key factors associated with COVID-19 mortality, including age, comorbidities (hypertension, diabetes), specific treatments (antibiotics, remdesivir, favipiravir, vitamin zinc), and clinical indicators (heart rate, respiratory rate, temperature). Notably, specific symptoms (productive cough, dyspnea, delirium) and laboratory values (D-dimer, ESR) also play a critical role in predicting outcomes. This study highlights the importance of feature selection and the impact of data quantity and quality on model performance.

CONCLUSION

This study highlights the potential of ML analysis to improve the accuracy of COVID-19 mortality prediction and emphasizes the need for a comprehensive approach that considers multiple feature categories. It highlights the critical role of data quality and quantity in improving model performance and contributes to our understanding of the multifaceted factors that influence COVID-19 outcomes.

Tick species diversity and potential distribution alternation of dominant ticks under different climate scenarios in Xinjiang, China

Ticks are a hematophagous parasite and a vector of pathogens for numerous human and animal diseases of significant importance. The expansion of tick distribution and the increased risk of tick-borne diseases due to global climate change necessitates further study of the spatial distribution trend of ticks and their potential influencing factors. This study constructed a dataset of tick species distribution in Xinjiang for 60 years based on literature database retrieval and historical data collection (January 1963-January 2023). The distribution data were extracted, corrected, and deduplicated. The dominant tick species were selected for analysis using the MaxEnt model to assess their potential distribution in different periods under the current and BCC-CSM2.MR mode scenarios. The results indicated that there are eight genera and 48 species of ticks in 108 cities and counties of Xinjiang, with Hyalomma asiaticum, Rhipicephalus turanicus, Dermacentor marginatus, and Haemaphysalis punctatus being the top four dominant species. The MaxEnt model analysis revealed that the suitability areas of the four dominant ticks were mainly distributed in the north of Xinjiang, in areas such as Altay and Tacheng Prefecture. Over the next four periods, the medium and high suitable areas within the potential distribution range of the four tick species will expand towards the northwest. Additionally, new suitability areas will emerge in Altay, Changji Hui Autonomous Prefecture, and other local areas. The 60-year tick dataset in this study provides a map of preliminary tick distribution in Xinjiang, with a diverse array of tick species and distribution patterns throughout the area. In addition, the MaxEnt model revealed the spatial change characteristics and future distribution trend of ticks in Xinjiang, which can provide an instrumental data reference for tick monitoring and tick-borne disease risk prediction not only in the region but also in other countries participating in the Belt and Road Initiative.

Resurgence of orbital mucormycosis during COVID-19 pandemic: Study from a tertiary care center in Eastern India

PURPOSE

A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens.

MATERIALS AND METHODS

This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge.

RESULTS

Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%).

CONCLUSION

Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..

Incidence of Helminthic and Viral Coinfections in Malaria Patients in the Tertiary Care Hospital Setup

Introduction

This study determines the incidence of common viral and helminth coinfections with malaria in the tertiary care hospital set up in southern Khyber Pakhtunkhwa, Pakistan.

Materials and Methods

The multidimensional research included malaria patients admitted to different hospitals of district Kohat during January and December 2021. Stool samples and blood were assembled from the patients. Giemsa-stained microscopy-positive samples were processed by the immunochromatography technique (ICT) to identify Plasmodium species. Common viral infections such as viral hepatitis (A, B, and C), HIV, and dengue (DENV) were analyzed by ICT kits while SARS-CoV-2 was confirmed through real-time PCR. Furthermore, the intestinal helminths were identified using the Kato-Katz thick smear method.

Results

Among 1278 patients, 548 were diagnosed with malaria, 412 (75.2%) were positive for P. vivax infection, 115 (21%) for P. falciparum, and 21 (3.8%) for mixed malaria infection (P. vivax/P. falciparum), with a higher incidence among males (65.2%) than females (34.8%). Coinfection with helminths was positive in 215 (39.3%) malaria patients. The most common infections were caused by the Ascaris lumbricoides species (42.6%) followed by Enterobius vermicularis (31.7%) and hookworm. A total of 24.6% of malaria-positive cases were also coinfected with different viruses with higher frequencies of confection for HAV (8.2%) and DENV (6.2%), respectively. The patients revealed higher incidence of coinfections with P. falciparum (57%) as compared with P. vivax (39.2%) and mixed infections (3.7%).

Conclusion

This study demonstrated that the study population exhibited a significant incidence of coinfections with intestinal helminth and viral malaria.

SARS-CoV-2 outbreak: role of viral proteins and genomic diversity in virus infection and COVID-19 progression

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is the cause of coronavirus disease 2019 (COVID-19); a severe respiratory distress that has emerged from the city of Wuhan, Hubei province, China during December 2019. COVID-19 is currently the major global health problem and the disease has now spread to most countries in the world. COVID-19 has profoundly impacted human health and activities worldwide. Genetic mutation is one of the essential characteristics of viruses. They do so to adapt to their host or to move to another one. Viral genetic mutations have a high potentiality to impact human health as these mutations grant viruses unique unpredicted characteristics. The difficulty in predicting viral genetic mutations is a significant obstacle in the field. Evidence indicates that SARS-CoV-2 has a variety of genetic mutations and genomic diversity with obvious clinical consequences and implications. In this review, we comprehensively summarized and discussed the currently available knowledge regarding SARS-CoV-2 outbreaks with a fundamental focus on the role of the viral proteins and their mutations in viral infection and COVID-19 progression. We also summarized the clinical implications of SARS-CoV-2 variants and how they affect the disease severity and hinder vaccine development. Finally, we provided a massive phylogenetic analysis of the spike gene of 214 SARS-CoV-2 isolates from different geographical regions all over the world and their associated clinical implications.

Molecular docking and molecular dynamic simulation-based phytoconstituents against SARS-CoV-2 with dual inhibition of the primary protease targets

A novel coronavirus has caused major health problems and is spreading globally. The main protease enzyme plays a significant role in the number of copies of ss-RNA produced during the proteolytic cleavage of polypeptides. This work aims to find possible dual inhibitors of the 3-Chymotrypsin-like proteases PDB-6W63 and 6LU7 which increase efficiency and faster inhibition activity. By using an in-silico technique, polyphenols are molecularly docked against these targets to inhibit protease enzymes. Some polyphenols, such as pelargonidin and naringin, have significant dual inhibition characteristics with remarkable binding affinities with active scaffolds of both proteins, which have important ADMET parameters. These organic molecules are strongly bonded with amino acids of protein via mostly hydrogen bonding. These polyphenols also have outstanding docking scores and MMGBSA energies. The validity of the docking score was evaluated using a molecular dynamics simulation that assessed the stability of the complex. With the aid of computer-aided drug design, we hypothesise that the dual inhibition of compounds pelargonidin and naringin could effectively and potentially oppose SARS-CoV-2.

"Long COVID" and Its Impact on The Environment: Emerging Concerns and Perspectives

The COVID-19 pandemic has caused unprecedented global health and economic crises. The emergence of long COVID-19 has raised concerns about the interplay between SARS-CoV-2 infections, climate change, and the environment. In this context, a concise analysis of the potential long-term effects of the COVID-19 epidemic along with the awareness aboutenvironmental issues are realized. While COVID-19 effects in the short-term have reduced environmental air pollutants and pressures, CO2 emissions are projected to increase as the economy recovers and growth rates return to pre-COVID-19 levels. This review discusses the systematic effects of both the short-term and long-term effects of the pandemic on the clean energy revolution and environmental issues. This article also discusses opportunities to achieve long-term environmental benefits and emphasizes the importance of future policies in promoting global environmental sustainability. Future directions for growth and recovery are presented to cope with long COVID-19 epidemic along with the critical findings focussing on various aspects: waste management, air quality improvement.

Hematological Indices in COVID-19 Patients with Rhinosinusitis Mucormycosis

Introduction

Rhinosinusitis mucormycosis (RM) is an invasive opportunistic fungal infection, especially among COVID-19 patients. The current study aimed to assess the peripheral blood hematological disorders of COVID-19 patients-associated RM.

Materials and Methods

During ten month, in two COVID-19 centers in Mashhad, Iran, from June 2021 to March 2022, eighty-three patients suspected of COVID-19 with rhinosinusitis or rhino-orbital mucormycosis participated in this study. The hematological indices of these patients were measured by independent sample T-test or Mann-Whitney test for quantitative data, and the qualitative variables were analyzed using Chi-square or Fisher's exact test in SPSS version 20 at a significance level of 0.05.

Results

Of the COVID-19 patients, 40 (48.2%) were affected by RM, and leukocytosis due to neutrophilia was observed in 30% of them. Leukocyte counts were normal in 10 (25%) patients, but 1 (2.5%) and 3 (7.5%) had leukopenia and lymphopenia, respectively. Leukocytosis plus lymphopenia was observed in 7 (17.5%) patients. Also, the synchronicity of leukopenia and lymphopenia was seen in 5 (12.5%) patients. Leukopenia, lymphopenia, and neutropenia have occurred concurrently in 2 (5%) patients. The complete blood count (CBC) showed that RBCs, hemoglobin (Hb), hematocrit (HCT), MCH, MCHC, platelet (PLT), and lymphocytes decreased while neutrophils increased.

Conclusion

Among the hematological parameters, leukocytosis due to neutrophilia and reduction in Hb, HCT, and PLT are more dominant factors in COVID-19 patients-associated RM.

Effect of Optimizing the Induction Regimen in Preventing Cough Reactions in Patients Undergoing General Anesthesia: A Prospective Randomized Controlled Study

PURPOSE

During the induction of general anesthesia, opioids and endotracheal intubation may cause coughing. This study aimed to investigate the safety and effectiveness of an optimized drug induction scheme for general anesthesia to prevent coughing in patients.

METHODS

A total of 220 patients aged 18 to 65 years who underwent surgery under general anesthesia with endotracheal intubation were randomly assigned to two groups, each with 110 patients. One group was administered a divided sufentanil bolus (group A) and the other with a single sufentanil bolus (group B). Anesthesia induction was performed according to the drug induction scheme of 1st, 2nd, and 3rd minutes. The primary outcome was a coughing episode associated with the administration of opioids during anesthesia induction. We also recorded the pain associated with drug injection, hemodynamics, and blood oxygen saturation during the induction of anesthesia.

FINDINGS

All patients were included in the final statistical analysis. Compared with group B, the incidence of opioid induced cough (OIC) was significantly higher in group A (9.1% vs. 0, P = 0.001). There was no cough reaction of tracheal intubation in either group. There was no severe pain due to propofol and rocuronium injection in either group (P > 0.05). The mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were within the normal range at each time point during the induction period in both groups.

IMPLICATIONS

According to the optimized 1st, 2nd, and 3rd minutes anesthesia induction regimen, with a single final intravenous bolus of sufentanil after the diluted rocuronium bromide administration, no sufentanil and tracheal intubation induced coughing reactions were observed.

TRIAL REGISTRATION

The study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2200062749, http://www.chictr.org.cn/showproj.aspx?proj=175018) on August 17, 2022.

Annulated Heterocyclic[g]Coumarin Composites: Synthetic Approaches and Bioactive Profiling

Coumarins, widely abundant natural heterocyclic compounds, are extensively employed in creating various biologically and pharmacologically potent substances. The hybridization of heterocycles presents a key opportunity to craft innovative multicyclic compounds with enhanced biological activity. Fusing different heterocyclic rings with the coumarin structure presents an intriguing method for crafting fresh hybrid compounds possessing remarkable biological effects. In the pursuit of creating heterocyclic-fused coumarins, a wide range of annulated heterocyclic[g]coumarin composites has been introduced, displaying impressive biological potency. The influence of the linear attachment of heterocyclic rings to the coumarin structure on the biological performance of the resulting compounds has been investigated. This review centers on the synthetic methodologies, structural activity relationship investigation, and biological potentials of annulated heterocyclic[g]coumarin composites. We conducted searches across several databases, including Web of Science, Google Scholar, PubMed, and Scopus. After sieving, we ultimately identified and included 71 pertinent studies published between 2000 and the middle of 2023. This will provide valuable perspectives for medicinal chemists in the prospective design and synthesis of lead compounds with significant therapeutic effects, centered around heterocycle-fused coumarin frameworks.

Systematic literature review of postponed elections during COVID-19: Campaigns, regulations, and budgets

The postponement of elections during the COVID-19 pandemic reflects a decline in global democracy. The policy of postponing elections due to health concerns, regulatory changes, and economic crises lacks empirical evidence. Several studies suggest that holding elections in countries that proceed with them does not significantly impact the spread of COVID-19. The acceleration of COVID-19 transmission is not limited to countries holding elections; it affects all countries, including those postponing them. Moreover, countries that continue to hold elections have turned this challenge into a COVID-19 mitigation strategy. This study aimed to analyze the findings of original research on election execution during the COVID-19 pandemic, focusing on campaign activities, regulatory changes, and election budgeting. It employed systematic literature review using 12 articles from the Web of Science and Scopus databases. The results show that conducting elections during the COVID-19 pandemic does not contribute to the spread of the virus. This is evident through the adoption of blended campaign strategies by the candidates. Election committees have adjusted voting procedures, including increasing the number of polling stations, tightly scheduling voter arrivals, and visiting red zone lockdown areas to prevent mass mobilization. The increase in election budgets during an economic crisis is not solely for the elections themselves but also for reinforcing health protocols. This research recommends a reconsideration of election postponements and advocates for conducting elections during the COVID-19 pandemic to uphold democracy. Furthermore, future research should explore the social and political implications, as well as the long-term consequences for democracy, which result from the implementation of soft campaign strategies and voting system modifications on a global scale, all in the pursuit of preserving democracy.

Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study

BACKGROUND

Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions.

OBJECTIVE

In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic.

METHODS

We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE).

RESULTS

Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively.

CONCLUSIONS

Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention.

Study protocol: infectious diseases consortium (I3D) for study on integrated and innovative approaches for management of respiratory infections: respiratory infections research and outcome study (RESPIRO)

BACKGROUND

Community-acquired respiratory infections are a leading cause of illness and death globally. The aetiologies of community-acquired pneumonia remain poorly defined. The RESPIRO study is an ongoing prospective observational cohort study aimed at developing pragmatic logistical and analytic platforms to accurately identify the causes of moderate-to-severe community-acquired pneumonia in adults and understand the factors influencing disease caused by individual pathogens. The study is currently underway in Singapore and has plans for expansion into the broader region.

METHODS

RESPIRO is being conducted at three major tertiary hospitals in Singapore. Adults hospitalised with acute community-acquired pneumonia or lower respiratory tract infections, based on established clinical, laboratory and radiological criteria, will be recruited. Over the course of the illness, clinical data and biological samples will be collected longitudinally and stored in a biorepository for future analysis.

DISCUSSION

The RESPIRO study is designed to be hypothesis generating, complementary to and easily integrated with other research projects and clinical trials. The detailed clinical database and biorepository will yield insights into the epidemiology and outcomes of community-acquired lower respiratory tract infections in Singapore and the surrounding region and offers the opportunity to deeply characterise the microbiology and immunopathology of community-acquired pneumonia.

One-step and Rapid Identification of SARS-CoV-2 using Real-Time Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP)

Background

SARS-CoV-2 as the cause of novel coronavirus disease (COVID-19) is a member of the family Coronaviridea that has generated an emerging global health concern. Controlling and preventing the spread of the disease requires a simple, portable, and rapid diagnostic method. Today, a standard method for detecting SARS-CoV-2 is quantitative real-time reverse transcription PCR, which is time-consuming and needs an advanced device. The aim of this study was to evaluate a faster and more cost-effective field-based testing method at the point of risk. We utilized a one-step RT-LAMP assay and developed, for the first time, a simple and rapid screening detection assay targeting the Envelope (E) gene, using specific primers.

Methods

For this, the total RNA was extracted from respiratory samples of COVID-19 infected patients and applied to one-step a RT-LAMP reaction. The LAMP products were visualized using green fluorescence (SYBR Green I). Sensitivity testing was conducted using different concentrations of the designed recombinant plasmid (TA-E) as positive control constructs. Additionally, selectivity testing was performed using the influenza H1N1 genome. Finally, the results were compared using with conventional real time RT-PCR.

Results

It was shown that the RT-LAMP assay has a sensitivity of approximately 15 ng for the E gene of SARS-CoV-2 when using extracted total RNA. Additionally, a sensitivity of 112 pg was achieved when using an artificially prepared TA-E plasmid. Accordingly, for the detection of SARS-CoV-2 infection, the RT-LAMP had high sensitivity and specificity and also could be an alternative method for real-time RT-PCR.

Conclusion

Overall, this method can be used as a portable, rapid, and easy method for detecting SARS-CoV-2 in the field and clinical laboratories.

Corona Virus Disease (COVID-19): Lessons Learned Impact on the Education of Health Professionals

The coronavirus disease (COVID-19) had a tremendous impact on the education of health professionals globally because of the lack of continuity in the medical education process. After it was declared a pandemic, stay-at-home orders forced students to learn virtually, to mitigate the spread of infection. While didactic courses transitioned easily to a virtual format, using platforms like Webex, Zoom, Google Classroom, etc. preclinical and clinical teaching suffered immensely. Patient care was halted for the safety of the patients, students and faculty, and staff involved. Uncertainty about clinical care and isolation during quarantine due to infections caused poor mental health among students. Most health professions innovated their teaching with simulations, role-play, educational videos, etc. but dental education suffered due to the need for psychomotor skill development. As the COVID-19 protocols evolved, and vaccinations became available, the teaching slowly transformed to Flipped Classrooms, Blended Learning, and Hybrid formats, and patient care was allowed with screening, triaging, and testing before scheduling for aerosol-causing procedures in dentistry. This new normal was accepted and silver linings in the pedagogies were appreciated by faculty and institutions alike as outcomes were analyzed. This chapter examines lessons learned on pandemic awareness, effective teaching pedagogies, and challenges of health professionals. An analysis of the lessons based on the framework of the Community of Inquiry is provided as guidelines to educate Gen Z for the future.

Coronavirus Disease 2019 Vaccination Coverage and Seropositivity amongst Nigerians 18 Years Old and Above

BACKGROUND

This was a cross-sectional community-based survey to study the prevalence of serum antibodies against the severe acute respiratory syndrome coronavirus 1 (SARS-COV-1) and determine possible source of antibodies as to whether from vaccination or from natural infection as well as attempt to compare antibody levels in response to the different four types of vaccines administered in Nigeria.

METHODS

A cross-sectional community-based study of the prevalence of serum antibodies against all four vaccine types used in Nigeria amongst a representative sample of people aged 18 years and above in the six geopolitical zones of the country using a multistage sampling technique covering 12 states of the country with two states being randomly selected from each geopolitical zone. High-throughput Roche electrochemiluminescence immunoassay system (Elecsys Anti-SARS-COV-1 Cobas) was used for qualitative and quantitative detection of antibodies to SARS-COV-1 in human plasma.

RESULTS

There was no statistically significant difference between the proportions with seropositivity for both the vaccinated and the unvaccinated (P = 0.95). The nucleocapsid antibody (anti-Nc) titres were similar in both the vaccinated and the unvaccinated, whereas the Spike protein antibody (anti-S) titres were significantly higher amongst the vaccinated than amongst the unvaccinated. Antibody levels in subjects who received different vaccines were compared to provide information for policy.

CONCLUSION

While only 45.9% of the subjects were reported to have been vaccinated, 98.7% of the subjects had had contact with the SARS-COV-1 as evidenced by the presence of nucleocapsid (NC) antibodies in their plasma. The 1.3% who had not been exposed to the virus, had spike protein antibodies which most likely resulted from vaccination in the absence of NC antibodies. Successive vaccination and booster doses either through heterogeneous or homologous vaccines increased antibody titres, and this stimulation of immune memory may offer greater protection against coronavirus disease 2019.

Potential Drugs in COVID-19 Management

The SARS-CoV-2 virus first emerged in China in December 2019 and quickly spread worldwide. Despite the absence of a vaccination or authorized drug specifically developed to combat this infection, certain medications recommended for other diseases have shown potential effectiveness in treating COVID-19, although without definitive confirmation. This review aims to evaluate the existing literature on the efficacy of these medications against COVID-19. The review encompasses various potential treatments, including antiviral medications, anti-malaria and anti-rheumatic drugs, vaccines, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), antipyretic and analgesic medicines, antiparasitic drugs, and statins. The analysis also addresses the potential benefits and drawbacks of these medications, as well as their effects on hypertension and diabetes. Although these therapies hold promise against COVID-19, further research, including suitable product production or clinical testing, is needed to establish their therapeutic efficacy.

ACE2-Fc and DPP4-Fc decoy receptors against SARS-CoV-2 and MERS-CoV variants: a quick therapeutic option for current and future coronaviruses outbreaks

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the Middle East respiratory syndrome coronavirus (MERS-CoV) are highly pathogenic human coronaviruses (CoVs). Anti-CoVs mAbs and vaccines may be effective, but the emergence of neutralization escape variants is inevitable. Angiotensin-converting enzyme 2 and dipeptidyl peptidase 4 enzyme are the getaway receptors for SARS-CoV-2 and MERS-CoV, respectively. Thus, we reformatted these receptors as Fc-fusion decoy receptors. Then, we tested them in parallel with anti-SARS-CoV (ab1-IgG) and anti-MERS-CoV (M336-IgG) mAbs against several variants using pseudovirus neutralization assay. The generated Fc-based decoy receptors exhibited a strong inhibitory effect against all pseudotyped CoVs. Results showed that although mAbs can be effective antiviral drugs, they might rapidly lose their efficacy against highly mutated viruses. We suggest that receptor traps can be engineered as Fc-fusion proteins for highly mutating viruses with known entry receptors, for a faster and effective therapeutic response even against virus harboring antibodies escape mutations.

Meaning and lived experience of Iranian COVID-19 survivors: A phenomenological study

BACKGROUND

The Coronavirus (COVID-19) is among the most contagious diseases worldwide. During the first peak of the illness, COVID-19 was considered a considerable crisis for survivors. This qualitative study explored the meaning and lived experience of Iranian COVID-19 survivors. This qualitative study was conducted in Iran sometime after the onset of the coronavirus in 2020.

METHODS

This interpretative phenomenological analysis (IPA) was performed on twenty survivors of COVID-19 disease, recruited through the purposeful sampling method via in-depth semistructured interviews. The interviews were recorded and transcribed, and several codes were extracted. Data were analyzed using the MAXQDA software (v. 12).

RESULTS

The main themes and subthemes obtained from the data analysis included (1) Taboo and stigma: COVID-19 as a monster, feelings of social exclusion and loneliness, an obvious sign of shamelessness and maltreatment, (2) God's predestination: God's will and test, COVID-19 as a wake-up call to remind low human power, (3) Shadow of death: The fear of death after positive test results, death is closer than the jugular vein, the mourning of a loved one's death, and mourning for an untimely death, (4) Caregivers as an angel: Family as an unrepentant supportive, know the level of family love and attention, and (5) Rebirth and new life: understand the higher value of health and pay more attention to self-care behavior, and God gives us a golden chance to experience a better life.

CONCLUSIONS

According to the results of this study, COVID-19 survivors experience various issues regarding the nature of the disease, coping with the illness, and their social and psychological status affected by COVID-19. Considering the multidimensional supportive programs, increasing public awareness and changing negative attitudes toward the patients and survivors of the pandemic for better rehabilitation and adjustment is essential.

The effects of meteorological factors on the COVID-19 omicron variant in Bangladesh

The COVID-19 omicron variant is exceptionally complicated and uncertain due to its rapid transmission and volume of infections. This study examines the impact of climatic factors on daily confirmed cases of COVID-19 omicron variant in Bangladesh. The secondary data of daily confirmed cases from 1 January 2022, to 31 March 2022, of eight distinct geographic divisions have been used for the current study. The multivariate generalized linear negative binomial regression model was applied to determine the effects of climatic factors on omicron transmission. The model revealed that the maximum temperature (Odds: 0.67, p < 0.05), sky clearness (Odds: 0.05, p < 0.05), wind speed (Odds: 0.76, p < 0.05), relative humidity (Odds: 1.02, p < 0.05), and air pressure (Odds: 0.27, p < 0.05) significantly impacted COVID-19 omicron transmission in Bangladesh. The study's findings can assist the concerned authorities and decision-makers take necessary measures to control the spread of omicron cases in Bangladesh.

Performance and labor conditions of physiotherapists in Brazilian intensive care units during the COVID-19 pandemic. What did we learn?

OBJECTIVE

To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration.

METHODS

An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units.

RESULTS

A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment.

CONCLUSION

Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.

'COVID-19 is just another way to die…': a qualitative longitudinal study of frontline COVID-19 response governance across Syria

INTRODUCTION

Governance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control. To improve response governance, better understanding of frontline response policy implementation across the country is needed. This study thus explored perspectives of COVID-19 response governance among frontline healthcare providers over time and across major areas of control.

METHODS

We used a qualitative longitudinal study design, conducting five rounds of remote semistructured interviews in Arabic (ie, approximately eight interviews each in March 2020, July 2020, September 2020, December 2020 and September 2021) with 14 purposively sampled public and private healthcare providers in the three main areas of control (ie, opposition-controlled area, Autonomous Administration-controlled area and al-Assad government-controlled area (GCA)). We conducted integrative thematic analysis in Arabic within and across geography and time.

RESULTS

Almost all participants across all areas and rounds expressed distrust of local health authorities and dissatisfaction with COVID-19 response governance. This was most apparent in initial rounds and in GCA. Response planning was identified as insufficient, non-participatory and non-transparent. Limited infrastructure and resources were the main challenges across time, though anticipated rapid virus spread and health systems' collapse did not occur and participant optimism increased over time. Public adherence to prevention measures varied-initially weak due to general scepticism, increasing after first cases were confirmed and then fluctuating with case numbers and challenges of insecurity and misinformation. Perceptions of COVID-19 vaccination varied, with low uptake and hesitancy attributed to misinformation, disinformation and disinterest. Suggested improvements to COVID-19 response governance focused on strengthening health systems' capacity and coordination.

CONCLUSION

This is a unique longitudinal study of COVID-19 responses. Addressing transparency and misinformation should be a first step to improving public engagement and trust and thus response governance for health emergencies in Syria.

The impact of SARS-CoV-2 infection in patients with cystic fibrosis undergoing CFTR channel modulators treatment: a literature review

Several risk factors for Coronavirus-2019 (COVID-19) disease have been highlighted in clinical evidence. Among the various risk factors are advanced age, metabolic illness such as diabetes, heart disease, and diseases of the respiratory system. Cystic Fibrosis (CF) is a rare disease with autosomal recessive transmission, characterised by a lack of synthesis of the CFTR channel protein, and multi-organ clinical symptoms mainly affecting the respiratory tract with recurrent pulmonary exacerbations. In view of the pathophysiological mechanisms, CF disease should be in theory considered a risk factor for SARS-CoV2 or severe COVID-19. However, recent clinical evidence seems to point in the opposite direction, suggesting that CF could be a protective factor against severe COVID-19. Possibly, the lack of presence or function of the CFTR channel protein could be linked to the expression of the membrane glycoprotein ACE-2, a key enzyme for the endocellular penetration of SARS-CoV-2 and related to the pathophysiology of COVID-19 disease. Furthermore, CFTR channel modulating agents could indirectly influence the expression of ACE-2, playing an important role in restoring the proper functioning of mucociliary clearance and the pulmonary microbiome in the host response to SARS-CoV-2 infection. In this review, the authors attempt to shed light on these important associations of issues that are not yet fully elucidated.

A longitudinal study of Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels

BACKGROUND

Middle East respiratory syndrome coronavirus (MERS-CoV) was identified in humans in 2012. Since then, 2605 cases and 937 associated deaths have been reported globally. Camels are the natural host for MERS-CoV and camel to human transmission has been documented. The relationship between MERS-CoV shedding and presence of neutralizing antibodies in camels is critical to inform surveillance and control, including future deployment of camel vaccines. However, it remains poorly understood. The longitudinal study conducted in a closed camel herd in Egypt between December 2019 and March 2020 helped to characterize the kinetics of MERS-CoV neutralizing antibodies and its relation with viral shedding.

RESULTS

During the 100-day longitudinal study, 27 out of 54 camels (50%) consistently tested negative for presence of antibodies against MERS-CoV, 19 (35.2%) tested positive and 8 (14.8%) had both, positive and negative test results. Fourteen events that could be interpreted as serological indication of probable infection (two seroconversions and twelve instances of positive camels more than doubling their optical density ratio (OD ratio) in consecutive samples) were identified. Observed times between the identified events provided strong evidence (p = 0.002) against the null hypothesis that they occurred with constant rate during the study, as opposed to clustering at certain points in time. A generalized additive model showed that optical density ratio (OD ratio) is positively associated with being an adult and varies across individual camels and days, peaking at around days 20 and 90 of the study. Despite serological indication of probable virus circulation and intense repeated sampling, none of the tested nasal swab samples were positive for MERS-CoV RNA, suggesting that, if the identified serological responses are the result of virus circulation, the virus may be present in nasal tissue of infected camels during a very narrow time window.

CONCLUSIONS

Longitudinal testing of a closed camel herd with past history of MERS-CoV infection is compatible with the virus continuing to circulate in the herd despite lack of contact with other camels. It is likely that episodes of MERS-CoV infection in camels can take place with minimal presence of the virus in their nasal tissues, which has important implications for future surveillance and control of MERS-CoV in camel herds and prevention of its zoonotic transmission.

Neuro-Ophthalmic Adverse Events of COVID-19 Infection and Vaccines: A Nationwide Cohort Study

Purpose

To evaluate the association of COVID-19 infection and vaccination with neuro-ophthalmic adverse events.

Methods

In this nationwide population-based retrospective cohort study, 8,498,353 patients were classified into three groups: control, COVID-19 infection, and COVID-19 vaccination. We conducted separate analyses for the early phase (within 60 days) and late phases (61-180 days) to estimate the incidence rates and hazard ratio (HR) for each neuro-ophthalmic adverse event. The adverse events included in this analysis were optic neuritis, papilledema, ischemic optic neuropathy, third nerve palsy, fourth nerve palsy, sixth nerve palsy, facial palsy, nystagmus, ptosis, blepharospasm, anomalies of pupillary function, and Guillain-Barré syndrome/Miller Fisher syndrome (GBS/MFS).

Results

Neuro-ophthalmic adverse events other than ptosis and GBS/MFS exhibited no significant increase after COVID-19, and their incidence was extremely low. The incidence rate of ptosis in both phases was significantly higher in patients administered COVID-19 vaccination (HR = 1.65 in the early phase and HR = 2.02 in the late phase) than in the control group. Additionally, BNT162b2 conferred a lower ptosis risk than ChAdOx1. GBS/MFS had a significantly higher incidence rate in the early phase (HR = 5.97) in patients with COVID-19 infection than in the control group.

Conclusions

Ptosis was associated with COVID-19 vaccination, particularly with the ChAdOx1 vaccine, while GBS/MFS was associated with COVID-19 infection. In contrast, no association was found between other neuro-ophthalmic adverse events and COVID-19 infection or vaccination. These results may provide helpful insights for diagnosing and treating the neuro-ophthalmological adverse events after COVID-19.

Attitudes toward the use of facemasks during the COVID-19 pandemic in the Indian community

Background

The use of face masks by all community members for the prevention of COVID-19 infection is considered one of the most effective strategies. However, the use of masks by community members was influenced by many factors which affected its efficacy as a preventive measure.

Aim

To evaluate the attitudes toward the use of masks during the COVID-19 pandemic in the Indian community.

Materials and Methods

We did an online survey with the help of a questionnaire which included information about demographic data, awareness and attitudes about COVID-19 infection and its preventive measures, and attitudes towards mask use in particular.

Results

Participants had a positive attitude towards mask use. However, there were certain reasons for not using masks some of which were gender specific.

Conclusion

People had good awareness and attitude towards mask use. However, some gender differences in perception of masks used in various settings should be addressed for future awareness and education of the community about mask use.

Lessons learned from behaviors of the employees in Iranian banks during the Covid-19 pandemic crisis: A phenomenological study

The aim of this research is to analyze the experiences of employees during the Covid-19 pandemic cri-sis and conceptualize the lessons learned to deal with similar crises in the future. To achieve this, a qualitative approach with a phenomenological strategy was conducted through semi-structured, in-depth interviews with 16 front-line employees of Bank Melli, the largest state bank in Iran. The study found that employee behavior plays a critical role in crisis management, with functional behaviors such as preventive measures, stress management, and sharing valid information being essential. Dysfunctional behaviors such as resistance to change and inconsistent behaviors were also identified. The prevention of infection and stress management were identified as key behaviors to cope with the crisis, while media literacy and acceptance of change were crucial for correct information analysis and crisis management. Overall, the study highlights the challenges faced by employees during the Covid-19 crisis and provides valuable lessons from a behavioral perspective for managers in the banking industry to manage disruptions caused by current and future pandemics. The study emphasizes the importance of learning from the lessons of the Covid-19 crisis to reduce negative effects on physical and mental health.

Belt and road initiative and healthy silk road: an alternative path for Pacific island countries to participate in global public health governance

Pacific island countries (PICs) located in a region with relatively insufficient capacity to respond to public health emergencies, establishing reliable public health cooperation is conducive to maintaining security and stability. The belt and road initiative (BRI) launched by China attempts to provide a novel form of international cooperation and has supported multi-channel investment and construction. This article elucidates the history of public health cooperation between China and PICs, as well as the current situation of the BRI in the field of public health and emphasizes that there are numerous constraints in the public health cooperation between China and PICs. Given the profound impact of COVID-19 on diplomatic strategies, gradual cooperation in the field of public health may be the initial exploration of the BRI in the PICs, but it also means that the initiative must deal with challenges from geopolitical competition and cultural differences.

Shift handover qualification in obstetric unit during the pandemic period: reinventions and learning

OBJECTIVE

Qualify the shift handover in an Obstetric Unit during the COVID-19 pandemic period, through Permanent Health Education.

METHOD

Action research conducted in southern Brazil. The research was conducted from interviews with healthcare professionals and students and the data were analyzed using the Reflexive technique. Interventions took place in different work shifts, with the support of a serial album as a didactic and educational resource.

RESULTS

The data analysis made it possible to record experiences and the delineation of two thematic categories: From traditional approaches to the reinvention of learning in healthcare work; and From conformism to professional growth.

CONCLUSION

The shift handover in the Obstetric Unit, through Permanent Health Education, enabled autonomous, interactive, and cooperative learning; awakened the desire to transcend the work routine; and highlighted the need to continuously (re)signify the healthcare work process.

e-Mental Health Program to Prevent Psychological Distress Among French-Speaking International Students in a Linguistic-Cultural Minority Context (Ottawa, Alberta, and Quebec): Protocol for the Implementation and Evaluation of Psy-Web

BACKGROUND

Based on experiences with the COVID-19 pandemic, postsecondary institutions were most affected by the restrictions. Students, especially international students, have borne the brunt associated with in-person learning restrictions imposed by public health recommendations. Canada is among the top 3 countries hosting international students (ISs), including Francophone students in provinces such as Quebec and other anglophone regions. Academic restrictions were accompanied by other measures such as quarantine, self-isolation, social distancing, and travel ban, to cite some. This has had a wide-ranging impact on these ISs. The resulting psychological distress and burden may have a much greater impact on Francophone ISs in anglophone settings, many of whom had ordinarily limited access to active offers of care in French in addition to cultural barriers and low literacy of the health care system. In order to take advantage of the effectiveness of eHealth as a pertinent and promising avenue, our project intends to build a web-based application that is cost-effective, user-friendly, anonymous, and capable to prompt interactive interventions as a first-line resource for psychological distress. In fact, internet applications have been increasingly used for the management of psychological distresses, and internet-based cognitive behavioral therapy is one of the preferred methods to prevent or control them.

OBJECTIVE

The aims of this study are to (1) design, implement, and maintain Psy-Web for the psychological support of ISs and (2) analyze the results of the implementation of the Psy-Web platform, the additional resources solicited, and the results obtained.

METHODS

This interventional project will use a sequential mixed design in the exploratory phase (phase 1) including the construction of the Psy-Web platform. A quantitative prospective component (phase 2) will include the intervention content of the Psy-Web platform. In total, 105 ISs participants (study group) and 52 ISs (control group), based on a ratio of 1:2, will be considered. The control group participants include those who did not use the web platform.

RESULTS

The project is at the data collection stage (phase 1). Psy-Web will be built in accordance with the DMAIC (Define, Measure, Analyze, Improve and Control) model with the perspective of boosting its robustness. As a first-line resource to prevent psychological distress and ultimately improve their academic performance, Psy-Web is an innovative opportunity for high education managers. The project involves a multisectoral and a multidisciplinary partnership.

CONCLUSIONS

The project will develop a promising web-based solution to prevent psychological distress. Ultimately, Psy-Web will be operable in multiple languages including French.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/47059.

Long-term effects of the COVID-19 pandemic on five mental and psychological disorders: in terms of the number of disease visits, drug consumption, and scale scores

BACKGROUND

COVID-19 caused mild to severe infections in humans. The long-term epidemic environment harms people's mental health. To explore the impact of the epidemic on people's mental and psychological conditions, we surveyed in Wenzhou.

METHODS

We collected the data of people who visited the First Affiliated Hospital of Wenzhou Medical University for five types of mental and psychological diseases from January 2018 to December 2021. Then, taking December 2019 as the cut-off point, the 48-month data were divided into the pre-epidemic group and the dur-epidemic group. Based on the above data, statistical analysis was done.

RESULTS

From 2018 to 2021, the number of initial diagnoses, the number of disease visits, and drug consumption for these five types of mental and psychological diseases were all on the rise. Compared with the number of disease visits for all disorders in both psychiatry and neurology departments, it was found that the growth rate of these five diseases was higher than the growth rate of all disorders. We found that the number of disease visits, drug consumption, and scale scores after the COVID-19 outbreak were significantly different from those before the outbreak (P < 0.05). And the number of disease visits positively correlated with drug consumption (P < 0.0001, r = 0.9503), which verified the stability of the data.

CONCLUSION

The epidemic environment has had a long-term and negative impact on people's mental and psychological conditions. Therefore, whether or not the epidemic is receding, we still need to be concerned about the impact of COVID-19 on mental and psychological health.

The Impact of the COVID-19 Pandemic on Surgical Services in Brazil's Healthcare System: A Retrospective Cross-Sectional Study

Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery, leading to the cancellation and postponement of various health services, including surgery. Numerous countries closed their borders and established laws mandating the use of face masks and social distancing and enforced lockdowns, and various activities were constrained. Brazil, the largest and most populous country in Latin America, also experienced a rapid and sustained surge in infections and deaths. Brazil was the most severely impacted nation in Latin America. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aimed to assess the impact of the COVID-19 pandemic on surgical services throughout the entire period. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022 and compared the following indicators: (1) number of hospital admissions, (2) length of hospital stay (LOS) (in days), and (3) volume of urgent and elective procedures. Data was divided into four time periods, pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the number of admissions and LOS based on surgical procedures performed by stratifying according to region, sex, age, and type of surgery (urgent versus elective). Results The number of admissions for surgical procedures ranged between 859,646 and 4,015,624 for 2019, 686,616 and 3,419,234 for 2020, 787,791 and 3,829,019 for 2021, and 760,512 and 3,857,817 for 2022 for the category of region; 4,260,900 and 5,991,775 for 2019, 3,594,117 and 4,984,710 for 2020, 4,182,640 and 5,590,808 for 2021, and 4,077,651 and 5,561,928 for 2022 for the category of sex; and 2,170,288 and 3,186,117 for 2019, 1,516,830 and 2,825,189 for 2020, 1,748,202 and 3,030,272 for 2021, and 1,900,023 and 2,859,179 for 2022 for the category of age. The variable age showed a comparable trend, albeit with an expressive decline for surgeries in the age range of 0-19 years. The LOS (in days) for surgical procedures ranged between 110,157 and 910,846 for 2019, 58,562 and 897,734 for 2020, 67,926 and 904,137 for 2021, and 100,467 and 823,545 for 2022. Thoracic surgery indicated no statistically significant difference in the number of admissions and LOS. Elective surgeries had a decline in the number of admissions and LOS, a 13% and 9.3% decline between 2019 and 2020, respectively. Urgent surgeries experienced a slight decrease in admissions and LOS, with a decline of 2.4% and 2.8% between 2019 and 2020, respectively. Conclusions Population characteristics, such as age, sex, and region, showed decreased hospital admissions during the pandemic, followed by a recovery toward pre-pandemic levels afterward. The number of surgical admissions and the length of hospital stays decreased during the pandemic but gradually returned to pre-pandemic levels in the recovery and post-pandemic phases. Notably, thoracic surgery remained statistically consistent across all periods, indicating its emergency nature compared to other surgeries. Thus, we conclude that the pandemic had minimal impact on thoracic surgery cases, contributing to a stable trend.

Factors associated with status and self-perceived mental health changes in the face of the COVID-19 pandemic in Brazil

The SARS-CoV-2-triggered Public Health Emergency of International Importance has significantly contributed to emotional and mental health issues. The aim of this study was to identify factors associated with self-perceived mental health changes while facing the COVID-19 pandemic in Brazil. This was a cross-sectional, descriptive, and analytical study that collected data via a web survey using a validated instrument. The study included individuals over 18 years old residing in the 26 federal units and the Federal District from August 2020 to November 2022. The sample was recruited using the snowball technique. Two logistic regression analyses were conducted to identify factors associated with the outcomes of interest. The first analysis considered individuals who rated their mental health condition as poor as the dependent variable, while the second analysis considered individuals who reported changes in their mental health during the pandemic as the dependent variable. The study found that individuals with complete college education and those using tranquilizers or antidepressants were more likely to perceive their mental health as poor (1.97 and 2.04 times higher likelihood, respectively). Increased consumption of ultra-processed foods during the pandemic was associated with a 2.49 higher likelihood of reporting mental health changes. Participants also reported more difficulty sleeping. The negative self-perception of mental health varied across Brazil's regions and changed over time, with different patterns observed before and after the vaccination period. In 2022, most regions of Brazil classified their mental health as "poor." The study highlights the impact of the COVID-19 pandemic on mental health, with increased prevalence of mental disorders and emotional problems among the population. The results highlight the presence of mental disorders and increased reporting of emotional problems among the population due to the impact of the COVID-19 pandemic.

Study on the spatial decomposition of the infection probability of COVID-19

In the course of our observations of the transmission of COVID-19 around the world, we perceived substantial concern about imported cases versus cases of local transmission. This study, therefore, tries to isolate cases due to local transmission (also called community spread) from those due to externally introduced COVID-19 infection, which can be key to understanding the spread pattern of the pandemic. In particular, we offer a probabilistic perspective to estimate the scale of the outbreak at the epicenter of the COVID-19 epidemic with an environmental focus. First, this study proposes a novel explanation of the probability of COVID-19 cases in the local population of the target city, in which the chain of probability is based on the assumption of independent distribution. Then it conducts a spatial statistical analysis on the spread of COVID-19, using two model specifications to identify the spatial dependence, more commonly known as the spillover effect. The results are found to have strong spatial dependence. Finally, it confirms the significance of residential waste in the transmission of COVID-19, which indicates that the fight against COVID-19 requires us to pay close attention to environmental factors. The method shown in this study is critical and has high practical value, because it can be easily applied elsewhere and to other future pandemics.

Evaluation of the mental health status of community frontline medical workers after the normalized management of COVID-19 in Sichuan, China

Background

During the coronavirus disease 2019 (COVID-19) pandemic, community medical workers, as the primary enforcers of community control measures, undertook many tasks with high exposure risk, resulting in severe psychological pressure, anxiety, depression and other psychological problems. Gender, type of workers, education, marital status, working years and other demographic factors were affect the mental state of medical workers. Community frontline medical workers gradually returned to normal work and life after the normalized management of COVID-19, but heavy work and high psychological pressure may continue to affect them. Thus, our research team used the same psychological questionnaire to investigate the psychological status of community frontline medical workers after the normalized management of COVID-19 compared with the COVID-19 period.

Methods

This was a cross-sectional study of community frontline medical workers in Sichuan, China, from February 6 to 17, 2023. Symptom Checklist-90 (SCL-90) and a self-designed questionnaire of demographic characteristics were provided to the participants point-to-point through a mobile network platform. Multiple logistic regression was used to analyze influencing factors related to community frontline medical workers' psychology.

Results

A total of 440 valid questionnaires were statistically analyzed, including 192 (43.64%) from doctors and 248 (56.36%) from nurses. There were 222 (50.45%) participants who were SCL-90 positive. The median total SCL-90 score of medical workers was 105.0 (IQR 95.00-123.75), which was higher than that during the COVID-19 period. The doctor's median SCL-90 score was 108.5 (IQR 96.00-136.25), and the positive item score was 16.5; the nurse's median score was 104.0 (IQR 94.00-119.50), and the positive item score was 12.0. Bachelor's degree education, no fixed contract and working years (10-19 years, 20-29 years, 30-39 years) were independent influencing factors for community frontline medical workers' psychology.

Conclusion

After the normalized management of COVID-19, community frontline medical workers still suffered from psychological problems that were even more serious than those during COVID-19. Doctors were more likely to have psychological problems than nurses. In addition, the mental health status of community frontline medical workers was affected by education, type of contract and working years. Managers should pay attention to the mental health of these people.

Impact of climate change on SARS-CoV-2 epidemic in China

The outbreak and prevalence of SARS-CoV-2 have severely affected social security. Physical isolation is an effective control that affects the short-term human-to-human transmission of the epidemic, although weather presents a long-term effect. Understanding the effect of weather on the outbreak allow it to be contained at the earliest possible. China is selected as the study area, and six weather factors that receive the most attention from January 20, 2020 to April 30, 2020 are selected to investigate the correlation between weather and SARS-CoV-2 to provide a theoretical basis for long-term epidemic prevention and control. The results show that (1) the average growth rate (GR) of SARS-CoV-2 in each province is logarithmically distributed with a mean value of 5.15%. The GR of the southeastern region is higher than that of the northwestern region, which is consistent with the Hu Line. (2) The specific humidity, 2-m temperature (T), ultraviolet (UV) radiation, and wind speed (WS) adversely affect the GR. By contrast, the total precipitation (TP) and surface pressure (SP) promote the GR. (3) For every 1 unit increase in UV radiation, the GR decreases by 0.30% in 11 days, and the UV radiation in China is higher than that worldwide (0.92% higher per day). Higher population aggregation and urbanization directly affect the epidemic, and weather is an indirect factor.

The effects of functional foods mixture on inflammatory cytokines and biochemical findings in hospitalized patients with COVID-19: a randomized double-blind controlled trial

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has been shown to affect nutritional recommendations. Some functional foods have been demonstrated to be useful in the treatment of people with COVID-19. However, little is known about the impact of combining functional foods on disease control. This study aimed to investigate the effects of functional foods mixture on serum levels of inflammatory cytokines and biochemical findings in patients with COVID-19.

METHODS

A randomized double-blind controlled trial was conducted in Baqiyatallah Al-Azam hospital in Tehran, Iran. Sixty patients were randomly assigned to receive either a soup containing functional foods (n = 30) or a usual soup (control group) (n = 30). Participants' sociodemographic information was gathered using a general questionnaire. Blood levels of inflammatory markers and biochemical findings were assessed using standard protocols.

RESULTS

The results showed that soup containing functional foods was more effective in controlling serum levels of D-dimer, blood urea nitrogen, and creatinine than the control group (P < 0.05). Also, more significant improvement was found in the intervention group vs control group in terms of interleukin (IL)-1β, IL-6, IL-17, IL-10, and tumor necrose factor-α (P < 0.05). In contrast, the control intervention more efficiently controlled potassium levels and reduced quantitative C-reactive protein than the intervention group (P < 0.05).

CONCLUSIONS

This study indicates a soup containing functional foods could alleviate biomarkers of inflammation in patients with COVID-19. However, its effectiveness on biochemical findings remained inconclusive which warranted further research.

TRIAL REGISTRATION

IRCT, IRCT20180201038585N11. Registered 23 August 2021, https://www.irct.ir/trial/57338.

The miRNA neuroinflammatory biomarkers in COVID-19 patients with different severity of illness

INTRODUCTION

The expression of specific miRNAs and their mRNA targets are changed in infectious disease. The aim of this study was to analyze the expression of pro-neuroinflammatory miRNAs, anti-neuroinflammatory miRNAs, and their mRNA targets in the serum of COVID-19 patients with different grades.

METHODS

COVID-19 patients with different grades were enrolled in this study and the expression of pro-neuroinflammatory miRNAs, anti-neuroinflammatory miRNAs, and their target mRNAs was analyzed by q-PCR.

RESULTS

The relative expression of anti- neuroinflammatory miRNAs (mir-21, mir-124, and mir-146a) was decreased and the relative expression of their target mRNAs (IL-12p53, Stat3, and TRAF6) was increased. Also, the relative expression of pro-neuroinflammatory miRNAs (mir-326, mir-155, and mir-27b) was increased and the relative expression of their target mRNA (PPARS, SOCS1, and CEBPA) was decreased in COVID-19 patients with increase of disease grade. A negative significant correlation was seen between mir-21 and IL-12p53 mRNA, mir-124 and Stat3 mRNA, mir-146a and TRAF6 mRNA, mir-27b and PPARS mRNA, mir-155 and SOCS1 mRNA, and between mir-326 and CEBPA mRNA in COVID-19 patients (P<0.05).

CONCLUSIONS

This study showed that the relative expression of anti- neuroinflammatory miRNAs was decreased and the relative expression of their targeted mRNAs was increased in COVID-19 patients from asymptomatic to critical illness. Also, this study showed that the relative expression of pro-neuroinflammatory miRNAs was increased and the relative expression of their targeted mRNA was decreased in COVID-19 patients from asymptomatic to critical illness.